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4.—The effect of Elementary Schools.—Dr. Thorne Thorne has so fully and
so carefully entered into this subject that his conclusion that increased school
attendance has had a material influence in increasing the spread of Diphtheria
is irresistable.
5.—Alteration in Classification.—Any changes made in classification by the
Registrar-General are usually commenced at the beginning of a decennium
and therefore would not affect the detailed London figures of throat diseases in
this Report. The Superintendent of Statistics, Dr. Tatham, has kindly
informed me that "membranous croup" was not classed with Diphtheria until
the commencement of the present year (1894), although "diphtheritic croup"
has been classed with Diphtheria for a long period, so that classification can
have had little or no effect upon the returns of mortality.
6.—Variation in Nomenclature.—Improved medical diagnosis due to improved
medical education and increased knowledge of diseases of the throat, enables
these diseases to be more readily differentiated than formerly. Now, most
forms of infectious sore throat are regarded as diphtheria, and the fatality of
such diseases is recognised, whereas formerly the term was restricted to
typical cases. The danger of the earlier practice has been pointed out in
the many instances brought to light in which apparently simple sore throats
in schools have culminated in serious and fatal epidemics.
7.—Change of Type.—In the last place, the question may be seriously asked
whether the variation in nomenclature may not be due to a change of type in
disease of the throat? Dr. Thorne Thorne says "that there is reason to believe
that attacks of so-called sore-throat exhibit under certain favouring conditions
a progressive development of the property of infectiveness, culminating in a
definite specific type which is indistinguishable from true diphtheria." A
change of type is probably taking place as the result of increased density of
population, especially in towns, more particularly of the aggregation in schools,
and of the effects of personal infection consequent on these. There is also a
strong probability, and it only remains to be definitely proved, that a sore throat
caused by insanitary or other conditions, may possess or acquire infective
properties, and in passing from person to person may also acquire such
virulence as to cause death from infectious sore-throat of a type which the
clinician would certify as diphtheria, whatever the pathologist might declare
it to be as the result of bacteriological examination.
I have the honour to be Gentlemen,
Your obedient Servant,
JOHN F. J. SYKES, D. Sc., M.D.,
Medical Officer of Health,
St. Pancras, N. TV.