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This diagram also shows that whereas the mortality rate of diphtheria is
steadily rising, that of typhoid is equally steadily falling pari passu with
improving sanitation, and that that of scarlet fever is also falling pari passu
with increased hospital isolation, no hospital accommodation having been provided
for diphtheria until the end of 1889.
It is important to note these points because diphtheria resembles scarlet
fever in its power of spreading directly from person to person, and also
resembles typhoid fever, in that either diphtheria, or some form of throat diseaes
closely allied with it, may arise from certain insanitary conditions. Comparing
the two last diseases, whereas typhoid only occasionally spreads
directly from one person to another, diphtheria always spreads with great
facility frrm person to person ; and whereas typhoid varies in direct proportion
to insanitary conditions, the relationship of diphtheria to insanitary
conditions is overwhelmed by the influence of personal infection. So that,
whereas the improvement of sanitation markedly decreases the mortality of
the former, it appears to have no effect upon the latter, and whereas
the increase of general density of population in all districts, of
special density in towns, and of aggregation in schools, only remotely and
indirectly affect typhoid, they closely and directly affect diphtheria.
Dr. Thorne Thorne has called marked attention to the special incidence of
diphtheria in children attending schools, and concludes " that apart from age
susceptibility, 'school-influence' so called, tends to foster, diffuse, and
enhance the potency of diphtheria, and this, in part at least, by t he aggregation
of children suffering from that 'sore-throat' which commonly is prevalent
antecedent to, and concurrently with, true diphtheria." The period of
life at which there is most susceptibility to acquire diphtheria is from 3 to 12
years of age, and school attendance increases the risks of personal infection
by the aggregation and prolonged association of children together.
The progress of educational legislation traces the progressive increase of
elementary education, and of school attendance.
In 1870, the Elementary Education Act was passed for the establishment
of School Boards and Elementary Schools.
The Act of 1872 empowered the London School Board to borrow money
and to erect further offices.
By the Elementary Education Act of 1873, any out-relief given to the
parent or guardian of a child aged from 5 to 13 years, was made conditional
on the child receiving elementary education.
In the Act of 1876, a child was defined as a person between the age of 5
and 14 years. A certificate of proficiency or of due attendance at school was
required for the employment of a child over 10 years of age, and further
provision was made as to the employment and education of children in
factories, 250 attendances being necessary; and for the payment of school
fees for poor parents, 350 attendances being nccessary. An Order of the
Court was made obtainable for enforcing the attendance of a child at school.
Day Industrial Schools were established. An increase of the Parliamentary
grant was made. School Attendance Committees were given power to make
bye-laws like School Boards, and to appoint local committees.
The Act of 1880 compelled bye-laws to be made by every School Attendance
Committee, under Sec. 74 of the Act of 1870, respecting the attendance
of children at school, and prevented children from 10 to 13 years of age being
employed previous to reaching the standard fixed by bye-law.