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16 Medical Officers of Health Annual Report.
still very large. There is not and has not been proportionally
more diphtheria in the Wandsworth District
than in the rest of London, so that the question of the
increase of it, that has been so prominent a one in recent
years, is truly a Metropolitan one. An interesting contribution
to the study of the question has been made by the
Medical Officer of Health to the County Council, in a
preliminary memorandum on the increase of diphtheria in
London. In this he shows that there has been a more
marked increase of the disease between the ages of 3 and
10 since the passing of the Elementary Education Act of
1870, and thus draws attention to one factor, that is now
generally recognised as being responsible for the spread of
diphtheria, that is, the aggregation of children in the
elementary schools. But it is very difficult to provide
against its spread in this way. Diphtheria is a disease
that is very difficult to diagnose, and it is at present
impossible to prevent a certain number of children,
suffering from diphtheria in a mild, unrecognised form,
from being at school and so infecting others. Possibly the
universal adoption of examining every case of sore throat
by bacteriological methods, to define the presence or
absence of the diphtheria bacillus in the throat would overcome
this difficulty, but this is a suggestion at present
quite impracticable. In this connection it is important to
notice that the system of applying these tests to all cases
admitted to the Asylums Board Hospitals and also before
their discharge has been adopted. The examination before
discharge is particularly important, as it appears that the
bacillus is present in the throat for sometimes a considerable
period after apparent recovery.
It is not unlikely, however, that school influence is not
the only reason why we now have so much diphtheria,
but that during these last few years an epidemic wave of
the disease has been passing over London, just as we are
accustomed to like waves of scarlet fever every 3 or 4 years.