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3. The diagrams I. and II. show that the notifications of diphtheria
in London increase rapidly after ago 1 year is reached, and go
on increasing until the beginning of school age, when a decrease
sets in. This shows that age as an absolute factor in the incidence
of the disease is enormously more active than any school
influence.
The notification rates are nearly constant through the age
period 3 to 6 years, but practically school attendance does not
begin until near the middle of this period, i.e., some time after
age 4 is reached.
4. If separate districts of London be examined, the same state
of things is noticed, viz., the period of greatest liability to the
disease begins before school age is reached, and, therefore, a
principle of ante hoc ergo propter hoc is required if the age
incidence of the disease is to be explained by school attendance.
In some of the poorest metropolitan districts the special liability
to diphtheria commences at a still earlier age than in other parts
of London, suggesting overcrowding as a probable potent cause.
5. The variations of diphtheria during and after school holidays
undoubtedly suggest that some amount of infection takes
place at school (which no one disputes), but taking the year 1895
in which a remarkable fall occurred in the holidays, the fall was
found to affect children of non-school ages almost to the same
extent as children of school age, and the fall was not shared in
(or only very slightly) by the poorest districts. It is probable
then that such variations are in great measure explained by the
smaller number of children in London during the holidays.
6. The remarkable similarity of the age incidence of mortality
in Berlin to that in London—although school age begins at quite
a different time—strengthens the conclusion already expressed,
that age, not school attendance, is the chief factor in the
incidence of the disease.
7. The progressively greater liability of girls as compared with
boys—in relation to age—points to personal contact as another
important source of infection.
8. The comparative immunity of infants under one year of age,
suggests that older children often infect one another at night,
young infants being removed from this risk by sleeping with
their parents.
9. That as the result of a special inquiry into 2,168 consecutive
cases, a very small number of cases could be traced to even a
possibility of school infection.
10. That school influence, as such, plays but an unimportant
part in the enormous increase of the disease during recent years
in London.
Fevers.
Ten deaths occurred in the district from Enteric Fever—
four in St. Margaret's Parish and six in St. John's. Last
year three deaths only occurred from this fever.
Thirty-three cases were notified, 12 being in St. Margaret's
and 21 in St. John's Parish. Last year 28 cases were notified
and in 1894 there were 42.
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