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16
Few diseases probably have a more voluminous literature devoted
to them than has Diphtheria, or a more kaleidoscopic series of causes
assigned as the origin of their epidemics. As I have elsewhere stated,
one authority views school association as the supreme law in this
matter, while another, without denying the dangers attending on close
contact in schools, considers it to have little effect in producing
epidemic prevalence. Damp in and around dwellings, variations in
sub-soil water, drainage and other sanitary defects, atmospheric
conditions—all have their champions and their traducers, and all,
doubtless, aid in the spread of the disease, but the essential factor
giving rise to the protean character which Diphtheria exhibits, both in
localized areas and throughout the country, is not to be found in any
one of these so-called causes. Bacteriological science has yet to write
the life history of the Klets-Löffler bacillus, but in the meantime a
patient collection of facts may lead to useful generalizations. The
figures given above show, even in our own district, some of the
difficulties to be met with in studying the distribution of Diphtheria
and are more clearly portrayed in the accompanying chart, in which
the seasonal curves of Diphtheria cases in the four Wards is compared
with that of the whole Borough. The high rise in Canning Town
Ward during November may be explained by a severe epidemic
associated with school infection in the Custom House district, but
school infection will not wholly explain the differences observable in the
Wards at the beginning of the year. On the other hand it is idle
to allege sanitary defects as of paramount importance when one
remembers the number of houses affected around the Park School,
a new district, substantially built, and one in which sanitary defects
are comparatively infrequent.
I have not yet been able to compare our seasonal curve with that
of England and Wales, but in comparing West Ham with other large
towns one finds that Diphtheria prevalence last year was to some of
them a matter of yet more serious moment, as shown by the following
Diphtheria death-rates:—West Ham .63. Portsmouth .64, Leeds .78,
Leicester 1.06, Sheffield 1.28, Swansea 1.36.