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110
Medical Officers of Health Annual Report.
notified per 1,000 of population was 2 9, compared with
31 in 1896, while in this sub-district, the proportion
notified was 4.03, and in 1896, 1 7 per 1,000.
This large increase was almost wholly due to the
two epidemics which occurred in Wards 1 and 3 of this
parish in the months of February and March, and so
fatal were these that a detailed account is necessary.
In these outbreaks there is no doubt that in every
case personal infection was the only cause in operation,
although it was not in every case that such could be
definitely proved. These outbreaks occurred in Wards
1 and 3 of the parish, which had a population, principally
working class, of 8,670 and 11,817 respectively at
the census of 1896. The wards are not adjacent to one
another, and the outbreaks had, as far as could be ascertained,
no connexion, although in both school infection
was proved to have been the means of spread, and this
most definitely in the outbreak in Ward 3. That school
attendance is a prominent factor in the dissemination of
Diphtheria has long been known, and Sir 11. Thorne
Thome, in his Milroy Lectures, has summarised all our
knowledge of the subject. The conclusions arrived at
by Sir R. Thorne Thorne are so generally known that it
is unnecessary to recapitulate them, but there is one
statement that, in view of the recent outbreaks in this
district, is especially noteworthy. Sir R. Thorne Thorne
states that "there are ample grounds for believing that
the aggregation of children in elementary schools constitutes
one of the conditions under which a form of
disease of particular potency for spread and for death
may be, so to speak, manufactured; "or, in other words,
that in Diphtheria there is a "progressive development
of the property of infectiveness."
Before proceeding to discuss this as a cause of the