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19
That this change in nomenclature is, however, only partial explanation of the increase of
diphtheria is shown by the following figures—

The following outbreak is referred to in the reports of the medical officer of health of St. Luke for
1891 and 1892. Fifteen cases of diphtheria occurred in the Finsbury Barracks in December, 1891, and the
beginning of January, 1892. The origin of the outbreak is thus explained a person who had been
nursing a case of diphtheria, and who was engaged to nurse one of the soldier's wives in her confinement,
called to see if her services were likely to be soon required. She was suffering from sore throat: she
took a child upon her lap and kissed it. The child was the first to have the disease, and died in the
barracks."
Reference is made in the reports of the medical officers of health of Plumstead, Putney
(Wandsworth), Clapham (Wandsworth), and Whitechapel, to sewer or drain emanations as a possible
cause. In the Plumstead report, ventilation of sewers through gratings in the road is condemned
wherever these gratings can act as outlets. In the Putney (Wandsworth) report, the occurrence of three
cases of diphtheria in one house is attributed to a leakage of drain air into the larder. The report of
the medical officer of health of Clapham (Wandsworth), contains the following statement referring to 56
cases of diphtheria, and 4 of membranous croup. "As regards causation of these cases the drains in
the houses where they occurred were carefully tested, and in 24 of these, serious defects, such as very
possibly caused the attacks, were found and remedied." The medical officer of health of Whitechapel
writes, " there is an almost universally prevailing popular opinion that defective drainage and diphtheria
are associated in the relation of cause and effect. It cannot, be too strongly stated that conclusive
evidence in support of such opinion, so far as I am aware, cannot be produced. Of course the inhalation
of sewer air may reduce the vital energies of a person, and so render him more susceptible to be the
victim of diphtheria as well as many other diseases."
The medical officer of health of St. Giles referring to Dr. Thome's Milroy lectures, 1891, says,
"In regard to the important question of school infection Dr. Thorne is in accord with other observers
'in regarding the aggregation of children at school as the most constant of the conditions under which
ordinary diphtheria arises out of the prevalence of indefinite sore throats which so generally precede and
accompany its attacks.'"
The medical officer of health of Bow (Poplar) refers to an outbreak of diphtheria in that parish
occurring in the neighbourhood of the Malmesbury-road Board Schools. He states that, in March, of
25 cases of diphtheria in No. 3 district, 20 were either amongst scholars of these schools or in houses
from which these scholars came. The cause of this local prevalence was not evident.

*Including 566 cases of membranous croup.