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36
It will be noted (Table B) that whereas there were more
than twice as many cases of Diphtheria in the District there were
less than half as many deaths as in the preceeding year. It is
the experience of many other communities that the disease is,
generally speaking, assuming a milder type.
The increase in Diphtheria during the past few years, more
especially in town districts has been a matter of great concern
among health officers. That this increase should grow at the
same time that the principles of sanitation are becoming more
and more appreciated by the general public, and more efficiently
applied by Sanitary Authorities, appears at first sight to be
almost a public health paradox, for there is no gainsaying that
Diphtheria is a disease, the true origin of which is associated with
the insanitary conditioms of dirt, dampness, and foul air. The
cause of the increase of the disease must doubtless be sought,
therefore, in increased facilities of spread from primary cases. I
think that the increase in the number of houses which were
originally planned and built to accommodate one family, and
which now, owing to the exigences of the times, are converted
into tenemented dwellings for several families, may in itself, by
reason of the overcrowding and the insanitary conditions which
are almost inseparable from such a state of things, be responsible
for some of the increase in Diphtheria in our large towns; but the
main cause for the increase will probably be found in school
attendance. Quite apart from any statistical evidence that may
be collected to support the latter view, it stands to reason that
where a disease is concerned that mainly affects children at ages
when they attend school, and which can be communicated in its
severest forms by those who are only affected by a mild unrecognised
type, that any circumstance that tends to bring large
bodies of children in close association with each other must be
attended with considerable risk and is presumably responsible for
some amount of spread. Mr Shirley Murphy, the Medical
Officer to the London County Council, has pointed out in a
recent report that while there has been of late an increase in the
death-rate from Diphtheria in the Metropolis, this increase has
been disproportionately great at ages between 3 and 10, a period
which may be taken to represent broadly that of school