July 25, 1895] 



NATURE 



299 



diseases, London shows an increased mortality over tha 

 average for the preceding ten years, the rate having 

 risen from 2'io to 2'28 per loao ; and althaugh this 

 zymotic death-rate compares favourably with that of th; 

 largest of our towns, yet as regards foreign capitals it 

 is only exceeded in two cases, i.e. by that of Stockholm 

 and Vienna. 



This increase is largely due to the alarming rise which 

 nas taken place in deaths from diphtheria, a rise repre- 

 sented by a death-rate of o"i2 per ioo3 in the years 

 1871-80, o'26 in i88t-90, o'3i in 1891, o'44 in 1892, and, 

 lastly, 074 in 1893. Such a diphtheria death-rate is 

 markedly in excess of that of other large English towns 

 having a population of more than 200,000, being, in fact, 

 more than double that of any with the exception of West 

 Ham (virtually a part of London) ; it was even ten times 

 as great as the diphtheria death-rate of Nottingham, and 

 six times as great as that of Liverpool. 



.Small-pox also appears to be on the increase, and 

 influenza and pneumonia claimed a number of victims 

 greatly in excess of the average of the preceding ten 

 years ; and there is, also, a substantial increase registered 

 in the scarlet-fever death-rate. 



Hut the most serious problem which we have to face is 

 our diphtheria epidemic ; various attempts have been 

 made to ascertain to what it can be traced, but so far, it 

 must be confessed, we are without any satisfactory clue as 

 to its source. It has been attributed by some to altera- 

 tions in the classification of diseases, more especially by 

 transference to diphtheria of deaths which in former 

 years were registered as croup, by others to increased 

 facilities for the spread of infection afforded by increased 

 school attendance, to sewer ventilators, &c. ; but the fatal 

 objection to all these explanations is that they are cir- 

 cumstances which are shared by all the other great cities 

 and towns of the countr\% and yet London alone is 

 pre-eminent in its death-rate from diphtheria. 



There appears, however, to be a very decided tendency 

 in England for diphtheria to increase in densely inhabited 

 centres, whilst in the more sparsely populated districts 

 there is a decrease, which has been especially emphasised 

 of late years. 



Curiously, this is not the experience of our neighbours 

 in Germany. Dr. Hecker has quite recently conducted 

 an elaborate inquiry into the diphtheria death-rate during 

 the years 1883-93 '" a number of German cities, and he 

 states that it is a decreasing one. 



The problem of diphtheria in London is as yet unsolved, 

 neither is its solution likely to be accomplished through 

 such isolated, individual investigations such as have 

 hitherto prevailed. What is required is the appointment 

 of a Commission, composed of men abreast of the time, 

 acc|uainted with modern methods, and capable of 

 pursuing experimentally, if necessary, the course of this 

 scourge. 



Fortunately, as regards cholera, our past experience 

 has enabled us to cope satisfactorily with what was at one 

 time our most dreaded foe, and altliough Europe has 

 suffered severely, England has escaped since the outbreak 

 of cholera in London in the year 1866. 



The freedom of London from this, to a large extent, 

 water-borne disease brings us to the consideration of 

 another malady in the communicability of which water is 

 also largely responsible, i.e. typhoid fever. 



In this connection it is satisfactory to read the follow- 

 ing : "A point well deserving of observation, is the 

 diminishing London typhoid fever death-rate." 



.Mthough it cannot be assumed that it is entirely due 

 to improvement in the water supply of London, yet the 

 evidence of the connection between typhoid fever and 

 mpure water sup|)lies, has been too firmly established 

 not to permit of the London water companies obtaining 

 some credit for this improved hygienic condition. 



NO. 1343, VOL. 52] 



On this point, the evidence afforded by the city of Zurich 

 is instructive, for it has been distinctly found that since 

 the establishment of the new filtration works in 1886, and 

 the consequent greatly improved bacterial quality of the 

 water distributed, a very marked diminution has taken 

 place in the number of cases of typhoid fever. This fact 

 has been vouched for after most careful investigation of 

 facts and statistics by the city authorities. 



Again, we ha\e only to recall the invariable increase in 

 cases of typhoid fever in Paris, when in consequence of 

 an insufficient supply of purer sources of water, recourse 

 has to be had to that of polluted river Seine water. Now 

 Dr. Percy Frankland, in his reports to the Local Govern- 

 ment Board, showed, for the first time in this country, 

 the bacterial purification which Thames water undergoes 

 at the hands of the London water companies ; and 

 although in his recent report to the Royal Society on the 

 vitality of the typhoid bacillus in various waters, he 

 points out that, whilst unable to increase in numbers, it 

 can yet remain alive for days and weeks in water, yet we 

 may assume that the typhoid bacillus will submit, as all 

 ordinary' water microbes, to the purification processes 

 which Thames water undergoes before delivery, processes 

 which Dr. Percy Frankland has repeatedly shown, re- 

 moves frequently as many as 99 per cent, of the bacteria 

 present. 



Under the heading of ".-Administration," we read that the 

 Council's inspectors made numerous inspections of dairies 

 and milk-shops, as well as cow-sheds ; as a result of these 

 investigations, no less than 133 cases of scarlet fever 

 were discovered as occurring on milk-shop premises, 46 

 cases of diphtheria and membranous croup, 21 cases of 

 typhoid fever, 10 cases of small-pox, 5 cases of erysipelas, 

 and 2 cases of measles. These probably represent only 

 a proportion of the actual number of cases which took 

 place in such establishments. Knowing as we do that 

 milk offers every facility for the growth and abundant 

 multiplication of pathogenic germs, it may be easily con- 

 ceived how much zymotic disease may have been dis- 

 seminated broadcast from these centres of infection. 



In the recent report issued by the Royal Commissioners 

 on tuberculosis, we find the following significant para- 

 graph : " In regard to milk, we are aware of the pre- 

 ference by English people for drinking cow's milk raw, 

 a practice attended by danger on account of possible 

 contamination by pathogenic organisms. The boiling of 

 milk, even for a moment, would probably be sufficient to 

 remove the very dangerous quality of tuberculous milk.'' 



We quote these words in full, not only because of the 

 official weight which attaches to them, but because it is 

 of such great hygienic importance that these facts should 

 be known and realised by the general public. 



On the continent, the practice of drinking raw milk is 

 fast becoming obsolete, and sterilised milk is an article 

 of commerce, and successful so-called "milk sterilising 

 associations '' have been formed for its distribution. 



We have seen that, as regards the zymotic-disease 

 death-rate, London is less favourably situated than the 

 majority of the capitals of Europe. May we not possibly 

 find at least one cause of this, to us humiliating fact, in 

 the insular prejudice which prevails in favour of raw- 

 milk ? 



In conclusion, valuable as statistics may be and un- 

 doubtedly are, it must be remembered that there is yet 

 much which statistics cannot reveal, that a lower death- 

 rate cannot express the whole result of hygienic enter- 

 prise and progress. To adequately measure the value of 

 sanitary reform to the community at large, we must look 

 as well to the numerous and important improvements 

 which have resulted in the increased comfort and well- 

 being of the indiviilual, and it is in such directions that 

 tlic London Counts' Council has accomplished some of 

 its most useful and meritorious work. 



