BACTERIA AND DISEASE 295 



From these figures the extraordinary increase during the 

 last few years is clearly demonstrated. 



Sir Richard Thorne Thorne, in 1891, drew attention to 

 the influence of damp soils and schools upon diphtheria. 

 In 1894 Mr. Shirley Murphy, Medical Officer to the London 

 County Council, reported that there had been an increase in 

 diphtheria mortality in London at school ages (three to ten) 

 as compared with other ages since the Elementary Education 

 Act became operative in 1871 ; that the increased mortality 

 from diphtheria in populous districts, as compared with rural 

 districts, since 1871, might be due to the greater effect of 

 the Education Act in the former; and that there was a 

 diminution of diphtheria in London during the summer 

 holidays at the schools in 1893, but that 1892 did not show 

 any marked changes for August. 



In 1896 Professor W. R. Smith, the Medical Officer to the 

 London School Board, furnished a report ' on this same 

 subject of school influence, in which he produces evidence 

 to show that the recrudescence of the disease in 1881-90 was 

 greatest in England and Wales at the age of two to three 

 years, and in London at the age of one to two years, in 

 both cases before school age ; that age as an absolute factor 

 in the incidence of the disease is enormously more active 

 than any school influence, and that personal contact is 

 another important source of infection. 



Although it is said that ** statistics can be made to prove 

 anything," there can be little doubt that both of these 

 reports contain a great deal of truth ; nor are these truths 

 incompatible with each other. They both emphasise age as 

 a great factor in the incidence of the disease, and whatever 

 affects the health of the child population, like schools, must 

 play, directly or indirectly, a not unimportant part in the 

 transmission of the disease. 



' Journal of State Medicine^ vol. iv. (i8g6), p. i6g. 



