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less than 19 occurred between January 12th. and February 13th.
The 20th, and final case in the outbreak failed on April 2nd. The
origin of this last case was not clearly traced, but it should be noted
that the child lived in a house which had been infected earlier in
the epidemic, though the first case was, as far as could be ascertained,
free from infection by March 4th. Subsequent to April 2nd no case
of diphtheria occurred at this school until the following October.
Rockmount Road is a specially favourable school for the successful
control of diphtheria, as nearly all the children in this part of the
borough live in a comparatively isolated district and attend the
same elementary school. It is thus possible to exercise more complete
supervision of the children than is possible in districts where
children from the same family may be attending two or three schools,
and where the opportunities of infection from other groups of
ctiildren are more frequent.
RELATION OF DIPHTHERIA TO DRAINAGE DEFECTS.—Our
views as to the relation of diphtheria to drainage defects have undergone
modification during the last quarter of a century. At a time
when only the more serious cases of diphtheria were recognised, it
was thought they were associated in the majority of instances with
drainage defects. The general opinion on this question has now
been modified. In all probability poisoning by drain or sewer gas
must be considerable in intensity and prolonged in time before it
need be taken into consideration. Even then it appears only to act
as a predisposing cause which is not operative unless there is contemporaneous
or previous exposure to specific infection from an actual
case of diphtheria. During 1908 the drains of all the houses in which
diphtheria occurred were tested. If we deduct houses where the
diagnosis of diphtheria was subsequently withdrawn, and houses
where diphtheria infection are shown to have been imported from
neighbouring districts, we get a nett total of 310 infected houses.
The following is the result of the examination of the drains of
these premises:—
Houses tested 310
Number of houses where no defects
were found 231 or 74.5 per cent.
Number of houses where serious
defects were found 27 or 8.7 „
Number of houses where slight defects
were found 52 or 16.8 „
The percentage of houses where no defects were found is somewhat
larger than the proportion of similar houses included in the
list of premises where the drains were tested in house to house inspection
during the same year (see page 28). These particulars