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the remaining 117 unsanitary conditions of major or minor importance were discovered.
In 42 instances there were histories of throat-illness in the houses in which the
patients lived, and in 54 of the cases there was evidence of infection from previous cases.
From my observations of diphtheria in Shoreditch, I am strongly inclined to the
belief that the disease is frequently spread through the medium of persons suffering
from what are regarded simply as sore throats, but which nevertheless are really
diphtheric in nature. Diphtheria, amongst adults especially, may be attended by but
slight constitutional symptoms and a person suffering from diphtheria may go about
his or her usual occupation without there being the least suspicion aroused as to the
true nature of the throat affection. It is unnecessary to dwell upon the danger pf
infection in such a case. All cases of "sore throat" should be regarded as infectious and
possibly diphtheric unti1 their true nature has been definitely ascertained. They
sh uld in all cases be treated as infectious so far as spoons, forks, cups, &c., used by
the patient are concerned ; and, under no circumstances should a child suffering from
" sore throat" be allowed to attend school.
The following instances may be mentioned of local prevalence of diphtheria in
which there were strong grounds for believing that school-attendance played a
prominent part in the dissemination of infection. From October 10th to December
20th, 18 cases of diphtheria were certified in the neighbourhood of Scrutton Street
Board School. They mostly occurred amongst children living in artizans' dwellings,
and altogether 13 households were invaded. From enquiries made there were
no reasons for suspecting that the sanitary conditions of the invaded dwellings could
in any way be called into question. The principal thing in common amongst those
attacked was attendance at the infants' department of the Scrutton Street School, for
practically the whole of the sufferers were children attending the department or had
been brought into contact with children attending the department. Upon the school
closing for the Christmas holidays the cases ceased.
Towards the end of November my attention was attracted by the occurrence of
several cases of diphtheria in households from which there were children attending the
Mintern Street Middle-Class School, and upon enquiry I ascertained that there had
been, besides the cases certified as diphtheria, several other cases of " sore throat. ' The
cases amongst the school children were practically confined to those attending the
infantb' department, which numbered, at the time of the outbreak, 110. The history
of the outbreak shewed that during the first fortnight of November a case or two ot
"sore throat" had occurred amongst the members of a family living in a house in
Cavendish Street. On or about November 19th, a little boy belonging to this family,
was taken ill with a "sore throat" and was subsequently certified to be suffering from
diphtheria. At the time he was taken ill he was attending the infants' department of
tho school mentioned. On November 21st or 22nd, one of the teachers in the infants,
department was taken ill with a "sore throat." She taught in the school, however, until
mid-day on November 23rd, when she became too ill to continue. This teacher was
subsequently certified to be suffering from diphtheria. Then followed a series of 15
cases of throat illness in houses from which children were attending the infants'
department of the school. The majority of the cases were certified to be diphtheria.
In one instance, in which a bacteriological examination was made, the specific