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and I think it may reasonably be conceded that wherever
large numbers of children are gathered together the opportunities
for personal conveyance of infection, which is so
necessary in diphtheria, exist to a great extent; more especially,
I believe, that often children are sent to school whilst actually
suffering from the disease, in an exceedingly mild form. I
have frequently been informed by parents that before diphtheria
had declared itself the child had been poorly, and only at its
urgent request they have allowed it to go to school, on account
possibly of some examination or prize which the child was
looking forward to compete in or for. Another fact which
points to the influence of the school is the remarkable falling
off in the figures for the first part of August, which corresponded
to the last three weeks of the holiday period. Not
only this, there are cases in which the child, although really
ill, is supposed to be shamming for the purpose of getting off
school attendance. Against this theory of school infection we
have the fact that the notifications in 1896 from the affected
area of patients over 15 increased in almost the same ratio as
those of the essentially school ages 4 to 10; but among these
adults there will be the mothers of the children who would be
brought into immediate contact with those attacked.
It is difficult without confusing the question to discuss
the possibility of infection otherwise than through the school;
at the same time it is a noteworthy fact that in a good many
instances there were a number of children attacked living in
the same streets, although these often attended different
schools I would especially mention Attwell Street, whence
children attended both Wood's Road and Choumert Road
Schools, and other streets in the immediate neighbourhood of
Choumert Road, where it was no uncommon thing to find a child
attending Bellenden Road School living next door to one who
attended Choumert Road, and who were attacked within a
short time of each other. The possibility, therefore, of
infection elsewhere than at school is a very real one.
Last year in my report I had occasion to remark on the
common belief as to the influence of bad drainage on the
causation of diphtheria, and to express my opinion that this
was much exaggerated. In support of this I now point out
that the amount of drainage work done has been large, not
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