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45
That a certain number of cases of infectious disease occurs in
houses where a defective condition of house drain is found is quite
true; but the sequence is by no means invariable. During the year
1897, the house drains of every dwelling house where a case of either
of the diseases given below occurred in this district were tested, and
the results are set out in the following table. I have, of course,
taken only primary cases into consideration.

From this table it appears that enteric fever and diphtheria occur
more frequently in houses with defective drains than scarlatina and
erysipelas, and that the former two diseases occur with almost the
same frequency as each other, the latter two behave in a similar
manner. But if any relationship exists beween defective drains and
the above diseases, it is closer, from the above table, in enteric fever
and diphtheria than in scarlatina and erysipelas.
With regard to enteric fever we are aware that this disease
may be spread by means of defective drains receiving the
evacuations of patients suffering from this disease ; but in the case
of diphtheria the effect of drain air would be, I imagine, to cause sore
throat, rendering this part of the body more vulnerable to the bacillus
of diphtheria, and may be thus considered a predisposing cause.
The connection of scarlatina and erysipelas does not appear to
be so close as in the former two diseases. I believe that if the whole