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126
the hospitals and 14 at their homes. Altogether 108 cases
occurred, nearly twice as many as in last year. The case
mortality was 28.7 per cent.; 41 were removed to hospital,
so that the mortality of those removed was 41.4 per cent.,
and of those remaining at home 20.8 per cent.
The houses where these cases occurred were all carefully
inspected, and the drains tested, and in forty-seven
instances more or less serious defects were found. In
considerably more than half, however, no fault could be
found with the houses as to dampness or drainage
nuisances. One fact, however, becomes obvious in looking
at the ages of the sufferers. Very nearly all were of
school age, very few indeed were under three years of
age, and very few over 15. I think, therefore, that
schools are responsible for spreading diphtheria from
pupil to pupil to a far greater extent than is generally
supposed. It is most important for parents to recognise
the great infectiousness of this terrible complaint, and
also that the duration of the infection is longer than the
obviously diseased condition of the throat.
The large proportion that the deaths bear to the cases
of illness—28.7 per cent., lends additional weight to the
opinion that a large number of mild cases are not
recognised as being diphtheria, and are therefore not
notified, and probably attend school with only an
absence of a day or two. It is certainly often an
extremely difficult question for a medical man to decide
whether a mild case is one of diphtheria or not, and
among the poorer classes a doctor is not generally called
in unless the child is obviously very ill. It appears to
me that the greatest help could be given by the managers
and teachers of elementary schools by insisting on the
exclusion of any child suffering from any sort of sore
throat, and not under any circumstances allowing