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the air and fossites, although these hitter have not been conclusively
shown. One of the chief causes of spread is by means of large
schools, such as Board schools. There have been several instances
of this, and one very notably in connection with the Rushmore
Road schools, where a considerable number of children were
attacked in the infant school, and not in any of the others. From
what I had observed previously, I requested the playground of
these children to be closed, but as that could not very well be
done, the infants were sent home without mixing with the other
children. In rather less than a fortnight the disease ceased, not
only in the schools, but in the district. As to sewerage I have but
little satisfactory evidence that bad drainage has had any direct
connection with the causation of diphtheria. Outbreaks have
occurred in connection with disturbance of soil and even opening
of sewers, but they are so few when compared with openings of
bad ground, and even of what has been termed germ-laden soil,
that the evidence is of little value. At the International Congress
of Hygiene this year, Dr. Seaton opened the discussion, which was
continued by delegates from all parts of the world, with a resolution
proposed by him and seconded by myself, that a comprehensive and
systematic enquiry should be made by the British Government into
the causes of diphtheria, including in such inquiry the places
known to be free from the disease, and taking into consideration
the results of previous investigations as to the carriage of infection
by milk, its relation to dirt, dampness, and insanitary surroundings.
The facts contained in the papers and the discussions were
insufficient to settle one point. As regards Hackney, many local
outbreaks have occurred iu connection with imported cases. There
was one important table exhibited showing that in localities where
sanitary works had been carried out for years and typhoid fever
had diminished, that diphtheria had increased its death rate. This
certainly indicates that diphtheria must be combatted with other
weapons than those in use for typhoid. In April, 1888, there was
a much more extensive outbreak of this disease near Southwold
Road and Detmold Road Board school. The first deaths were
returned as "cynanche maligna," but which the medical attendant,