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All the cases are investigated, the source, if possible, ascertained,
the premises are inspected and notices served for sanitary
defects.
The following conditions were discovered in the houses where
126 cases occurred.
Dirty rooms (25), damp rooms (1), verminous room (1), yard
dirty (5), staircase and passage dirty (3), area dirty (1), w.c. foul
and dirty (9), w.c. leaking (1), w.c. choked (3), w.c. insufficient
flush (2), drains defective (6), soil pipe broken (1), foul water
cistern (3), cistern cover broken (1), dustbin broken (1), washhouse
undrained (1), yard and washhouse paving broken (4),
washhouse dirty (7), water-waste preventer defective (4), loose
manhole cover (2), leaky roof (2), broken guttering (1), rain-water
pipe defective (1), insufficient w.c. accommodation (1), no water
supply to upper storeys (2), overcrowding (1).
Source.—In 16 cases the disease had been contractcd from
previous cases in the same house or near by, in 9 other cases from
members of the same family already affected with the disease. In
two persons the source was a previous case with which they came
into contact at an entertainment. In three instances there was
reason to believe that diphtheria was caught from another patient
while visiting a general hospital. In 6 cases the disease was contracted
after the patients had been admitted as in-patients at a
hospital.
School infection was responsible in 4 instances.
It is sometimes very difficult to convince parents, head teachers
of schools and their assistants that a patient may have diphtheria
and yet appear to be quite well and complain of little or no discomfort.
Thus, a boy, 11 years of age, complained of sore throat
and visited a general hospital on a Monday. On the Tuesday he
again visited the hospital and a swab was taken from his tonsils;
he was asked to return to hospital on the next day. On the
Wednesday he felt better and returned to school. He went to
school on the next two days—Thursday and Friday. On the
Friday the hospital authorities found that the culture from the
boy's throat showed the presence of diphtheria bacilli, and notified
the case as one of diphtheria by telephone. The boy's home was