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81
[1899
" 5th. There are ample grounds for believing that the aggregation
of children in elementary schools constitutes one of the conditions
under which a form of disease of particular potency for
spread and for death may be so to speak manufactured.
" 6th. The danger of school aggregation is by no means limited
to the period in which the throat disease is acute. . . .
"7th. The practice of kissing and of transferring sweetmeats
from mouth to mouth—practices which are more common amongst
girls than boys—also the joint use of drinking cups, etc., must according
to experience be credited with assisting in the diffusion of
diphtheria amongst school fellows."
Here we have summarized the dangers arising from the
aggregation of children in schools, apart from such influences as
may arise from the faulty sanitation of the building themselves.
Milk has often been the means by which diphtheria has been
conveyed, and indeed twenty-one years ago the present Medical
Officer to the Local Government Board, Mr. W. H. Power, traced the
epidemic which prevailed in St. John's Wood and Kilburn to such
a source.
The disease may also be conveyed by bedding and by the
personal clothing, both of the patients and their attendants, and
contracted by the occupation of rooms recently tenanted by persons
suffering from the disease, which have not been disinfected. My
experience is, however, that these are less potent factors than is the
case with scarlet fever. They are, nevertheless, real elements of
danger, and as such, should be rigidly guarded against.
It has been alleged that the disease has sometimes been spread
by animals, especially cats, who are themselves liable to contract
the disease. I have, however, never been able to trace a case to
such a source, although for some years back I have always made,
or caused to be made, special inquiries in this direction.
So far, as my inquiries in Islington have led me to conclusions I
have found that the cases have been caused chiefly by direct
infection, whether in home life or in schools, while the great predisposing
causes have undoubtedly been dampness in the house, or