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82
1899]
dampness of its site, or dampness of its surroundings. It cannot,
therefore, be too strongly impressed on the public, on property
owners, and on those who exercise sanitary control that everything
possible should be done by them to remove these conditions. In
the county borough of which I was Medical Officer of Health
for many years and where my advice in this respect was
followed the death rate from diphtheria in the ten years
was very low being only 0.08 per 1,000 of the population,
and in 1899 it was only 0.06 per 1,000 as against 0.50 per 1,000
here. In other words the death rate from the disease in
Islington is 525 per cent. higher than that of the northern borough.
I ascribe this in a very great degree, although not altogether, to
the fact that the surroundings of the houses, especially the back yards
are paved with a substance that is impermeable, and which is
generally good cement concrete. During the years I was Medical
Officer of Health of that borough I always advised that the yards
should be paved in this manner, and I am, therefore, glad to
note that although diphtheria has of late years increased and multiplied
in the large towns, it has at all events up to now taken no
hold on Sunderland, although its juvenile population is proportionally
much greater than in Islington.
I am aware that the circumstances of the two districts
are not quite the same. There, for instance, it is not the custom
to have gardens at the rear of the houses, while it has been so
here. Of late years thousands of houses in Islington that were
once occupied by private wealthy families are now tenanted by
three, four or even more artizans families, while the gardens
which once flourished, are now very often nothing but trodden
and sodden earth which is frequently permeated with the drainings
from clothes hung out to dry, slop water intentionally or accidently
spilt, the excremental filth from dogs, cats, poultry and even
from little children who play in such places. Such yards as these
are only the breeding places of diseases, such as diarrhoea, enteric
fever and diphtheria, for in winter they are sloppy dirty places, and
in summer with every wind that blows they fill the house with dust
laden with the germs of disease. So long as human nature is what
it is, and so long as houses are let out to many tenants, so long will