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How Disease is Spread.- - Among the cases of diphtheria
recorded, the following groups may be cited as illustrations of
how the disease may be spread, owing to failure to recognise
a first case. The first group comprised no fewer than eight
cases in one household in a South Kensington mews. The
outbreak came to my knowledge on receipt of six notifications
of "diphtheritic tonsillitis," a disease not named in section
.55 of the Public Health (London) Act, 1891. The premises
were at once visited for enquiry, when it appeared chat one
of the children had fallen ill, with throat disease, eleven days
previously. A doctor was called in, but failed, in his single
visit, to recognize the illness as diphtheria. Nine days later
the doctor was again sent for, to find a second child sick unto
death, and five other children more or less ill with a disease,
which, in his certificates, received three days later, he
described as above mentioned. On two consecutive days two
children were removed to a general hospital: both of them
required immediate relief by tracheotomy, and one did not
long survive the operation. The other four children were
removed to hospital, by the Asylums Board, at my request.
Subsequently a stable helper living at the same premises was
removed to hospital, also suffering from diphtheria, making
eight cases in all, with two deaths. Seeking for a cause for
the first case—for the other cases were explicable upon the
assumption of direct infection from person to person—I ascertained that there had been much cause for complaint of stench
arising from a surface sewer ventilator, immediately under the
windows of the rooms over the stable in the mews, which has
not been taken over by your Vestry. It was stated, moreover, that the child first to be attacked (and not he alone) had
been accustomed to dabble in the water which lay in a hollow
near to the ventilating opening, and it was presumed that in
this way he had inhaled the pestiferous vapours, and so contracted this malignant disease. I lost no time in calling the
attention of the Surveyor to the nuisance, and he forthwith
had the ventilating opening closed. Susbequently the