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7
becoming less in number, but suggested that the throats
of all the children attending school should be examined.
This was according done, with the result that not a
single case of even suspicious throat was found among
the children attending. Dr. Shirley Murphy asked if
we could arrange for the Assistant M O.H., C.C., to
make a thorough enquiry into the prevalence of diphtheria
in this neighbourhood, and the part which school
influence had in it. After a long enquiry, Dr. Hamer came
to the conclusion that closing the schools might have had
a good influence in bringing the outbreak to an earlier
termination; but that the schools should have been closed
at an early period. He does not, however, state at what
period he considers the schools should have been closed, and
what per centage of infectious disease should make it advisable
for the M.O.H. to take the grave step of closing a
school Until some definite rule is laid down in this matter,
it will always be, as it has been in the past, one of the most
difficult questions which a Medical Officer of Health can
have to deal with, and one which will be certain to expose
him to a considerable amount of adverse criticism, whether
he decides to close, or not to close, a school. In the present
instance I consider that my action in not closing the school
was the right one. Knowing the neighbourhood in which
diphtheria prevailed, I believe that the outbreak arose (as is
so often the case in low-lying districts such as this) from the
long period of excessive wet weather following on a long
period of unusually dry hot weather. The class of people
whose children suffered were most of them of the class who,
in spite of every care possible on the part of the Sanitary
Authorities cannot be induced to keep their houses in a
thoroughly sanitary condition; and though the origin of
diphtheria is still actually unknown, it is known to breed
and multiply in insanitary surroundings. What I endeavoured
to do in this outbreak, instead of closing the schools,
and consequently making the homes in all cases still more
congested and consequently unhealthy, was to remedy as
soon as possible, all sanitary defects in the houses, and get