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far as practicable inspection was made of the sanitary
arrangements of the house in which it occurred, and in many
obvious defects were found. We are bound to admit
however that in many cases no fault could be found in the
sanitary condition of the house, and the selection often of the
individual least exposed to sanitary dangers in the household,
compelled us to look elsewhere for the cause of the disease.
The system of ventilation of the sewers by gratings in the
open street (often near frequented places such as crossings, &c.)
which obtains in most parts of London is not devoid of danger,
and will have to be replaced sooner or later by some safer
method. The accumulation of house refuse in stationary
receptacles close to dwelling houses, is in my opinion a not
improbable source of danger. The time is surely not very
distant when the daily removal of household refuse (often of a
highly decomposible nature) will be undertaken by the sanitary
authorities themselves, and not by contractors who have no
interest in its frequent removal.
Atmospheric conditions must not be forgotten as a probable
cause of diphtheria. It has several times been observed
that an epidemic of this disease has followed a continuance
of dry weather. The charging of the air with dust containing
organic impurities may at such times lead to the disease in
those who have weak throats and enlarged spongy tonsils.
The absence of water leads of course to defective flushing of
the drains and the drying up of traps dependant upon the
rain.fall for their effectiveness.
Constitutional and Local Diseases, &c.—Very little requires
to be noted regarding these groups which maintain much the
same proportion as in previous years. In the following table
the usual eleven years' comparison will be found.