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115
Parish of Wandsworth.
found after testing, but these, as in the outbreak in Ward 1,
were of a slight character, mainly consisting of defective
watercloset arrangements. In all the cases occurring in
these houses a definite history of contact with a previous
case was obtained. The milk-supply in all cases was the
subject of careful inquiry, but no connexion between this
and the outbreaks in either Ward could be traced. The
sanitary arrangements of the school in Ward 1 were carefully
examined and the drains tested, but only a slight
defect was found, this consisting of an untrapped rainwater
pipe. In Ward 3 the sanitary arrangements of the
school were excellent, the drains having only recently been
laid under the supervision of the sanitary inspector.
A review of all the circumstances attending the three
outbreaks—the one at Roehampton and the two in Wandsworth—emphasises
the fact that Diphtheria may show
varying degrees of virulence in different outbreaks. In the
Roehampton outbreak out of 30 cases reported not one
proved fatal. In the first outbreak in this parish 45 cases
were reported, of which 12 proved fatal, and in the
second 31 cases with 13 deaths. Again, in Ward 1 of this
parish Diphtheria had been present, though in a mild form,
during the previous year; and it is a well-known fact that
virulent outbreaks are frequently preceded by a prevalence
of sore-throat or of true Diphtheria of a mild character.
It is difficult, to say definitely whether the outbreak in
Ward 3 arose out of that in Ward 1. Every inquiry was
made into the history of the child first affected in Ward 3,
but no definite information could be obtained as to contact
with any of the cases in Ward 1. It is quite within the
bounds of possibility that such contact did take place, and
if so it would further verify the statement made by Sir R.
Thorne Thorne as to the progressive power of infectiveness
of this disease. The lessons to be drawn from these and
similar outbreaks are, in my opinion—that all cases of
12