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a common condition met with being that the two floors of the house are let to separate tenants. In
about half the houses in which cases of diphtheria had occurred drainage defects of one kind or another
had been noted by the sanitary inspector as requiring remedy. On the other hand in several instances
it was found that diphtheria had broken out in a house in which the drainage system had, within the
last year or two, undergone complete reconstruction. In a few cases houses were found to be in a dirty
and neglected condition, and in a smaller number of cases there was reason for supposing that overcrowding
existed.
Almost every street included in the second class of bouses contributed one or more instances
of families attacked by diphtheria. The few exceptions (in the case of streets containing any
considerable number of houses) were instances of streets containing houses which it may be assumed
would let at a rental above that of the majority of the houses belonging to the second of the classes
already referred to.
Water supply.—Almost all the houses in which cases of diphtheria occurred, as is the case in
the district generally, were supplied with water by the Kent Water Company. In one instance it was
noted that the supply of water was from a well.
Milk supply.—Inquiry as to this matter was made in all the cases investigated, the sources from
which milk was derived were found to be numerous, and no single vendor had been supplying more than
a very limited number of the families attacked. In several instances it was ascertained that condensed
milk only was consumed by persons who had suffered from diphtheria, but inasmuch as four or five
different brands of condensed milk were found to have been used, it appeared that no one particular
variety had been consumed in any considerable number of the families invaded.
Seivers.—A few complaints of smells from sewer ventilators came under notice during the
inquiry. The hot weather and the smallness of the rainfall during several weeks prior to [the outbreak
possibly tended to render smells of this kind more noticeable tban is ordinarily the case. There are
certain dead ends of sewers in the affected area, but on the other hand several flushing tanks with
automatic syphons are in use.
Diphtheria prevalence.—During the year 1893, in which London suffered markedly from
diphtheria, there were only 5 cases of diphtheria and membranous croup notified in the " affected
area." The number of such cases notified in Lewisham parish, i.e., in the whole of the area under the
jurisdiction of the Lewisham Board of Works, with the exception of Penge, was 207.
In 1894, 9 cases of diphtheria and membranous croup were notified in the affected area, and 153
in Lewisham parish.
In 1895, 29 cases were notified in the affected area, and 128 in Lewisham parish. The affected
area therefore suffered from diphtheria prevalence to a distinctly greater extent in this year than had
been the case in either of the two preceding years.
During the first 26 weeks of 1896, 23 cases were notified in the affected area and 127 in
Lewisham parish, and thus during the first half of the present year the somewhat increased incidence
of diphtheria upon the affected area, which had already manifested itself during 1895, was maintained.
From the 27th-44th weeks of the present year 158 cases were notified in the entire parish, and of these
no fewer than 108 were in the affected area.
Before proceeding to study more in detail this last period during which so great an increase in
the incidence of diphtheria in the affected area was manifested, it may be well to show the extent to
which the diphtheria during the period of special prevalence was limited to that area, and for this
purpose it may be well to compare the affected area with a less extensive district than that of the entire
parish of Lewisham. The area under the jurisdiction of the Lewisham Board is divided into three
districts for administrative purposes. The affected area forms part of what is known as the " Blackheath
and Lewisham " district. The other two districts are those of " Penge " and of " Sydenham
and Forest-hill." In the annexed table the cases notified week by week in the affected area are
compared with those notified from the whole of the " Blackheath and Lewisham " district, of which
the affected area forms part.

From this table it is clear that during the period under consideration (viz., from the 27th to the
44th weeks) the diphtheria in " Blackheath and Lewisham " was practically limited to what has been
defined as the " affected area."