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tut for the care taken to debar from school attendance all children
residing in houses where it appeared. In 1888 some 44 children
attacked were connected with the very large Board School in
Wornington Road, in 1889 only 17, the cases moreover, as has
been shewn, were spread over the whole year. St. John's Church
School furnished the largest number of cases, 18, of which 8
occurred in May, 4 in June, and 3 in July. I have no doubt that
the disease spread by direct contagion in this school, which was not
in an altogether satisfactory sanitary condition. Only two cases
occurred after the summer holidays, during which amendments
which I had advised were carried out. Few as the cases were
in any school, it was observed that they tended to occur in small
groups, indicating connection of the several members of each
group. I am pleased to be able to testify that the school authorities
generally were assiduous in their efforts to prevent the spread
of the disease by exclusion of suspicious cases, which were duly
reported to me; but they laboured necessarily under a difficulty
arising from the fact that diphtheria presents no external eruption
to attract attention to it as something different from a
common or non-specific sore throat. Slight cases, therefore, are
liable to escape notice, and to the occurrence of such unrecognised
cases, spread of the disease through the agency of schools may be
reasonably attributed.
In some instances sanitary defects were found in the invaded
houses, but these were few compared with the total number; in
some of the streets, moreover, offensive sewer manholes or gullies
were observed. But for the most part the cases occurred singly
in houses, and on the whole the information collected seemed to
point to direct infection, especially through schools, as the more
probable cause of the spread of the disease.
The Registrar-General in his Annual Summary, states that
the mortality from diphtheria, which had been increasing steadily
for many years, in the last two years, 1888 and 1889, made the
most alarming bounds, the deaths rising from a total of 953 in
1887, first to 1311 in 1888, and then in 1889 to no less than