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they are nearest to the dust accumulation, whilst in the 10
having defective arrangements which were connected with the
ordinary sewers of Clapton, cases of disease occurred in all but
one. I may mention here that nearly all the Clapton sewage is
carried into the high level sewer, whilst the four houses abovenamed
drained into a sewer which opens into a system of sewers
connected with the low level sewer. I think that it is
impossible to have stronger evidence that the infection was
conveyed into the houses of the patients by the agency of the
sewer gas. Why this gas should have had a peculiar infective
power at a particular time, shown by the infection simultaneously
of persons living a mile apart, I am unable to determine; but
this is only in accordance with what has been observed in
outbreaks of diphtheria elsewhere. The occurrence, almost
simultaneously of very unpleasant smells from the sewer, which
is very unusual at Clapton, and of the diphtheria outbreak, point
to some unusual potency for evil in the sewer gas"
After this outbreak the disease declined to about its usual
level in the district, as one death occurred in April, at
Grange Road, Clapton, and the other in Orchard Terrace, on the
1st of May. There were also some other cases in the Grange
Road and at Dalston. The water supply and drainage arrangements
were not satisfactory in either of the cases examined, as
in one the air pipe from the closet opened into the cistern which
was covered, and there was a rush of air through it when the
handle of the closet was pulled; as regards the other the rain
water pipe was untrapped and connected with the drain, so that
sewer gas could enter the sleeping rooms from the hopper of
the pipe which is close to it.
During the year a very suspicious outbreak of typhoid
occurred in some houses and large institutions in this district,
and in Bethnal Green, which was supplied by the same milkman.
The facts are briefly these:— In October a young man residing
in a milkman's house was attacked with typhoid, and kept his