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17
to an alarming extent. We are never long without a case of
diphtheria, and almost every year sees an extension of the disease.
Various suggestions have been made to account for this increase.
Some see in it the result of exposure to drain or sewer emanations,
and believe the disease can be generated de novo from foul effluvia.
While many cases of Diphtheria arise in houses where such
sanitary defects exist, the connection of the two is not so close or
frequent as to justify at present the statement that sewer or drain
effluvia are the cause of the disease; but whatever future investigations
may reveal in this direction, there is no doubt in my mind that
one cause of the spread of Diphtheria is what is known as "school
influence." I do not mean by this term, that the school as a
building exercises any influence in this direction, but that it operates
by affording facilities for the aggregation of persons at susceptible
ages, who are by these means brought into close proximity to, and
actual contact with one another; and as Diphtheria is a disease
which spreads chiefly by personal infection, no surer mode of
spreading the disease can be conceived, than the introduction of one
or two cases of diphtheria amongst a group of children engaged in
the routine of school attendance and work. Anyone who has had
experience in personal investigation of cases of diphtheria, must
have been struck with the number of instances in which the source
has been traced to a fellow scholar in the same school, with whom
there has been close contact, such as occurs in dancing, or the
contiguity of adjacent scholars. I can easily conceive other means
of spreading the disease in the use of slates and pencils, if they are
interchanged.
From these considerations, I am convinced that school influence
is real and powerful in the spread of Diphtheria. The experience
of the past year in no way weakens this conviction ; on the contrary,
evidence has been furnished to strengthen it.
A study of the chart furnished with this report shows that
Diphtheria was prevalent the whole year, although fluctuating
irregularly; but in the third week of September a definite and
well-sustained rise in the notifications took place. This rise was