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18
Diphtheria assumed somewhat epidemic proportions
during the autumn which continued into the winter.
In the first half of the year 14 cases occurred, spread
over the neighbourhoods of the Bessborough Estate, Pinner
Road, Greenhill and Roxeth. The bulk of the cases occurred
in the second half of the year, and the greater number of
these in Roxeth. The origin of the first infection in 22 cases
which appeared in a private school, could not be traced : no
evidence was forthcoming that the primary infection was
contracted in Harrow.
As is well known diphtheria is carried mostly by direct
contact and occasionally by milk supplies.
I satisfied myself that no milk supply operated in this
epidemic. The disease spread principally by contact.
Individual classes of the Roxeth Elementary Schools in
which cases occurred were at first examined and swabbed,
and later the entire schools. What part the schools played
in the spread of infection is most difficult to estimate. I am
inclined to the view that the greater number of infections
took place in the children's homes. In one house in Stanley
Road (in which road 13 cases occurrcd), two families lived
in 4 rooms and produced amongst them 5 cases, viz., 3
primary cases in one family, in six weeks a secondary case in
the other family, and 4 weeks later a secondary case in the
first family. It may be argued that the last two cases obtained
their infection outside : this is possible, but from study
of a number of cases in houses similarly situated, I think
not probable. A like tale of infection is to be told almost
exactly of 3 houses in Valentine Road, each containing 4
rooms and accommodating two families, in all of which I
was able definitely to exclude school influence in the spread
of infection. And so of various other houses. Some of these
houses are overcrowded containing 9, 10, 12 or more inmates;
some dirty. Overcrowding is a most effective factor
in spreading infection; so also the irregular and untidy habits
of families who keep a dirty house.
On going in and out amongst these people I have been
struck by the irresponsible manner in which many parents
treat the injunction "not on any account to mingle with others
until free from infection." Within half an hour of visiting
and advising an infected family I have found a member of this
family in a neighbouring house, with the result to be expected,
viz., a new case in the latter house. They transgress not
with a wish to do wrong but from sheer inability to appreciate
the importance of the position. Hope of reform lies