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disease. For the first six of these years the
returns were all in double figures and show an
average of over 21 cases a year, followed by four
years in succession with an average of only a little
over 6 cases per annum. Apart from personal
contagion which is without question the main
cause of the spread of this disease, prompt notification
and speedy and efficient isolation are of
extreme value in limiting an outbreak as cases
declare themselves, and so far as sanitary shortcomings
may act as predisposing causes, the everimproving
sanitation of the district ought to be of
value, but it may be a fact not generally appreciated
that "a close relation between imperfect drainage
or a polluted water supply and diphtheria has not
been determined." The few cases that occurred
were spread over the year, one being notified in
each of the months of February, October, November
and December and five in July. Of these
latter, two were on the Hill and three below.
All were in Surbiton and none in Tolworth or
Hook.
One case of modified small-pox of a very mild Sma11 Pox
type was notified early in the year ; it was removed
to the Joint Small-Pox Hospital at Cheam and
made a good recovery. The other inmates of the
house were all promptly re-vaccinated and kept
in strict quarantine for the requisite period
followed by thorough disinfection and cleansing
and no further case occurred.
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