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8
infection to spread from first cases will be avoided,
and where the requisite preventive measures are
carried out to the letter. Cases of propagation of
this disease are sometimes due to the milk supply,
but in no instance could the disease be traced to
this cause. Inquiries were made whether cows
were in a healthy condition and whether the people
employed in the cow sheds and dairies were in
good health, but in neither instance did the
inquiries lead to any result. It is advisable that
people should, where there has been an out-break
of diphtheria, take the precaution of having the
milk boiled. Infection in school was clearly
established in one case, where two children were
attacked who sat next to each other; both children
were day pupils. No boarders suffered from the
disease and the sanitary arrangements of the
school were all in good order.
As in the case of Scarlatina, Diphtheria never
appeared in an epidemic form. In three cases more
than one person in the same family was attacked.
The majority of cases (14) occured during the
second half of the year, and the increase of
diphtheria during that period was also noticed in
neighbouring districts and especially in the metropolis.
Diphtheria does not obey the same law
which determines the prevalence of other diseases
of the zymotic group ; formerly it prevailed more
in the country than in the towns, but there has
been observed during the last few years an increase
of diphtheria in the more densely populated districts,
and in some instances, also in places where
the disease had prevailed in an epidemic form
shortly after the substitution of the new and
elaborately constructed sewerage system for the
old cess-pool. I cannot disguise the fact that in
this district the number of cases of diphtheria has