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all portions of the District as widely separated as Havelock
Road, St. George's Road, Amity Grove and the Common.
Fortunately it was possible to remove all cases requiring
admission to the Hospital, the Enteric Fever Ward being
available owing to the absence of Enteric Fever at this
period.
The 83 cases occurred in 75 houses, in one of which there
were four patients, in another three, and in three other
houses two each.
As has been the custom for some years, the drains and
sanitary arrangements of every house from which a case was
notified were tested and examined At 59 houses no defects
were noted; at seven houses slight insanitary conditions
such as damp walls, dirty and uncovered cisterns, defective
flushing boxes, &c., were found, whilst at seven others the
house drains were found in such a defective state as to
require their reconstruction, and in two other instances
considerable alterations were necessary.
It was the general opinion until recent years that
exposure to sewer air, defective drainage and insanitary
surroundings, were the principal causes of Diphtheria, but
apparently, bacteriology has proved this not to be the case.
However, insanitary conditions must undoubtedly always
be searched for and remedied, for they are unquestionably
contributory causes by lowering the general health and
thereby rendering the individual more susceptible to any
infecting agent bv making the mucous membrane of the
nose or mouth unhealthy, and affording a favourable field for
the growth of any germ that may gain access.
Cerebro Spinal Meningitis or Spotted Fever.—In consequence
of this disease having been somewhat prevalent in
parts of Ireland and Scotland, the Local Government Board,
on the 20th February, sent a circular letter to all Local
Authorities together with a memorandum prepared by their
Medical Officer dealing generally with the characteristic
symptoms of the disease, and especially with its minor and
anomalous manifestations, asking in the event of any cases
occurring in the District that the Board shouldbeimmediately
notified, and further stating that they would be prepared to
render the Sanitary Authority such advice or assistance
as in the circumstances might appear to be necessary.
They also pointed out that the Sanitary Authority
could, if they thought fit, make an order to the effect that
the disease should be compulsorily notifiable in their
District.
I advised the Sanitary Committee that if the disease
was made notifiable it would probably create a scare. A
copy of the memorandum was, however, sent to each member
of the medical profession practising in Wimbledon, with
a