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Eglinton-road school (Woolwich) had had an excess of cases of diphtheria in the girls' department
in the previous year; the cases in the time now under review were practically confined to a single
class of eight-year-old girls. On April 8th the whole class of 45 children was examined, and in four cases
cultures of Klebs Löffler bacilli found. These were excluded, but cases showed again, and on April 18th
38 children were tested, four "carriers" then detected, and it was found that a child who had escaped
examination on the previous occasion, had returned to school in the interval, the mistress having admitted
her because the absence was ascribed to an accident to her foot. This child was found to be a carrier,
and all the fresh cases had occurred since her return to school. On this date the teacher of the class
suffered from a slight sore throat, which her medical attendant notified as having diphtheria bacilli
associated with it. Under these circumstances the class was closed over the Easter vacation. The
whole class was again tested on June 28th, and neither diphtheria nor even pseudo organisms were then
found in the cultures.
In this case diphtheria continued to affect a single class over a considerable period without
spreading to the other classes, and suggests some special class dissemination as by particular educational
means such as pencils or "penholders. Pencil biting is a very common habit, and as these materials are
collected at noon to be redistributed in a couple of hours, it is evident that they may act as vehicles
of infection, and may serve to explain the fact that diphtheria is but rarely contracted by a neighbour,
even when the children are sitting in the objectionable dual desks, but arises at new spots dotted over
the class-room.
Grafton-road (Islington, N.)—During April, 1905, some cases of diphtheria occurred amongst the
infants; out of 33 cultures one boy was discovered to be a carrier, and on his exclusion the outbreak
ceased.
Monteith-rond {Bromley and Bow).— Owing to defective notification a number of cases had occurred
at this school and the disease become widespread without our knowledge. Cultures were taken from
51 children on July 7th, and among them six carriers discovered in the upper classes of the infants'
department. Being spread over several classes, pressure of other work made it impossible to undertake
the large amount of work required here for complete suppression, so the school was closed till
the summer vacation.
From September to December eight schools came under observation specially on account of
diphtheria.
St. Mark's (Kennington).—Several cases were notified in children whose absence began after
September 18th. On September 28th, two carrier cases were detected. One of these was a girl who
had been away for 14 days previous to September 18th with tonsilitis. There can be no doubt that
she suffered in reality from mild diphtheria. These two cases were in class A, and with their exclusion
no further cases occurred; there having been eight cases and three exclusions in this outbreakbetween
September 18th and 29th.
Nine days later (October 6th), a further case occurred in class B, and the local authority interfered
unnecessarily by closing the department for 14 days. Some time after reassembling another case
showed on November 2nd, but no further school spread took place.
Marner-street (Bromley and Bow).—Information was received on October 8th, that a child in
the girls' department had died of diphtheria, and a wake had been held, which a number of her school
fellows had attended. Immediate enquiry was made; 29 school girls had visited the house; they were
all tested, and seven found with Klebs Löftier bacilli. Of these seven girls five had actually kissed the
dead child. The exclusion of these children prevented any extension of an outbreak which might have
been serious.
Brompton schools (Kensington, S.),—Ten cases of diphtheria were notified on October 18th, and
nine of these were in children aged 5 to 7. Investigation showed that one girl in whose class most of the
cases had occurred, and who had been absent with sore throat, was a carrier of diphtheria bacilli. After
her exclusion on October 20th, the outbreak ceased to have the characters of being school spread,
although sporadic cases cropped up irregularly in different parts of the school for some time without it
being possible to trace any connecton between them through the school.
William-street, (Fulham).—An upper class of the Infant's department having had several cases,
33 of the children were bacteriologically tested, and six found to be harbouring the bacillus. On excluding
them the outbreak terminated.

Union-street (Woolwich).—Much illness and some diphtheria being reported, a visit of enquiry
was made on December 11th, 35 infants being examined, nine presented Klebs Löffler bacilli. Measles
and whooping-cough were also prevalent, and, as the children seemed in a condition of low vitality and
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