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likely to be disposed to aid dissemination of infections disease, the department was closed till the
Christmas vacation.
Lombard-wall (Greenwich).—Seven cases were notified from the infants' department immediately
before the Christmas vacation. On December 18th cultures were taken from 17 children and four found
to be carriers and excluded. In addition to the cases of diphtheria notified, some others had been absent
for sore throats, which, it may be assumed, were mostly cases of unrecognised diphtheria. During the
closing period other unrecognised cases probably occurred, for on the re-opening of the school, further
cases occurred in different parts of the infant school, and there were absences for sore throat, which the
Medical Officer of Health, Dr. Annis, ascertained to be diphtheritic. The school was frequently visited
and carrier cases found in diminishing numbers during February and March. Practically every
school absentee was followed up with great energy by Dr. Annis, who was able to demonstrate that a
very large proportion of the sore throats which accompany a notified outbreak of diphtheria are really
mild cases of this disease, recognisable only by bacteriological means, yet infectious. The work was
rendered more arduous by the attitude of a few local practitioners, who, after the Klebs Löffler bacillus
had been isolated from the throats of children, refused to look upon them as diphtheritic, and remained
apparently unconvinced when other members of the family suffered from undoubtedly clinical diphtheria
The neighbouring schools, particularly Glenister-road, Fossdene-road and Dreadnought-street,
were carefully watched. One or two carrier cases were detected and excluded, and any school diffusion
appeared to have been effectually prevented.
Brandlehow-road (Wandsworth).—Five cases having occurred in the Infants' department, an
investigation was begun on January 23rd. Several children had been absent with sore throat, one still
in school showed a typical follicular tonsilitis, but gave, however, a pure culture of the bacillus. Nine other
children gave unsatisfactory cultures, and were excluded. It was learned that in this school the drains
had been temporarily obstructed and the basement flooded some weeks previously; so, although we have
never had any evidence of diphtheria being diffused by faulty drainage, thorough disinfection of the
basements was ordered. All these measures were aided by the co-operation of Dr. Caldwell Smith,
the Medical Officer of Health., and no further case of diphtheria has occurred in the school.
Wood-street (Woolwich).—An outbreak showed itself here at the end of January. On the 30th,
the children were examined, and cultures showed three carrier cases among the six-year-old children.
In this case the teacher had showed great discretion in at once excluding all children showing
the slightest sign of ill-health, and notifying them. These were followed up by Dr. Davies, the Medical
Officer of Health and, with this help what threatened to be a serious outbreak at once subsided.

Gordon School (Woolwich).—During the week previous to February 7th, six cases were notified.
On enquiry several previous cases of sore throat came to light. Cultures were taken from these cases,
and five still presented Klebs Löffler bacilli—having been mild cases of diphtheria who had
returned to school whilst still infectious. A diminution in the occurrence of cases followed, and
then a few recommenced, still almost entirely confined to the six-year-old class. Considerable alarm took
place, and the attendance dropped in all departments; six further cases of carriers were detected and
notified, and to reassure the parents the school was allowed to be closed for three weeks. Here again
23 out of the 27 cases were in the highest class (six-year-old) of the infants' and four of the six cases
in the boys' department were in the lowest (eight-year-old) class.
Hugon-road (Fulham).—Three recent cases having occurred in one class of nine-year-old girls, Dr.
Stevenson visited here in February. No case was detected, but on a second visit three sisters who had
previously been absent with sore throat, were found to give a positive result in each case. One of these
girls was a member of the class affected. After their detection there were no further cases.
Vauxhall-street (Kennington).—A letter was received on February 23rd, from the head mistress
that there had been in the previous week two cases of diphtheria in one class and several of sore throat.
On examination of the children of this class one carrier was found and three others were also excluded
as doubtful. No further case occurred. This child who was excluded on account of known diphtheria,
both clinical and bacteriological, was taken to an isolation hospital, but because she did not appear
ill was admitted only to an observation ward, and was later sent out with an intimation to the Medical
Officer of Health that it had not been a case of diphtheria. The hospital authorities offered no evidence
that any bacteriological test had ever been applied. This multiplicity of authorities in London
responsible for the isolation of cases of infectious disease is one of the greatest of the difficulties which
those engaged in preventive medicine have to encounter.
When the late authority gave permission to establish a small bacteriological laboratory, a
systematic attempt was begun to control diphtheria in the schools by a scrutiny of the returns from the
head teachers, and a wide testing of all suspects by bacteriological means. It was then pointed out that
diphtheria seemed to be on the ebb of one of its epidemic phases. Waves of greater and less incidence
spread over many years are part of the natural history of the disease, and the tendency to ascribe the
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