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of the family, in 15 others to previous cases in the same house or its immediate vicinity, and in 3 cases
to infection at school; inWoolwich, of 240 cases occurring in the district, in 31 instances the disease
appears to have been due to infection from other inmates of the house, in 8 instances from neighbours
and friends, and in 4 from schoolmates. Two cases in Finsbury and four in Woolwich were attributed
to visiting at general hospitals. Of 29 cases occurring in Stoke Newington, infection was in 3 instances
attributed to a known antecedent case. Cases due to infection from a patient discharged from hospital
are mentioned in the reports relating to Holborn, 2 ; Finsbury, 5, of which 3 followed the return of the
same patient from hospital, the original case being subsequently sent back to hospital; Wandsworth
4 cases ; and Woolwich 3 cases.
Particular prevalences of diphtheria are discussed in some of the reports. Dr. Allan mentions that
in connection with one school in Westminster " 18 persons proved to have the specific organism in their
throats, and two of them had been ill some weeks previously, and were probably acting as sources of
infection in the school; after they were excluded, no further cases were detected." In connection
with the ability of bacillus " carriers " to give rise to infection, Dr. Annis refers to the case of a boy
(G.C.) who, on account of an attack of scarlet fever, was removed from the Royal Hospital School in
Greenwich to the Brook Hospital. The occurrence of a case of diphtheria in the convalescent ward
where this boy was, led to the bacteriological examination of material from the patients, and this boy
was found during June to be harbouring diphtheria bacilli, but not to be suffering from any symptoms
of the disease. No diphtheria bacilli were found as the result of two examinations early in July. He
was discharged on July 7th, and after his return to the Royal Hospital School, he was isolated for a few
days and then allowed to mix with the other boys. No case of diphtheria occurred before the summer
vacation, but one boy on reaching home developed diphtheria, from which he died. G.C. went home
to a somewhat isolated part of Ireland on July 30th, and after his return five members of the family
speedily developed diphtheria, the first commencing to be ill about three days after G.C.'s arrival. Two
of the cases proved fatal. Dr. Annis states that there had been no case of diphtheria in that part of
Ireland for the previous fifteen years.
In a few reports mention is made of special incidence of diphtheria in particular schools, and of
the steps taken for limitation of disease, by way of exclusion from school of children found to be harbouring
diphtheria bacilli or by closure of classrooms. Information is much needed concerning the evidence
found, in the homes, of the infectiveness of the children thus excluded, as manifested by subsequent
attack of other members of the family, and as to the circumstances which determine the pathogenicity
of such cases as that described by Dr. Annis. With the present state of knowledge, the bacillus carrier
must be regarded as a very possible source of danger to other children. Dr. Davies writes that in
Woolwich, " after a case has been notified in a house, no children from that house are allowed to return
to school until they have been certified free from infection after a bacteriological examination." Dr.
Caldwell Smith states in his annual report " At no period of the year was there any outbreak to call
for special notice, and this is due, as was stated in my report for last year, largely to the methods
adopted for dealing with cases in elementary schools." He notes, moreover, that with decline of
diphtheria from 527 cases in the borough in 1908 to 335 in 1909, the number of cases among school
attending children constituted 40 per cent, of the total cases in 1908, and 49'2 per cent, of the total
cases in 1909, a relatively increased incidence on school attending children.
Reference will be found on page 106 to a memorandum issued in 1909 by Dr. Newsholme and
Dr. Newman, medical officers of the Local Government Board and Board of Education respectively,
dealing with the administrative measures necessary for the prevention of the spread of infectious
diseases among children attending elementary schools.
Information concerning the number of specimens examined for diphtheria bacilli by the
sanitary authorities is contained in the reports relating to the following districts :—

The action taken in connection with this work is thus stated by the medical officer of health of
Woolwich: " Positive cases with any symptoms were notified and sent to hospital, or strictly isolated;
positive cases without any symptoms were excluded from school and from mixing with other children
outside the house."