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cause of Diphtheria in many more cases than 46. There are,
however, considerable difficulties in tracing infection in a district
like Finsbury.
In April there were signs of the commencement of a small
outbreak of Diphtheria, which, largely owing to the prompt and
efficient action of the medical man in attendance, who availed
himself of the arrangements for bacteriological diagnosis and
anti-toxin inoculation provided by the Public Health Department,
was successfully prevented. On April 17th, M. L.
returned to an institution in Finsbury from Bournemouth. She
had been engaged at Bournemouth in nursing diphtheria
patients for 5 weeks in an institution. She rested for one week
previous to coming to London. But the night before she left she
went to take leave of her diphtheria patients in Bournemouth.
On April 18th, the day after her arrival in London, she went to
a Branch Home in Finsbury and there nursed a small boy, W. P.,
aged 2½ years. Two or three days after, he sickened with
diphtheria, and on April 28th he was notified. Careful enquiry
elicited no other possible source of infection than that which
had been obtained from M. L. Further, there was now
evidence of sore throats in several persons who had come into
contact with M. L. Accordingly, the medical man and myself
agreed that bacteriological examination should be made of the
throats of the other inmates of the Home. This was carried
out, on April 26th, 28th, 29th and 30th, with the result that the
diphtheria bacillus was found in the sore throats of B. H., N. N.
and N. V., and these three patients were notified and removed to
hospital. It was also found in the throats of 4 other persons who
showed no clinical symptoms. It was absent in the throats of 6
other persons in the Home. Of all these, 7 persons were at once
inoculated with anti-toxin as prophylactic, and antiseptics applied
to their throats. One of these (O. A.) having the diphtheria
bacillus in her throat (on April 29th) but who showed no signs
of illness, slept away from the Home and came into contact with
M iss C., who slept in Poplar, and she apparently took infection
from O. A. and sickened with Diphtheria.