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disease of Diphtheria. This family history illustrates that point,
and there can be little doubt that it is by such unrecognised cases
—having a slight sore throat or no sore throat at all—that the
infectious germ is disseminated in the community. To discover
such cases and prevent them infecting their neighbours is the
business of preventive medicine. In accordance with this view we
have in a number of cases made bacteriological examinations of the
throats of "contact" persons. In some cases where the Diphtheria
bacillus was found we have notified the cases and had them returned
as not cases of clinical Diphtheria as may be seen in the above
family. Probably it is desirable that the Metropolitan Asylums
Board's Hospitals should not admit as cases of Diphtheria, persons
who though they may have the bacillus in their throats are not
suffering from the clinical symptoms of the disease. But it will be
evident that these persons are yet a danger to the community, and are
in my opinion one of the chief causes of the spread of the disease in
Finsbury. What is to be done with them? I think they should
be isolated as much as practicable at home and kept from school
and their neighbours; and also direct throat treatment should be
adopted with a view of clearing their throats of the infective bacillus;
and if any throat symptoms occur in addition to the presence of the
bacillus they should not only be notified but admitted to hospital,
and not discharged until it has been bacteriologically demonstrated
that their throats are clear. If this view be right I think Alfred S.
should have been received into hospital.
Another family in which diphtheria occurred also raises difficulty.
A little boy, William S., aged 4 years, of 1, R. Street, contracted
diphtheria and was removed to hospital. His sister Amelia, aged
11, slept with him and suffered from a similar sore throat, and two
little brothers, aged 9 and 7 years respectively, contracted the sore
throat and "bad coughs.'' I visited the family and took careful
swabs of each child, four in all. The bacteriologist found the
diphtheria bacillus not to be present in any of the four throats, but
in all four he found diplococci, a staphylococci, and in two he
found streptoccus. I am satisfied that the same illness affected
these children. One is isolated as suffering from Diphtheria, the