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78
show the presence of organisms resembling the Diphtheria bacillus.
This course was at this time rendered possible owing to the
action taken by the Guardians in removing a large number of
adult patients to other Institutions under their control. All these
cases were liberated by the end of June.
The total number of cases in the outbreak notified to be
suffering from Diphtheria was 76. All of these cases were removed
to the Metropolitan Asylums Board Hospital, and were
detained in hospital for periods ranging from 2 weeks to 21 weeks.
Origin of the Outbreak.
For reasons which will be apparent from a description of the
details of this outbreak, the difficulties associated with the tracing
of the origin of the infection, or the means by which the disease
gained access to the Infirmary, were insurmountable, and the
deductions drawn from the material at one's disposal must be
accepted as being largely conjectural.
The Infirmary is an irregular structure, part of which dates
back to 1833. It consists of three Main Blocks, which are known
as "A," "B," and "C." The first-mentioned runs north and south,
the greater portion of which is a fairly modern building, which
was opened in 1871. There are several Wards in this part of the
building. The majority of these Wards are large, lofty, well
lighted and airy. The other two Blocks, "B" and "C," run east
and west at right angles to "A" Block, each Block consisting of
six Wards. These Wards are in all respects much inferior to
those in "A" Block, and although attempts have been made from
time to time to improve them, they are structurally incapable of
being made adaptable to modern requirements. These Wards
had originally been part of the old Workhouse, and whatever their
suitability as dormitories for inmates of a Workhouse, they cannot
be considered satisfactory as Wards for the reception of
patients. In addition to these three Blocks there are Receiving
Rooms (a recently constructed and useful addition) and a Nurses'
Home. The planning of the building is therefore defective, and
it further suffers from the absence of a separate Isolation Block