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87
house Committee, who, however, do not appear to consider
this course necessary, but which, in my opinion, would have
been an additional precaution to these measures which-have
already been or are being carried out by the Guardians since
the outbreak began."
The importance of this probable channel of infection in the
earlier cases cannot be overlooked. The majority of the children
admitted to the Infirmary come from other Institutions over which
the Guardians have control, and it is quite probable that some of
the patients admitted with other affections are at the same time
harbouring either in a mild or latent (clinical or bacteriological)
form the Diphtheria bacillus. Under the adverse conditions which
prevailed at the time at the Infirmary amongst a diseased population—e.g.,
overcrowding and its attendant evils—the disease may
assume greater virulence, and affect others who are more susceptible
to its effects.
Of the 76 cases of Diphtheria removed to the Metropolitan
Asylums Board Hospital, 54 (i.e., 71.0 per cent.) were admitted
to the Infirmary from the Workhouse or the Branch Workhouse.
This is significant, and, when taken in connection with the fact
that 12 of the new patients admitted to the Infirmary Receiving
Room were found, on bacteriological examination, suffering from
Diphtheria, there would appear to be strong grounds for suspecting
that the disease may have gained access to the Infirmary from
the Workhouse or Branch Workhouse.
The risk of infection reaching the patients from without is
still further emphasised, from the fact that at the Infirmary there
is no "probation" or "observation" Ward available in which
doubtful cases might be retained until the result of a bacteriological
examination has been ascertained. It is to be hoped that
some steps will be taken to remedy this drawback at the new
Infirmary, which is in course of erection, by the provision of a
suitable Isolation Block away from the main building, into which
such eases might be quarantined pending result of diagnosis.