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105
The groupings of the Hoffmann pseudo-diphtheria bacilli at
times, in some of the cases, seemed to point to a sort of connection
or co-relation of such baciili with the true Klebs-Lœffler
diphtheria bacilli, antecedently or subsequently.
The outbreak at the Norwood Schools is interesting bacteriologically
from another point of view, viz., the presence in the throats
and noses of some of the patients of a mixed infection, viz., (a)
Vincent's organisms, in addition to (b) Hoffmann's pseudodiphtheria
bacilli, and (c) Klebs-Lœffler diphtheria bacilli. By
means of the presence in some of the cases of these Vincent's
organisms, the source of the outbreak was definitely traced.
Vincent's organisms are (1) fusiform, elongated bacilli, varying
in length from 6 to 12 u, and from 1 to 1.5 u in breadth,
vacuolated, motile or non-motile, not staining with Gramm's
fluid but staining irregularly with Ziehl's liquid; and (2) fine,
long spirilla of varying lengths, sinuous and very motile, staining
badly (or not at all) with the usual staining fluids. The
fusiform bacilli are readily cultivated in ordinary broth or in
human serum, but the spirilla not at all.
The Vincent's organisms found (only the fusiform) were due
to a concurrent attack, or outbreak, of either ulcerative stomatitis,
or the ulcerative form of Vincent's Angina, which occurred
at (and about) the time of the diphtheria outbreak. They are
found in both these diseases—of which the former is well known,
and the latter has been fully described by Professor H. Vincent
in the Lancet of May 13th, 1905. From this description it
appears that Vincent's angina (angine de Vincent) is a disease
allied to diphtheria and other forms of throat troubles, and is
at times, contagious, spreading from person to person, either by
direct contact (e.g., kissing) or indirectly (through the use of
towels, drinking utensils, spoons, forks, knives, &c.). The
disease exists in two forms, e.g., (a) diphtheroid (like diphtheria)
or (b) ulcero-membranous (deep ulcerations of the membranes
over the tonsils, palate, &c.), and though it may appear at any
age, it is specially frequent amongst children from 8 to 10 years,
and amongst young adults from 18 to 30 years, of age.
Details of the Outbreak.
The details of the Diptheria Outbreak at the Lambeth Parochial
Schools are set out in full, as it is a unique instance of
diphtheria infection being definitely traced from child to child,
the individual cases fitting one into another like a Chinese puzzle
(vide Tables V. and VI. at the end of the Report).