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a real one, and it is gratifying to report that the Guardians have
now laid down such rules as will prevent such a danger in the
future. Other reasons why the disease spread may be tabulated
as follows:—
(1) Mildness and type (nasal) of the disease in many of the
cases—clinical symptoms, as such, being practically absent (i.e.,
latent Diphtheria).
(2) Want of sufficient accommodation at the Schools for the
isolation of "doubtful" and suspected cases of infectious disease,
and their ultimate adequate classifications.
(3) The urgent need that exists at the schools for an efficient
disinfecting machine (a fact previously pointed out, at the time
of the Measles Outbreak 1902-3, to the Guardians, who decided
on May 8th, 1903, that such a machine—an Equifex—should be
provided, but who have not yet provided it).
(4) The quarantining of infected children (and also "suspects"
and "contacts") in C South Block in close proximity to the other
main buildings with the consequent spread of the disease from
children to children and from building to building.
(5) The apparent power of the true Klebs-Lœffler Diphtheria
bacillus to lose its virulence, to lie dormant for a time, and,
afterwards, to regain its virulence under suitable conditions (e.g.,
state of mucosa, etc).
(6) The fact that the Diphtheria organisms vary greatly from
the point of view of virulence and morphology, e.g., long, short
and medium bacilli with involution forms and granular, barred,
or even stainings, etc.
(7) Timidity in removing to the Metropolitan Asylums Board
Hospitals patients who appeared to have no clinical symptoms
of Diphtheria, but in whose throats or noses (or both) the
Diphtheria bacillus was found.
(8) Doubt in the minds of some of the Guardians as to the
value of bacteriological examinations.
(9) The fact that the Medical Officer of Health was not granted
an interview with the Guardians until June 19th, 1905, when it was
at once decided to do what ought to have been done before, viz.,