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38
Each boy has his own towel, which is marked with his number, also his
own tooth brush, and has to clean his teeth each day under the supervision of an
instructor.
Sanitary conveniences are situated in the fore part of the ship and are kept always
in a clean condition ; the excreta pass direct into the river.
Ventilation is sufficient; the ports are kept open and there is through ventilation
in all quarters.
The boys' friends visit the ship once a week and may possibly introduce
infection.
Boys who had been ill with Diphtheria returned to the ship after an absence of
only six weeks; convalescents have been known to be infectious for some considerable
time after apparent recovery.
The outbreak was not a severe one, and consisted of 27 cases spread over a period
of 10 months, affecting one out of three ships moored in the same locality, and which
are occupied by boys of similar age, and two of them by boys drawn from the same
station in life, and who go on shore in the same village. If there had been any general
cause, it would be natural to suppose that each ship would have been affected, and
therefore, whatever the source of infection might have been, it had solely to do with
the "Warspite."
The drinking water, milk and sanitary conveniences were considered, but if the
disease was communicated by either of these means, a number of boys would have been
taken ill in the first instance at about the same time.
Case 22 occurred in a boy who had only been on board five days, and he might
possibly have been infected before joining the ship.
I made the following recommendations:—
(a) No boy should be allowed to return to the ship after suffering with
Diphtheria, until three swabs had been taken from the nose and throat on
three successive days, and had been found free from the organism of
Diphtheria.
(b) Slate pencils and pens were to be cleansed daily with boiling water.
(c) Tooth brushes should be sterilized.
(d) Should cases continue to occur, swabs should be taken from each boy on
board as well as the instructors and attendants to ascertain if there was
a "carrier"on board—that is, a person harbouring the bacilli of
Diphtheria in their persons although well and showing no signs of the
disease.
(e) To consider the administration of anti-diphtheritic serum to each person on
board as a prophylactic.
(†) That the pump in connection with the drinking water tank should never
be used for pumping water from the river.