View report page

41
person has a few months after an attack again become susceptible to
the action of the organisms be has been harbouring, and thus apparently
has a second attack of diphtheria.
In forty instances I have had a bacteriological examination made of
the throats of the members of families in which a case has occurred,
where no medical man was in attendance, and in five instances the
true bacillus was recognised and in six the pseudo-bacillus.
In conjunction with the County Education Committee, the Metropolitan
Councils have agreed that it is desirable that when children are
excluded from school on account of a case of diphtheria, they should
not be allowed to return without a certificate of freedom from infection
based on a bacteriological examination.
The following experience in one of the Westminster Schools during
the last year, illustrates some of the points mentioned above:—
The French Protestant School, Noel Street, was visited, by request,
on October 19th, to inquire into the causes of a number of cases of
sore throat which had occurred among the children. The symptoms
noticed were soreness and redness of the throat, with vomiting and
swelling of the glands in the neck. In some cases, glairy secretion
or points of matter were observed. Not all these symptoms were
present in every instance. In no case was any sign of membrane
observed.
History of the Outbreak.—The School was opened after the holidays
on the 27th August, and the first case of sore throat occurred on 17th
September. The child attacked remained at home until October 1st.
The second case occurred on the 19th September, and the child was
away until the 15th October. No association of these cases with
previous cases of diphtheria was discovered, but the mother and brother
of the second child suffered at the same time from some form of sore
throat. The attack must have been of some severity, since the child was
absent for four weeks. On September 20th three fresh cases occurred,
but the attacks must have been very mild, as in each instance the children
were absent for only two days. Two more cases occurred on the 24th,
and after this date there were none until October 4th, when another
child was taken ill. On the 8th, four more children were attacked;
cases occurred also on the 11th, 15th and 19th, and there were two
more on the 23rd.
There appears to have been two distinct outbreaks, separated by an
interval of ten days, one lasting from the 17th to the 24th September
(7 cases), and the other from the 4th to the 23rd October (11 cases).
It is probable that the second outbreak was started by the return to
school, on October 1st, of two of the children attacked during the earlier
one, and, as will be seen farther on, one of these children was found