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42
when examined three weeks later, to have Hoffmann's bacilli in her
throat. It it difficult, however, to be certain as to which were the
infecting children, because, as already stated, three of the children of
the first group were absent only for two days, and may have returned
in an infectious state. Only four of the children were absent from
school for a fortnight or longer. Three were known to have been
attended by a doctor, but in none of them was the diagnosis of
diphtheria made, owing apparently to the mildness of the attacks, and
to the absence of visible membrane. The children attacked varied in
age from 6 to 13 years.
Distribution and Incidence.—The outbreak occurred only in the
Girls' Department of the school. There were no cases in the Boys'
Department, which immediately adjoins and forms part of the same
building. There were two classes in the Girls' Department—one for
the older pupils containing 29 girls, and one for the younger containing
22 girls. There were 11 cases in the former class and 7 in the latter.
The two classes mixed at prayers and used the same towels, basins, and
drinking cups. The effect of personal contact on the spread of the
disease is shown by the fact that 13 out of the 17 children attacked sat
next to one another in class. The accompanying diagram shows the
places in class occupied by the sick children:—
PLAN SHOWING PLACES IN CLASS OCCUPIED BY SICK CHILDREN.
SMALL CLASS ROOM.
(22 GIRLS—7 ATTACKED).
LARGE CLASS ROOM.
<29 GIRLS- 11 ATTACKED).
A = Suspected First Case in this Class Room.
B = Suspected First Case in this Class Room.
Oblongs = Desks.
= Cases of First Outbreak.
= Klebs-Löffer Bacillus found..
= Cases of Second Outbreak.
= Hoffmann's Bacillus found.