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16
ON THE SANITARY CONDITION OF
disease herself, and communicated it to the girls in the beds on
each side of her own. These three cases were early recognised
and removed to a hospital, and no further cases appeared until a
few days after their return home in the beginning of March. The
first of these cases did not attract attention for some days, and by
March 23, five cases cropped up in the same dormitory. A
bacteriological examination of the throats of the three former
cases revealed the fact that two of them contained typical diphtheria
bacilli. These children were promptly isolated, and the
others having been removed to hospital, it was hoped that the
outbreak had been checked. On April 22, however, several cases
were recognised, and then it was discovered that in the interval
three girls had suffered from inflamed throats with some fever,
but no formation of membrane. (It should be stated that a
medical man was only called in when those in charge thought
necessary, and unfortunately at this time the regular medical
attendant was himself ill.) Under the circumstances I thought it
desirable to obtain permission to examine all the children remaining
in the institution, and took swabbings from their throats. Bacteriological
examination disclosed that twenty.seven throats had
the diphtheria bacilli therein more or less plentifully, many yielding
pure cultures of typical bacilli. In six instances the result
was indefinite, and in fourteen instances the bacilli were not
isolated. The children were then divided into three groups, and
restricted to separate parts of the building. I suggested that a
protective dose of antitoxin should be given all round, but it was
not possible to do this until April 29, by which time eight children
developed the clinical symptoms of diphtheria and several others
had inflamed throats without membrane. Cases had been occurring
daily, but after the injection, although the organisms persisted in
the throats, there were no more cases of diphtheria or of sore
throat. Bacteriological examination of the throats of the children
remaining in the home was made from time to time. At the
second examination five of those apparently clear at first yielded
the bacilli, showing that it is not safe to accept a negative result
on the strength of one examination. Of the sixty children, nine
only never gave evidence of infection, fourteen were in hospital,