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resorted to now as a confession of failure, either from want of time or want of staff, as the
measures detailed are efficacious in immediately arresting the spread of the disease in 95 per centof
the outbreaks. Through the immense amount of work of other kinds thrown upon the staff, the
ideal state of things in which a department should be visited as soon as any suspicion of school
influence has arisen has not been attained. It will be some time yet before the effect of the work
shows on the incidence of diphtheria. The average notifications weekly for the past three years are,
however, encouraging, in the relative rate decrease in cases in Provided Schools.

Details of Outbreaks.—Dr. Thomas gives the following notes on these outbreaks:—
Atley-road School.—During April and May, 1904, there had been 20 cases of diphtheria
or exclusions in the Girls' Department. Amongst 44 children swabbed 4 were found to have
diphtheria, one had a sore throat at the time of examination; the other 3 were sisters who
had been away from school as shown by the class registers ; the reason given by the Mistress was
that they had no boots, on examination they betrayed clear signs of recent illness, and all three gave
diphtheria bacilli on culture. With the exclusion of these children no further cases occurred.
Eleanor-road School—In May, 1904, 20 cases of diphtheria or exclusions occurred, they had
been connected with the class aged 6-7 and the baby room. These two classes were swabbed, and
3 cases of diphtheria were discovered amongst the former and none amongst the babies. On
exclusion of these 3 children the outbreak ceased.
Eardley-road School.—On May 2nd, 1904, an examination was made of the children of Class D
(aged 6) on account of several cases of diphtheria, most of which had occurred in connection with
this class. Out of 40 children swabbed 3 were found to be carrying diphtheria bacilli. After the
visit of May 2nd, no further cases occurred in connection with Class D, but some more cases
occurred in Class B (aged 5). The Medical Officer of Health (Dr. Caldwell Smith) thereupon
asked that the department should be closed, and this was done, not, however, before Class B was
swabbed, amounting to 45 children, on May 12th; amongst these two cases of "carriers" were found.
In one case (H. S.) the child had been sent home on suspicion by the teacher, but she returned; a
swab was taken by me, and she was found to swarm with Klebs-Loeffler bacilli. The mother then
took her to a medical man, who, upon ocular inspection, said that there was nothing the matter,
and the next that was heard of the case wa3 that the mother had tried to get the child admitted to
the Infants' Department of a neighbouring voluntary school. The second of these cases was a
boy with old-standing ear discharge, in which Klebs-Loeffler bacilli were found. A case of ear
discharge should always be looked upon with great suspicion in a class where cases of diphtheria
have been failing.
At this school many children came from an extra-metropolitan area, and notifications of the
occurrence of diphtheria were not received from the Sanitary Authority. Since that time steps
have been taken to ensure the notification of disease to the schools from all districts in which
children come to school from outside the London area.
Chisenhale Road School (Infants).—In June, 4 cases of diphtheria had occurred, and 6 cases of
exclusion on account of infection at home. They were connected with the classes aged 5 and 6.
Fifteen children were selected for swabbing on account of clinical symptoms, and 34 for other
reasons; five children showed diphtheria bacilli on culture, and these were entirely amongst those
presenting clinical symptoms, such as rhinorrhœa, cervical adenitis, and anæmia.
Bromley Hall Road School.—Sixty-one children were swabbed on September 1st in the Infants'
Department. Amongst these two were found harbouring diphtheria bacilli: the two children were
brother and sister. Upon their exclusion a threatening outbreak subsided.