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151
Report of the County Medical Officer—Education.
E. M. was a very robust and healthy girl. The cause of the outbreak was never definitely determined,
but the subsequent history led to suspicion being cast upon R. C. It was suggested that she
became infected with the germs of diphtheria during the period of her convalescence in the fever
hospital, most probably from some other carrier child, and that she brought these germs back with
her to the school. The infective condition must on this hypothesis have been dormant in her case for
some time. Her throat began to yield diphtheria bacilli some time in August, however, and she may have
been responsible for infecting other children in the school. As already stated, only two of these developed
diphtheria, whilst 28 others passively carried diphtheria bacilli in their throats without showing any
symptoms of illness or indisposition. These germs soon disappeared when the throats of the
children had been treated with gargles, etc., and the original source of infection had been removed.
F. D. returned from Grove Hospital on 7th September, 1911, and D. T. on 13th October. They
were isolated at school for the usual period, bacteriologically examined, and finally allowed to mix with
the rest of the girls. R. C. and E. M. returned from the Grove Hospital on 2nd November. They were
placed in isolation together and bacteriologically tested. As R. C. was found to be a carrier of the
infection of diphtheria she was sent back to hospital on 11th November. She remained at the S.W.
Hospital from 11th November to 4th April, 1912. Upon her return to school on the latter date she was
swabbed, with the result that diphtheria germs were again detected in the culture. A specimen was
sent to the Lister Institute for a virulence test, with the result that both the throat and nose swabs
showed typical Klebs-Loeffler bacilli and were slightly virulent. She was not returned to hospital, but
bacteriological tests were made weekly. E. M. subsequently also yielded positive results and was sent
back to hospital on 16th November, where she remained until 22nd December. Upon her return to
school she remained in quarantine for 14 days, and as two series of three successive swabs proved
negative, she was allowed to return to Dormitory IV. She subsequently remained in good health.
On 3rd June, 1912, M. W. from Dormitory IV. was found suffering from diphtheria and sent to
hospital, where the diagnosis was confirmed. On the same date R. C. was sent to the N.E. Hospital
as a carrier and possible source of infection. Between 4th April and 3rd June, 1912, cultures from the
nose and throat of R. C. proved positive, but after admission to hospital no suspicious germs were found
between 4th to 27th June. On 28th June a positive result was obtained. She continued harbouring
true diphtheria germs until December, 1912, and then for three weeks negative results were obtained.
In January, 1913, Klebs-Loeffler bacilli were again discovered, and since that time she has been
continuously discharging them from the throat and nose. During her detention in the N.E. Hospital
the virulence of the germs has been tested regularly, and during the major portion of the period she
was discharging Klebs-Loeffler bacilli, they were found to be non-virulent, but on several occasions,
especially during November, they proved to be virulent. After the occurrence of diphtheria in the
school in June, 1912, every child was bacteriologically tested, with the result that one girl, E. M., the
companion case to R. C., during the previous outbreak, was found with the typical bacillus, six others
were carrying suspicious germs, and the remainder were free. E. M. was removed to the N.E.
Hospital, whilst the six suspects were isolated, bacteriologically tested from time to time, and
eventually returned to school routine. E. M. remained in the N.E. Hospital from 12th June, 1912, to
19th October, 1912, and Klebs-Loeffler bacilli were isolated from the throat only. The virulence was
tested on several occasions and the result in each case was reported as follows:—
Reaction — Neisser +
Gram +
Sugar broth +
Animals 0
E. M. was detained in hospital until these non-virulent bacilli had disappeared, and was proved
to be free from diphtheria germs on three successive occasions. She was placed in quarantine at the
school from 19th to 30th October, 1912, and, as successive examinations gave negative results, she was
re-admitted to Dormitory IV. and has remained in good health since.
The suspicion that E. M. acted as a chronic carrier of infection to others cannot be Seriously
entertained. In the case of R. C., however, the facts are difficult of interpretation. The suspicion that
she might have been at fault was first entertained on the occurrence of the group of scarlet fever cases,
the first of which was removed on 7th April, 1911. R. C. was subsequently found to be a carrier of
diphtheria bacilli, and on the occurrence in July, 1911, of cases of diphtheria, the question arose as to
whether she might have been the source of infection. She continued from time to time to give positive
results as regards diphtheria bacilli, but no further cases of diphtheria occurred until June, 1912.
For some time preceding the occurrence of this last case R. C. had been quarantined at the
school. The facts have been set out in detail inasmuch as much interest attaches to the questions,
first, whether R. C. suffered from scarlet fever, and, second, whether she was responsible for the spread
of that disease, of dipthheria or of certain septic conditions which prevailed in the school. The case of
this girl is, moreover, as already stated, unique in respect of the lapse of time during which she was
shown to be a carrier of diphtheria bacilli.
It is noteworthy that during the outbreak of scarlet fever in the school from December, 1910,
to 7th April, 1911, a number of cases of septic infective abscesses and sores were observed amongst
the inmates, which lasted from 15th January, 1910, until May or June of 1911. Many of the children
admitted to these industrial schools have previously been neglected and are often in a poor state of health.
It is possible that their condition of sepsis is associated with their previous life, and is really not of notably
infectious character ; it is, however, remarkable to find so many cases occurring within a definite period
amongst such a small community.
Although the circumstances were suspicious, no relation could be traced between the septic cases
and scarlet fever.