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it was assumed that the association of her return with the subsequent outbreak was one of cause and
effect; she was promptly returned to hospital where she was isolated until her return to school on
May 11th; for a fortnight she remained in more or less strict quarantine at the school, and then later
mixed freely with the other girls.
On July 27th, 1911, there was some sore throat illness at the school, and two of the children
developed diphtheria. The child, A, who had returned to school on May 11th, and another child, B,
who had returned from hospital on the same date, though neither of them showed signs of illness, were
found to be carriers of diphtheria bacilli. Both children yielded positive results for some nine or ten
weeks ; and in the case of the first child the bacillus carrying propensity persisted ; indeed, throughout
the next three years Dr. Brincker continued to obtain positive results on bacteriological examination.
During this period note was made of any case which could by any possibility be associated with
her, but only one case of diphtheria occurred in the person of a child living in the school; the occurrence
of this single case cannot reasonably be regarded as being more than a mere casual coincidence. The
whole period of six years may be divided into three sections. First the time, nearly two years, prior to
the discovery that the child was a carrier. During this time two outbreaks of illness (septic conditions
and scarlet fever) occurred in the school. (See tabular statement on page 35.) Then came the outbreak
of diphtheria and sore throat of July, 1911 (see table) and the consequential institution of bacteriological
investigation which elicited the fact that the child, A, was a carrier. On this discovery being made, a
suspicion which had already arisen at the school that she might have been responsible for the outbreak
of scarlet fever in July, 1911, was recalled to mind, and she was now also held responsible for the outbreak
of septic conditions in 1910, and for the cases of diphtheria. Opinion as time went on, indeed, hardened so
much in this regard, that during this second period (i.e., the three years in which the child continued
persistently to yield evidence of the presence of diphtheria bacilli in her throat) there was a disposition
to assume that she must be held responsible for any form of illness which might affect the inmates of
the various institutions in which she lived. This attitude of mind led to somewhat close restrictions
being imposed upon the girl's freedom from time to time, particularly just subsequent to the outbreak
of diphtheria of July, 1911, and again when the single case of diphtheria occurred in June, 1912.
The third period reviewed covers some eighteen months, and extends from the time when the
conclusion was reached that further bacteriological examination was undesirable until the present date.
Some months after the commencement of this period, viz., in July, 1915, an outbreak of sore throat
illness occurred in the school, and this was again attributed to the girl. My colleague, Dr. Thomas and
I, in association with the medical officer of the school, examined the children and found the outbreak
was certainly not one of either scarlet fever or diphtheria ; the clinical features of the cases suggested
to us that it was in all probability influenza, which was somewhat prevalent in London at the time.
The history of this child, A, is deserving of being specially recorded inasmuch as apart from the
initial group of cases of diphtheria occurring when she was first bacteriologically examined, only one
case of diphtheria was subsequently associated with her. Thus, during the entire period of more than
three years, in which she was known to be a carrier, despite the fact that she came in contact with a
considerable number of persons—freely for two months with children and adults in the school, with
more or less restriction at other times there, and also with other persons in hospital and elsewhere—
there was only the one case recorded as being possibly infected by her, and in this instance the contact
was doubtful and remote.
It is deserving of note, moreover, that for the greater part of the period under review, in addition
to this girl A, there was also in school the child B, who from time to time was found to be carrying
diphtheria bacilli. The table on page 35 gives particulars relating both to the girl A, and to this second
girl, B, whose history from the occurrence of scarlet fever in April, 1911, until after the occurrence of
the single case of diphtheria in June, 1912, was practically identical with that of girl A. Girl B, however,
was never regarded with the amount of suspicion which attached to girl A, presumably because of
girl A's antecedent history.
It has during the last 10 or 12 years become widely recognised that bacteriological inquiry in
connection with prevalences of typhoid fever, cerebro-spinal fever, and diphtheria, frequently brings to
light the fact that some individual, who has been in contact with the sufferer or sufferers, is a carrier of
the particular germ associated with the disease, and this individual has thereupon been commonly
regarded as the probable source of all the mischief. It is a matter of vital importance that the history
of a large number of such individuals should be minutely studied and that the inquiries should be extended
over some length of time, with a view to discovering whether the suspicion which a priori attaches to
the carrier, by reason of the existence of his carrying propensity, is warranted a posteriori by the occurrence
of proof of the carrier's infectivity. Such study has, however, only been made in comparatively
few instances : the amount of bacteriological labour entailed, and the difficulty experienced in keeping
the case under observation, being two of the main obstacles which it is particularly difficult to surmount.
The history of the child, A, must, therefore, be regarded as of value ; it supplies an exact account, first
of the bacteriological examinations made of a persistent carrier of the diphtheria bacillus ; and second of
the illnesses reported in children with whom this carrier came in contact. It may be observed that
careful study of all the facts in this instance, as in many of the other notable histories of carriers, reveals
no clear evidence demonstrating that the carrier conveyed to others the disease with which the particular
germ in question is commonly associated; though it is interesting to note that outbreaks of other diseases
were, of course without any justification, ascribed to contact with the carrier.