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16
November 18th two cases, and on November 22nd one case were
notified. The source of infection could not be traced, until an
examination of all suspicious cases of sore throat was undertaken,
and a mild case of Diphtheria was again discovered. Almost
similar circumstances were observed in January, 1906, and
probably the same conditions obtained in December, but as the
school was closed on the latter date for the Christmas Holidays,
the children were not examined.
It is unnecessary to dwell upon the numerous opportunites
which children in school have of transferring an infection if
present, from one to the other. It is more than probable that
the act of coughing or sneezing or even talking, is sufficient to
distribute into the atmosphere in the immediate vicinity any
germs lurking in the throat or nose. To the sucking of pencils
and other pastimes in which children occasionally indulge
infection has been traced. Any of these conditions would be
brought into operation, and it is not necessary to go further
afield, although other paths along which infection is sometimes
carried might be mentioned.
The periods during which the district was free of the
disease are not incapable of explanation. Only a very small
percentage of the children was examined, and it is legitimate to
assume that someone was acting as a carrier of the disease
without exhibiting clinical symptoms. There is another factor
which sometimes operates in the spread of Diphtheria. Convalescent
children are sometimes discharged from Isolation
Hospital in a state of infection, and cause what are termed
"return cases." No instance of infection due to this cause was
discovered in the Willesden district, but the following case
illustrates the possibility of such a source. On February 25th,
a child was removed from a house in Westminster to one of the
Metropolitan Fever Hospitals, suffering from Scarlet Fever.
She was transferred to a Convalescent Hospital and discharged
on December 12th. On December 19th, her mother was removed