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partly due to the fact that "carrier" cases are responsible for a
majority of those attacked, and under such conditions the
disease is more difficult of control in schools like the Central.
It has been shown conclusively that a certain proportion of
those who are brought into contact with Diphtheria patients
harbour the bacilli in their throats or nasal cavities.
The percentage is highest in the immediate contacts, that
is, in members of the same family ; it diminishes rapidly as we
enlarge the interpretation so as to include school fellows and
when the term is so widened as to include such extremely
remote contacts as the general inhabitants the percentage
showing the bacilli is a negligible one.
There is another explanation why the incidence of the
disease is heavier on some schools than on others.
"Carrier" cases may be divided into three Classes:—
1. Those who show or have shown no signs of disease.
2. Those who suffer from a mild attack.
3. Those who have recovered from a recognised attack.
Those belonging to the third group are, of course, notified ;
some are removed into the Hospital and some are nursed at
home. No cases are discharged from the Hospital until the
results of at least two consecutive swabs taken from the throat
show that the Klebs Loeffier bacilli are not present One
bacteriological examination is insufficent, but I find, from
inquiry, that a majority of the doctors are satisfied with one
negative result in the case of those nursed at home.
It is true that the patients are kept out of school for three
weeks after the premises have been disinfected, but experience
shows that it is possible to obtain a single negative result after
the disappearance of the clinical symptoms, and yet detect the
germs in the throat many weeks afterwards.
"Carrier" cases are rarely found in the Priory, Beaumont
Park and South Acton Schools, and a majority of the cases
occurring amongst the children attending these schools are
removed to the Hospital.