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17
which bacteriological examination proved to be associated with
the Klebs-LÖffler bacillus. This case was one of the first of an
almost general prevalence of sore-throat, more or less mild in
character, at this Institution. Six cases in October, and one in
November were reported as diphtheria, but the infection, whether
diphtheritic or otherwise, was more extensive than was indicated
by the number of notifications.
In a report on the outbreak I showed that it followed
immediately upon the reassembling of the children after the
summer holiday, and expressed the opinion that the disease was
at that time imported, and spread rapidly by means of personal
contagion, this being facilitated by arrangements which are
probably common to many Institutions like this. Special
allusion was made to the dormitories, where the children seem to
be somewhat crowded as regards floor space, and in which much
of the ventilating system was interfered with by various obstructions,
and by the existence of fixed screens which can only
interfere with the free circulation of air. Drainage defects were
also found, but I attached no importance to them, as regards this
outbreak, in view of its commencement and course.
The disease was very mild throughout, and to this extent
gave evidence of the healthy surroundings of the inmates of
this Orphanage, The throats of nearly all the children were
examined bacteriologically, with the result that in 4 the KlebsLÖffler
bacillus was found to exist, while in 17 the pseudodiphtheria
bacillus was found. By these examinations the real
extent of the infection was ascertained, and controlling measures
became comparatively easy.
Diphtheria became more prevalent in the District itself in
October, the first case reported being in Merton, where enquiries
elicited that there had been a good deal of sore-throat in
connection with one of the schools there. Special attention was
directed to a child who had resumed attendance after an attack
of sore-throat, and upon bacteriological examination being made,