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19
here in education, and that of the young; most of the elders
are hopeless. Domiciliary and institutional instruction as
well as treatment is an integral part of this portion of preventive
medicine; and to the teacher who in the phrase of Ruskin
"cares very much " there is some reward; he will perceive
that there is nothing more beautiful in English social life
than the charity of these people to one another in times of
distress.
The following paragraph is taken from my Report to the
Health Committee in the month of November :
"The spread of diphtheria is favoured by overcrowding,
faulty ventilation, dirty and damp houses. Children under 15
are most susceptible. When a child gets sore throat and fever
it should be placed in a room by itself and a physician called.
Delay breeds danger. The attack may occur two to four days
after exposure, sometimes only twelve hours. School children
should be taught not to use each others things—books,
pencils, etc. Immediate isolation of the patient followed by
disinfection of his surroundings are of the greatest importance.
Some children are specially susceptible to diphtheria
and acquire it where others less suceptible escape. In identifying
diphtheria in the throat or nose the bacteriological test
is of subsidiary value where the clinical features are at all distinctive;
and a negative result from a swab is of very little
value indeed, unless confirmed by one or preferably two subsequent
examinations, if possible on successive days. In suspicious
cases the physician should not therefore wait but
inject antitoxin early. Prophylactic doses of antitoxin for
contacts is good practice. In very toxic cases intra-venous
injection of antitoxin is desirable. If the throat secretions of
diphtheria convalescents be bacteriologically examined daily
during the third and fourth weeks of their attack in more
cases than not the results will prove contradictory. The
bacillus may not be recoverable for a day or two, perhaps
more, to reappear the day following. In half a dozen cases
observed in a large fever hospital in London in which the
clinical and post mortem evidences were conclusive of
diphtheria repeated bacteriological examination by an expert
entirely failed to reveal the presence of the diptheria bacillus.
Virulent diphtheria bacilli may often be found in the throat
and quite harmless to their host, and only occasionally a
source of infection to others. Patients who have had
diphtheria should remain in hospital as long as an inflammatory
condition of the throat exists."
The following is from my Report to the Public Health
Committee for December :—