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explain these illnesses were found. The third case most
probably caught it from the second, and it is a question
whether infection from the first case was or was not
active from January to October. This supposition is not
so unreasonable as may be supposed, for bacteriological
examination is now revealing unsuspected sources of
contagion, and for periods of time that a few months ago
would not have been thought possible. The following
extract from a letter written me by Dr. Armand Buffer,
Director of the British Institute of Preventive Medicine,
and which was embodied in a circular letter that I sent
to all the medical men in the district by your direction
in connection with the anti-toxin treatment, exactly illustrates
to what I refer:—"a boy [H.] had diptheria in May
last at school. He got perfectly well, went home and
returned to the school in November. At that time another
boy [S.] sitting at the same desk, and another boy [B.]
in the form had diphtheria and recovered. As nothing
could be found to account for this, I examined the first
boy's [H.] throat and cultures at once revealed the
presence of diphtheria bacilli in his throat. Now mark
what follows. Three weeks after the boy [S.] was to all
appearances perfectly well, bacilli were still present in his
throat. His father, nevertheless, took him home with the
result that his sister got diphtheria seven days after the
boy's return. All three boys were then ordered antiseptic
gargles and two of them are now free from diptheria
organisms." As a further illustration of spreading by
personal contact the following is an example, and accounts
for no less than six out of the twenty cases notified. A
servant had been ailing but had had no special treatment,
a child of 3 years old was then found to have diphtheria,
the maid's throat was examined and was found also to
be infected; she was removed forthwith to the Isolation
Hospital and all precautions I was assured by the medical
attendant were taken, but nevertheless, personal contact
evidently was responsible for a succession of cases, dating
as notified, on the 9th, 10th, 13th, 14th, 17th and 19th