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Of the four cases carrying K.L.B., the virulence of which was not tested, two were cases of
acute nasal diphtheria and were immediately dispatched to the fever hospital, and the third
was a "contact" of one of these acute cases. The fourth case presented a foreign body in the
nose.
Of the 21 cases oarrying virulent K.L.B.:—
One case, a small child, suffering from a congenital heart lesion, had atrophic rhinitis
and failed to respond to nasal treatment. After seven months intermittent attendance the
child was referred to a fever hospital.
One case lapsed in attendance for two months owing to bronchitis, and on return to
the clinic was found to be clear of the Klebs Lceffler bacillus infection.
Nine cases became spontaneously clear in three weeks or less, i.e., before the period
requisite to define them as true carriers, and were probably contact cases only.
Four cases, long standing tonsillar carriers with no other focus of infection in the upper
respiratory tract, were freed as the result of tonsillectomy. In each of these cases virulent
organisms were recovered from the depths of the tonsils.
The residue, six cases in all, had almost certainly contracted nasal diphtheria during
the few weeks prior to the first attendance at the clinic, but had not been certified. Four
of these cleared up in three weeks or less ; two cases ceased attendance, and it is probable
that these were referred to fever hospitals.
Thus, with the two cases of nasal diphtheria referred to isolation hospital on their first
appearance at the clinic, there were eight cases of nasal diphtheria attending during the year.
In addition, several other cases were suspected of having had nasal diphtheria.
The medical officers on duty record it as their opinion that the child suffering from nasal
diphtheria is a more potent source of danger to the community than either the case of acute
faucial diphtheria, or any carrier, since this child is usually not sufficiently ill to be confined to
the house, and exudes a bloodstained nasal discharge which is a most effective vehicle for the
spread of infection. They therefore emphasise very forcibly the fact that eight cases of recognisable
nasal diphtheria, i.e., cases with membrane in the nose and a bloodstained nasal discharge,
were referred to the clinic during the year.
Scarlet fever.
It will be noted that there has been a small increase in the number of cases
of scarlet fever reported from the schools during 1932 as compared with the previous
year, but the figures are not so high as those for the preceding three years. As a
result of special examinations in school by the Council's medical staff, cases of
mild type were discovered and notified, and a number of children excluded from
school on account of such findings as sore throat, etc. In ten schools children were
kept under observation by the nursing staff for periods ranging from two to six
weeks.
Smallpox
among
school
children.

The cases were all of the prevalent mild type.
Facilities for vaccination on the school premises by public vaccinators were
granted whenever applications for vaccination were received from the parents,
and, at the written request of the parents, about 500 children in 7 schools were
vaccinated.
The special arrangement whereby home contacts of smallpox are allowed to
attend school if in a healthy condition, which has now been in force for some years,
has been continued. These contacts are kept under daily supervision by the school
nurses, whose services have also again been extensively used in connection with
the daily surveillance of schools attended by children notified as cases of smallpox.