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Case II.— Rose H., 9 years, admitted with diphtheria 25-4-09,
and discharged 25-6-09. Lily H., 9 years, failed 6-7-09, was
admitted to Borough Hospital 8-7-09, but swab taken of Rose on
9-7-09 was negative. Lily H. was discharged on 20-8-09, and
Violet, 8 years, failed with diphtheria 22-8-09. Swabs taken of the
whole family on 26-8-09 sho ved that Lily was free from infection,
but the nose swab of Rose and the throat swab of her father were
positive. The father was found negative at the end of fourteen days,
and Rose and all other school contacts were finally freed for school
on 4-9-09.
In case I. it was suspected that the diphtheria germs were
lurking at the back of the nose on the child leaving the hospital,
and were not capable of detection or producing ill results until the
subsequent development of nasal discharge.
In the second case it would seem not improbable that the
father's throat was persistently infectious.
NECESSITY FOR PROMPTNESS IN DEALING WITH
DIPHTHERIA.
In my last Annual Report I called attention to the fact that
many patients die from diphtheria because they do not come under
treatment sufficiently early in the course of the disease.

It is noteworthy that none of the cases admitted on the first
day died, and that the mortality of those admitted on the second
day of the disease is small, while there is a considerable rise on the
third day and a still larger on the fourth and fifth days.
It is satisfactory to find that a larger proportion of diphtheria
patients came under treatment within the first three days of the
disease, and it is probable that this helped to diminish the fatality