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Diphtheria.—84 eases were admitted as diphtheria, of
which 43 (51 per cent.) were mild, 31 (37 per cent.) were moderately
severe, and 10 (12 per cent.) were severe. Two cases died,
(one within 12 hours), giving a case rate of 2.4 per cent. One
case required tracheotomy and made a good recovery. In four
cases the evidence of diphtheria was bacteriological only.
Complications: In practically all cases there was some degree
of adenitis on admission. The severe cases had typical severe
adenitis ("bull-neck"). Fifteen cases suffered from post-diphtheritic
paralyses, of which two were severe necessitating a
prolonged stay in hospital. One child developed myocarditis.
Virulence tests: All cases are swabbed (nose and throat)
and tested twice bacteriologically before being dismissed. When
the swabs are returned " positive " after several consecutive
swabbings the cultures are forwarded to the Wellcome Laboratories
for a Virulence test. This procedure allows in certain
cases a non-virulent positive carrier to be dismissed sooner than
if reliance were only placed on an examination microscopically
of the culture. This question of the virulent carrier case is one
of some difficulty, for they cannot be discharged from hospital
to spread infection generally. Local applications and general
treatment would appear to have little or no effect, and the
patients remain, sometimes for weeks, without any sign of
change, and then, suddenly for no explainable reason they clear
up and become free from infection. This may be attributed to
the treatment being given at the time of clearing, but more
probably it is pure coincidence, and for this reason the use of
special remedies, such as vaccines, cannot definitely be recommended.
Active surgical treatment, such as tonsillectomy or
clearing of the nasal passages, has been advised, but in such
cases special expert skill, combined with a thorough bacteriological
control, is necessary—a matter of considerable difficulty
in smaller isolation hospitals.
Scarlet Fever.—123 cases were admitted as scarlet fever.
Of these 110 (89 per cent.) were mild, 10 (8 per cent.) were
moderately severe, and 3 (2.4 per cent.) were severe. 2 cases
died, giving a case rate of 1.6 per cent. Of these two fatal
cases, one was a septic infection occurring in a debilitated
child, and death took place four weeks after admission from
general septic infection. The second case was admitted with
acute toxic scarlet fever and died with meningeal signs, four
days later.
One case was admitted desquamating. One case advanced
in pregnancy ran an uncomplicated course in hospital, and
was safely confined shortly after discharge from hospital of
a healthy infant.
Eight cases were atypical scarlet and were of the nature
of an acute tonsillitis with a diffuse erythematous rash. Three
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