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house soon after the return of a case from one of the Fever Hospitals. In
one of these desquamation recurred after the return of the patient. In most
of the "return" cases other causes can be assigned. These cases are but a
small percentage of the total number of cases discharged from the hospitals.
DIPHTHERIA.
During the last six months of the year there were notified 36 cases of
diphtheria and membranous croup. During the same four months (August
to November) that there was an epidemic of scarlet fever, the number of
diphtheria cases was also three times the number of the corresponding
months of 1894. The Metropolitan Asylums Board Hospitals were also full
for diphtheria patients, so that the same difficulties were experienced as for
scarlet fever cases.
As it is sometimes difficult or impossible for a medical practitioner to be
certain that a case of throat illness is diphtheria or not, I am very glad that
your Board has recently given its consent to supply the medical practitioners
of the district with tubas, so that they can have a bacteriological examination
made of the doubtful cases. This method was begun in New York, in May,
1893, and has been found to work satisfactorily.
Our knowledge of the disease, and of the time when the patient ceases to
be a possible source of infection, has thereby been made much more
accurate.
The procedure is as follows :—Each medical practitioner is supplied with
a "culture outfit," which consists of small box containing two tubes, one of
which has some blood serum in it, this being a good medium for the growth
of the diphtheria bacillus, the other contains a swab of cotton wool. Both
tubes have been sterilized.
On visiting a case suspected to be diphtheria, the swab is applied to the
affected part, and then immediately inserted in the other tube, and rubbed
over the surface of the blood serum. The tubes are then transmitted to the
Medical Officer of Health at the Town Hall, who has them forwarded to the
British Institute of Preventive Medicine, for bacteriological examination.
The results of this examination are communicated about ten o'clock the next
morning.
The medical practitioner probably would not notify any such case unless
the bacteriological examination proved it to be diphtheria, and cases that are