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number in 1909 being 6. The average duration of the stay in hospital of
these 4 cases was 27 days, as against 17 in 1909. One case of diphtheria
on discharge from hospital was stated to be still suffering from rhinorrhœa,
but free from diphtheria bacilli.
During the year medical practitioners sent 122 throat swabbings to
the Lister Institute for bacterioscopic diagnosis, and 9 were sent from
this department by myself, the cost being defrayed by the Borough
Council. Seventy-two of the swabs (55 per cent. of the total) were sent
by the medical staff of the Victoria Hospital in respect of Chelsea
children. Of the total of 131 swabbings, 37, or 29.6 per cent., afforded
positive evidence of the presence of the specific diphtheria bacillus, and
88, or 70.4 per cent., gave negative evidence. Ten of the "negative"
swabbings showed the presence of Hoffman's pseudo-diphtheria bacillus.
Bacterioscopic examination is coming more largely into use for the
diagnosis and prevention of diphtheria. In 1905, the first year that
arrangements were made with the Lister Institute for free bacterioscopic
examinations, 12 swabbings were sent, in 1906 60, in 1907 90, in 1908
60, in 1909 93, and in 1910 131. It is especially in dealing with school
outbreaks of diphtheria that bacterioscopic examinations of throat
swabbings find their most useful application (see infra).
The Diphtheria Antitoxin (London) Order of the Local Government
Board, 1910.—This order was issued in August last, and sanctions the
provision by a London Borough Council in pursuance of Section 77 of
the Public Health (London) Act, 1891, of a temporary supply of
diphtheria antitoxin, and of medical assistance in connection therewith,
for the poorer inhabitants of their Borough.
This order was considered by the Public Health Committee, but no
action was taken upon it, as there is no demand amongst medical
practitioners in the Borough for antitoxin for their poorer patients, the
cases of diphtheria being at once removed to hospital as soon as a
diagnosis is made. As regards the use of antitoxin for prophylactic
purposes, this appears to be unnecessary in the ordinary sporadic cases
occurring in households, and is only exceptionally advisable under special
circumstances in schools and institutions. The dangers of anaphylaxis
have to be taken into account when antitoxin is used for prophylactic
purposes, symptoms of cyanosis, dyspnœa, and collapse occasionally
supervening when a second dose of antitoxin is given to an individual
who had received a first dose more than 10 days before; so that, until
the dangers of this condition are more fully ascertained, it would appear
to be undesirable to inject antitoxin for prophylactic purposes, unless for
very special reasons.
School Outbreaks of Diphtheria.—Special school incidence of
diphtheria was shown in respect of the Infants' Department of the
Christchurch School, and the Girls' Department of Holy Trinity School.
Christchurch School.—Seven cases of diphtheria were notified
amongst children attending the Infants' Department of this school
between the 28th September and the 5th November. On the 30th
September, children found to be suffering from sore throat or nasal
discharge were excluded from school; and on the 14th October, the
throats of some of the children attending school were "swabbed" for
bacteriological examination. One "carrier" case was found in the