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34
DIPHTHERIA.
399 (civil) patients were notified in 1918 as suffering from diphtheria or
membranous. croup. Of these 58 were afterwards found not to be suffering
from the disease by Medical Superintendents of the Metropolitan Asylums
Board Hospitals, and 1 by other medical practitioners.
The corrected number of diphtheria cases (civil) notified was therefore 310,
equal to an incidence rate of 1.93 per 1,000 civil population.
The number of deaths from diphtheria certified during the year was 31,
equal to a death-rate of 0.17 per 1,000 civil population and a case mortality
of 9.1 per cent. of cases notified.
Other statistical facts will be found on pages 15-17.
Of the notified cases of diphtheria, 370 (or 92.7 per cent.) were removed to
hospital as follows:—
To Metropolitan Asylums Board Hospitals 367
Other Hospitals 3
370
Return Cases.—(Definition: A case of diphtheria occurring within 28
days of the return from hospital to the same house of a previous case of
diphtheria). There were 4 such cases in 1918, occurring in 4 houses, and in
each case in the same family as the (?) infecting case. In every instance the (?)
infecting case bad rhinitis showing diphtheria bacilli. The intervals between
the return of the (?) infecting case and the onset of the illness in the return
case were respectively 7, 13, 15, and 21 days. There was a similar care
occurring after an interval of 47 days, and in this also the (?) infecting case
had rhinitis showing diphtheria bacilli.
There was one instance also, in which a case of diphtheria occurred 3 days
after the return from hospital to the same house (and in this instance, the
same family) of a previous case of scarlet fever. The former case returned
herself sickening for diphtheria and thus infected her sister.
Nasal Diphtheria.—There is reason to believe that one of the causes of the
spread of diphtheria is the existence of eases of rhinitis, generally
characterised by nasal discharge with or without bleeding, excoriation in and
about the nostrils, and sometimes "spottiness" of the face. The patients
are not generally acutely ill, though frequently "out of sorts," and arc very
commonly overlooked, either through not being brought to the notice of the
doctor or being disregarded by him. A few of such cases have been notified
by doctors, and the women Sanitary Inspectors have brought to the notice of
the Medical Officer of Health any suspicious cases which they have discovered
in investigating cases of diphtheria. They are sometimes found in association
with cases of scarlet fever, and occur as the "infecting case" of return cases
of scarlct fever or diphtheria. Where the clinical appearances have been
bacteriologicallv confirmed the patients—nearly always children—have been
isolated in hospital.