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16
The number of Kensington deaths was 15, representing a case mortality of 7.9 per cent. In
the three preceding years the deaths were 25, 34 and 14.
Three patients developed diphtheria within 28 days of a member of their family having
returned from a fever hospital after having been treated for diphtheria, and two others who
developed the disease were members of another family living in the same house as a person who
had been discharged from hospital after diphtheria less than 28 days previously.
On investigation it was found that two of the "primary" or returning cases had nasal
discharge after leaving the hospital, and it is possible that in these cases the nasal discharge was
responsible for the spread of infection. There is no evidence to show how infection was conveyed
in the other cases.
Thirty.eight notified cases admitted to hospital were found not to be suffering from diphtheria
or any other infectious disease.
Owing to the degree of accuracy which has now been secured by bacteriologists in the
diagnosis of diphtheria, it is customary to take a throat swab for bacteriological examination in all
suspicious cases, and for some years past the Council have paid for such examinations performed
at the Lister Institute on behalf of Kensington patients.
Sterile swabs are obtained from the Town Hall, and, in order to reduce the interval which
occurs from the time the doctor takes the swab to the time he obtains the result, arrangements
have been made for medical men to leave inoculated swabs at the Kensington Tuberculosis
Dispensary, 119, Ladbroke Grove, before 3.30 p.m., or at the Town Hall, before 4 p.m., on any day
(Saturdays, Sundays and Bank Holidays excepted). Swabs so left are collected by one of the
Council's messengers, who delivers them at the Lister Institute before 5 p.m. on the same day, and
the results are telephoned to the doctors on the following morning. On Saturdays, Sundays and
Bank Holidays medical men can send swabs direct to the Lister Institute before 5 p.m. and obtain
an equally speedy result.
During the year 698 throat swabs were examined at the Lister Institute at the expense of the
Council, and of these 70 gave a positive diphtheria result.
It is well established that outbreaks of diphtheria may originate from persons who have the
germs of the disease in the throat or nose, but show no signs of illness. Such persons are called
"carriers" and with a view to discovering the possible existence of any of these in connection with
limited outbreaks where the source of infection was unknown, a number of throat and nose swabs
were taken by medical men at my request and by myself. These swabs are included in the 698
referred to above. In six of them the germs of diphtheria were discovered. Germs so found in
these apparently healthy throats or noses may be of a virulent type (capable of conveying
diphtheria infection to other persons) or of an avirulent type (incapable of conveying diphtheria
infection to other persons), therefore it is necessary to ascertain the particular type of organism
present before submitting the patient to prolonged isolation and treatment.
A further examination in each of these six cases revealed the organisms to be virulent in four
cases. Three of the four cases were removed to hospital; in the fourth case it was possible to
secure satisfactory isolation at home. One of the virulent " carriers " was discovered during an
investigation in a boarding house following the notification and removal to hospital of a member of
the same household who had fallen ill with diphtheria. The "carrier" was also sent to hospital
where she remained until 1st January, 1925, when all evidence that she was infectious had
disappeared. Two other members of the same household fell ill a few days after her return home
and they were removed to hospital. The original "carrier" was carefully re.examined and again
found to have virulent germs of diphtheria in her throat. She was removed to hospital and no
further cases occurred.
Another of the "carriers" of virulent infection was discovered during an investigation of an
outbreak of diphtheria in a private house. A child of the family and two maids had developed
diphtheria within a short time. As the usual enquiries failed to ascertain the probable source of
infection, swabs were taken from the throats of all members of the household with the result that
a maid, who had recently entered upon service at that particular house, was found to be a "carrier'.
of virulent diphtheria organisms. After her removal to hospital no further case developed.
Under the Anti.toxin Order, 1910, Local Authorities are empowered to supply diphtheria
anti.toxin for administration to patients who are too poor to pay, and on signing the necessary
declaration that the patient cannot afford specific treatment, a medical man can obtain a free
supply from Mr. Worsley, Chemist, at No. 135, Ladbroke Grove, W. 10, or from the Public Health
Department at the Town Hall. The anti.toxin is obtainable at all hours of the day and night
from Mr. Worsley's premises, and during office hours from the Town Hall. When the Town Hall
is closed, applications for anti.toxin can be made to Mr. Sutton, an Officer of the Department,
who lives at No. 1, Hornton Place, Hornton Street, (only a few yards from the Town Hall).
The Council loan syringes with portable sterilizers to doctors for the purpose of administering
the anti.toxin. Medical men administering the Council's anti.toxin to poor persons are, on
application to the Medical Officer of Health, paid a fee of 5s. per patient treated.
In 1924, the Borough Council supplied 196,500 units of anti.toxin for 43 patients at a cost of
£14 14s. 11d.