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ship at Gibraltar. The stewardess occupied a cabin next to that in which the
case was isolated prior to landing. The patient was removed to the Hospital
of the Metropolitan Asylums Board. The Public Vaccinator immediately visited
the home and the contacts were re-vaccinated the same evening or early next
morning. No secondary case occurred.
In order that parents should have the advantages of vaccination brought
home to them, since October a leaflet dealing with the subject has been sent to the
home shortly after the birth of any child in the Borough.
Two cases of smallpox were notified in London.
Diphtheria.
Of 167 cases of diphtheria notified, 21 were returned as not diphtheria.
Five were apparently only "carriers," as diphtheria bacilli were found in the
swabs taken before the removal of the patients. Only three of the notified cases
remained at home; in two of these cases the second bacteriological examinations
were negative; the third case was a "carrier."
There was one "Return" case of diphtheria notified 17 days after the
return home of the primary case (a brother).
In two or possibly three cases of diphtheria, the disease was apparently
contracted from a boy who was evidently a "chronic intermittent carrier."
This boy was removed to hospital with diphtheria in November, 1920, and
returned home at the end of February, 1921. Four weeks afterwards he was
again notified as suffering from diphtheria and was re-admitted to hospital. In
May he was returned home diagnosed as not suffering from diphtheria. Bacteriological
examination of swabs, however, gave positive results and continued to do
so until at the end of July he was again notified and removed to hospital.
In one family where four cases of diphtheria occurred, there was evidence
of probable infection from a fifth member of the family, who had recently
returned from hospital, convalescent from scarlet fever. The scarlet fever patient
returned home on the 25th April. The first case of diphtheria was notified on
the 11th May, followed by other cases on the 22nd May and 3rd and 6th June.
Swabs from the throat and nose of the scarlet fever patient gave positive results.
The case illustrates the close association between these two diseases.
On account of the occurrence of a case at the Kingsway Creche, 21 of the
children were swabbed—16 were found to be positive. Information respecting
the children not residing in this Borough was sent to the Medical Officers of Health
of the districts concerned. All the children giving positive results were excluded
until they were found no longer to harbour diphtheria bacilli.
One patient notified as suffering from diphtheria was a milk carrier working
in a district adjoining the County of London. Information respecting the case
was sent to the Medical Officer of Health of that district. The patient was removed