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Six "return" cases were notified, of these, two were subsequently found
not to be suffering from diphtheria, the remaining four were notified, 12, 14, 13
and 17 days, respectively, after the return of the primary cases from hospital.
The four "return" cases occurred in two homes; medical examination of the
primary case in each of these homes disclosed evidence that the primary patients
were still suffering from diphtheria. In each case they were re-notified and
returned to hospital for further treatment.
In London 13,526 cases were notified giving rise to 538 deaths.
We endeavour to co-operate with the Medical Superintendents of the
Metropolitan Asylums Board Fever Hospitals; information is now sent to them
as to any bacteriological examinations before admission or after discharge of the
patients, and also with regard to return cases of scarlet fever.
Diphtheria in Hospitals.
During the year notifications were received from a hospital in the Borough of
55 cases of diphtheria. Of the 55 cases, 34 were reported as clinical diphtheria
(including ten nasal cases) and 21 as harbouring diphtheria bacilli. Forty-five
of the cases were in-patients, all being non-residents of Holborn. The remaining
ten were members of the hospital staff; of these seven were clinical diphtheria,
viz., resident medical officer 1, nurses 5, maid 1, and three harboured diphtheria
bacilli, viz., nurses 2, maid 1.
The number of cases of diphtheria occurring from year to year amongst the
nursing staff of hospitals suggests the need for the immunisation of hospital
nurses. It would seem to be obvious that fever hospital nurses should be
protected against diphtheria and it is difficult to avoid the conclusion that all
hospital nurses, nursing in children's wards, should be immunised. It must be
within the experience of many that nurses in children's hospitals and subsequently
the children themselves are often attacked.
The possible objection that a nurse would have to be immunised against
diphtheria, scarlet fever and typhoid and paratyphoid fevers does not carry much
weight. Many during the war were immunised against more diseases than these
—those going East were protected against smallpox, typhoid and the paratyphoid
fevers, cholera, dysentery and plague. Who can show that they suffered any
harm by taking advantage of the progress of science?
The Schick test and immunisation against diphtheria is already being
successfully applied to the nursing and domestic staffs in certain hospitals, including
those of the Metropolitan Asylums Board.