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259
arisen from this course, and that improvement will
result from our hospital extension, not only by removing
cases from homes where it is practically impossible to
effectually isolate the disease, but also, by preventing a
too early return of those recovering into social relations
with the healthy. A careful analysis of cases treated
in hospital from April 1st to November 13th shows that
the average time during which diphtheria patients were
retained in hospital amounted to 35 days, while of those
cases treated at home during the same period the
average time of isolation amounted only to 19 days, in
some cases patients being allowed their freedom in
seven, eight, or nine days. In this connection it is well
to note the rule adopted by the Medical Officers of
Schools Association" XXI. A pupil may go home
or rejoin school after diphtheria in no case in less than
four weeks, provided convalescence is completed and
that there is no longer any sore throat or any abnormal
discharge from the throat, nose, ears, or eyes, and no
albuminuria, and that bacterioscopic examination of the
pharygeal (or nasal) mucus for the specific bacillus has
been attended with negative results; this examination
having been made in not less than three days after the
discontinuance of local antiseptic applications."
The wording of the above rule emphasizes, in my opinion,
the rigid observance of a four weeks' complete isolation
in cases of diphtheria, especially among children of the
poor classes, whose convalescence is so often returned
by the nature of their home surroundings, and in whom
an early return to school may be very liable to produce
recrudescence of infectivity.
Such are the chief circumstances recently associated with
diphtheria in West Ham, and the Council has not been idle in dealing
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