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diphtheria.
15
hospitals, and one followed an operation. Multiple cases were reported from 15 houses, viz.,
2 from 9 houses, 3 from 5, and 4 from one. The frequency of multiple attacks after correction
for errors of diagnosis was—
Houses with 2 cases, 9; with 3 cases, 4; and with 4 cases, 1.
The secondary cases numbered 29, or 13.1 per cent, of the correctly diagnosed cases,
whereas in 1910 there was only one secondary ease.
The disease spread to a second family in the same house on two occasions, the date of the
second case suggesting that it was due to the return home of the previous patient, while in the
other instance the spread was synchronous with the earlier cases (there were three cases in all in
that house). Simultaneous notification of multiple cases was noted in four instances, once from
a house with two cases, and three times from houses with three. In the latter, all three cases
were reported together twice, and in the other instance two out of the three cases. With regard
to the house whence four cases were reported, the facts elicited were of some interest.
A young lady arrived at a boarding-house on October 15th, and was certified to have diphtheria on the
24th, being removed to hospital on the same day. Between the 15th and the '24th the patient was nursed by
a daughter of the proprietor of the house, the daughter being taken ill on the 23rd, and removed to hospital
on the same day as the first patient. Two further cases occurred on November'22nd and 26th, the case on
the 2'2nd being in the person of the son of the proprietor, and the other a guest. All the cases were certified
after bacteriological verification.
The first case of all appears to have sickened at an address in Westminster earlier than October 15th, and
to have had medical treatment before moving to Paddington. She had also been to an address in Liverpool.
Enquiries were made of the Medical Officers of Health of Westminster and Liverpool, but no history of any
known case of diphtheria with which the patient had been in contact could be obtained.
On November 30th the medical practitioner in attendance "swabbed'' the throats of every person in the
boarding house, and the Klebs-Loffler bacillus was demonstrated in 4 out of the 16 swabs taken (one being
from the throat of the family cat). Attention was given to the throats from which the bacillus was recovered
(the cat was not infected), and no further case occurred.
There was also a small outbreak of diphtheria at the Lock Hospital, presenting very nearly
the same characteristics, but as none of the patients belonged to the Borough the cases were
not included in the number reported.
On August 11th a case (male, aged 3 months) was reported by the House Physician of St. George's
Hospital, the address being given as " 283, Harrow Road " On enquiries being made it was ascertained that
the child had been an in-patient of the Lock Hospital, and had been transferred to St. George's Hospital for
operation to relieve dyspnoea. At the latter hospital a swab had been taken, and the Klebs-Lcffler bacillus
had been found. The patient was then transferred to the Asylums Board's Hospital.
On October 6th a second case occurred, and a third on the 10th. On the latter date the throats of all
the patients in the ward and of the staff attached to it were "swabbed," and the Klebs-Loffler bacillus was
found to be present in the throats of three other children. They were removed to the Asylums Board's
Hospital, although none of them presented any sign of clinical diphtheria—one had a slight "cold in the
nose"—and no further case of the disease occurred.
There was a group of cases in one of the class-rooms of Moberly School, particulars of
which will be found under school attendance.
Sixty-one of the cases of reported diphtheria were notified after bacteriological test, the
Klebs-Loffler bacillus being reported GO times (one of the cases being ultimately reported as
"not diphtheria"), and the Hoffmann (pseudo-diphtheria) bacillus once. Two of the reported
cases were nothing more than "bacteriological diphtheria," that is to say, the patients had the
Klebs-Loffler bacillus in their throats (or noses), but presented no clinical signs of the disease.
Six of the patients had nasal diphtheria only. In two instances diphtheria followed preceding
attacks of measles ; in four the disease was contracted through nursing other patients, and once
the family cat (not the one referred to above) fell under suspicion as the source of infection, but
no proof of the suspicion was forthcoming. One patient was reported with a second attack of
the disease, the diagnosis being confirmed on both occasions.
Of the 168 reported cases, 154, including 13 "errors," were removed to hospital. The
percentage of patients removed last year was 916, or 3.6 more than the average (87.9) for the
years 1906-10. The percentages of cases removed from the individual Wards varied from 100