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20 DIPHTHERIA.
The 233 cases regarded as correctly diagnosed included 6 in which the disease was
contracted in hospital, 6 which were imported, i.e., the infection was apparently contracted
outside the Borough, but not in any institution, and 6 "return." In 43 other cases the symptoms
were so trifling at the time of notification that the cases were marked as "carriers," 1.4 of
those cases being reported among the patients and staff of the Children.s Hospital and 18 among
children specially examined in school.
To obtain a correct impression of the house distribution of the reported cases, it is
necessary to pass over 15 cases which occurred among the staffs of local hospitals and that
of an important business house (living.in). The remaining 233 certificates were received from
198 houses. The secondary cases (uncorrected for errors) formed 15 per of that total, as
compared with 131 per of the reported cases in 1911. The house distribution is given
below.
1912. 1911. 1910. 1909. 1908. 1907.
Houses with 2 cases 20 9 2 10 8 13
3 4 5 — 1 3 3
4 1 1 — 1 1 —
5 „ 1 - - - -
In one house whence 2 cases were reported the second case was an "error," and in
another the 2 cases occurred in 2 families. In 2 houses both cases were reported together,
and in each of 2 others the second case was a "return." In 13 instances the second case
was due to direct personal infection from the first, an independent source of infection being
suspected in one instance only.
In the 4 houses from which 3 cases were reported, direct personal infection was apparently
traced in 3 instances, the second and third cases in the fourth house being "return" cases.
The circumstances attaching to the houses with 4 and 5 cases were of some interest,
and brief notes of those cases are appended.
I. G. T., f., aet. 8; sickened 10 iii.; to hospital 12 iii.; discharged 19 iv.
H. T., f., set. 5; ., 10 iii.; „ 13 iii.; „ 26 iv.
Fre. T., m., aet. 1; „ 11 iii.; „ 14 iii.; „ 1 xi.
Fra. T., m., aet. 4; „ 25 iv.; „ 26 iv.; „ 20 vi.
Fra. T..s case commenced 6 days after the return home of G. T., H. and Fre. being then still in hospital.
G. and H. were brought to the Town Hall on April 29th (10 days after the discharge of G. T., and 3 days
after that of H. T.), and swabs were taken from the nose and throat of each child. G. T. had nasal discharge
and enlarged tonsils. H. T. presented no abnormality in nose or throat. The swabs from both throats yielded
cultures of the Klebs.Loffler bacillus, and the Hoffman.s bacillus was obtained from the nose of H. T. Both
children were re.admitted to hospital on the next day. They were detained in hospital until May 31st. The
Medical Superintendent of the hospital from which G. and H. T. were discharged wrote that cultures taken
from the nose and throat of G. T. on April 16th (8 days before her first discharge from hospital) showed no
diphtheria bacilli, cultures from H. T. on the same day showing no diphtheria bacilli in the throat, but some
"organisms resembling D. B." in the nose. Cultures taken from the latter child on April 22nd (again
3 days before discharge) "showed no D. B."
All the other members of the family, except the baby, aged 5 months, were swabbfd on April 30th, viz.,
father (" negative "), mother (" negative"), W. T., m., æ. 11 (" negative "), R. T., m., æ. 10 (" Hoffman " nose
and throat), and A. T., m., æt. 5 (throat "negative," nose " Hoffman..).
II. H. P., m., æt 2; sickened 20 iv.; to hospital 23 iv.; discharged 1 vi.
M. P., æt . 7; „ 26 iv.; „ 27 iv.; „ 1 vi.
S. P., f., æt 11; „ 9 v.; „ 9 v.; „ 18 v.
E. S., f., æt 17; „ 10 v.; „ 11 v.; 18 v.
S. A. P., æt,. 31; „ 24 v.: „ 25 v.; „ 1 vi.
The first two cases were certified without preliminary bacteriological examination.
S. P. and E. S. were swabbed on May 22nd and the cultures yielded Klebs.Loffler bacilli. Both patients
were re admitted to hospital on the 23rd, and discharged on June 1st. The three elder females. illnesses
appeared to be cases of " bacteriological diphtheria" only, without clinical symptoms.
The bacteriological test was known to have been used in 104 cases last year, but was
probably resorted to privately in other instances. In 1911 the test was recorded in 60 instances.