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33
DIPHTHERIA.
per cent. and the average for the five years 1908-12 11.4. Moreover, there were 9 cases of
"bacteriological diphtheria" among the cases reported in the general population, and 25 among
the Infirmary patients, and 1 among those from the Orphanage, making the total of such cases
35, equal to 117 per cent. of the total notifications. A few years ago such cases of " bacteriological
diphtheria" would have been counted as " errors," inasmuch as the patients present no
clinical signs of the disease. It is hardly an exaggeration to say that upwards of one-quarter
of the cases notified last year were not cases of clinical diphtheria, a statement which discounts
the recorded increase in the prevalence of the disease to a very considerable extent. At the
same time it has to be recognised that the notification of the non-clinical cases is advantageous,
as it allows precautions to be taken whereby the possibility of transmission of infection, may be
resulting in a severe form of the disease, is reduced to a minimum. In 13 patients the nasal
form of diphtheria was reported, and in 5 others the nasal combined with the faucial.
Of the 199 " definite" cases in the general population there were 12 which were contracted
in institutions other than the Infirmary or the Orphanage, 3 which appeared to be due to
sources of infection outside the Borough, and 4 which followed the return home of earlier
cases from hospitals.
The 232 cases were reported from 213 houses, there being 29 secondary cases in all, equal
to 125 per cent, of the whole group, as compared with 15 per cent, in 1912.* The house distribution
of the notifications is given below in comparison with the experience of the preceding
five years.

In two houses the infection spread outside the original family, in one instance (the house
with seven cases notified) to three families. In the houses with 2 or more cases, 5 "errors," 4
cases of "bacteriological diphtheria," and 4 return cases were noted. The distribution of
multiple cases—for houses and families—is shown below. On seven occasions 2 cases were
reported on the same day from the same house, and on four, 3.

The following information was obtained by the Department with reference to the houses
with 5 and 7 cases.
I. House with 5 cases.—Family, consisting of man, wife, and four children aged 12 to 7 years :—
W. S., f., aet. 12 ; sickened 3 iii. ; admitted to hospital 8 iii. ; B + ve (throat).
V. S., f., aet. 9 ; 4 iii.; „ 8 iii. ; no B.
K. S., f., aet. 38 ; „ 7 iii. ; „ 12 iii.; B + ve (throat).
G. S., f., set. 5 ; „ ? ; „ 13 iii. ; B +ve (nose and throat).
A. S.. m.. ast. 7 : ,, ? ; ,, 13 iii.: B + ve (throat).
Note.—"B +ve means that the Kleb-Loffler bacillus was found in throat or nose, as the case may be.
The patient G. S. appeared to have been the origin of the disease. She was sent to hospital ill with
scarlet fever on December 20th, 1912, and discharged February 14th, 1913. On March 11th G. S. and A. S.
were brought to the Town Hall and examined by the Medical Officer of Health. In a letter to the medical
* After correcting for "errors" the secondary cases in the general population constituted 12.0 per cent. of
the total of the cases from that source, as compared with 15.6 per cent. in 1912.
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