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34
DIPHTHERIA.
practitioner attending the family the Medical Officer of Health summarised the results of his examinations
in the following terms :—
" G. S.—Child very pale and looking far from well; thick purulent discharge from nose; glands
of neck hard and swollen; fauces normal to eye, except that the tonsils are slightly enlarged and
tongue slightly furred.
"A. S.—Slight mucoid discharge from nose; submaxillary glands large and hard; right tonsil
much enlarged, left slightly enlarged ; tongue slightly furred."
Swabs were taken from the nose and throat of both children, and the Klebs-Loffler bacillus was found in
both swabs from G. S. and from the throat swab from A. S.
The only member of the family who was not reported was the father.
II. House with 7 cases.—House occupied by 4 families, comprising 29 persons (13 aged 10 years and
over, and 16 under 10 years).
M. P., f., æt. 8 ; sickened 29 vi. : to hospital 3 vii. ; discharged 18 viii.; B + ve
V. P., f., æt. 1 ; ,, 10 vii. ; „ 22 vii.; „ 21 viii.; B + ve
S. P., f., æt. 32; „ 25 vii.; „ 26 vii.; „ 21 viii.
A. H., f., æt. 3 ; „ 5 ix. ; „ 8 ix. ; „ 28 x.; B + ve
M. H., f., æt. 8; „ 6 ix.; „ 8 ix.; „ 3 xi.
G. H., f., æt. 10; „ 9 ix.; „ 9 ix. ; „ 9 x.
C. C., m., æt. 6; „ 9 ix. ; „ 9 ix.; „ 28 x.
The P. family comprised 7 persons, including 4 children under 10 years of age. In 1912 the mother
(S. P.), 3 of her children (H. P., m., aet. 2; M. P., f., jet. 7 ; and S. P., f., aet. 11), and the servant were
removed to hospital with diphtheria. (Notes of the outbreak were included in the Report for 1912, page 20,
Case 2). The sequence of events last year—discharge of 3 patients on August 18th and 21st, followed by the
first of the second group of cases from September 5th onwards—suggests very strongly that the cases in the H.
and C. family were return cases, A. H. being the primary return case, and the others secondary. All members of
the P. family were swabbed on September 11th with negative results.
In 121 instances bacteriological tests were known to have been applied in respect of the
232 cases reported among the general population. In 108 instances the Klebs-Loffler bacillus
was found, in 12 (certified on clinical symptoms) it was not present, and in one the Hoffman
(pseudo-diphtheria) bacillus was present. Six of the patients in whose swabs the Klebs-Loffler
bacillus was not present were subsequently found to be not suffering from diphtheria. Bacteriological
tests were used in all the cases reported from the Infirmary, and in 8 out of the 9
reported from the Orphanage. In addition, there is no doubt that the test was used in the 12
cases which occurred in institutions other than those just referred to, and (privately) in some of
the cases reported from the three southern Wards of the Borough in which the proportion of cases
certified after bacteriological investigation by the Department is disproportionately low.
Of the 296 notified cases 281 were removed to hospital (9 cases of " bacteriological
diphtheria" kept at the Infirmary being regarded as in hospital), equal to 94.9 per cent. of the
total notifications, as compared with 93.1 per cent. in 1912, and an average of 92.1. Of the
232 cases in the general population 217 (93.5 per cent.) received hospital treatment. (See
Tables 28 and 29.)
There were 15 deaths among the notified cases, all but one occurring in hospital (Table 28)
and all among the cases notified from the general population. After deducting the 4 deaths of
patients subsequently found not to be suffering from diphtheria, the fatality per 100 definite
cases from all sources will be found to be 42, as compared with 3.4 per cent. in 1912, and an
average (1908-12) of 6 8. (Table 29.) The fatality calculated on the number of definite cases
receiving institutional treatment was 4.l per cent. in 1913, 3.2 in 1912, and 6.5 during the five
years 1908-12. Inasmuch as all the 11 deaths from diphtheria occurred amongst patients drawn
from the general population, the true fatality last year was 43 per cent.
The total number of deaths registered during the year was 14, one being certified as due to
membranous croup. The difference from the number mentioned in the last preceding paragraph
is due to (a) one of the deaths included in the 10 deaths in institutions being transferred
to Liverpool, and therefore not appearing in the local mortality returns, and (b) to two of
the deaths included therein having been notified in 1912, and two others not notified at all. The
14 deaths were equal to a mortality of 0.09 per 1,000 persons, as compared with one of 0.04 in
1912, and an average of 0.07. (Table 29.) The local rate appears in Table 24 as 0.08, which is
the highest of the series included in that table, except that of the County. All the rates for the