View report page

36
DIPHTHERIA.
Infirmary Cases.—On February 27th a case of diphtheria was certified after bacteriological
test ("positive") in the person of a nurse. Between that date and April 22nd 47 cases were
reported among the patients and nursing staff of the institution, all after bacteriological tests.
Between April 22nd and August 18th no cases were reported, but between the latter and the
end of the year 8 other cases were reported, all after bacteriological tests. There were in all 55
cases reported during the year, 21 among the nursing staff and 34 among the patients (one
patient being reported twice). No case ended fatally.
The cases were distributed throughout the year, as shown below, the numbers of staff
patients included in the total for each month being indicated in parentheses. All the patients,
except 9 of the nursing staff, were removed to the Board's hospitals.
February. March. April. ... August. ... October. November. December.
1 (1) 28 (8) 18 (10) 1 1 2 (1) 4 (1)
From inquiries addressed to the hospitals to which the patients were sent, it was ascertained
that 4 of the cases were "errors"—all patients, 2 of whom were sent to hospital without
any previous bacteriological test; that 16 were cases of "bacteriological diphtheria "—15 being
patients at the Infirmary and 1 member of the nursing staff; and that the remainder (26)—15
patients and 11 members of the nursing staff—were clinical diphtheria. The 9 cases not sent to
hospital were all cases of "bacteriological diphtheria." The seasonal distribution of each type of
case is given below :—
February. March. April. ... August. ... October. November. December.
Clinical ... 1 (1) 15 (7) 5 (1) 1 — 1 (1) 3 (1)
Bacteriological — 12 (1) 11 (9) — 1 1
"Errors" — 1 2 — — — 1
The origin of the outbreak was thought to be a fatal case of diphtheria which occurred at
the Infirmary on December 30th, 1912. Systematic "swabbing" of the inmates and staff lead to
the discovery of most of the cases reported, as clinical indications, when present, were of the
slightest.
Orphanage Cases.—During December—more precisely, between the 5th and 15th of that
month—9 cases were reported from the Orphanage of Mercy, all the patients being sent to
hospital. The cases included 8 of clinical diphtheria (all mild) and 1 of bacteriological. Here,
again, systematic swabbing was the principal means of discovery of the cases. The origin of
the outbreak could not be traced.
The following notes of cases investigated by the Department will be of interest:—
III.—G. D., f., set. 3, was removed to hospital with scarlet fever on July 1st, 1912, and discharged
August 23rd. The Medical Superintendent of the hospital subsequently informed the Medical Officer of
Health that the attack was an uncomplicated one.
She was reported to have diphtheria in July of last year and was removed to hospital on the 13th of that
month, being discharged on August 23rd. From that date until November 26th she appears to have had good
health, and then failed with " pneumonia." A swab from her throat was submitted on December 1st, but
although the result was negative, the clinical symptoms were considered to indicate an attack of diphtheria,
and she was removed to hospital on December 2nd, where she died two days later.
The Medical Superintendent of the hospital to which G. D. was admitted in July, 1913, communicated the
following notes of the case :—
"This child was admitted with several patches (sc. of diphtheritic membrane) on the left tonsil
and one on the right. The Klebs-Loffler bacillus was found in the throat swab.
"Later a direct smear showed the fusiform bacillus and spirillum of Vincent's angina. There
was much sloughing of soft tissue (cancrum oris ?) and some necrosis of upper and lower jaws with
exfoliation of bone. At the same time she had whooping cough and broncho-pneumonia. Her condition
was critical for three weeks or so, but she ultimately made a good recovery. There is no note
of a bacteriological examination previous to her discharge."
The Medical Superintendent of the hospital to which she was admitted in December reported that the
child had no diphtheria then, and that the cause of her death was purpura haemorrhagica and pneumonia. It
is not improbable that the illness immediately preceding her death was really of a septic origin.
IV,—S. K, f., aet. 66, was certified to have erysipelas on October 2nd by the Medical Superintendent of
the Infirmary, to which institution she had been admitted on the 30th of the previous month. Swabs from her
throat were received on October 1st and November 4th, both of which contained the Klebs-Loffler bacillus
She was removed to hospital on the 7th of that month and discharged thence (to the Infirmary) on the 18th.