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re-admitted to hospital and retained until September 27th. On April
27th and May 2nd his mother and two brothers were notified.
(2) G. Y. returned home from hospital end of December, and his
brother and two others in house were notified on the 5 th and 11th
January.
(3) E. L. discharged 26th February, mother notified March 10th.
(4) L. G. discharged 9th March, brother and sister notified 19th
March.
It is impossible in every case to be certain that no trace of infection
exists in the-nose or throat, but the few cases in which "return" cases
have resulted, show that considerable care is exercised in the Metropolitan
Asylums Board Hospitals. It is even possible that some of the
four mentioned above were not the cause of the subsequent cases, as in
several instances second cases occurred in houses a few days before the
return of the first child from hospital, thus F. L. returned from hospital
on April 6th, but a child, F. G., in another family in the house was
notified on the 3rd April, and F. L.'s two sisters were notified on the
18th and 23rd.
Diphtheria.—As with scarlet fever, so with diphtheria, there was
also an increase generally, but the notified cases were not so much
above the numbers notified in recent years. There were 206 in
Westminster (189 went to hospital), and 30 were eventually stated not
to be suffering from the complaint (but as to that there is room for
some doubt). There were many cases with scarcely any symptoms to
attract attention, As an example, the case of a young child might be
mentioned who died suddenly, and at the post-mortem examination it
was found that the larynx contained a distinct membrane. His brothers
and sisters were found playing in the street with others, and one of
them was found to have a slightly inflamed throat, which on bacteriological
examination yielded pure cultures of the specific organism.
There is a further complicating circumstance in connection with
diphtheria, in that persons who have been in contact with infected
persons may themselves get the organism into their throats, and being
insusceptible to the disease may carry it about in their throats without
any symptoms or harm resulting to themselves, but may pass it on to
other persons not so immune. Again, there is strong evidence that the
organism itself may undergo changes, and in some forms (possibly that
known as Hoffmann's pseudo diphtheria bacillus, a name which probably
covers more than one form) may give rise to an infective form of sore
throat, the appearance of which may not be recognised clinically as
diphtheria. A further difficulty in dealing with this disease arises from
the fact that in a few cases the organism may persist in the cavities of
the nose for very long periods, and cases are not unknown where a