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Farm on 19th February, during convalescence. He was sent home on
18th March, and on 23rd March was again notified to be suffering from
diphtheria. The shortest period during which the protection conferred
by an attack lasts, is about five weeks.
In three instances 2 cases occurred in one house, and in two
instances 3 cases.
Bacteriological Examination.—Advantage was taken by medical men
of the means provided by the City Council to have the diagnosis of
their cases assisted by bacteriological examination of swabbings from
the nose or throat in 120 instances.
In 10 instances I have had a bacteriological examination made of
the throats of the members of families in which a case has occurred,
and no medical man was in attendance; the bacillus was present
in three of them.
The practice is, when there is a private medical attendant, to suggest
to him the desirability of taking swabbings from the throats of all who
may have been in contact with the patient. If there is no private
medical attendant swabbings are taken by the medical officer of health.
A difficulty arises to know what to do with persons having the
diphtheria organism in their throats able to infect other persons, but
not being affected themselves to such an extent as to show any signs of
diphtheria. Generally, such organisms disappear promptly under treatment,
the person being isolated as far as possible at home meanwhile.
If treatment fails then the case is sent into hospital if complete isolation
cannot be effected at home.
A further difficulty occurs in connection with patients in the outpatient
departments of hospitals. At many hospitals swabbings are
taken of all cases of sore throat on the patient's first attendance; if
there is no definite appearance of diphtheria nothing is said to the
patient, who returns home or to work. The report of the bacteriologist
is received by the physician next day, who then notifies the case as one
of diphtheria if the organism has been found, and the first intimation
to the patient is when the fact is announced to him by an officer of the
Public Health Department (sometimes the person is found at his place
of business.) If there is no means of isolation at home the person is
sent to the isolation hospital, and then it may turn out that the treatment
had got rid of the organisms in the interval, and the patient is
sent home again with a report that he is not suffering from diphtheria,
and it is chronicled as an "error of diagnosis." If such cases could be
seen again by a medical man it might be possible to decide if they were
genuine cases or "carrier" cases which might be dealt with at home.
Typhoid Fever.—As usual, a number of these cases resulted from
infection contracted out of London, often abroad, 15 of those whose
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