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"doubtful." In Islington, material from 97 cases was sent to the Jenner Institute; in 47 cases the
results were positive, in 50 negative. In Stoke Newington, material from seven cases was examined
in the laboratory of University College, the results being that the disease was considered diphtheria
in three cases, and not diphtheria in four cases. In St. Giles, material from six cases was sent to the
laboratory of the Conjoint Board of the Royal Colleges of Physicians and Surgeons. The bacillus was
found in three cases and not found in the others. In St. Martin-in-the-Fields material from one case
was sent to the above laboratory, the result being that the disease was considered to be diphtheria.
In the Strand district Mr. Cribb, the Board's bacteriologist, examined material from nine cases. " In
two instances the result was doubtful, and on a second trial one case proved to be diphtheria, the other
not. In the remaining cases the diphtheria organism was not found." In the Holborn district
material from 109 cases was sent to the Jenner Institute, the diphtheria bacillus was isolated in
35 and the pseudo-bacillus in 13 cases; in the remaining 61 cases the bacillus could not be
isolated. In Clerkenwell material was sent to the Jenner Institute. In Limehouse material
from three cases was sent to the bacteriologist of the London Hospital with positive
results in 2 cases, and a negative result in 1 case. In Poplar (Poplar parish) material
from 48 cases was sent to the Jenner Institute; in 21 cases the bacillus of diphtheria was
isolated, in five cases the pseudo-bacillus, and in 22 cases there was " no result." In Poplar (Bow
parish) material from 3 cases was sent to the institute, the result being positive in 2 cases and
negative in 1 case. In St. George-the-Martyr the medical officer of health recommended that facilities
should be given by the vestry for bacteriological examination of material. In Lambeth material
from 216 cases was sent for examination, and in 101 cases Klebs-Lceffler bacilli were found, the
pseudo-bacilli of Hoffman being found in 49 others. In Wandsworth material from 29 cases
was sent to tho Jenner Institute, the result being positive in 13 and negative in 16 cases. In
Camberwell material from 426 cases was examined by the vestry's bacteriologist, Dr. Bousfield, the
results being positive in 207, negative in 192, and doubtful in 27 cases. In Eltham material from a
few cases was sent to the Jenner Institute. In Plumstead material from 15 cases was sent to the
Clinical Research Society and the Jenner Institute, in two of which the result was positive, and in
one the pseudo-diphtheria bacillus was found.
Use of antitoxic serum.
The medical officers of health of several districts state that their authorities now supply antitoxic
serum to medical practitioners, so as to ensure that a supply shall be available whenever it is
needed. Thus Dr. Kenwood writes that " the provision for the sale of antitoxin at the vestry's offices
continues to be much appreciated "; Dr. Warry states that " this treatment is certainly finding favour
with medical practitioners in this district (Hackney), to whom during the year 45 bottles were supplied
from the Public Health Department." In Lambeth the vestry supplies antitoxin without charge, and
Dr. Priestley states that 69 bottles were thus distributed, and that of 53 cases treated with antitoxin
the results were successful in 52 cases and unsuccessful in one case. In Eltham antitoxin was supplied
on ten occasions by the Lee District Board.
The reduction in the case mortality of diphtheria in recent years will be seen on reference to
diagram XIX. (page 50).
Diphtheria and Elementary Schools.
Prevalence of diphtheria in relation to school attendance is discussed in the reports of medical
officers of health relating to the following districts—
Paddington.—As in the case of scarlet fever the medical officer of health found that there was
greater incidence of disease upon children attending board schools than upon children attending other
schools, and he notes that tho incidence upon children attending other schools was in 1899 greater
than in 1898: He finds this due to increase of diphtheria among the children attending three schools,
St. Augustine; St. Luke, Fernliead-road ; and High School, Saltram-crescent.
Kensington.—Seven cases of diphtheria occurred after the Christmas holidays among children
attending the St. Barnabas and St. Philip's Associated School in Earl's-court-road, one in the boys',
another in the girls', and five in the infants' department. Dr. Dudfield came to the conclusion that the
first two cases were not due to school attendance, and that the others were due to infection at school or
at home.
Fulham.—The medical officer of health publishes a table showing the number of cases of
diphtheria occurring in each month among tho pupils of the several board and primary schools. The
infants' department of the Ackmar-road Board School was closed during the end of February and
beginning of March for three weeks on account of the prevalence of diphtheria among the children.
In October and November a class in the infants' department of the Star-road Board School was closed
for nearly three weeks for a similar reason, and other children living in the same houses as children
attending that class were excluded from attendance.
Stoke Newington.—Dr. Kenwood writes " school attendance is either alleged by the parents or
surmised by myself, on good grounds, to be the cause of three attacks during the year and to be
responsible for 9'7 per cent, of the cases as compared with 5'7 per cent, in the preceding year."
Mile-end Old-tou:n.—Dr. Taylor states that, although cases of diphtheria occurred in all parts of
the district, " a number of children who had been attending two particular schools were reported to be
suffering from the disease." The cases related to one school were fatal in large proportions, and the
drainage and ventilation of the school was found to be in satisfactory condition, but later, on taking up
the floor boards, " a large amount of filth was found, including the skeleton of a cat, a dead rat and a
quantity of orange peel and fermenting rubbish. The whole of this was of course removed and the
floor concreted; from that time the disease ceased." Children who were found to be ailing or who
had " suspicious-looking throats " were excluded from attendance.