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of 1934, the number of specimen bottles issued was 1,553 and 1,445 or 93 per cent, of those issued
were returned. During 1934 the number containing red cells or casts in the centrifuged deposit
was : intravenous series, 13 or 1.3 per cent. ; intraperitoneal series, 3 or 1.5 per cent.
On receipt of these " abnormal" specimens, a simple enquiry was made by post as to the
patient's health, and request made for a further specimen to be sent. Of the 13 abnormal cases
who received antitoxin by the intravenous route, 12 became normal within 14 days and the
remaining case could not be traced after 14 days. Of the 3 abnormal cases in the intraperitoneal
series, 2 became normal within 14 days and 1 within 28 days. None of these cases exhibited any
symptoms of illness and presumably the condition would have passed unnoticed had it not been
for the searching microscopic test of the centrifuged urine. In so far as this scheme is concerned,
no evidence was obtained of clinical nephritis occurring after discharge from hospital.
Three cases in the intravenous series (.3 per cent.) were re-admitted for complications
on information obtained from other sources, viz., 1 case of albuminuria and nephritis with mild
pyrexia but no symptoms, 1 case of acute otitis media, and 1 case of catarrhal otitis media.
(6) " Return " cases.—In the " intravenous " series there were 27 presumed infecting cases,
or 2-7 per cent., and these gave rise to 28 " return " cases. The duration of stay in hospital of
the infecting cases was : 7 to 14 days, 6 cases ; 14 to 21 days, 13 cases ; 21 to 28 days, 6 cases ;
over 28 days, 2 cases.
In the " intraperitoneal " series there were 4 presumed infecting cases, or 2 per cent., and
these gave rise to 5 " return " cases. The duration of stay in hospital of the infecting cases was :
14 to 21 days, 2 cases ; 21 to 28 days, 2 cases.
These " return " cases rates are not above the average for London, and do not appear to show
any very significant relationship with the duration of stay in hospital.
(c) " Intramuscular " and " no antitoxin " groups.—These are small groups not strictly
comparable with the above because they consist largely of selected cases, viz. (i) those deemed on
admission to be too mild for serum treatment; (ii) very young children in whom intravenous
injection was difficult or impossible ; and (iii) those who reacted to the preliminary intradermal
test with horse serum and were consequently considered to be unsuitable for intravenous
injection. This series is therefore distinctly loaded with children of the younger ages in whom
complications might be expected, but on the other hand it contains larger numbers of very mild
cases than the intra venous and the intraperitoneal groups. The results obtained in the " intramuscular
" and " no serum " groups, although not strictly comparable are nevertheless highly
instructive.
" Intramuscular "
series.
*' No antitoxin "
series.
Number of completed cases 86 298
Average duration of residence in hospital |25.6 days J28.3 days
Number of deaths Nil 4
Complications occurring after admission. Number. Per cent. Number. Per cent.
Purulent otitis media 8 9-3 25 8.4
Albuminuria and nephritis 1 1.2 6 2.1
Rheumatism — — 5 1.6
Carditis — — 1 .3
Adenitis 8 9.6 14 4.6
Tonsillitis — — 5 1.6
Abscess 1 1.3 3 1.3
Minor septic foci 2 2.6 1 .3
Relapse 1 1.3 1 -3
Other 4 4.8 8 2.6
Total 25 29.1 70 23.4
The above are exclusive of those developing
nasal diphtheria, viz. 4 4.6 27 7.8
Age grouping—
0- 5 years 62 72 111 37.2
5-10 19 22 100 33.5
10-20 5 6 53 18.0
Over 20 — — 24 8.1
+ Excluding 12 cases detained for conditions unassociated with scarlet fever.
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