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carrier rate, an effect, which it has been stated, is produced in residential institutions
for children. It is to be noted, however, that nurses sleep not in dormitories
with exiguous bed spacing but in separate bedrooms.
As regards the hæmolytic streptococcus, it may be added that Dr. V. D.
Allison, of the Ministry of Health, kindly typed the strains which were recovered
from the field swabbings alluded to above. They comprised 38 strains, 19 of which
(50 per cent.) fell into the types frequently associated with scarlet fever, tonsillitis,
puerperal fever, and other hsemolytic streptococcal infections.
Diphtheria and scarlet fever.
In continuation of the report on the protective inoculation of nursing and
domestic staff contained in the annual report for 1933, the medical superintendent
of the North-Eastern hospital (Dr. E. H. R. Harries) has reported as follows:—
During the year all new members of the nursing and domestic staff have been offered the
Schick and Dick test and immunisation has been offered to those found to be positive reactors.
No member refused these tests or the subsequent immunisation.
Protective
inoculation
of nursing
and domestic
staff.

Three cases of diphtheria occurred amongst the staff in 1934. One occurred in a Schick positive
nurse within a few days of joining the hospital staff. One occurred in a nurse just after she had
completed her immunising course and before there had been time to retest her. The last case
was that of a senior technician in the Northern group laboratory who had joined the hospital
staff before Schick-testing and active immunisation were practised.
Of the three cases of scarlet fever, one occurred in a probationer nurse within a few days of
joining the service. The other two cases occurred in Dick positive reactors who had both had the
first injection only of an immunising course—one case was that of a probationer nurse and the
other was a domestic assistant.
As in the previous year formol toxoid supplied by the Belmont laboratory was used exclusively
in active immunisation against diphtheria. In the case of scarlet fever, a course of 3
injections of toxin (B.W.) was used until the middle of the year when a scarlet fever prophylactic
from the Belmont laboratory was introduced. In contrast with B.W. toxin a full course of Belmont
prophylactic consisted of five injections—given at intervals of one week. It will be seen that
the results, as indicated by the production of an active immunity are equally good, nor were
any untoward reactions recorded. The details of the numbers tested and immunised during
1934 are as follows:—
(i) Schick test and active immunisation with toxoid (Belmont).
Schick test—Negative 126
Positive 75 (37.3 per cent.)
Total 201
Of the 75 Schick positive reactors, 11 left before completing an immunisation course,
2 developed diphtheria (vide supra), and 62 were immunised and retested.
Of the 62 who had been given a complete course of 3 injections of .1, .2 and .3 c.c. of toxoid,
59 had become Schick negative on retest and in the other 3 the test was still positive. All 3
became negative after a further injection of toxoid.
(ii) Dick test and active immunisation against scarlet fever:—
Dick test—Negative 164
Positive 37 (18.4 per cent.)
Total 201
Of the 37 Dick positive reactors, 3 left before completing an immunisation course,
3 developed scarlet fever {vide supra), and 31 were immunised and re-tested.
In 15 cases, toxin (B.W.) was used. Eleven had become negative after the full immunising
course of three injections and four remained positive. Of these, three became negative after a
further injection of toxin (B.W.) and the other, who was strongly positive, was given a full
immunising course of five injections of Belmont prophylactic and then became negative.