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at first made its appearance, were resident in East Acton, but
subsequently there were cases in West Acton. The spread of the
disease may probably be accounted for by the fact that Acton
Wells draws its pupils from East Acton and West Acton.
On October 7th, a case of Diphtheria was notified; the
child lived in East Acton and attended the East Acton School.
On October 5th, in the course of the routine medical inspection
at the school, one of the children had a nasal discharge and there
was a history of recent sore throat. This child lived in Perryn
Road. A swab was taken from the throat and it was found that
the germs of diphtheria were present. On October 10th, a child
under school age living at East Acton was also notified.
The district had been comparatively free of Diphtheria
throughout the summer—2 cases being notified in each of the
months of June, July and August and one case in September.
Another feature which caused uneasiness was the fact that
recently Diphtheria in a virulent form has been prevalent in
certain areas of London.
In these circumstances, it was decided to extend the scope
of inquiry beyond the contacts of the house, and as usual the
next inquiry was directed towards the pupils attending the East
Acton School.
On October 10th, an examination of the children was made
at the school, and many children gave a history of recent store
throat. In the circumstances, it was decided to swab most of
the children in two of the classes. 67 children were swabbed,
and 4 of these were found to harbour the germs of Diphtheria.
These 4 children had recently suffered from sore throats, so that
is is probable they had suffered, or were suffering from a mild
attack of Diphtheria.
We have been particularly fortunate in recent years, as
far as Diphtheria is concerned. In 1927 there was only one death
from the disease, and in 1926 there were two deaths. It is therefore
possible that the Schick testing and immunization are not
questions of urgent importance here. But there are ominous
signs that Diphtheria of a virulent type is on the increase in
London, and during the first quarter of 1028 we had 3 deaths
from Diphtheria, or as many as in the two years 1926 and 1927.
At present we have no exact knowledge of the determining factors
which govern the prevalence and still less the type of these
epidemic diseases. It is well therefore that we should be prepared
and know what measures are adopted in districts where
Diphtheria of a virulent type is prevalent. Immunization by
means of Toxin-Antitoxin or Toxoid-Antitoxin has ceased to be
experimental, and where it has been carried out, the authorities