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1928
26
isolated. The detection of carriers and of mild cases is to this
extent rendered easier.
Diphtheria.
78 cases were notified and 7 deaths occurred. Although
the increase of notified cases was small, 78 compared with 69 in
1927 (it is the highest number of deaths in any year since 1922)
there were 7 deaths compared with one in 1927.
All the deaths occurred in the first half of the year, and
in every instance death was due to delay in carrying out the
appropriate treatment. Broadly speaking, no one dies from
diphtheria who is treated with antitoxin on the first day of the
disease. Each day's delay in giving antitoxin increases
enomously the risk of a fatal result and less and less is
accomplished by antitoxin, so that by the fifth or sixth day it is
questionable if anything is gained by its administration. Some
children die because the doctor is not called in early enough,
and sometimes there is a difficulty in the diagnosis.
The doctor when called in may not be able to obtain a
good view of the child's throat, and frequently cannot get a
swab from the throat. Moreover, it should be remembered that
some of the worst cases of indubitable clinical diphtheria give
negative results on the first or even the second swabbing.
Swabbing should not be relied on for diagnosis except in adults
or in children showing no exudate. Many fatalities in children
are due to the time lost in awaiting the result of the swab and
in relying on a negative result as excluding diphtheria, which it
does not; frequently true cases have given negative results prior
to admission.
Typhoid and Paratyphoid Fever.
The two cases of Paratyphoid fever which were notified
here belonged to the series of cases which occurred in London
in July. All the investigations point to a cream supply as being
the agent responsible for the outbreak. The probability is that
the infected cream was entirely consumed within three davs and
that the cause of its being consumed in a contaminated state
was that, the demand for the cream being excessive, there was
a breakdown in the safeguarding apparatus.
On July 7th, a person from Suffolk had strawberries and
cream at a friend's house in Fulham. In due course, both host
and visitor sickened with paratyphoid. This evidence bv itself
is almost sufficient to prove not only against the cream, but to
fix the exact date on which it was dangerous. Other evidence,
of course, pointed to the same source of infection.