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77
spread uniformly throughout Barking Town and the
Becontree Estate, neither being focussed in any particular
locality.
The swabbing for Str. pyogenes has been extended
to diphtheria patients, many of whom, and particularly
the severe cases, often have initially a double infection
with C. diphtherias and Str. pyogenes, although they
seldom show a rash.
Cases of suspected diphtheria which are admitted to
the Barking Hospital are isolated in side wards or
cubicles until the result of a swab for Str. pyogenes is
known. Negative cases are then admitted to the
open ward and positive cases are kept in isolation until
they are free from streptococcal infection, sometimes
for the whole of their stay in hospital. It should be
pointed out that this procedure in no way interferes
with the patients' serum treatment which is initiated
immediately on their admission to hospital.
A number of cases which were admitted as suspected
diphtheria have subsequently proved to be acute
streptococcal tonsillitis. Such cases are with advantage
kept in isolation, as it is all too infrequently realised that
they are equally as infectious as scarlet fever. The
incidence of types of Str. pyogenes occurring in these
patients and in the diphtheria patients ran parallel
with those occurring in scarlet fever patients.
It is noteworthy that during 1938 no cases of puerperal
fever of streptococcal origin have been detected,
this being the classical type which is so highly infectious
and which has such a high mortality. The few cases
of generalised puerperal infection which have occurred
have for the large part been in patients who have been
debilitated and anæmic throughout pregnancy or who
have been weakened by haemorrhage. The germs