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38
Return Cases.
There was a remarkable freedom from return cases of
liphtheria in the course of a year, the only case occurring
being one in one of the older houses of the district. The,
infecting patient was removed to hospital on the 5th day, being
detained 38 days or 43 from the onset. The onset of the Return
casc was 26 days from the discharge of the presumed infecting
case, who however had appeared healthy. with normal mucosa
and giving a negative swab.
Death Rate.
15 deaths, 7 male and 8 female, occurred from Diphtheria
in the course of the year. Of these 3 were laryngeal cases. Two
other children died, having had croup following measles. The
case mortality is under 7%. 8 of the cases were admitted
to hospital on or after the 4th day from the alleged onset.
8 died within a short period after admission.
Schick Testing and Immunisation.
No children have been Schick tested or immunised.
Bacteriological Examination.
497 swabs were examined during the year at the Essex
County Public Health Laboratories.
Schools and Diphtheria.
On only one occasion did school attendance appear to
have any effect on the dissemination of infection. This was
an Infants School of the old type of building from which 4
scholars were notified in the course of a few days. the school
was run as two separate classes, though mixed for some pur poses.
J'"' seating accommodation was of benches in front of long
desk All four cases were from one class, from the register
was found that one boy had been absent recently with a
septic throat " and another with a " poisoned stomach. these
two on examination were found to have typical blood stained
nasal discharge with excoriation. Examination of the children
showed another boy with a patch on his tonsils. These three
children were excluded. The nasal cases both subsequently
gave positive swabs. No other children were swabbed, nor
were the premises disinfected. One case occurred subsequent
to the removal of these two nasal carriers, but proved to be a
home contact of one of them.