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35
Out of the 211 cases, 196 were primary, 13 secondary and 2
were return cases. Each of the secondaries arose from a separate
primary case. In only one case did the onset of the secondary
occur within the 5th day from the onset of the primary. In 3
of the secondary cases the onset was on the 11th, 12th and 16th day
after the removal to hospital of the infecting case. No other cases
were found in the house to suggest a connecting link between the
primary and the secondary case. In cases with such a long incubation
period, the presumption is that the organisms are not sufficient
in the earlier stages to overcome the resistance of the individual,
but probably through some local or general lowering of resistance
they gain the upper hand, the reaction being then demonstrated
by the occurrence of a clinical case of the disease. Of the return
eases, the onset of one was within one week and the other, in the
third week after the discharge from hospital of the infecting case.
No difficulty was experienced during the year in removing
cases to hospital. Four cases remained at home during the entire
course of the illness, at the election of the parent. A few cases were
admitted to the London Countv Council hospitals, these being
children who had attended as Out-Patients at the various London
General Hospitals.
Of the cases, 6 were laryngeal and 10 were nasal without
faueial involvement. There were two cases of double infection, the
concurrent illness in one being smallpox and the other scarlet fever.
Death Rate.
12 deaths (9 male and 3 female) occurred from diphtheria
in the course of the year, being a case mortality of 5.8 per
cent. One of these was a case of laryngeal diphtheria. Two of the
fatal eases were admitted on the third day from the alleged onset,
all the others being the fourth day or after.
Bacteriological Examination.
368 diphtheria swabs were examined during the year at the
Essex County Public Health Laboratories and 373 at the Public
Health Offices.
Schools and Diphtheria.
Schools again appeared to play no part in the dissemination of
this infection. Out of the 196 primary infections, 90 occurred
amongst children attending schools. On two occasions only did
the cases Soccur in the same week in children attending the same
'pavtment, and on three occasions a case occurred in the same
department in two successive weeks. Apart from these instances,
all eases in any one department were separated bv intervals of at
■east one week.
. No schools were closed during the year on account of this
information, and no schools or schoolrooms were fumigated.