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Death occurred in eight cases, five from the Girls' Department,
two from the Infants' and one from the Boys'. The day of illness
on which death occurred was as early as the third in two cases,
and as late as the forty-sixth and forty-seventh in two other cases.
I have said above that the very great severity of the majority
of the cases suggested that the disease was of the "gravis" type,
but bacteriological investigation did not altogether confirm this.
Swabs taken from the throat or nose were positive in practically
every case, and in about a third of the cases, including all the most
severe cases, swabs were sent to Dr. W. M. Scott, of the Ministry
of Health, for determination of the type of organism. In the early
cases Dr. Scott found that the organism did not conform altogether
either to the "mitis" or to the "gravis" type as usually described.
In formation of colonies it had the characteristics of the "mitis"
type, while in the fermentation tests it conformed to the "gravis"
type. Previous examples of this new mixed type had been found
on two occasions in the north of England, but not in the London
area. Cultures from some of the later cases in the outbreak were
reported by Dr. Scott to be definitely "gravis'' in type, a finding
which was altogether in keeping with the clinical features of the
disease.
Of the 56 cases connected with this outbreak 8 occurred in
children who had previously been given full courses of protective
injections against diphtheria. Two of the eight had been immunised
five years previously, four two years, and one sixteen
months previously. All these had been Schick tested subsequently
to immunisation and were found to be Schick negative. In the
eighth case the course of injections had been completed only seven
months before the onset of the disease, but as the child had not
been brought for the subsequent Schick test there was no information
available as to whether she was Schick negative or not.
It has to be admitted that these figures are rather disconcerting.
It is not surprising perhaps that after five years an immunity which
had been conferred by artificial means should have passed off in
two cases, when we remember that even a severe attack of diphtheria
does not always confer lasting immunity, so that second attacks
of the disease are commonly met with. The fact, however, that
children immunised as recently as two years or even sixteen months
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