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In 122 instances the patient was a school-going child, and in 97 of these the child
had been attending school within one week of the onset of symptoms. In 118 instances,
although the patients themselves were not attending school, there were children,
members of the patients' families, or living under the same roofs, who were attending
school. In a few instances there were reasons for believing that the patients must have
been attending school whilst suffering from the disease before it was recognised to be
diphtheria. In a number of instances insanitary conditions of more or less gravity
were discovered in connection with the houses where the patients dwelt, but the
majority of the houses were in a satisfactory sanitary condition. In 51 instances there
were histories of cases of throat illness in the houses where the patients lived, several of
which were cases of diphtheria.
In connection with the subject of diphtheria, reference may here be made to an
epidemic of throat illness which prevailed amongst the employes of a large business
establishment in the parish from the middle of May to the end of November. The
establishment, which will be alluded to as Messrs. X., gives employment to between
five and six hundred persons from about 14 years of age upwards. About one-fourth
of these live and sleep on the premises, and the remainder elsewhere, but they all have
their meals on the premises. Altogether, 80 cases of throat illness came under observation,
and of these eight were cases of scarlatina. The cases of scarlatina may be briefly
dealt with at once. The first case was certified on June 19. This was followed by six
in July and an eighth on the 4th of August. The history of the last case showed that
the patient, who was an apprentice lad, had about five weeks previously had a "sore
throat," for which he stayed at home for a few days, and then returned to his duties.
He went about his work until August 4th, when he was discovered to be desquamating.
There appears very little doubt that this lad was the source of the infection of the six
cases of scarlatina which occurred during July. He was at once isolated, and no
further cases of scarlatina occurred.
With respect to the 72 cases of throat illness not scarlatina, the first came under
observation on May 15th, and the last on November 29th. They occurred as follows:
2 in May, 5 in June, 19 in July, 13 in August, 10 in September, 16 in October, and 7
in November. Of these 14 were certified to be diphtheria, namely, 2 in May, 3 in
June, 4 in July, 2 in August, 2 in September, and 1 in October. In 23 of the cases
bacteriological examinations were carried out for the medical attendant by the Clinical
Research Association. The results were positive as to the presence of the microorganism
of diphtheria in 7 and negative in 16. In 7 instances the diagnosis was
made from the clinical appearances of the throat. Nearly all the cases of throat illness
were of a mild type. Only one case terminated fatally, that of an apprentice lad who
died from diphtheria in May. The low mortality is probably to be largely accounted
for by the patients being beyond the age of childhood, all being over 14 years of age.