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60. Return Gases of Diphtheria are now quite exceptional,
as it is I believe the rule at the Brook Hospital not to discharge
cases till they are found free from the bacilli. Last year
however, there were six cases in one family in which infection
followed the return home of a child with a nasal discharge,
which was found to contain diphtheria bacilli. This child
though sent to Hospital for Diphtheria, was found not to have
that disease, but to have Measles on admission, and was
separately treated in an isolation Ward. The nasal discharge
apparently acted as a carrier of the diphtheria bacilli, which
gained access in spite of the precautions taken.
Another case developed Diphtheria a few days after the
return of a brother from Hospital on recovery from Scarlet
Fever. In his case however, a bacteriological examination
failed to detect the Diphtheria bacilli.
61. The value of Hospital Isolation in Diphtheria is
decidedly greater and more general than in Scarlet Fever.
The injection of antitoxin and the performance of tracheotomy
in laryngeal cases, are operations which can usually be much
more safely performed in a well equipped Hospital than in the
patient's home. Further, the practice of examining all cases
bacteriologically before the discharge obviates the occurrence of
return cases, as pointed out above, so that Hospital isolation
can only exceptionally be held responsible for any spread of
infection.
Enteric Fever.
62. There were 37 cases of Enteric Fever, (excluding 5
found not to be Enteric after observation in Hospital), giving
a case rate of 0.34, compared with 0.59, 0.58, and 0.40 in the
three preceding years. This is the lowest rate recorded. The
London case rate was 0.51.