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53. Tlie increase of cases is largely due to the increased use
of bacteriology and consequent discovery of mild cases or
"carriers" without any symptoms. The importance of this means
t>f discovering the infection is shown by the following incident.
A child in Stanley House had Diphtheria before the Christmas
Holidays; after the holidays another case occurred in the same
block, and it was found that a sister of the first case, with nasal
catarrh, was acting as a "carrier," and had, doubtless, infected
the second case.
The Medical Officers of the Royal Arsenal examined employees
from infected houses before allowing them to return to work, and
discovered several bacteriological carrier cases. Altogether, 73
cases, found to be "carriers" of the Diphtheria bacillus, without
having any symptoms, were notified. Three cases were reported
as nasal.
In addition to the notified cases, a number of bacteriological
cases were discovered by myself and were not notified, but
isolation precautions were advised and carried out at home.
54. Mistaken diagnosis. 31 cases, or 8 per cent, of notifications,
after removal to hospital, were stated not to be diphtheria.
The percentage in the three preceding years was 12, 7, and 7
55. Source of Infection. In 160 cases a probable source of
infection was noted, viz., in 87, other inmates of the same houses
were considered the source; 51 were attributed to school
infection : 8 to infection by neighbours and friends ; 5 were
" return cases," and 2 infected while travelling ; 4 were infected
at a general hospital, and 4 in barracks.
An undiscovered case of nasal diphtheria was the cause of
infecting five other persons in Frith's Buildings and Lorne
Ten-ace before the true nature of the disease was detected and the
patient isolated. Another child died suddenly without medical