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41
in the four preceding years. A certificate of efficient home
isolation was given in 1 case (8 in 1905, 21 in 1906, 30 in
1907, 7 in 1908, and 1 in 1909).
The case mortality was 3.4 per cent., compared with 6.6,
5.7, 6.3, 5.5, and 10.4, in the five preceding years, and
8 0 in London.
In 5 cases there were no throat symptoms, 4 had discharge
or soreness of the nose, and 1 had otorrhoea (running at
the ear).
Such cases rarely have medical attendance, and would
escape detection if other cases in the family or school did
not lead to a search for the source of infection. It is mainly
mild cases of nasal diphtheria or children with other nasal
affections, acting as carriers, who prevent the abolition of
this disease.
Owing to the occurrence of several cases at Purrett Road
School, a medical examination of the children in certain
classes was made and one child detected with nasal diphtheria,
and two who had diphtheria bacilli in their throats,
but with no symptoms of illness. Healthy children acting as
carriers of this disease were also found at Plum Lane, High
Street, and Earl Street Schools.
If the Diphtheria death-rate which prevailed from 18961900
had been in operation last year, there would have been
60 deaths from this disease last year instead of 5, the actual
number.
51. Bacteriology is now systematically used to prevent
children attending London County Schools in an infectious
state. After a case has been notified in a house, no children