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homes each patient gave rise to one infection, the onset of the
secondary case being the day of the removal of the primary case
in one instance, and five days later in the other.
In two homes cases of diphtheria occurred shortly after the
return home of a patient discharged after being in hospital for
the treatment of scarlet fever.
Two patients were bacteriological cases occurring after the
removal of tonsils and adenoids.
Ten patients were suffering only from nasal diphtheria.
Place of Treatment.
Most cases were admitted for treatment at the Rayners Lane
Isolation Hospital. Towards the end of the year even an average
of three cases per week over six weeks was too much for the
accommodation available and patients were admitted to the
hospitals of other authorities. During the year nine patients were
admitted to the isolation hospitals of the London County Council,
four being removed as in-patients and five as out-patients of general
hospitals in London.
Deaths.
Four deaths were recorded as due to diphtheria. In one,
the child admitted on account of diphtheria died shortly after
admission from tetany. Another patient was admitted on the
seventh day of illness suffering from hsemorrhagic diphtheria.
Delay occurred in another instance, the patient not being admitted
until the eighth day of disease. One patient admitted on the
third day appeared to be attacked by a virulent strain, two other
children in the same class being affected about the same time,
but fortunately recovered.
Bacteriological Examinations.
1,963 nose and throat swabs were examined for Klebs-Loeffler
bacilli at the Rayners Lane Isolation Hospital during the year
and a few at the laboratories of the Clinical Research Association.
Immunization.
The same arrangements were continued as in previous years
by which immunization against diphtheria was carried out by the
patients' own medical attendants, T.A.M. being used as the antigen,
three doses being given at two or three weeks' interval. 226
children completed the course of injections and a further 8 received
one or more doses after Schick testing had proved them to be still
susceptible after they had received a previous course. Of the 118
children Schick tested subsequent to the course of inoculations,
9 were found to re-act positively.
Of recent years much publicity has been given to the one-shot
method. In the case of the earlier preparations injections were