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15
Tolworth Hospital. One case was rapidly fatal, the child
dying before she could be removed to hospital. None of
the cases had been immunised. Six suspected cases were
sent to hospital and were afterwards discharged as not
so suffering. There was a considerably greater tendency
for multiple cases to occur in the same household than
with scarlet fever. Groups of four, three, three, and two,
respectively, occurred, the remainder being single cases.
Fifteen carriers were treated in hospital. These were
contacts who, on routine investigations being made after
the notification of a case of diphtheria, were discovered
to be harbouring diphtheria bacilli in the nose or throat.
The majority of them, although apparently in satisfactory
general health, showed an unhealthy condition of the nose
which was very evident on inspection. This type of
carrier is, in my view, the most dangerous and is capable
of giving rise to infinite trouble. This was well exemplified
on two occasions. On one occasion the notification of
a case of diphtheria led to the examination of the child's
class contacts at school. A carrier of this type was discovered
and she was immediately removed, but she had
already infected three other children. In the other
example, an outbreak arose as the result of the introduction
of a nasal carrier into a Home for young children.
This child gave rise to three clinical cases and a widespread
carrier condition among the children who
remained healthy.
The following statistics refer to immunisation carried
out during the year. The scheme is still carried out on the
lines described in my Annual Report for 1935, but toxoid
antitoxin floccules in three doses of 1 cc. have now been
substituted for toxoid antitoxin mixture, and, in the case
of children under eight years of age, alum precipitated
toxoid in two doses of .2 cc. and .5cc. respectively are
given.