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Cases of mistaken diagnosis are not excluded from the above Table.
Thirty-six cases notified as suffering from diphtheria were found after admission to hospital
not to be suffering from any infectious disease at all, with the result that they were returned home.
The number of Kensington deaths was eleven, representing a case mortality of 3 per cent.
In the three preceding years, the deaths were 15, 10 and 22.
Ten patients developed diphtheria within twenty-eight days of a member of the household
returning from a fever hospital after having been treated for this disease. In one instance, the
original case was proved to be responsible for three secondary or "return cases"; and in another
instance, the original case was responsible for one "return case," who in turn was responsible for
two further cases; in the remaining four "return cases" there was no direct evidence that infection
was contracted from the primary patients who had returned from hospital.
During the year 1,688 throat swabs were examined at the Lister Institute at the expense of
the Council, and of these 196 gave a positive diphtheria result.
It is well established that outbreaks of diphtheria may originate from persons who have the
germs of the disease in the throat or nose, but show no signs of illness. Such persons are called
" carriers " and with a view to discovering the possible existence of any of these in connection with
limited outbreaks where the source of infection was unknown, a number of throat and nose swabs
were taken by medical men at my request or by myself. These swabs are included in the 1,688
referred to above. In a number of cases germs of diphtheria were discovered ; but germs so found
in apparently healthy throats or noses may be of a virulent type (capable of conveying diphtheria
infection to other persons) or of an avirulent type (incapable of conveying diphtheria infection to
other persons), therefore it is necessary to ascertain the particular type of organism present before
submitting the patient to prolonged isolation and treatment.
In the last four months of the year, twenty-four cases occurred in one of the elementary schools in
the Borough. The outbreak commenced on the 20th September when one case was reported. On the
23rd September there were two cases, another on the 26th September and another on the 29th September.
Most of these cases were detected by the taking of swabs from all those children in the school
whose throats were unhealthy in appearance In view of the repeated discovery of cases by swab
examination, it was decided to take swabs from the throats of every child in the school and in this
way six cases of mild diphtheria were discovered on the 30th September. One of these six was a
child who had entered the school that term for the first time and from the first day the teacher
noticed that she seemed to have some difficulty in breathing through her nose. This child was
found to have slight nasal discharge and the bacteriological examination showed that she had
diphtheria germs in both the nose and throat. Curiously enough, she had been absent from school
on those sessions when the previous medical examinations had been made. These six cases were
removed to hospital and, although further swabbing was undertaken and careful medical examinations
made from time to time, no other cases occurred for a fortnight. It was thus presumed that
the child with the "stuffy" nose had been responsible for the outbreak. Four cases occurred
towards the end of October and the remainder during November and December. Most of these
cases were detected as a result of bacteriological examinations of swabs taken from the throats and
were not serious. It is probable that the cases occurring in October, November and December had
been contracted from some child who had been infected by the child with the "stuffy" nose, but
whose infective condition had remained undetected. Indeed, one of the cases discovered in October
or November may have been a previously undetected infective child.
This outbreak serves as a very excellent example of the way in which an epidemic can sometimes
be cut short and rendered almost free from danger by repeated medical inspections and
careful bacteriological examinations. Out of the twenty-four cases, only two or three were seriously