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15
I have noticed in a few cases a peculiar mode of onset. I have
notes of three; where children were suddenly taken ill with
vomiting, drowsiness and high temperature. An inspection of throat
and nose carefully made from day to day failed to reveal any
Diphtheretic deposit up to the third day, when the membrane appeared
on the Tonsils and the temperature fell to normal. The occurrence of
the disease in previously infected houses has caused us to regard all
convalascences from Diphtheria with the greatest suspicion.
I regard three weeks from the commencement of the disease as the
minimum time for isolation. Before this period at least has elapsed, a
child should not be allowed to mix with his companions, and much less
attend school. Whether the attack has been slight or severe makes
no matter; the same causes have been at work. And although in
slight cases the manifestations of the disease may have entirely passed
away, yet microscopic examination of the secretions of the mouth have
shown that even up to 5 weeks after the membrane had completely
disappeared, the microbe of the disease was found in the mouth.
Dr. Herman Biggs, Bacteriologist to the city of New York,
subjected the secretions of the mouth of 405 cases of true Diphtheria
to repeated Bacteriological examination during convalascence, and he
found that the microbe persisted in the mouth for a considerable time
after all objective signs of the disease had disappeared.
In 254 cases (60.5 per cent.) microbes persisted for 3 days after
complete separation of the false
membrane.
„ 103 „ (25.4 „ „ ) „ „ 7 days
„ 34 ,, ( 8.4 „ „ ) ,, „ 12 ,,
„ 16 „ (4 „ „ ) „ „ ,,
„ „ 4 „ ( 1 „ „) „ „ 21 „
„ 3 „ ( .75 ,, „ ) „ ,, 35 ,,
Such results from a competent Authority suggest danger in the
mixing of convalescents with healthy people, unless a prolonged
quarantine has been enforced, for not only are they capable of
spreading the disease, but of conveying it in a far more serious form
than that from which they have recovered.
Scarlet Fever.
By far the larger number of the cases of Scarlet Fever occurred
during the earlier months of the year, only nine having been notified
during the last six months of the year.
In all the latter cases it appeared fairly clear that infection was
contracted outside the District. The outbreak upon which I reported
last year virtually ended in July.
Systematic medical inspection of the scholars attending schools in
the affected area, for a period of 3 months, proved very efficacious in
in stamping out the disease, as all suspicious cases were excluded from
School Attendance.