An outbreak of diphtheria in a hospital for the mentally subnormal

An account is given of two separate outbreaks of diphtheria amongst mentally subnormal patients and nursing staff. In a total hospital population of about 1000 the number of people involved as carriers or cases was 60 and there were five deaths. The 60 people comprised 56 patients, of whom four were involved in both outbreaks, and four nurses. The organisms isolated were C. diphtheriae mitis but five strains were non-toxigenic. It is postulated that the outbreak began following the conversion of a non-toxigenic organism to a toxigenic one by bacteriophage action. The fatal cases were examples of membranous pharyngo-laryngo-tracheo-bronchial diphtheria with well marked pseudo-casts of the upper air passages.