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These reports have for a number of years contained accounts of the evidence which London
affords of the spread of diphtheria from one person to another by means of intermediary persons, who,
although infective, are not themselves suffering from symptoms of the disease. In 1902 Dr. Brown,
Medical Officer of Health of Bermondsey, made bacteriological examination of material from the throats
of 259 persons of school age living in houses in which cases of diphtheria had occurred, and in 32, or
12.4 per cent., found the Klebs-Loeffler bacillus. The parents of these were informed that their child
harboured diphtheria bacilli in its throat, and were advised to keep the child under the close observation
of their medical attendant, and 16 of these later developed the clinical symptoms of diphtheria and
were removed to hospital. "By this method," Dr. Brown states, "there is no doubt that the 16 cases
notified were placed under treatment, and isolated much earlier than they would otherwise have been."
In 1903 he examined material from the throats of 193 "contacts" in 64 families, and found that of this
number 20 had diphtheria bacilli in their throats, and he states that 3 of the 20 subsequently developed
sore throats and were notified as suffering from diphtheria. In his annual report for the year 1904,
Dr. Brown states that he has continued to examine material from the throats of persons in contact with
cases of diphtheria, and that in 1904 the number of contacts examined for the purpose of determining
whether they should attend school was 145, being members of 60 families. of this number 12 had
diphtheria bacilli in their throats, and of these 4 subsequently showed symptoms of diphtheria and
were removed to hospital. One contact, whose examination gave a negative result, was subsequently
removed to hospital with laryngeal diphtheria. "The bacilli were evidently confined at the time of
the examination to the larynx, which cannot be reached by the ordinary throat swab."
Dr. Brown makes it his practice to examine the children at the Town Hall in the second week
after removal to hospital of the original case of diphtheria. If no diphtheria bacilli are found, the head
master of the school and the parents are informed that the "contact" may return to school, but if
diphtheria bacilli are found the head master is requested to exclude the child from school till
further examination. The parents are also advised to take the child to their medical attendant for
direct throat treatment. Only after subsequent examination of the throat at a fortnight's interval, and
when the throat is found free of diphtheria bacilli, is the child allowed to return to school.
So, again, Dr. Newman, the Medical Officer of Health of Finsbury, in discussing the part played
by "carrier" cases in communicating disease, writes: "To discover such cases and prevent them
infecting their neighbours is the business of preventive medicine. In accordance with this view we
have in a number of cases made bacteriological examination of the throats of 'contact' persons." He
gives account of a family attacked with diphtheria, some members of which, while harbouring the
diphtheria bacillus in their throat, were not received into hospital, and he writes : "Probably it is desirable
that the Metropolitan Asylum Board's hospitals should not admit as cases of diphtheria persons who,
though they may have the bacillus in their throats, are not suffering from the clinical symptoms of the
disease. But it will be evident that these persons are yet a danger to the community, and are in my
opinion one of the chief causes of the spread of the disease in Finsbury. What is to be done with them?
I think they should be isolated as much as practicable at home, and kept from school and their
neighbours ; and also direct throat treatment should be adopted with a view of clearing their throats
of the infective bacillus; and if any throat symptoms occur in addition to the presence of the bacillus,
they should not only be notified, but admitted to hospital, and not discharged until it has been
bacteriologically demonstrated that their throats are clear."
The annual report of Dr. Kerr (See Appendix III.) contains accounts of the finding of " carrier "
cases among the children attending numerous schools invaded by diphtheria, and the exclusion of
which was attended by the termination of the outbreak. The need for careful inquiry for "carriers"
among all "contacts" with cases of diphtheria, both in the home and in the school, is very obvious.
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