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to 24 per cent., were notified as diphtheria when diphtheria in my opinion
was absent clinically and bacteriologically.
on
was absent clinically and bacteriologically.
(d.) That a certain number of cases (14 per cent.) were doubtful,
considered either from a clinical or bacteriological point of view, and sometimes
from both these standpoints.
As regards (c) there were no further cases notified from any of the
houses except one; in this case the second notification was of a lad in the
same house, and as the second patient was not removed to hospital there
was no confirmation of the diagnosis.
Concerning the seven cases in which either or both of us were in
doubt, there was only one case notified again, and it was a supposed
second attack. This time, however, there was no doubt either in the mind
of Dr. Bousfield or in my own that it was not a case of diphtheria.
This inquiry has again brought out the fact, noticed previously in
America, that the bacilli may be present in a throat which appears
perfectly healthy, and a large field for investigation is therefore opened up
as to the date when persons who have suffered from diphtheria can be
pronounced free from infective power, for it is well known that the bacilli
are present in the throat of a person who has suffered from this illness
after all its signs have long since disappeared.
The advantages of calling in the aid of bacteriological examination
are that in cases which are doubtful on clinical examination, the doubt is
confirmed or dispelled by the further investigation, and I am enabled
either to allow children to re-attend school at a much earlier date than I
otherwise should have felt justified in doing, or on the other hand to insist
on strict precautions against the spread of infection.
We have also been able to render disinfection and the possible
stripping of rooms unnecessary.
If the Committee should consider the results commensurate with
the cost, I recommend that the following course of action be adopted:-
That the Vestry arrange for the bacteriological examination of specimens
taken from the throats of persons supposed to have diphtheria, either by
myself or by the doctors in attendance and to be forwarded by me for
examination.
The medical practitioner, if a wish has been expressed by him, has
been informed of the result of the case. In no case have we requested the
notification to be withdrawn. —Yours faithfully,
FRANCIS STEVENS, Medical Officer of Health.
On account of this report and a letter at the same time
from Dr. Bousfield, they decided to appoint him Bacteriologist
to the Vestry. It is unnecessary for me to point out the
advantages that may be obtained from this appointment, not
only in the way of diphtheria, but also many other diseases in
which a bacteriological confirmation of the diagnosis is
occasionally of great advantage to the public health.
xvi.