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73
"carrier" cases are capable at times of conveying diphtheria to
others susceptible to the disease. Were it not for the course
taken in connection with these cases, it would have been impossible
to have stamped out the outbreak, and the result, too, might
have proved of far greater danger to the lives of the patients
and nurses at the infirmary.
It is a well-known fact that Diphtheria varies, as is the case
with other diseases (e.g., Scarlet Fever), in severity of type from
the mild, clinically unrecognisable to the most severe. The clinically
obvious attack presents little difficulty in diagnosis, but this
is not the case when the well-known local lesions characteristic
of the disease are absent, or present in such slight degree as to
give rise to considerable doubt as to their nature. Again, it has to
be borne in mind that there is no relation between severity of clinical
symptoms and the local (throat) lesions, or vice versa. The only
certain test to employ, therefore, is the bacteriological, and in all
"suspects" and in the case of contacts the only safe course to
pursue is to apply this' method as a routine aid to diagnosis.
Especially is this procedure to be carried out in outbreaks such as
this, with the rigid enforcement of immediate isolation in
all cases in which the bacillus is found on bacteriological examination
of the secretions from the nose or throat of persons, whether
clinical symptoms be present or not. It has been over and over
again established beyond doubt that outbreaks of diphtheria have
occurred through the fact that these clinically-mild cases and cases
presenting no symptoms have been overlooked often with disastrous
results, so far as the danger to life is concerned.
The outbreak at the Infirmary was characterised by the large
number of mild cases, and of cases presenting no clinical symptoms
of the disease. The specific organism or true Klebs-Loeffler
bacillus was, however, found to be present in the secretions from
the oral or nasal (or both) passages of all the 76 cases notified.
The patients, according to the severity of type, may be classified
as follows:—
1. Those with clinical symptoms of the disease (more
or less severe), showing evidence of the Klebs-Loeffler
bacillus on bacteriological examination.