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severity—from the very slightest (if any) departure from normal
health, with no characteristic local lesion, to the well-known
typical manifestations and symptoms of the disease in its acute,
severest form, with (or without) characteristic local lesion. There
is no correspondence between (a) severity of clinical symptoms
and virulence of infection, or between (b) virulence of infection
and special morphological type of diphtheria bacilli. Whilst
occasionally, very rarely, the true virulent Klebs-Lœffler diphtheria
bacilli may be found in the throat or nose of a person in normal
health, and who has not been in known contact with diphtheria,
it is generally agreed that their presence in the throats and noses
of children (who are always, more or less, susceptible), when
aggregated together—more especially with diphtheria about—
calls for strict attention, e.g., in the way of isolation, disinfection,
and other preventive measures. Indeed, the infectivity of
what are known as "latent" (i.e., symptomless) forms of
diphtheria is one of the most troublesome things to deal with,
and the safest line of action is to strictly isolate, &c., not only
all patients, who show in their throats or noses (or both) "true"
or "real" diphtheria bacilli, but also all contact or suspect
patients (especially children), who show in their throats or noses
(or both) "doubtful" or "suspicious" diphtheria bacilli, during
the prevalence of a genuine diphtheria outbreak or epidemic.
These latter patients may prove to be sources of infection as well
as the former. All "latent" forms of disease are important, and
have proved specially so in connection with the outbreak of
diphtheria, and pseudo-diphtheria at the Norwood Schools.
Clinical diphtheria as it is sometimes seen (e.g., high temperature,
swollen throat, discharging nose, the presence of membrane,
&c.), can be readily diagnosed by a mere tyro in medicine,
but "latent" diphtheria (e.g., with few, if any, clinical
symptoms, but with simply the diphtheria bacilli in the throat or
nose, or both) can only be diagnosed by bacteriological examination.
Between these two types, there are many intermediate
gradations.
The clinical symptoms found in the 64 Norwood Schools
diphtheria patients varied from the usual severe ones to a slight
redness or catarrh of the nose or fauces or both; whilst, in some
few cases, there was, apparently, an entire absence of any such
clinical symptoms. The true Klebs-Lœffler bacilli were found
in the throat or nose (or both), on bacteriological examination,
of all the 64 notified diptheria patients, either before or after
their removals to hospital.
The patients may be classified as follows:—