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A "return" case may be defined as one which occurs within
28 days after the release of the original case from isolation. The
persistence or recurrence of mucous discharges from the nose or
ears of the original case is the cause of the spread of the infection.
To avoid the probability of return cases occurring, the women
Inspectors visit the homes of the patients discharged from hospital
and strongly advise, where possible, that he should have a
bedroom to himself for a few weeks. Warning is also given that
should any discharge of the nose or ears occur a doctor's advice
and treatment should be obtained.
An outbreak of diphtheria occurred in an Institution under the
care of the Camberwell Board of Guardians at the end of 1925,
13 cases being notified. The cause of the outbreak was traced to
a carrier of virulent germs of diphtheria.
Although bacteriology is a valuable aid in diagnosing this
disease, there are many factors which may cause the result of
the swab not to be satisfactory.
It cannot be emphasised too strongly that a negative bacteriological
report does not contraindicate a clinical diagnosis of
diphtheria. Conversely, the presence of morphological diphtheria
bacilli does not necessarily imply clinical diphtheria, as the
bacilli, although morphologically K.L.B., may not be of a virulent
strain, and contribute no menace to the public health. Far more
important from the patient's point of view than the swabbing of
the throat is the giving of antitoxin in every suspicious and
clinical case.
The routine swabbing of contacts for the discovery of
"carrier" cases is carried out in Camberwell only amongst
such families where the spread of the disease is suspected to be
due to a "carrier."
It is necessary to discriminate between the dangerous carrier
of virulent bacilli and the harmless bearer of non-virulent
organisms, which can only be done in the laboratory by tests on
guineapigs. The segregation of the virulent carrier is, in my
opinion, necessary. On the other hand, care should be taken for
the prevention of persons harbouring non-virulent organisms
being sent to hospital. It is possible that many such cases are
notified as diphtheria and are sent to hospital, thus occupying
valuable beds needed for more serious cases, and incidentally, of
course, falsifying the statistics of the disease. Fortunately, in
London, notification and removal to hospital follow immediately
in the majority of cases in which diphtheria is suspected.
Prophylaxis of Diphtheria.
The usual administrative measures in dealing with epidemics
of this disease have not in the past given satisfactory results. Consequently,
the work of Schick and others in determining the