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INFECTIOUS DISEASES
Diphtheria
The outbreakof di P h theria which occurred from December
1960 to January 1961 was fully discussed in the annual
report lor 1960; I am, however, indebted to Dr. B.H. Pentney
for the following notes on the outbreak from the general
practitioners' point of view:-
The outbreak of diphtheria in Camberwell presented
features of particular interest. It was centred around one
primary school. In all, thirty-eight patients had positive
throat swabs. Of these 13 were clinical cases of the disease
and 25 were carriers. One general practice was concerned
with nine clinical cases and seventeen carriers All cases
occurred in children between the ages of five and nine years
There was one death - a girl of eight years who had not
been immunised.
As a clinical type the disease was mainly tonsillar
coimiencing insidiously, there being no complaint of severe
sore throat or pain. In the early stages the tonsils showed
some swelling with a smooth patch of deposit on the mucosa.
In most cases this was ivory white with a fine red margin
Later this membrane appeared thicker and of creamy colour -
well defined. It was not frequently seen to have spread
to the soft palate. In a later stage all showed congestion
and oedema, and in some cases this was most marked. The
lymph nodes were always palpable in the early stage, and
later became swollen remarkably quickly; this sudden enlargement
was on some occasions the presenting feature.
In no case was there noted the characteristic foetor. There
was always a raised temperature, and in some cases this
was quite high.
In general practice the throat and nose were swabbed,
and the case notified to the local public health authorities
and admitted to hospital. Contacts were also swabbed.
The first case arousing suspicion was diagnosed on
the 17th December, 1960, and admitted to hospital; two days
later it was transferred to the Infectious Disease Centre
at Hither Green.
On the 20th December, 1960 the first clinical case
was diagnosed and admitted direct to the same hospital
The absence of notorious and characteristic features un-