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26
eventually minimising the disease. I refer to the Schick test. Below
I explain this test once again. May it be that this long drawn out
anxiety—the hopeless attempt to prevent Diphtheria—will be alleviated
by the grant of permission to perform the test described.
The causes of Diphtheria as I found them this winter are:—
overcrowding; lack of cleanliness; carriers; lack of food. Diphtheria
is caused by a germ which is actually sometimes present in the persons
throat and nose without causing any harm; in such a state the germ is
avirulent—more or less harmless. Something then happens to induce
the germ to become virulent. The individual's resistance it may be
becomes lowered. Mentally depressed through want of work, herded
together with others in the family, poorly fed, sometimes dirty in
personal habits, it is easy to see how propinquity leads to interchange of
germs from throat to throat; the avirulent germ is stirred up to activity
by some germ so transmitted and the soil (throat and health generally)
being weak, the now virulent germ proceeds to form membrane.
The patient is sent off to hospital and contacts are examined and
given antiseptics. Now the difficulty with regard to throat swabbing
is this: if one swabbed a contact's throat on Monday, the result might
be negative. Swabbed again the next day the result might be positive.
Again swabbed on Wednesday the result is negative again. It simply
comes to this, that swabbing is of limited value, and the reason is that
whereas one day the germ may be accessible, on the next it may be
buried in some of the crypts and lacunae of the tonsils. Where we
found the germ present, a positive swab, the case could not be sent to
hospital unless there were signs that the child had membraneous,
clinical diphtheria. It is true that I have sent cases into hospital when
I felt that such a "positive" throat was the cause in a family of
other cases, but the infectious disease hospitals have surely more to do
than receive cases in which there is nothing to be seen in a throat. If
a contact is found to have a positive swab and yet presents no clinical
evidence of the disease, the only means of determining whether the case
should be sent into hospital is by inoculating a guinea pig with an
emulsified growth of the germ. If this proves the germ to be malignant,
the case should be sent into hospital.
With my experience of diphtheria in 1925 in my mind, I have no
hesitation in saying that whereas there may be a fall in the incidence of
the disease in this, that, or the other year, the Borough will continue to
be scourged from time to time with this disease, which it is clearly