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not fall on stony ground. In a few weeks we get the sequel—another
child from the same house is notified, infected from the recent case—
the germ having come to the surface of the tonsil. Another kind of
carrier falls to be mentioned. From 3 to 8 per cent. of children harbour
the germ in their fauces or nares; the germ is quiescent or weak, it
does not set up Diphtheria. But if that child is run down or receives
another kind of germ into its throat somehow, this germ number two
may light up or activate the Diphtheria germ, and then the grey, or
whiteish-yellow false membrane of true Diphtheria appears, and trouble
ensues. Schools have been blamed, but after all, children are only in
school for five hours and are under discipline. None the less, be it
noted that as soon as the schools close down for two or three weeks
holiday, the incidence of all infectious disease falls. Of what use is
swabbing ? If a doctor sees a sore throat in a child, he should do two
things and not take risks. He should swab the throat and give antidiphtheritic
serum at once. A negative swab is of little help in diagnosis.
Even if the throat clears up in a day or two and proves to have been a
simple tonsillitis, no harm has been done in giving the serum. If the
case actually turns out to be a true Diphtheria, then the child is saved
by this prompt administration of serum. Would to God that this
prompt administration of serum were always done.
Swabbing is of great use in doubtful cases; it is also of use when
Diphtheria keeps raising its head amongst children, for thus a carrier
may be detected. Swabbing as a routine measure amongst contacts is
a waste of money. It is justified only when there is evidence for its
use. During the last few years, I have examined upwards of 80 per
cent. of the contacts of Diphtheria cases and from time to time have
detected a clinical case or a carrier, but on the whole my efforts have
failed. Taking London as a whole, the disease is increasing in incidence.
During the five years 1921-1925, there were 65,000 notified cases of
Diphtheria and close on 4,000 deaths. 82 per cent. of notified cases,
and 97 per cent. of deaths occurred in children under 15 years of age.
In 1923 there were 10,301 cases, and in 1926, 13,574; fortunately,
however, the number of deaths has decreased, and this I believe to be
due to the earlier administration of anti-diphtheritic serum and to the fact
that we have taught parents in Infant Welfare Clinics and in the
Schools, to make a point of examining children's throats always when
they are ailing ; thus commencing cases of Diphtheria have been nipped