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54
Owing to the degree of accuracy which has now been secured by bacteriologists in the diagnosis
of diphtheria, it is customary to take a throat swab for bacteriological examination in all suspicious
cases, and for some years past the Council have paid for such examinations performed at the Lister
Institute on behalf of Kensington patients.
Sterile swabs are obtained from the Town Hall, and, in order to reduce the interval which
occurs from the time the doctor takes the swab to the time he obtains the result, arrangements
have been made for medical men to leave inoculated swabs at the Kensington Tuberculosis
Dispensary, 119, Ladbroke Grove, before 3.30 p.m., or at the Town Hall, before 4 p.m., on any day
(Saturdays, Sundays and Bank Holidays excepted.) Swabs so left are collected by one of the
Council's messengers, who delivers them at the Lister Institute before 5 p.m. on the same day, and
the results are telephoned to the doctors on the following morning. On Saturdays, Sundays and
Bank Holidays medical men can send swabs direct to the Lister Institute before 5 p.m. and obtain
an equally speedy result.
During the year 1,110 throat swabs were examined at the Lister Institute at the expense of
the Council, and of these 105 gave a positive diphtheria result.
It is well established that outbreaks of diphtheria may originate from persons who have the
germs of the disease in the throat or nose, but show no signs of illness. Such persons are called
" carriers " and with a view to discovering the possible existence of any of these in connection with
limited outbreaks where the source of infection was unknown, a number of throat and nose swabs
were taken by medical men at my request and by myself. These swabs are included in the 1,110
referred to above. In a number of cases germs of diphtheria were discovered ; but germs so found
in apparently healthy throats or noses may be of a virulent type (capable of conveying diphtheria
infection to other persons) or of an avirulent type (incapable of conveying diphtheria infection to
other persons), therefore it is necessary to ascertain the particular type of organism present before
submitting the patient to prolonged isolation and treatment.
A further examination revealed that the organism was virulent in three cases. One of the
virulent "carriers" was a case of considerable interest. The original discovery was made during
an investigation in a boarding-house in November, 1924, following the notification and removal to
hospital of a member of the household who had fallen ill with diphtheria. The "carrier" was also
sent to hospital where she remained until January 1st, 1925, when all evidence that she was infectious
had disappeared. Two members of the same household fell ill with diphtheria a few days after
her return home and were removed to hospital. The original "carrier" was re-examined and again
found to have virulent germs of diphtheria in her throat. She was removed to hospital and
remained in some months on this occasion, but returned home during the Summer. Towards the
end of the year two further cases were traced to the original "carrier" who, on re-examination,
was again found to have in her throat virulent germs of diphtheria. She was removed to hospital
where she remained until the end of the year.
The second virulent "carrier" was revealed towards the end of the year. A boy went to the
South-west of England for Christmas and on arrival he was found to be suffering from diphtheria.
It was obvious that the boy had contracted the infection before he left Kensington and a careful
search was made for the source of infection. It was discovered that he had been in recent contact
for a few days with a Kensington relation who had been discharged from a fever hospital in the
North of England in the Autumn. An examination of the throat of this relative revealed the
presence of virulent diphtheria germs, with the result that she was carefully isolated for many
weeks, during which various applications to her throat were made for the purpose of destroying
all organisms present. The relative is now free from infection.
In the third case, a maid in a Day Nursery was removed to hospital on February 24th. With
a view to tracing the source of infection every child in the Nursery was examined and all the
children's homes were visited, but without success. On March 27th, a midwife in the same district
was removed to hospital with diphtheria. It was then discovered that the midwife and maid had
lived in the same house and a visit revealed that a domestic servant engaged thereat had a na al
discharge, which proved to be chronic nasal diphtheria. She was removed to hospital and no
further cases developed.
These cases demonstrate that careful investigations for the source of infection have from time
to time well repaid the labour undertaken, for they enable persons in an infective condition who are
quite innocent of the fact to be isolated. Doubtless many a localised outbreak can be terminated
in this way.
Under the Anti-toxin Order, 1910, Local Authorities are empowered to supply diphtheria
anti-toxin for administration to patients who are too poor to pay, and on signing the necessary
declaration that the patient cannot afford specific treatment, a medical man can obtain a free
supply from Mr. Worsley, Chemist, at No. 135, Ladbroke Grove, W. 11, or from the Public Health
Department at the Town Hall. The anti-toxin is obtainable at all hours of the day and night