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persons are known as "carriers" and harbour
diphtheria bacilli in the nose, throat, or even the
ear. As already stated, clinical signs (e.g., sore
throat or obvious nasal discharge) such as would
justify the notification of the case as diphtheria,
are absent, and diphtheria carriers are not notifiable
and are not treated as in-patients in infectious
disease hospitals. They require a different type
of treatment. Carrier clinics have now been
established in Guy's Hospital, St. Mary's Hospital
and in the London Hospital.
The carrier condition may last for a short time
only, but it may last also for prolonged periods.
During the investigation of outbreaks of diphtheria
among children in schools the Public Health
Department of the London County Council ascertained,
on swabbing large numbers of children,
that over 3 per cent. of the swabs examined were
carrying germs indistinguishable from diphtheria
bacilli. Some of the bacilli were found on further
tests (inoculation into guinea-pigs) to be nonvirulent,
that is to say they were innocuous to
the child carrying them and did not spread
diphtheria. Children harbouring true diphtheria
bacilli (true carriers), however, as stated by Sir
Frederick Menzies in his reports, present a serious
problem.
Frequently when enlarged tonsils and adenoids
are removed and diseased conditions or abnormalities
(deflected septum) in the nasal passages are
treated on the recommendation of the physicians
at the carrier clinics, the carrier condition disappears.
In addition to the routine use of mild
nasal douches and surgical measures, vaccines
have been employed at weekly intervals in carrier
cases.
Inanimate objects, called fomites, with which
diphtheria patients have been in contact are of
secondary importance as regards the spread of