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43 1927
"BACTERIOLOGICAL" DIPHTHERIA.
The difficulties of dealing with children who show that they are harbouring
Diphtheria bacilli, but who may be quite well, was exemplified during the year in
an alleged "epidemic" of Diphtheria at the Claremont Day Nursery, in Finsbury.
A letter was received from the Medical Officer of Health of Finsbury on the 1st
[une stating that the doctor who attended the Claremont Mission had decided
to take swabs from all the children in the creche. The Public Health Departmnt
of Islington did not consider that the financial responsibility for these
swabbings of Islington children in Finsbury lay with them. The nine children,
however, were kept under observation.
On the 13th September the Medical Officer of Health of Finsbury stated that
recently there had been another " epidemic " of Diphtheria amongst the toddlers
attending the creche, but at that time we had knowledge of only one Islington
case.
As regards the occurrence of this "bacteriological" Diphtheria, which might
come under the designation of an "outbreak" (it certainly was not an epidemic),
the first case was said to have been an Islington child, aged 3 years, 10 months,
stated to have been languid on the 11th May. The case was removed to hospital.
This was a verified case of Diphtheria. An alleged second, case on the 15th May,
of the same age, was also removed to hospital, but it was considered to be only
a case of tonsillitis ; the cultures were all negative. This information was furnished
to us by the hospital authorities. Virulence tests were carried out on
such Islington cases as the Islington Medical Officer of Health thought necessary.
The virulence test, although more costly, is of definite value, inasmuch as a
child who shows an alleged positive result may be non-virulent, and therefore noninfective
while in this condition. It has been alleged that occasionally such cases
may become virulent, but as to whether this is a fresh infection or a change in the
bacilli present is a moot point. In any case, if the test shows non-virulence,
one may disregard the bacteria and consider the child safe. It was, therefore,
considered of greater value in Islington to do a few virulence tests. This has
been our practice now for some years. I understand that the outbreak at Claremont
Mission was complicated by a nurse being found to be a carrier in July, as
well as carrier cases among probationers and voluntary workers, in addition to
toddlers, these cases being found in the course of the investigation of the Medical
Officer of Health of Finsbury.
The Ministry of Health some years ago issued among reports on public
health subjects, No. 10 Dr. Copeman's Report on Diphtheria, and Sir George S.
Buchanan, in his preliminary note to this report to the Chief Medical Officer, Sir
George Newman, in November, 1921, then emphasised the futility of notifying
"bacteriological" cases of Diphtheria. The following extract from the Ministry
Report has been circulated by the Islington Health Department for some years
to the medical practitioners of Islington :—
MINISTRY OF HEALTH REPORT ON DIPHTHERIA.
"Notifiable Diphtheria.—The notification of cases of Diphtheria
should be limited to persons actually suffering from Diphtheria, i.e., those
exhibiting clinical signs of the disease, with or without bacteriological
evidence of the presence of Diphtheria bacilli. In the practice of some districts
and of many medical practitioners, including, often, the medical
officers of hospitals and residential schools, notification is frequently extended
to include Diphtheria carriers who themselves present no signs of illness. It