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1928]
46
"BACTERIOLOGICAL" DIPHTHERIA.
Early in 1928 a letter was received from the Medical Officer of Health of a
Rural District in Middlesex. A visitor from Islington had stayed in the district
for a week end with her child. This child had recovered some considerable time
from Diphtheria, after treatment in hospital and afterwards had been in a convalescent
home. He had also been at home after convalescence a considerable
period. No children had apparently been infected from him since his return to
the household, at home, or among his companions. Still, there was a shrewd
suspicion that he was the cause of the Diphtheria cases in the country household,
who were relatives. The Medical Officer of Health had this child's throat swab
examined, with negative results, but not being satisfied with the one examination,
later had another swab taken and examined, which was positive, and this was
further confirmed by being tested for toxicity, the guinea pig dying in five days.
The circumstances of this country visit to relatives was particualrly sad, as
one of he two children who contracted the disease died. It also is interesting,
as it gives an example of what has been known in recent years, namely, that town
children owing to their contact with other children in schools and crowded
assemblies, acquire through contact with infectious cases a degree of immunity
which the country child does not possess. Briefly this may be stated thus, that
the town child requires a fair amount of contact and a fair dose of infection to
acquire Diphtheria, whereas the country child is peculiarly susceptible to the least
infection. This infectivity I have referred to being thus proved by the toxicity
test, had to be specially dealt with. The District School Attendance Officer in
Islington, knowing the circumstances of the case from our reports, took a keen
interest in the child, and he was sent to a special clinic at Guy's Hospital which
had been established for the purpose of giving special treatment to clear up these
carriers.

*2 not tested for Pathogenicity