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Diphtheria belongs to a large category of diseases which are disseminated from
person to person through the medium of the respiratory channels, that is, in the act
of coughing, sneezing, talking, etc. It is rarely, if ever, conveyed by means of
fomites or inanimate objects. The part played by non-infected contacts, school
rooms, books, desks, etc., is so slight that it can be disregarded. These facts are
borne out in recent studies on the subject of disinfection and confirmed in the Board
of Education's recent publication relating to school books.
The three principal sources of the spread of diphtheria therefore are :—
(1) Persons suffering from the disease.
(2) Persons who have recovered from the disease and for some reason
retain the infection, or in whom the infection recurs. There is frequently some
abnormality of the throat or nose to explain these cases.
(3) So-called healthy carriers who may have suffered from a transient sore
throat or tonsilitis, or may be immune persons who harbour the germs.
The carrier problem has for years taxed the resources of public health
authorities, especially the school medical service. During the investigation of
outbreaks of diphtheria among children in the schools large numbers of children
are bacteriologically examined and at times as many as 10 per cent, of swabs
examined in connection with these enquiries are found to be carrying germs, indistinguishable
under the microscope from diphtheria bacilli, in the nose or throat and
occasionally the ear. Some of these micro-organisms, however, while resembling
in all respects diphtheria germs, are found on further tests to be non-virulent. They
do no harm, and children in whom they are discovered are readmitted to school.
The percentage of non-virulent carriers varies according to the season, environment
and prevalence of clinical dinhtheria.
Diphtheria
carrier
clinicB.
Children harbouring true diphtheria germs without any symptoms of diphtheria,
however, present serious difficulties. The isolation hospital, which is intended
for treatment of the sick, is not the right place for the healthy carrier, although
when they are taken to a private doctor they are frequently notified as cases of
diphtheria and removed to hospital, only to be discharged in a short while to their
families and social life where they are liable to spread the disease all over again.
In fact some of these carriers have previously been in hospital as cases of clinical
diphtheria.
A certain percentage of "carriers" quickly lose their capacity for harbouring
the germs, whilst others remain obstinate to treatment for long periods. It has
for years been evident to medical officers engaged upon epidemiological work that
the reason for this persistence in carrying diphtheria micro-organisms must be
looked for in some abnormality of the throat and nose as has already been pointed out.
It was for this reason that the suggestion was made in November, 1926, that
a special clinic should be established for such cases at Guy's Hospital.
A provisional start had actually been made in July, 1926, as a result of conversations
between the medical staff of the Council and Guy's Hospital. The difficulties
which had been experienced in dealing with these cases was quickly appreciated
by Mr. Eason, the medical superintendent, and he accordingly called in Mr. Layton,
the throat surgeon, and Prof. Eyre, the bacteriologist, to the informal discussions,
in order to explore the possibilities of setting up a special clinic, attached to the
hospital, for the treatment of individual cases and the study of the causation and
cure of the " carrier " condition generally. It was accordingly arranged that cases
should be dealt with weekly on Wednesday afternoons, and Messrs. L. W. and R. J.
Cann were appointed to carry out the work under the direction of Mr. Layton
and Prof. Eyre, and they have given practically the whole time to the work for the
last 2½ years. Although the clinic was primarily established to deal with school
children referred for treatment by the School Medical Officer, it was realised that
children under school age also required to be dealt with, inasmuch as they played