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after treatment, 6 left school or refused further treatment and 1 case was still under
treatment at the end of the year. The operation for tonsillectomy was performed
in five of the positive cases ; six (nasal cases) received vaccine treatment.
The clinic at St. Mary's Hospital dealt with 22 cases. Five of these were
discharged after negative virulence tests were obtained. Stock vaccine was used
in six cases. The period of treatment averaged 5 weeks, and with the exception of
two children, who ceased to attend the clinic, all the cases were discharged by the end
of the year.
Dr. John Eyre, who is in charge of the clinic at Guy's Hospital, has submitted
the following summary of the work done during 1930 :—
" The routine work of the clinic during this, its fourth year, has been continued
as originally planned with very few and then only trivial modifications.
" The results of our examination of the new cases seen during the year are
summarised as follows :—
Total number of new cases 79
Organism isolated :—
("Virulent 21)
K.L.B. Non-virulent 5 30
Not tested 4
B. Hoffmanni 28
Nil (no diphtheroids detected) 21
"The nose continues to be recorded as by far the commonest site of persistent
residence both for the Klebs Loeffler Bacillus and the Bacillus Hoffmanni.
"Compared with previous years we note that although the total numbers are
smaller there is a greatly increased percentage of virulent over non-virulent amongst
the strains of diphtheria bacilli isolated from these carriers.
"Once more we must emphasise the insufficiency of one routine swab as a means
of detection of carriers. It still frequently happens that cases, in which the first
smears made from 24-hour inspissated serum slopes after no matter how careful
a search fail to disclose any K.L.B., show a few colonies of that organism when
plated upon a selective medium. (In this connection it may be noted that the
selective medium described by Allison and Aylings has been tried out during the
year, but the results obtained have not been such as would warrant its substitution
for the Douglas's differential medium—which latter continues to be the medium we
employ for the isolation of B. diphtheriae.)
"Those cases showing a paucity of K.L.B., although probably of little present
danger to others, may upon the development of some intercurrent catarrh proceed
to expel much larger numbers of diphtheria bacilli and thus immediately become
dangerous to those in their immediate neighbourhood.
"This point is brought forward, not to encourage an elaborate but possible
remedy by repeated swabbings,but to emphasize one of the reasons for our continued
pessimism that this procedure can ever become more than an inefficient partial
means of controlling diphtheria in the London County Council schools.
"Treatment has in the main been purely local and upon general lines. Nine
cases, however, were treated by vaccine therapy with good effect. For the persistent
carriers with negative nasal swabbings tonsillectomy is still practised and during
1930 was carried out upon four cases; these cases have never yet failed to clear
rapidly.
"From the individual case records we may quote one which illustrates a not
infrequent, but often unsuspected, factor in the 'carrier' condition.
"E.V. female cet. 7.— In September, 1929, an elder sister was taken away with
diphtheria. The patient (E.V.) was subsequently swabbed and the nose was found
to contain K.L.B.—virulence test positive.
"As repeated swabs were positive the patient was admitted to the local hospital
where various gargles and other forms of local treatment were used. On one occasion
even the throat was ' scraped.' At the end of twelve months the child was still a
carrier and was sent to this clinic. In the course of the routine examination a