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daily saline douche, combined with monthly packs on three consecutive nights, has been found
to be the best. Iodoform gauze is used, the object of the pack being to clear away the scabs.
After treatment the patient is again inspected, and sent to the bacteriological department, and
ultimately discharged when two negative reports are obtained. Should the case still be positive
the inoculation department is then called in to help.

Dr. A. B. Porteous who has charge of the diphtheria "carrier" clinic at
St. Mary's hospital, Paddington, reports as follows:—
17 cases (including one adult) were referred to the clinic during 1931.
In all cases nose and throat were swabbed and examined in the routine way. One case
was reported to be carrying K.L.B. in the ear, but this proved to be avirulent.
Of these cases, on first examination, eight were negative in both nose arid throat ; five had (?)
K.L.B. in nose only; three had (?) K.L.B. in both nose and throat; one had (?) K.L.B. in throat
only.
Several of these cases cleared up almost at once on local treatment before virulence tests were
done.
Virulence tests were done in six cases (subcutaneous method), and three proved to be virulent.
In two cases, carrying suspicious organisms in both nose and throat, it is interesting to note that
the nose organism in both was virulent, but that that isolated from the throat gave a negative
virulence test.
Treatment.—Local douches of 5 per cent, salt solution, of Pulv. Chlor. Co. one drachm to
the half-pint of water have been used to clear up nasal soreness, etc., Pulv. Chlor. Co. is as
follows:—
Sodii Bicarb one drm.
Boracis „ „
Sodii Chlor. „ „
Sacchari two drms.
Vaccines.—Autogenous vaccines were used in the proved virulent cases and stock vaccines
were used as a routine until the former were available or proved to be unnecessary.
The dose of vaccine has been weekly starting at five million and this year no dose has been
given higher than 15 million K.L.B. There is a tendency for local necrosis to occur at the site
of inoculation with strong diphtheria vaccines. Cases have been few, but I believe that theee
vaccines are of very definite use in clearing up carriers. Close co-operation is necessary with
the nose and throat specialist to clcar away spurs, etc., which harbour sepsis in the nose, or to
eradicate persistently infected tonsils. Three cases of chronic rhinorrhoea were found in the
throat department of the hospital to be really carriers and were referred to this department for
treatment.
One case was interesting in that it carried virulent bacilli in the nose for three months. The
nose was treated by the throat department but still the infection persisted. This child was
then treated by the local medical officer of health in the anti-diphtheria clinic with toxoid-antitoxin
mixture, the usual three injections. (Schick test was not done unfortunately.) The nose
was found to be clear a fortnight later, and has remained so.
The great importance of nasal infection over tonsillar infection is again illustrated in this
year's results.
Clinic at
St. Mary's
hospital.