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86
Clinic at
Guy's
hospital.
An attempt has been made to see if differentiation of types of K.L.B. could be made out
in these carriers, as recorded in the Journal of Pathology and Bacteriology (September, 1931)
by Anderson, Happold, McLeod and Thomson. The special tellurite medium described by them
has been tried. It may be said that so far we have been unable to separate definite strains, the
young colonies are usually smooth and look like the "mitis" form. The sugar reactions have
corresponded with this; form starch and glycogen have never been fermented.
The older colonies, however, have grown in radiated forms not unlike those described as
gravis." Hemolysis was slight. This tellurite medium, or that of Allison and Ayling has
proved extremely useful in isolating K.L.B. in dirty cultures and the proportion of virulent
K.L.B. has, since the use of these special media, gone up in relation to the non-virulent varieties.
I believe that this increase is due to the improvement in technique, so that where a slight
infection of K.L.B. is present, we are now able to isolate them more consistently.
Professor John Eyre has submitted the following statement on the work carried
out at the clinic at Guy's hospital:—
During the past year (1931) 70 new cases attended the diphtheria carrier clinic and, upon
investigation, fell into the following groups:—

It is satisfactory to note that by 31st December all these carriers had been discharged as
free from Klebs Loeffler bacilli.
The appropriate oto-naso-laryngological measures obviously indicated by the existence
of some definite pathological state, e.g., atrophic rhinitis, otitis media, etc., have been instituted
in such of the carriers of non-virulent B. diphtheria: as needed them and have proved effective.
Treatment has been continued in those cases carrying virulent K.L.B. upon lines similar
to those in force last year.
(а) It is of interest to note that four cases, in which no abnormality could be found in the
nose or tonsils, became spontaneously free from K.L.B. in about 7-14 days.
(б) Tonsillectomy was performed with success in six cases.
(c) In five cases the "carrier" state was terminated by treatment with local applications
only.
(d) In the two remaining cases vaccine treatment with a stock B. difhtherice vaccine was
combined with local applications with satisfactory results.
Since the inauguration of the clinic in 1926 some 75 carriers of virulent K.L.B. have been
treated during four consecutive weeks by the injection of a "stock" polyvalent K.L.B. vaccine.
A critical study of the results noted sheds no light upon the value of this method of treatment.
There is no evidence of its success that is not open to criticism and it has been decided in
future to discontinue this form of treatment at the clinic.
This opinion, of course, in no way conflicts with the claims put forward to support the
administration of autogenous vaccines made from the organisms secondarily infecting and,
therefore, presumably responsible for the maintenance of lesions in the nose and naso-pharynx.
Such vaccines may assist in removing the nidus of infection, and with it a "home" for the
diphtheria bacillus.
In the detailed report upon the clinic published in 1929, the opinion was expressed that
Schick testing and immunisation held the eventual solution to the problem of diphtheria in the
Council's schools.
A few cases of mild type were notified as a result of the examinations in school
by members of the Council's staff, and a number of children were excluded from school
on account of sore throat, etc. The children in five of the affected schools were kept
under special observation by the nursing staff for periods ranging from two to six
weeks.
Among the 1,452 cases of smallpox notified in London during 1931, there were
604 school children. During the previous year, 1,774 school cases were recorded.
Scarlet fever.
Smallpox
amongst
school
children.