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49
To deal with 1933 in more detail, the investigation of the 129 new cases led to their separation
into four groups instead of the three previously set out in these reports:—Group 1, comprising
those from whom morphologically typical K.L.B. were isolated; Group 2, diphtheroids of
doubtful morphology; Group 3, Hoffmann's bacilli; and Group 4, those in whom no diphtheroids
could be detected ; as follows :—
Group 1—K.L.B. present. Virulent—throat 8, throat and nose 2, nose 10, total 20
(including 4 cases diagnosed as nasal diphtheria).
Non-virulent—throat 5, throat and nose 3, nose 9, total 17.
Not tested—throat 2, throat and nose 1, nose 8, total 11 (including 3 definite and 3
probable cases of nasal diphtheria).
Group 2—Diptheroids of doubtful morphology 11. Virulence test on 8 strains—all
negative.
Group 3—B. Hoffmanni. No K.L.B. throat 1, throat and nose 3, nose 23, total 27.
Virulence test on 7 strains—all negative.
Group 4—No K.L.B. or other diphtheroids detected 43.
It will be noted that in connection with 11 of the strains of K.L.B., virulence tests were
omitted. This was due to: (1) the assumption of virulence in seven cases of nasal diphtheria
diagnosed on clinical grounds, and confirmed by the isolation of K.L.B. strains of typical
morphology, (2) a break in routine owing to absence through illness of the bacteriologist.
The methods of treatment set out in previous reports have now become routine measures.
Four tonsillar cases that failed to clear had tonsillectomies performed, with successful results.
Seven cases of frank nasal diphtheria and three "probable" cases were either sent to a fever
hospital or advised as to home isolation. The remainder have been treated by local application,
etc., depending upon the lesions present, and, with the one exception referred to below, ceased
to "carry" virulent K.L.B. within two months of the first attendance. Those cases with definite
looal lesions but not harbouring K.L.B. were advised and directed as to further action, but
were discharged from this clinic as fit for school.
As usual, there have been a number of cases of atrophic rhinitis. When possible these
have been given intensive local treatment whilst attending this clinic, and upon discharge
advised to attend at some other suitable clinic.
The only case (referred to above) which has continued to carry virulent K.L.B. after attendance
and treatment for two months was also a patient with atrophic rhinitis. The K.L.B. which
appeared in the cultures was apparently of an attenuated virulence as three different cultures
tested by subcutaneous inoculation killed the experimental animal in five, eight and fourteen
days, respectively. When the last of these animals died it was thought unlikely that death
was due to a K.L.B. infection, but at the post-mortem examination a local indurated lesion was
still present, and from it K.L.B. was recovered in pure culture. No macroscopical haemorrhages
could be found in the suprarenals. A second animal inoculated subcutaneously with this
" passage " culture died within forty-eight hours with extensive local oedema and all the typical
appearances of K.L.B. infection.
Dr. A. B. Porteous, who is in charge of the clinic at St. Mary's hospital, has
submitted the following report:—
During the year 1933, 22 cases were referred to the diphtheria carrier clinic of St. Mary's
hospital.
With the exception of two adults aged 40 and 20 years respectively, who were referred here
direct by St. Mary's hospital, their ages ranged from 4 to 13 years—17 being sent through the
Council, and three from various medical officers of health.
Of these 22 cases, 9 proved to be consistently negative from their first visit.
6 had organisms suspicious of K.L.B. in nose only.
3 „ ,, ,, ,, ,, in throat only.
4 „ ,, ,, „ „ in both nose and throat.
Virulence tests were carried out in nine cases—four being positive. One case had to be
sent to a fever hospital. Two cases would not clear until their tonsils were removed.
Autogenous vaccines were made in four cases—and these all cleared up with doses ranging
from 5 to 20 millions, the treatment lasting from 7 to 12 weeks. In four other cases stock vaccines
were used.
Four of these patients had had diphtheria previously, but in only one of these was the more
recently isolated organism found to be virulent.
Active
immunisation
against
diphtheria.
Clinics for Schick-testing and active immunisation against diphtheria have
been established by some of the metropolitan borough councils, and are at present
open in 14 boroughs. In order that every encouragement should be given to parents
to take their children to these clinics, it was decided, after consultation with the
Board of Education and the Metropolitan Society of Medical Officers of Health, that
attendances at the centres for this purpose should be recognised as equivalent to
school attendance under similar conditions to those applicable to attendance at
school treatment and bathing centres.