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The following were the methods and results of treatment in various types of carrier:—
(а) Tonsillar—Pure tonsillar carriers occurred in 9 (8.6 per cent.) of the total treated. The
carrier state was terminated by—
Cases.
Removal of tonsils and adenoids 5
„ „ „ and dimol snuff treatment 1
Dimol snuff alone 3
Total 9
The average period of treatment of patients in this category was 4½ weeks.
(б) Nasal—There were 43 purely nasal carriers (41.3 per cent.). Termination of the carrier
state was brought about as follows:—
Cases.
One course of dimol snuff 32
Dimol snuff, douches, etc. 6
Dimol snuff and operative measures 5
Total 43
An average period of treatment of just over 4 weeks was necessary for these nasal carriers.
(c) Combined tonsillar and nasal carriers—In 49 instances (47.1 per cent.) tonsils and nasal
mucosa were the sites of infection. These were successfully treated as follows:—
Cases.
One course of dimol snuff 27
Dimol snuff, douches, etc. 12
Removal of tonsils and adenoids after clearance of nasal infection
by local treatment 10
Total 49
These cases required an average period of treatment of 6 weeks.
(d) Other sites—The middle ear was infected in three cases: in one case alone; in one in
conjunction with the nose; and in one with both nose and throat. Two of the three cases
cleared up after local treatment, but the other (nose, throat and ears) only after removal of
tonsils and adenoids.
As regards the bacteriological standard of cure, six consecutive negative cultures from nose and
throat, taken twice weekly, were required before carriers were discharged from hospital. Three
sets of negative cultures were obtained during treatment and three were required (except after
tonsillectomy) after treatment before release. Thus a minimum course of treatment lasted for
10 days if the response was immediate. The average time for any one course of treatment was
14 days. The longest period of treatment found necessary for any one case was 15 weeks and
the average period for the 104 carriers treated was just over 5 weeks. There was no failure to
clear a carrier ; in 22 cases some operative procedure upon the nose and throat was necessary
before a cure could be effected.
Prophylactic
inoculation
of nurses
and
domestic
staff.
Following on his reports referred to in the annual reports for 1931, 1932 and
1933, the medical superintendent of the North-Western hospital (Dr. Joe) states
that immunisation against diphtheria was continued as in previous years in the
nursing staff, all entrants, to the number of 89, being Schick-tested. Of these 55
were Schick negative and 34 Schick positive, the latter being given two injections of
formol toxoid. Twenty-eight were completely protected, 5 left during the course of immunisation,
and in 1 case immunisation had not been completed at the end of the year.
In addition the immunisation of 7 nurses still undergoing the course of injections at
the end of 1933 was finished. In the latter year the number of protective inoculations
was reduced from 3 to 2, the interval between being increased to 4 weeks.
The results of this method have proved highly satisfactory during 1934, 92.5 per
cent. becoming immune 4 weeks after the second injection as against 73.3 per cent.
immune 4 weeks after the third injection of the former course, in which the interval
between inoculations was 2 weeks. During 1934 only one day's duty was lost as
a result of immunisation. Observations were continued on the reliability of the
Maloney test by Dr. R. Swyer, and a detailed account of these will probably be
published, but the general conclusions were that whilst a positive Maloney test
almost invariably meant that the reactor was sensitive to toxoid injections, a
negative reaction did not mean that the possessor would be free from reactions
during the course of immunisation. During the year one nurse lost 32 days' duty