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as a result of mild faucial diphtheria. She had been found Schick negative 16
months previously after 3 injections of formol toxoid, but on being warded with
diphtheria was found to be pseudo-positive. No antitoxin was given, her throat
cleared up in about 24 hours, and no sequelae occurred. The strain of C. diphtheriæ
isolated by Dr. Mair was reported as a non-fermenter of starch and corresponded
to the mitis type of the Leeds workers. Another case was also a mild faucial
diphtheria in a ward sister who had been protected in 1926 and found Schick
negative. She left the hospital but returned in 1931, and on retest was found
Schick positive. She then received two doses of alum toxoid and was afterwards
Schick negative. On complaining of sore throat she was examined and the
appearance of typical membrane was not in doubt, but on being Schick-tested she
was again Schick negative. A virulent strain of a starch fermenting diphtheria
bacillus was found in the throat, corresponding to the gravis type of the Leeds
workers, and 20,000 units of antitoxin given. The membrane disappeared in the
course of a few days, and the main feature of the subsequent course of the illness
was severe serum sickness which resulted in a loss of 55 days' duty. Another nurse
came under observation as a possible case of diphtheria, and although virulent
K.L.B. were cultured from her throat the clinical appearances were equivocal, her
Schick test was negative, and a final diagnosis of catarrhal sore throat in a diphtheria
carrier was made.
At the Brook hospital seven nurses contracted diphtheria during the year.
Five of the seven nurses had been only partially immunised, two because they had
refused to complete the course of injections, and the other three (probationer nurses)
because their courses of injections had not been completed owing to the fact that
they had not been long enough at the hospital. The remaining two were not Schick
negative and in each case the diagnosis of clinical diphtheria was doubtful. One
of them did not receive antitoxin.
Half way through the year, active immunisation was offered to the domestic
staff at the Brook hospital, and all but a few have now been Schick-tested and
immunised. Alum precipitated toxoid (Mulford's) has been used and the results
have been as follows:—
Cases Schick-tested. Schick negative. Schick positive.
77 61 16
Of the 16 positive cases, 14 received one injection of alum precipitated toxoid. Of
these 11 were negative when Schick-tested six weeks later, one was positive but
became negative after a further five weeks, one was positive and re-inoculated.
She became negative four months later. One was faint positive but was negative
on retest two months later.
The probable explanation of the high percentage of Schick negative reactors
amongst the domestic staff is the fact that there had been comparatively few
changes in the personnel, the majority having been on the staff for a long time.
They thus had had time to acquire a degree of immunity by constant contact with
infection.
An investigation was made at the North-Eastern hospital by Dr. N. Begg,
senior assistant medical officer, in conjunction with Dr. W. Mair, assistant director
of research and pathological services, of the Northern group laboratory, in an
attempt to assess the incidence of streptococcal and diphtheria carriers amongst
the nursing staff.
Incidence
of carriers
amongst
nursing
staff.
For this purpose the staff were divided into two main classes : (a) permanent
staff with at least three months service who were known or assumed to be immune
to scarlet fever and diphtheria, and (b) new candidates. It is convenient to
describe these two classes separately.
Field examination of permanent staff.—In all 173 members of the nursing staff
were examined, these included 21 sisters, 82 staff nurses and 70 probationer nurses.
The examination consisted of a swab from nose and throat for hsemolytic streptococci
and a corresponding examination for diphtheria bacilli. Two such