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43
The carrier condition was originally detected in swabs taken in the following circumstances:—
Routine examination before going to a convalescent home 13
Diphtheria contact at school 7
Recent diphtheria 5
Diphtheria contact at home 4
Nasal discharge 4
Tonsilitis 1
After arrival at the clinic the following results were obtained:—
In 14 cases (41 per cent.) three consecutive swabs of nose and throat taken at weekly
intervals failed to show the presence of K.L.B.
In 3 cases the K.L.B. found was shown to be of a non-virulent variety.
In 17 cases (50 per cent.) the K.L.B. present was virulent and the distribution of cases
according to the site of the K.L.B. was as follows:—
Tonsils and nose 4
Tonsils only 6
Nose only 7
With the exception of one carrier (non-virulent K.L.B.), all cases yielded to the appropriate
treatment and were discharged after three consecutive swabbings had failed to show the presence
of the diphtheria bacillus.
During the above investigations and treatment the following bacteriological examinations
were found necessary:—244 swabs taken and cultured; 23 virulence tests.
Dr. A. B. Porteous, who is in charge of the clinic at St. Mary's hospital,
Paddington, has submitted the following report:—
During the year, 28 cases were referred to St. Mary's hospital diphtheria carrier clinic,
compared with 36 in the previous year. Of these, 2 were adults and the remainder were children
of ages ranging from 13 months to 13 years.
Only 3 of these cases had previously had diphtheria, and 2 were contacts of diphtheria; the
rest were so-called carriers, found whilst being swabbed previous to going to convalescent homes,
or detected in schools.
At the outset I should state that 18 of these cases were found consistently negative from
the first examination. This means probably that the so-called K.L.B. reported was only present
for a very short time, or else the diagnosis of K.L.B. was made too readily. In this regard it
should be also stated that all these 18 cases had been reported as carrying the germ in the nose
only.
The technique at the clinic has been to plant the swabs directly from the patient on to
inspissated serum. Where so-called positives are obtained, these are subcultured on to tellurite
plates in order to obtain pure cultures, thence they are again planted on serum and made into
vaccines, or used for virulence tests.
It has been found necessary to perform virulence tests in respect of only 5 of the cases, and
all of these were negative.
Active
immunisation
against
diphtheria.
Facilities for Schick-testing and immunisation against diphtheria were provided
by four more metropolitan boroughs during the year, making a total of 22 boroughs
in which this work is now carried out at the infant welfare or special centres, or by
special arrangement with medical practitioners.
The Council has assisted in propaganda in connection with this work by
authorising the use of the school organisation for the distribution of leaflets issued
by the Borough Councils.
A reference to the Schick-testing and active immunisation against diphtheria
of children in the Council's residential schools and homes appears later in this section
of the report.
Passive
immunisation
against
scarlet fever
and
diphtheria.
Cyril Henry
treatment
centre.
Reference has been made in previous annual reports to the practice which has
been adopted at the Cyril Henry treatment centre of passively immunising children
against scarlet fever and diphtheria with a combined antitoxin consisting of
streptococcus and diphtheria antitoxins before tonsil and adenoid operations, with
a view to the prevention of the occurrence of those diseases after the operations are
performed. The practice was continued during 1935. Parental consent is obtained
in each case. During the year the following modifications were introduced :
(a) if a further operation became necessary after the lapse of an interval of 3 weeks
the antitoxin was again administered; (b) the antitoxin was given in cases in which
there was a previous history of scarlet fever or diphtheria attack.
The following report on the results of the scheme has been received from Dr.
H. R. Kidner, divisional medical officer:—
The surgeons concerned agreed to inject even when there was a previous history of an
attack of scarlet fever or diphtheria or a previous pre-operation injection.