View report page

25
A recrudence occurred in October, and on November 1st, aN
examination of the children in the school was made. As a
result of the bacteriological examination four were found to be
harbouring the germs of Diphtheria.
These latent cases of diphtheria constantly crop up, and their
detection and mode of dealing with them give rise to continual
misunderstandings and complaints.
Before the specific Bacillus was discovered, it was known
that persons who had recovered from recognisable Diphtheria,
gave rise to the disease in others, though a considerable time
had elapsed since all symptoms had disappeared in the original
sufferers. It was also recognised clinically that persons who had
not themselves suffered from recognisable Diphtheria, but who
had recently recovered from a sore throat were liable to give
Diphtheria to others. Moreover, it is not only during
convalescence from Diphtheria and after slight attacks of sore
throat that the bacillus may be present, but also after contact or
association with Diphtheria patients, both adults and children are
liable to harbour the bacillus in the throat, even when no local
constitutional disorder of any kind has been noticed.
These phenomena have become the best known facts of
bacteriology, which are of practical every-day interest, and at the
same time one of the chief bugbears of general practitioners and
Medical Officers of Health.
It is with the second and third aspects of the question that
we are now concerned. The number of return cases of
Diphtheria is probably now reduced to a very low figure, as a
negative result is almost invariably obtained before the patient is
pronounced free from infection.
The question may be approached from three stand points, the
clinical, the bacteriological, and the administrative. From a
public health point of view the administrative is, of course, the
most important, but administrative measures should be based,
upon clinical and bacteriological experience.