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29
If a history of a previous sore throat in the family be
obtained, the doctor in attendance is communicated with, and
either he is asked to take a swab, or permission is obtained
to take one. When two or more cases are notified from one
class-room in a school, attention is paid to that class and if that
class or department is suspected to be the focus of infection, the
scholars are examined, and where necessary a swab is taken of
the throat or nose.
In some districts the taking of swabs is practised to a far
greater extent, and occasionally every member of a household
where a case of Diphtheria has occurred is swabbed.
A certain proportion of those who are brought into contact
with Diphtheria patients harbour the bacilli in their throats or
nasal cavities. The percentage is highest in the immediate
contacts, that is, in members of the same family; next, in classmates
at school; it diminishes rapidly as we enlarge the
interpretation so as to include such extremely remote contacts as
the general inhabitants, and the percentage showing the bacilli
is a negligible one.
Theoretically, the swabbing of all contacts seems an ideal
system, but it would be impossible under present conditions to
carry out such a practice here. Moreover, the practice adopted
in this district has been sufficient to prevent the spread of the
disease in the different schools.
It has been reported, on several occasions, how the detection
of carrier cases has coincided with the subsidence of the
notifications from different schools.
When necessary, some of the children are excluded pending
the result of the bacteriological examination, but sometimes it is
impracticable to take a swab. It is at this stage that misunderstandings
occur and difficulties arise. Occasionally it is
understood that the child will be seen by a private doctor, when
as a matter of fact a doctor is not called in. At other times,
the child is taken to see a doctor, who pronounces the case not