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to be Diphtheria, without a bacteriological examination. This
only occurs in some of the. schools, but the incidence of
Diphtheria is heaviest on those particular schools.
Having discovered the carrier case, to what extent should
isolation be carried out ? In this respect, the practice of
different sanitary authorities differs considerably. Some
authorities observe the same rigid rules as in the case of clinical
Diphtheria, and advise the removal to hospital, whilst others
refuse to admit the carrier cases to the general wards.
In Cambridge the Sanitary authority has furnished a house
for the reception of carrier cases.
In this district, we do not advise the removal to Hospital,
except under very exceptional conditions. There seems no risk
to the carrier cases themselves in being mixed with ordinary
clinical Diphtheria. Although the nature of the immunity is
obscure, yet, for the time being, it seems to be absolute, and
there is no record of a carrier case exhibiting clinical symptoms
in a general Diphtheria Ward. Nevertheless, it is safe to relax
and modify somewhat the isolation rules practised in clinical
Diphtheria. So long as the carrier case does not come into
immediate contact with children, the risk is practically nil.
There is no record of indirect infection through clothing, &c.,
from a carrier case.
The carrier case himself, of course, is excluded from school,
and so are all the children of the family. The period of
exclusion extends until two negative swabs are obtained.
The other children are allowed to attend school in eight
days after a negative result, and the carrier case in three weeks.
The movements of the other inmates of the house are not
interfered with, except in very exceptional circumstances. The
Public Libary is communicated with, and during quarantine
books are not given out to members of the family.