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1920
38
The risk of these carriers varies enormously, and it is impossible
to decide clinically or bacteriologieally what danger is attached to
them. Even injections into guinea-pigs does not seem to clear up
all the difficulties. The natural answer to the question of what
constitutes a dangerous carrier is, that a person harbouring virulent
bacilli, as tested by a guinea-pig inoculation is a dangerous carrier.
But even here we are on uncertain ground, for it is an acknowledged
fact that the virulence of the organism may wax and wane, and in
time it may become non-virulent. It is also possible that a strain
found non-virulent may later assume virulent characters.
Again, it appears possible for even a strain virulent to the
guinea-pig to have a very low virulence towards human beings.
The procedure adopted here has been to exclude from school
those contacts in which the Klebs Loeffler Bacillus is found in the
throat.
The children found harbouring the Klebs Loeffler Bacillus
in the school belong usually to two categories. In one category
are the children where a positive swab is obtained, but no clinical
symptoms have appeared; usually, though, a history of slight sore
throat is given when children are found to be harbouring the diphtheria
bacillus and attending school.
In the Southfield Infants' Department 11 swabs were taken
of children attending school who had suffered recently from a sore
throat, and 3 of these were found to be cases of diphtheria. In
view of these circumstances it was deemed advisable to swab all
the children in certain classes. In the first instance 13 swabs
were taken and 3 were positive. This particular class was closed
for a fortnight; when it was re-opened the whole class was again
examined. Altogether 76 swabs were taken, and 13 were positive.
On enquiry it was elicited that most of these children
had suffered from a slight sore throat, so that these children really
came under the category of missed or mild cases, and not carrier
cases. But the same difficulty confronts us in the treatment of
these cases. The parents do not welcome the suggestion that these
children should be isolated in the fever hospital, and it is certain
that sufficient precautions are not taken to isolate them at home.
Some of the cases are undoubtedly virulent. One instance
may be given. A child was found in school harbouring the germs
of diphtheria. A history of slight sore throat was obtainable,
but the parents did not believe that the child had suffered from
diphtheria. He was allowed to sleep with an elder brother. In
about a week's time this brother was notified as suffering from
diphtheria, and he exhibited undoubted clinical symptoms of the
disease. Shortly after, a smaller child, too young to attend school,