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1921
11
of Health, it is stated that the notification of cases of Diphtheria
under the Infectious Diseases (Notification) Acts should be limited
to persons actually suffering from Diphtheria, i.e., those exhibiting
clinical signs of the disease, with or without bacteriological evidence
of the presence of diphtheria bacilli. In the practice of some districts
and of many medical practitioners, including, often, the medical
officers of hospitals and residential schools, notification is frequently
extended to include diphtheria carriers who themselves present no
signs of illness. It is doubtful if this practice is justifiable. Statistically,
it leads to much confusion ; indeed, comparisons between
diphtheria notification rates in different areas and in different parts
of the country have for some years been rendered very unreliable
by reason of uncertainty in this respect. Administratively, the
effect may be equally unsatisfactory. The healthy carrier, as a result
of his notification as a victim of diphtheria is removed to hospital
where he may stay to the exclusion of persons urgently requiring
treatment.
The foregoing remarks were written by a very eminent
epidemiologist, but in practice the problem is a much more difficult
one. The cases are not limited to the well-marked, easily recognised,
clinical types, and the healthy contact or carrier who exhibits
none of the symptoms of the disease. It is obviously unnecessary
for the medical attendant to swab all the inmates of an infected
house, and notify all those who give positive results, and the doctors
who follow this practice must be few and far between. Many
authorities now swab as a routine the school contacts from an infected
house, and the difficulty arises when a decision has to be made
when a positive swab has been obtained. Some of the positive
contacts have not exhibited any of the symptoms of the disease,
but in others a previous history of sore throat can be obtained. It
is not always easy to obtain a correct history and it is frequently
difficult to decide to what extent must the symptoms develop before
it is decided that the case is one of clinical diphtheria. You can have
all gradations between the healthy carrier and the severe clinical
case. I have seen cases admitted to the hospital with perfectly
clean throats, and one is apt to assume that the cases have been sent
in simply as a result of the bacteriological examination, but in rare
cases these have developed paralysis of some groups of muscles.
In this district the danger of over-notification is at present
practically non-existent. I have frequently seen examples of the
danger attaching to delay in treatment. Even in severe cases,
the disease had existed for some days untreated, and almost invariably
these were the ones that resulted in death. In others,