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APPENDIX
A DIPHTHERIA OUTBREAK
Not so long ago diphtheria was a prevalent killer disease but
nowadays it tends to produce local epidemic outbursts only. Such
outbreaks can be troublesome to control because of the presence of
human chronic carriers, themselves immune to the disease, who act
as reservoirs of infection to the susceptible young members of the
community.
The local epidemic now described occurred in Barking, Essex,
during September and October, 1958.
On the morning of 30th September, 1958, the Health Department
was notified by a local isolation hospital that a diagnosis of
diphtheria had been arrived at in the case of two Barking infant
school children.
The following details were obtained.
Case I. boy of 7 years, fifth in a family of eight children was
taken ill on: urn from school on 19th September. He was treated
at home as a case of tonsillitis for four days and received antibiotic
therapy, but failed to make a good response and on 24th September
he was admitted to an Isolation Hospital. Routine nose and
throat swabs on admission failed to reveal the presence of C.
diphtheriae. He appeared to be making satisfactory progress during
the next few days, when on 29th September he became pale, lethargic
and collapsed with an irregular pulse and marked electrocardiographic
abnormalities. The diagnosis of diphtheria was now made on clinical
grounds in the absence of laboratory confirmation. This boy died on
September 30th.
Case II. A girl of six years, a close friend and classmate of
Case I, and fourth in a family of seven children, was taken ill with
we throat on 25th September, and was seen and treated for tonsillitis
with antibotics on 27th September. She was admitted to hospital
on 29th September where she was found to be very ill, with " bull
neck," pharyngeal exudate, and cardiac involvement. An E.C.G.
showed Bundle Branch Block. Diphtheria was diagnosed immediately
and anti-toxin administered, together with cortisone therapy. This
child was extremely ill for some days but eventually recovered. No
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