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Diphtheria "Carriers."—Ten persons were found on examination
to have positive swabs but without any clinical evidence
of diphtheria. With an increasing number of persons becoming
artificially immunised, it becomes more and more important
carefully to investigate the significance in each case of a positive
swab. Where, as in this district, a practice is made of securing
swabs of the home contacts of every case of diphtheria, it is inevitable
that many immunised children will be swabbed and a certain
proportion will probably be found to have positive swabs without
suffering from the illness. This is one type of " carrier," but
there is another which is more difficult to identify and that is the
one which carries diphtheria whilst suffering from another infection.
A striking instance of this occurred during the year. Two sisters,
both of whom had been immunised 12 months previously, developed
sore throats. The doctor in attendance, in view of the fact that
the brother had suffered from diphtheria a year before, swabbed
both patients and the result in both cases was returned as positive.
They were admitted to isolation hospital and a third child in the
home, without symptoms, was then swabbed and also found to be
positive. She too was admitted to hospital. The two immunised
patients with sore throats each presented a typical clinical picture
of follicular tonsillitis and had no evidence of diphtheria other than
the positive swab. Had the investigation been left at that stage
it would have been difficult to maintain the view which was formed,
that these cases, while carrying diphtheria bacilli, were not suffering
from the disease but from a follicular tonsillitis. However,
further swabs were examined and the diphtheria organisms, again
found, were tested for virulence and in all three cases, the two with
sore throats and the one without symptoms, the bacilli were found
to be non-virulent. Whilst it is an easy matter to assert that
patients with throat infections cannot be suffering from diphtheria
where the organism is shown to be non-virulent, what of the cases
with positive virulent swabs but against which is the clinical evidence
and the fact of immunisation ?
Diphtheria Immunisation.—The number of persons immunised
under the Council's scheme is shown in the tables which
follow :
77