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15
Diphtheria:—The incidence of this disease was high in
January and February, fell in March, rose again in May, and
dropped to low figures in June and July. It rose again in
September, was high throughout October and November and
fell in December to an average figure.
Amongst diphtheria patients there are some who carry
the micro-organism of the disease an inordinately long time.
There is now sufficient evidence to show that vaccine treatment
with the dead organism is valuable in dealing with
these cases. Vaccine emulsion is kept on hand for the use of
the medical practitioners of the district.
The spread of diphtheria is favoured by overcrowding,
faulty ventilation, dirty and damp houses. Children under 15
are most susceptible. When a child gets a sore throat and fever
it should be placed in a room by itself and a physician called.
Delay breeds danger. The attack may occur two to four days
after exposure, sometimes only twelve hours. School children
should be taught not to use each others things—books,
pencils, etc. Immediate isolation of the patient followed by
disinfection of his surroundings are of the greatest importance.
Some children are specially susceptible to diphtheria
and acquire it where others less susceptible escape. In identifying
diphtheria in the throat or nose the bacteriological test
is of subsidiary value where the clinical features are at all distinctive
; and a negative result from a swab is of very little
value indeed, unless confirmed by one or preferably two subsequent
examinations, if possible on successive days. In suspicious
cases the physician should not therefore wait but
inject antitoxin early. Prophylactic doses of antitoxin for
contacts is good practice. In very toxic cases intra-venous
injection of antitoxin is desirable If the throat secretions of
diphtheria convalescents be bacteriologically examined daily
during the third and fourth weeks of their attack in more
cases than not the results will prove contradictory. Thebacillus
may not be recoverable for a day or two, perhaps
more, to reappear the day following. In half a dozen cases
observed in a large fever hospital in London in which h
clinical and post mortem evidences were conclusive of
diphtheria repealed bacteriological examination by an expert
entirely failed to reveal the presence of the diphtheria bacillus.
Vir lent diphtheria bacilli may often be und in the throat
and quite harmless to their host, and only occasionally a
source of infection to others. Patients who have had
diphtheria should remain in hospital as long as an inflamma-.
tory condition of the throat exists.