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may be obtained from a superficial smear of the tonsil which, later,
when sectioned, may show the organism deeply buried in the crypts of
the tonsil. Undue reliance placed upon the bacteriological results of
a swab has, of late, tended to delay the placing under treatment of
persons with clinical signs, and it cannot be too strongly urged that
suspicion of diphtheria demands, not swabbing, but the early administration
of anti-toxin.
Similarly, the practice of labelling a person showing one positive
swab a "carrier" is to be deprecated, and dealing with him, in the
absence of clinical symptoms, by hospitalization, is illogical. To
constitute the "carrier" state, positive swabs would require to be
obtained weekly for a period of at least four weeks and, in order to
eliminate error, they would need to be taken from at least both tonsils,
both nostrils and the back of the throat, and the results checked by a
Schick and virulence test. Obviously this is impracticable except,
perhaps, in exceptional cases; but if swabbing for diagnosis is to be
relied upon, no less stringent measures than the above would be
adequate.
The detection of "Carriers," except in a "closed community,"
assists only by possibly leading to the discovery and subsequent eradication
of any unhealthy condition in the nose or throat of the carrier.
To the general community it brings little benefit, for the remaining
population still remains susceptible to diphtheria or to becoming themselves
carriers. The procedure of dealing widely with carriers amongst
the general population is impracticable and its cultivation will not
appreciably reduce the general incidence of the disease.
In the home, supervision would be best met by Schick testing.
Amongst those who are Schick negative a search might be made for
carriers of virulent strains of the diphtheria organism. Those who are
Schick positive might then be closely observed for the development of
any signs of diphtheria with, later, their active immunisation if they
escape the disease.
It is now fairly generally agreed that active immunisation affords a
method by which parents may protect their children from an attack of
diphtheria. The Borough Council has established a clinic for this
purpose and, with proper safeguards as adopted there, it may confidently
be said that no risk attaches to the method.