Diphtheria carriers with particular reference to the treatment of the convalescent carrier with detoxicated diptheria vaccine

Abstract

One of the most difficult problems to deal within Fever Hospital practice is that of the convalescent diphtheria carrier. The patient having survived the various dangers of the disease,and having reached an advanced stage of convalescence,the all important question of discharge now arises. This disease, unlike Scarlatina (in which the causative organism is as yet unknown) is not one in which the patient can be discharged after a stay of a certain definite number of weeks in hospital. Here the freedom of the original focus of infection from the Diphtheria bacil­lus is an essential. It is the attainment of this object that one finds so difficult in a certain percentage of cases. Even though this percentage may be small Ker states: "It is large enough to make the management and treatment of carriers a most important question." Many varying methods of treatment may be tried, but the condition may still persist in spite of all efforts, and cause considerable inconvenience to the patient, and give rise to a certain amount of unpleasantness with importunate relatives.

The term ’diphtheria carrier’ is used to denote an individual,who while not clinically suffering from diphtheria,harbours the Klebs-Loeffler bacillus,and through the elimination of which he is capable of infecting others.

With the exception of twelve, all my series of 223 cases fall into the convalescent group of carriers. On admission, 211 showed a definite clinical diphtheria of either faucial, nasal or laryngeal type.The twelve healthy or passive carriers were patients who on admission had no clinical symptoms suggestive of diphtheria. Most of the latter were contacts ,and were found to harbour the diphtheria bacillus in throat or nose. A few were convalescent Scarlatina patients who were incidentally found to be diphtheria carriers.