HEALTH NOTES.

Hawera Star, Volume XLVI, 24 January 1927, Page 8

HEALTH NOTES.

CARRIERS OF DISEASE. THEIR RECOGNITION AND CONTROL. (Contributed by the Department of Health). The origin of epidemics of infections disease' has long been a mystery, and it is still largely a matter of conjecture how or why they come to an end. With regard to the latter several factors may co-operate, such as a gradual diminution and ultimate loss of virulence of the infecting agent, the survival-of the fittest among the population attached, and the production of an acquired immunity by these individuals. With regard to the former problems, however, as to how cases of infectious disease — whether sporadic or epidemic —start, nothing definite was known until it was discovered that person® who had previously suffered from certain infectious diseases, notably enteric fever, _ were the cause of outbreaks of the disease among people with whom they came, in contact. Such individuals are known a® “carriers.” A carrier may he defined as a person who in some part of his body carries the germs of an infectious disease without himself exhibiting symptoms of the disease. “This “carrier state,” as it is called, may develop as a consequence of having had the special disease, or .it may develop in on© who has never had the disease —that- is. we may have “convalescent carriers” or “contact carriers.” Also carriers may be either temporary or chronic, that is, they mav harbour the germs either for on, y a short time or for a much longer time, stretching to months, years, or even m some cases the rest of a lifetime. Now it will he easily understood that from a public health point of view the recognition of these “carriers” is most important, and even when recognised the problem of dealing with them is bristling with difficulties. Having recognised the carrier,-and identified the particular bacteria that he or she is harbouring, it has next to be proved that the germs present are capable of infecting another person. Because not all germs are what we term pathogenic, that is. are capable of causing disease. For instance, it is well known that a person may harbour in his throat germs that, on microscopical examination, are identical in all respects with diphtheria bacilli and yet these may he quite a virulent or quite incJVDEtM© of eausincr diplvtftOTin, cithor in himself or anyone else. It is admitted among bacteriologists that bacteria that are a-vindent never become virulent. but are always quite incapable of oaupsing any infection, so that here, at least as far as diphtheria carriers are concerned, wc have another problem to solve. We must not only identify the carrier, but also must prove whether he is a dangerous or a harmless carrier. This problem, as far a® we at present know, arises only in the case of diphtheria carriers. ' and fortunately we have in this case means at our disposal to help us in arriving at a definite conclusion. From the public _ health aspect in this Dominion the following diseases nresenf their “carrier’ _ problems:— (D Diphtheria: (2) enteric infections f tvphoid and paratyphoid forms): (3) ceitebro-somal meningitis:, (4) siTepto-coeoal infections. DIPHTHERIA.

This question of the “earner” in tins disease is in this country the most important of them all. The earner state Slav develop here as a result of an attack of diphtheria or merely as the> result of comine into contact with a oUnteal case of diphtheria or another carrier. The earner state may persist for some months, but is seldom or never permanent. It is, as has been pointed out, mosi important to differentiate between those carriers who convey virulent serais and those who harbour only a-viruent germs. Brieflv, _ the method of doing this consisted in isolating the diphtheria bacilli, and seeing, if they will give a reaction in an animal like a "uinea-pig, which has first been protected by a dose of diphtheria antito^!nother wav is to subject the carrier to the “Schick Test.” which is a test that has been devised with the object of ascertaining whether a person is susceptible or not—susceptible to diphtheria infection. If a. person gives what we call a “negative Schick reaction. he is considered to he nehily. hut not absolutely, immune .to dmhtheria. If be gives a positive Seine* reaction he is considered to be shscep- j tible to diphtheria. Ts T ow. the inference is therefore that if ive isolate diphtheria baci'li from a person who is Schick positive, either he will deve op diphtheria or his bacilb are o-viru-lent But if the person is Schick negative then the bacilli isolated may or mav not be a-virnlent and must be ! tested further. . 1 The throat and the nose are the usual sites for carrying diphtheria bacilli, although thev have occasionally been isolated from + he ear. and from wounds. The oiiefition of .isolation of diphtheria carriers is one in winch no snecific statement eqn he made, the decision hi eneh ease Is one resting -vH, the individual medical officer of health

KNTERIO CARRIERS. These are persons who harbour the worms of typhoid or the paratyphoid forms. These “carriers” may also be of the two kinds, temporary or permanent The temporary carriers are usually persons who are convalescing from the disease and they usually soon clear up Occasionally, however, the condition may become more permanent, and these unfortunate individuals may “carry” these bacteria for years or even for the rest of their life-time. They are not usually, however, continuous carriers, that is, there may be intervals of from several weeks up to several months during which it is impossible to recover the specific organism from their excretions. These carriers” are usually of the intestinal type, that is the bacteria are usually recovered from contents of the bowel. Occasionally we find “urinary .car:ri&r who ©xcrotos "the bacteria, in t/iio urine. The intestinal carrier state may also arise in one who has never had the disease. The identification of these enteric carriers is a problem presenting much greater difficulties than in the case of the diphtheria carriers. The bacteriological examination and test required are more elaborate and time consuming. They also differ in one other respect from diphtheria carriers, in that none of them as far as we know are ‘‘a-vir-ulent,” but all are capable of inlectmg other people. Most of them are women and many present some symptoms of gastro-intestinal disease such as pain in the region of the gall bladder, indigestion, diarrhoea, etc. As to the treatment of these “enteric carriers, a cure is practically impossible; they may remain apparently clear of the organism for months And. the carrier state may again bo in evidence. Fortunately, the observance of a fe\v simple precautions is usaully sufficibrit to protect other people. The chibf of these precautions arb . (a) Prompt and efficient disinfection and disposal of the excretions; (b) cleanliness of the hands after having had a bowel move-

ment; (c) abstinence from having anything’ to do with preparation or servino- of food, for other people. Usually when the position is explained to the unfortunate carriers, their oomplete co-operation is secured, and thus the possibility of their being a menace to their fellow creatures is removed. Obviously isolation of those people would be possible unless isolation was observed for the remainder of their lifetime. The chief storehouse for these germs is usually the gall bladder and some then have been cured byhaving that organ removed; but even then no guarantee can be given. Manytyphoid epidemics in New Zealand ae well as in other parts of the world have been traced to carriers of typhoid germs. CEREBRO-SPINAL MENINGITIS. It can he safely said that in. no other disease is the continuance of infection from season to season or from epidemic so dependent on carriers as in cerebro-spinal meningitis. The carrier is of importance not only in the spread of epidemics, but also in the occurrence of sporadic or occasional cases. The cause of the disease is a minute organism called the meningococcus. It is an extremely frail organism, and when removed from the bodv it very soon dies. The organism usnhllv inhabits the region behind the nose, called the naso-pharynx. Here again the “carrier” state may arise as a consequence of having had the disease. More usually, however, in this disease the carrier state arises as the result of having been in contact with an actual ease. of cerebrospinal meningitis or with another carrier. The carrier state may last from only a week or two up to several months. It is estimated that m an ordinary healthy .community there are two per cent of meningo-coorus carriers. . How then is it that more cases of this ailment do not occur? Simply because it has been discovered that before an outbreak of this disease can occur there must be a much greater concentration of carriers, and there- must be a certain continuous period of contact with a carrier before sufficient infection is received to overcome our natural or acquired resistance. The identification of these carriers is not difficult. The chief essential is to make the bacteriological examination as promptly as possible' after the material has been taken from the n.aso~T>ba;rynx. The n a.so-pharynx is swabbed with a spemnllv . constructed swab and a suitable material is inoculated on the spot, or if a laboratory is hnndv the suspected carrier is sent there to have his examination made. Orebro-sninnl meningitis is most likelv to occur where we get great, concentration of people. as in . army camps, etc. .Another peculiarity of this disease is that it is very rare . for a carrier to develop cerebro-sninel meningitis. The carriers- are treated usually hy various antiseptic douches inhalations. or paints. The usual T->i-o"edure is to consider a. carrier as free if consecutive swabs taken at 43honr intervals give negative results.

STREPTDOOOO.ATj OARRIERS. Streptococci form a large group of micro-organisms or bacteria, possessing certain features in common but still capable of being differentiated into certain fairly well-defined groups or “strains” as they are called. Thev ane widely distributed in nature, .and it. is considered by competent authorities a large percentage of people carries streptococci in the throat in and about the tonsils. Many disease conditions are due to infection by streptococci and tunny of the lung conditions following infection of influenza, in- the late epidemic were due to' a 1 secondary infection of streptococci.. Similarly some of the. lung ctsjrnplications following measles are due to infection of streptococci from the patient’s own throat. Tt is now known that scarlet fever is caused by . a specific istreptococcus. Other conditions due to invasion of these organisms are erysipelas, puerperal fever, septicaemia, or blood poisoning. etc. Unfortunately our knowledge of the streptococci is .still very incomplete. We can identify the strentooecus. hut we ennno-t accurately differtinte between the various strains. Neither can we determine aeeuratelv the “virulence” or power of invasion of the various strains. However, rapid strides in our knowledge are dailv being mode and it Is not too much to hone that in i the near future we shall be able to identify the harmful carrier of stroofeencei as com ole tel v as ve can that o'" diphtheria Other diseases present their corvrier rn-nhlems hut in this petin-+-v the?’’ r>nhlie health importance isnot great.

ECZEMA AND SKIN IRRITATION. Ever have any irritation of the skin? There are many forms of it. Piles, s - obstinate to cure. Eczema, just as bad and just as hard to cure. But, Doan’s Ointment does it, cures every irritating skin trouble. No irritation of the skin can resist its soothing, healing influence. Every reader of this article suffers, or has at some time suffered, with tormenting skin irritation, and it may return at any time. Can any reader doubt the following: Mrs H. Vincent, 40 John St., North Williamstown, Melbourne, says: “I have proved that Doan’s Ointment is a splendid remedy for any irritation of the skin. One of my children was troubled with a rash resembling Eczema. I used remedies trying for a cure, but no improvement was noticeable until I applied Doan’s Ointment. A few applications gave relief, so I continued with the treatment until the rash had completely gone. The soothing -and healing properties of Doan’s Ointment are wonderful, and I recommend its use with every confidence. Six months have elapsed since the cure was effected, and there has been no return of the rash, a fact that proves. Doan’s Ointment gives lasting benefit. ”

Twelve years later, Mrs Vincent says: “I have had no reason to alter my opinion of Doan’s Ointment. It cured my daughter twelve years ago, and she has hot been troubled with the rash since. ’ ’ Doan’s Ointment is Sold by all chemists and storekeepers at 3/- per pot, or will be posted on receipt of price by Foster-McClellan Co., 15 Hamilton St., Sydney. But, be sure you get DOAN’S. 10