THE DIPHTHERIA EPIDEMIC.

Hawera & Normanby Star, Volume LXXVII, Issue LXXVII, 19 July 1918, Page 5

THE DIPHTHERIA EPIDEMIC.

DISCUSSED BY HOSPITAL BOARD

SUGGESTED CLOSiiNG^OF SCHOOLS

The diphtheria ■epidemic formed the subject v-i s..nii> uiscas^iLn at the meeting of the Hawera Hospital Board yesterday.

Inspector Gray reported that fifty cases were notified during the past month, being four fewer than the previous month. Twenty-one cases were from the Hawera borough, sixteen from Hawera County, one from Eltham borough, eight from Waimate West County, three from Eltham County, and one from Manaia Town Board district. All the cases were- removed to tha hospital and the premises disinfected.

The acting-medical superintendent (Dr MacDiarmid), who was present, made a rather interesting statement in reference to the epidemic. No infectious cases arcse anew nowadays, said the superintendent. There was no such thing as spontaneous generation of infectious disease. EA'-ery new case must have come from a previous case. The conditions for favoring the spread of the disease were more common at certain times of the year, and the climate had a marked influence in some way that was not always understood at present. Bad sanitation and unhealthy conditions generally had an influence in favoring the continuance of an epidemic, hut'those could not ■start an epidemic •off themselves. He wished to emphasise that no matter how many cesspits and septic tanks there were about in a district these could net start an epidemic of diphtheria. Even if they were badly infected they were a very unlikely source of infection, as people preferred to keep clear of them. In diphtheria ini'ection might be spread through the medium»of bedclothes, eating utensils, books, and a hundred and one other things used in a household or school. The microbe was very resistant, and a case had occurred in which the diseaise was contracted from a mattress which had been used six months previously by a diphtheria patient. It was said that domestic animals might transmit the disease—e.g., cats—and an epidemic had been traced to diphtheria sores on a cow's udder. Public conveyances might be a source of infection. This was possibly common in railway carriages, where windows were slmt and people crowded together, but it was very unlikely in t»e case of a motor car, which wss contkiually opsn to the light and air. Even if a car were deliberately infected it would very quickly become sterile under ordinary circumstances. Direct spread by personal contact was by far the most frequent source of infection. In diphtheria this was many hundred times more frequent than all the other sources put together. By personal contact he meant people living under the isame roof, sharing the same rooms, eating at the same table, reading the same books, etc. ; in short, in condi-

tions such as were foiuid in the home | and in the tochool. The crux of tlio ■whole matter was to know which children were injected, afccl which were not. Most :infGc^. lOus " caS6S Avere infective before there were sufficient symptoms to mai:e a diagnosis. In diph->' theria a day or so pa&sed in which j there was general malaise and perhaps ! fever, prseedecl by slight shivering, but > no sore throat, and patients were highly infective in this stage. Not ; every individual exposed to infection j would develop the disease. The old • and the very young were almost im- ' mune, and adults were not very sus-1 ceptible. Diphtheria was essentially a ' children's disea.se. Though there were i children who were not susceptible at' all, there were others who took it in such : a mild form that they did not feel ill; their threats were not sore, and they continued to go about. They might have it in the nose without having a sore throat. These early and mild cases were the main source of infection, and it was largely due to these that the epidemic continued. He was' constantly seeing cases in which children had been attending .school with. sore throats and which subsequently proved -to be diphtheria. He saw a large family of school age recently in which all the children had had sore throats and had continued attendance at school. The sore throat had gone I right through the family until the youngest contracted it. This child, a j girl, happened to be pretty bad, and ) ho was sent for. He found that she ! was suffering from well-marked diphtheria. He had not the slightest doubt that all the children had had it and! had probably scattered the infection I far and wide. Some children, although they recovered from the disease quite j well, still harbored tne germs in the ' throat, and might da so for months.j This held true with regard to mild attacks' as well as severe cases. Children with unhealthy condition of mouth ; and throat, such as carious teeth, en- : larged tonsils and adenoids, were very I liable to become earners. Diphtheria ; often gave rise to a chronic nasal dis- ' charge, which was very infective, j Close association greatly favored the! chances of infection. Young children ! had a habit of putting everything in j their mouths, raid at school and at j home they were constantly exchanging ! articles which might easily be infected. At home it was not such a serious matter, as infection would be limited to a household, Irat at school the infection might easily become widespread. In churches and theatres, where children wore distributed among .adults, the danger was not so great. Sunday schools and children's picture shows were a source of infection. The great trouble, however, was the carelessness of the parents. There had not been enough deaths to make people realise th& seriousnss of the disease; the low mortality was due to the early treatment with anti toxin. There was practically only one treatment for diphtheria, and that was the adminisi tration of anti toxin. Never once in 54.000 casfs <lid it do any harm, and

it was absolutely life-<saving. It hud no depressing action on the heart, and did not cause paralysis. Diphtheria might be absolutely prevented by an injection cf a small dosa cf 'anLi toxin| given before the d-S-vas.} uevekped.! Unfortunately this lin.nurJcy WcS Oi n\ very evanescent typo, and it only last-' ed three weeks or v month. 'i..0 iui-\ manity conferred by an attack Wi.s more lasting, hat ii, wus not permanent, and an individual might suffer from re- ■ peated a etudes. Ail schools should be ■ elcsea lor a time \i'A vhe epidemic was over, and the congregation of children anywhere should oe prohibited. Child- i ren's ..nd young people's parties' should be discouraged, and children! should Le kept &t home and not allow- • ed to play with children of other! families. * Parents should not allow anyone to kiss their children,* be they children or adults. Lending handkerchiefs, besides being a filthy habit, was vrry dangerous. Every individual under 1:0 years of age in an infected house should be strict:y quarantined after an outbreak for ;;r Least cix j weeks. This held in;e even if the I patient went to the hospital. Pocpio' must be warned of tho duiigor cf mild I cases, and every cu:;e of Lluess should! be isolated till they wars »sure it wesj not diphtheria. Cleanliness was a! means cf prevention; gallons of Jeyes' | Fluid could not drown dirt. isoniej people seemed Lo think that if there j was a saucer full of .Jeyes' Fluid somewhere in the scullery all the microbes from all parts cf the house would tumble over each other in their eagerness to get into it. Gargling night and morning was very useful and might prevent an infection developing into the disease. In all cases cf gross neglecc where tho re were ciNses of diphtheria proceedings -snould be'iajienj against the. persons e.r.corned. A u.cteriologist would be vory useful to the ; medical profession. He would give them accurate information as to whiph children were infected. A bacteriolo-1 gist could detect "carriers," and could discharge a great many people from hospital much earlier. He could tell which homes were free from infection and raise the quarantine very much earlier. A bacteriologist would not stop the epidemic, for the matter was in the hands of the people themselves. They must realise that it was largely due to the ignorance and indifference! on the part of the community that the! epidemic continued. I

Members considered that Dr MacDiarmid had given the Beard some very valuable information, and the suggestion to close the schools commended itself to the Board.

Mr Campbell moved fhat the Taranaki Education Board he written to recommending that all the schools in the Hawera hospital district be closed for at least two months.

Mr Linn seconded the motion, which was carried.