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 |   Related post: 1917 5 O O" 1918 47 4 8.3 Prior to taking the office of health officer, my predecessor, Dr. A. H. Allen, called my attention to the prevalence of diphtheria in the city. Upon as- suming office all the diphtheria cases for the years 1918 and 1919 were spotted on a large map of the city, and although it was not confined to one sec- tion, the majority of the cases seemed to centre about one school. At the same time a study was made with reference to the diff'erent milk routes in the citv, but this did not establish any connection between milk and disease. It was assumed, there- 850 BREWER: DIPHTHERIA EPIDEMIC. [New York Medical Journal. fore, that- the problem was one of carriers, and the campaign was based upon that assumption. Cultures were taken immediately from all the pupils and the teachers in the school where the largest number of cases had occurred. This netted twenty-three carriers, and immediately the number of new cases in that vicinity was cut down. Later in the season a case occurred in a children's home where there were eighty residents. Cultures from those children revealed twenty-two carriers. La;r;r in the summer several cases were reported in a short street, and after a study of the cases a num- ber of cultures were taken, resulting in the dis- covery of several carriers. Early in the fall a num- ber of cases appeared in another street, and cultures taken from the children disclosed six carriers. Shortly after the opening of school in the fall three cases were reported from one room, and cultures taken revealed twelve carriers. We also adopted the plan of culturing all members of the family, and a number of carriers were picked up in that way. In all 105 carriers were discovered. Thai many of them were but transient carriers is obvi- ous, but we believed then, and still believe, that most of them were sources from which other cases would have developed. \'irulence tests were made in a number of these cases, but the number was too small to be reported. During September a child became ill with what was called enteritis, but as there was no improvement under the usual treatment a more careful study was made, when it was found that the child had an extremely sore throat which clinically was diag- nosed as diphtheria. The child was so sick that cultures were not made, but a large dose of anti- toxin was immediately given. On receiving the re- port of the case cultures were taken from the rest of the family, including a relative who had recently arrived and who had a slight nasal catarrh. Three out of five cultures taken in this group were posi- tive, but virulence tests were negative, and these persons were immediately released from quarantine. That the laboratory diagnosis was reliable is demon- strated by the fact that no new cases occurred in that vicinity or among the friends or associates of these persons. We did not expect to eliminate the carrier from the community, but we did hope to find a large number of them, and by so doing to control the disease. During the year 1919 we took 3,092 cul- tures, and a considerable number were taken by the Buy Angeliq physicians of the city and examined at a local laboratory, which were not included in the number given. The taking of so many cultures was quite a tax upon the force of the department. The diphtheria carrier was a new thing to many of the citizens, and they could not miderstand at first the reason for isolating a person who was ap- parently well. To overcome this we started, through the cooperation of the editors of the Times and the Standard, a campaign of education, the re- sult being that when the last batch of carriers was discovered there was practically no opposition to the necessary isolation. The happy termination of the campaign is largely due to the splendid cooperation with the physicians of the city. They were prompt in reporting their cases, and many of them made cultures on many sore throats which did not appear to be diph- theritic. Personally I have felt for a long time that in a large number of cases, inflammation of the throat, especially that which is called tonsillitis, is really diphtheria. A case which illustrates this came under my observation recently. Upon look- ing into the child's throat one tonsil was seen to be covered with membrane, having all the appear- ance of tonsillitis. It was easily wiped off, but cul- tures showed the diphtheria bacillus, and it was a long time before we were able to get a negative culture. A physician who saw the patient on the day the result of the culture was reported said that he was sure it was nothing but tonsillitis. Treatment. — Antitoxin was used freely by the local physicians, and as a rule was administered early. Its use as a prophylactic was general. In most of the fatal cases the patients were seen late in the course of the disease or died from complica- tions. In the treatment of carriers the removal of the tonsils is the most satisfactory procedure, pro- vided they are enlarged or contain diseased follicles. Time and time again we have seen a case which had resisted all known local treatment rapidly clear up after the removal of the tonsils. In cases where the tonsils were not diseased some physicians were successful with the use of dichloramine-T, others found ten per cent, nitrate of silver equally eft'ec- tive, while others used chlorazene with good results. Toward the end of the epidemic we were able to do the Schick test on a large number of children in an institution. Many of these children had received an immunizing dose of antitoxin about six months previously. The result of this study will be reported later. It was not found practical to try the Schick test on other children. Statistics of the disease. — During the first week of 1918 one case was reported. The next case was recorded during the week ending March 4th. Xo cases were reported Angeliq Hrt until the week ending April 30th, when two were reported. New cases con- tinued to be reported each week until the week of June nth, when the number fell to zero. An interval of two weeks occurred without a case, after which there was an interval of four weeks without a case. During the week of August 14th there were Related links: Mebendazole Buy, Nizoral 200mg Tablets, Toprol 25mg, Acai Berry 1000mg, order topamax online, Zantac 150 Price, Elimite Permethrin, propecia generic finasteride, Asacol Hd Dosing, Purchase Quetiapine
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