26
REPORT OF THE KING INSTITUTE, GUINDY
APPENDIX I.
May and. June 1930.
A REPORT ON AN INVESTIGATION INTO AN OUTBREAK OF DIPHTHERIA IN
GUNTŪR AND THE NEIGHBOURING VILLAGES
BY
DR. Y. S. NARAYANA RAO, M.B., B.S.
At present the common opinion of some medical men is that Diphtheria is very rare in
India. Our experience at the King Institute is to the contrary. The outbreak under report
is a good instance.
Dr. Mary Glowery, M.D. (the doctor in charge of St. Joseph's Hospital, Gunt ū r) sent
swabs of suspected patients in March 1930. Out of seven of these cases four were positive.
She then sent a full report, dated 23rd March 1930, in which she stated that several similar
cases were occurring in Guntū r. Briefly her report was to the effect that the first case was
at Nellore. The patient (a nursing sister at Nellore) had conjunctivitis and sore throat
about the first week of March 1930, and developed some paralytic symptoms about a week
later. A swab from this patient was reported positive to Diphtheria by the Institute on
18th March 1930. Dr. Mary Glowery first attended this case a few days prior to 18th March
1930 and herself developed sore throat. A swab from her own throat was reported positive
on 25th March 1930. She then sent swabs from similar cases. As the epidemic appeared.
to be intense a bacteriological unit was sent to Gunt ū r on 6th May 1930.
Bacteriological and clinical findings .—At Guntur I found that some suspicious cases
were attending (as out-patients) St. Joseph's Hospital. Of 22 cases examined bacterio-
logically 13 were found positive to Diphtheria. The Medical Officers of the District Hospital
and the Kughler Hospital (another Mission Hospital) informed me that they had had no
suspicious case up to 7th May 1930. But on further investigation 3 out of 12 suspected.
cases in the District Hospital were found positive to Diphtheria. Of these three one was
treated as in-patient and the other two attended as out-patients. The history of the former
is of importance as this was the second case of this series that showed signs of paralysis.
The patient aged 50 was admitted into the Hospital with paralysis of all the extremities.
Knee and elbow jerks were absent. He had no fever on admission. History revealed that
he had fever for four days about 20 days prior to his admission and that paralysis was
existing since then. Swabs from the nose and throat of this patient were positive on
12th May 1930. Diphtheria anti-toxin was given from the 13th and a total of 18,000
units was given by the 18th. On the 16th the patient informed me that he was feeling
much better, and he was then able to move all his extremities. He was discharged—relieved
on 19th March 1930. The quick effect of anti-toxin in relieving his symptoms is further
proof, if any further proof be needed of the epidemic being true Diphtheria.
No suspicious cases were reported from Kughler Hospital (a gosha hospital) during the
period of investigation.
The District Health Officer and myself went to three villages near Gunt ū r from where
cases were reported (Dr. Mary Glowery's report). We found no cases in two of these villages.
In one village Lam, seven miles from Guntū r—with a population of 1,500, we found no
suspicious cases in the Hindu localities. In the Christian Quarters which Sisters from St.
Joseph's Hospital are said to frequent, we found some suspicious cases. One baby K. Kotayya
who had attended St. Joseph's Hospital died at its village house on 14th May 1930.
Since its mother was later found to be positive to Diphtheria it is likely that the baby died
of Diphtheria. In these three villages nine suspected cases were examined and only one was
positive, that from K. Busamma, the mother of the above baby.
The Municipal Health Officer and. myself went round the suspected localities in.
Guntū r town and we found no more fresh cases.
Incidentally we found that whooping cough was prevalent amongst the children in
Guntur and the villages.
Repeated examinations of 44 cases showed that 17 were positive and 27 negative to
Diphtheria. Swabs and cultures from swabs were examined. Usually swabs were taken
from the nose and throat. In two cases where there was conjunctivitis swabs from the
eyes were also taken, but both these were negative. In one case where there was Ottorrhœa
a swab from the ear was examined and was found negative. In another case where there
were some boils on the face (in a positive throat case) a swab from one of the boils was
also examined and was found negative.