Is there a Doctor in the house?? Diptheria Carriers

[seaforths]

I was looking at tracing a man about 10 days ago and managed to find he was admitted to a CCS in 1915 but all it says is ‘diptheria carrier’ and wondered what the implications of that might be under trench conditions.

 

He was wounded in December of the following year (1916) and is on the WO Cas List as such. Would anyone know if they would be likely to admit & evacuate him even if was just for minor wounds - just as a precaution, being a diptheria carrier?

 

Another couple of men were also wounded and admitted to a hospital in France but their wounds do not seem to have been serious and they did not appear on the WO Casualty List. Whereas, this man does appear on the Cas List. It could of course be, that his wounds were more serious.

 

[seaJane]

You can be a diphtheria carrier without showing any symptoms, as I understand it, so presumably the problem was that if he had been transferred without this being noted, there would have been another outbreak somewhere. Perhaps the duty of the 1915 CCS was to eradicate the diphtheria he was carrying?

(it would be interesting to know if there was a 1915 cluster of diphtheria cases from his squad).

[seaforths]

Hi sJ,

 

Thanksfor the info. 

 

He was a 19 year old Sgt in September 1915 when the note ‘Diphtheria carrier’ appeared and by the time he was wounded in December 1916, a 20 year old CSM. I don’t know what treatment they would have had at that time as they didn’t have the anti-toxins or antibiotics that would be used in later years. He did survive the war and died in 1974 at the age of 78 from peritonitis and bronchial pneumonia.

 

I suspect he might have been symtomatic in 1915 when he was in the CCS. I don’t know whether the CCS diagnosed that he was a carrier. In which case, he would have been evacuated from the FA with sickness. Or, the FA picked up that he was a carrier and evacuated him. I would have thought that, if it was the latter, the FA would have not have evacuated him at the risk of spreading infection and would have kept him in quarantine. I think, from memory, the FA were only allowed to hold patients for a maximum of 7 days at which point, they had to put them back to their unit or evacuate them down the line. However, I get the feeling that infectious cases like diphtheria were an exception to that 7 day rule.

 

 I couldn’t seem to find anything online for what might trigger a carrier to become symptomatic and wondered if something like the trauma of being wounded, even if it was minor wounds might trigger something. Or maybe certain conditions in the trenches might trigger symptoms. If I get time, I’ll look out my grandmother’s old medical book - it predates antibiotics etc so you usually find some quite drastic treatments in there for sickness, diseases and ailments!

[seaJane]

I must check the date for when Sir Sheldon Dudley was working on a diphtheria vaccine with the RNMS. I know I have it recorded somewhere!

 

[add] 1920s & 30s, so not in our range...

[seaforths]

Managed to grab a minute to get grandma’s old book. No publication date but in her writing on the inside fly - ‘Medical Book - 1932’ It does mention the anti-toxin use but there is nearly two pages about diphtheria, causes and treatments prior to the development of the anti-toxins. I did find this snippet on the History of Vaccines website but a little contradictory...

 

‘Diphtheria was the third leading cause of death in children in England and Wales in the 1930s.[1]

Since the introduction of effective immunization, starting in the 1920s, diphtheria rates have dropped dramatically in the United States and other countries that vaccinate widely. Between 2004 and 2008, no cases of diphtheria were recorded’

 

Meanwhile, the pages from the book are more helpful and at least they are closer to the time-frame of the war. It seems that his 1915 admission ties into the information of the book. It is thriving and spreading in hot dry conditions and cases will begin to rise in September - he was admitted in September. It then goes on to say that it peaks in November with cases going into decline so I guess on the 9th December, it is unlikely that any wound(s) he received would have made him symptomatic again and it would have been the severity of wounds alone that got him onto the WO Cas. List. 

 

Pages from the book below - you might spot something I’ve missed or find them useful anyway...

 

 

 

[Dai Bach y Sowldiwr]

Interesting reading.

How we have forgotten how nasty these infectious diseases were, before the advent of safe vaccines.

There is reference in the article to antitoxin, which is a different thing to vaccines.

Basically, you injected a horse with diphtheria which then generated toxins inside the horse.

The horse's immune system would then create antibodies (antitoxin) against the toxins.

The horse's blood would then be taken off and immunoglobulins extracted from it, which were then purified (as best as they could in the 1880s) into an injectable form. This would then be injected into any patient who was suspected of having diphtheria, all the while hoping the patient wasn't allergic to it.

Similar theory to production of anti-Tetanus serum, although probably a different horse.

Modern day Diphtheria vaccines are toxoids (as are tetanus vaccines).

The toxin is altered by formaldehyde or heat to inactivate it, but without destroying its structure too much, so that the immune system can see it and build antibodies against it.

 

Horse lovers will be pleased to note that their equine friends are no longer part of the production chain of diphtheria or tetanus toxoids.

 

[seaforths]

Quite a drawn out procedure getting the horses to produce the antibodies. We forget that a lot of medicinal treatments involved cows, pigs, horses etc. Woud the antitoxin then just be treating the symptoms of the sufferer and they would continue to be open to reoccurences and remain carriers? Reading through the treatments and preventions paragraphs on the strictness of preventing contact with others and contiminated clothing, curtains, etc. I’m surprised they moved him down the line to a CCS and didn’t quarantine him at the FA. I’m also surprised they continued to allow him to serve. A major outbreak could have serious implications in the front line. I do recall something about an outbreak of measles keeping an entire battalion (4th Seaforth) away from the front line for a couple of months and if I remember rightly, it cost them their 1914 Star awards.

[Dai Bach y Sowldiwr]

7 minutes ago, seaforths said:

Woud the antitoxin then just be treating the symptoms of the sufferer and they would continue to be open to reoccurences and remain carriers?

It would just be treatment of an acute episode, as the passive immunity given to the patient only lasted a few weeks.

Interestingly, I've just found out that Diphtheria Immunoglobulin (yes, you guessed it- from horses) is actually still available in the USA, even though there have only been a handful of cases there in this century.

[seaforths]

Well, when I was googling around prior to posting the topic. I did see something about President George Washington dying of diphtheria - perhaps they keep making it, just in case. There is probably a more scientific reason. There has been much publicity in the last few years about the vaccines developed decades ago no longer giving us protection as the diseases have mutated over time and new vaccines need to be developed. Retaining some antitoxin production might be useful as a back-up if diseases were to break out before anything more effective could be mass produced.

 

I noticed that in the snipped piece I posted previously, it referred to statistics for England and Wales as Scotland would probably have had their own statistics. I did find this piece referring to the late 19th & early 20th century about infectious diseases: https://www.sehd.scot.nhs.uk/publications/his0/his0-02.htm

There aren’t that many cases of diphtheria and rural areas were probably less affected, especially in the north as it seems to rely on specific climate/weather conditions to take hold. I doubt John Tawse, as a farm labourer from Forres would have had much chance of being exposed to it pre-war, given the climate. However, being in the south of England (Bedford) for 9 months over the summer of 1914, he could have been exposed to it there. Even more likely, he first contracted it in France in the September of 1915 and once infected, it would presumably have had him labelled as a carrier. It doesn’t seem to be one of those things that could be triggered by stress or trauma and my initial ponderings about his wounding triggering diphtheria in 1916 would be highly unlikely.

 

As an aside, I did find something else in that book that is of interest and will post it under another thread ‘Trench Diseases’

[seaJane]

The main article is for the wrong war, but there are a couple of Great War mentions. It may make interesting reading, however, regarding diphtheria:

https://www.ums.ac.uk/umj087/087(3)188.pdf

[Dai Bach y Sowldiwr]

Thank you Jane,

A great warrior.

[seaforths]

Wow! What a great article - thank you for sharing it. I read it last night start to finish but I was worn out and read it a couple of times today. There were a couple of things I noticed last night. I touched on Bedford where they trained - something had come up in another article about Scottish statistics ‘Although disease was a feature of rural life, it was more of a problem in the cities.’ They were saying, in a nutshell that geography provided a natural barrier to the disease spreading because it was a large area that was sparsely populated. I had picked up on the bit about susceptibility in the pages of the book I posted under the paragraph on carriers. It features quite a bit in the article on Sir Sheldon Dudley.

 

When the Highland Division were in Bedford (Aug 1914 - Apr 1915) the sickness rate for them was huge and the death rate was also high. They were dying from simple illnesses that other local people of the town were able to shake off. They began to suspect the water supply which did not go down well with the town’s dignitaries and it was pointed out to them that local townsfolk were using the same water supply without the sickness and death. Eventually, it was realised that all these young men were, for the most part, rural farm hands that had not been subjected to these illnesses and for quite a few of them, their immune systems were unable to fight off the illnesses. In the case of the majority of others, it must be assumed that they were either less susceptible and able to build up immunity to these new illnesses they were being exposed to.

 

The article on Sir Sheldon Dudley appears to show that “ ‘New’ boys were three times as often susceptible to diphtheria as ‘old boys’ (Fig. 3). The article doesn’t state what areas of the country the ‘new boys’ came from - whether rural or urban. It also goes on to say that ‘old boys’ being older didn’t have anything to do with them being more immune/less susceptible - so if age wasn’t the factor, it might have been that they had previous exposure to the germs causing diphtheria.

 

I’ve not been so well myself today from this afternoon onwards but I did go back into the MH file for John. I had checked the WD for the FA the day before yesterday and went through the months July - October and could find no mention of diphtheria and ditto the Bn WD. I thought I’d recheck the medical entry for John to make sure there weren’t any other entries...

 

...First of all, my apologies for earlier stating it was a CCS he was actually with the 31st Ambulance Train. John’s entry is at the top of the page and underneath his entry it seems that there ARE more entries below. After seeing this, I then skipped back a page to check the entries at the bottom of the previous page. So here are the crops from both and John wasn’t the only one from the Bn.:

 

 

AND FROM THE BOTTOM ENTRIES OF THE PREVIOUS PAGE:

 

Edited 5 November , 2018 by seaforths
Typo