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War Surgery and Medicine

Cutaneous Diphtheria

page 572

Cutaneous Diphtheria

Has probably been just as commonly the cause of post-diphtheritic paralysis or peripheral neuritis as the faucial type.

Infected sores, desert sores, etc., if there is the slightest suspicion of diphtheria, must be promptly treated with anti-toxin.

It was recognised that the type of diphtheria experienced in the Middle East tended often to be of a very virulent nature, and was readily picked up by those who were susceptible.

In 2 NZEF it was considered desirable that all nursing sisters and voluntary aids should be Schick-tested and, if necessary, immunised. As fresh reinforcements of sisters and nurses arrived overseas from time to time, and as supplies of Schick-testing and immunising material were not always immediately available there, the Consultant Physician 2 NZEF suggested that the immunisation of susceptibles be attended to in New Zealand prior to placing on the overseas roll.

This raises the question of the desirability of immunisation in the future for members of the services, firstly for sisters and voluntary aids, then for other medical personnel and for other service personnel generally.

In November 1943 a nurse died of severe faucial diphtheria, with an associated streptococcal infection complicated by myocarditis and cardiac failure.

There were two deaths, one from diphtheria and one from diphtheritic infection of a wound, in October 1941, and one from diphtheritic polyneuritis in June 1943.

In Italy diphtheria presented peculiar or unusual features, but there were no deaths. For example, multiple ulcers in the natal cleft were found to be due to Klebs-Loeffler infection and cleared up quickly with anti-toxin; a case of faucial diphtheria developed palatal paralysis on the fourth day of his illness; another case treated within twelve hours of onset with ample anti-toxin developed very extensive polyneuritis. The number of hospital admissions in 2 NZEF MEF and CMF, July 1941 to December 1945, recorded were faucial diphtheria, 339; nasal diphtheria, 23; while a group of 180 included unspecified diphtheria, cutaneous cases and carriers. There were four deaths.

Invalided to New Zealand
January 1942 Diphtheria, 1.
January 1945 Ischio-rectal abscess with diphtheritic infection, 1.
February 1945 Diphtheritic infection, 1.
March 1945 Polyneuritis diphtheritic, 1.
January 1946 Diphtheria, faucial, 1.
page 573
Epidemic, 1 NZ General Hospital (Italy)
Faucial Cutaneous Polyneuritis Clinical D Nasal Wound Infections Total
Sep 1944 1 1
Oct 1944 2 3 1
Nov 1944 6 10
Dec 1944 14 3 3
Jan 1945 15 4
Routine Swabbing (Majority Carriers) 3–14 Feb 4 5 17 27
52 16 1 10 20 27 126

Note: Table incomplete—figures not available after 14 February