Treatment of the Carpal-tunnel Syndrome

remain unsuspected in such a case is thus perfectly understandable and reflects no discredit on the clinical acumen of any physician.But we do feel that it was a pity that, in the absence of any attempt at bacteriological confirmation, Case 12 was written off as " streptococcal tonsillitis."This diagnosis made-as, in our experience, it not infrequently is-with the unaided senses is not merely a delusion of muddled minds, it is a dangerous snare which by the mesmeric influence of a jargonistic label closes the mind to the possibility of reappraisal." Tonsillitis " is a perfectly valid clinical diagnosis; only the laboratory can ascribe to it a specific aetiology.We do not wish to embark here on the perennial controversy concerning the indications for antibiotics or chemotherapeutic agents in the treatment of acute sore throats, but it is pertinent to plead that if the physician in charge has made up his mind to administer one of these drugs he should at least take a throat swab-he need not await the result of the culture-before starting his course of treatment. SummaryA localized epidemic of diphtheria involving 12 cases (one fatal), the brunt of which fell on one infants' school class, is described.Virulent C. diphtheriae gravis was isolated from nine of these cases and 14 other carriers.The relatively low immunity status of the school community (less than 50% of the children having been immunized) was thought to be an important factor in the development of the epidemic.The treatment of carriers is considered, the obstacles (notably the widespread use of antibiotics) to bacteriological diagnosis are recounted, and the difficulties in tracing the original source of infection is discussed.Our thanks are due to Dr. A. J. H. Tomlinson and the staff of the Public Health Laboratory, London County Hall, for accepting our strains for confirmation and virulence tests, and for accepting direct the enormous number of swabs taken when the mass swabbing had to be extended.It is a pleasure to acknowledge our debt to the medical, nursing, and administrative staffs of the Barking Public Health Department and to local family doctors for their ready help and full co-operation throughout the epidemic.