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to a Hospital of the Metropolitan Asylums Board. Arrangements were made
with the Medical Superintendent of the Hospital for the results of the bacteriological
examinations made prior to the patient's discharge to be furnished to
prove that he would not spread infectious disease by carrying on his trade.
In consequence of the extreme prevalence of diphtheria (and scarlet fever)
in London the number of bacteriological examinations made for the presence of
diphtheria bacilli was much larger than usual. A large number of child contacts
were also swabbed. As a rule swabs of the noses of the contacts as well as of the
throats were taken.
The parents or others in charge of children harbouring diphtheria bacilli were
given written directions as to the precautions necessary; these are detailed
below:—
1. Until the Holborn Health Department or the London County Council
notifies the parent or guardian to the contrary, attendance of the "carrier" at
day school, Sunday school, cinemas, theatres, music halls, teas or treats or any
gatherings is forbidden. The child must be kept away from all other children
and no other child be allowed to visit the house.
2. The child must sleep by himself or herself.
3. Special cups, saucers, plates, spoons, knives and forks should be reserved
for the use of the carrier and washed up separately after the others have been
washed up.
4. The child should use pieces of rag instead of handkerchiefs. These
rags should be burnt as soon as possible.
5. No books belonging to a public library should be read by the "carrier,"
or any book which the parents or guardian are not prepared to destroy or have
disinfected by the Public Health Department.
Swabs of these "carriers" were taken fortnightly until the child was no longer
found to harbour diphtheria bacilli. The results of the examinations were communicated
to the School Medical Department of the London County Council so
that children harbouring diphtheria bacilli could be kept from school.
For a few of the contacts we were able to make arrangements for the Schick
reaction test to be carried out and for the immunisation of those found susceptible.
Of the 167 cases of diphtheria notified there were only four deaths, i.e., a
death-rate of only 2.4 per cent. which indicates that the cases generally were of a
very mild type.
Diphtheria anti-toxin was supplied free of charge on application by medical
practitioners. During the year it was supplied in 30 cases.
16,344 cases of diphtheria were notified in London in 1921.