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Of those 74 were removed to hospital. Sixteen cases were returned from the
hospitals of the Metropolitan Asylums Board certified as not suffering from diphtheria.
Two deaths occurred.
Seventeen "secondary" cases were notified. A "secondary" case is one
occurring in the same household as the primary case.
Thirteen of the secondary cases were nurses or staff at hospitals in the
Borough. (From the same hospitals 40 in-patients were notified as suffering from
diphtheria; none of the in-patients were residents of the Borough.)
There were two "return" cases notified 16 and 18 days respectively after
the return of the primary cases from hospital.
In London 12,472 cases were notified giving rise to 481 deaths.
We endeavour to co-operate with the Medical Superintendents of the
Metropolitan Asylums Board Fever Hospitals; information is now sent to them
as to any bacteriological examinations before admission or after discharge of the
patients, and also with regard to return cases of scarlet fever.
Diphtheria in Hospitals.
During the year notifications were received from two hospitals in the Borough
of 64 cases of diphtheria, 47 and 17 respectively.
Of the 47 cases occurring in the first hospital 34 were reported as clinical
diphtheria, 12 as carriers only, and in one the diagnosis was not confirmed. Seven
of the clinical cases were nurses on the hospital staff and two were ward-maids;
the remaining cases were in-patients of the hospital, all the latter being nonresidents
of the Holborn Borough.
Of the 17 cases at the second hospital seven were clinical and ten carriers.
Two of the clinical cases were nurses on the hospital staff, and one carrier was a
member of the resident medical staff.
The number of cases of diphtheria occurring from year to year amongst the
nursing staff of hospitals suggests the need for the immunisation of hospital
nurses. It would seem to be obvious that fever hospital nurses should be
protected against diphtheria and it is difficult to avoid the conclusion that all
hospital nurses, nursing in children's wards, should be immunised. It must be
within the experience of many that nurses in children's hospitals and subsequently
the children themselves are often attacked.
The possible objection that a nurse would have to be immunised against
diphtheria, scarlet fever and typhoid and paratyphoid fevers does not carry much
weight. Many during the war were immunised against more diseases than these
—those going East were protected against smallpox, typhoid and the paratyphoid
fevers, cholera, dysentery and plague. Who can show that they suffered any
harm by taking advantage of the progress of science?
The Schick test and immunisation against diphtheria is already being
successfully applied to the nursing and domestic staffs in a few hospitals, including
those of the Metropolitan Asylums Board.