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36
to attribute the lessened incidence and virulence of the disease on
the populations as due to the moneys expended in the past in
systematic isolation and treatment hospitals for scarlet fever
patients. These facts have been pointed out in previous Annual
Reports by the Medical Officer of Health, from time to time.
The Metropolitan Asylums Board has decided to pay more
attention in future to the isolation and treatment in hospitals of
more measles (and whooping cough) patients than hitherto in
place of scarlet fever patients. The decision is noteworthy and the
subsequent results will be watched with interest.
Diphtheria and Membranous Croup.
A total of 767 cases of diphtheria and 2 cases of membranous
croup have been notified, but, bacteriologically, all these cases
were not, necessarily, true cases. Even the bacillus diphtheria
(Klebs-Loeffler), when found in the throat or nose, without concurrent
clinical symptoms, may be of the non-virulent type, and,
correspondingly, harmless and negligible—at least in the opinion
of some bacteriologists. In this connection, the Lambeth method
is as follows:—If the Klebs-Lceffler bacilli found in pure cultivation
are, on inoculation, found to be virulent to guinea pigs, precautionary
measures are taken (notification, isolation, exclusion from schools,
disinfection, &c.); whereas, if the Klebs-Loeffler bacilli found in
pure cultivation are (on inoculation into guinea pigs) proved to be
non-virulent, the above-mentioned precautionary measures are
not insisted upon. The method is experimental, at present.
Prevention of Diphtheria.
In view of the statistics of Lambeth and other districts, the
time has arrived for a serious consideration by the Council of the
advisability or otherwise, of adopting systematically the Schick
test, and toxin-antitoxin* inoculation (as a consequent and subsequent
preventive measure.)
The Medical Officer of Health has no hesitation in recommending
the Council to try the experiment (if experiment it still be)
within the Borough in so far as children under 5 years of age are
concerned—children of school age being under the control of the
London County Council as the educational authority. Beyond
school age (i.e., adolescents and adults), the responsibility rests
with the Borough Council. A statistical table has been prepared
for Lambeth, dealing with the diphtheria-incidence and diphtheria
mortality rates, during the past 32 years (vide p. 37).
* See footnote on page 40.