London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1910

[Report of the Medical Officer of Health for London County Council]

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40
Annual Report of the London County Council, 1910.
Diphtheria—
Incidence in
relation to
school
attendance.
In connection with the question of the reduction in the prevalence of the disease
among persons of school age during the summer holiday when the schools are closed it has
been thought well to include, as in previous reports, the following table. The summer holiday
of the schools of the London County Council began on Thursday, the 21st July, i.e., the
latter part of the 29th week, and the schools re-opened on Monday, the 22nd August, i.e., at
the beginning of the 34th week.

If the number of cases in the four weeks preceding, and the four weeks subsequent to, the weeks most subject to holiday influence be compared, the following results are obtained for the age periods of 0—3, 3—13, and 13 years and upwards.

Period.Notified cases—Age periods.Increase (+) or decrease (- ) per cent.
0—3.3—13.13 and upwards.0—3.3—13.13 and upwards.
Four weeks preceding weeks ofholiday influence (27th to 30th)7226845
Four weeks of holiday influence(31st to 31th)6819275— 5.6-28.4+66.7
Four weeks following weeks of holiday influence (35th to 38th)7031466+ 2.9+ 63.5-12.0
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The annual reports of medical officers of health show that in no instance was any considerable
outbreak observed during the year. In Bethnal Green 10 children in a Children's Home were attacked.
In a few districts a special incidence upon children attending a particular classroom or school was found,
but only a few children were attacked. Such occurrences are mentioned in the reports of the medical
officers of health of Chelsea, Lambeth, Wandsworth and Woolwich. They were dealt with by the
exclusion from school of particular scholars, bacteriological examination being made of material from
children who were found to be suffering from sore throat, or who were contacts with the cases which
occurred. Closure of schools or departments or classes of schools had not to be resorted to. In considering
the sufficiency of the methods adopted for limitation of diphtheria or scarlet fever, it is all important
to bear in mind that those which can be relied upon at times like the present, when these diseases are
characterised by largely diminished prevalence and fatality, may not suffice in times of epidemic
prevalence and high fatality, and that constant observation must be kept on the results which are
being obtained in view of the expectation that the type of these diseases will, at a future date, revert
to that which characterised them in former years.
Careful enquiry has been made during the year into the source of infection of cases coming to the
knowledge of the medical officers of health, and as a result other cases of the disease have frequently been
found which were previously unknown. In Kensington, of 150 cases, association with a previous case was
found in 17 ; in Finsbury, in 25 among 126 cases ; in Shoreditch, in 22 of 120 cases ; in Woolwich,
in 39 of 147 cases. The discovery of other cases, as a result of such inquiries, is especially mentioned
in the reports relating to Greenwich and Woolwich.
Information as to the number of houses in which more than one case of diphtheria occurred is
given in several of the annual reports. In Paddington this only occurred in one house among 102
invaded ; in Fulham in 20 houses among 231 invaded ; in Islington in 33 of 387.
In August of 1910 the Local Government Board made an Order sanctioning the provision by
sanitary authorities, in pursuance of Section 77 of the Public Health (London) Act, of a temporary
supply of diphtheria anti-toxin for the poorer inhabitants of their districts, and of medical assistance
in connection with such supply. In many districts in London the sanitary authorities have, for a
number of years, given facilities for medical practitioners to obtain without delay anti-toxin for use in
their practices. The effect of the Order has been to legalise this action and to increase the number of
authorities who are prepared to give this opportunity for the early treatment of diphtheria by the use
of anti-toxin ; but in some districts, for instance, Paddington, Hammersmith, Chelsea and Woolwich,
the sanitary authorities decided not to take any action on the Order.
A circular letter from the Local Government Board points out that anti-toxin may be used
as both a prophylactic and a curative agency. The value of its use for curative purposes has been
demonstrated for a number of years. Experience of its use for prophylactic purposes is more limited.
In connection with the larger use of anti-toxin for the prevention of attack among persons who are
exposed to infection there needs to be taken into account the condition of hypersensitiveness to subsequent
injection of serum if the patient becomes attacked by diphtheria, and of which an account has been
given during the present year by Dr. E. W. Goodall, Medical Superintendent of the Eastern Fever
Hospital.(a)
(a) "Public Health," vol. xxiv., p. 132.


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