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98
were attacked. From the outset each case was promptly removed to the isolation
hospital, disinfection was carried out by the local authority, careful observation
was kept on all cases of slight indisposition; visiting by parents was stopped and
new entries to the school countermanded, all the contacts among the pupils and the
staff were swabbed. These measures were fortunately successful and no further
cases developed after 1st December. Subsequently it was found that the school
dentist, who already had a slight sore throat on 1st December, was in fact suffering
from a slight attack of diphtheria.
The first case occurred on 25th November and was a boy, aged 10, from the
"Springfield" school in Lambeth. This pupil suffered from a severe attack and
unfortunately died at the isolation hospital on 2nd December. Very close watch
was kept up to the end of the term. As a result of continued observation and
swabbing of contacts, eight boys were found during this time with suspicious
organisms in their throats and as a matter of precaution were removed to isolation,
but none of these boys was at any time ill and none developed any symptoms of
diphtheria. Of the six cases other than the boy who died only two were described
by the Metropolitan Asylums Board as severe, the remainder being mild.
No cause of the outbreak could be discovered in the school itself. All the boys had
been examined immediately before and immediately after admission. The outbreak
took place amongst the Lambeth group of boys which was admitted on 18th November,
and, as reported above, the first and most severe case occurred on 25th November.
The outbreak was almost entirely confined to this group of boys and it is highly
probable that the disease was introduced by visitors on Saturday, 22nd November.
Dr. Forbes'
report on the
Schick test
for
diphtheria,
and artificial
immunisa-
tion
In the Annual Report for 1922 (vol. III., p. 84) reference was made to the
Schick test and active immunisation for the preventive control of diphtheria, and
the results of the work of Park and Zingher in applying the test to large numbers
of children in New York were quoted. Since then this measure of prophylaxis
has been widely extended in New York and other parts of America and adopted to
a more limited extent in certain other countries. In the Annual Report for 1923
(vol. III. p. 93) the mortality from diphtheria, including croup, in New York was
compared with that in London and England and Wales since 1858, and reference
was made to the confusion which had occurred in the earlier years of the period
between scarlet fever and diphtheria to which attention was drawn in the New
York reports. In the diagram on p. 95 contours are shown for the two diseases
in combination. It will be noticed that in the earlier years, peaks in the New
York curve were broadly associated with similar peaks in the London contour,but
it should be borne in mind that the New York curve relates to a smaller area up
to 1897, and since then to a much extended area. Reports recently received
appear to indicate some increase in the diphtheria death-rate for New York in 1924,
while the London rate has remained the same as in 1923. In Great Britain the
Schick test and immunisation have only been tried on a small scale and mainly in
fever hospitals and such residential institutions as poor law schools. Between 1921
and 1923 it was ascertained that in residential institutions in the London area some
4,320 individuals had been tested, of whom 1,390 were Schick positive and 1,160
received injections of toxin-antitoxin. This has mainly been the work of Dr. O'Brien
and his assistants. Dr. Monckton Copeman and Dr. W. M. Scott of the Ministry
of Health have also carried out similar work at private schools and institutions in
the provinces. In London the Metropolitan Asylums Board now requires the Schick
testing and immunisation of the nursing and medical staff and one of the London
boroughs (Holborn) provides facilities for obtaining immunisation at its maternity
and child welfare centre.
In the provinces inquiries of the medical officers of health of some twenty of
the largest towns elicited the fact that testing and prophylactic immunisation had
not been adopted, so far as the school children or general population were concerned.