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There is the further argument to be adduced, that whilst the general incidence
of diphtheria among persons of all ages has been maintained at a high level the
mortality has steadily declined during the past three years.
Whilst making due allowance for the improvement in the treatment of diphtheria
in recent years, by the more comprehensive and speedier use of antitoxin, the inference
to be drawn from this table is either that the disease has been of a considerably
milder type during the past three years or that there has been a greater tendency
to notify cases as diphtheria on slenderer clinical evidence or on purely bacteriological
grounds; or it may be that the lower case-mortality may be explained by a
combination of both these reasons.
The geographical distribution of the disease in 1925 roughly coincided with
that of 1924. The districts principally affected were those south of, and in close
proximity to, the Thames—viz., Southwark, Bermondsey, Camberwell, Deptford,
Wandsworth, and in the later part of the year, Battersea. On the north of the
river, Islington, St. Pancras and Hackney were specially involved in the prevalence
throughout the year, whilst in the autumn a localised outbreak of persistent
character occurred in a part of Westminster. In the east end of London, mainly in
Stepney, and to a less extent Bethnal Green, the disease maintained a fairly high
level of prevalence, though these districts were not so badly attacked as those south
of the river, nor were school children so markedly affected. The western boroughs
were relatively little affected.
During 1925, 214 schools were visited by the Council's medical officers for the
purpose of investigating the occurrence of diphtheria among the pupils, entailing
405 visits to separate departments and the examination of some 43,000 children.
The number of bacteriological examinations conducted during the course of
the year in connection with visits to schools and otherwise amounted to 7,910,
of which 609 revealed the presence of diphtheria bacilli and 289 of organisms of a
doubtful character. These figures, however, include re-examinations, the actual
number of children found to be carrying diphtheria bacilli being 390, whilst 213
were suspicious; 169 children were removed to hospital as a result of these
bacteriological examinations and the remainder were re-swabbed from time to time
until negative results were obtained.
In May, 1925, the Education Committee, as a result of the advice contained
in the " Memorandum on Closure of and Exclusion from School," referred to on a
previous page, authorised virulence tests in a limited number of cases of diphtheria
carriers. These tests have been restricted mainly to the chronic carriers and special
cases, and out of 92 specimens 68 were found to be virulent and 24 avirulent; the
children included among the last-mentioned twenty-four cases were allowed to
resume school attendance. The question of dealing with the virulent "carrier" is a
difficult one. If there are any clinical signs of diphtheria there will be no hesitation
in notifying the case and removing the child to hospital. On the other hand there
are many cases in which there are insufficient clinical grounds on which a notification
can be based, and a certain number in which an abnormality of the throat or nose,
though not symptomatic of diphtheria, may constitute a condition favourable
for the diphtheria bacillus. The main object in such cases is to employ such remedial
treatment, whether operative or otherwise, as will tend to remove the bacilli, and
enquiry is being pursued as to the best means of attaining this end.
The services of school nurses are being utilised more and more in connection with
outbreaks of infectious illness. They have been of considerable assistance in the reswabbing
of diphtheria carriers and their employment on this work has not only
been of service in keeping the children concerned under close observation and securing
appropriate medical treatment where necessary, but in reducing the intervals
between their re-examinations has minimised the period of absence from school in
a large number of cases.
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