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As regards diphtheria, the discovery by Klebs and Loeffler of the specific microorganism
associated with the disease in 1884 was hailed with much satisfaction as
constituting the dawn of a new era in the prevention of diphtheria, but, although
it has certainly been of great assistance in enabling us to secure more efficient control
over the disease in schools and similar groups of persons, and also in securing confirmation
of diagnosis, it has certainly added to our difficulties by introducing the
problem of the apparently healthy germ carrier and the method of his disposal and
treatment.
In this connection, it may be mentioned that arrangements were made during
the latter part of 1926 with Guy's Hospital to treat a certain number of diphtheria
carriers at a special clinic, under the supervision of Mr. Layton, the throat surgeon,
and Professor Eyre, the bacteriologist. This clinic was opened in July as an experiment
with a view to the more intensive study of the carrier question, and for the
purpose of ascertaining whether by special treatment, including where necessary
surgical interference, a speedy and reliable cure of chronic carriers could be effected.
Up to the end of the year 33 children had been treated, including two cases notified
and removed to hospital, and 24 were able to return to school cured. It is as yet
too early to report upon the methods employed or the results obtained, but suffice it
to say that the clinic has already proved of great value, and it is hoped that similar
centres may soon be established in connection with other large hospitals, in order
that a wider area may be covered. The clinic at Guy's Hospital has also been of
service as providing a nucleus in London for the Schick testing and active immunisation
of school children, this method of protection having been employed in a number
of cases. If similar clinics were opened elsewhere, their establishment would be
exceedingly valuable, not only for the treatment of carriers, but also for spreading
the net of active immunisation over a wider area.
The prevalence of diphtheria within the last few years should bring home to the
minds of all public health authorities, especially in London where the epidemic
prevalence has been experienced in a greater degree than other parts of the country,
the urgent need for taking the fullest advantage of the new method of protection
afforded by the Schick test and active immunisation.
223 schools were visited during 1926 by the school medical staff for the purpose
of conducting inquiry into the occurrence of diphtheria amongst the pupils, entailing
433 visits or revisits to separate departments and the examination of some 47,000
children. The districts chiefly affected were Southwark, Bermondsey, Camberwell,
Deptford and Wandsworth, south of the river; Islington on the north ; and Bethnal
Green and Stepney in the east end. Altogether 9,039 bacteriological examinations
were conducted in the Council's laboratory during the year in connection with
visits to schools, swabbing of contacts of "carriers" or clinical cases in certain
instances, 766 of which revealed the presence of diphtheria bacilli, the actual number
of children affected being 569. Of these, 237 were removed to hospital after official
notification by the Council's medical officers, private medical attendants or borough
medical officers of health. The remainder were re-swabbed from time to time
until negative results were obtained. The family contacts of "carriers" are excluded
from school until they are found to be free from infection of diphtheria after bacteriological
examination. Virulence tests have been restricted to the chronic carriers
and certain special cases, and, out of 110 specimens, 73 were found to be virulent
(including 3 teachers) and 37 were avirulent. Children found to be harbouring
avirulent micro-organisms were allowed to return to school whilst the virulent
"carriers" were re-swabbed from time to time and were excluded from school
attendance until three consecutive negative results had been obtained.
In 16 schools (including one secondary school) which have been affected in one
or more departments by outbreaks of diphtheria, the special examination of the
children by the school medical staff was supplemented by special visitation by the