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In addition to investigations by medical officers, valuable work was done by
school nurses in following up the medical officers' visits for scarlet fever and diphtheria,
as well as in connection with minor infectious ailments. For example, the services
of the school nurses were utilised for advising head teachers and examining suspects
in a large number of schools where outbreaks had occurred, as follows:—mumps,
160 schools; chickenpox, 154; whooping cough, 17; impetigo, 8: ophthalmia, 3.
The part played by the school nurses in the control of measles is dealt with on page 143.
Although in 1927, the prevalence of diphtheria showed a slight diminution,
5,097 cases having been reported as occurring among school children, as compared
with 5,634 in the previous year, the consistently high incidence in the last few years
has been causing no little anxiety, especially as local reports have suggested from
time to time that the disease has been exhibiting a specially virulent type of illness.
During the year 287 schools were visited owing to outbreaks of diphtheria
in the localities concerned, involving 533 visits by assistant medical officers, whilst
in a number of these schools a nurse was also in attendance daily during the outbreak,
with a view to advising the head teachers and swabbing suspects. In the course
of these investigations and during ordinary medical inspections, etc., 11,020 swabs
were bacteriologically examined in the Council's pathological laboratory, of which
1,021 showed the presence of micro-organisms indistinguishable from B. Diphtheria,
and the remainder were negative. These 1,021 positive results related to 748
children, of whom 253 were officially notified as cases of diphtheria. In 40 cases
which yielded several successive positive results, tests were made for the virulence
of the micro-organisms and 12 of them proved to be virulent, whilst 28 were avirulent.
These latter cases were readmitted to school without further treatment.
With a view to the more intensive treatment of diphtheria carriers, the Council,
in November, 1926, sanctioned an arrangement with Guy's Hospital for dealing
with such cases at a special clinic attached to the hospital.
This clinic was commenced as an experiment for one year with a view to the
observation and treatment of those difficult cases of children, who, though harbouring
virulent diphtheria organisms in their throats and/or noses, and therefore potentially
infectious cases, are nevertheless immune to diphtheria and do not suffer the usual
clinical symptoms of the disease. They are therefore unsuitable tor admission to
the M.A.B.'s infectious hospitals, and for years the problem of treating these cases
effectively, both in the interests of the individual carrier and their associates, whom
they are likely to infect, has proved very difficult. Medical practitioners have
neither the facilities nor the requisite experience to give proper attention to such
cases, and it frequently happens that the affected children are sent back to school
with medical certificates to the effect that they are in good health, no attempt
having been made to provide treatment. These certificates cannot be accepted
unless they are based upon bacteriological examination, and the refusal to admit
the children naturally meets with resentment on the part of the parents, who do
not understand the position ; unnecessary friction is thus engendered, whilst the
unfortunate children concerned remain untreated. In many such cases the parents
decline to allow the children to be re-swabbed or subjected to any kind of treatment,
and, apart from the risks of spread of disease, considerable loss of school attendance
is thus entailed. In one case quite recently the affected child with her brothers
and sisters were excluded from school for several months, merely because the parents
refused to allow them to be examined until they were finally induced to give their
permission after a threat of prosecution for non-attendance at school.
Even the general hospitals are at a loss to know bow to deal with these cases.
It is a common practice for diphtheria carriers to be taken to a general hospital,
where they wait in the ordinary out-patients' department at a grave risk of spreading
diphtheria, and steps have been taken to obviate this practice as far as possible.
Usually the only action taken at the hospital is to swab the child ; it frequently
Diphtheria.