View report page

139
London holds an unenviable position both in Great Britain and the whole of
Europe as regards the incidence of, and mortality from, diphtheria. During the 15
years, 1911-25, the average attack rate from this disease in London was higher than in
any other large city in Great Britain. At the same time it must be borne in mind
that the statistical records of notified cases of diphtheria in London tend to exaggerate
the actual incidence of clinical diphtheria, as experience has shown that
since the introduction of bacteriological aids to diagnosis of this disease, many
doubtful cases, with little or no clinical evidence of diphtheria, are notified on
bacteriological evidence alone, although the notification and removal to hospital
of diphtheria "carriers," in more or less normal health, is officially discouraged.
This tendency to notify cases on slender clinical grounds, if a bacteriological examination
reveals the presence of the diphtheria micro-organism, is necessarily greater
in a place like London where bacteriological facilities are more readily attainable.
On the other hand, it must be remembered that bacteriological assistance in diagnosis
has been invaluable in discovering many mild anomalous cases, frequently mistaken
for tonsilitis, which in pre-bacteriological days were overlooked until the later
symptoms of paralysis supervened.
There is a further aspect of the question to be noted, namely, that a substantial
proportion of cases notified as diphtheria prove, in the light of subsequent observation,
not to be diphtheria. Of the 12,478 cases of diphtheria notified in London in 1925,
11,613 were admitted to the Metropolitan Asylums Board's hospitals, and in 2,366
of these cases, i.e., 20 per cent., the diagnosis proved to be erroneous. To what extent
similar considerations apply in other large towns in England and Wales cannot be
generally stated, but in Birmingham, during 1925, 1,999 cases were admitted to
hospital as diphtheria, and in 290 (14 per cent.) of these, there was no evidence, on
admission, either of clinical or bacteriological diphtheria.
As regards average death rates during the 15 years 1911 to 1925, London
occupied the fourth place in the order of the large towns in Great Britain. Talcing
the large capital towns of Europe the death rate in London from diphtheria in 1924
(the latest for which the figures are available) was exceeded only by Edinburgh and
Rome. There is no doubt, however, that in London, as elsewhere, the mortality
from diphtheria has been markedly reduced since the introduction of antitoxin
treatment, and that greater promptitude in the application of this form of treatment
is bound to exert a progressively beneficial influence.
(2) By what means and under what circumstances the new measure of prevention
should be employed, if considered desirable.—This is a question for consideration, not
only by the Council, but by all public health authorities in London. There is no
doubt that diphtheria is attended by most fatal consequences under the age of five
years, and, therefore, the problem of immunisation is primarily the concern of the
metropolitan borough councils. The Westminster City Council and the Battersea,
Camberwell, Deptford, Hackney and Holborn Metropolitan Borough Councils have
initiated centres providing facilities for this purpose, and in several other metropolitan
boroughs the matter is under consideration.* The extent to which the facilities
for immunisation are made use of in the six boroughs mentioned is directly proportionate
to the amount of propaganda and education of the parents which has been
carried out. It would appear desirable that all public health bodies, both voluntary
and public, including hospitals, provided they are persuaded as to the soundness of
the measure, should assist the borough councils, as far as possible, by the dissemination
of authoritative information on the subject.
On the question whether the Council should supplement the efforts of the
metropolitan borough councils by undertaking the immunisation of school children,
we are informed that facilities, though at present very limited, already exist for
*Stoke Newington, Marylebone, Poplar, Finsbury, and Wandsworth Borough Councils
have since established immunisation centres.