London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1931

[Report of the Medical Officer of Health for London County Council]

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The following table gives information regarding the schools specially visited by the school medical staff during the year:—

Division.Diphtheria.Scarlet fever.Smallpox.
Number of visits.Number of depts. visited.Number of children examined.Number of visits.Number of depts. visited.Number of children examined.Number ol visits.Number examined.
N.E25232,51845435,616509,382
N.19181,50530272,617142,275
N.W.131199124222,6181437
S.W.11894721191,918477,940
S.E.28252,54739354,319121,364
Total96858,50815914617,08812421,398

The children in four schools were specially examined by the school medical
staff from time to time in connection with the occurrence of cases of ophthalmia.
It will be noted that some diminution is recorded in the number of cases of
diphtheria reported from the schools during 1931, compared with the last few years.
Swabs were taken in 2,465 instances from children in the course of the special
medical examinations, and submitted for bacteriological examination in the laboratory
at the County Hall. Of these, 83 showed the presence of micro-organisms
indistinguishable morphologically from B. diphtheria. These 83 positive results
related to 79 children, of whom 25 were notified and removed to hospital. Tests
for virulence were applied to some of the cultures; 51 being returned as virulent
and 11 as avirulent diphtheria bacilli. The children from whom a virulent results
were returned were allowed to resume attendance at school. Where virulent results
were obtained and the children were not notified as cases of diphtheria, the parents
were invited to take the children for treatment at one of the special diphtheria
" carrier " clinics.
The arrangements made with three voluntary hospitals, viz.: London, St. Mary's
and Guy's, for the establishment of special clinics for the treatment of diphtheria
"carriers" were continued during 1931. The borough medical officers of health
have, in certain cases, taken advantage of the facilities offered by these clinics for
the treatment of persistent "carriers."
The following reports, which the medical officers in charge of the "carrier"
clinics have very kindly furnished, are of special interest.
The clinic at the London hospital is under the care of Mr. F. Muecke, who
reports as follows:—
Children who, although at school, are suspected of being able to infect others with diphtheria,
are sent to the special department of the London hospital for investigation and cure.
When the ordinary out-patients are finished, the carriers are brought into the clinic, and
their upper air passages thoroughly investigated as follows:—
Tonsils.—The appearance, size and setting are noted, those deeply set or buried
always being treated with suspicion. The tonsil is squeezed by pressure over the anterior
pillar, and the amount and character of the expressed matter, if any, observed. The
presence or absence of muco-purulent matter in the naso-pharynx, and the condition of
the teeth complete the first part.
Nose.—The nose is then examined, and the amount of air-passage, crusts, or mucopurulent
discharge recorded, the healthy condition or otherwise of the middle meatus
and midturbinate being a guide to the sinuses, as transillumination is not satisfactory in
children.
Ears.—Lastly, the ears are inspected, and the presence of any external or middle ear
discharge noticed.
The suspect is then sent to the bacteriological department, and a swab taken of the nose
and throat. The result is communicated to the surgeon at the next week's sitting. Should
this and a second swab be negative the patient is discharged, unless treatment in the ordinary
way (as tonsillectomy) is advisable.
A positive swab always indicates removal of tonsils and adenoids, unless this has already
been done, in which case a careful search for remains or nasal trouble should be made.
The nasal condition is usually of an atrophic character, and it is still disputed whether such
a case is a genuine carrier and whether a true diphtheria bacillus is to be found. The treatment
of this distressing condition is practically hopeless. Of the numerous remedies put forward the
Diphtheria.
Diphtheria
"carrier"
clinics.
Clinic at the
London
hospital.