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the occurrence of scarlet fever, diphtheria, smallpox, ophthalmia and trachoma, as
well as in the special visitation of the schools where there were outbreaks of whoopingcough
and chickenpox.
Diphtheria.
During the year 116 investigations into the occurrence of diphtheria were conducted
in 98 different schools, twelve having been visited twice and three on three
occasions. Including the children seen during these visits and a number of others
individually inspected as possible carriers or as home or school contacts of diphtheria
cases, a total of 3,058 were examined by throat and nose culture, and in 5, with a
history of ear discharge, cultures were taken from the ears as well. Of the total,
137, or 4.5 per cent., including 3 with ear discharge, showed the presence of diphtheria
bacilli.
Virulence tests applied to the 137 positive cultures by animal inoculation at the
Council's Southern group laboratory showed 124 (over 92 per cent.) to be virulent,
and 13, including the 3 ear cultures, to be avirulent.
In subsequent re-examination of 49 positive carriers, 24 still proved positive and
25 were then negative; 8 of the 24 cultures were tested for virulence, 6 being returned
as virulent.
It may be noted that in 62 of the 98 schools visited for special investigation a
total of over 1,100 children were examined in affected classrooms, where, previous
to the visits, a total of nearly 200 cases of diphtheria had been reported, or an average
of over three cases per school, but not a single culture from the 1,108 swabbed
yielded bacilli morphologically resembling diphtheria.
These findings are of particular interest as there are still many people who look
upon the day school as the most potent, if not the only, cause of spread of the
infectious disease in the community.
In 44 schools, including eight schools where previous investigation had failed
to show any carriers, 889 children were examined in affected classrooms. In these
schools a total of 180 cases of diphtheria had been reported up to the time of the
first or second visits, or an average of over four cases per school.
Of the 889 children examined, 77 showed the presence of bacilli morphologically
resembling diphtheria. Tests showed 72 to be virulent. Therefore eight per cent,
of those examined were carriers of virulent organisms, whilst the carrier rate per
school was 1.5.
Individual schools, however, varied considerably both in the number of cases
reported and in the carriers found. Thus in one school, where 7 cases had occurred
(3 in one classroom), out of 21 children examined, 6, or 28 per cent, of those examined,
proved to be virulent carriers. In a second school, where 8 cases were reported in
one classroom, 4 out of 19 children, or 21 per cent., were positive and virulent. In
a third with a total of 8 cases (6 being in one classroom), there were 6 virulent carriers
amongst 45 examined, or 13.3 per cent. In another school, with 5 cases reported
(4 being from one classroom), out of 23 children examined, 3, or 13 per cent., proved
positive carriers. In a fifth instance, 4 cases had occurred, and examination of 44
children yielded 3 virulent carriers, i.e., 7 per cent. In the remainder of the 44
schools, the discovery of one or two carriers resulted from each investigation.
Thus in the five schools referred to above, among 152 children examined, there
were 22, or 15 per cent., yielding virulent diphtheria bacilli, and in 39 schools, where
734 children were examined, 55 were found to be carriers of bacilli morphologically
resembling diphtheria, 50, or 6.8 per cent., being virulent and 5 avirulent.
Diphtheria
"carrier"
clinics.
The arrangements made with three voluntary hospitals, viz.: London, St.
Mary's and Guy's, for the treatment of diphtheria carriers at special out-patient
clinics, were continued during 1932.
Reports have been kindly furnished by the medical officers in charge of these
clinics. In this connection it may be noted that the cases referred to the clinics
through the school medical service are those in which virulence has been established
as a result of animal inoculation.