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

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London County Council 1934

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

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Diphtheria appeared in epidemic form in parts of London during the autumn,
and this is reflected in the increase in the number of cases reported from the schools
—2,727 cases during the first seven months of the year, and 2,712 during the four
months of the autumn and winter terms.
During the year 4,985 children attending elementary schools were examined by
swabbing of the throat and nose (and of the ear in a small number) for the presence
of diphtheria bacilli. Of these 4,728 proved negative and 257 yielded positive
results, i.e., 5.1 per cent. of those swabbed. Re-examination of positive or doubtful
cases was made in 54 cases and diphtheria bacilli were found to be still present in
34 of these.
The results of biological virulence tests applied to the 257 diphtheria cultures
showed 225, or 87.5 per cent., to be virulent and 32 avirulent (i.e., of all the
children swabbed 4.5 per cent. were virulent carriers). Among 38 school teachers
who were home or class contacts of diphtheria, two only yielded diphtheria bacilli,
one proving avirulent in 3 successive swabbings and the other virulent in the
primary swab but avirulent in two subsequent reswabs.
There were 181 special visits by assistant medical officers to 143 school departments
for the investigation of the occurrence of diphtheria in the various classrooms.
The children in 20 schools were kept under special supervision for various periods
by the school nurses. In the course of the visits of the assistant medical officers
a total of 15,390 children were examined and 3,390 swabbed. At the time of the
visits 127 children were excluded on account of suspicious conditions of the throat
and nose.
In 110 of those swabbed, or 3.1 per cent., diphtheria bacilli were obtained,
105 of the cultures proving virulent and only 5 avirulent.
Of the remaining children other than those examined in the course of special
investigations, one group included 1,361 children who were swabbed as selected
cases by doctors or school nurses in schools or at treatment centres owing to some
suspicious defect of throat, nose or ear. In this group of 1,361, diphtheria bacilli
were obtained in 142 (or 10.4 per cent.), 116 (or 8.5 per cent.) proving virulent
and 26 avirulent.
The other group consisted of 234 children who were swabbed preparatory to
their being sent to convalescent homes as a safeguard to exclude chance diphtheria
carriers being admitted to the homes. In 5 of the 234 swabbed, diphtheria bacilli
were found, four proving virulent and one avirulent.
The three groups of school children may be summarised as follows:—

Table 18.

Group.Numbers swabbedDiphtheria bacilli present inVirulentAvirulentVirulent diphtheria carrier rate.
School investigations3,3901101055per cent. 31
Selected children1,361142116268.5
Convalescent home entrants2345411.7

*87.5 per cent. of those in whom diphtheria bacilli were present.
In the five respective divisions the subjoined table presents a comparison of
the results of school investigations including the apparent diphtheria carrier rate,
as well as the diphtheria incidence and case mortality in the total boroughs included
in each division. The figures for diphtheria incidence are provisional and subject
to correction in the various boroughs concerned.