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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The second case gave negative cultures from one tonsil, a fair number of K.L.B. in the
other, whilst the adenoids gave an almost pure heavy growth of K.L.B. This although striking
is the only occasion upon which the adenoids from a carrier have been cultured.
One case was a persistent carrier for six weeks at the end of which time a brother was
removed to hospital with diphtheria. As home conditions made it impossible to keep the child
isolated he was notified and sent to the carrier unit at the North-Eastern hospital.
The only case not recorded in the above list was the best case since the clinic commenced.
He was not placed in the above list as he was a dental surgeon who had recently qualified at
Guy's and was not really eligible for the clinic. On his first attendance at the end of February,
he was greatly worried as his wife and two patients had recently contracted diphtheria—both the
latter with an interval of four days after the extraction of teeth. On his next attendance a
few days later he brought the more convincing evidence that two further cases, whose teeth
he had extracted a day or two before his first visit here, had developed diphtheria. In each
case the interval was again four days. After enquiry he said there had been no other case of
diphtheria in the neighbourhood except for one man, another of his patients, who contracted
diphtheria about three weeks after extraction of teeth. He had a cleft palate with a history of
infected nasal infection and chronic catarrh. Three sets of swabs from right tonsil, left tonsil,
right nostril and left nostril showed K.L.B. only in the left nostril and not in large numbers.
A virulence test was positive. It was thought likely that the left antrum was the chief focus.
With intensive local treatment including the use of Dimol snuff three negative sets of swabs
were obtained by the end of the month. As nothing has been heard from him since discharge,
it is presumed that no further infection has occurred.
It is of interest that (i) the case gives almost conclusive evidence of repeated infection
within a few days ; (ii) 5 out of the 6 cases had only one contact with the carrier so that the
interval could be accurately assessed. In 4 out of the 5 the interval and presumptive incubation
period was four days. These 4 cases were all children, the 5th being an old man.
Generalised Schick-testing and immunisation are awaited to end this clinic.
Dr. A. B. Porteous, who is in charge of the clinic at St. Mary's hospital, has
submitted the following report:—
During the year, 36 cases were referred to St. Mary's hospital diphtheria carrier clinic,
compared with 22 in the previous year. Of these, 2 were adults and the remainder were children
in ages ranging from 14 months to 14 years.
17 cases were consistently negative.
6 „ gave suspicious organisms in throat only.
9 „ „ „ „ „ nose only.
2 „ „ „ „ „ both nose and throat.
1 „ „ „ ,, ,, ear only.
1 „ „ „ „ „ nose, throat and ear.
Virulence tests were carried out in 10 cases, and 5 were positive. Vaccines were used in
7 cases, and 3 were referred to the throat department for tonsillectomy and other treatment.
The case which was under treatment longest during the year lasted 13 weeks. Two cases were
returned patients who had previously been discharged as negative from fever hospitals.
Facilities for Schick-testing and immunisation against diphtheria were provided
in three more metropolitan boroughs during the year, making a total of 18 boroughs
in which this work is now carried out at the infant welfare or special centres, or by
special arrangement with medical practitioners.
The Council has assisted in propaganda in connection with this work by
authorising the use of the school organisation for the distribution of leaflets issued
by the Borough Councils.
A reference to the Schick-testing and active immunisation against diphtheria
of children in the Council's residential schools and homes appears at the end of this
section of the report.
Scarlet fever.
Although the incidence of scarlet fever did not reach epidemic proportions,
the number of cases reported from the schools was high throughout the year ; and
234 special visits were paid to 191 school departments by assistant medical officers.
In 24 schools the children were kept under observation by the school nursing staff
for various periods. In the course of the special investigations 28,387 children
were examined, and 405 excluded from school owing to suspicious conditions of
the throat, nose or ears, or skin—but only 8 cases were notified as suffering from
scarlet fever at the time of visit.