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 medical superintendent of the Park hospital (Dr. Banks) reports that the
use of the Luer tracheotomy tube with open pilot has rendered the operation of
tracheotomy in young children less dangerous, and easier to perform. During the
year 27 operations of tracheotomy were performed in laryngeal diphtheria cases at
the Park hospital, with 25 recoveries and 2 deaths. In 4 cases intubation preceded
tracheotomy but proved insufficient.
The medical superintendent of the North-Eastern hospital (Dr. Harries) reports
that cases of laryngeal diphtheria were not numerous at that hospital during the
year, and that of those admitted as such the diagnosis was not confirmed in many,
as the following note upon the value of direct laryngoscopy in diagnosis, based on
the observations of Drs. M. Mitman and N. D. Begg, senior assistant medical
officers, and Dr. Hilda M. Linford, assistant medical officer, shows :—
Direct laryngoscopy is used in laryngeal diphtheria for two purposes (i) for diagnosis (ii) for
When employed for diagnosis, the clinical appearances of the larynx and adjacent trachea
can be ascertained. In addition, direct swabbing of the larynx may provide bacteriological
evidence of the presence of diphtheria, when other signs are doubtful or negative. Following
such diagnostic examination, attempts are made in suitable cases to treat the local condition
through the laryngoscope. Removal of membrane and mucus by aspiration and direct intubation
are the two procedures employed. At the North-Eastern hospital this method has been in use
for over two years. Detailed records of each case have been kept and it is proposed to publish
the findings in due course. The diagnostic value of the method is indicated from the figures
given below of the bacteriological findings in 57 cases notified as suffering from laryngeal
diphtheria. The diagnosis was confirmed bacteriologically in 34 cases by the presence of the
diphtheria bacillus in the nose, throat or larynx.
Organisms present. No. of cases.
Diphtheria bacilli 28
Diphtheria bacilli and hsemolytic streptococci 6
Pneumococci 4
Pneumococci and hsemolytic streptococci 2
Pfciffer bacilli 3
Pfeiffer and hsemolytic streptococci 2
Hsemolytic streptococci (pure) 5
Streptococcus viridans 1
No organisms 6
Total 57
34 positives.
23 negatives.

The 34 positive cases are further analysed to indicate the sites where the organisms were found:—

Site.No. of cases.
Larynx only723 positive laryngeal swabbings.
Larynx and throat12
Larynx and nose1
Larynx, nose and throat3
Nose only411 negative laryngeal swabbings.
Throat only4
Nose and throat3

Very great use has been made at the North-Eastern hospital of the electrocardiograph
in the early detection of impending cardiac complications, and in the
control of clinical observations upon the failing heart in the severer cases of faucial
diphtheria. Four of the acute wards in the permanent blocks at that hospital are
wired to the cardiograph which is housed in one of the small side wards. A system
of light signals facilitates the taking of records from patients in any of the four wards.
During the latter part of the year a portable electro-cardiograph of a new type,
in which a visible tracing of the curve is produced by the use of a cathode tube and
fluorescent screen, was lent to one of the assistant medical officers at the Brook
hospital (Dr. Thompson), who has made considerable use of it in the study and