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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early diagnosis of myocarditis in diphtheria. It was found very useful for this as
prolonged observations can be made without any disturbance of the patient. Dr.
Thompson proposes to embody the results he has obtained in a short paper.
In the annual report for 1933 (Vol. IV, Part I, p. 114), reference was made to
an investigation of the value or otherwise of accessory glucose and insulin therapy
in the treatment of toxic diphtheria by Dr. Norman D. Begg, senior assistant
medical officer, North-Eastern hospital. Dr. Begg's observations were embodied
in an article, to which a note by Dr. Harries, medical superintendent of the hospital
was appended, which appeared in The Lancet for 2nd March, 1935 (p. 480).
glucose and
The medical superintendent of the North-Eastern hospital (Dr. Harries) has
reported that, as in previous years, diphtheria carriers have been received from
other infectious diseases hospitals of the Council's service. During 1934 the work
of the carrier wards was under the immediate charge of Dr. Norman D. Begg, senior
assistant medical officer. The total number of patients admitted to the carrier
wards during the year was 162, compared with 170 in 1933. With the exception
of 8 cases, which were derived from the acute diphtheria wards of the NorthEastern
hospital, all were cases transferred from other hospitals. No patient so
transferred was regarded as a carrier until a positive and virulent culture had been
obtained at this hospital.
Of the total of 162 reputed carriers 58 (35.7 per cent.) never yielded positive
cultures after transfer and were discharged after three consecutive negative cultures
from nose and throat, taken at bi-weekly intervals, had been obtained. (This
figure compares with 52 (30.5 per cent.) of 170 reputed carriers admitted in 1933.)
In explanation of these figures it may be suggested that the patients were
transferred as carriers just at the point of becoming free from infection, but the
high percentage makes this unlikely as a general explanation. Much more probable
is it in Dr. Harries' opinion that many of these patients were really contact
carriers as the result of their stay in convalescent wards, and that with segregation
and the consequent avoidance of re-infection the carrier state came to an end.
As in previous years special carrier wards were provided. No acute cases of
diphtheria were admitted to these wards. Carriers whose carrier state had been
terminated as the result of treatment were, if considered unfit for discharge on
physical grounds, transferred to a negative ward, and thus escaped the possibility
of re-infection when up and about pending discharge. Dr. Harries points out that
it is significant, in view of what was written last year (Annual Report, 1933, Vol.
IV, Part III, p. 7), that this precaution eliminated entirely the "intermittent"
carrier who, in his opinion, is usually the product of re-infection by his fellow carriers.
As previously reported, the reception of diphtheria carriers from other hospitals
had from time to time been followed by outbreaks of scarlet fever in carrier wards.
It was found that a proportion of transferred diphtheria carriers had a recent history
of scarlet fever, and were in fact double carriers of the diphtheria bacillus
and the hsemolytic streptococcus. A special ward is maintained at the NorthEastern
hospital into which are received only Schick and Dick immune double
carriers. Since this measure was instituted no case of scarlet fever has occurred in
the diphtheria carrier wards.
Dr. Begg has reported as follows upon the 104 true carriers of virulent diphtheria
bacilli under treatment during the year:—
The site of infection was either the nose, throat or ear, alone or in combination. It
was always possible to demonstrate some pathological change at the site affected. Rhinitis,
frequently of a mild type with fine crusting on the nasal mucous membrane, was common. Less
common, but far more difficult to treat was rhinitis of atrophic type with large adherent crusts.
Excessive adenoid growth and unhealthy tonsils were common foci of infection. In three instances
the carrier state was maintained by the presence of a foreign body in the nose. Deflected
septa and other anatomical abnormalities in the nose were found to be important only in so far
as they were accompanied by inflammatory changes. Paranasal sinusitis was noted in two
nasal carriers, but in neither instance was it found that the unhealthy sinus was the actual
reservoir of the diphtheria bacillus.