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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examinations were made at an interval of six weeks. Streptococci found on swabbing
were graded into three classes: (a) few colonies; (6) numerous colonies; (c) nearly
pure cultures. This grading indicated the number of colonies on a blood plate.

Percentage incidence of carriers.—It will be seen from the following table that 77 of the nurses examined were found to be streptococcal carriers whereas a comparatively negligible number were revealed to have virulent diphtheria bacilli in nose or throat.

Streptococcal carriers.Total diphtheria carriers.
Few colonies.Numerous colonies.Nearly pure cultures.Total.
173 nurses26.5 per cent. (46 cases)16.3 per cent. (28 cases)1.7 per cent. (3 cases)44.5 per cent. (77 cases)1.2 per cent. (2 cases)

The finding of a few colonies of streptococci in an examination is a common
event; and, whilst it is not suggested that such a result is without significance, it
is thought that danger mainly lies in those carriers who yield fairly profuse growths
of streptococci on blood agar plates. For this reason attention was directed principally
to the 31 nurses who revealed numerous colonies or nearly pure cultures
of streptococci, and to the 2 nurses from whom virulent diphtheria bacilli were
recovered. A table showing the type of ward in which these 33 nurses were employed
is subjoined.

It will be seen that streptococcal carrying was most common in those nurses working in scarlet fever wards; carriers of pure cultures were found exclusively there just as the two diphtheria carriers were found in diphtheria wards.

Type of ward.Numerous colonies of streptococciNearly pure cultures of streptococciVirulent diphtheria bacilli.
Scarlet fever67.1 per cent. (16 cases)100 per cent. (3 cases)-
Diphtheria32.2 per cent. (9 cases)-100 per cent. (2 cases)
Other diseases, e.g. measles10.7 per cent. (3 cases)--
(28 cases)(3 cases)(2 cases)

Further it was possible to examine clinically all but a minority of the 173 nurses who
formed the subject of this investigation. It was found that the percentage with
unhealthy mucous membranes was higher amongst the carriers than amongst the
non-carriers. These percentages are tabulated below:—
Of 96 nurses who had no hæmolytic streptococci, 38.5 per cent. had unhealthy
mucous membranes.
Of 46 nurses who had a few colonies of hæmolytic streptococci, 67.5 per
cent. had unhealthy mucous membranes.
Of 28 nurses who had numerous colonies of hæmolytic streptococci, 75
per cent. had unhealthy mucous membranes.
Of 3 nurses who had nearly pure cultures of hæmolytic streptococci, all
had unhealthy mucous membranes.
Of 2 nurses who had virulent diphtheria bacilli, both had unhealthy
mucous membranes.
Finally, an impression was gained that streptococcal carrying to any degree did not
appear to take place amongst the older members of the staff. In order to test this,
the 33 carriers were divided into three classes according to the length of their hospital
service: (a) over 3 months and under 1 year; (b) 1 to 3 years; (c) over 3 years.