London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1934
[Report of the Medical Officer of Health for London County Council]
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The results are recorded in the table below, and show that the highest incidence of carrying falls in the first year of service. This would seem to indicate that, with intimate contact over a period of years, some degree of anti-bacterial immunity develops.
| Period of service. | Numerous colonies of streptococci. | Nearly pure cultures of streptococci. | Virulent diphtheria bacilli. |
|---|---|---|---|
| 3/12—1 year | 42.8 per cent. (12 cases) | 100 per cent. (3 cases) | 100 per cent. (2 cases) |
| 1—3 years | 32.2 per cent. (9 cases) | — | — |
| Over 3 years | 25 per cent. (7 cases) | — | — |
| (28 cases) | (3 cases) | (2 cases) |
It will be noted that no reference has been made to the first 3 months of service.
Nurses in this group have, as originally stated, been dealt with separately and these
will be considered below.
Examination of new candidates.—41 new candidates were examined ; these
included 27 probationer nurses, 12 staff nurses and 3 sisters. All save the last
three were doing infectious nursing for the first time.
The procedure was essentially the same as in the previous group except that
examinations were undertaken at more frequent intervals. Further, the swab results
could now be correlated with the result of a Dick and a Schick test.
The first swab was taken before the candidate commenced ward work, and
subsequent swabbing took place at fortnightly intervals up to a period of three
months from the date of joining hospital.
cases. Diphtheria carriers were again a minority and only one was revealed.
| Few colonies of streptococci. | Numerous colonies of streptococci. | Nearly pure cultures of streptococci. | Total streptococcal carriers. | Percentage Dick negative reactors. | Diphtheria bacilli carriers. | |
|---|---|---|---|---|---|---|
| On joining | 31.7 per | 24.4 per | _ | 56.1 per | 6.4 per | _ |
| cent. | cent. | cent. | cent. | |||
| (13 cases) | (10 cases) | (23 cases) | ||||
| Whole 3-month period | 24.4 per | 61.0 per | 7.3 per | 92.7 per | 74 per | 2.4 per |
| cent. | cent. | cent. | cent. | cent. | cent. | |
| (10 cases) | (25 cases) | (3 cases) | (38 cases) | (1 case) |
Two factors influenced this increase. In the first place a somewhat increased
rate, both absolute and relative, was experienced in those nurses working in scarlet
fever wards as compared with that experienced in other wards exemplified in the
table set out below, where it is also shown that the incidence of streptococcal tonsillitis
is higher amongst staff in scarlet fever wards. It is, however, apparent that
an increase in carrying takes place on contact with non-scarlatinal cases, although
this may not be so marked. A second factor must therefore be operative. Unhealthy
mucous membranes were again found to be of the first importance. New
candidates who were found on admission to have enlarged tonsils or an unhealthy
nasal mucosa soon showed a relative increase in the number of streptococci or