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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became carriers for the first time, irrespective of the type of ward in which they were stationed.

Number with unhealthy mucosa.Percentage carrying streptococci on joining.Percentage carryin streptococci after two months' service.Percentage who developed tonsillitis.
Scarlet fever wards1947.3 ( 9 cases)100 (19 cases)26.3 (5 cases).
Other wards2263.3 (14 cases)86.3 (19 cases)13.6 (3 cases).

Cross infections of streptococcal tonsillitis are still unfortunately not rare.
Unlike diphtheria it cannot be prevented by passive immunisation, so that the
problem of carriers is a very real one. There can be no doubt that staff carriers are
occasionally responsible for cross infection, and an outbreak of streptococcal
tonsillitis in a negative ward which was traced to such a source is described.
Ward outbreak
A probationer nurse was found to be Schick and Dick negative on joining, and
a swab of nose and throat was negative for hæmolytic streptococci and diphtheria
bacilli. Her tonsils were moderately enlarged and pitted. She was allocated to
an acute scarlet fever ward, and within a week developed an acute sore throat with
confluent exudate on both tonsils from which a nearly pure culture of hæmolytic
streptococci was obtained. Recovery was uneventful and on discharge a few
colonies only of hæmolytic streptococci were present in the throat swab. After
a period of sick leave she commenced work again in a ward containing twelve
negative cases. A field swabbing of the ward population had been done at that
time for another purpose and revealed a few colonies of hæmolytic streptococci in
the throats of three children—the nursing staff were negative. Two days after her
return to work the suspect nurse contracted a severe "cold," and five days later
another nurse was removed from the same ward with streptococcal tonsillitis. For
this reason the suspect was re-swabbed and now showed numerous colonies of
hæmolytic streptococci in nose and throat. She was promptly removed from the
ward, but not before she had infected four of the children who developed typical
attacks of streptococcal tonsillitis within a week.
The medical superintendent of the North-Eastern hospital (Dr. Harries), who
has submitted this report, states that the streptococcus is world-wide in distribution,
and it is not always possible to assess its pathogenicity in an individual case.
Nevertheless certain strains, commonly found in human carriers, are capable of
producing well defined diseases such as scarlet fever and tonsillitis. The results
of this investigation show that streptococcal carriers abound in the nursing staff of
a fever hospital, and that these carriers betray certain characteristics by which they
may be suspected or recognised. For that reason some control is possible by
allocating nurses to appropriate wards, not only on the result of a Schick and Dick
test, but on the evidence of these tests combined with repeated swab results and
an examination of the nose and throat for pathological abnormalties. This practice
has been pursued at the North-Eastern hospital with success.
Dr. Harries summarises the conclusions as follows:—
(1) A high percentage of nurses in a fever hospital are shown to carry
hæmolytic streptococci in contrast to a negligible percentage of diphtheria
(2) Newly joined nurses are more likely to become carriers than staff with
long experience of infectious work.
(3) Unhealthy mucous membranes and intimate contact with streptococcal
diseases are important factors in determining the carrier state.
(4) Outbreaks of streptococcal diseases are occasionally traceable to staff
carriers and some control is possible.
In Dr. Harries' opinion this is an important investigation. So far as diphtheria
is concerned it is clear that active immunisation of the staff does not increase the