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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Table 19.

Division.Population.No. of visits to Schools.No of depts. visited.No. of children examined.No. of children swabbed.Diphtheria bacilli present inNo. virulentCarrier rate per cent.Diphtheria rates (all ages.)
Total notificationsCase rate.Total deaths.Mortality rate.Case mortality rate.
per 1,000per 100,000Per cent.

In all, 5,439 cases of diphtheria were reported from schools, representing an
attack rate of 10.3 per 1.000 of the 527,283 children on school rolls.
The arrangements made with three voluntary hospitals, viz., London, St.
Mary's and Guy's, for the treatment of diphtheria carriers at special out-patient
clinics, were continued during 1934.
Reports have been furnished by the medical officers in charge of these clinics.
In this connection it may be noted that the cases referred to the clinics through
the school medical service are those in which virulence has been established as a
result of biological tests, and that efforts have been made, more especially during
the last three months of the year, to limit the cases referred for treatment to those
who might be regarded as persistent "carriers."
The clinic at the London hospital is under the care of Mr. Francis Muecke, who
has submitted the following summary of cases for 1934:—
On arrival 38 cases were found to be positive and 42 negative. The following is an analysis
of these cases:—

Table 20.

Result.Positive on arrival. (26 operations.)Negative on arrival. (1 operation.)Total.
Discharged cured374178
Ceased to attend112

Dr. L. W. Cann has furnished the following statement regarding the work
carried out at the special clinic at Guy's hospital:—
During the year there were 95 new cases, while 13 cases were carried over from 1933 and
are included in the following summary. Six cases still attending are not included.
K.L.B. present. Virulent—tonsils 10, tonsils and nose 4, nose 24, total 38 (including 4
cases notified as nasal diphtheria).
Non-virulent—tonsils, 3, nose 8, total 11.
Not tested—nose 1, total 1.
Total cases with morphological K.L.B., 50; Hofmann only found, 18 (two virulence tests).
Other diphtheroids found, 5 (three virulence tests). No diphtheroid organisms, 29.
There has been no alteration in the standards used or treatment employed. It is again
obvious that the majority of cases sent to the clinic are not persistent carriers. Many have
already lost their K.L.B., by the time they reach the clinic and the majority of the remainder
become clear after a few attendances. It would be unwise to attribute this to any treatment.
The 10 cases carrying virulent K.L.B., in the tonsils only, cleared rapidly except for two.
In both of these latter tonsillectomy was done about one month after the last swab taken at the
clinic. In one case subsequent superficial and deep cultures from each tonsil were negative
for K.L.B. It would have been well to have swabbed the child again after admission to the
ward, before tonsillectomy.