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46
Virulence tests were applied in six of the eleven positive cultures from the ears,
three proving virulent and three non-virulent, while the single case of conjunctivitis
(diphtheria bacilli) proved non-virulent.
As a precautionary measure cultures from throat and nose were taken from 482
children prior to entry to convalescent homes, holiday camps, etc. In 7 (1.45 per
cent.) bacilli morphologically resembling diphtheria were found in culture; 4 proved
virulent and 3 non-virulent.
The arrangements made with Guy's hospital, St. Mary's, Paddington, hospital,
and the Hospital for Sick Children, Great Ormond-street, for the treatment of diphtheria
"carriers" at special out-patient clinics, to which reference has been made in
previous annual reports, were continued throughout 1937. During the year, 66
children from the Council's schools, who were found to be harbouring virulent diphtheria
bacilli, were sent to these clinics. The medical officers in charge of the clinics
have furnished reports on the methods of treatment employed and the results obtained.
Some of the cases were found to have lost their "carrying" propensity by
the time they reached the clinics. The persistent "carriers" all cleared up after
intensive treatment. In one case, it was found necessary to remove unhealthy
tonsils and adenoids before the "carrier" condition cleared up.
As stated in the annual report for 1936, arrangements for immunisation against
diphtheria are now made by the Corporation of London and the Metropolitan Borough
Councils, the work being carried out at infant welfare or special centres, or by arrangement
with medical practitioners or voluntary hospitals. The Council has assisted in
propaganda in connection with this work by authorising the use of the school organisation
for the distribution of leaflets issued by the Councils providing the facilities.
The following review of the incidence of diphtheria, and the mortality amongst
the child population of London for the ten-year period 1926-1935, and of the
measures of prevention by immunisation, will be of interest:—
The mean of the total child (0—15 years) population (1,000,100) for the period of
the review shows annual averages of 9,047 notified cases (9-01 per 1,000); 367 deaths (3-05
per 10,000) and a case mortality of 4 per cent.
Immunisation against diphtheria by the Metropolitan Borough Councils was commenced
in 1922 in the metropolitan borough of Holborn, and by the beginning of 1927 two other
authorities adopted preventive inoculation, yielding in all at that date a total of under 1,000
Schick-tested and fewer than 500 immunised. Five years later, at the end of 1932, marked progress
had been made, as, by that time, fourteen local sanitary authorities were affording facilities,
and not far short of 16,000 individuals had been tested or inoculated, including over 9,000
actively immunised. During the next three years, 1933-35, provision was made by ten additional
local sanitary authorities, either by the establishment of immunisation clinics or through cooperation
with general medical practitioners who undertook the inoculation of their private
patients, so that by the end of 1935 it was possible to record that 14,000 further individuals
had been immunised, and that a total of over 38,000 were Schick negative or had been inoculated,
i.e., more than double the number dealt with at the close of 1932. During 1936, four more local
sanitary authorities, which had not, up till then, adopted preventive measures, decided to open
immunisation clinics at treatment centres.
During the period under review, 6,498 children were found to be Schick negative at the primary
test. A course of diphtheria prophylactic treatment was given to 31,573 positive cases, and of
these 23,118 were subsequently found to be Schick negative. The total number of clinical cases
of diphtheria reported among the 23,118 immunised children was 41, but in the majority the
symptoms of the disease were mild in character. There was no death. The attack rate was 1.77
per 1,000. Additional reported cases occurring among those who had received prophylactic
inoculation, but who had not been subsequently Schick-tested, are not included in the 41 cases mentioned
above. Those known or presumed to be protected, including primary Schick negatives
(i.e., naturally immune) and those immunised (i.e., found negative after inoculation) numbered,
at the end of 1935, 29,616—a proportion of 2.96 per cent, of all children under 15 years of age.
By taking into account those children who received the full prophylactic course, but who were
not proved immune by subsequent Schick negative test, a total of 38,071 potentially protected
individuals was reached at the end of 1935. If the child population of the five boroughs in which
there is no record of immunisation up to 1935 is discounted, the following percentages would be
obtained: known or presumed to be protected 3.87; potentially protected 4.97. A diphtheria
protection rate of approximately 3 per cent. for the whole of London will leave the general incidence
and mortality practically unaffected, as, to produce any material effect, the immunisation of
between fifty or sixty per cent. of the child population, including the pre-school age group,
should be secured and maintained. There is, however, substantial benefit to the individuals
who have been immunised.
Diphtheria
"carriers"
out-patient
clinics
Active
immunisation
against
diphtheria