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34
In addition, a special examination was held at one school on account of the prevalence
of a skin complaint. The sequel illustrates the value of such epidemiological
field work. The condition was found to be molluscum contagiosum, and as a result
it was found possible to arrange for the admission of one child to a Council hospital,
while others were treated at home by private medical practitioners and at school
clinics.
Valuable work was done by the school nursing staff in following up the investigations
by medical officers shown above, and also in making special visits to schools
in connection with the occurrence of infectious disease as indicated below:—
Nature of No. of special visits
infectious disease by school nurse
Diphtheria 173
Scarlet fever 126
Chickenpox 108
Mumps 63
Whooping-cough 33
Sore throats 88
Diphtheria
As shown in table 21, school doctors made 175 visits to 131 departments in
elementary schools, during the course of which 15,548 children were inspected and
swabbingS from the throat and nose of 2,380 selected children were taken. Of this
number, 103 (4.3 per cent.) proved positive. In addition, 1,082 children were swabbed
at treatment centres or clinics, and bacteriological examination showed that 98 (9.1
per cent.) of them were positive for Bacilli diphtheriœ.
As a precautionary measure, swabs were also taken from the throat and nose of
638 children prior to entry to convalescent homes, and 635 of these proved to be
negative.
It was considered necessary to re-swab children in 62 cases when examination
of a primary swab was inconclusive or suspicious. In 27 of these cases, Bacilli diphtherice
were found to be present.
The systematic swabbing of contacts and of certain other children is of considerable
value because it leads to the segregation of possible sources of infection.
During the period 1st January to 13th April, 1938, morphological Bacilli diphtherice
were isolated and tested for virulence in 70 cases, of which 61 (87 per cent.)
proved virulent and 9(13 per cent.) non-virulent. Since April, however, the virulence
tests have been largely discontinued and replaced by fermentation tests.
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 were continued throughout 1938,
60 children of school age being referred there by various authorities, hospitals or private
doctors. A report has been furnished by the medical officer in charge of each of the
clinics, giving details of treatment and the results obtained. The majority of cases
were found to have lost their " carrying " propensity by the time they were examined
at the clinics. Three cases were removed to hospital as cases of clinical diphtheria,
and one with measles. Tonsillectomy was advised for three more cases, and the remainder
were given treatment and ultimately discharged as cured.
The Corporation of London and the Metropolitan Borough Councils arrange for
immunisation against diphtheria to be carried out at infant welfare or special centres,
or by arrangement with medical practitioners or voluntary hospitals. As in previous
years, 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.
Children in the Council's residential establishments are immunised against
diphtheria and a summary of the work done during the year appears later in this
section of the report.
The incidence of scarlet fever among school children was slightly higher than in
1937, 3,988 cases having been reported, compared with 3,903 cases during 1937. The
average number of cases for the years 1932-8 was 6,409. Investigations were made on
62 occasions at schools where several cases had occurred.
Diphtheria
"carriers"
out-patient
clinics
Active
immunisation
against
diphtheria
Scarlet fever