View report page

22
In June and July a small but severe outbreak of diphtheria occurred in a school
in Bermondsey. The first school child affected was a girl, who had not been immunised,
who developed the disease on 29th May, and becoming rapidly worse, died the same
day before removal to hospital. A further case was notified on 14th June, but this
child had not been in school for the 10 previous days. On 21st June, 8 children were
absent with sore throats, 3 of whom developed diphtheria. On the following day
5 more were absent and 3 of these also developed the disease.
Information of this outbreak reached the Public Health Department (the
Divisional Medical Officer) on 24th June, when the school was closed for the day
because of the election. The next day, the Divisional Medical Officer with the
Medical Officer of Health for the Borough visited the school and decided to close it
temporarily in an endeavour to reduce the spread of infection. In all, 12 children
from this school, 11 of them from one class, developed diphtheria and 3 of them
died. There were 15 notifications among children in neighbouring schools with no
death, 11 with one death in children under school age and 10 cases with no death
amongst adults in the neighbourhood, a total of 48 notifications and 4 deaths. None
of the children who died had received immunising injections.
When the outbreak was apparent, arrangements were immediately made to
immunise all children in the school and in the neighbourhood. In 4 days, 1,500
children received a first injection, including practically the whole of the school
affected where previously only about 20 per cent. of the children had been immunised.
The static clinics were supplemented by the mobile immunisation van from another
division.
The school was re-opened on 4th July, and continuous efforts were made to
increase the percentage of children immunised.
This outbreak underlines the need for the close co-operation which exists between
the Borough Medical Officer of Health, who is responsible for the control of the
spread of infectious diseases and who receives notifications of such diseases from the
general practitioners, and the County Medical Officer, who is responsible for the
health of the children in the schools and for the provision of immunisation against
some of these diseases.
Detailed figures of new cases of tuberculosis notified in 1949 are shown in Tables
12 to 15 (p. 126 to 130). Non-civilians are included in the statistics and total populations
are used except where otherwise stated.
The general trend of morbidity and mortality since 1921 is indicated by Table 12
(p. 126), and is also illustrated by diagram (p. 23). The consistent decline in deaths
and notifications during the inter-war years was substantial. New cases of pulmonary
disease were reported at the rate of 2.1 per 1,000 living in 1920 and at only 1.3 per
1,000 in 1938, a fall of about 40 per cent. in just less than twenty years. In 1938 the
death-rate from pulmonary disease was 0.64 per 1,000, i.e., about 40 per cent. lower
than the 1920 rate of 1.04; a saving of some 1,600 deaths annually at the 1938
population level. In the early years of the war the upsetting of the balance between
input and output of energy, the general deterioration in living conditions, the strain
placed upon the population by bombardment and the increased opportunities for
the spread of infection, associated with the discharge of tuberculous patients from
hospitals to make room for air-raid casualties, all combined to reverse the trend of
both morbidity and mortality and by 1941, the ground gained in the inter-war years
had been lost. Mortality rates rose to a peak of 1.10 per 1,000 for pulmonary disease
and 0.15 per 1,000 for non-pulmonary disease in 1941, but in so far as this rise was
mainly due to the impact of the hard conditions of war upon existing advanced
cases, it was short-lived and the mortality quickly began to decline again as the
war progressed. By 1946 the mortality rates had fallen below the pre-war levels
Tuberculosis