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of those attending more than once stopped smoking altogether: some did so after the first
interview, others took up to 13 weeks, the average time being four to five weeks. Until
July the clinic was run on the basis of a cycle of three meetings for each client; subsequently
a less rigid programme was adopted, clients being encouraged to attend until they themselves
wished to stop coming. This may account for a slightly longer average time taken to stop
smoking since July (four to five weeks as against three to four).
These results reflect the immediate effect and it is feared that longer term follow.up may
reveal a number of relapses. The success of the sessions should not be gauged, however,
purely on this basis for there can be no question that many of those who attend influence
in turn their circle of friends and acquaintances; in the same way the sessions have also
acted as a focus for health education in this particular field for members of our own staff.
Infectious disease—Toward the end of the year there was a diphtheria incident involving
three schools in the division. A schoolboy aged eight, with siblings in his own school,
was admitted to hospital with a provisional diagnosis of mumps but suspected by the
physician to be suffering from diphtheria. Nose and throat swabs of the boy's class were
taken on the day this information was received from the borough medical officer of health
and instructions were given to check the immunisation state of the class. Next day, following
information that another pupil, newly arrived from Cyprus, was carrying diphtheria
organisms in her throat, arrangements were made to take throat and nose swabs from the
whole school without delay. Simultaneously, parental consent for immediate immunisation,
either reinforcing active or combined active and passive as required, was sought from parents
of all children in the class of the original schoolboy. All absentees from the school were
followed up and swabbed at home, and the swabbing of school and home contacts revealed
ten children carrying diphtheria germs spread over six of the nine classes in the school.
All were admitted to hospital and four were diagnosed as cases of diphtheria. The original
schoolboy was gravely ill, requiring tracheotomy and later developing complications
involving both heart and nervous system.
Investigations and follow.up continued over the next few days, including the weekend,
the borough medical officer of health tracing and following up home contacts whilst
divisional staff undertook follow.up and immunisation of school contacts; co.operation
was close and most satisfactory. The Public Health Laboratory Service covered speedily
and effectively the major commitment of processing and reporting on the swabs.
That weekend a positive throat swab, taken from a school girl cousin of the Cyprus
immigrant involved in the earlier enquiries, was received from a general practitioner.
Through her large family this extended enquiries into several other schools and two
carriers (bringing the divisional total up to eight in addition to five cases) were found in
one class after the weekend. In the ensuing week tracing and swabbing continued on the
basis that no class (with one case or carrier) and no school department (with more than
one case or carrier) was considered clear until two completely clear swab rounds (comprising
both throat and nose swab for each pupil, including absentees) had been obtained. All
children considered at risk in schools in which cases or carriers were found were immunised
at once. During the whole operation some 2,500 swabs were taken by divisional staff and
processed by the Public Health Laboratory Service; many more were of course taken by
borough staff in Islington, Finsbury and elsewhere.
The incident highlighted serious deficiencies in the immunisation state of school children.
Earlier in the year an attempt had been made, with the co.operation of many head teachers,
to improve the immunisation state in the infant departments by a special drive and a
start had been made in the autumn term with the junior departments. Parental apathy and
the extensive population movements into and out of the division necessitate intensive efforts
to maintain a continuous state of protection in the school population, even if this may
involve some loss of school time.
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