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17
NOTIFICATION OF MEASLES AND WHOOPING COUGH.
The County of London (Measles and Whooping Cough) Regulations, 1938, which came
into operation on the 1st October, provide that cases of measles and whooping cough must
be notified to the local medical officer of health by the medical practitioner in attendance,
unless a previous case of the disease has occurred in the same house and has been notified
within the preceding two months.
In accordance with the instructions contained in the Order, the provisions were suitably
advertised within the City, and a copy of the Regulations themselves, together with a covering
letter, was forwarded to every medical man practising in the area.
HOSPITAL ACCOMMODATION FOR SCARLET FEVER, MEASLES, &c.
In view of the difficulties which were experienced in obtaining nurses, the London
County Council had to restrict the admission of cases of scarlet fever, dysentery, measles,
whooping cough, chicken-pox, german measles and mumps, to their Hospitals to cases in
which hospital treatment was essential owing to severity of the case and unfavourable
home conditions, and in the case of measles to children under two years of age.
The restriction operated from the early part of the year until the middle of May, 1938,
and so far as the City of London was concerned was not attended with any-difficulty.
CEREBRO-SPINAL FEVER.
Early in May the secretary of a firm in the City telephoned to say that a member of
his staff had been reported to be suffering from Cerebro-Spinal Fever and to ask if it was
necessary to take any stef>s to prevent the spread of infection. The offices of the firm,
which were high up in a large modern building, were visited, and it was found that they
were well lighted, there was provision for good ventilation and there was no crowding.
Disinfection of the patient's desk and of articles used by him was carried out, but no other
action was taken.
On May 16th, a second case was reported from the same office, and as the staff was not
very large, it was decided to try to find a carrier.
It was ascertained that, in the second case, the infecting organism had been typed
* and had proved to be Meningococcus, Group I. Unfortunately, the first case, which had
been admitted to a different hospital, was not typed.
Your Bacteriologist, Dr. Garrod, visited the office of the firm on May 16th, and obtained
post-nasal swabs, from which cultures were made forthwith, from all the occupants of the
two rooms in which the cases had occurred. The number of persons swabbed was 49, and
Dr. Garrod reported that an unduly high proportion of them were suffering from pharyngeal
or post-nasal catarrh. In 11 cases cultures yielded a profuse growth of meningococci,
the majority being nearly pure cultures, and in 12 others there was an almost pure growth
of. pneumococci, no less than seven of which were of the " mucosus " type. Dr. Garrod
Remarked that these facts indicated that upper respiratory tract infections had been spreading
freely from person to person in the office.
By the kindness of Dr. Scott, of the Ministry of Health, the serological type of the
meningococci was ascertained. With'one exception, they were of Group II. In one case,
L. C., the meningococci were of Group I, the epidemic type, and the type known to have
been responsible for the second case. L. C. lived at Wimbledon, and the Medical Officer
of Health was informed of the circumstances. As his home conditions were not suitable
for isolation, L. C. was admitted to the Wimbledon Infectious Diseases Hospital.
Post-nasal swabs were taken on May 31st, June 7th and June 15th, and cultured by
Dr. Garrod. On each occasion the swabs yielded a profuse growth of meningococci. Dr.
Garrod deemed it advisable to have the meningococcus examined serologically again, and
accordingly sent the culture of June 15th to Dr. Scott.
Dr. Scott reported that the organism had lost type specificity and virulence.
L. C. was therefore discharged from hospital, and after a holiday in the country, returned
to his work on July 4th, seven weeks after he had been detected as a carrier. No further
cases occurred. The investigation and the isolation of the carrier were greatly facilitated
by the sympathetic co-operation of the principals of the firms concerned.