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Infective Hepatitis
On 15th June 1968, infective jaudice became statutorily notifiable throughout the country. This
was an important advance in the technique of understanding this mysterious disease whose cause
apparently a virus, has proved extremely difficult to identify. Ever since Haringey was formed we
have been interested in infective hepatitis, and quite early on we asked general practitioners to
inform us of cases so that they could be reported by location in the weekly Haringey Infectious
Diseases Bulletin. This certainly made us more aware of it, and on a few occasions outbreaks were
identified and followed through. After 15th June 1968, the number of notifications increased
strikingly, and there were 68 by the end of the year, with no evident outbreaks, compared with 28 in
the corresponding period in 1967. A system using coloured pins on a map was devised, with a
different colour for each month, so that a first case could be kept in mind over an incubation period
which can be as long as 50 days. Surprisingly enough, however, no evidence of localised outbreaks
came to light; the pins spread themselves fairly evenly over the map and tended not to clump together.
Thus it would appear that, so far at any rate, our instrument is not yet delicate enough to track the
course of infections through the community.
Another purpose of statutory notification is the identification of serum jaundice, which is only
too liable to occur in drug addicts who inject themselves with dirty needles and syringes. As far as
we are concerned this has not resulted in any new addicts being found, and notifications of these
cases have only served as milestones on the downward paths of known addicts; but a careful watch
is being kept nevertheless.
Influenza
As far as the Hong Kong A2 virus was concerned, this is the disease that hardly ever was. We
all watched with mingled fascination and anxiety as the infection took its inexorable progress across
the world, wondering if the appropriate vaccine would be ready before it arrived here. When it did, a
large amount of vaccine had been distributed, but for some reason the virus unaccountably wilted and
produced only comparatively few cases throughout the country. It is consoling to learn that even
influenza germs have problems.
It was the policy of this Health Department to keep strictly to the request of the Chief Medical
Officer of the Department of Health and Social Security that the vaccine should be given only to
priority groups. Where we were concerned this meant physically handicapped school children in our
care and medical and nursing staff who might be needed to take over the duties of their colleagues in
the other branches of the Health service in the event of an epidemic that threatened its breakdown.
One hundred and fifty doses were obtained and administered to carefully selected personnel and
children.
It may not be generally realised that the distribution of this vaccine was not organised by the
Department of Health or the local authorities, but was dependent on arrangements between the
manufacturers and their customers. We were therefore concerned during the early stages to learn that
industrial firms and other large organisations were receiving large quantities, which they were giving
to their staff whether or not these individuals had any priority. At the same time it was proving
extremely difficult for doctors and hospitals to obtain vaccine for patients in genuine need. We
expressed our alarm to the Department of Health and were somewhat reassured to hear that they had
metthe manufacturers and obtained their agreement to giving priority to hospitals and local authorities.
However we felt it necessary to point out that similar arrangements would be required in order to
ensure that supplies were available to general practitioners for their patients at home. No doubt
others were making a similar plea, and we were greatly relieved when this was done.
It is perhaps just as well that Hong Kong A2 proved to be a virus lacking in teeth, for the state
of affairs that prevailed over distribution of the vaccine might well have exposed many frail and
vulnerable people to serious illness and death. It is to be hoped that the lesson has been well
learnt, and that stricter rules will apply in future years when the prospect of large influenza epidemics
faces us again. No standing contract between a business firm and a drugs manufacturer should ever
be allowed to stand in the way of the deserving patient and the health and well-being of the community
as a whole.
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