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106
METHODS OF CONTROL ADOPTED IN THE PRESENT EPIDEMIC.
The methods of control were those in common vogue, viz.,
(1) Isolation of the patient in an isolation hospital as soon as he was notified to be suffering
from Diphtheria.
(2) Disinfection of the rooms and bedding of the house in which the case occurred.
(3) Quarantine of contacts of school age.
(a) All home contacts who had not previously suffered were excluded from school for
10 days and any who developed suspicious signs were swabbed by the Health
Visitor who visited the affected homes daily.
(b) All contacts in school were inspected twice daily, in the morning by a Medical Officer
and in the afternoon by a Health Visitor. Any who developed suspicious
signs or symptoms were swabbed and if necessary excluded from school until
the result of the swab was known.
(4) General improvement in sanitation.
SUMMARY.
It is interesting to note in this outbreak that the number of cases occurring in the different
schools varied considerably. For example, Stonebridge School had 39 cases among approximately
900 scholars, while Wesley Road School had 18 cases among approximately 800 scholars. These
two schools stand opposite to one another in the same road. They are Elementary Schools. The
sanitary arrangements in both are very much alike and were found to be satisfactory. Further the
number of cases occurring in Wesley Road and Acton Lane Schools were comparatively small, while
isolated cases occurred in the remaining schools. This, therefore, goes to prove that the infection
was presumably not spread through School Attendance.
In addition the type of home which had the largest number of multiple cases was similar in
structural and sanitary arrangements to those homes which had only one case or which escaped altogether.
Further those multiple cases were found not in houses grouped together, but scattered
throughout the various streets, nor was it found that the infection was localised to a particular street
or streets.
The important part played by family infection in spreading Diphtheria is well illustrated by
this outbreak. Whole families were stricken with the disease within a few days of the entry of the
infection, this proving that once it gains a footing in a family it spreads rapidly, attacking all susceptible
adults and children alike. It is essentially a disease in which the infection is conveyed from
person to person, and as most cases are not examined by a Doctor until they have been suffering
from the disease for some hours at least, other people in their vicinity have been exposed to infection.
Hence the futility of the above methods of control in protecting the immediate contacts from the risk
of infection and limiting the number of cases.
THE VALUE OF THE SCHICK TEST FOLLOWED BY ACTIVE IMMUNISATION OF THE
SUSCEPTIBLE.
The only way known at present in which members of a community can be protected against
an attack of Diphtheria is by discovering by means of the Schick Test who are susceptible to the
infection of Diphtheria and by actively immunising them against it. The value of this method has
been well demonstrated in Birmingham, Edinburgh and New York, where Park in 1922 by this method
reduced the number of cases occurring among school children by about 80 per cent. Similarly this
method employed in isolation hospitals has made a notable reduction in the number of cases of
Diphtheria occurring among the staff.