London's Pulse: Medical Officer of Health reports 1848-1972
View report page
Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
East Ham 1928
[Report of the Medical Officer of Health for East Ham]
This page requires JavaScript
38
is encouraged ; the discharge of patients directly from an acute
ward is also very unsatisfactory, and one looks forward to the
time when a discharge block will be provided for this purpose.
(b) Diphtheria.
Excluding the 66 cases remaining in the Hospital at the end
of the year, 635 completed cases of Diphtheria were treated during
the year 1928, and of this number 45 died. This equals a case
mortality of 7 per cent, as compared with a rate of 6.5 per cent,
in the year 1927. Ten of the. fatal cases were of the haemorrhagic
type of Diphtheria, four died from post-diphtheritic paralysis of
the respiratory muscles, one case was complicated by gangrene of
the lower extremities, two cases developed broncho-pneumonia,
and in three cases the patients were already suffering from endocarditis,
enteritis and marasmus respectively. Of the remaining
25 fatal cases, 11 died within twenty-four hours of admission to
Hospital and 14 were suffering from profound toxaemia on
admission. The average duration of illness, prior to admission
to Hospital, in the 45 fatal cases, was 4.3 days, and the administration
of anti-diptheritic serum holds out little hope of recovery
in cases so advanced in the disease.
The ages at which death occurred were :—
| At 1 year | 3 | 27 | At 6 years | 3 | 14 | At 11 years | 2 | 4 | |
| „ 2 years | 5 | „ 7 „ | 4 | „ 12 „ | 1 | ||||
| „ 3 „ | 5 | ,, 8 ,, | 4 | „ 13 „ | 0 | ||||
| ,, 4 „ | 6 | „ 9 „ | 1 | „ 14 „ | 0 | ||||
| ,, 5 ,, | 8 | „ 10 „ | 2 | ,, 15 „ | 1 | ||||
The cases of Diphtheria throughout the year were, for the
most part, of that very severe type which showed itself towards
the end of the year 1927 : a type which has not occurred for many
years. The majority of the patients exhibited diffuse foul-smelling
pharyngeal deposits with marked glandular enlargement, periglandular
oedema and severe toxæmia with the only too frequent
supervention of vaso-motor paralysis, cardiac dilatation and circulatory
failure. In these cases bacteriological examination has
revealed the presence of streptococci in addition to the diphtheria
bacillus and, for this reason, 43 patients were treated by means
of a combined injection of anti-diphtheritic serum and polyvalent
anti-streptococcus serum ; the results of this method have been very encouraging.
The types of Diphtheria classified according to
the site of the local lesion were as follows :—