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WORK OF THE DEPARTMENT
Control of Infectious Diseases
This, the original raison d'etre for the appointment of Medical Officers of Health remains
still their prime responsibility although it now comprises but a small fraction of the work of a
modern Health and Welfare Department. Nevertheless, over 2,000 visits were made by the Deputy
Medical Officer of Health and/or Infectious Diseases nurse for this purpose and a total of 1,431
specimens collected and examined during the year.
During 1966 scarlet fever showed a significant fall from 176 cases to 147; as did
tuberculosis (79 cases as against 111 in 1965). Measles cases notified totalled 1,157 but 817 of
these occurred in the last quarter of the year. In 1965 with 4,147 cases, 3,087 were in the first
quarter and only 13 cases in the last quarter so illustrating the established pattern of measles
epidemics to occur every second winter and very high figures may be anticipated in the first
quarter of 1967.
We are currently participating in a survey, led by a research team from the Public Health
Laboratory Service, with the object of developing a more effective vaccine against whooping cough.
Despite the high acceptance rate (74% of all Waltham Forest babies are immunised in the first
year of life), whooping cough continues to be prevalent unlike poliomyelitis following the widespread
acceptance of polio vaccine. During the last ten years the annual number of polio cases in
England and Wales has fallen from 3,200 to 32 and deaths from 137 to 4, while over the same period
92,407 cases of whooping cough with 92 deaths have been reduced proportionately much less to
19,482 and 20 respectively. With a more effective vaccine we feel these figures will be substantially
reduced.
One case of diphtheria (England and Wales 24 cases, 3 deaths) did occur during the year
at Chingford and in a most unusual way. A young lady, after dressing an abscess on a riding horse,
developed a sore throat clinically suggestive of diphtheria and later confirmed by isolation of the
diphtheria bacillus from throat swabs. With appropriate treatment the patient made a complete
recovery. There is little doubt that the horse was infected (horses are, of course, used in the
preparation of both diphtheria and tetanus antitoxins) but despite some perseverance necessary to
secure its co-operation we could not recover the germ from its throat and the source of infection
remains a mystery.
There were two fairly extensive outbreaks of dysentery; characteristically they occurred
at midwinter and centred on two infant/junior schools, 24 children in one and 42 in the other
being affected in addition to parents and pre-school siblings. Vigorous action was taken,
continuous disinfection of the lavatories, and all children made to wash in disinfectant solution
and use paper towels after toilet and again before eating.
It is not always realised that when a W.C. pan is flushed a spray of fine droplets of
water is thrown up in an invisible mist which, if the last user has dysentery, will contaminate the
air and the entire structure of the closet. With commendable initiative one of the head teachers
concerned told parents to ensure that their child used the lavatory before coming to school even
if it meant missing the first lessons. I believe that this practice materially reduced the extent
and duration of the outbreak. The modern design of infants' schools whereby an individual
lavatory suite with washbasins is attached to each classroom offers, I believe, the only chance
of ending these school outbreaks every winter.
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