[Report 1930] / Medical Officer of Health, Warwickshire County Council.

  • Warwickshire (England). County Council.
Date:
1930
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1930] / Medical Officer of Health, Warwickshire County Council. Source: Wellcome Collection.

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    42. Examinations at University of Birmingham. Swabs from Suspected Diphtheria 1926. 1927. 1928. 1929. 1930. Cases ... 2,170 1,741 2,030 2,785 3,435 Swabs from Diphtheria Contacts ... Blood Examination for Typhoid 456 273 502 603 827 and Para-typhoid 100 247 278 132 226 Blood films for Malaria ... 2 2 4 — — Faeces for Typhoid 2 12 48 15 26 Faeces for Dysentery — — 6 2 5 Sputa for Tubercle 932 975 1,143 1,108 525 Cerebro-Spinal Flu'd 3 4 4 — 1 Special Examinations 4 15 33 13 30 3,669 3,269 4,048 4,658 5,075 43. Among the special examinations were the following :—Virulence test for Diphtheria, 6 ; Puerperal Fever Swabs, 20; Urine for Typnoid, 3; Urine for Tubercle, 1. 44. In addition to the above Dr. L. L. Fyfe, Medical Officer of Health for the Stratford- on-Avon District carried out 136 examinations :—Diphtheria, 64 ; Sputa for Tubercle, 59 ; Cerebro-Spinal Fluid, 3 ; Swabs for Gonorrhoea, 10. 45. From the above figures it will be seen that the number of swabs in connection with Diphtheria and Suspected Diphtheria has increased steadily smce 1927, the year after I circularised all Practitioners on the question of Diphtheria Swabs, and particularly on swabs from Contacts. 46. There is, however, a definite relationship during the past year between the number of swabs taken and the prevalence of Diphtheria, 574 notifications being recorded as compared with 435 in the previous year, and it must also be remembered that included in the total number of swabs taken are those from all Infectious Diseases Hospitals in the County to which Diphtheria cases are admitted. The practice of two consecutive negative swabs before discharge is still common at most of these Hospitals, and in some instances cases are not discharged until a negative result has been given in nose as well as throat, which again increases the number of swabs per case. 47. Little heed appears to have been taken by the profession to the recommendations made by the Medical Research Council in their Report on the value and limitations of Laboratory Diagnosis in Diphtheria, 1923. In the circular letter referred to above I drew attention to their conclusion in connection with Diphtheria Convalescents, which was as follows : — “ Swrabbing of Diphtheria Convalescents need be undertaken only in those cases shewing chronic nasal discharge, chronic sore throat or any other clinical signs of infectivity, freedom from infection being assumed when clinically all diphtheria infected surfaces have returned to the normal and infective discharges have ceased.” This procedure places a responsibility on the practitioner which experience shews he is not prepared to take, consequently he continues to place responsibility on the shoulders of the Bacteriologist. In this he is undoubtedly encouraged by the public, who want to know “ the result of the swab,” and who themselves look for confirmation of the doctor’s opinion when given on clinical grounds alone. 48. Medical Officers in charge of Infectious Diseases Hospitals will in all probability con¬ tinue their procedure of two consecutive negative swabs before discharge, since the method of discharge by reliance on clinical signs only would place much greater responsibility on the Medical Officer, but the responsibility should not be any greater than he has to take at present in the discharge of Scarlet Fever patients. 49. On the other hand it has been pointed out to me that virulent Diphtheria germs may remain in a throat that is clinically normal. If that is so then such a case must be rare, and so extremely unusual as to have little influence indeed on the method of discharge of Diphtheria Convalescents suggested by the Medical Research Council.