Discussion on the modern control of infectious diseases / R.A. O'Brien.

  • O'Brien, Richard Alfred, 1878-1970.
Date:
[1926?]
Catalogue details

Licence: In copyright

Credit: Discussion on the modern control of infectious diseases / R.A. O'Brien. Source: Wellcome Collection.

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    What Evidence is Available in England? For the past four years we have been in close touch with three institutions in which diphtheria had occurred, and in which testing and active immunization were begun by ourselves and have been carried out for a period of years. During that time there has been no case of undoubted clinical diphtheria amongst any of the children who have been tested and found negative, to the Schick test, either naturally or after immunization. It is true that there are no adequate statistical controls ; the only evidence that these measures of testing and immunization have caused the drop in incidence is that no infections have occurred amongst the children living in these residential schools but attending outside day schools, whereas amongst the other unprotected children attending these day schools many cases of diphtheria have occurred. If the practice of Schick testing and active immunization, efficiently applied, is to be justified in the general community, these processes should be able to control diphtheria in a group of people exposed constantly, and in high degree, to the risk of infection ; such groups are represented by the nurses in the diphtheria wards of infectious hospitals. Incidence of Diphtheria amongst Nurses in Diphtheria Wards. In 1913, in the hospitals of the Metropolitan Asylums Board, there were 5,475 patients with an attack of diphtheria admitted and fifty-one cases amongst the staff, i.e., one staff case for 107 admissions. The corresponding figures for 1914 were 6,591, 108, i.e., one case for sixty-six admissions. Figures kindly supplied by the Clerk to the Board show that there have been somewhat over 280 “ staff ” cases of diphtheria in the last three years in which the total admissions were 25,000, i.e., one staff case per ninety admissions. The Medical Officers of Health of a number of the large cities of England have kindly supplied me with a considerable number of figures. In five cities one nurse became infected with diphtheria for between fifty and 100 admissions, in four cities one nurse for between 100 and 150 admissions, in two cities one nurse for between 150 and 240 admissions. I have therefore assumed that one nurse (or member of the ward staff) catches diphtheria for each 100 admissions. The total number of cases of diphtheria during the past four years in England has averaged 50,000 a year ; probably annually 500 nurses in diphtheria wards have suffered from diphtheria. From the information placed at my disposal by the medical officers of the above- mentioned cities, we find that in one city fever hospital testing and immunization are, since a very recent date, obligatory on admission, in nine cities these measures are not used, in two they are offered but little used, in six they have been offered and generally used, in one since 1924, in the others since July last, or at a later date ; one hospital reports that the measures were used (apparently for a short period), were “unsatisfactory,” and were dropped. Is it possible or practicable to control the incidence of diphtheria amongst nurses ? In three fever hospitals in Great Britain, thorough testing and immunization have been in use during the past few years. Sir John Bobertson has told us that in Birmingham from 1916 to 1922 an average of eighteen cases occurred each year amongst the staff ; that since active immunization had been applied by Dr. E. H. B. Harries the incidence has dropped and is now non-existent amongst nurses tested and found to be negative to the Schick test. Dr. Kinloch, of Aberdeen, and Dr. Benson, of Edinburgh, very kindly have permitted me to publish the following figures, indicating a large drop in incidence immediately following the use of testing and immunization.
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