Methods of prevention in diphtheria and scarlet fever

Abstract

Hospital isolation is not effective as a means of prevention of diphtheria and scarlet fever. The reduction of deaths from diphtheria and scarlet fever during the past 54 years has been associated with the introduction of anti-toxin treatment of diphtheria and with the hospital treatment of both diseases. The methods of disinfection in general use are without influence in the prevention of the spread of diphtheria and scarlet fever. 3·1 per cent. of hospital treated cases of diphtheria gave rise to return cases while home treated diphtheria cases gave rise to no such return cases in Willesden during a period of five years. 14·1 per cent. of hospital treated cases of scarlet fever but only 3·7 per cent. of home treated cases of this disease gave rise to return cases of scarlet fever in Willesden during a period of five years. Isolation hospitals, by increasing the length of infectiousness of cases, defeat to some extent the object of prevention for which they have been established. Quarantine of well contacts, especially if they are children, cannot be effective practically as a means of prevention of diphtheria and scarlet fever. “Missed” cases have not been demonstrated to be a real factor in maintaining the prevalence of diphtheria or scarlet fever. “Carrier” cases greatly increase the difficulties of control in respect of both diphtheria and scarlet fever and may indeed be a source of the regeneration and continued prevalence of these diseases. Daily supervision of contacts in diphtheria cases with immediate administration of anti-toxin on the first appearance of symptoms would be likely to prove an effective means of prevention with further reduction of deaths from this disease. Routine prophylactic injection of anti-toxin for diphtheria contacts cannot be recommended. The Schick test for diphtheria has been demonstrated as reliable for separating the susceptible from the immune. Active immunisaton against diphtheria has been practised in New York, Edinburgh, Birmingham and Bristol, with results which go to show that this method will reduce the cases of diphtheria which now occur by at least 75 per cent. The Dick test for scarlet fever has been demonstrated as reliable for separating the susceptible from the immune. Immunisation of persons susceptible to scarlet fever can be carried out effectively. Hospital provision for the isolation of diphtheria and scarlet fever cases costs £3,000,000 per annum, exclusive of the cost of disinfection and other means of prevention. The bulk of this cost could be saved by the application of the newer methods of prevention revealed by recent research, namely, the Schick test and the Dick test and Immunisation. The progress of medical science in its relation to their work is a matter of interest to Local Authorities, and they should assume some responsibility in connection therewith. The prevention of diphtheria and scarlet fever is especially a problem for Local Authorities. The value of laboratory findings can be measured only by their field results. Recent Research work into the prevention of diphtheria and scarlet fever indicates that it would well repay a Local Authority of sufficient size to employ an epidemiologist to devote himself mainly to infectious diseases and the newer methods of their control. Communities would reap the benefit of such action by reduction of suffering, damage and deaths from diphtheria and scarlet fever, and enormous saving of expenditure on the hospital isolation of these diseases.