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The following references to diphtheria are found in the reports of medical officers of health—
Paddington.—Analysis of the cases in this district by the medical officer of health, shows that,
apart from imported and " return " cases, 154 were primary cases and 17 secondary. The distribution
of all the cases in the district was as follows—there were 140 houses with one case, 11 houses with two
cases, 5 houses with three cases and 1 house with four cases.
Islington.—Commenting on Dr. Newsholme's statement that "Diphtheria only becomes epidemic
in years in which the rainfall is deficient and the epidemics are on the largest scale when three or
more years of deficient rainfall immediately follow each other," Mr. Harris states that he has
compared the diphtheria returns of Islington with the rainfall, and that he finds that these statements
are practically borne out, and that he has noticed that if a heavy rainfall, accompanied by a low
barometer, occurred during a prolonged dry period, an outbreak of diphtheria to a certainty followed. He
attributes this to tho washing beneath houses of the diphtheria organisms which have multiplied
in warm soil that is free from excessive moisture, and he urges the importance of the ground
surrounding and beneath houses being made impervious.
Shoreditch.—The medical officer of health gives account of an outbreak of throat illness among
the employes of a large business establishment in the district, 80 of whom were attacked, of these
eight appeared to be cases of scarlet fever, of the remaining 72, 14 wero certified by the medical men
who saw them to be suffering from diphtheria. Material from the throats of 23 was sent to the
Clinical Research Association, with the result that the micro-organism of diphtheria was reported to
be found in seven cases and not found in 16. As to cause, some of the employes were in the habit of
frequenting a milkshop from which the supply to the establishment was for some time received.
Dr. Bryett ascertained that about May 1st, antecedent by about a fortnight to the occurrence of the
earliest case of throat illness among the employes, a woman who served in this shop was taken ill with
a sore throat, which confined her to bed for four or five days, after which she continued to serve in the
shop, her throat being still sore. The drainage of this milkshop was defective. Dr. Bryett's conclusion
is that " in whatever manner the infection may have been introduced in the first place, there
appears to be very little reason to doubt that the prevalence of the throat illness amongst Mr. X.'s
employes was due to the infection being conveyed from person to person either directly or through the
medium of fomites, such as forks, spoons, cups, and other articles used in common."
Poplar (Bow).—The medical officer of health has recommended that the rent limit in the by-laws
for houses let in lodgings should be raised so as to make a larger number of houses subject to these
by-laws. He thinks that the adoption of this course would, by improving the sanitary condition of
tenement houses, tend to reduce diphtheria prevalence.
Lewisham.—The medical officer of health discusses the prevalence of diphtheria in Lewisham
in 1899, the number of cases of diphtheria notified having been in 1890 and successive years as
follows—248, 125, 237 and 433. He found that the Lewisham-village ward and Lewisham-park ward
were chiefly affected. Dr. Jolly states that in his opinion the causes are two: (1) The nearness of
this part of the district to a slowly-running river, from which there must always be a considerable
amount of dampness in such a low-lying neighbourhood ; (2) The condition of the combined drainage.
In reference to the effect of attendance at school, he writes—" It will also be seen that out of 433
cases, only 227 were attending school at the time at which the disease was notified. This shows to
some extent that school infection cannot be the main factor in the spread of the disease, although in
many instances it undoubtedly assists."
In some of the annual reports the occurrence of " return cases " is discussed. In Paddington
there were five such cases ; in Fulham five cases ; in Shoreditch five cases ; in Battersea " many " ; in
Plumstead one case. The history of one case is given by Mr. Jackson to show the occasional
persistence of the infectiousness of diphtheria. A child who had suffered from diphtheria in the
Fountain Fever Hospital was discharged in tho middle of August. She went to Leytonstone for a
month, returning to Fulham the middle of September. Her mother contracted diphtheria, and was
removed to hospital on October 2nd. The child then returned to Leytonstone, where she slept with
her father, who suffered from diphtheria on October 23rd. On October 21st the child went to stay
with relatives in another street in Fulham, and on November 6th her cousin developed diphtheria.
Shortly after this she went to visit an uncle and aunt at Kingston-on-Thames, both of whom were
attacked with diphtheria. " Several bacteriological examinations were made, and the bacillus of
diphtheria was found on every occasion in the nasal secretion until the end of January, though both
the throat and nose appeared perfectly healthy." In Battersea the return home of one child from
hospital on the 9th February was followed by attacks among other members of her family on the
17th, 18th, 26th and 28th February, and on the 3rd March. It is interesting to note that both in the
Fulham and in the Battersea case the first patient had been admitted to hospital on account of an
attack of scarlet fever, and had contracted diphtheria in the hospital, suggesting that the persistency
of the condition of infectiousness may have been due to the fact that the patient's throat had been
previously affected by scarlatinal disease.
Bacteriological examination.
In a number of districts facilities are given by the sanitary authority for the bacteriological
examination of material from the throats of persons suspected to be suffering from diphtheria, but the
nature of whose illness was doubtful. Thus the following statements are found in the reports of
medical officers of health. The Vestry of Kensington made an arrangement, which has been of great
service, for this purpose with the Jenner Institute. In Fulham, material from 139 cases was
examined, and the bacillus of diphtheria was found in 76. In Chelsea, the medical officer of health
is empowered to send material to the Jenner Institute. In St. George, Hanover-square, material
from 15 cases of diphtheria was sent to the Jenner Institute, of which six yielded the diphtheria
bacillus and two the pseudo-diphtheria bacillus. In St. Pancras, material from 81 cases was examined,
with the result that in 43 the bacillus was found, in 36 it was not found, and two were recorded as