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notifications of diphtheria occurring in children of school-age (3 to
13 years) have suddenly undergone a very considerable reduction
during the period of the summer holidays, when the schools have
been closed, but have increased again very largely in the week
following the re-opening of the schools—the incidence of the disease
upon children under 3 years, and upon persons over 13 years being
comparatively unaffected by school closure.
Recent research has shown that the specific organism of
diphtheria—the Loeffler bacillus—may be found in the throat
secretions of patients convalescent from this disease for very
considerable periods after the disappearance of all symptoms, and
at a time when the patient is to all appearances completely
recovered. The specific organism has also been found in the
throats of those who are apparently suffering from simple tonsillar
inflammation, without any diagnostic sign of diphtheria being
present. It is highly probable that wherever the virulent organism
is present, there is a real danger of infection being imparted ; and
such facts as these show that the problem of the prevention of
diphtheria is one attended with many grave difficulties.
It is understood that the method of bacteriological diagnosis
of cases admitted as diphtheria is now being extensively employed
at the Metropolitan Asylums Board Fever Hospitals, and that
convalescents from this disease are not permitted to return to their
homes until a bacteriological examination has shown that the
diphtheria bacillus is no longer to be found in the secretions of the
patient. Such a precaution as this was urgently necessary, and is
likely to be productive of much good. The larger question of the
establishment by municipal means of a system of gratuitous
bacteriological examination in aid of the diagnosis of medical
practitioners throughout London is still under consideration.
Typhoid. Fever showed a slight increase in 1894 over that
observed in 1893. As usual, the greatest prevalence was in the
last four months of the year, 43 out of the total of 85 cases
occurring in the home district having been notified in these months.
Only two cases of this disease were notified in August, whereas
twelve were brought to the knowledge of the department in
September. It is probable that a considerable percentage of the
September cases contracted the infection outside Chelsea, when
away for their annual holidays.
In Kensal Town in 1894 there were 79 notifications of scarlet
fever, 41 of diphtheria, and 10 of enteric fever. In proportion to
its population Kensal Town's share of the total Chelsea notifications
was, scarlet fever 77, diphtheria 59, and enteric fever 23; thus
showing that whilst scarlet fever prevailed relatively to the same
extent in Kensal Town as in the home district, the former district
suffered less from diphtheria, and very much less from enteric fever
than the home district.
The following Table IX. shows the case mortality, or percentage
of deaths to notifications, of scarlet fever, diphtheria, and enteric
fever in Chelsea and in London for each of the five years 1890-4.