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Diphtheria.
There were 172 cases of diphtheria notified in 1903, of which 115 occurred in Bermondsey,.
38 in Botherhithe, and 19 in St. Olave's. This shows a remarkable decrease since 1901, when
the figure was 329, that for 1902, viz. 277, standing in a medium position. Sixteen cases were
returned from hospital as not suffering from this disease, but, as explained in the opening
paragraph to this section, I prefer to take the notification as the true figure of the cases.
Diphtheria is a disease which is kept going by the presence of the bacillus diphtheriæ in the
throats of persons who have either had it or been in contact with a case. Unfortunately this
bacillus often exists there without producing any symptoms suggestive of its presence, so that
while this infected person may be in no danger of contracting the disease, he may be a source of
great danger to others, and, as a matter of fact, often is. The cause of the present reduction in
notifications is not very capable of explanation. We are at present at the bottom of an epidemic
wave which affects both diphtheria and scarlet fever. This marked reduction of prevalence
exists all over London and began in 1901. It is probably partly due to the increased attention
paid to these diseases. The cases were pretty evenly distributed over the year, the greatest
numbers occurring in the first and fourth weeks of July, viz., 9 and 12 respectively. The work
of examining the contacts was proceeded with.
During the first nine months of the year the contacts were generally the children of all ages
and occasionally the mothers of those families in which diphtheria occurred. During the last
three months this plan was slightly modified and more systematised, inasmuch as the
examination of contacts was practically limited to those attending school, the remaining ones
only being examined if they showed sore throat.
The plan of procedure is as follows: On the notification of a case of diphtheria the
Inspector visits the house and sees that the necessary of removal, disinfection, etc.,
are duly carried out. He then requests the parents to send up those children attending school
to the Town Hall during the second week after removal of the case, to have their throats
examined by the Medical Officer. If no diphtheria bacilli are found the headmaster and parents
are notified that the children may return to school at once, but if they are found a request is
sent to the headmaster to exclude them until further examination. The parents are at the
same time notified of this and asked to bring the children to their medical attendant for an antiseptic
gargle and requested to bring them up for a second bacteriological examination in 14 days.
If, of course, any of these " contacts" at the time the inspector calls or during the
subsequent period develop sore throats the parents are advised to call in their medical attendant
at once.
Before carrying out this plan I consulted the Medical Officer of the School Board as to its
feasibility and got encouragement and promise of help from him. The Board has now appointed an
assistant Medical Officer, who, when he sees any particular school or class attacked or threatened
with an outbreak of diphtheria, visits and examines the suspicious cases bacteriologically and
immediately notifies the Medical Officer of Health if diphtheria bacilli are found. These two
plans so far have worked very well and I have experienced, as yet, no difficulty in carrying out
my part, and hope to see it before long adopted all over London and applied to all schools. I,
of course, see difficulties in following it completely in a district like Bermondsey if there was.
anything like a large epidemic or a very large number to be examined. If such unfortunately
took place the only plan would be to appoint a temporary assistant to examine throats. Another
difficulty would be if all the cases had to be visited, but the parents so far have shown themselves
willing to co-operate by bringing their children to the Town Hall, when the advantages of the
early warning of an impending attack were explained to them.
The number of contacts examined during the year was 193, belonging to 64 families. Of
these 20 were found to have diphtheria bacilli in their throats, and of these 16 three developed
sore throats and were notified as diphtheria. Seventeen of these contacts were boys from the
Home, Shad Thames. A case of diphtheria occurred there on May 28th, 1903, which was
immediately isolated. At the request of the medical attendant, who acted very promptly in this
matter, I examined the throats bacteriologically. Fortunately no second case occurred.
I hope in my next annual report to be able to give a fuller account of the working of the
plan sketched above, after it has been working for a year.
Membranous Croup.
There were two notifications from this cause. They were not removed to hospital as the
medical attendant was not prepared to certify that they were diphtheritic in nature. They both
recovered.
I hope medical men will soon cease to use this term, and call the cases diphtheria if they
are diphtheritic in nature, or if not prepared to say this call them simple croup or laryngitis.
Scarlet Fever.
There were 400 notifications of scarlet fever, 259 for Bermondsey, 71 for Botherhithe,
and 70 for St. Olave's. These figures show a diminution since 1901, when the figures were 932
Borough, 657 Bermondsey, 216 Rotherhithe, and 59 St. Olave's. The greatest diminution
followed immediately this year, as the the figures for 1902, viz., 491 Borough, 336 Bermondsey,
112 Botherhithe, and 43 St. Olave's, show.
18 cases were returned as not suffering from scarlet fever, i.e., Bermondsey 14,
Botherhithe 3, St. Olave's 1.
The unequal distribution of cases in the three sub-registration districts is caused by
Bermondsey and St. Olave's having rather more than their average of cases compared with
Rotherhithe, which seems to have escaped lightly.
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