View report page

There is no doubt that all the cases here mentioned were mild attacks which culminated
on December 5th with a typical case. I may mention that the first and second were seen by a
doctor about the eruption period, and he found no evidence of a rash, and had scarlet fever in
his mind at the time. I give this as an example of what happens very often, though the chain
of connecting cases is by no means always so distinct.
Enteric Fever,
76 of this disease were notified in 1903, beinq 50 for Bermondsey, 20 for Rotherhithe
and 6 for St. Olave's. 11 cases were returned as not suffering from enteric, viz., 7 Bermondsey,
and 2 each from Eotherhithe and St. Olave's. The actual cases thus numbered G5. The
diminution for this year seems to be part of a general diminution in London since the number
of cases in the Metropolis in 1903 was 2,340, the other numbers being 3,194 for 1901 and 3,412
for 1902.
The sources of infection in the great majority of the cases could not be ascertained, but
in 11 the disease was attributed to the following : —
1 case —London County Council sewerman who complained of sickness as the result
of a bad smell.
2 cases —defective drains were found in the house.
2 patients frequently ate fried fish.
3 patients ate raw mussels.
1 patient ate raw cockles.
1 patient complained of water at Cranbrook, Kent, where he had been hop-picking.
1 patient had been hopping at Maidstone.
Oysters and other shell fish eaten raw have been amply proved by the investigations of the
Medical Officers of Health for the City of London and Southend-on-Sea to be a common source
for conveying the infection, but do not appear to have played an important part in its causation
in Bennondsey, for though mentioned in the above Table the causation at the time of investigation
appeared doubtful.
Puerperal Fever.
9 cases of puerperal fever were notified, and 4 deaths took place. In 1902 there were 6
notifications and 4 deaths. The number of notifications in this disease do not give data for
comparison with past statistics, since what was looked upon formerly as puerperal fever was really
puerperal septicremia, and was almost uniformly fatal, whereas now many cases of puerperal
fever are cases of mild pelvic cellulitis, which generally recover.
The nurses and midwives in attendance on these cases were kept from attending other
cases for from a fortnight to a month, and were in addition required to have their clothes and
hands disinfected to the satisfaction of the Medical Officer of Health.
Four of these notifications were from Guy's Hospital, where the cases were attended by
extern students, under the supervision of the physician for that department. In making
enquiries I ascertained that frequently a case is attended by two or three of these " externs,"
and accordingly wrote to the Hospital suggesting that the first to visit the case should be
responsible for it throughout, since a number of attendants must multiply the chances of
infection.
Measles.
In the Spring of 1903 the County Council made an Order applying certain Sections of
the Public Health (London) Act, 1891, to measles. This came into operation on April Ist.
The following are the Sections which apply, viz.: 60, 61, 62, 63, 64, 65, 68, 69. 70, 72, 73, 74.
These Sections refer to cleansing and disinfecting of premises, etc., disinfection of bedding,
disinfection of infective rubbish thrown into ashpits, etc., penalties for letting infected houses, and
other matters connected with letting, penalties for exposure of infected persons and things, and
lastly, regarding carrying on milk trade, etc., in infected houses, and the use of public conveyances
for infected persons. The Sections which are omitted are those which deal with notification
and removal to hospital.
Practically the only method we have of becoming cognisant of measles in any house is
through the School Board notifications, and in this way we heard of 74 cases between April Ist,
1908, when the Order came into force, and January 2nd, 1904. These 74 occurred in 53 houses.
When the new Education Act comes into force I hope to see all private schools brought into line
with the Board Schools and obliged to send notification to the Medical Officer of Health of all
exclusions from School through infectious disease. On receipt of the notification these cases were
handed lo the Sanitary Inspectors with instructions to see that as soon as the illness was
complete the rooms where the patients were treated were to be disinfected. This was done in
the majority of the cases. In some cases it was objected to and in others certificate of
satisfactory disinfection were received from the Medical Attendant.
In the School Board certificates there is a natural confusion between Rötheln or German
measles and the genuine form, which is a much severer complaint, as the following report to the
Public Health Committee on April the 14th shows: —
" I received information from Alexis Street School that there were 23 cases of
measles among the scholars, and 8 exclusions (among contact) from this cause. The
patients were mostly about Lucey Boad, Alexis Street, Macks Boad, Blue Anchor
Lane, etc. There have been, however, a great many more cases than here reported.
I visited some 15 houses, made enquiries, and examined some of the cases, and
discovered that the children were not suffering from measles but ' epidemic roseola,'
or Rötheln, often called German measles. The nature of the complaint in the
remaining cases was ascertained from the medical attendants. It is a very mild
complaint and rarely renders the patient seriously ill. No action has been taken
beyond excluding the children of the affected families from school."