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in nature. As a consequence there was a delay of several hours before getting the patient under
treatment. The case was a very serious one, and the delay may have accelerated, if it did not
actually cause, the patient's death. On writing to the Metropolitan Asylums Board on the
matter, I received the following reply:—
Sir,
30th October, 1902.
Diphtheria and Membranous Croup.
In reply to your letter of the 28th inst. re refusal to remove a patient, T. H. P., on
a certificate of "membranous croup," I have to inform you that some years back the
opinion of the Local Government Board was asked as to whether the term "diphtheria"
was to be taken to include "membranous croup," and whether cases of the latter
disease could be admitted into the Managers' hospitals, and the Managers were
informed "that, in the opinion of the Board, a case of 'membranous croup,' which the
medical officer concerned states to be diphtheritic in nature, may properly be admitted
into such a hospital."
I am, Sir,
Dr. R. K. Brown,
Your obedient Servant,
Medical Officer of Health,
(Signed) T. Duncombe Mann,
Metropolitan Borough of Bermondsey.
Clerk to the Board.
Erysipelas.
192 cases of erysipelas were notified in 1902, against 155 notified in 1901.
Scarlet Fever.
There were 491 notifications of scarlet fever. Of these, 31 were returned as not suffering
from that disease, leaving 460 actual cases. There were 18 deaths, making a case mortality of
3.9 per cent. During the year 1901 there were 932 notifications, thus showing a reduction in
the number of cases by almost a half. The attack rate, therefore, was 3.8 per thousand living in
1902, against 6.99 in 1901. On looking at the chart the disease cannot be said to have been
more prevalent at one time of the year than another. The cases, on the whole, were fairly
evenly distributed, averaging from 5 to 10 per week, whereas in 1901 there was a very marked
prevalence during the months of May to November, the maximum number of 44 in one week
being reached in the middle of September; the greatest number in 1902, viz., 17 in one week,
occurred in the last week of January. It is difficult to account for this great diminution, but
that it is due to local conditions is shown by the fact that the numbers for London, viz., 18,381
in 1901, and 18,258 in 1902, are practically the same for the two years. As to the sources of
infection, the following causes are attributed: —
Previous cases in family 28 cases.
Previous illness in family with symptoms of scarlet fever 1 „
From school mate 1 „
From friend 2 „
Visiting infected houses 2 „
Previous cases in neighbouring tenements 5 „
From cases recently returned from hospital 10 „
Total 49 „
In the remainder the source of infection cannot be definitely traced. The percentage of
"return cases" to the total number is 2.2 against 3 per cent, in 1901. The cause of these "return
cases" and the best way to prevent their occurrence is the subject of a special investigation on
the part of the Metropolitan Asylums Board, and a report on the subject is expected shortly. It
is satisfactory, however, to note that the number of such cases is tending to decrease.
Typhus Fever.
One case was notified during the year, but was returned from the hospital as not
suffering from that disease.
Enteric Fever.
125 cases of enteric fever were notified, being 79 for Bermondsey, 44 for Rotherhithe,
and 2 for St. Olave's. 16 cases were returned as not suffering from that disease, leaving
109 actual cases, against 147 in 1901. This decrease in numbers is the more satisfactory
since there was a considerable increase in the corresponding figures for London, the
numbers for the latter being 3,194 in 1901, and 3,412 in 1902. The source of infection
in these cases is very indefinite but, from recent investigations by Professor Koch in connection
with an outbreak in a small country town in Germany, it would appear that mild unrecognised
cases, commonly known as "ambulant" cases, keep the infection living. These "ambulant"
cases may not exhibit any symptoms beyond perhaps a little diarrhœa and general malaise
insufficient to keep them from work or confined to bed, and may last any time from 1 to
3 weeks. This source of infection probably applies to most of the ordinary infectious diseases,
and these will not be stamped out until more attention is paid to mild attacks and improved
means of diagnosis enables them to be discovered and isolated early.
Puerperal Fever.
Six cases of puerparal fever were notified, and four deaths took place. Puerperal fever
is a general term which includes several varieties of septic diseases occuring in women at, or
soon after, childbirth. The term cannot be very well dispensed with until the name has been
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