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No. of cases.
Deaths.
Rate per cent.
Vaccinated
174
18
10.34
Unvaccinated
20
12
60.00
Doubtful
1
1
100.00
Total cases
195
31
16.00
As there was a Special Report on this subject issued to the Council in October, dealing
with the epidemic and precautions taken, and since only two cases occurred from the issue of
that report to the end of the year, I do not purpose to deal at length with the matter, but only to
state that the statistics given above confirm the previous statements as to the efficacy of
vaccination.
Contrary to the general expectations and prophecies, the epidemic practically ceased in
London about the middle of the year. There has been some recrudescence during the present
year, but the cases have been largely imported from the Midlands, where the disease is more or
less prevalent.
Diphtheria.
There were 277 cases of diphtheria notified during the year 1902, of which 194
occurred in Bermondsey, 60 in Rotherhithe, and 23 in St. Olave's. This is considerably lower
than the corresponding figures for 1901, of which the total amounted to 329. 34 cases were
returned as not suffering from this disease, thus making a total of 243 actual cases. Notwithstanding
the cases which were returned, I think the higher figure more nearly represents the
cases in the district, since a considerable number of cases of diphtheria are of an extremely mild
type, and, in common with all other infectious diseases, it is these cases which keep the disease
going. Diphtheria is a disease which varies in type in different individuals, even in the same
household. One child takes a sore throat which is hardly noticed by the family. The next child
which becomes infected takes a virulent attack of diphtheria, necessitating very prompt treatment,
and it is only on the occurrence of the latter case that the primary case, which caused the
disease, is discovered.
This reduction in the number of notifications in Bermondsey was part of a general
reduction of the disease in London, the numbers for which were 12,156 in 1901, and 10,735 in
1902. It was also in part due to the measures which were taken in connection with the
bacteriological laboratory mentioned below.
As compared with other districts in London, this is a low prevalence of diphtheria.
There seems to have been very little difference in the different times of the year as regards
prevalence, but it was, if anything, more prevalent during the summer months, as a glance
at the accompanying chart will show. The number of cases treated in hospital was 251, and,
subtracting the 34 returned as not suffering from diphtheria, we have a total of 217. The
number of deaths in hospital was 22, thus making a "case-mortality" of 10.1 %. With the
total cases at 243 there were 29 deaths, making a "case-mortality" of 11.9 %, which is the same
as that for the previous year.
Enquiries were made into the source of infection in cases notified. In three it was
attributed to a case returned recently from a hospital, and in 19 there had been a previous case
in the family. In the remainder the source of infection was indefinite. During the year 1902 I
visited 102 families in which diphtheria had occurred. Examinations were made of the members
of the family who were in immediate contact with the patient, and these examinations were
practically confined to "contacts" of school age, i.e., up to 15 years of age. The number of
examinations made was 259, and swabs were taken from the throats, and, in a few cases, from
the noses of those examined. In 32 specimens, or 12.4 per cent, of the examinations, Klebs-
Loeffler Bacilli, which constitute the immediate infective agent of diphtheria, were found. 16
of these cases, or 50 per cent., later developed the clinical symptoms of diphtheria, and were
removed to hospital. Those who had bacilli in their throats, but did not develop the clinical
symptoms of diphtheria, were kept isolated, as far as possible, until they were considered to be
free from infection, and were advised to go to their medical attendant for an antiseptic gargle.
These latter did not, as far as I am aware, give rise to any further cases in the household. In
all cases of children in which diphtheria bacilli were found, the parents were immediately
notified that their child harboured diphtheria bacilli in its throat, and might either develop
diphtheria later, or be a source of infection to others, and were advised to keep the child in
question under the close observation of their medical attendant.
By this method there is no doubt the 16 cases notified were placed under treatment and
isolated much earlier than they would otherwise have been.
Some objection has been taken to my action in this matter, and it was stated by at least
one medical man that I exceeded my powers in making these examinations. This, however, is
not the case. Careful enquiries were made in each case as to whether there was a medical man
in attendance, and none of the patients who were under treatment were examined without the
permission of the medical attendant, and none examined in any case without the voluntary
consent of the parents. This consent was scarcely ever refused.
Membranous Croup.
Three cases were notified as membranous croup. It is a pity that medical men still use
this term, since the cases notified as such are diphtheritic in nature. There was one case, during
1902, notified as membranous croup, and, on endeavouring to have it removed, it was ascertained
that the Metropolitan Asylums Board could not do so unless it was certified as being diphtheritic
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