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There were 17 deaths, making a case mortality of 8.9 per cent. in 1904, against 10.5 per
-cent, in 1903. This is a strikingly low mortality and this is principally due to the introduction
of antitoxin. Previous to its introduction the mortality was about 20 per cent.
The accompanying chart shows that the notifications were pretty evenly distributed
throughout the year, and that there was an absence of special outbreaks.
25 cases were returned from hospital not suffering from the disease. This number of
cases returned is largely due to the general practitioners not taking advantage of the facilities
afforded for free bacteriological examination of swabs, etc.
Of the 20 specimens sent in by medical practitioners and examined with positive results
before being sent to hospital, 2 cases were returned. One of these cases occurred in Guy's
Hospital where it was bacteriologically examined, and the other was examined here. I examined
the Guy's specimen which was a very typical example of diphtheria bacilli. In my opinion these
were both cases of genuine diphtheria, and the hospital made a mistaken diagnosis because they
did not find the bacilli. In such cases one positive result is more valuable than two or three
negatives.
During the year the plan of examining school contacts, inaugurated the year previously,
was continued with useful results. This was outlined in my last annual report and I reproduce
it for the information of the Council.
" On the notification of a case of diphtheria the Inspector visits the house and
sees that the necessary precautions 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 the 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 till 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."
The only alteration in this was sending an additional notification of the result of the
examination to the Divisional Superintendent of the schools so that the school visitors should
know the result at the same time as headmasters.
The method here described has worked very satisfactorily during the year, and no
difficulty has been experienced in getting parents to have their children examined, especially
when the advantages of early knowledge of the commencement of an attack was explained to
them.
The number of contacts examined for school attendance was 145, belonging to 60 families.
Out of this number 11 had diphtheria bacilli in their throats, and of these 4 subsequently showed
symptoms of diphtheria and were removed to hospital. This is a smaller number than 1903,
when the number of infected children was 20, 16 of whom developed the disease.
One contact was examined for bacilli with a negative result, but he was removed
subsequently to hospital with laryngeal diphtheria. The bacilli were evidently confined at the
time of the examination to the larynx, which cannot be reached by an ordinary throat swab.
Those contacts which had the bacilli in their throats but no clinical symptoms of
diphtheria were advised to have an antiseptic gargle, and were not allowed to attend school till a
subsequent examination of the throat, at an interval of 14 days, showed them to be free from
infection.
Many experts consider that there ought to be at least three examinations of the throats
of convalescents and "contacts " before they can be considered free from diphtheria bacilli, but
that is not practicable in a district of this kind where the children come to the laboratory.
I am still of opinion that this method is a very valuable safeguard against the introduction
of the disease in question into public elementary schools.
Scarlet Fever.
There were 451 notifications of scarlet fever, 268 for Bermondsey, 163 for Rotherhithe and
20 for St. Olave's. This is an increase of 51 for the Borough on the figure for 1903, the only
decrease in the sub-districts being St. Olave's, which had 70 cases in 1903, owing to the outbreak
in Parish Street Workhouse.
Eight cases were returned from hospital as not suffering from scarlet fever. Looking at
the chart of the notifications, it will be seen that they remained fairly constantly between 5 and
10 per week with two exceptions, viz., the middle of June, when there were 18 cases in one week,
and during October and the first week in November, when the cases went above 20. This is a
normal scarlet fever curve for London, since a curve taken on the mean of 40 years shows a
seasonal maximum during the months of October and November and a minimum in March and
April. In 1903 the maximum was in March.
Out of the 451 cases notified there were 18 deaths, making a case mortality of 3.9 per
cent. This is much lower than 1903, when it was 6.25 per cent., and slightly above that for
1902, which was 3.7 per cent. This indicates that the cases were of a milder type than 1903.
From a good many cases which I had the opportunity of visiting in consultations I can confirm
this.
The attack rate per 1,000 living was 3.49, compared with 3.08 in 1903.