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Attendant, and did not return to school till their throats were free from infection as proved by a
subsequent examination. One case deserves special mention to show the difficulty of getting rid
of the bacilli. M. F. (F.) 10 years, of Abbey Buildings, was removed to hospital with diphtheria
on September 2nd, 1905. An elder sister attending a school in the neighbourhood came for
examination on September 8th. As she had a nasal discharge a swab was taken from her
nostrils as well as the throat. Plentiful diphtheria bacilli were found in her nose but none in
the throat. She was recommended to get the nose syringed by boric acid and permanganate
solutions as well as carbolic acid, but subsequent examinations on September 21st and October
3rd still showed the presence of diphtheria bacilli. After the last examination I had the bacilli
tested for virulence by Dr. Eyre, of Guy's Hospital, who stated they were genuine Klebs-Loeffler
bacilli of low virulence and suggested syringing with formalin. She was therefore supplied with
a solution of 1 in 1,000, and told to syringe four or five times daily. About October 17th two
examinations were made, when the nose was found quite free as well as the throat. The points
about this case were : —(1) The persistence of the infection in the nose alone, and (2) the
resistence of the organisms to the ordinary antiseptics. Such cases as this are extremely likely
to spread infection among school children without giving any indication of the source of
infection.
In 12 eases of diphtheria the source of infection was attributed as follows: —
Previous cases in house or family
7
From friends (visiting)
1
t
Patient picks up cigarette ends in street
1
Drains up in workplace of patient
1
"1
"Eetum"case
1
Patient previously had diphtheria, returned home, and renotified
in 23 days
1
Scarlet Fever.
There were 768 notifications of scarlet fever, 329 for Bermondsey, 409 for Rotherhithe,
and 30 for St. Olave's. This is an increase of 317 for the Borough on the number for 1904.
While, however, the increase in Bermondsey and St. Olave's might be considered normal,
i.e., coincident and proportion, to a general rise of the disease in London during 1905, that in
Rotherhithe is abnormal: thus Bermondsey shows an increase of 61 over 1904, while Rotherhithe,
with just half the population, shows an increase of 246 over the year previous.
As statistics in wards were not kept prior to 1905 it is impossible to say in which Wards
the increase took place, but an examination of Table 111. of Appendix will show that the cases
were very evenly distributed in Bermondsey, thus suggesting no more prevalent cause in one
Ward over another, and that on the contrary Rotherhithe with Ward population of 15,000 in
1 and 2, and 8,000 in Ward 3, shows a great preponderance in the first named, not only over the
other Wards in the same district, but over any Ward in Bermondsey, the actual numbers being
206. No. 1 Ward, Rotherhithe, has a density of population of 118 persons per acre, which is
higher than the remaining Wards, but is considerably lower than most of the Bermondsey Wards,
so that density of population as recorded on this basis will not account for it. An examination
of the distribution in time, of the cases in Ward 1, Rotherhithe, reveals nothing striking, since
they occurred fairly evenly throughout the year with the exception of some increased prevalence
in the end of August and the beginning of September.
Eighteen cases were returned from hospital as not suffering from scarlet fever, and
considering the mildness of the type and the difficulty of diagnosis this may be considered a very
small number. Even about these cases there must have been considerable difficulty, since
they were retained varying periods, 2 to 4 weeks, before being sent home, the average before
being sent home being 19 days, and in some of these I do not think that the diagnosis was
finally set at rest by the certificate of the Medical Superintendent of the hospital where the case
was sent.
The accompanying chart tells a very different tale from 1904, when the weekly numbers
were not so fluctuating. In 1905 there was a steady rise of notifications from July till the third
week in November, when a maximum of 38 in one week was reached. This is in accordance
with the normal curve of scarlet fever in London, which always show a maximum in the
autumn and a minimum in the spring.
Out of the 768 cases notified there were 17 deaths, making a case mortality of 2'2 per cent.
This is very low and shows the mild type of the disease. The case mortality in 1903 was 6 - 25,
in 1904, 3-9.
The attack rate per 1,000 living inhabitants was 5*9, compared with 3'49 in 1904.
In 120 cases the source of infection was attributed as follows : —
Previous cases in house or family
47
From friends (visiting)
8
Cases contracted in hospitals where they were sent for other
reasons
4
School infection
35
" Return" cases *
26
These include 4 cases in which the source of infection was attributed to cases returned to neighbouring houses.
It will be seen from this in how large a number of cases the source of infection is unknown
and this is quite in keeping with the mild character of the cases; and the view I have expressed
in every annual report, that the source of infection of a very large number of cases of infectious
disease is unrecognised cases, appears to find confirmation here.