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the second quarter 10, in the third quarter 13, and in the fourth quarter
29. The percentage of cases of school age (8 to 13 years) of the total
number in the Borough was 69.5, as against 67 in 1912. In North
Chelsea 19 cases were notified, and in South Chelsea 40, so that whilst
scarlet fever was slightly more prevalent in North Chelsea, South Chelsea
showed a large excess of diphtheria. For the whole Borough, however,
the incidence of diphtheria was slight, and since 1890, when notification
of infectious disease first became compulsory, there has only been one
year (1905) when the incidence of diphtheria was less. The month of
greatest prevalence was October (12 cases), and the month of least
prevalence March (1 case). The type of disease was very mild, as there
was only one death from diphtheria in the year. This gives the very
low case mortality of 1.7, which is but very little above the 1913 case
mortality of scarlet fever.
The average duration of stay in hospital of 32 cases, of which the
records are to hand, was 52 days, as against 58 in 1912. There were no
returns by M.A.B. hospital superintendents of cases admitted under a
wrong diagnosis.
There was no special school incidence of diphtheria in 1913 in respect
of any of the schools in the Borough. Several " carrier'' cases were
found in the course of the year amongst children attending elementary
schools, and were notified to the Public Health Department by the
school medical officer. So far as can be ascertained, there was no spread
of infection from any of these "carrier'' cases; and it seems very
doubtful if, at times when diphtheria is but little prevalent, these
"carriers" are any source of danger to others. The Klebs-Loeffler
bacillus is present in the throat, and sometimes in the nose secretions,
but it seems to be without pathogenic power. I have no doubt, however,
that when diphtheria is prevalent or becoming epidemic, these " carriers''
are liable to be active propagators of infection.
During the year medical practitioners sent 134 throat swabbings to
the Lister Institute for bacterioscopic diagnosis, as compared with 160 in
1912. Six were sent by myself from this department. The entire cost
was defrayed by the Borough Council. Of the total swabs, 89, or 66 per
cent., were sent by the medical staff of the Victoria Hospital in respect of
Chelsea children. Of the total of 134 swabs, 23, or 17.2 per cent.,
afforded positive evidence of the presence of the specific Klebs-Lceffler
bacillus, and 111, or 82.8 per cent., gave negative evidence. In 1912 the
positives were 27.5 per cent., and the negatives 72.5 per cent. The
presence of Hoffmann's pseudo-diphtheria bacillus was not recorded in
any of the negative results.
No applications were made during the year by medical practitioners
for anti-toxin, nor for repayments for the supply of anti-toxin by chemists
in the Borough for the use of the poorer class of patients prior to removal
to the fever hospitals.
Enteric Fever.—The number of cases of enteric fever notified in
Chelsea in 1913 was 7, as against 10 in 1912, the case-rate being 1.05 per
10,000 of the population. One case was notified in the first quarter of the
year, none in the second, 4 in the third, and 2 in the fourth quarter.
Three cases were notified in North Chelsea, and 4 in South Chelsea.