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infectious disease, and did not trouble to remain in the house. However, he seems to have
been sufficiently ill on the Wednesday to take the advice of the Inspector and come up to
see me at the Laboratory, when I found he had marked clinical symptoms of diphtheria in
his throat, a very weak pulse and every sign of being seriously ill.
As he had been returned from the Park Hospital as not having this disease I
naturally hesitated about sending him off immediately, so I took a swab from his throat,
and the following morning found very typical diphtheria bacilli present; but to make
certain I sent the specimens to Dr. Eyre for confirmation, which he immediately gave me.
I then notified the case and had the patient removed to Park Hospital the same day, and
he is still there.
In proportion to the notifications there have been more cases of diphtheria returned
from this particular Hospital as " not suffering " than any of the others, many of which
have been certified as having the disease upon a bacteriological diagnosis.
The facts were communicated to the Clerk to the Metropolitan Asylums Board, who
replied that the subject had been investigated by a sub-committee who had considered a report
which they had received from the Medical Superintendent of the hospital, in which he stated
that the patient did not have diphtheria, but was suffering from a chronic ailment which
yielded to proper treatment.
With this diagnosis I did not at all agree. There are several points in connection with
the case which are explained in the following letter sent by the Public Health Committee to the
Metropolitan Asylums Board : —
Diphtheria Patient—Joseph Baker.
Your letter of the '23rd inst. upon the above subject was submitted to the Public
Health Committee at their meeting last evening, and 1 am directed to inform you that
the Committee are not satisfied with the explanation contained in your letter " that in
Dr. Birdwood's opinion this patient did not have diphtheria but that he was suffering from
a chronic ailment that yielded to appropriate treatment." lam to remind the Board
that although the case was in the first instance notified from Guy's Hospital and not by
an ordinary private practitioner, the patient was returned to his home almost at once
and when it was practically impossible for any proper careful diagnosis of the case
to have been made. The return was aggravated by being made at midnight when the
patient was seriously ill. On the second occasion, when the case was notified —i.e.,
within 5 days of being returned —by the Council's Medical Officer, supported by Dr. Eyre,
of Guy's Hospital, the patient was retained for three weeks, although, according to
Dr. Birdwood, he was not suffering from an infectious disease and had no right to be in
the Board's hospital. I am further to call the Board's attention to these facts: that
although the case was notified from Guy's Hospital and by the Council's Medical Officer,
the usual notification that the patient was not suffering as certified was not sent to
either of the certifying doctors nor was any such notification sent to the Medical Officer
of Health; on the 12th November, however, the usual notice was received that the
patient would be discharged on the 14th November as cured, presumably of the disease
for which he was notified.
This Committee will be glad to receive some better explanation.
In further correspondence the Board declined to give any better explanation, so the
Committee gave instructions that the whole correspondence and facts should be laid before the
Local Government Board for their investigation. No reply has, so far, been received from
them.
Scarlet fever.
There were 1023 notifications of scarlet fever—697 for Bermondsey, 262 for Rotherhithe
and 64 for St. Olave's. This is an increase of 46 for the Borough on the total for 1006. The
distribution of the disease in the various Wards, as shown in Table 111. of Appendix, was fairly
uniform.
30 cases were returned from hospital as not suffering from scerlet fever. This may be
considered very satisfactory considering the mildness of the type and the increased number of
cases notified.
The accompanying chart shows the prevalence of the disease in each of the 52 weeks
under report. The curve is a very characteristic one, the maximum of 50 cases occurring in
the last week of September.
The average notifications for the past seven years are shown in green.
There were 36 deaths, which gives a case mortality of 3.5 per cent. This is very
slightly higher than in the previous year when it was 3 per cent. The disease, as in the
previous year, was of a very mild type. The attack rate per thousand inhabitants was 8.0
against 7.6 in 1906.
In 131 cases the source of infection was attributed as follows: —
Previous cases in house or family
80
Previous cases in neighbouring houses
33
Cases contracted in hospital where they were sent for other
reasons
1
School infection
5
"Return cases"
12
In the twelve cases classified as "return cases" the source of infection was some other