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The attack rate per thousand inhabitants was 1.6, against 1.5 in 1909. The case
mortality was 8.7 per cent., against 6.3 per cent, in 1909 and 10.3 per cent, in 1908. 15 cases
were returned as not suffering from this disease.
122 specimens were sent in by medical practitioners for bacteriological examination, against
134 in 1909 and 199 in 1908. Of these 27 were found to contain diphtheria bacilli, all of
which were notified.
In 10 cases of diphtheria the source of infection was attributed to previous cases in the house
or family.
Diphtheria is a disease caused by a characteristic bacillus known as the Klebs-Loeffler
Bacillus, which occurs in the throats of persons attacked by the disease. It seems to be conveyed
from person to person by direct contact, and there is no virulent disease which will spread more
rapidly under certain circumstances than this will among school children. It is more or less directly
conveyed from throat to throat by children passing sweets, slate pencils, and other articles which
they are liable to put in their mouths, from one child to another. Kissing an affected person on
the mouth will also frequently give rise to the disease, and an infected child coughing in the
neighbourhood of non-infected ones will also often transmit the disease to them. Sometimes the
bacilli will exist in the throat for a long time without producing any symptoms, but such children,
while not suffering themselves, will be liable to convey the infection to others.
For this reason they have been called " carrier " cases, and, as expressed in previous reports,
my belief is that a large part of the spread of the disease is due to such cases. Since 1902 an
endeavour has been made in this Borough to prevent any of these "carrier" cases returning to
school, and each Annual Report has contained some account of the working of the plan. This
consists in getting the parents of a child which is notified as suffering from diphtheria to bring up
the other members of the family within a week or so after the removal or recovery of the case to
the municipal laboratory at the Town Hall for examination. If diphtheria bacilli are found in the
throats they are excluded from school for a fortnight, and if then found to be free, are allowed to
return to school. The number of children thus examined in 1910 was 260, belonging to 119
families. Out of this number 7 had diphtheria bacilli in their throats or noses, and one
developed the clinical symptoms of diphtheria, and was therefore notified.
Provision of Diphtheria Anti-toxin.
In October, 1903, the Council decided to keep a small stock of diphtheria anti-toxin which was to
be sold to practitioners in this Borough at cost price. The demand has not been very great, for
only twenty bottles have been sold in the seven years. During the year 1909 six were sold, and so
far none have been required this year. Each of these bottles contains a dose of 2,000 units, which
is generally regarded as the minimum dose for curative purposes, and the cost is 2s. 3d. per bottle.
The reason of this small demand is obviously due to the fact that the large majority of cases are
removed to hospital within a few hours of notification, and very often before they are notified. In
1909, for instance, of 191 cases notified, 174 were removed at once to hospital and only li treated
at home. No doubt the six bottles of anti-toxin were used for the latter patients.
I believe it would be a very useful thing to have a free supply of anti-toxin at the Town Hall,
and it would be specially useful for those doubtful cases which are sometimes held over twenty-four
hours pending bacteriological diagnosis and for such cases as are kept at home. There is also
another class in which it would be useful, viz., those cases which, while not suffering from diphtheria,
have the infection in their throats or noses. They are very few in number, but when they exist
are a great source of danger, as the infection may remain for a month or two. The most effective
treatment for these would be small prophylactic doses of anti-toxin.
Taking these three classes into consideration, it is impossible to say how much will be required,
but Ido not think it will cost more than a few pounds. The case mortality of diphtheria for the
Borough in 1909 was 6*3 per cent. This is very low and not more than a quarter to a sixth of
that which obtained in the pre-anti-toxin times. I do not think, therefore, that diphtheria patients
in this Borough have suffered much from delay in treatment. Diphtheria is a disease which is, of
course, liable to break out suddenly at any time, especially in connection with a school, and for this
as well as other reasons stated above I would recommend the Council to keep a small stock, say of
one dozen tubes, the initial cost at the present rate being 27s., and this stock could be renewed from
time to time as required. A letter should also be sent to the practitioners in the Borough advising
them that tubes can be obtained free by application at the Town Hall. I do not think that any
distinction should be made as to the social status of the patients, but that anti-toxin should be given
free to any practitioner who asks for it.
The above report was made to the Public Health Committee on October 11th and from that time
to the end of the year three tubes were applied for.
Scarlet Fever.
There were 361 cases of scarlet fever notified—260 for Bermondsey, 78 for Rotherhithe, and
23 for St. Olave. This is a decrease of 78 for the Borough on the total for 1909. The distribution
of the disease iin the various Wards, as shown in Table 111. of Appendix, was fairly uniform.
54 cases were returned from hospital as not suffering from scarlet fever.
The accompanying chart shows the prevalence of the disease in each of the 52 weeks under
report. The average notifications for the past nine years are shown in green.
There were 14 deaths, which gives a case mortality of 3.8 per cent. This is the same rate as
that for the previous year. The disease, as in recent years, was of a mild type. The attack rate per
thousand inhabitants was 2.8, against 3.4 in 1909.
In 47 cases the source of infection was attributed as follow :—
Previous cases in house or family or neighbouring houses 35
School infection 6
"Return" cases 6