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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 1911 was 332, belonging to 148
families. Out of this number 15 had diphtheria bacilli in their throats or noses, and 11
developed the clinical symptoms of diphtheria, and were therefore notified.
Scarlet Fever.
There were 305 cases of scarlet fever notified —206 for Bermondsey, 89 for Rotherhithe, and
10 for St. Olave. This is a decrease of 56 for the Borough on the total for 1910. The distribution
of the disease in the various Wards, as shown in Table III. of Appendix, was fairly uniform.
34 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 ten years are shown in green.
There were 6 deaths, which gives a case mortality of 2.0 per cent., against 3.8 per cent, in
1910. The disease, as in recent years, was of a mild type. The attack rate per thousand inhabitants
was 2.4, against 2.8 in 1910.
In 36 cases the source of infection was attributed as follow: —
Previous cases in house or family or neighbouring houses
25
School infection
5
"Return" cases
6
In the 6 cases classified as " return " cases the source of infection was some other
member of the family or occupant of the same house who had returned from hospital after an attack
of scarlet fever within a fortnight previous to the second case occurring. In this case the source of
infection in the second case is presumed to be the child recently returned from hospital. The following
statement on the subject is reprinted from my Annual Report for 1907 : —"A good deal of attention
has been given to these so-called 'return' cases on the part of the laity, and also by medical
authorities, the former generally being inclined to attribute it to premature discharge from the
infectious disease hospital. As stated, however, in previous reports, facts do not support this view,
because in the first place the cases are very few compared with the number discharged, and in the
second case it is sometimes those children who are detained months over the usual time and that
cannot be considered to have been prematurely discharged who produce the disease.
"The micro-organism which produces scarlet fever has yet to be discovered, and the probability
is that when this is made it will be found it behaves in a somewhat similar manner to diphtheria, and
will be found to exist in the noses and throats of the patients who either have not got the disease at
all, or who have recovered from an attack some considerable time previously. Those patients who
have suffered from complications leading to pathological discharges from nose, throat and ears are
more liable to spread the disease than simple, uncomplicated cases."
Measles.
The number of deaths for 1911 was 51, against 143 in 1910 and 196 in 1909,
The annexed table gives the number of notifications received from schools, the number
of "contacts" excluded. In the first quarter there were 27 deaths, in the second 15, in the third
2, and in the fourth 7.
As remarked in my previous report, there is no doubt that the infants' departments of the
schools are very largely responsible for the spread of this disease, but the London County Council's
regulations, of which the following is a copy, are strictly carried out:—
(1) Senior Departments—
(a) If a child has had measles it need not be excluded from attendance at school.
(b) If a child has not had measles it should be excluded from attendance at
school for a period of 14 days from the date of the occurrence of the
first case.
(2) Infants' Departments—
All children should be excluded from attendance at school for a period of 14
days from the date of the occurrence of the last case.
Enteric Fever.
29 cases of enteric fever were notified, being 18 for Bermondsey, 7 for Rotherhithe, and
4 for St. Olave. 1 case was returned as not suffering, making an actual total of 28. The total
number of cases notified in the previous year was 37.
The majority of the cases may be classified as sporadic, i.e., isolated cases. There was one
small chain of cases which occurred towards the end of the year, but as they extended into the
spring of 1912 they will be dealt with in the report for that year.
In 6 cases the source of infection was attributed as follows:—
From previous cases 5
From eating cockles 1
Puerperal Fever.
13 cases of puerperal fever were notified. There were 4 deaths.
Membranous Croup.
2 patients were notified as suffering from membranous croup.