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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 1912 was 356, belonging to 157 families. Out of this number 2 had
diphtheria bacilli in their throats or noses, and both developed the clinical symptoms of diphtheria,
and were therefore notified.
Scarlet Fever.
The numbers for scarlet fever have been low for many years, but it is showing a tendency
to increase again. The form of the disease is very mild and it is possible that this is one of the causes
of the increase. Many cases seem to have no rash or if one occurs it is so slight that it is liable to be
missed. This I have no doubt tends to facilitate its spread.
There were 411 cases notified —265 for Bermondsey, 118 for Rotherhithe, and 28 for St. Olave.
This is an increase of 106 for the Borough on the total for 1911. The distribution of the disease
in the various Wards, as shown in Table 111. of Appendix, was fairly uniform.
19 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 8 deaths, which gives a case mortality of 1.9 per cent., against 2.o per cent, in
1911. The disease, as in recent years, was of a mild type. The attack rate per thousand inhabitants
was 3-3, against 2-4 in 1911.
In 43 cases the source of infection was attributed as follow : —
Previous cases in house or family or neighbouring houses ... 29
School infection 11
"Return" cases 3
In the 3 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 1912 was 101, against 51 in 1911, 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 14 deaths, in the second 49, in the third 25,
and in the fourth 13.
This disease is subject to considerable fluctuations, and as practically every child gets it it
depends largely on the number of foci in a district which start the infection.
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, though 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
until Monday following 14 days from the commencement of the illness of the last
case in the house.
(2) Infants' Departments—
All children should be excluded from attendance at school until Monday following
14 days from the commencement of the illness of the last case in the house.
Enteric Fever.
34 cases of enteric fever were notified, being 23 for Bermondsey, 6 for Rotherhithe, and 5 for
St. Olave. 3 cases were returned as not suffering, making an actual total of 31. The total number
of cases notified in the previous year was 29.