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DIPHTHERIA.
Cases of diphtheria and membranous croup to the aggregate number of 332 were notified, as
compared with 332, 222, and 257 in the three preceding years: 233 in North Kensington, and 99
in South Kensington. The deaths registered were 27 (against 82, 26, and 42 in the three preceding
years), being 31 below the corrected decennial average (58): 25 of them belong to the Town subdistrict,
and 2 to Brompton ; 25 to North Kensington, and 2 to South Kensington. Twenty-one of
the deaths were of children under five years of age, including two under one year. Twenty-one of
the deaths took place at hospitals, to which 288 cases were removed. The case-mortality was 8.l
per cent., and the lowest on record.
Detailed information as to diphtheria mortality in the borough, 1871-1900, is set out in
Appendix I., Tables B, C, and D, pp. 85-86.
In London, as a whole, the deaths (including deaths from membranous croup), were 1,558, and
705 below the corrected decennial average, as compared with 2,261, 1,772, and 1,964, in the three
preceding years. The notifications of diphtheria were 11,998, as compared with 12,811, 11,561,
and 13,701 in the three preceding years successively. The cases of diphtheria admitted to hospitals
are stated by the Registrar-General to have been 7,966, and the deaths in hospitals 991, a casemortality
of 12.7 per cent.
The above favourable statistics indicate a progressive decline in the prevalence, and especially
in the fatality of this terrible disease.
The following illustrative cases may be cited:—On January 3rd the illness of a man from
diphtheria was notified, an address at North Kensington being given. The patient, who resided in
another borough, apart from his wife, had called at her abode on New Year's Day to see his infant
of eight months, whom he nursed, kissed, and infected. On the 4th the child fell ill: he was taken
to a children's hospital on the 5th, but too late to be seen as an out patient. The following day,
Saturday, was allowed to pass without medical help; on Sunday the child was worse, with difficulty
of breathing, &c., but no doctor was called in. On Monday a medical relief order was applied for.
The patient, when visited in the afternoon, was moribund, and he died the same night. The body
was removed to the mortuary; but no inquest was held. Another case indicating similar neglect
occurred at about the same date. The child was moribund when the doctor was called in. He
notified the illness as "diphtheritic croup?", but declined to certify the cause of death. An inquest
was held and a post-mortem examination was made. The jury found that the cause of death was
diphtheria. The house where the child lived was inspected and found to be in an insanitary
condition.
An interesting group of cases occurred in April-May, in two families living in separate
houses in Convent-gardens. The first case, in order of occurrence, was that of a man, John J—,
a cab-washer, out of work, who began to suffer from sore throat, &c., on or about April 11. With
his wife and six children he occupied two rooms. Four of his children, aged respectively, 2, 9, 6,
and 12 years, were notified as suffering from diphtheria on April 19, 24, and 27, and May 5,
respectively. Other two cases occurred in the family of a police-constable, who, with his wife
and four children, occupied four rooms at another house. The cases, of twins, aged 6 years, were
notified April 25th and 29th respectively. The several patients were removed to hospital, on
receipt of the successive notifications; not one of them, fortunately, proved fatal. Five of the
children had attended a church-school: but the outbreak neither originated there, nor was spread
to other children in attendance; the children having been excluded immediately after the first
notification. The spread of disease was due to direct infection, and to commingling of the children
at play, &c. Hearing, after the fourth notification, that the man John J— had had a sore throat,
a bacteriological examination was made: the bacteria of diphtheria were isolated, and the patient
was forthwith removed to hospital. Convent-gardens is a cul-de-sac. There were in the street four
brick catch-pit gullies of unusually large size; and the sewer was unventilated, excepting by these
untrapped openings. The Sanitary Committee having viewed the street, at my request, decided to
trap the gullies to ventilate the sewer at the highest point, by a pipe shaft carried up against a
house, and to asphalt-pave the roadway. A great sanitary improvement was thus effected.
A considerable number of cases of diphtheria occurred in streets in the vicinity of
St. Marylebone Infirmary, North Kensington. The children attacked, or many of them, had
been accustomed to play in a field on the St. Quintin estate, where was a foul open branch of the
Counter's-creek sewer. At the instance of the Sanitary Committee, the County Council had this
sewer cleared of the offensive accumulations of years, and, whether post hoc or propter hoc, the special
incidence of the disease upon the locality thereupon greatly diminished, and practically ceased.