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danger of, an attack of either disease, to be at home during illness rather than amongst
strangers; but protection of the public from danger, through exposure of infected persons or
things, should be the paramount consideration, even when the illness has not yet assumed a more
than doubtful or suspicious phase. It is, however, difficult to prove guilty knowledge on the
part of persons suffering, or in charge of sufferers, so as to enable the sanitary authority to take
proceedings under section 68 of the Public Health (London) Act, 1891, which reads as
follows: —
If any person
(a) While suffering from any dangerous infectious disease wilfully exposes himself without
proper precautions against spreading the said disease in any street, public place,
shop, or inn; or
(b) Being in charge of any person so suffering, so exposes such sufferer; or,
(c) Gives, lends, sells, transmits, removes, or exposes, without previous disinfection, any
bedding, clothing, or other articles which have been exposed to infection from any
such disease;
He shall be liable to a fine not exceeding five pounds.
It is well that public attention should be drawn, from time to time, to the provisions of
the law in regard to this matter.
"Return Cases" of Scarlet Fever and Diphtheria.— A cause of spread of
scarlet fever and diphtheria, sometimes overlooked, is the persistence of infective
germs either in the throat or in a nasal discharge of a "recovered" patient. A striking
group of cases of this sort was reported in the last annual report. A girl
suffering from scarlet fever returned home from hospital after fourteen weeks' absence, to all
appearance well, save for a nasal discharge. She resumed customary intercourse with her
young friends, four of whom shortly afterwards contracted scarlet fever. They had been
infected by their companion, who had kissed them, and with whom they had played in the street
and within buildings. Doubtless the infectious material was contained in the matter passing
from the child's nose, for desquamation of the skin had long since come to an end; the long
detention in hospital having been due to the continued discharge from the nose. The same sort
of thing happens, but not so frequently, after diphtheria—disease reappearing in a family soon
after the return of an apparently recovered patient. Two striking illustrations of this kind were
recorded during the year. In the first instance a boy aged five years was sent to hospital,
February 13th, and discharged "recovered" on 6th March. Four days later his brother, aged
15 months, fell ill, dying shortly afterwards. A swab from the first boy's throat was sent to the
Jenner Institute for examination; the diphtheria bacillus was isolated, and the boy was sent to
hospital again, together with a sister, aged three years, who had fallen ill on the 9th March.
In the second instance a boy, aged eight years, was sent to hospital on February 17th, and
discharged "recovered" on 12th March. Eleven days later a younger brother was notified as
suffering from diphtheria and removed to hospital. A swab from the throat of the first boy was
examined at the Jenner Institute, and the bacilli were isolated. There can, I think, be no
doubt that the spread of disease in the two families was due to the presence of the bacillus in
the original sufferers at the time, and after their return from hospital. This important question
has received attention at the hands of the Asylums Board, who, a few years ago, were disposed
to attribute the occurrence of such "return cases" to any but the probable cause, viz., the
continued infectiousness of an apparently recovered patient. The Managers thought it a
reasonable explanation of the occurrence of such cases in this parish, to cite but one instance,
that the late Yestry employed a contractor to do the work of disinfection, and that superheated
steam was not employed in the process. But, resolving to make a more precise investigation of
the whole subject, in 1898, they appointed a medical expert to inquire into whatever cases
should be reported by the medical officers of health. The investigation was completed in 1899,
but the result had not been published at the end of the year dealt with in this report.
WHOOPING-COUGH.
Whooping-cough was the cause of 33 deaths, against 19, 52, and 59 in the three preceding
years; 30 in the Town sub-district, and three in Brompton, the corrected decennial average
being 65. Thirty of the deaths were of children under five years of age, including seven under
one year. The deaths in London, as a whole, from this cause, were 1,948, and 483 below the
corrected decennial average.
FEVER.
Enteric Fever.—One hundred and four cases were notified during the year, against 117,
104, and 107 in the three preceding years. The deaths were 16 (two below the corrected
average), viz., 14 in the Town sub-district, and 2 in Brompton. Twelve of the deaths took place
in hospitals, to which 72 cases were removed, and 4 at home. The deaths in the three preceding
years had been 21, 12, and 23.