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11
Annual Report of the Medical Officer of Health—1897
diphtheria are extremely difficult to detect. The diagnosis can only be made after a
period of waiting. Moreover, it seems probable that a certain number of cases are
never detected at all As an illustration of this difficulty I have it from a doctor that
four of his patients in Cornbury Street, although suffering from suspicious sore-throats
remained unnotified owing to the clinical evidence being too weak in his judgment to
support the theory of dipthheria. Hence, it is of the utmost importance to be able to
decide at once whether a sore-throat is or is not of a diphtheritic nature. This can
now be done in a bacteriological laboratory. In Marylebone, for instance, every
medical man is provided with a small cardboard box containing two sterilised testtubes.
One of these tubes is for membrane if it can be obtained, and the other is
furnished with a sterilised swab of wool wound round a wire. The medical attendant
touches the throat with the wool and sends it off to the Medical Officer of Health,
who is able to send back within twenty-four hours a definite report as to the existence
of the disease. The cost of the whole examination of each case amounts to
2s. 7d. It should be clearly understood, however, that the examinations are not
for the purpose of revising certificates, but for dividing the cases into those which
might possibly be treated at home with safety, and those which require strict isolation
in an infectious hospital."
The Salvation Army Shelter.
This institution, as I mentioned in a previous report, was founded by Mr. Booth
for the night shelter of poor persons. Although, no doubt, started on philanthropic
lines, a charge is made for accommodation, and there is no attempt to disguise the
fact that enterprises of a similar kind are not only self-supporting, but are even carried
on at a profit. Notwithstanding this commercial aspect of the case, in the Court of
Appeal, Her Majesty's Judges decided that these shelters did not fall within the
regulations of the Common Lodging Houses Act. Another judicial decision showed
tbat such institutions did not come under the Public Health (London) Act, so far as
disinfection was concerned. On that occasion Mr. Justice Wills said that "the case
was clearly one in which the Act ought to apply, but does not."
During the year 1896 the Salvation Army authorities attempted to upset the
decision of Mr. Slade in 1895, convicting them of gross overcrowding. The case was
decided in favour of Mr. Slade. There is reasou to believe that, in consequence of
the proceedings undertaken from time to time by your Vestry, the numbers admitted
to the Blackfriars Shelter have been materially decreased. Apart from that fact,
however, the sanitary control over this large collection of poverty-stricken people,
housed nightly in the building in question, is still in an unsatisfactory condition. The
danger to the public health caused by a large nightly aggregation of persons practically
out of the control of the District Sanitary Authority is beyond dispute. The obvious
remedy lies in the inclusion of the Shelters within the Common Lodging Houses Act.
Respiratory Diseases.