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58
is the average rate during the previous eleven years. The London case
mortality was 3.2 in 1901, 3.0 in 1902.
1 Hphtheria.—280 cases of diphtheria and 5 of membranous croup were
notified during 1902, equal to a rate of 15.4 per 10,000 inhabitants, as
compared with 13.6 in 1901, with 16.0 the rate in the previous ten
years, and with 23 the rate for all London for 1902. There were thirtyone
deaths, equal to a mortality of 11 per 100 cases, as compared with
8per cent.3 per cent. in 1901, and 10.8 for all London for 1902.
Bacteriological Diagnosis.—The arrangements made with the Jenner
Institute for the bacteriological examination was taken advantage of
with regard to 179 persons who were suffering from throat affection or
had been exposed to infection; 204 examinations and re-examinations
were made by the Jenner Institute, but many others were made at
hospitals and in private laboratories. In sixteen of the above instances
the bacillus was found, and in thirteen the pseudo-diphtheria bacillus (a
modified, less virulent organism) wes present on first examination;
thirty-six subsequent examinations were made in cases treated at home,
and a positive report was obtained in seventeen instances, negative in
nineteen. The longest period of the persistence of the organism from the
beginning of illness was fifty-seven days. There are, however, many
cases which are at the other extreme, and yield readily to treatment, and
it is probable that this was so in a considerable proportion of the
twenty-eight cases returned from hospital as not suffering from this
disease; most of these were out-patients at general hospitals, and had
their throats examined bacteriologically there. By the time the Report
was ready and the cases admitted into an isolation hospital, the
treatment under which they had been put proved sufficient to remove
the cause of the disease, and thus a second examination proved them
not to be then suffering.
It has been found in families in which a case occurs that, not
infrequently, other members get the diphtheria organism in their throats,
and may or may not develop symptoms according to their susceptibility
and the state of their health; but if they do not develop symptoms
the}per cent. may pass the organism on to other persons. If diphtheria is to be
got rid of, it will be necessary to examine children and others in affected
families, especially in tenement houses, so that they may not go about
spreading the disease.
A large number of the above examinations were necessitated by the
outbreak of diphtheria in one of the boarding houses of the Westminster
School. Every master, boy and servant was examined, and the school
was closed for fourteen days. No pupil was allowed to return without
a certificate certifying that a bacteriological examination had been made
and no infectious organism found.