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53
To enable tlie variations in diphtheria prevalence in the several metropolitan boroughs
to be more clearly appreciated the following table has be?n prepared. This table shows the comparative
case-rates of each borough in each of the years 1891-1902 inclusive, i.e., the case-rates
of each borough are shown in relation to the London case-rate of the same year, the London
rate being taken as 100.

The annual reports for the year 1902 show a considerable advance of opinion as to the
origin of notified, cases of diphtheria, and as to the measures necessary for limitation of the
spread of the disease. In much larger degree have unrecognised cases, and cases presenting no
clinical symptoms, but in whose throats or noses the Klebs-Loeffler bacillus existed, been sought
for, and bacteriological methods utilised for their detection. Dr. Brown, the medical officer of
health for Bermondsey, thus found the bacilli in the throats of 32 persons who had been exposed
to infection, 1G of whom subsequently developed clinical symptoms of diphtheria. He writes
as follows—
"During the year 1902 I visited 102 families in which diphtheria had occurred. Examinations
were made of the members of the family who were in immediate contact with the patient, and these
examinations were practically confined to 'contacts' of school age i.e., up to 15 years of age. The
number of examinations made was 259, and swabs were taken from the throats and, in a few cases,
from the noses of those examined. In 32 specimens, or 12 4 per cent, of the examinations, KlebsLoeffler
bacilli, which constitute the immediate infective agent of diphtheria, were found ; 16 of
these, or 50 per cent., later developed the clinical symptoms of diphtheria, and were removed to
hospital. Those who had bacilli in their throats, but did not develop the clinical symptoms of
diphtheria, were kept isolated, as far as possible, until they were considered to be free from infection,
and were advised to go to their medical attendant for an antiseptic gargle. These latter did not, as far
as I am aware, give rise to any further cases in the household. In all cases of children in which
diphtheria bacilli were found, the parents were immediately notified that their child harboured
diphtheria bacilli in its throat, and might either develop diphtheria later, or be a source of Infection
to others, and were advised to keep the child in question under the close observation of their medical
attendant. By this method there is no doubt the 16 cases notified were placed under treatment and
isolated much earlier than they would otherwise have been."
An interesting account of an outbreak in which cases occurred which, under other circumstances,
might probably have remained unrecognised, is contained in the annual report of Dr.
Newman, the medical officer of health of Finsbury, who thus states the circumstances of this
outbreak— ,
" On April 17th M. L. returned to an institution in Finsbury from Bournemouth. She had been
engaged at Bournemouth in nursing diphtheria patients for five weeks in an institution. She rested
for one week previous to coming to London ; but the night before she left she went to take leave of
her diphtheria patients in Bournemouth. On April 18th—the day after her arrival in London—she
went to a branch home in Finsbury, and there nursed a small boy—W. P., aged years. Two or