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With the continued decrease in the case-rate and in the case mortality of diphtheria, as
manifested by the statistics of 1903, only a few localised outbreaks of this disease, all due to
school attendance, occurred during the year. In Paddington 10 cases occurred among children
attending the St. Michael's school, which was closed in consequence, with the result that no
further cases appeared. In Chelsea 9 cases occurred among the children in the Duke of York's
school. In Finsbury 7 cases occurred among the children of the Brewer-street school
and 10 among those of the Moreland-street school. Dr. Newman, as the result of inquiry,
was able to establish a relationship between these two occurrences. In Wandsworth a special
prevalence was observed, in Streatham particularly, among the children attending the Eardleyroad
school. Examination of material from the throats of children attending the school was
made by the medical officer of the School Board, and several cases of the disease were thus discovered
and isolated. The cases in Streatham were largely due to attendance at school of
unrecognised cases of diphtheria; closure of the school was not found to be necessary. In
Deptford prevalence of diphtheria among the children attending the Alverton-street Board school
led to closure of the infants' department from 7th July to the end of the summer holiday. In
Camberwell the Infants' National school at Dulwich was closed for three weeks for the same
reason.
The appreciation of the part played in the dissemination of diphtheria by unrecognised
cases of the disease, or by "carrier cases," must inevitably lead to fuller examination of persons
who have been in contact with those who have liad attack of diphtheria which is recognised and
notified. Fortunately, in respect of diphtheria, bacteriological methods are able to be utilised for
this purpose, and the more completely this system of examination of "contacts " is carried out
the more thorough will be the control over extension of diphtheria. In a community like that
of London, with its vast population, and with its divided administration, the difficulties which
stand in the way of complete success are no doubt great. They do not, however, prevent steps
being taken which will largely reduce diphtheria prevalence, and especially extension of the
disease, due to the attendance at school of children who are infective, but present no clinical
symptoms of the disease.
In the last annual report account was given of the results obtained by Dr. Brown, the
medical officer of health of Bermondsey, in his examination of the inmates of houses in which
cases of diphtheria were known to have occurred. In his anmial report for the year 1903, Dr.
Brown supplies information as to his procedure and the results obtained in similar examinations
made during that year. Dr. Brown's experience may well be given in his own words—
"During the first nine months of the year the contacts were generally the children of all ages and
occasionally the mothers of those families in which diphtheria occurred. During the last three months
this plan was slightly modified and more systematised, inasmuch as the examination of contacts was
practically limited to those attending school, the remaining ones only being examined if they showed sore
throat. The plan of procedure is as follows—On the notification of a case of diphtheria, the inspector