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Report of the County Medical Officer—General. 31
The following table shows the notified cases, deaths, case-rates, death-rates and fatality of
diphtheria at the several ages and for each sex in London during the year 1912. At "all ages" the
fatality was higher among males, and the incidence of attack and of death were also slightly higher
among males than among females. In the age-groups adopted for the purposes of this table the greatest
incidence of attack was upon males and females aged 4-5 years; the greatest incidence of death was upon males and females aged 1-2 years.
Diphtheria
cases and
deaths by
age aDd sex
—London.

During the year 1912 both the incidence and mortality of diphtheria were lower than in 1911,
though in both Kensington and Hampstead the medical officers of health have to record a distinctly
increased prevalence. In the report relating to the latter district the high infectivity of the disease is
commented upon. Some of the reports refer also to the persistence of the "carrier condition" in certain
individuals; for example Dr. Stevens refers to particular instances in which positive results were obtained
at a considerable interval after the first swabbing. This persistence has for some time received
the attention of the medical superintendents of the Metropolitan Asylums Board hospitals, and in
the medical supplement to the report of the Board for 1912 is included an article by Dr. J. D.
Rolleston, of the Grove Hospital, on the treatment of "diphtheria carriers" with bouillon cultures of
staphylococcus pyogenes aureus. The experiments carried out showed that the treatment was successful
in cases in which the fauces were involved, but unsuccessful where the nose only was affected. The
method of treatment must be conducted with caution, firstly, because it entails some discomfort to the
patient, and secondly because if used in the early stages of the disease there is danger of infection of the
deeper tissues by the pyogenic organisms. The conclusion, however, is that in view of the futility of
most other methods in ridding the throat of diphtheria bacilli the application of staphylococcus cultures
is worthy of trial. In Part II (Education) of this report, the detailed history is given of a carrier of
diphtheria bacilli in whom the condition has continued to be demonstrated for a period of nearly three
years. In the same report comment is made upon the association of scarlet fever and diphtheria in
30 selected schools.
Diphtheria
in London.
The result of inquiry into the source of infection is shown in some of the reports as follows: In
Paddington, of 233 cases 6 contracted the disease in hospital, 6 were imported, and 6 were "return"
cases. In 43 cases the symptoms were so trifling as to cause them to be regarded as "carriers," 14
of them occurred among the patients and staff of a children's hospital, and 18 among children specially
examined in school. Dr. Sandilands, in the report relating to Kensington, thus classifies the source
of infection in 51 cases: In residential institutions other than schools or hospitals, 11 cases; in schools,
9 cases; in hospital wards, 10 cases; from a case previously notified in a patient's home, 8 cases; from
unrecognised cases, 3; and from sources beyond the borough, 8 cases. There were also 2 "return"
cases.
In Marylebone, of 147 cases, 14 were infected at home, 9 from a case in the same family, 5 from
another family in the same house. There were in Finsbury, 148 true cases of the disease, and of these
15 were infected by members of the same family, 3 by missed cases, 9 cases were attributable to hospital
infection, 3 to playfellows, 2 to visits to the country, and 6 followed an attack of measles. The result
of inquiries in Shoreditch showed that in 8 cases there was a previous history of sore throat in the same
house, 9 cases were infected outside the borough, 45 by playfellows and neighbours, and 62 patients
were children attending school. In Woolwich it is noted that in 71 cases other inmates of the house were
involved, in 47 cases there was history of school infection, in 13 cases neighbours and friends were
suspected, 3 cases were attributed to general hospitals, and 9 to the fever hospital. There were 9
"return" cases.