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London County Council 1913

[Report of the Medical Officer of Health for London County Council]

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Report of the County Medical Officer—General.
Human anthrax was made a notifiable disease under the Public Health (London) Act, 1891, by
order of the Council as from 26th April, 1909. The following is a return of the number of cases notified
from that date :—
1909 9
1910 6
1911 6
1912 2
Three cases of anthrax in man were notified in 1913. It will be seen, therefore, that very few
cases of this disease among human beings occur in London. The Home Secretary has appointed a
committee to inquire into the dangers of infection from this disease in the processes of sorting, willeying,
washing, combing and carding wool, goat hair and camel hair, and in the processes incidental thereto,
with a view to considering whether something more can be done to minimise the risk. The Committee
had not reported at the end of the year.
The introduction of mechanical traction has resulted in a large reduction in the number of horses
kept in London, particularly in the case of large owners, both for private and commercial purposes,
and there has been a corresponding reduction in the number of cases of equine glanders reported under
the Glanders and Farcy Orders.

The following figures indicate the number of cases notified in London from 1901 to 1913 inclusive :—

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Glanders in man was made a notifiable disease under the Public Health (London) Act, 1891, by
order of the Council on 6th April, 1909 (p. 926). This Order came into operation on 26th April, 1909.
Between that date and March, 1910, only six cases were notified under the Order and the diagnosis
was confirmed in only two cases. The results of an investigation respecting glanders conducted by
Dr. J. M. Bernstein and Dr. W. H. Hamer were given in the Annual Report of the Council for 1910*,
and particulars of the known cases of human glanders which had been reported from 1893 to 1911,
49 in number, including the above-mentioned six cases, were set out in an appendix to the report. Among
the conclusions drawn from the inquiry were these—that equine glanders is more prevalent in stables
where only few horses are kept, that in such cases the "horses, often badly fed and overworked, and
so offering little resistance to infection, are still liable to constitute a serious source of infection, both
to other horses and to man," and that "the men who own these horses would be, and in fact are,
if they suspect themselves to be suffering from any infectious disease, very loth to draw attention to
themselves and interfere with their freedom." The inquiry further indicated that in the majority
of the cases of alleged glanders in human beings which were investigated the patients had had direct
contact with horses, but that there were several cases in which no evidence of such contact was obtainable.
It was found that there were varying clinical symptoms in the cases investigated and that
difficulty of diagnosis was experienced even after bacteriological examinations had been made. The
only case of glanders in man which was notified in 1913 should now be added to the list given in the
report for the year 1910. The case occurred in Deptford and the subjoined information has been
extracted from the annual report of the medical officer of health for the borough:—
"S. O. B., 17 years, of Lewisham High-road. The patient was removed to St. John's
Hospital where he died. Bacteriological examination confirmed the diagnosis. It was found
impossible to trace the source of infection."
The occurrence of this case led to elicitation of the fact that three suspected cases of glanders
had been under treatment in the hospital in which the man S. O. B. died. The particulars relating
to these cases afford further illustration of the difficulties of diagnosis already referred to; the following
summary is given of these cases, which were described in "The Lancet," by Drs. H. M. M. Woodward
and K. B. Clarke in December, 1913 (p. 1696) :—
Case 1.—The patient, aged 19, a sailor, who had been ill for three days, was admitted
for pyrexia and complaining of a deep-seated pain in the right epigastric region. There was
nothing of importance in his previous history, and as far as can be ascertained, he had nothing
to do with horses. As the patient had complained of some pain after micturition, a catheter
was passed and material was planted out on all the ordinary media. In twenty-four hours
there grew colonies of staphylococci and of a gram-negative bacillus which it is stated proved
on further investigation to be the bacillus mallei. Later there appeared over the chest, back
and face an eruption simulating small-pox. After being delirious for several nights, the patient
gradually passed into a state of coma and died eleven days after admission. "At the autopsy
* Annual Report of the Council, 1910, Vol. iii., pp. 109-114.
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