View report page

Annual Report of the Medical Officer of Health—1898. 13
(2) It is generally looked upon as a mild disorder that wants little or no
treatment, whereas it requires careful isolation and nursing, as it is
liable to many grave accidents.
(3) Bad environment; measles does little harm among the well-to-do, but
among the poor it is estimated that twenty to thirty die out of every
hundred attacked by the disease.
As frequently pointed out by me before, I think that the compulsory notification
of cases of measles throughout London, with subsequent hospital treatment and
disinfection, could not fail, in a poor parish like St. George's, to result in a great
saving of life.
Diphtheria Mortality.
There has been a further increase in deaths from diphtheria. There were 19
deaths in 1895; 26 in 1896; 28 in 1897; and 36 in 1898. (These figures including
membranous croup, according to the method of the Registrar-General.)
There can be no doubt that the density of population, and the modern system of
Board School education, have a considerable influence upon the prevalence of this
highly infectious disease. As I have said in previous reports, it would be prudent. I
think, to consider the desirability of the frequent and systematic inspection of all
schools. It is in such places that early and undetected cases of diphtheria, in the
sore throat stage, are to be found under circumstances that afford every opportunity
for the spread of infection.
Last year I quoted from a special Report made in 1890, pointing out the value
and necessity of obtaining an early diagnosis in doubtful sore-throat. As the passage
in question contains the pith of the matter, I venture again to insert it :—" Early
Diagnosis : It is well known to medical men that some cases of diphtheria are
extremely difficult to detect. The diagnosis can only be made after a period of
waiting. Moreover, it seems probable that a certain number of cases are never
detected at all. As an illustration of this difficulty I have it from a doctor that four
of his patients in Cornbury Street, although suffering from suspicious sore-throats,
remained unnotified owing to the clinical evidence being too weak, in his judgment, to
support the theory of diphtheria. Hence it is of the utmost importance to be able to
decide at once whether a sore-throat is or is not of a diphtheritic nature. This can now be
done in a bacteriological laboratory. In Marylebone, for instance, every medical man
is provided with a small cardboard box containing two sterilised test tubes. One
of these tubes is for membrane if it can be obtained, and the other is furnished with
a sterilised swab of wool wound round a wire. The medical attendant touches the
throat with the wool and sends it off to the Medical Officer of Health, who is able to
send back within twenty-four hours a definite report as to the existence of the
disease. The cost of the whole examination of each case amounts to 2s. 7d. It
should be clearly understood, however, that the examinations are not for the purpose
of revising certificates, but for dividing the cases into those which might possibly be
treated at home in safety, and those which require strict isolation in an infectious
hospital."
In March, 1898, in compliance with a resolution of your Vestry. I drew up a
special Report upon the bacteriological diagnosis of doubtful cases of diphtheria and
of typhoid fever. This communication will be found under Section III. of this Report.
It deals fully and systematically with the whole matter of the scientific detection of
the two diseases named in early and doubtful cases. 1 here is no doubt, in my own
mind, that a public bacteriological service such as that suggested, would materially
add to the powers of your Vestry in the control of infectious diseases, which is one of
the most important duties of a Sanitary Authority. A free bacteriological examination
has been established in at least eight metropolitan parishes, and their legal
position has not been questioned by the Local Government Board.