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26
It is a remarkable fact in reference to epidemic diphtheria, to which I first drew
attention in my Annual Report for 1894, that whereas previous to 1891 the
mortality from the disease fluctuated independently of scarlet fever, since 1891
the death-rates from the two diseases have fluctuated simultaneously in parallel
lines, both reaching their maximum in 1893.

This is extremely interesting in its bearing upon the large number of cases of
diphtheria occurring after scarlet fever, and the very interesting paper by
Dr. Todd, of the London Fever Hospital, upon "A form of external rhinitis
due to the Klebs-Loffler bacillus appearing in children convalescent from Scarlet
Fever," published in the " Lancet " of 28th May, 1898.
The mode of spread of Typhoid Fever. — We are slowly but surely tracing the
manner in which enteric fever spreads. We know that the virus is eliminated
from the human body in the fœces and the urine, and that the micro-organisms,
the cause of the disease, will survive and multiply outside the body in favourable
media to which they may gain access either directly or indirectly. The disease
may thus spread—
(1) By contamination of food and drink, such as water, milk, ices, oysters,
mussels, whelks, &c., which are ingested.
(2) By contamination of the earth, through leaky drains, unpaved yards,
accumulations of filth, &c., giving rise to soil emanations, and—
(3) By contamination of the person, or personal infection from a patient
through failure to exercise scrupulous cleanliness and exclusiveness.