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26 [Appendix IV.
Immediately after the removal of the patient his room, bed, &c., were completely disinfected, just
as if the original diagnosis had been accepted.
The second case was that of a woman, aged 58, who died in the Infirmary on August 13th,
five days after admission from a house in Crompton Street. The deceased was a cook, who had
been in service at a public-house in Oxford Street. She gave up her situation on account of ill
health on July 27th, and went to Crompton Street, where she retained a room always at her
disposal. Her movements between July 27th and August 8th could not be traced, as the case was
not reported during the life of the patient, the diagnosis of typhus fever being made only after
post mortem examination.*
The history obtained at the Infirmary indicated that the illness commenced some three weeks
before deceased's admission. The onset appeared to have been gradual, associated with "pains all
over" the body, but no definite symptoms. The deceased had not been confined to bed. The
clinical examination was practically negative. On the 10th, drowsiness was observed in the
afternoon, and a large hæemorrhagic bulla was observed on the second finger of the right hand.
On the 11th, deceased was less drowsy; the breath was very foul; tongue thickly furred and
tending to dryness; another "blister" was found on the hand; and the right eye was bloodshot
and the eyelids swollen. On the 12th, a mottled rash was found on backs of wrists, but nowhere
else; the face was congested; the right eye was bloodshot and the conjunctiva swollen. She
was drowsy, and became practically comatose in the afternoon. She died at 6 a.m. on the 13th.
The temperature, which had ranged between 103° (afternoon of 8th) and 98° (afternoon of l2th)
since her admission, rose to 106.6° just before death. At the post mortem examination the only
pathological appearances noted were a congested state of the lungs and patchy congestion of the
mucous membrane of the intestines. The deceased admitted being a drinker, but not a drunkard.
The diagnosis of typhus was made faut de mieux. Two somewhat similar cases came to the
knowledge of the Medical Officer of Health in the summer of 1899, and were briefly described in
the Annual Report for that year.† It would seem more probable that the present case was one of
ptomaine poisoning, but, for reasons already given, the point could not be cleared up.
PLAGUE.
In consequence of the outbreak of this disease in Glasgow in September of last year, this
disease was added to the schedule of diseases to be notified in pursuance of Sec. 55 of the Public
Health (London) Act, 1891, by Order of the Local Government Board, as from September 20th.
One case was notified in the Metropolis during the last two months of the year, but the diagnosis
was not confirmed by bacteriological examination.
On receipt of the Order of the Local Government Board, a circular letter was issued to the local
practitioners, informing them of the Order, and asking them to report all suspicious cases to the
Medical Officer of Health, and arrangements were made for bacteriological examination. The
Asylums Board set apart accommodation for the disease, and the London County Council retained
the services of Mr. Cantlie, F.R.C.S., who obtained special experience in the diagnosis of the disease
during the Hong Kong epidemic, and made arrangements for the segregation of "contacts." All
persons arriving over sea from an infected port are subject to medical inspection at the port of entry,
and the names and addresses of all who land are taken and forwarded to the local authorities of the
districts to which such persons are proceeding.
The assistance of the Medical Officer of Health was sought once before the close of the year
with reference to a case which was thought to simulate plague. The case was so peculiar that a
* This case was reported during the vacation, and was, in consequence, not fully investigated until some weeks
after its occurrence.
† See p. 39.