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93
Various forms of the disease are recognised, differing markedly
in their clinical characters. Considerable difficulty arises in consequence
in diagnosing the more obscure forms of the malady, and
the only reliable test is by bacteriological examination. •
The disease has been classified into three main groups:—
1. Malignant form, in which the onset is very sudden and
death occurs within a few hours (in one case recorded,
within five hours) from the first symptoms.
2. Ordinary form. The onset is also sudden, but there are
usually premonitory symptoms, and the characteristic
symptoms of the disease are more or less evident. The
course of the disease in these cases is very variable,
ranging from a few hours to several months. More than
half the deaths occur within the first week. The cases
that recover are mainly those which survive the first
week, a gradual lessening of the symptoms and gradual
restoration to convalescence ensuing.
3. Abortive forms—
(a) An abortive type in which the symptoms set in with
great severity but in a day or two rapidly subside and
the patient rapidly improves.
(b) Intermittent type, commonly observed in epidemics,
characterised by exacerbations of the fever which occur
daily or every other day.
(c) Chronic form, and stated by some authorities to be a
relatively frequent form. In this form the disease may
be prolonged for many months, giving rise to great
weakness.
Numerous Complications arise in the course of the disease.
The mortality varies in different epidemics, ranging from 20 to 75
per cent. The disease is extremely fatal to children.
It is a very difficult disease to diagnose at times, and without a
bacteriological examination it is impossible, in the majority of
instances, to recognise its nature. The quickest method of
obtaining material for bacteriological examination is by spinal
puncture, a method which requires a certain degree of skill which
can only be acquired from experience and practice. For other
obvious reasons also it is not desirable that this method of diagnosis
should be carried out in the patients' houses. When cases are
notified they can be at once removed to the Metropolitan Asylums
Board's hospitals, which are, I understand, prepared to receive