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54
been found that many get infected and have the organism in their
throats without symptoms sufficiently serious to attract attention
being set up, and yet they may convey infection to others.
Two conditions operate in determining if the case is to be a
mild or serious one—viz., the virulence of the organism, and the
state of health of the patient. The bacillus often appears to gain
in virulence as it passes from one throat to another, but there is no
doubt that this quality is increased by insanitary conditions; air
rendered impure in any way stimulates the bacillus, at the same
time depresses the resistive power of the individual. Scarlet fever,
measles, &c., and ordinary colds affecting the throat render it more
susceptible, or prepare a soil on which the diphtheria bacillus can
grow and produce the poison which, being absorbed, produces
degeneration of the nerves, and often paralysis of the heart.
Prompt use of a7iti-toxin in the early stages neutralises this poison.
In many towns the municipality supplies anti-toxin free for use
among those unable to pay for it, and to use as a protective
injection for others Avho have been exposed to infection, as it
appears to possess the power of protecting the person for three or
four weeks at the least.
In Westminster 75-8 per cent, of the cases were treated in
hospital. The weekly notifications are shown on the accompanying
chart (p. 48).
Enteric or Typhoid Fever.—104 cases were notified during the
52 weeks of 1901 as enteric fever, and two as continued fever (both
probably mild forms of enteric), but four of the patients were found
to be suffering from some other complaint (miliary tuberculosis,
leukoemia, appendicitis).
The total notifications were only 5'62 per 10,000 inhabitants in
Westminster, as compared with 7*03 for all London. But as a
result of enquiries, it was found that 24 of the 102 actual cases
came into the City suffering from the complaint which they had
contracted, some in South Africa, some in France, and a number at
other places in this country. Probably some of the other cases
contracted the disease similarly, but no history could be obtained
to that effect.
Of the 78 actual cases among citizens, seven were due to direct
infection from a previous case—three of these were in private
families, two hospital nurses, and two soldiers in barracks; five
persons were infected through eating shell-fish. The origin of
infection in the remaining 66 was not discovered.* These 78 cases
* See Appendix II for Report on Water Supply and Typhoid Fever.