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less interference with school work, and if it can be carried through
promptly at an early stage, children may be detected with the organism
in their throats who may be exhibiting no symptoms of the disease,
but, as in the instance noted above, may be a source of danger to others.
In another case a boy returned home from hospital, where he had
been under treatment for diphtheria. Twenty days after his return
2 other persons in the same family were taken ill with it, and
the suspicion arose that he was still in an infective condition;
bacteriological examination showed this not to be so.
Twenty-three cases were found eventually to give no positive results
after admission to hospitals, although in a number of them the
organism had been found by competent bacteriologists previously,
which shows that in many instances the infective agent may be readily
destroyed if only medical treatment is begun early enough.
Typhoid Fever.—Fifty-one cases of this disease were notified in the
City, as compared with 71 in the previous year, but 5 cases were
afterwards proved not to be so, while 1 case in barracks was not
reported; there were also 2 cases notified as continued fever (1
afterwards found not to be so), which may be included. These cases
were equal to 3 per 10,000, which is the lowest hitherto recorded.
The whole of London also showed a decrease, the rate being 4.0, against
7.7 for the ten years. Eleven deaths occurred in the City from this
cause (being 21 per cent. of the cases), the mortality for London being
15 per cent. of the cases. The death-rate per 1,000 persons was 0 06
for both City and county.
In 27 instances the complaint was ascertained not to have been
contracted in the City. Probably others might be included among these.
but the information was not obtained. In many cases it is very difficult
to discover the manner in which the disease was contracted. This is
due to several reasons, such as the long period between the inception
of infection and the appearance of symptoms and the removal of
patients to hospitals, so that information cannot be obtained from them.
The efforts made during recent years to protect the shell-fish
industry has evidently produced good results, judging from the decrease
in the number of cases alleged to be due to eating contaminated shellfish;
in only 4 instances was there direct evidence of probable
infection by this source, although information has reached me of
persons living in other Boroughs who have been taken ill after eating
oysters in this City.
Recourse was had to a bacteriological test in 17 instances, in order
to assist in the diagnosis; in 2 the result was positive, in 15 it was
negative.
Typhus Fever.— One case of this disease was notified, but from
inquiries I made I do not consider it was typhus fever.