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conditions operate very largely indeed in determining the
susceptibility of persons, when the specific micro-organism
happens to appear, so that it is as important as ever that such
matters should receive attention, and that their causes should be
removed.
Nevertheless, it is very important that as much as possible
should be done to discover the existence of these active organisms ;
and it may be presumed that at some future time every District
will have a centre, at which investigations in this direction can
be carried out, not only to determine the possibility of certain
diseases appearing, but also to determine the positive existence
of such disease.
In the case of diphtheria, it is becoming a more and more
common practice to decide by such bacteriological methods
whether the disease is diphtheria or not; and also to decide
when the disease, or rather its infectivity, has come to an end.
The necessity for the latter was shown in a striking way in this
District. Two persons, suffering from diphtheria, were removed
from a house in Mitcham to the Croydon Infirmary, towards the
end of August, and one of them died there. The other was
detained until the second week in November, owing to protacted
cardiac weakness; nevertheless, after this prolonged detention,
as soon as the patient returned home, the disease reappeared
among her relatives, and the patient herself had a second attack.
I understand, also, that a young man living in Croydon, to
whom this patient was engaged, was also attacked with the
disease, and died. Consequently, on my advice, arrangements
wtre made towards the close of the year for the bacteriological
examination of throats after diphtheria, to determine the actual
termination of the illness, and in the future this will be carried
out in every case in the District before isolation is relaxed, or
disinfection performed.
Fever.—Twelve cases of Enteric or Typhoid Fever were
notified, the diagnosis of one of which was afterwards reviewed
and altered. Of the eleven remaining cases, three occurred in