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35
Diphtheria.—A few days after the outbreak of throatillness
i.e., on November 13th, I received notification of 4
cases of Diphtheria, and within the course of the following 12
days I had received notification of 38 such cases. These 38
cases represented infection in 28 houses, and 25 of them were
patients who had previously suffered from the peculiar throat
affection associated with the mild epidemic. I was informed by
the medical gentlemen in charge of these cases that the original
throat affection had materially subsided in most cases and that
after a day, or perhaps two, of comparative convalescence, the
temperature suddenly rose and more or less true diphtheritic
symptoms supervened. Whether the true explanation of this
is to be found in a secondary infection (which in every case
seemed most improbable) or by a progressive developement of
diphtheria from out of the original throat trouble which I
satisfied myself from bacteriological cultivations was not
diphtheria, I am not able to state; but it is I believe, a
general experience that where there is much throat illness
about, cases of diphtheria generally supervene.
The distribution of the cases was as follows:—
Chukch End 20 cases in 16 houses.
North Finchley 9 „ 5 ,,
Whetstone 5 „ 4 „
East Finchley 4 „ 3 „
In the 28 houses in which it occurred there was a complete
absence of those insanitary conditions (i.e., defective drainage,
evil smells, refuse accumulations, dirt and damp) which undoubtedly
favour the appearance of diphtheria. I attributed the
predisposing cause in some cases to the exceptional climatic
conditions already indicated on a previous page, and in other
cases to the throat trouble arising out of the milk infection.
The throats were thus prepared for the diphtheritic infection and
were in their unhealthy state incapable of resisting it. Whence
the diphtheria infection came, however, I was unable to tell. I
satisfied myself that it could not have arisen from infection from
any pre-existing case in 25 of the 28 cases.