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limited. Notification, isolation, visitation and disinfection, to be of
any use, must be thoroughly carried out. This means increased
cost, but it is to be hoped as people become acquainted with the
serious nature of the illness through the means of notification and
visitation, they may be more careful in regard to isolation and
disinfection.
Diphtheria.
Twelve cases of this illness came to my knowledge. Three
cases occurred in one house during the year, and in the same
premises a year or so previously a similar case happened. There
can be little doubt that the insanitary state of the house was the
cause of the illness. A defective drain was found when the ground
was opened, and a leaky joint causing soakage of sewage matter
into ground. The back yard was very dirty from fowls being kept
close to the house. On my inspection a chicken appeared ill, it
had been affected with what is commonly known as "Roup." One
of the sick children had attended to this fowl. Suspecting the
illness might have been caused through this channel, I purchased
the bird and sent it to the Laboratory of the College of Surgeons,
the Curator kindly examined the bird and reported that he could
not find any trace of the bacillus of diphtheria. In the other cases
the insanitary state of the premises was the likely cause of the
illness. Unfortunately the mortality from this illness was considerable,
namely four. In three cases removal to a London hospital
was made.
Typhoid Fever.
In five out of the seven cases of Typhoid Fever it was possible
to trace, with almost a certainty, the cause of illness; in the
remaining two the cause of illness was not so apparent. In the
case of a female nurse in the County Asylum, it was ascertained
that some short time previously she, together with two friends,
visited Southend and partook of some oysters. On arriving home
all three persons were taken ill, her two friends escaped with severe
diarrhoea and sickness, but she developed Typhoid. I communicated
with the Medical Officer of Health of Southend, but it
was not possible to trace other cases of Typhoid Fever to the same
source. However, at this period, investigations were going on by
the Local Government Board into the possibilities of oysters
subject to sewage pollution giving rise to Typhoid, and from the
report on the. subject to the Local Government Board it is clear
that the condition of things in regard to the care of oysters at
Southend was not what it ought to be. In another case the
probable cause was ascertained to have been contracted while
visiting away from district. In three other cases that occurred in
one house the cause was traced to a leaky drain polluting soil
through which passed a pipe conveying drinking water to the
house; the pipe was constantly under pressure, as this part of
Friern Barnet lies at a lower level than the surrounding district,