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child is suffering from that form of the disease which though not
latent, may fail to be recognised, i.e., nasal diphtheria. It is well
in any company, medical or otherwise, to lay stress on the
importance of being on the careful side and taking a swab for
examination in the case of any child who is suffering from a continued
offensive nasal discharge which is blood stained: it is
perhaps more suggestive if it is affecting one side of the nose only
and excoriating the skin.
It happens, therefore, that in ordinary practice it is not
uncommon to meet with what are not really sequelae but complications
of diphtheria which have passed unrecognised, and have not been
treated by serum. The commonest form of complication noted in
this way is paralysis. As you probably know, this takes the form
of a neuritis, but it is peculiar in that it picks out certain nerves.
The symptoms commonly include a nasal voice, regurgitation of
food through the nose and difficulty in swallowing, squinting, a
weakness of the legs with an unsteady gait. Sometimes also, a
striking event, paralysis of the nerves which supply the diaphragm,
so that breathing becomes altered and difficult. This latter
disability may lead to serious complication of broncho-pneumonia.''
Enteric Fever.—During the year under consideration 1 case of
enteric fever and 13 cases of paratyphoid B fever were notified.
This shows an increase of 11 on the number of cases that occurred
during 1934. The attack-rate was 0.066 per 1,000 inhabitants,
compared with 0.04 for England and Wales.
All the cases were removed to hospital. One case terminated
fatally.
During the year 17 specimens of blood from persons suspected
to be suffering from enteric fever were submitted to Widal's test.
All gave a negative result.
Continued Fever.—There were no notifications of continued
fever in the Borough during the year.
Typhus Fever.—There was not any notification of typhus fever
in the Borough during the year.
Puerperal Fever.—There were 19 cases of puerperal fever
notified during 1935; all of these occurred in or were removed to
hospital.
None of these patients lived in a house in which there had
occurred recently a case of scarlet fever.