156 THE ENZYME THEORY OF DISEASE [CH. xi 



by Andrewes and Horder (1906) of a number of cases of 

 contagious disease, obviously passed on from one patient to 

 another, of which some presented the symptoms of scarlet 

 fever and others those of puerperal fever {vide p. 98). 



Another remarkable instance (recorded by Dunn and 

 Gordon, 1905) has been already alluded to but is of sufficient 

 interest, in this connection, to warrant a second description. 

 They mention an epidemic in Hertfordshire characterised by 

 an extraordinary diversity of symptoms in diflFerent patients. 

 In some cases there were sneezing, coryza and the ordinary 

 symptoms of a common cold. In other cases patients com- 

 plained of aches and pains all over and stiff neck, and suffered 

 subsequently from great debility ; such cases had all the 

 appearance of influenza. In others, again, the illness closely 

 resembled scarlet fever ; it began with sore throat, rigors, 

 vomiting, headache, fever and rapid pulse, and was ac- 

 companied by a punctate rash at the end of the first 24 hours 

 (followed later by desquamation), the "strawberry" tongue, 

 circum-oral pallor, enlarged cervical glands which in some 

 cases suppurated, and in some patients by complications such 

 as nephritis, arthritis and otorrhoea. A fourth type resembled 

 diphtheria and exhibited a suspicious membrane on the 

 tonsil. A fifth type was notified in some cases as typhoid 

 fever and was characterised by epistaxis, melaena, prostration 

 and, in some cases, it is stated, a positive Widal reaction. 

 Finally, a number of cases, particularly amongst children, 

 resembled cerebrospinal fever and were so diagnosed ; these 

 were characterised by profuse nasal discharge, pain in the 

 back of the neck, headache, photophobia and irritability, 

 dilatation of one or both pupils, persistent vomiting, drowsiness, 

 head retraction, paralysis, coma, and sometimes convulsions 

 and death. 



Sometimes these widely divergent types were exhibited by 

 the different members of a single family or household struck 

 down by the disease, either simultaneously or consecutively. 

 After a thorough investigation, these observers were convinced 

 that the outbreak of these various types of iUness was due to 

 the prevalence and spread of only one disease and not a 



