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DIPHTHERIA. 



Baillou, a French physician living at the close 

 of the sixteenth century. Subsequently it was 

 described by Villa Real, a Spanish physician, 

 Alaymus, G-hisi, Home, and Cullen. The most 

 accurate descriptions were given by Bretonneau 

 in 1826, and by Abercromie in 1828. Since the 

 writings of these two celebrated observers little 

 attention seems to have been given to the sub- 

 ject, as not much has been added to our knowl- 

 edge of the malady. There has been some ad- 

 vance in treatment, but the mortality still aver- 

 ages 30 per cent. The first positive account of 

 an epidemic of diphtheria is that in Spain, about 

 1590. An epidemic appeared at Naples in 1617, 

 in Sicily in 1625, in Italy in 1640, at Palermo in 

 1748, at Paris in 1750," in Sweden in 1757, at 

 Edinburgh in 1765. The first epidemic with 

 which America was visited occurred in New 

 York in 1789. In 1826 the disease again ap- 

 peared in epidemic form in Edinburgh, at Paris 

 in 1853, and at Folkestone, England, in 1856. 

 During 1858 a severe epidemic spread over most 

 of England. In 1882 diphtheria prevailed to a 

 very great extent in Michigan and Wisconsin. 

 These epidemics were very fatal and very sin- 

 gular. The disease would appear first in one 

 town, then in the pine forests miles distant, and 

 no medium of communication between the cases 

 could be discovered. Medical societies in East- 

 ern cities sent experts to ascertain new facts con- 

 cerning diphtheria, but little of importance was 

 learned. In the pine regions of Michigan were 

 a vast number of immense sawdust heaps, the 

 accumulation of years, at the saw mills ; and the 

 view that decomposition of the sawdust gave 

 rise to the poison of diphtheria and infected sur- 

 rounding localities was expressed by several in- 

 vestigators. 



During 1892 the disease was very prevalent in 

 Boston, New York, Philadelphia, Detroit, and 

 Cincinnati. In Philadephia the epidemic was 

 quite severe ; the total number of cases during 

 the year amounted to 5,051, and the deaths were 

 1,484. During the year the average rainfall 

 was much below normal, consequently the sewers 

 were dry for a considerable length of time. No 

 effort was made to flush them, although this 

 could easily have been done. The range of tem- 

 perature during January, February, March, Oc- 

 tober, November, and December was higher than 

 the average for the same months. During April, 

 May, June, July, and August the range of tem- 

 perature was also higher than the average for the 

 same months, and the relative humidity was 

 much above the usual average. Investigation 

 shows that the greatest number of cases occurred 

 during the cold months, and that in August, 

 when the temperature was remarkably high and 

 the relative humidity also, the record of new 

 cases was lowest. When the temperature rose 

 the disease decreased; when the temperature 

 fell it increased. In the lower wards of Phila- 

 delphia, the old part of the city, surface drain- 

 age exists to a great extent, and in these wards 

 the population is greatest, the poorer classes 

 predominating. In the upper wards, the newer 

 part of the city, the elevation i* considerably 

 higher, surface drainage does not exist, the resi- 

 dents are mostly of the wealthier classes, and the 

 sewerage connections in the houses are almost 

 universal. In these wards the number of cases 



was greatest. In the district known as West 

 Philadelphia, where the elevation is also high, 

 the houses modern, sewer connections universal, 

 and of the most approved pattern, the number 

 of cases was also greater. It is also a fact that 

 about the end of the summer months many 

 streets were torn up in order to construct new 

 sewers and to replace cobble stones with im- 

 proved pavements. When these operations were 

 begun the number of new cases of diphtheria in- 

 creased to a marked extent, and when the work 

 was at its height the epidemic was also. The 

 inferences from these facts are very apparent. 

 The rate of mortality was about what it has been 

 from diphtheria from its earliest history. 



The exciting cause of diphtheria is a specific 

 contagium. It is exceedingly doubtful whether 

 it ever does originate de novo. Within the past 

 few years authorities have agreed that, in order 

 to have what we term specific diseases, we must 

 have the specific poison producing them. Most 

 recent observers hold to the opinion that the 

 poison consists of minute particles of matter 

 which possess the power of floating in the at- 

 mosphere. Except where implanted by direct 

 contact, this poison probably enters the human 

 system by means of the respiratory tract. It is 

 indeed very doubtful whether it ever enters 

 through the digestive. That such is at times 

 the case, has been held by several well-known 

 writers. There is no doubt that the poison of 

 diphtheria is influenced to a greater extent by 

 atmospheric conditions than almost any poison 

 of the same nature. What most affects this is 

 dampness. Dry cold and dry heat do not favor 

 its development. In the far north and in the 

 tropics the disease rarely exists. Of all the con- 

 tagious diseases it is the most easily contracted. 

 Its poison seems to be more active, and remains 

 so longer than does that of cholera, typhoid 

 fever, or smallpox. Persons not affected can 

 carry the poison on clothing or hands to others. 

 Many incidents are recorded where this virus has 

 lain dormant for more than a year. 



Within the past few years the separate identity 

 of croup and diphtheria has almost been estab- 

 lished. Without going into a minute descrip- 

 tion of the two diseases, it can be said that the 

 clinical history is so different that we wonder 

 why it was that for so great a length of time 

 they were considered identical. Diphtheria is 

 very contagious, croup never is ; diphtheria is 

 very fatal, croup rarely is. Croup is often re- 

 peated in the same individual, while diphtheria 

 may be, but seldom is. The membrane of croup 

 is white, of fibrine ; that of diphtheria is a dirty 

 yellowish one, of lymph. One is capable of in- 

 oculation, the other never is. Croup appears 

 suddenly, diphtheria has its prodromes. The 

 period of incubation of diphtheria is short, usu- 

 ally from two to four days. An exposure to a 

 severe case produces a severe case. Where we 

 find a family predisposition, a severe case may be 

 looked for. This disease attacks persons of all 

 ages ; yet when the victim is between one and 

 five years of age, a severe case generally results. 

 As a rule, after a person has passed fifteen years 

 of age an attack of diphtheria is light, but there 

 are many exceptions. 



Diphtheria is prone to attack persons who 

 have delicate throats; frequent sore throat 



