August 20, 1891] 



NATURE 



369 



principal seat of the malady, and that in the three parishes this 

 seat was in precisely the most elevated hamlet of all, a fact 

 which from the first appears somewhat strange. One may, 

 perhaps, conclude that LofHer's bacillus does not like too much 

 clamp, and that it is in this respect that its character differs from 

 the bacillus of Eberth, 



Dr. Hewitt, Secretary and Executive Officer of the State 

 Board of Health of Minnesota, U.S.A., said that his experience 

 covered eighteen years of sanitary service with the disease in an 

 interior State of the American Union with a very complete 

 public health service, consisting of 1575 local boards of health, 

 with a State Board. Notification of infectious disease by 

 physicians, householders, hotel and inn keepers, has been obli- 

 gatory since 1883 with penalty, as is also isolation and dis- 

 infection by the local boards of health. The facts believed to 

 be proven in Minnesota were that the disease is very infectious, 

 that it is communicable by persons and things, that the infec- 

 tion lives and grows outside the body and below the body 

 temperature, that it is very tenacious of life as against measures 

 of disinfection, and lives for long periods in clothing and bedding 

 and on floors and walls. Isolation and systematic disinfection, 

 with the most perfect sanitary regulation, are most efficient at 

 present in the control of the disease. Since these had been in 

 efficient use the prevalence had assumed a family character, 

 limiting itself to one or more associated families, and rarely 

 going beyond, except by evasion of the law on the part of an 

 infected person. What was needed now was more careful 

 collection of the facts of each outbreak with a view to a more 

 accurate knowledge of the disease, not neglecting the preventive 

 and controlling measures now found to be most efficient, as above. 

 Dr. Jules Bergeron, of Paris, followed with a paper entitled 

 "Notesuria Prophylaxie de la Diphtheric." Dr. Bergeron said 

 that the measures to be taken against diphtheria were disinfec- 

 tion and isolation : disinfection of all clothing, &c,, contami- 

 nated with secretions from the affected parts ; isolation of all 

 cases and of all doubtful cases, such as those of a herpetic 

 character, which are difficult to distinguish from diphtheria in 

 the early stage of the disease. An important question to be 

 answered is, How long ought isolation to continue ; how long, in 

 fact, does contagion last ? Dr. Bergeron says that he adopts six 

 weeks' isolation as the maximum, and that he has never observed 

 a case of transmission of the disease when a case has been isolated 

 for this period. 



Dr. Gibert, of Havre, spoke of diphtheria in Havre. He 

 said that diphtheria appeared in Havre about i860, and was 

 limited to the Graville Quartier. In 1864, there was an 

 epidemic close to Eryonville. From this date the number of 

 deaths constantly increased; and the disease, which at first was 

 confined to only a few localities, spread throughout the town. 

 The severity of the disease increased until 1885, when a 

 brigade de saliibrite was formed as an annexe to the Bureau 

 d'Hygiene. The dwellings occupied by diphtheritic patients 

 having been regularly disinfected, the mortality curve has since 

 decreased to such an extent as to justify the hope of its total 

 extinction, provided all the medical men of the town furnish 

 accurate information to the Bureau d'Hygiene. 



Dr. S. W. Abbott, of Boston, U.S.A., read a paper on 

 " Diphtheria in Massachusetts from 1871-88." From his observa- 

 tions he concludes that diphtheria is an eminently contagious 

 disease, that it is infectious, not only by direct exposure of the 

 sick to the well, but also through indirect media, such as cloth- 

 ing and other articles that have come in contact with the sick ; 

 that the infection is not so great as in the case of some of the 

 other infectious diseases, notably small-pox and scarlet fever. Dr. 

 Abbott also concludes that overcrowding, &c., favours the spread 

 of the disease ; but that its transmission through the water supply 

 is not proved. Its transmission is favoured by soil-moisture and 

 damp houses ; and the poison may remain infective in houses for 

 a long period. 



Mr. Matthew A. Adams, of Maidstone, read a paper on 

 "The Relationship between the Occurrence of Diphiheria and 

 the Movement of the Subsoil Water." The conclusions he 

 arrived at were that the organism of diphtheria inhabits organic- 

 ally polluted surface-soil, and that, subject to suitable conditions 

 of environment, especially as respects moisture, temperature, and 

 food, it thrives and multiplies in the soil, the micro-organism 

 thus produced being liable to displacement from the interstices 

 of the polluted surface-soil, and to dispersal into the superin- 

 cumbent air ; in this manner determining outbreaks of the disease. 

 So that, given the existence of the pathogenic organisni, two sets 



NO. 1138, VOL. 44] 



of factors at least are engaged in the -production of a state of 

 affairs that culminate in an outbreak of diphtheria. First, those 

 that promote and support the growth of the germ in the soil, 

 such, for instance, as moisture, temperature, air, food, and so 

 on. Secondly, agents of dispersal, by which the germs already 

 existing in the soil are driven out and distributed into the atmo- 

 sphere, and so come to be breathed by man and animals ; for 

 example, sudden rainfall, rise of subsoil water, lowering of 

 barometric pressure. 



Mr. Charles E. Paget, of Salford, followed with a paper on 

 " A Local Examination of the Difference in Susceptibility 

 between Old and New Residents." 



The general conclusion at which he arrived as the result of an 

 examination of the statistics of Salford was, that a shorter 

 average period of residence before an attack of diphtheria was 

 observed where the general mortality rate was highest and vice 

 versd ; that, in fact, the relative incidence of diphtheria during 

 an epidemic period, in respect of length of residence, was de- 

 pendent to no small extent on general sanitary circumstances. 



Prof. D'Espine, of Geneva, foil )wed in the discussion. He 

 drew attention to the great value in the prophylaxis of diphtheria 

 in the systematic washing out of the mouth and pharynx by 

 antiseptic solutions, corrosive sublimate (l in io,ojo), salicylic 

 acid (i in 2000), and lime-juice. In his practice he used salicylic 

 acid in the strength of i A to 2 per 1000. 



Dr. Tripe, of Hackney, who followed, said he had had large 

 experience of this disease, as he had been 35 years Medical 

 Ofificer of Health in Hackney. During that time all ileaths had 

 been investigated, and lately all cases, with the result that there 

 was no evidence that insanitary conditions of houses caused the 

 disease, although they might predispose to it. He believed that 

 closing playgrounds in schools is as effectual in checking the 

 disease as closing the schools ; that prompt removal to hospital 

 and disinfection of clothing and rooms, burning of infected rags, 

 &c., are the best methods for checking the disease. 



Dr. Thursfield, of Shrewsbury, agreed with Dr. Hewitt that 

 dampness had a great deal to do with the etiology of diphtheria; 

 he had himself stated so thirteen years ago in a series of papers 

 on the subject. He thought Dr. Adams's conclusion regarding 

 the connection of the rise and fall of the subsoil water with out- 

 breaks of diphtheria a somewhat hasty generalization. 



Dr. Giinther of Dresden, Dr. Janssens of Brussels, Dr. 

 Hubert of Louvain, Dr. Escherich of Graz, Dr. Jules Felix of 

 Brussels, and Dr. P. Sonsino of Pisa, also took part in the dis- 

 cussion ; many of the speakers emphasizmg the need of local 

 antiseptic measures in the prophylaxis of diphiheria. 



At the end of the discussion, the following recommendation 

 was unanimously adopted by the Section : — 



"That this Section urges the European Governments to 

 make a comprehensive and systemative inquiry into the causes 

 of diphtheria." 



On Tuesday afternoon, Sir John Banks, K.C.B., and 

 Overlaege Bentzen, Christiania, occupied the chair. 



Discussion of the Prevkntability of Phthisis. 



Dr. Arthur Ransome, F.R.S., read a paper " On the Need of 

 Special Measures for the Prevention of Consumption." He said, 

 that consumption is both curable and preventable will be 

 acknowledged at once by all medical men who have had any 

 experience of modern methods of dealing with the disease. 



Its curability is attested (i) by the reports of many pathologists 

 as to the presence of evidence of healed phthisis in a large pro- 

 portion of bodies examined in public institutions. Many 

 thousands of such examinations have now been made, and the 

 results show that from 25 to 50 per cent, of persons dying from 

 other diseases than phthisis give signs of spontaneous cure of 

 tubercular disease. (2) The testimony of all the most eminent 

 modern physicians is to the same effect, that consumption is 

 distinctly curable. 



With regard to the preventability of the disease we have also 

 a strong basis for our faith. 



(i) In the marvellous results that followed the improved 

 drainage and ventilation of the barracks of the British army in 

 all parts of the world. Before the year 1854, the mortality from 

 lung disease amongst the picked population of these dwellings 

 was a scandal to the nation, and was enormously greater than 

 that of the ordinary inhabitants of our towns, especially in the 

 battalions sent to warm climates, such as those of India, Ceylon, 

 the West Indies, the Mediterranean, &c. 



