DIPHTHERIA 291 



world that this was the one method of successfully combating the 

 disease. The experimental and clinical data, and the favourable 

 statistics brought forward by Roux, at once put this method in a 

 secure position from the practical standpoint.* 



Conditions Favourable to the Spread of Diphtheria. 



Sir Eichard Thome Thome held that soil, and especially surface soil, 

 when considered in connection with relative altitude, slope, aspect, 

 and prevailing winds, plays a part in the maintenance and diffusion 

 of diphtheria, and possibly has relation with its beginnings. He 

 believed that where a surface soil retained moisture and organic 

 refuse, and where buildings founded on such soil were exposed to 

 cold wet winds, there you had conditions likely to foster diphtheria.f 

 Dr Newsholme of Brighton considers that such conditions act as 

 "vital depressants," favouring sore throat and catarrh, and thus 

 preparing the way for the inroads of the diphtheria bacillus. He 

 concludes as the result of extended investigations that " diphtheria 

 only becomes epidemic in years in which the rainfall is deficient, and 

 the epidemics are on the largest scale when three or more years of 

 deficient rainfall immediately follow each other. Occasionally, dry 

 years are unassociated with epidemic diphtheria, though usually in 

 these instances there is evidence of some rise in the curve of 

 diphtheritic death-rate. Conversely, diphtheria is nearly always at 

 a very low ebb during years of excessive rainfall, and is only 

 epidemic during such years when the disease in the immediately 

 preceding dry years has obtained a firm hold of the community and 

 continues to spread presumably by personal infection." J Newsholme 

 thinks the specific micro-organism has a double cycle of existence : 

 one phase passed in the soil, saprophytic ; another in the human 

 organism, parasitic. 



Insanitary surroundings necessarily act prejudicially. Damp and 

 ill-constructed houses and bad drainage, have undoubtedly played a 

 part, and that not a small part, in diphtheria outbreaks. The 

 position of many houses must inevitably lead to dampness ; there is 

 also the dampness arising from undrained and unpaved curtilages ; 

 and lastly, there is damp and steamy atmosphere. Now these con- 

 ditions cannot but affect the health of children and give rise to sore 

 throats and similar complaints. When to this dampness of houses 

 is added the pollution of the soil, the undrained condition of towns, 

 and the nuisances readily arising from ash-pits, cess-pits, and similar 

 methods of refuse removal in close proximity to the houses, there is 



* See also Brit. Med. Jour., 1900, it, pp. 658-62 (Marsden) ; Metropolitan 

 Asylums Board Reports, 1869-1902. See also pp. 425-431 of present volume. 

 f The Natural History of Diphtheria, p. 17. 

 Epidemic Diphtheria (Newsholme), p. 157. 



