The record-union., 1891-11-20
DIPHTHERIA AND THE DUTY OF
THE GOVERNMENT.

g1ene and Demography, held in London
August last, one of the most important
topics of the discussion was diphtheria,
by the section on preventive medicine.
DR.. Seaton cited the case Of an English
town where the construction of new
system of sewerage was followed by
severe outbreak of the disease, and hence
he concluded that disturbance of the soil
might have led to the freeing of the
germs. His idea was that governments
ought to inaugurate systematic inquiry
into the cause of the disease.
DR.. Schrevens of Journal said that the
true cause could be arrived at only by ex-
amining and comparing results of in
quiry in different countries. In Belgium
typhoid fever and diphtheria run concur
rently-Eastern Flanders alone being
excepted. This led to the belief that the
connection between the two diseases must
be their origin from local matters, and
the psychological researches of Loffier
and Eberth agreed with this view. The
exception in the case of Eastern Flanders
confirmed the view, for the soil was there
so humid that it was easily washed clean
from all impurities.
DR.. Hewitt of Minnesota said that
diphtheria appeared in that State in $780,
and is now the commonest cause of death
but two-infantile diarrhea and tuber-
culosis. In his State it was noticed that
diphtheria started in families settled on
banks of large streams, and then spread
to the higher plains, as increasing busi-
ness led to greater intercourse. He drew
formation he had been able to collect,
viz: 1. That from 20 to 80 years of age
women are more liable than men-a fact
which he accounted for by the contagious
ness of the disease, and women being
generally employed as nurses. 2. That
forty-four per cent. of all cases occurs
at or under years of age.
DR.. Abbott of Boston was the next wit
ness, and he set forth his views in an
elaborate paper with these conclusions:
l. That diphtheria is an eminently con-
not only by direct exposure of the sick to
the well, but also through indirect media,
such as clothing and other articles which
have come in contact with the sick. s.
That the certainty of infection is not as
great as in the case Of some of the other
infectious diseases, notably smallpox
and scarlet fever. 4. That overcrowding,
faulty ventilation, and filthy condition of
tenements favor its spread. 5. That the
influence of defective plumbing is not
proven. 6. That its transmission through
public and private water supplies is not
proven. Z. That its propagation is fav-
ored by soil-moisture, damp cellars, and
general dampness of houses. s. That the
poison may remain inactive in houses for
long period.
Mr.. Charles Paget of Stafford had found
as result of his study and researches
that as the people of a district were more
subjected to the continuous influence of
their unsanitary surroundings, they
were found less fitted to resist the infec-
ton of this disease. A shorter average
period of residence elapsed before an at
tack of diphtheria was observed where
the mortality rate was highest, and vice
versa. The relative incidence of diph-
liberia during an epidemic period, in re-
spect of length of residence, was thus de-
pendent to no small extent on general
sanitary circumstances.
Professor D'Espine of Geneva, DIR.
Jausseus of Brussels and DIR. Escherich
of Graz held that local disinfecting meas
ures were of great use in preventing the
spread of the disease. DR.. Thursfeld of
Shrewsbury believed that the failure of
sanitary Improvements to stop the in
crease of diphtheria was to be attributed
TO the dissemination of the disease by
very mild, medically unattended and
therefore not notified cases-generally
acting through school agency. More i'm
portance should be attached to the fact
bdSAI thS SlASA I'LL ASLCc IdNOI1uS tDe III
cidence of the disease was personal sus-
ceptibility. He had, some years ago, in
published papers, taken the view ex-
pressed by DR.. Hewitt, who laid consid-
erable stress on the connection of the dis
ease with damp houses. He had met
with cases in which a very prolonged
period Of infection had been observed,
and thought these might be explained
by the fact that relapses might occur in
diphtheria.
DR.. Tripe of Hackney said that, as the
result of thirty-fiye years experience, he
had noticed that good drainage had but
little effect in diminishing the virulence
and extent of epidemics of diphtheria
The best method of preventing its spread
was by destroying by fire all rags in
fected by secretions. He believed the
disease was spread by contact, and had
found that closing the playground was
as effective as closing the school.
Finally the section voted to solicit all
European Governments to enter upon
comprehensive and systematic inquiry.