Report by the Medical Officer on the prevalence of diphtheria in London and elsewhere : and its alleged connection with the elementary schools.

  • Smith, William Robert.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Report by the Medical Officer on the prevalence of diphtheria in London and elsewhere : and its alleged connection with the elementary schools. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    It is not necessary for me to say more of the varied symptoms of Diphtheria, but it is desiralile, I think, that attention should briefly be drawn to the pathology of the disease, to enable your Board to appreciate more thoroughly the conditions favourable to its spread. The specific cause of Diphtheria is now generally admitted to be a bacillus, originally described b}- Klebs in 1883 as being present in the deeper layers of the affected mucous membrane, but Loeffler in the followinor year pointed out in more detail its connection with the disease, and showed that cultivations of the organism when injected into guinea pigs produced locally, at the site of the inoculation, changes identical with those found in the throat of man, together, subsequently, with similar general symptoms. In 1889 Dr. Klein, in the report of the Medical Officer to the Local Government Board, carried this part of the subject still further, and it is now agreed that the organism known as the Klebs-Loeffler Bacillus and the disease stand to each other as cause and effect. It is true that other organisms are found associated with the bacillus, such as the streptococci and staphylococci of pus, and to these the secondary suppurations and inflammations of serous surfaces which so frequently arise are due. (Plate I.) In the throat the Klebs-Loeffler Bacillus finds those conditions which are most favourable its development, viz., a mucous membrane, a proper temperature, moisture, and a free current of air ; consequently, if the bacillus obtains access to the surface every condition exists for its rapid growth and multiplication. The bacillus is an immotile, straight, or slightly curved rod about the same length as the bacillus of tubercle but thicker; it requires for its growth a temperature of 20°G., and retains its vitality when dried, Loeffler finding it capable of development after an interval of 101 days. These bacilli are only found at the site of the local manifestation of the disease, never in the blood, or in the organs, or in the deeper tissues, and consequently the cause of the general symptoms and complications of the disease, such as paralysis, were presumed to arise from some chemical substance produced during the growth of the organism, which substance subsequently became absorbed, through the abraded surface or otherwise, and gave rise to the local after-eflfects. Brieger and Frankel, Roux and Yersin, and others have cultivated this organism under favourable conditions outside the body, and they have succeeded in separating from the cultures a toxalbumin, which if injected into animals produces exactly those symptoms which are associated with the disease in man, namely paralysis, kidney disease and albuminuria, thus proving beyond all doubt that the organism is really the infective agent of the disease. Knowing now the cause of Diphtheria to be a minute organism, and its usual site the throat, many ways will at once suggest themselves which render it easy enough to understand how the disease can be communicated either by direct or by indirect means. In the great majority of cases, undoubtedly, the disease is transmitted by personal contact such as kissing, and the history of school or village epidemics bears strong testimony to this. A great deal of work has been done in connection with Diphtheria, and many skilled observers have furnished reports of investigations into outbreaks, and given deductions from their observations, the value of which has been tested by later researches, and in the Milroy Lectures delivered by Dr. Thorne Thorne in 1891, an admirable epitome of the work done to that date is given. Dr. Thorne Thorne brings important evidence to show how a waterlogged condition of the soil is favourable to the development and spread of the disease, and he lays stress upon the influence that school attendance had on its transmission in some instances. He also alludes to the large amount of ill defined throat complaints which are often associated with an epidemic of Diphtheria, and expresses the belief that attacks of so-called sore throat exhibit under certain circumstances a progressive development of infectiveness which ultimately is indistinguishable from true Diphtheria. There is also an important memorandum by Mr. Shirley Murphy, the Medical OflJicer to the London County Council, dated March 8th, 1894, which, taken in conjunction with his presidential address to the Epidemiological Society in November, 1894, gives such statistical evidence of the increased incidence of Diphtheria in the school ages as to call for, as he. says, further investigation into the question of the importance of school influence.''