[If diphtheria is suspected or ascer tained, the physician should, before en tering the sick-room, remove his coat and vest, and cover his body, neck, and extremities with a blouse or a sheet fastened around his neck and body.
When the physician has completed his examination, and is about leaving the family, he should bathe his head, face, beard, and hands in an antiseptic lotion, as one of corrosive sublimate or carbolic acid. All articles not required for the comfort of the patient, as carpet, cur tains, pictures, and decorations, should be removed, and all persons except the physician and those who nurse the pa tient should be excluded from tbe sick room. J. LEWIS SMITH and F. M. WAR NER, Assoc. Eds., Annual, '94.1 Apart from the question of the trans mission of the disease from case to case, many other factors may influence the development and spread of diphtheria.
Sex apparently has no influence, but age materially influences the suscepti bility. Nursing children are, happily, remarkably immune. The greatest sus ceptibility lies between the ages of two and five years; from five to ten many cases are seen; after ten the suscepti bility diminishes very rapidly, and in adults it is but slight. The following table of 14,688 deaths occurring in New York in ten years, tabulated by Billing ton, illustrates these points:— The season of the year exerts some influence. Thus, in England and Wales the average number of deaths for each quarter of the year, from 1870 to 1893 inclusive, was as follows: First quarter, 1000. Second quarter, 819. Third quarter, 847. Fourth quarter, 1192. (Thorne.) Diphtheria is, therefore, more com mon during the cold months of fall and winter than during the spring and sum mer. The same fact is borne out by Bosworth's analysis of 13,6SS deaths from diphtheria occurring in New York during thirteen years. Of these 10,769 occurred from October to March, and 7919 from April to September, inclusive.
Rebult of an extended epidemiological inquiry into the incidence of diphtheria, during the twenty years of 1877-96, in the city of Catania (population in 1896, 116,000). During the nine years of 1877 85 the deaths per 10,000 at all ages were l5.8, while in the nine years of 1886-94
they fell to 7.1, and in the four years of 1893-96 they were only 2.7. These two nine-yearly periods were characterized by a sudden rise in the mortality and a slow decline, but the maximum in the first period (1879) was 34 per 10,000, while in the second period it was 16.
Taking the whole twenty years, the influence of season is very marked. The lowest month is August (4.8), and the highest is January (12.25); and taking the summer quarter as June, July, and August, it is 5.71; while the autumn and winter quarters are 10.9 each, and the spring 8.3. The meteorological ele ments which differentiate the seasons are temperature, relative limpidity, and rain-fall. Taking the whole twenty years' period, it is shown by curves of temperature, relative humidity, and rain fall that the two latter agree directly with the diphtheria death-curve, while the first agrees with it inversely. The important consideration is the cause of this marked diminution in diphtheria mortality. Serum-treatment is virtually not practiced at all, and disinfection is little followed. It is in general sanitary improvements that the explanation is to be looked for. Giagunta (Gior. d. SOQ. ital. d'ig., No. 8, '98).
The massing of children in schools, asylums, and hospitals produces condi tions favorable to the development and spread of diphtheria, doubtless by in creasing the chances of infection. The schools have often been pointed out as the sources of epidemics of diphtheria, which could only be controlled by clos ing the institutions concerned.
Out of 654 convalescent hospital cases, the bacillus was found in 309 after the entire disappearance of the membrane. Among 107 of these, cultivations from the throat gave negative results for some days, and then the bacillus would reappear. Since the same fact was ob served in discharged cases, this reap pearance was hardly due to reinfection. The following list shows the time the bacillus was present:— Disinfectants for the throat had been carefully applied. The use of anti diphtheritic serum did not prevent the persistence of the bacillus in the upper respiratory- tract.