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THE STRAND DISTRICT, LONDON. 145
bacilli still there, it would be difficult for a medical
man to insist on further isolation when the patient was
to outward view apparently well. If diphtheria is to be
stamped out, I feel sure that greater insistance must be
laid on this point before disinfection of premises and
clothing are carried out.
Defective drainage and insanitary conditions play a
part in the production of this disease, probably in two
ways. They may lead to an unhealthy or weakened
state of the throat which may thus prove to be a good
soil for the growth of the bacillus (and in this way
preceding attacks of scarlet fever may also act), or the
action of impure air (from sewers, in overcrowded
rooms and houses, &c.), may act as a stimulant to
organisms, perhaps existing previously in a harmless
state, and induce in them the virulence which leads to
the serious effects we know as diphtheria.
The experience in the Hospitals of the Metropolitan
Asylums Board during 1892, exhibits an example of a
combination of these two actions, viz., of a previous
predisposing disease and of overcrowding. No scarlet
fever patients in one of the Hospitals had up to that
year developed diphtheria, but during the summer of
1892, it became necessary to treat 24 patients in a
ward intended for 18, and within three weeks 7 cases
of diphtheria and 3 cases of other throat illness
appeared. As soon however, as the crowding was
abated, there was no further occurrence of the affection.
Dr. Thorne Thorne, the Medical Officer of the Local
Government Board, has pointed out how a similar
result ensued in schools. The compulsory attendance
of children who may be not sufficiently free from
infection, with the small amount of cubic space required
K