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the ordinary explanation that it is passed from the sick to
the healthy by more or less close contact. In this, connection
it has been shown that it is transferred along lines of communication
between various countries. Of course, if it
occurs in the summer, it is obvious that the patients will be
less liable to pulmonary complications, but that does not
mean that the disease is less prevalent, because I think
there is no doubt that in the summer epidemic of 1918 the
disease was very prevalent, but the fatal cases were much
less numerous than they were in the autumn.
The causes of the epidemic can be divided into (1) predisposing,
and (2) exciting.
The Predisposing Causes are in my opinion, everything
that interferes with health and vitality, and this will apply
not only to defective sanitation and overcrowding, but also
to matters of food; so if one must have a theory of the predisposing
cause of the world-wide prevalence it must be one
which will apply to every nation of the globe. Now the great
European War would seem to provide the basis of a theory
which will comply with the conditions here stated, for by
putting a stop to building operations not only have the existing
homes in practically every country got into a very insanitary
condition, but the absence of fresh building has led to
more or less overcrowding in large centres of population.
The result is that the health of the inhabitants has deteriorated,
and the overcrowding has facilitated the spread of infection.
The withdrawal of men from agricultural pursuits
has further led to a decreased production of the staple foods,
and an enormous increase in the price of those available.
The general result is that most of the civil populations have
suffered from a general deficiency of food, together with
greatly diminished quantities or the absence of certain staple
foods, such as fats, to which they were previously accustomed.
In the British Isles, too, the practical disappearance
of fresh fruit has resulted in a great dimution of
"vitamines" or "accessory food substances" in our daily
diet. It is well known that the spread of infectious diseases
require two factors, the seed and the soil. The seed may be
ever present, such as in the case of tubercle bacillus, but it