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80
1899]
well paved, and why damp courses should always be placed between
the foundations and the walls of houses, and why the sites on which
the houses stand should be covered with a thick layer of concrete.
The aspect of a house is also important, for an exposure to
cold wet winds tends both to foster the disease and to cause fatal
results to the persons attacked.
Direct infection is a most potent factor in the disseminating of
the disease. Speaking on this subject in his Milroy Lectures on
" Diphtheria : Its Natural History and Prevention," the late Sir
Richard Thorne, C.B., Medical Officer to the Local Government
Board, said that " school influence would appear, then, to be operative
in a number of ways."
" 1st. It brings together those members of the community, who
are by reason of age, most susceptible to diphtheria.
" 2nd. The children thus brought together are placed, and
remain for many hours of the day in exceptionally close relation
with each other. In this connection it must be remembered we
are dealing with a disease, the communication of which from
person to person is largely dependent on the closeness of the mouth
and noses of the individual by whom the infection is imparted.
And when it is remembered that children are so placed in elementary
schools as necessarily to be for a long period inhaling the lung
exhalations of their fellows, and that collective singing and a
kindred form of general intoning often forms part of the school programme,
it will not be difficult to understand how especially
favourable such circumstances are to the transmission of a specific
infection which has a primary seat upon the mucous membrane and
in the secretions of diseased fauces.
"3rd. The closer the aggregation and the greater the lack of
ventilation with corresponding hindrance to the free movement of
air, the greater is the risk.
"4th. Such faulty sanitary circumstances of the school house and
its surroundings, and such other conditions as tend to a condition
of general ill-health, in that they induce sore throat, favour the
reception, by children so suffering, of any imported diphtheria
infection.