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75—One of the difficulties of investigations of this nature arises
from the mildness of the disease in some cases, and the impossibility
of arriving at a definite conclusion as to its specific character
(without a skilful bacterioscopical examination) for some considerable
time, until the advent of paralytic or other sequela: discloses
its true nature.
76—It seems clear, however, that the supposed relation of
diphtheria to drainage defects is quite unconfirmed as far as
Croydon is concerned, the main local factor in its dissemination
being undoubtedly school attendance.
77—It has also been observed that a prevalence of sore throat
among school children frequently precedes the notification of
cases of diphtheria and seems to pave the way for its development,
the threatened outbreak at Woodside schools in July.
78—A large number of cases still remain, particularly in certain
localities which cannot be ascribed to either school attendance,
pre-existing throat illness or drainage defects, and these would
appear to have an entirely de novo origin, and the chief causes of
their evolutionary development are possibly darkness, dampness,
and decomposition, and the contamination of the surrounding soil
with effete products.
79—Complications.—A summary has been prepared of the
principal complications occurring among the 59 patients admitted
for diphtheria.
80—Those in which the heart was implicated gave rise to most
anxiety and required most careful nursing In eight of these cases,
acceleration and irregularity of the heart with its corresponding
effect upon the pulse were observed, and in live, attacks of cardiac
syncope, occurring most frequently at night, were noted. Endocardial
murmurs were present in six.
81—In one case where death took place from sudden syncope,
a microscopical examination of one of the cardiac musculi papillares
showed that every muscle fibre was degenerated, the tranverse
stiration completely lost,and the continuity of the fibres interrupted.