ON THE CAUSATION OF DIPHTHERIA. —AN IMPORTANT LESSON.

New Zealand Herald, Volume XI, Issue 4048, 3 November 1874, Page 3

ON THE CAUSATION OF DIPHTHERIA. —AN IMPORTANT LESSON.

Tiie Melbourne Argus is at present publishing a series of excellently written articles upon the subject of diphtheria, its causation and prevention> from the pen of an eminent Victorian medical gentleman whose anonyma is " Mucor." The following extracts are from his latest article and it is toted in "proposition XII —a complete removal of excitement from a place preludes the occurrence of the malaria at the place." As occupying four columns of the Argus the article as a whole would be too long for our pages, but we transfer all the material points, which are as follow

This largo inference (viz., that a complete removal of excrement fiom a place precludes the occurrence of the malaria at the place J is drawn from an extensive collection of data, and is the natural sequence to the other propositions—the obvious corollary. Its urgency and importance, to the inhabitants of this colony especially, cannot well be overrated ; for, if sound, it may readily be brought into immediate practical use where diphtheria is either present or imminent. Though the evidence to be produced in support of the proposition is, Kke all the evidence hitherto brought forward, of necessity, in the present state of our knowledge, negative and circumstantial, it is not to be rejected simply on that account. To my mind the law of gravitation neither rests upon a surer foundation nor admits of such easy proof or disproof as the law contained in this proposition.

Every fact and inference tending to shew that the malarial form of the poison of diphtheria is a specific product of fecal matter under certain conditions, tends equally to shew that where there is no faßcal matter there can bo no diphtheritic malaria. All that has been advanced, therefore, to exhibit the constancy of these conditions when the product has resulted, bears on this proposition with whatever force it may have had in its place. There are, however, other facts and inferences.

The report of the Victorian Commission, contains the following passage (page ix.) : —■ "Gaols, penal establishments, industrial schools, lunatic asylums, and public institutions generally, have been remarkably free from diphtheria. The Geelong Protestant Orphanage is the only exception to this. The Chinese raccs are the only people known to be free, from attacks of diphtheria, and in half-caste Chinese children instances of the disease are very rare, even in localities where it prevails extensively amongst other races."

"With reference to the freedom of our public institutions, I would observe that with the exception of the Panopticon at Pentridge, none are supplied with water-closets ; and that in all of them, with one other exception, a daily complete excrcment removal obtains, or a periodical removal at short intervals. The latter exceptional case is the Geelong Orphanage, audit is curiously suggestive. The evidence of Ur. AY. Shaw is to theefl'ect that there were 3(! or 37 very severe cases of diphtheria among the orphans, that the asylum is in a very healthy locality, and that the sanitary conditions were very good. As the precisc mode of dealing with the excreta of the place is not touched upon, and as I inferred a cesspit system, I madc inquiry and found that at the time of the diphtheria invasion part of the asylum was supplied with earth-closets, emptied daily, and for the rest there were eight privies with water-tight cesspits, emptied about every six months. I ascertained further, that at the time of the outbreak there were no cases of diphtheria in the neighbourhood of the asylum, end that there was nothing to shew how the disease had occurred.

The non-occurrence of diphtheria in the public institutions of Victoria is not only consistent with tho view of faecal causation, but was, I submit, a direct consequence of excreta removal. For in tlic Geelong Orphanage alone of all these institutions were to be found the conditions here assumed to be required for the evolution af the diphtheria poison. In 110 other were there well-made, decently-kept, and regularly-emptied privies. Of course, it may be that tho occurrence of the disease in the Orphanage, and its nonoccurrence in the other institutions, were merely coincidences with, and not consepuence of, tho excreta system ; but if we turn to England we shall find the same phenomena rccurring so regularly during so many years, : that they may be regarded almost as constants. As a matter of inference I venture to say that not one instance of the occnrrencc of local malaria in a public institution in England from which the excreta have been removed in the sense now understood, can be produced. Diphtheria has been unknown where f;ecal matter has not been stored in cesspits, or otherwise placed under the conditions suggested. Wherever methodical steps were taken to extrude the excreta of large numbers of persons from public or other buildings, the malaria did not originate, or establish itself by any means, at periods of the greatest intensity of the local epidemics in England. Neither in London nor in any part of the kingdom can it be shewn that iu hospitals, penal establishments, or places haying similar exeretal arrangements, diphtheria appeared, even when prevailing inthe immediate neighbourhood. In the London Hospital for Sick Children there is a history of its introduction and limited spread by communication from the body, but not of local infection. Drs. Grcenhow, Sanderson, and Gull make no allusion to public institutions in the Sscond Report—an omission as expressivo as words. A fewiustances are scattered through the journals and elscwhero of diphtheria in workhouses and such places ; but there no record of an outbreak in any English establishment for tho reception of adults or children, unless where tho excreta were retained in privy cesspits or reservoirs. Not only does the negative evidence derived from tho exemption of public institutions in England and Victoria point all one way, but there is a large mass of similar evidence connected with private liouses._ Instances are numerous where the malaria has clung tenaciously to localities until direct overflow from cesspits, or sewago from the surface, or drainage from a f;ccaUy saturated soil, has been prevented from passing under the foundations of dwellings, and into cellars, and bolow the iloorings of tho weatherboard tenements of the poor. * * * Bytlieyoar JBSS the water-closet system was almost universal ill the houses of the middle and upper classes in London; but tho dwellings of the shopk-;ep.-n\s artisans, labourers, and others, were sujjj'licd with cesspits. 1 he exeretal arrangements correspond with the occurrence v■ diphtheria. Only those portions of the metropolis suffered severely where the privy was in vogue; and there were no mure cases in the houses furnished with watiT-closets than would eoincide with the number of leakages from defects, nogligenee, &c., in so manythousand dwellings. In the country the privy was in use among all classe- of people with few exceptions; and all ola s n>» we subject to attack—the rich ocsfc.-doiiailv firing worse than the poor;

for cleanliness and tidiness preclude the malaria. What was done by the water-closet, for the ■wealthier classes in the west end of London, and for the inmates of hospitals and other large establishments, has been brought about to a great extent in Melbourne for°all citizens alike in another way. At the time whon diphtheria assailed the city with the greatest virulence, nearly every, house in the place had a cesspit connected with it. Since then several thousands of cesspits have been filled up, and for some years past the corporation have prevented the sinking of new shafts for cess purposes. A weekly excreta removal, by means of night carts and. portable receptacles, has been substituted for the old plan. The drainage of Melbourne has also been improved, so that the settlement of sewage under the foundations of houses is far less than formerly. In some of the suburbs the old cesspit has not been disturbed as yet by the local municipal authorities, though generally speaking the surface drainage is more effective of late years. In many of the inland towns, and in the country, the old privy system is adhered to, or an abominable habit of surface pollution obtains. Though diphtheria breaks out frequently with terrible effects in many parts of the colony up to tlio present day, and still maintains its hold upon the environs of Melbourne, yet for years it has almost entirely disappeared from the city itself.

Such a series ot facts as these now drawn attention to in connexion with the disease in England and Australia—such frequent associations of the malady with the presence of excreta, and of its disappearance with the removal of excreta—appear to me to be more than coincidences.

Perhaps the most striking argument that can be adduced in. support of the proposition that the absence of excrement involves the absence of diphtheria is to be found in the reference to the Chinese in the report of the Commission. The exemption of this race fro.n the disease is, I submit, a remarkable confirmation of thepresent proposition.. Their immunity in the colony may be traced, as I conceive, to a very simple procedure by which they effectually, through unintentionally, place themselves outside the area of poison distribution. These people take the greatest eare of their excreta—not for hygiene, but for profit. The escape of the Chinese without a single attack during all these years is, I venture to say, inexplicable except by the aid of their excreta system. There is no other possible element in the differentiation between Chinese and Europeans in the colony. Both solid and fluid excreta are carried off by the Chinese gardeners, and by this curious thrift is ensured not only a complete but a speedy removal. So that whatever f;ecal matter is retained in their camps or quarters is not under the conditions for the production of the malaria; and, if it were, it is not kept long enough to pro--duee it. The Chinese, in fact, have placed themselves in the same position as the inmates of our public institutions, and luvre, as I infer, thus warded off diphtheria.

Altogether, therefore, the Chinese in Victoria have made a perfect negative experiment, than which few could be devised that should be moro complete, satisfactory, or conclusive. Here is a people whose liability to diphtheria is unquestionable. They come amongst us in thousands, and dispose themselves in parts of the colony where the disease is prevalent. Their camps are redolent of decaying organic matters. They are exposed to all the same general causes of disease as ourselves, and they soon assimilate their diet to that of the mining population. In line, there is only one essentia l , difference between the two races. The Chinese neither make cesspits, nor wastefully pollute the surface of the soil with their excreta. As a consequence, they are not exposed to whatever ma'ai ious emanations may come from privies, or from sewage under habitations. JCx rnvjue honcm ; and from the immunity of this people alone I submit the causation of diphtheria might be inferred to a certainty by the scientific method.

With this illustration in support of_ the assumption that the removal of the teecal matter is the prevention of diphtheria, i eioio the case. Many other counts in the indictment against the excreta systr* .1 ol' Europeans could lie brought forward ; but if there be a flaw in these now produced, it j« a fatal one. If the argument up to tlie point readied be vicious, it is useless to extend it: if sound, there is enough

The poison of diphtheria,'' the Lanccl says, "isof a very subtle kind." This is the keynote of its utterance, and the apology for its virtual confession of nescience. My especial object nov.% however, is to caution tli.;je who tl iay have been so far interested as to study the present paper, not to be deterred from coming to their conclusions independently of this great European authority. . . .

With this fertile store of facts there was uo absolute occasion, therefore, to go outside the limits of this colony to seek the causation of the disease. All the European experience condensed in this paper is m reality scientific surplusage—convenient and handy material for the purposes of illustration, 110 doubt, but surplusage nevertheless. By fastening ou to the facta to be picked up at our own doors, and never letting go until W e have extracted every inference, we may come quite as near the truth as they can get in the old world It is folly to refuse light because others are ill darkness. For Victorians now to refuse to believe that the iumatea of our public institutions are saved from diphtheria by the removal of their excrcta, because European ctiologists have not yet traced the connection between f;tcal matter and the disease, would be akin to their disbelieving in the effects of the injection of ammonia for suakc-bito because the like effects, it is said, are now produced in India ; and the facts we know to be authentic are not yet universally accepted as such _iu Europe. Educated persons, who, having i examined the facts as to diphtheria collected I hero, elect to wait the decision of European investigators, rather than to form their own judgment and to give practical effect to it, arcliot far removed from those who would decline to allow ammonia to be injected into the veins of a person moribund from snake venom because the efficacy of Professor Halford's practice is doubted, and the employment of his means to avert death is still unsanctioned by eminent authorities who know very little of the matter.

It is submitted that the factors of the diphtheria poison have been made out sufficiently clear for all the practical purposes of sanitation and prevention ; and, moreover, though it is here a point o". secondary consideration, that the poison itself has been inferentially proved to be a mildew developed on ftecal matter under the conditions given in my Second Proposition.