Excerpt from Encyclopædia Medica, Vol. 3: Diphtheria to Food

Age and Sex and case-mortality. - The London notifications for 1892 to 1897 Show that rather more than one-third of the cases are under the age of five years, and rather less than one-third are between the ages five and ten. With every succeeding quinquennium the number becomes very much smaller. Age has also a marked influence on the case-mortality. This is highest in infants under one year. It then gradually falls up to the fifth year, and after that more rapidly; but it rises again after forty. Before the introduction of the antitoxin treatment the case-mortality of the patients under five admitted to the hospitals. Of the Metropolitan Asylums Board was 50 per cent; from five to ten, 28 per cent; from ten to fifteen, 10 per cent; from fifteen to twenty, 4 per cent; from twenty to forty, nearly 5 per cent; and over forty, 17 per cent.

Diphtheria attacks more females than males; this is usually attributed to the fact that the nature of the duties and habits of the female sex render its members more exposed to infection than the male.

Modes of Dissemination - By far the most common mode is by personal communication between the affected and the healthy, either directly as in such an act as kissing, or perhaps more often indirectly by means of utensils for eating and drinking, handkerchiefs, toys, etc. The infection may be harboured for a considerable time in such articles as wearing apparel and toys. It is not often conveyed by third persons.

There are now on record several epidemics of diphtheria in which it has been clearly proved that the infection was conveyed in milk. In some instances the source of infection has not been traced; in others the specific contamination has been derived from a human source during the collection and distribution of the milk; in a third group the infected milk has been obtained from cows that have been at the time the subjects of a disease of the udder, a febrile affection in which the local lesions consist of vesicles which pass on to pustules and ulcers. It was suggested by Power that the connection between this disease and the specific infection of the milk was more than accidental. Working at the subject experimentally, Klein found that in five out of ten milch cows inoculated in the shoulder with a virulent growth of diphtheria bacilli, there was produced after, a few days an eruption on the teats and udders Similar to that occurring naturally. The disease could be transferred to calves by inoculation. In two out of the five cases diphtheria bacilli were obtained from the milk yielded by the' animal, and in two the bacilli were shown to be present in the vesicles and pustules upon the udder. The experiments of Klein, so far as they go, corroborate Power's hypothesis. It is true that the disease set up by Klein in the cow differs considerably from that met with in the hiiman being, notably in the production of vesicles and pustules containing the specific organism in a region remote from the seat of inoculation. With respect to the two Similar experiments on cows by Abbott (of Philadelphia) with negative results, it may be observed, firstly, that some of Klein's own experiments were also negative, and that the negative can hardly be allowed to weigh against the positive results; secondly, that Abbott did not observe the same conditions as those under which Klein worked. The Specific bacillus has been found in milk presumed to be the cause of an outbreak of diphtheria (bowhill and Eyre), but it has not yet been demonstrated in the milk and in the lesions on the udder of a cow to which a definite epidemic has been traced.

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