Page:1902 Encyclopædia Britannica - Volume 27 - CHI-ELD.pdf/511

 DIOMEDES — DIPHTHERIA of which Aristides also has made considerable use (see Aristides, Apology of). The Epistle may be read in Lightfoot’s Apostolic Fathers (ed. min.), where there is also a translation into English. (j. A. R.) Diomedes, The.—Two small islands situated in the middle of Bering Strait, about a mile apart, between which passes the boundary line between the possessions of Russia and the United States. They are granite domes without a harbour, and are occupied by a small tribe of Eskimo (85 in 1890), who have plied the trade of middlemen between Asia and America from prehistoric times. They are situated in bL lat. 65° 46'; the western is called by the natives Nunarbook, and the eastern, Ignalook. They were discovered by Deshneff in 1648. Di6sgry6r, a market-town of Northern Hungary, Similes west of Miskolcz. Population (1891), 6537; (1900), 11,526. The state has here some of the largest iron and steel works in the country, employing regularly, in company with the mines, 6000 men. To accommodate these, two large barracks have been erected, besides numerous houses; also schools, hospitals, and other institutions. A large paper-mill likewise deserves mention. The Hungarian kings in old times used often to visit the now dismantled fortress. Diphtheria..—Great attention has been paid to diphtheria in recent years, with some striking results. Its cause and nature have been definitely ascertained, the conditions which influence its prevalence have been elucidated, and a specific “ cure ” has been found. In the last respect it occupies a unique position at the present time. In the case of several other zymotic diseases much has been done by way of prevention, little or nothing for treatment; in the case of diphtheria prevention has failed, but treatment has been revolutionized by the introduction of antitoxin, which constitutes the most important contribution to practical medicine as yet made by bacteriology. The exciting cause of diphtheria is a micro-organism, identified by Klebs and Loffler in 1883. A description of be found under the of Pathology ausa on. it ^pwill It heading has been shown by aras^c Diseases). experiment that the symptoms of diphtheria, including the after-effects, are produced by a toxin derived from the micro-organisms which lodge in the air-passages and multiply in a susceptible subject. The natural history of the organism outside the body is not well understood, but there is some reason to believe that it lives in a dormant condition in suitable soils. Recent research does not favour the theory that it is derived from defective drains or “sewer gas,” but these things, like damp and want of sunlight,' probably promote its spread, by lowering the health of persons exposed to them, and particularly by causing an unhealthy condition of the throat, rendering it susceptible to the contagion. Defective drainage, or want of drainage, may also act, by polluting the ground, and so providing a favourable soil for the germ, though it is to be noted that “the steady increase in the diphtheria mortality has coincided, in point of time, with steady improvement in regard of such sanitary circumstances as water supply, sewerage, and drainage ” (Thorne Thorne). Cats and cows are susceptible to the diphtheritic bacillus, and fowls, turkeys, and other birds have been known to suffer from a disease like diphtheria, but other domestic animals appear to be more or less resistant or immune. In human beings the mere presence of the germ is not sufficient to cause disease; there must also be susceptibility, but it is not known in what that consists. Individuals exhibit all degrees of resistance up to complete immunity. Children are far more susceptible than adults, but even children may have the Klebs-

467

Loffler bacillus in their throats without showing any symptoms of illness. Altogether there are many obscure points about this micro-organism, which is apt to assume a puzzling variety of forms. Nevertheless its identification has greatly facilitated the diagnosis of the disease, which was previously a very difficult matter, often determined in an arbitrary fashion on no particular principles. Diphtheria, as at present understood, may be defined as sore throat in which the bacillus is found; if it cannot be found, the illness is regarded as something else, unless the clinical symptoms are quite unmistakable. One result of this is a large transference of registered mortality from other throat affections, and particularly from croup, to diphtheria. Croup, which never had a well-defined application, and is not recognized by the College of Physicians as a synonym for diphtheria, appears to be dying out from the medical vocabulary in Great Britain. In France the distinction has never been recognized. Diphtheria is endemic in all European and American countries, and is apparently increasing, but the incidence varies greatly. It is far more prevalent on the preva Continent than in England, and still more so in ience. the United States and Canada. The following table, compiled from figures collected by Dr Newsholme, shows how London compares with some foreign cities. The figures give the mean death-rate from diphtheria and croup for the term of years during which records have been kept. The period varies in different cases, and therefore the comparison is only a rough one. Mean Death-Rates from Diphther and Croup per Million living. . . 990 New York . . 1610 Munich. . . .990 Chicago. . . 1400 Milan . . 830 Buenos Aires. . 1360 Florence. . . 770 Trieste. . . 1300 Vienna. . .720 Dresden. . . 1290 Stockholm . 650 Berlin. . .1190 St Petersburg. . . 640 Boston. . . 1160 Moscow. . . . 630 Marseilles . .1130 Paris . . 490 Christiania . .1090 Hamburg. . . 386 Budapest. . . 1880 London. There is comparatively little diphtheria in India and Japan, but in Egypt, the Cape, and Australasia it prevails very extensively among the urban populations. The mortality varies greatly from year to year in all countries and cities. In Berlin, for instance, it has oscillated between a maximum of 2420 in 1883 and a minimum of 340 in 1896; in New York between 2760 in 1877 and 680 in 1868; in Christiania between 3290 in 1887 and 170 in 1871. In some American cities still higher maxima have been recorded. In other words, diphtheria, though always endemic, exhibits at times a great increase of activity, and becomes epidemic or even pandemic. The following table shows fairly well the periodical rise and fall in England and Wales. Diphtheria and croup are given both separately and together, showing the increasing transference from one to the other of late years. Diphtheria was first entered separately in the year 1859, with which the table begins. Deaths from Diphtheria and Croup per Million living in England and Wales. Diphtheria Croup. Diphtheria. Years. and Croup. 1859 . 1860 . 1861-70 1871-80 1881-90 1891-95 1896-97 1898 . 1899.

517 261 185 121 163 254 269 244 293

286 220 246 168 144 70 43 27 32

803 481 431 289 307 324 312 271 325