. Diphtheria: its natural history and prevention . ult of them is widelyscattered. I would therefore propose to trace the variousstages by which, as the result of skilled inquiry, ourpresent knowledge as to the conditions under whichthe development and spread of diphtheria take placehas been acquired; to point, as far as I may be able, tothe degree of importance attaching to these several con-ditions ; to indicate the lines for future research whichappear to promise most; and to suggest such measuresas may usefully be resorted to with a view to the preven-tion of the disease. And it may be con
. Diphtheria: its natural history and prevention . ult of them is widelyscattered. I would therefore propose to trace the variousstages by which, as the result of skilled inquiry, ourpresent knowledge as to the conditions under whichthe development and spread of diphtheria take placehas been acquired; to point, as far as I may be able, tothe degree of importance attaching to these several con-ditions ; to indicate the lines for future research whichappear to promise most; and to suggest such measuresas may usefully be resorted to with a view to the preven-tion of the disease. And it may be convenient to state at once, that suchinformation as we possess on these points is largelybased on our knowledge of the behaviour of fatal diph-theria only; for, except in regard of isolated inquiries,no systematic attempt had been made until quiterecently to ascertain the extent to which diphtheria as adisease, and apart from its fatality, had prevailed in ourmidst. 1 These heads of inquiry are reproduced in Appendix No. I. ! \ \ ENGLAND &WALES. rwGr 0 ITS NATURAL HISTORY, AND PREVENTION 17 It has been very generally held, and I believe withtruth, that the broad geological features of a districthave no known influence on the development or thediffusion of diphtheria. Any one who will recall themain features of England and Wales as ordinarily shownon a geological map, will find in the chart prepared byDr. Longstaff,^ and which shows by different degrees ofshading the average diphtheria death-rates in the regis-tration counties of England and Wales for the twenty-sixyears 1855-80, abundant material in support of thisview. Dr. Longstaff takes 100 as representing theaverage diphtheria death-rate for England and Wales asa whole, and he then proceeds to divide the countiesinto five groups according as they fall short of or exceedthat average rate. We thus learn that during the periodin question the greatest excess of fatal diphtheria tookplace in Lincolnshire, Norfolk, Sussex, and Nort
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