Licence: Public Domain Mark
Credit: Diphtheria: its natural history and prevention. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![excess of death in Norfolk (rate 164), where the chalk formation largely predominates; whereas Hertfordshire (rate 70) and Buckinghamshire (rate 54), which also lie largely on chalk, present diphtheria death-rates which are amongst the lowest in the kingdom. North Yorks, with its large excess (rate 149), lies partly on carboniferous rocks, partly on the oolites and lias of the oolitic epoch; whereas Lancashire (rate 79), with its wide extent of carboniferous rocks, as also Bucks (rate 54), Gloucester- shire (rate 79), and Oxfordshire (rate 82), which lie largely on the oolite beds, have comparatively small diphtheria death-rates. And, if the various strata be examined more in detail as regards incidence of diphtheria, even greater differ- ences than those indicated may be shown in respect of communities living on the same geological formations. But, whilst I thus far concur in the view which has been commonly held on this point, I can hardly agree with Hirsch when he declares, and this largely on experi- ence stated to be derived from this country, that alti- tude and soil [are] irrelevant, and that the assumption that conditions of soil have some influence in the develop- ment of diphtheria, or on its epidemic diffusion, is one that has no warrant. Soil, and especially surface soil, when considered in connection with relative altitude, slope aspect, and pre- vaihng rainfall, has, I believe, concern in the maintenance and diffusion of diphtheria, and has very possibly some relation with its beginnings. Speaking generally, I think that the experience of careful investigations extending](https://iiif.wellcomecollection.org/image/b21205814_0032.jp2/full/800%2C/0/default.jpg)
