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It is within the recollection of almost all of us that it is not more than ten years since scientific investigation gave us any actual idea of the immediate cause of the disease known as diphtheria. At that time even its contagiousness was disputed by many; and while medical practitioners having experience with the disease had noted its special incidence in certain localities and still more in certain dwellings, yet the cause was by most supposed to be due to local unsanitary conditions wherein the decomposition of organic matter, whether animal or vegetable, in cellars, sewers, etc., was supposed to exert a causative influence. While to-day such conditions are readily acknowledged to exert influences favorable to the occurrence of the disease, yet actual observers of this as of other zymotic diseases give such influences the secondary place, and speak of them as exciting causes rather than as the immediate cause.
BRYCE PH. PRACTICAL DIFFICULTIES OF MEDICAL HEALTH OFFICERS AND PHYSICIANS IN DEALING WITH SUSPECTED CASES OF DIPHTHERIA.. JAMA. 1894;XXIII(18):670-673. doi:10.1001/jama.1894.02421230010001b