THE SERUM TREATMENT OF DIPHTHERIA. 513 



been found as the morbid agent in any other similar affection, or 

 in a spontaneous disease among lower animals ; nor is there any- 

 existing evidence to support the idea that true diphtheria may be 

 conveyed from sick animals to human beings. 



The diphtheria bacillus may be found in the air passages, 

 especially the nose, of healthy persons, in whom it has produced 

 no disturbance whatever, nor does it cause any indication of sick- 

 ness until it has settled down for good. Lesions of the mucous 

 membrane of the nose or throat, small eruptions in the air pas- 

 sages, chronically enlarged tonsils, and especially catarrhal 

 changes consequent upon cold, damp weather, favor the develop- 

 ment of the bacillus. If these membranes are normal, the bacillus 

 finds insufficient material in which to multiply, and the poisonous 

 products that it forms are thrown out with the mucus ordinarily 

 produced ; but if there is any lesion or disorder of the membranes, 

 then these poisonous products act at first locally and cause such 

 disturbances of the usual processes of the affected region that the 

 bacilli multiply vigorously and form such quantities of their poi- 

 son that it is absorbed into the system and the disease follows. 



From the moment the bacilli are found on the membranes the 

 person should be regarded as infected, and the term diphtheria 

 should be reserved exclusively for those affections in which this 

 particular bacillus is found. Not infrequently cases are met with 

 that present the physical features of diphtheria, but a bacterio- 

 logical examination will show that the condition is due to other 

 organisms, such as pneumococci, streptococci, and staphylococci. 

 Indeed, in 1887 Loeffier announced that, in addition to the organ- 

 ism identified with his name and Klebs's, there occurred in diph- 

 theritic membranes another organism resembling it in many essen- 

 tial respects, but differing from it in its disease-producing power, 

 and to this organism he gave the name of pseudo-diphtheria ba- 

 cillus ; these bacilli are shorter and more uniform in size than the 

 typical Klebs-Loeffler bacillus. 



The importance of distinguishing between these forms of 

 throat inflammations is apparent when it is recalled that the 

 specific character of the disease not only determines the neces- 

 sity of isolating the affected person but also the method of treat- 

 ment that should be followed. New York was the first city in 

 which a municipality endeavored to make that distinction, and 

 what is now known as the " New York plan " was inaugurated by 

 Prof. Hermann M. Biggs, and his associate, Dr. William Hallock 

 Park, of the Board of Health. In New York, as in most cities, 

 physicians are required to report the cases of diphtheria they are 

 called upon to treat ; if the environment of the affected person 

 renders it desirable to transfer the individual to a hospital for 

 contagious diseases, it is a matter of importance to decide that 



YOL. XLTI. 37 



