1895.] on the Antitoxic Serum Treatment of Diphtheria. 435 



plying the antitoxic serum. To prove that this bacillus is really 

 the cause of the disease, Loeffler, in an elaborate series of experi- 

 ments, inoculated the pure cultures of the bacillus grown on 

 artificially prepared media, into animals ; he was thus able to set 

 up characteristic lesions, especially if he took the preliminary pre- 

 caution to abrade slightly the mucous membrane, thus, as it were, 

 ploughing the ground before scattering the seed. On such abraded 

 surfaces the bacilli grew very luxuriantly, and false membranes were 

 produced ; in these lesions the bacilli could afterwards be found and 

 again separated in pure cultures, whilst the characteristic toxic 

 symptoms of diphtheria were, in each case experimented upon, 

 repeated with the utmost fidelity. Loeffler also pointed out a most 

 important fact in connection with the presence of the organism in 

 the body. He found that it was strictly confined to the local wounds 

 or lesions in the throat and posterior part of the nose, and he was 

 also able to prove that in this position these organisms commenced 

 to manufacture most virulent poisons, which, unlike the bacilli, can 

 become diffused throughout the body. Klein and Sydney Martin 

 in this country have both made very valuable contributions to our 

 knowledge, the former concerning the bacteriology of the disease, 

 the latter in regard to the chemical action on the tissues of the toxic 

 or poisonous products of the bacillus, 



Martin found that after the poison formed in the throat has made 

 its way into the internal organs of the body it undergoes certain 

 changes; it is broken down into somewhat less poisonous com- 

 pounds, but these, accumulating at certain points, act especially on 

 the nerves and muscles. It appears then that we have to deal with 

 two sets of poisons : a very virulent poison formed by the bacilli 

 directly from the fibrin and albuminoids of the fluids of the blood, 

 exuded on the surface of the mucous membrane ; and secondly, a less 

 poisonous series which appear to accumulate especially in the spleen. 

 So long as these poisons remain in the body we have the general 

 fever, rise of temperature, and altered conditions of circulation (as 

 evidenced by the pulse), so characteristic of the disease. At a later 

 stage, sometimes after all the primary symptoms of diphtheria have 

 passed away, there are often met with what are called post-diph- 

 theritic paralyses, which are due apparently to alterations in the 

 nerves going to muscles, especially those going to the delicate 

 muscles of the soft palate and around the opening into the windpipe, 

 though other groups of nerves and muscles may be similarly affected. 

 These post-diphtheritic paralyses may be due then to the action 

 either of the virulent poison (ferment) formed in the membrane, or 

 of the somewhat less poisonous, but more stable toxines that are 

 formed in the later stages of the disease. Through the kindness 

 of Dr. Martin I am enabled to show you figures of nerves and 

 muscles, the degeneration of which is due to the action of these 

 poisonous substances [Illustration shown]. It is here unnecessary 

 to enter into any detail as to the minute changes that take place in 



