330 DIPHTHERIA. 



was the cause of the disease, for he did not find it in all 

 the cases of diphtheria examined, he was not able to produce 

 paralytic phenomena in animals by its injection, and, further, 

 he obtained the same organism from the throat of a healthy 

 child. This organism became the subject of much inquiry, 

 but its relationship to the disease may be said to have been 

 definitely established by the brilliant researches of Roux 

 and Yersin, who made an extensive study of its characters 

 and life history, and showed that the most important 

 features of the disease could be produced by means of the 

 separated toxines of the organism. Their experiments were 

 published in 1888-90. A considerable amount of further 

 light has been thrown on the subject by the work of Sidney 

 Martin, who has found that there can be separated from 

 the organs in cases of diphtheria substances which act as 

 nerve poisons, and also produce other phenomena met 

 with in diphtheria. 



General Facts. Without giving a description of the 

 pathological changes in diphtheria, it will be well to men- 

 tion the outstanding features which ought to be considered 

 in connection with its bacteriology. In addition to the 

 formation of false membrane, which may prove fatal by 

 mechanical effects, the chief clinical phenomena are the 

 symptoms of general poisoning, great muscular weakness, 

 tendency to syncope, and albuminuria \ also the striking 

 paralyses which occur later in the disease, and which may 

 affect the muscles of the pharynx, larynx, and eye, or less 

 frequently the lower limbs (being sometimes of paraplegic 

 type), all these being grouped together under the term 

 " post-diphtheritic paralyses." It may be stated here that 

 all these conditions have been experimentally reproduced 

 by the action of the bacillus of diphtheria, or by its toxines. 

 On the other hand, there are various secondary inflamma- 

 tory complications in the region of the throat, such as 

 ulceration, gangrenous change, and suppuration, which may 

 be accompanied by the symptoms of general septic poison- 

 ing, and in the production of which other organisms besides 

 the diphtheria bacillus are concerned. 



