February 1, 1895.] 



KNOWLEDGE. 



45 



tracheotomy (opening the windpipe in the neck to relieve 

 impending suffocation, caused by the membrane formed in 

 this disease) the surgeon has courageously attempted to 

 assist Nature, by applying his lips to the tube inserted in 

 the neck. 



To sum up briefly certain results gained by investigation 

 on lines suggested by these facts, it may be said that in a 

 family where one patient is suffering from diphtheria, 

 other members are likely to have sore throats, and 

 many of these subsequently develop the disease. From 

 the throats of those exposed to infection, but not 

 showing signs of the disease, cultivations of the bacillus 

 diphtheria; can often be obtained, and it is probable 

 that this latter class may help to trinsmit the disease. 

 Further cultivations of the specific bacillus have been 

 obtained from the throats of patients some weeks after 

 apparent convalescence ; a fact which suggests the neces- 

 sity of using antiseptic gargles and sprays for some time 

 after all symptoms have disappeared. 



Dr. Thorne Thorne, Principal Medical Officer to the 

 Local Government Board, in his Milroy Lectures, delivered 

 before the Eoyal College of Physicians of London, has 

 shown the part played in propagating epidemic diphtheria 

 by elementary schools where many children are in close 

 contact with each other in rooms too often iU-ventilated. 

 I may here remark that the cubic floor space per child 

 allowed in Board schools is far too little, and there can be 

 no doubt that this is a serious factor in the dissemination 

 of this and other contagious diseases. In the large blocks 

 of workmen's dwellings, often euphoniously but incorrectly 

 called " models," the percentage of cases is higher than 

 in other more separated dwelliogs, and this arises from 

 causes similar to what I may call the school propagation. 



Passing by these two factors, which after all merely 

 account for the increase and not for the causation of the 

 disease, evidence has of late years accumulated which tends 

 to snow that the lower animals sometimes suffer from 

 diphtheria, and so may be sources of danger. Cats are 

 sometimes affected by the disease, and the domestic tabby, 

 at once perchance a sufferer and the common playmate of 

 several juvenile members of a family, may be the innocent 

 means of a good deal of harm. The cat may contract the 

 disease independently or by direct infection from a child. 

 It follows, therefore, that doctors and heads of house- 

 holds, when dealing with a diphtheria case, should keep a 

 watchful eye on any pets, and should banish them 

 from the sick room. Cows may suffer from what is 

 known as bovine diphtheria, a disease mainly affecting the 

 skin of the udders and the internal organs, such as the 

 kidney. Several epidemics have been traced to milk 

 derived from infected cattle, and from the causation of 

 these epidemics means can, fortunately, be taken to cut at 

 the root of the mischief. 



I have before attributed the symptoms of diphtheria to 

 a poison — a toxine as it is called — developed by the 

 specific bacilli. If these are grown on suitable material, 

 such as gelatine, broths, or in milk, and some be in- 

 jected into an animal — for instance, a guinea pig, or horse 

 — the animal, presuming the dose to be sufficiently large, 

 will contract diphtheria. It has also been noted that the 

 virulence of the bacilli can be modified by growing them 

 at different temperatures, and by using cultivations of 

 different ages; and these "attenuated cultures" can be 

 introduced into animals without giving them diphtheria. 

 Further, it has been shown that if the virulence of these 

 cultures be gradually increased, the animals into which 

 they are injected may be rendered insusceptible. From 

 this it was argued— and the argument was suggested by a 

 knowledge of the bacteriology and pathology of other 



B. — From a colony of 

 the bacillus diphtherise 

 (human) grown on gela- 

 tine. 



kindred infective diseases — that in these artificially 

 immune animals a body was developed which neutraUzed 

 the action of the toxine. 



Eeoent observers have shown that these immunity- 

 giving bodies — the antitoxin — are contained in the blood ; 

 and that the serum derived from the blood of these 

 immune animals also contains this body. The result of this 

 research has lately been utilized in a twofold direction. If 

 a small quantity, say ten or twenty cubic centimetres, of 

 the antitoxin serum be injected into animals susceptible 

 to diphtheria, and they then be inoculated with the bacillus 

 diphtherile, they will not (provided that the dose of the 

 bacillus be not too large) contract the disease, being 

 protected by the antitoxin. Certain limits of the toxine 

 dose have to be observed, as the protective influence of 

 the antitoxin appears to weaken somewhat in cases of 

 profound toxine poisoning, and this may explain some of 

 the apparent failures of the treat- 

 ment in actual practice. Never- 

 theless, the serum has been 

 successfully used as a preventitive 

 inoculation ia persons who are 

 exposed to infection, and clinical 

 evidence shows that such injec- 

 tions confer a real though tem- 

 porary immunity. It has also 

 been found that if the antitoxia 

 be injected in suitable doses into 

 a patient suffering from diphtheria, 

 the disease is practically cut short, 

 the expulsion of the membrane 

 rendered easy, and the dread 

 symptoms of collapse and paralysis 



prevented or ameliorated. The fever also may be 

 markedly reduced. The injection appears to be harmless, 

 even to persons not suffering from the disease. 



Enough evidence has not yet accumulated to prove that 

 the remedy will stand the test of time, but sufficient light 

 has already been shed on the subject to show that in the 

 antitoxin we possess a most hopeful remedy. Popular 

 prejudice is hard to overcome, but it may be hoped that 

 the remedy will be given a fair trial, and though extended 

 experience may suggest modifications iu the technique of 

 the treatment, it seems not too much to hope that experi- 

 mental science has at length gained an important point in 

 its struggle against this fell disease. 



A systematic investigation of the throats of those exposed 

 to infection is very helpful, and in America has been 

 attempted on a large scale. In New York, physicians 

 having doubtful cases can obtain the assistance, gratis, of 

 public experts, who examine bacteriologically material 

 from the throat, and who report definitely within thirty-six 

 hours on the case. It is greatly to be wished that some 

 such State aid could be given to the medical profession in 

 England. 



The Goldsmiths' Company, with enlightened generosity, 

 have given £1000 to the laboratories of the Koyal Colleges 

 of Physicians and Surgeons in London, in order to promote 

 further investigation into the nature and action of the 

 remedy, which has been successfully used in the diphtheria 

 wards of the Metropolitan Asylums Board hospitals, and 

 which is now being prepared at no less than five scientific 

 institutions in London. 



Much good may be and is being daily done by rigid and 

 careful isolation of infected patients, by attending to the 

 hygiene of places where many, particularly the young, 

 congregate ; by seeking to give to the poor and rich alike the 

 blessings of light and pure air and water; but the richest 

 i reward will surely await those who by laborious research. 



