410 DIPHTHERIA 



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 toxins. Other 

 bacteria are, however, concerned in producing various secondary 

 inflammatory complications in the region of the throat, such as 

 ulceration, gangrenous change, and suppuration, which may be 

 accompanied by symptoms of general septic poisoning. The 

 detection of the bacillus of Loffler in the false membrane or 

 secretions of the mouth is to be regarded as supplying the only 

 certain means of diagnosis of diphtheria. 



Bacillus Diphtherise. Microscopical Characters. If a film 

 preparation be made from a piece of diphtheria membrane (in 

 the manner described below) and stained with methylene-blue, 

 the bacilli are found to have the following characters : They are 

 slender rods, straight or slightly curved, and usually about 3 //, 

 in length, their thickness being a little greater than that of 

 the tubercle bacillus. The size, however, varies somewhat in 

 different cases, and for this reason varieties have been dis- 

 tinguished as small and large, and even of intermediate size. 

 It is sufficient to mention here that in some cases most are 

 about 3 /A in length, whilst in others they may measure fully 

 5 p. Corresponding differences in size are found in cultures. 

 They stain deeply with the blue, sometimes being uniformly 

 coloured, but often showing, in their substance, little granules 

 more darkly stained, so that a dotted or beaded appearance is 

 presented. Sometimes the ends are swollen and more darkly 

 stained than the rest ; often, however, they are rather tapered 

 off (Fig. 115). In some cases the terminal swelling is very 

 marked, so as to amount to clubbing, and with some specimens 

 of methylene-blue these swellings and granules stain of a violet 

 tint. Distinct clubbing, however, is less frequent than in 

 cultures. There is a want of uniformity in the appearance of 

 the bacilli when compared side by side. They usually lie 

 irregularly scattered or in clusters, the individual bacilli being 

 disposed in all directions. Some may be contained within 

 leucocytes. They do not form chains, but occasionally forms 



