82 MICROBES AND HEALTH. 



treated cases, being in doctors' families, were not neg- 

 lected and that the treatment was begun early in the 

 disease. 



"There is no convincing evidence that antitoxin 

 exerts any influence on the false membrane in causing 

 its early detachment or disappearance, or in prevent- 

 ing it from spreading. Even if it did, it would not 

 signify much, for the membrane is simply the effect 

 of something, it is not the disease. Patients often die 

 after the membrane has disappeared. The diphtheritic 

 lesion is identical anatomically with croupous inflam- 

 mation due to traumatic and other causes. Back of 

 the formation of the false membrane is that deranged 

 condition of the system permitting the growth of per- 

 nicious bacteria, which abnormal state is really the 

 disease. We do not 'know but what the formation of 

 the false membrane is nature's method of protecting 

 the patient, and until it shuts off the air from the 

 lungs the membrane may serve some useful purpose. 

 Eupp couldn't see any effect on the membrane in his 

 twenty-four antitoxin-healed cases, in'such a way as to 

 be beyond doubt. 



"It is a common thing, in cases not treated with 

 antitoxin, for the membrane to begin to fall off after 

 the first day, to disappear completely in three of four 

 days. Eupp needed to visit two cases which were not 

 treated with antitoxin only four days, and one, a 

 croupal case, only three days. The diagnosis in each 

 case was confirmed by bacteriological examination. 

 Bretonneau in his classical work on diphtheria dis- 



