486 Diphtheria 



with difficulty, leaving an abraded surface. When the mem- 

 brane is divulsed during the course of the disease, it imme- 

 diately forms anew by the coagulation of the inflammatory 

 exudate. 



The coagulation-necrosis seems to depend upon the local 

 effect of the toxin. Morax and Elmassian * found that 

 when strong diphtheria toxin is applied to the conjunctiva 

 of rabbits every three minutes for eight or ten hours, 

 typical diphtheritic changes are produced. 



Flexnerf has made a study of the minute lesions caused 

 by bacterial toxins and especially of the diphtheria toxin, 

 and Councilman, Mallory, and Pearce,J of both gross and 

 minute lesions that the thorough student should read. 



Specificity. Herman Biggs, in an interesting discus- 

 sion of the occurrence of the diphtheria bacillus and its 

 relation to diphtheria, comes to the following conclusions: 



1. "When the diphtheria bacillus is found in healthy 

 throats, investigation almost always shows that the indi- 

 viduals have been in contact with cases of diphtheria* 

 The presence of the bacillus in the throat, without any 

 lesion, does not, of course, indicate the existence of the 

 disease." 



2. "The simple anginas in which virulent diphtheria 

 bacilli are found are to be regarded from a sanitary stand-" 

 point in exactly the same way as the cases of true diph- 

 theria." 



3. "Cases of diphtheria present the ordinary clinical 

 features of diphtheria, and show the Klebs-Loffler bacilli." 



4. "Cases of angina associated with the production of 

 membrane in which no diphtheria bacilli are found might 

 be regarded from a clinical standpoint as diphtheria, but 

 bacteriological examination shows that some other organ- 

 ism than the Klebs-Loffler bacillus is the cause of the pro- 

 cess." 



Any skepticism of the specificity of the diphtheria bacillus 

 on my own part was dispelled by a somewhat unique ex- 

 perience. Without having been previously exposed to 

 diphtheria while experimenting in the laboratory I acciden- 



* "Ann. de 1'Inst. Pasteur," 1898, p. 210. 

 f" Johns Hopkins Hospital Reports," vi, 259. 

 J " Diphtheria : A Study of the Bacteriology and Pathology of 

 Two Hundred and Twenty Fatal Cases," 1901. 



"Amer. Jour. Med. Sci.," Oct., 1896, vol. xxn, No. 4, p. 411. 



