354 DIPHTHERIA. 



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 he 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. 

 Other bacteria are, however, concerned in producing various 

 secondary inflammatory complications in the region of the 

 throat, such as ulceration, gangrenous change, and suppura- 

 tion, 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 

 the only certain means of diagnosis of diphtheria. With 

 the exception of the tubercle bacillus, there is probably no 

 organism which has been the subject of so much routine 

 examination, and the opinion of all who are competent to 

 judge may be said to be unanimous on this subject. 



Bacillus Diphtheria Microscopical Characters. If a 

 film preparation be made from a piece of diphtheria mem- 

 brane (in the manner described below) and stained with 



