DIPHTHERIA. 309 



development can be removed, and unfavourable conditions 

 substituted ; whilst, as regards treatment, it is evident that, 

 because of the energetic toxic action of the material formed 

 by the organisms, diphtheria should be attacked as early as 

 possible. If sufficient time be allowed to the bacilliis to 

 form a large dose of the poison, it is useless to remove the 

 false membranes, as, though the bacilli may be then destroyed, 

 sufficient poison may have passed into the system to cause 

 the death of the patient, " for in diphtheria, contrary to what 

 occurs in most other infective maladies, the infection is not 

 produced by the invasion of the tissues by a microbe, but 

 by the difiusion through the organism of a toxic substance 

 prepared on the surface of a mucous membrane altogether 

 outside the body, so to speak." 



The bearing of recent researches on the prevention of 

 the spread of an outbreak of diphtheria can only be fully 

 understood when some of the facts that they brought to 

 light are enumerated. It was found, for instance, that the 

 presence of the diphtheria bacillus in the mouth is not 

 necessarily followed at once by the appearance of the diph- 

 theritic membrane, and it appears that these bacilli can exert 

 little or no injurious eflfect where the mucous lining of the 

 throat, larynx, &c., remains sound and unaffected by minor 

 diseases. When once, however, we have such conditions as 

 inflamed tonsils or inflammation and ulceration of the mucous 

 membrane, the diphtheria bacilli find a soil ready prepared 

 for their reception, and t5rpical diphtheritic symptoms are the 

 result. That such ulcerated sore throats, inflammation of the 

 tonsils, and similar conditions usually precede outbreaks of 

 diphtheria, has for long been a well recognized clinical fact ; 

 these experiments give the explanation of it, whilst they also 

 afford indications as to the mode of treatment. Antiseptic 

 throat washes, not merely gargles, plenty of fresh air, and good 

 nourishing food, are what are required. Kill the germs as 

 far as possible by means of the antiseptics, and strengthen 

 the tissue cells by plenty of oxygen, and by promoting the 

 excretion of effete products, by food and exercise, so that the 

 cells shall be able to form their protective products and shall 

 also be able to play their part as phagocytes when called 

 upon to do so. Another important point to be borne in 

 mind is that the disappearance of the bacilli from the mouth 

 is not simultaneous with the removal of the false membrane, 



