ESSAYS ON BACTERIOLOGY. 77 



great practical value in diagnosis. Eurther, it has 

 been shown that, while the diphtheria bacilli are not 

 nsually disseminated through the body, they may, be 

 carried about and set up secondary infection, giving 

 rise to acute ulcerative endocarditis and other lesions. 

 Finally, we are apparently nearing a solution of the 

 vexed question of the relationship between diphtheria 

 and membranous croup. The writer has reported some 

 investigations in this line. Of late several boards of 

 health, which are conducted upon scientific rather 

 than political lines, have been giving close study to 

 the problem, and with somewhat startling results. 

 The pathologists of the !N"ew York board have exam- 

 ined several hundred reported cases of membranous 

 croup, finding the diphtheria germs present in about 

 80 per cent. Corresponding results have been 

 reached in other cities. The l^Tew York board has 

 therefore recommended that membranous croup, so 

 called, should be included among the diseases to be 

 reported by the physician for the purpose of institut- 

 ing protective measures. Whether all cases of mem- 

 branous croup are simply laryngeal diphtheria re- 

 mains to be settled by further and more exhaustive 

 studies. In the meantime it may fairly be asked 

 whether the report of about a hundred deaths from 

 membranous croup in this city during the. last three 

 years does not come near to being an example of gross 

 professional carelessness. 



Something more might be said in regard to some of 



