198 APPLIED BACTERIOLOGY 



coating is found covering the fauces, tonsils and uvula, 

 from which it may be spread into the larynx and trachea. 

 Traumatic diphtheria may arise through the organism 

 coming into contact with an abraded surface. 



In diphtheria we have to deal chiefly with a poison 

 elaborated by the growth of the bacillus ; and therefore, 

 whether antitoxin or any other form of treatment is to be 

 applied, it is of pressing importance to circumscribe its 

 growth by antiseptic treatment as far as possible. 



An attack of diphtheria affords little or no protection 

 against a second, and, as in many other diseases, the 

 mortality is greatest at the beginning of an epidemic. 



Kanthack and Stephens (' Transactions Pathological 

 Society,' London, 1896, p. 361), contrary to the generally 

 stated view, find that in cases of fatal diphtheria, almost 

 without exception, diphtheria bacilli are to be found in the 

 lungs, and generally in the cervical and bronchial glands 

 and spleen, and in two out of three cases examined in the 

 kidney. They think these observations are of importance 

 since they prove the necessity of using the antitoxin 

 energetically in all serious cases of diphtheria, the amount 

 of toxin to be counteracted being always enormous when 

 the bacilli have gained access to the lungs or other 

 organs. The existence or suspicion of broncho-pneumonia 

 should always excite us to action, and the antitoxin should 

 not be spared when this complication arises. In laryngeal 

 cases prompt and copious injections should be administered 

 to circumvent the dangers of a diphtheritic broncho- 

 pneumonia. 



There is a considerable body of evidence to show that 

 the intensity of the infection may be aggravated by the 

 presence of other organisms, as the streptococcus, less often 

 the pneumococcus, and still more rarely the staphylococcus. 

 De Blasi and Russo-Travalli have found considerable increase 



