BACILLUS DIPHTHERIA. 357 



outstanding features which ought to be 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 poison- 

 ing, 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 some- 

 times of paraplegic type), a'U these being grouped together 

 under the term "post-diphtheritic paralyses." It may be stated 

 here that all these conditions have been experimentally repro- 

 duced by the action of the bacillus of diphtheria, or by its 

 toxins. Other bacteria are, however, concerned in producing 

 various secondary inflammatory complications in the region 

 of the throat, such as ulceration, gangrenous change, and sup- 

 puration, which may be accompanied by symptoms of general 

 septic poisoning. 



The detection of the bacillus of Lofifler in the false mem- 

 brane or secretions of the mouth is to be regarded as supplying 

 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 Diphtherias. — Microscopical Characters. — If a film 

 preparation be made from a piece of diphtheria membrane (in 

 the manner described below) and stained with methylene-blue, 

 the bacilli are found to have the following characters. They 

 are slender rods, straight or slightly curved, and usually about 

 3 /u, in length, their thickness being a little greater than that of 

 the tubercle bacillus. The size, however, varies somewhat in 

 different cases, and for this reason varieties have been distin- 

 guished as small and large, and even of intermediate size. It is 

 suiBcient to mention here that in some cases most are about 3 /x 

 in length, whilst in others they may measure fully 5 /.t. Corre- 

 sponding differences in size are found in cultures. They stain 

 deeply with the blue, sometimes being uniformly coloured, but 

 often showing, in their substance, little granules more darkly 

 stained, so that a dotted or beaded appearance is presented. 

 Sometimes the ends are swollen and more darkly stained than 



