DIPHTHERIA, or DIPIITHERMS (ante). This is really a very old disease with a modern name, unfortunate because misleading, and the cause of much inefficient treat ment. By many the disease has been regarded as a local more than a general affection, but within the last twenty years thorough study has revealed its nature and causes so that few things are more certain than that it has for many centuries been one of the dangerous diseases of the human race. That its characteristics were always precisely what they now are is not probable, because the sanitary condition of the world centu ries ago, when devastating plagues swept the face of the earth, would be likely, especially when large numbers of human beings were collected together, to give this disease a more general inflammatory and malignant character. The causes which are now known to produce the disease have always been present wherever the human family has con gregated in numbers, and wherever even a few have lived together without regard to cleanliness. It is thought that descriptions of the disease can be traced to a time anterior to Hippocrates (460 n.c.), and there is no doubt of its identity with that described by Aretmus of Cappadocia (100 A.D.), who called it tilcus Syriacum and also Malum Eg,ypticum. Several other ancient authorities describe it, but during the dark ages little is recorded that is trustworthy. One of the•earliest treatises upon it in mo4 ern times was by Hecker, who gives an account of an epidemic which prevailed in Holland in 1337. Besides the names given it by Aretmus, it has been called cynanche maligna, eynaneke gangrenosa (cynanche means, literally, " dog-choke"), putrid fever, malignant inflammation of the pharynx, and putrid sore throat. The last name was the one adopted by the celebrated Dr. John Fothergill in his description of the epidemic which appeared in Lontion in 1745. Some have contended that the disease which he described was malignant scarlet fever, but so accurate an observer and great physician as Dr. Fothergill, draAring the distinctions, as he does, between the diseases, could not have been mistaken. His treatise, published in his works, is in many respects unex• celled. Of course some of the remedies now found most efficient were either not then known, or not obtainable in their best form, but his general treatment was more rational than much of more modern date; indeed it was not greatly different from that which an experienced physician of the present day would employ if limited to the remedies which were then available. The disease is well described by Dr. Samuel Bard of New York, in the first volume of the Transactions of the American philosoph ical society, in the review of an epidemic which appeared in 1771. The disease did not again attract the special attention of writers until 1818, when Bretonnean published his opinions and gave it the name under which it is now generally known, claiming, in his first papers upon the subject that the disease was at first local, and that the constitu tional affection resulted from infection propagated by the local disease. The origin of diphtheria was ascribed by Vogel to the development of a microscopic organism, the oidium albicans, but this is also largely developed in Thrush, and is present in various diseased conditions of the month and throat. The present doctrine is, simply, that the disease is caused by certain disease germS, but what they precisely are has not been determined. This much is certain—D. is a septic disease, never found where no septic origin can be assigned. Feculent matter, passing through stages of putrefication and fermentation, such as obtains in sewers, cesspools, and vaults of privies, and all manner of conduits or receptacles of waste matter, and the effluvia engendered in piles and masses of garbage, or of human or animal excrement, are the now recognized causes of diphthereia. Wherever these causes are constant, there the disease is constantly devel oped and is endemic. The only apparent exception to this is that at certain seasons of the year putrescent and feculent matter is liable to develop other diseases, when D. may
occupy a more or less subordinate place. Again, there may be times when the septic causes are in abeyance; but when they become active, the disease becomes epidemic if the air is sufficiently impregnated with the infectious germs. In regard to the question of contagiousness or infectiousness, the following may be said, premising, however, a few words explanatory of these terms. In many respects contagiousness and infectious ness are synonymous, and some writers use only the former word. But there is this dif ference—such diseases as scarlet fever and small pox are contagious, and they are com municated through the air as well as by contact. There are other diseases which aro contagious only by contact, as the itch. It would be more correct to call itch an infec tions disease. Most other diseases which are communicated in the same manner aro infectious. It appears, therefore, that there is some confusion in the use of the terms, and it is for this reason that some authorities use only the word contagious. But there are two distinct modes, and some diseases are communicated only by one of these modes; and if we desire to express the difference, the employment of the two terms is convenient, but care should be taken to distinguish clearly what idea it is intended to convey. If D. be a communicable disease, but not in the same manner as scarlet fever, we distinguish the difference by calling the former an infectious disease; and that D. has been communicated by contact there is no reasonable doubt. There have been many instances when diphtheritic expectorations have communicated the dis ease by being projected into the mouth or eyes of the attendant. Bretonneau and others maintained this. It is a matter of dispute as to whether exposure to the air breathed by patients having the disease is capable of communicating it, but the great mass of authority is now on the side of the affirmative. What is the explanation of this disagreement? The poison of D. is a species of ferment, and like many other fer ments, it requires a certain quantity to produce a given effect. The contagious virus of small-pox is different; the minutest quantity, when inhaled, or when introduced by vaccination, being sufficient to propagate itself throughout the system, and there seems to be no provision of nature for its elimination until a crisis is reached. The poisonous principles which propagate some other diseases, when taken into the system do not need to ripen before they are again cast out; the excretory action of the animal economy sometimes removes them as fast as they are received. It is because of this conservative power, this action of the is medkatrix naturce, that mankind, as well as the lower animals, have been enabled to exist. We are all the time taking poisons into our bodies, and. it is one of the offices of the various organs to remove them by the various processes of excretion. The poisonous principle of ordinary intermittent fever, if received only in small quantities, is readily disposed of, and the system retained in a healthy condition, but if the malarial poison be absorbed faster than it can be carried away, there results a series of morbid phenomena characteristic of this periodical disease. And so it is, most probably, with diphtheria; if the air of a sick-room be loaded with the effluvia from the breath and perspiration of a person laboring under a violent case of the disease, one who should remain in the room only a few moments, would be likely to receive enough germs of the disease to cause a manifestation of its presence, and if he were to remain a considerable time there would be danger of a serious attack. On the contrary, if the case were a mild one, or if the sick-room were well ventilated and disinfected, and the visitor were in good health. time danger would be slight. It is these varying circumstances which have caused a difference of opinion between differ ent physicians; but the weight of evidence supports the opinion that D. is both conta e and infectious, and in a late work, Drs. Pepper and Meigs of Philadelphia give this as their conclusion.