or from phenanthrene (q.v.), the constitution of which it determines. See [Benzidine] for diparadiaminodiphenyl.
DIPHILUS, of Sinope, poet of the new Attic comedy and contemporary of Menander (342-291 b.c.). Most of his plays were written and acted at Athens, but he led a wandering life, and died at Smyrna. He was on intimate terms with the famous courtesan Gnathaena (Athenaeus xiii. pp. 579, 583). He is said to have written 100 comedies, the titles of fifty of which are preserved. He sometimes acted himself. To judge from the imitations of Plautus. (Casina from the Κληρούμενοι, Asinaria from the Όναγός, Rudens from some other play), he was very skilful in the construction of his plots. Terence also tells us that he introduced into the Adelphi (ii. 1) a scene from the Συναποθνήσκοντες, which had been omitted by Plautus in his adaptation (Commorientes) of the same play. The style of Diphilus was simple and natural, and his language on the whole good Attic; he paid great attention to versification, and was supposed to have invented a peculiar kind of metre. The ancients were undecided whether to class him among the writers of the New or Middle comedy. In his fondness for mythological subjects (Hercules, Theseus) and his introduction on the stage (by a bold anachronism) of the poets Archilochus and Hipponax as rivals of Sappho, he approximates to the spirit of the latter.
Fragments in H. Koch, Comicorum Atticorum fragmenta, ii.; see J. Denis, La Comédie grecque (1886), ii. p. 414; R. W. Bond in Classical Review (Feb. 1910, with trans. of Emporos fragm.).
DIPHTHERIA (from διφθέρα, a skin or membrane), the term applied to an acute infectious disease, which is accompanied by a membranous exudation on a mucous surface, generally on the tonsils and back of the throat or pharynx.
In general the symptoms at the commencement of an attack of diphtheria are comparatively slight, being those commonly accompanying a cold, viz. chilliness and depression. Sometimes more severe phenomena usher in the attack, such as vomiting and diarrhoea. A slight feeling of uneasiness in the throat is experienced along with some stiffness of the back of the neck. When looked at the throat appears reddened and somewhat swollen, particularly in the neighbourhood of the tonsils, the soft palate and upper part of pharynx, while along with this there is tenderness and swelling of the glands at the angles of the jaws. The affection of the throat spreads rapidly, and soon the characteristic exudation appears on the inflamed surface in the form of greyish-white specks or patches, increasing in extent and thickness until a yellowish-looking false membrane is formed. This deposit is firmly adherent to the mucous membrane beneath or incorporated with it, and if removed leaves a raw, bleeding, ulcerated surface, upon which it is reproduced in a short period. The appearance of the exudation has been compared to wet parchment or washed leather, and it is more or less dense in texture. It may cover the whole of the back of the throat, the cavity of the mouth, and the posterior nares, and spread downwards into the air-passages on the one hand and into the alimentary canal on the other, while any wound on the surface of the body is liable to become covered with it. This membrane is apt to be detached spontaneously, and as it loosens it becomes decomposed, giving a most offensive and characteristic odour to the breath. There is pain and difficulty in swallowing, but unless the disease has affected the larynx no affection of the breathing. The voice acquires a snuffling character. When the disease invades the posterior nares an acrid, fetid discharge, and sometimes also copious bleeding, takes place from the nostrils. Along with these local phenomena there is evidence of constitutional disturbance of the most severe character. There may be no great amount of fever, but there is marked depression and loss of strength. The pulse becomes small and frequent, the countenance pale, the swelling of the glands of the neck increases, which, along with the presence of albumen in the urine, testifies to a condition of blood poisoning. Unless favourable symptoms emerge death takes place within three or four days or sooner, either from the rapid extension of the false membrane into the air-passage, giving rise to asphyxia, or from a condition of general collapse, which is sometimes remarkably sudden. In cases of recovery the change for the better is marked by an arrest in the extension of the false membrane, the detachment and expectoration of that already formed, and the healing of the ulcerated mucous membrane beneath. Along with this there is a general improvement in the symptoms, the power of swallowing returns, and the strength gradually increases, while the glandular enlargement of the neck diminishes, and the albumen disappears from the urine. Recovery, however, is generally slow, and it is many weeks before full convalescence is established. Even, however, where diphtheria ends thus favourably, the peculiar sequelae already mentioned are apt to follow, generally within a period of two or three weeks after all the local evidence of the disease has disappeared. These secondary affections may occur after mild as well as after severe attacks, and they are principally in the form of paralysis affecting the soft palate and pharynx, causing difficulty in swallowing with regurgitation of food through the nose, and giving a peculiar nasal character to the voice. There are, however, other forms of paralysis occurring after diphtheria, especially that affecting the muscles of the eye, which produces a loss of the power of accommodation and consequent impairment of vision. There may be, besides, paralysis of both legs, and occasionally also of one side of the body (hemiplegia). These symptoms, however, after continuing for a variable length of time, almost always ultimately disappear.
Under the name of the Malum Egyptiacum, Aretaeus in the 2nd century gives a minute description of a disease which in all its essential characteristics corresponds to diphtheria. In the 16th, 17th and 18th centuries epidemics of diphtheria appear to have frequently prevailed in many parts of Europe, particularly in Holland, Spain, Italy, France, as well as in England, and were described by physicians belonging to those countries under various titles; but it is probable that other diseases of a similar nature were included in their descriptions, and no accurate account of this affection had been published till M. Bretonneau of Tours in 1821 laid his celebrated treatise on the subject before the French Academy of Medicine. By him the term La Diphthérite was first given to the disease.
Great attention has been paid to diphtheria in recent years, with some striking results. Its cause and nature have been definitely ascertained, the conditions which influence its prevalence have been elucidated, and a specific “cure” has been found. In the last respect it occupies a unique position at the present time. In the case of several other zymotic diseases much has been done by way of prevention, little or nothing for treatment; in the case of diphtheria prevention has failed, but treatment has been revolutionized by the introduction of antitoxin, which constitutes the most important contribution to practical medicine as yet made by bacteriology.
The exciting cause of diphtheria is a micro-organism, identified by Klebs and Loffler in 1883 (see [Parasitic Diseases]). It has been shown by experiment that the symptoms of diphtheria, including the after-effects, are produced by Causation. a toxin derived from the micro-organisms which lodge in the air-passages and multiply in a susceptible subject. The natural history of the organism outside the body is not well understood, but there is some reason to believe that it lives in a dormant condition in suitable soils. Recent research does not favour the theory that it is derived from defective drains or “sewer gas,” but these things, like damp and want of sunlight, probably promote its spread, by lowering the health of persons exposed to them, and particularly by causing an unhealthy condition of the throat, rendering it susceptible to the contagion. Defective drainage, or want of drainage, may also act, by polluting the ground, and so providing a favourable soil for the germ, though it is to be noted that “the steady increase in the diphtheria mortality has coincided, in point of time, with steady improvement in regard of such sanitary circumstances as water supply, sewerage, and drainage” (Thorne Thorne). Cats and cows are susceptible to the diphtheritic bacillus, and fowls, turkeys and other birds have been known to suffer from a disease like diphtheria, but other domestic animals appear to be more or less resistant or immune. In human beings the mere presence of the germ is not sufficient to cause disease; there must also be susceptibility, but it is not known in what that consists. Individuals exhibit all degrees of resistance up to complete immunity. Children are far more susceptible than adults, but even children may have the Klebs-Loffler bacillus in their throats without showing any symptoms of illness. Altogether there are many obscure points about this micro-organism, which is apt to assume a puzzling variety of forms. Nevertheless its identification has greatly facilitated the diagnosis of the disease, which was previously a very difficult matter, often determined in an arbitrary fashion on no particular principles.