17,1 Gomez et al.: Diphtheria in the Philippines 43 
symptoms. In view of these findings we consider eighteen of 
the cultures virulent, one weakly virulent, and one avirulent. 
PATHOLOGY 
There were, altogether, twenty-seven autopsies made at the 
College of Medicine and Surgery, University of the Philippines, 
since 1908 up to the time of the writing of this paper. In 
eighteen of these positive bacteriological diagnoses were made. 
The cases autopsied were usually fairly well-nourished chil- 
dren, in which, on opening the throat organs, a definite dirty 
white-gray pseudomembrane was shown which left an abraded 
mucosa when torn off. This membrane was firmly adherent at 
times, and easily detached or practically loose at others, causing 
a more or less mechanical stenosis of the respiratory passages. 
There was also found congestion of the lungs, or definite 
bronchopneumonia, which was at times hemorrhagic. The 
kidney and liver exhibited more or less parenchymatous degen- 
eration, and the spleen, lymphoid hyperplasia. The heart also 
showed parenchymatous degeneration and more or less dila- 
tation of the right side. There was only one autopsy in which 
there was a distinct record of a fatty heart on gross examina- 
tion. There were thirteen cases, or 48 per cent, which showed 
bronchopneumonia. There is no record of histological examina- 
tions in any of these autopsies. 
The location of the membrane is interesting because of its 
striking frequency in the larynx as compared with figures from 
other countries, such as those given by Osler(5) in Table 5, 
where percentages are given in relation to the total number of 
cases showing membrane, which gives a lower relative percent- 
age for the Philippine autopsies than would be the case were 
the figures compiled from the total number of cases. 
TABLE 5.—Location of diphtheritic membrane. 
Location. Osler’s cases.* | Philippine cases. 
Per cent. Per cent. 
TONGS. oieck cuebiwbed co seebunbwus a demeodelvod sod beceaen 65 61.1 15 57.6 
Pharynx Rie abide Mitel aS 2G te SECC ELE ae bate 51 40.1 12 46.1 
RE og rcs tng oe wow eeneatads wdda ke Glens 75 58.8 2; 682.3 
TEM OTEE oe ia j caaeon nee pewin accsueuences dak eee 60 47.2 6 23.0 
EYMOHOR b55 55205 oe i een 66 51.9 9 84.6 
SFOS os 0 erin cmiden seat noe tea mse 42 33.0 8 11.5 
SS NIM oe Sipe sans mew nee eae cave eiean 5 8.9 | 1| 8.7 
RPM ee es See eee eee 1 0.7 1 8.7 
* Osler’s figures are compiled from 220 autopsies showing membrane present in 127, or 
55.4 per cent; whereas the figures for the Philippines are taken from 27 autopsies showing 
membrane present in 26, or 96.3 per cent. 
