500 ARMAND RUFFER. 
albuminuria. Bouchard! has described cases followed by 
pseudo-rheumatism, and Joal? has seen ovaritis and orchitis 
come on after inflammation of the tonsil. 
Whether the micro-organisms of pneumonia or scarlet fever 
penetrate or not through the tonsils is an open question, but 
there can be no doubt that the Bacillus diphtheriz often 
attacks the tonsils primarily. The first diphtheritic patch 
frequently appears on the tonsils, and the researches of MM. 
Roux and Jersin® have proved that diphtheria is a local dis- 
ease starting and localised in the mucous membrane, the 
severe general symptoms being produced by the soluble 
poisons secreted by pathogenic organisms, which are absorbed 
and then circulate in the blood of the diseased animals. 
Occasionally, however, the local diphtheritic process opens 
the way to other microbes. Thus, Léfflert has reported two 
cases of diphtheria in which, after the patients had died, he 
found streptococci in the heart, liver, spleen, and kidneys. In 
one of these the diphtheria was the primary disease, in the 
other it came on during an attack of scarlet fever. 
Heubner and Bardt,> G. Crooke,® Fraenkel and Freude- 
berg,’ have also put similar facts on record. Fraenkel® has 
lately reported two very interesting cases of general infection 
following disease of the tonsils. In the first of these, a retro- 
pharyngeal abscess following disease of the right tonsil sank 
into the pericardium, the patient dying of purulent pericar- 
ditis, a right purulent and a left semi-purulent pleurisy being 
also found at the post-mortem examination. The second case 
was one of diphtheria of the larynx and pharynx, at subse- 
sequent ulcerous endocarditis. 
Now, pathogenic organisms are constantly found in the 
1 Bouchard, loc. cit. 
2 Joal, see Balme, loc. cit. 
3 Roux and Yersin, ‘ Annal. de l'Institut Pasteur,’ 1888. 
4 Loffler, ‘ Mitthei!. a. d. kais. Gesammt.,’ Bd. 1, 1884, p. 451. 
5 Heubner and Bardt, ‘ Berlin. klin. Wochschr., 1884, No. 44. 
6 G. Crooke, ‘ Fortschr. d. Med.,’ 1885, No. 20. 
7 Fraenkel and Freudeberg, see Fraenkel. 
8 Fraenkel, ‘ Zeitschr. f. klin. Med.,’ Bd. xiii, Heft i, p. 14. 
