THE INFECTIOUS DISEASES. 259 



guish them oil mophological examination alone. But the greater variety 

 in the developmental stages of the tuberculous foci which may be found in 

 a single individual ; the grouping of the lesions in a manner indicative of 

 local infectious, and in the last resort the demonstrtatiou of the presence 

 of the tubercle bacillus, will usually suffice to distinguish the tuberculous 

 from the syphilitic lesion, even without recourse to the clinical history. ' 

 For further details regarding syphilitic lesions of the viscera see Part 

 III. 



Rhinoscleroma. 



This disease, which occurs especially in eastern Europe and occasionally in other 

 parts of the world, is a chronic inflammation of the nasal, pharyngeal, and laryngeal 

 mucous membrane. In this inflammation a diffuse or nodular formation of new tissue, 

 somewhat resembling granulation tissue, occurs, which tends to assume a dense cicatri- 

 cial character. 



Constantly associated, it is said, with this lesion is a bacillus called Bacillus rhino 

 scleromatis. This bacillus in most of its morphological and biological characters closely 

 resembles the pneumobacillus of Friedlander, growing readily on the common culture 

 media and developing a capsule, and it may be identical with it. 



The relationship of this bacillus to the lesions of rhinoscleroma does not appear to 

 be as yet definitely established, since inoculations in men and animals have not given 

 positive results. 



DIPHTHERIA. 



Diphtheria is an acute infectious disease incited by the Bacillus diph- 

 theria (Loffler), and usually characterized by a pseudo-membranous iii- 

 riammatiou on some of the mucous membranes or occasionally on the 

 surface of wounds, and by immediate or remote effects of absorbed toxic 

 substances. The mucous membranes which are the most frequently 

 affected in diphtheria are those of the tonsils, 



pharynx, soft palate, uares, larynx and tra- JS^i^^^SS."^^^ 

 chea: less frequently those of the mouth, &&& iffSSSSH 



, , r : r t: i " 3 MEMBRANE UNDERGOING COAGCLA- 



there may be a simple catarrhal innamma- T10S NECROSIS . 



tion. On the other hand, m the more 



marked forms of the TesToii there may be a jibrinous exudate which 

 infiltrates the mucous membrane, or, intermingled with pus cells, epi- 

 tEefiaL celfs, red blood ceLUg^Jftacferia, and granular material^ forms a 



1 For critical summary of syphilis with recent bibliography see Lang and UUiniinn 

 in Lubarsch and Ostertag's "Ergebnisse," Jabrg. v. for 1898, p. 481. 



For a study of blood-vessel changes in syphilis with bibliography see A?>r<iinmr. 

 Ziegler's Beitrage, Bd. xxvi., p. 202. 



