260 



THE INFECTIOUS DISEASES. 



thick or thin pellicle on the affected surfaces (see Fig. 99, p. 209). This 

 pellicle may undergo coagulation necrosis (Fig. 132), and haud-in-hand 

 with this there may be superficial or deep necrosis of the mucous mem- 

 brane. The jalse membrane in diphtheria is thus formed by aj3ombina- 

 tion of inflammatory products and necrotic tissue, the extent of the 

 necrosis and the amount of inflammatory products varying in different 

 cases. The membrane may disintegrate or exfoliate, with or without 

 loss of tissuejn^the underlying mucous membrane. Phlegmon, abscess, 

 and oedema are liable to occur aslocal complications. 



FIG. 133. DIPHTHERITIC INFLAMMATION OF THE TONSIL. 

 Showing Loffler's bacilli in the pseudo-membrane. 



and distant lymph- nodes are jipt to be swollen, and often 

 show, on microscopical examination, endothelial-cell hyperplasia with 

 small foci of cell necrosis and disintegration. 1 Similar foci of cell 

 hyperplasia with necrosis with small spheroidal -cell accumulation and 

 fatty degeneration may~T)e found in the_lddney, spleen, and liver. Al- 

 buminous degeneration in the kidney- and acute nephritis are not infre- 

 quent! .SmaJLhaBnxorrhagic foci may be present iiitne liver and kidneys. 

 Degeneration of the heart muscle may ogpur." The exact nature of the 

 nerve lesions which may be associated with the late paralyses of diph- 

 theria is not yet clear, but degeneration of the peripheral nerves and 

 chromatolysis of the ganglion cells occur, indicating the action of an 

 absorbed toxic substance in the body fluids. Leucocytosis may be pres- 

 ent. 



1 Consult Waschkewitsch, Virch. Archiv, Bd. clix., p. 137, 1900. 



* For studies of the lesions of the myocardium in diphtheria consult Scagliosi, Vir- 

 chow's Arch., Bd. cxlvi., p. 115, 1896; also TJwmas and Hibbard, Reports of Boston 

 City Hospital, 1900, p. 204, bibl. ; for a study of nerve lesions with bibl. see Batten, 

 Pediatrics, vol. vii., p. 97, 1899; also Rainy, Jour. Path, and Bact., vol. vi., p. 435, 

 1900. For a comprehensive study of the bacteriology and pathology of two hundred 

 and twenty fatal cases of diphtheria see Councilman, Mallory, and Pearce, Jour. Boston 

 Soc. Med. Science, vol. v., p. 139, 1900. 



