42O Diphtheria 



staphylococci. Howard* studied a case of ulcerative endocarditis 

 caused by the diphtheria bacillus, and Pearcef has observed it in 

 i case of malignant endocarditis, 19 out of 24 cases of broncho- 

 pneumonia, i case of empyema, 16 cases of middle-ear disease, 8 

 cases of inflammation of the antrum of Highmore, i case of in- 

 flammation of the sphenoidal sinuses, i case of thrombosis of the 

 lateral sinuses, 2 cases of abscesses of the cervical glands, and in 

 esophagitis, gastritis, vulvo-vaginitis, dermatitis, and conjunctivitis 

 following or associated with diphtheria. 



A case of septic invasion by the diphtheria bacillus is reported 

 by Ucke,{ who gives a synopsis of the literature of similar cases. 



The disease pursues a variable course. In favorable cases the 

 patient recovers gradually, the pseudo-membrane first disappearing, 

 leaving an inflamed mucous membrane, upon which virulent diph- 

 theria bacilli persist for weeks and sometimes for months. Smith* 

 describes the bacteriologic condition of the throat in diphtheria 

 as follows: "The microscope informs us that during the earli- 

 est local manifestations the usual scant miscellaneous bacterial 

 flora of the mucosa is quite suddenly replaced by a rich vege- 

 tation of the easily distinguishable diphtheria bacillus. Frequently 

 no other bacteria are found in the culture-tube. This vegeta- 

 tion continues for a few days, then gradually gives way to 

 another flora of cocci and bacilli, and finally the normal condition 

 is reestablished." 



Associated Bacteria. Streptococcus pyogenes and Staphylococci 

 pyogenes aureus and albus are, in many cases, found in associa- 

 tion with the diphtheria bacillus, especially when severe lesions of 

 the throat exist. 



In a series of 234 cases carefully and statistically studied by 

 Blasi and Russo-Travali,|| it was found that in 26 cases of pseudo- 

 membranous angina due to streptococci, staphylococci, colon bacilli, 

 and pneumococci, 2 patients died, the mortality being 3.84 per 

 cent. In 102 cases of pure diphtheria, 28 died, a mortality of 27.45 

 per cent. Seventy-six cases showed diphtheria bacilli and staph- 

 ylococci; of these, 25, or 32.89 per cent., died. Twenty cases 

 showed the diphtheria bacilli and Streptococcus pyogenes, with 6 

 deaths 30 per cent. In 7 cases, of which 3, or 43 per cent., were 

 fatal, the diphtheria bacillus was in combination with streptococci 

 and pneumococci. The most dangerous forms met were 3 cases, 

 all fatal, in which the diphtheria bacillus was found in combination 

 with Bacillus coli. 



In 157 cases of diphtheria and scarlatina studied at the Boston 



* "Amer. Jour. Med. Sci.," Dec., 1894. 

 t "Jour. Boston Soc. of Med. Sci.," March, 1898. 



I "Centralbl. f. Bakt. u. Parasitenk.," original, XLVI, Heft 4, March 10, 1908, 

 p. 292. 



"Ann. de PInst. Pasteur," 1896, p. 387. 



