Pathogenesis 4.63 



in the culture-tube. This vegetation continues for a few 

 days, then gradually gives way to another flora of cocci and 

 bacilli, and finally the normal condition is reestablished." 



Diphtheria bacilli were first found in the heart's blood, 

 liver, spleen, and kidney, by Frosch.* Kolisko and Pal- 

 tauff had already found them in the spleen, and other 

 observers in various lesions of the deeper tissues and occa- 

 sionally in the organs. In the blood and organs it is com- 

 monly associated with Streptococcus pyogenes and some- 

 times with other bacteria. While present in nearly all of 

 the inflammatory sequelae of diphtheria, the Klebs-Loffler 

 bacillus probably has very little influence in producing them, 

 the conditions being almost invariably associated with the 

 pyogenic cocci, either the streptococci or staphylococci. 



Howard} studied a case of ulcerative endocarditis caused 

 by the diphtheria bacillus, and Pearce 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 High- 

 more, i case of inflammation 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 asso- 

 ciated with diphtheria. 



In animals artificially inoculated with the diphtheria 

 bacillus the resulting lesions resemble those seen in the 

 human subject, in that they consist of a local infection 

 with a general toxemia. 



Human beings, horses, rabbits, guinea-pigs, mice, kittens, 

 and young pups are susceptible ; rats are immune. When half 

 a cubic centimeter of a twenty-four-hour-old bouillon culture 

 is injected beneath the skin of a susceptible animal, the bacilli 

 multiply at the point of inoculation, producing a fibrinous in- 

 flammation with edema. The animal dies about the third 

 day. When examined post-mortem the liver is found en- 

 larged and sometimes shows minute whitish points, which 

 upon microscopic examination prove to be necrotic areas in 

 which the cells are completely degenerated, and the chrom- 

 atin of their nuclei scattered about in granular form. Similar 



* "Zeitschrift fur Hygiene," etc., 1893, XIII Heft i. 



t "Wiener klin. Wochenschrift," 1889. 



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



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



