39 8 PATHOGENIC BACTERIA. 



is always favorable to the development of the bacillus, 

 is destroyed by the production of an acid. When the 

 culture is old the acid is replaced by a strong alkaline 

 reaction. 



Palmirski and Orlowski ' assert that the bacillus pro- 

 duces indol, but only after the third week. Smith, how- 

 ever, came to a contrary result, and found that when 

 diphtheria bacillus grew in the dextrose-free bouillon 

 that he recommends no indol was produced. 2 



The entrance of the diphtheria bacillus into ths 

 internal organs can scarcely be regarded as a common 

 occurrence, though in the severe cases it is by no means 

 rare, as will be shown by the synopsis of Pearce's work 

 given below. It must be remembered, however, that his 

 cases were all fatal, and that the conditions found may 

 not parallel the usual course of affairs. 



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

 liver, spleen, and kidney, by Frosch. 3 Kolisko and 

 Paltany 4 had already found it in the spleen, and other 

 observers in various lesions of the deeper tissues and 

 occasionally in the organs. In the blood and organs it 

 is very commonly associated with the Streptococcus 

 pyogenes and sometimes with other bacteria. While 

 present in nearly all of the inflammatory sequelae of 

 diphtheria, the Klebs-Loffler bacillus may have very 

 little influence in producing them, as in such conditions 

 it is almost invariably associated with the pyogenic cocci, 

 either the streptococci or staphylococci. 



Howard 5 has observed a case of ulcerative endocarditis 

 depending upon the diphtheria bacillus, and Pearce 6 has 

 observed it in i case of malignant endocarditis, in 19 

 out of 24 cases of broncho-pneumonia, in 1 case of 

 empyema, in 16 cases of middle-ear disease, eight times 



1 Central/)!, f. Bakt. u. Parasitenk., Mar., 1895. 

 ''■Jour, of Exp. Med., Sept., 1807, vol. ii., No. 5, p. 546. 

 8 Zeilschrift fiir Hygiene, etc., 1893. x iii> Heft I. 



4 Wiener klin. Wochenschrift, 1889. 



5 American Journal of Medical Sciences, Dec, 1894. 



6 Journal of the Boston Society of Medical Sciences, Mar., 1898. 



