DIPHTHERIA. 399 



in inflammation of the antrum of Highmore, 1 case of 

 inflammation of the sphenoidal sinuses, 1 case of throm- 

 bosis of the lateral sinuses, in 2 cases of abscesses of the 

 cervical glands, and in oesophagitis, gastritis, vulvo- 

 vaginitis, dermatitis, and conjunctivitis following or 

 associated with diphtheria. 



Diphtheria as it occurs in man is generally a disease 

 characterized by the formation of a pseudomembrane 

 upon the fauces. In unusual cases the diphtheria pseudo- 

 membrane may occur elsewhere than upon the fauces. 

 It is not infrequent as a form of rhinitis; it may occur in 

 the mouth, upon the genital organs, or upon wounds. 

 Williams ' has reported a case of diphtheria of the vulva. 

 Nisot and Bumm have also reported cases of puerperal 

 diphtheria in which the bacilli were cultivated from the 

 membranes. It is a local infection, due to the presence 

 and development of the bacilli in the pseudomembrane, 

 but is accompanied by a general toxemia resulting from 

 the absorption of a violently poisonous substance 

 produced by the bacilli. The bacilli are found only 

 in the membranous exudation, and most plentifully in 

 its older portions. As a rule, they do not distribute 

 themselves through the circulation of the animal, though 

 at times they may be found in the heart's blood and 

 internal organs. 



The disease pursues a course of rather variable length, 

 and in favorable cases the patient recovers gradually, the 

 pseudomembrane first disappearing, leaving an inflamed 

 mucous membrane behind it, upon which the virulent 

 diphtheria bacilli persist, always for several weeks, 

 sometimes for months. Smith 2 describes the bacterio- 

 logical condition as follows: "The microscope informs 

 us that during the earliest local manifestations, the usual 

 scant miscellaneous bacterial flora of the mucosa is quite 

 suddenly replaced by a rich vegetation of the easily-dis- 



1 American Journal of Obstetrics and Diseases of Women and Children, 

 Aug., 1898. 



* Boston Medical and Surgical Journal, 1898, i., p. 157. 



