568 PATHOGENIC MICROORGANISMS 



bacilli produce. Although the diphtheria bacillus has been found after 

 death in the spleen and liver, we have no data which would justify the 

 assumption that a true diphtheria-septicemia may occur during life. 

 It is probable that in those cases which Baginsky 12 has called the sep- 

 ticemic form of diphtheria, bacillus diphtheria has merely opened a 

 path by which accompanying streptococci have gained access to the 

 lymphatics and the blood stream. The most frequent sites of diph- 

 theritic inflammations are the mucous membranes of the throat, larynx, 

 and nose. They have also been found in the ear, upon the mucous 

 membrane of the stomach and the vulva, and upon the conjunctiva and 

 the skin. According to Loeffler, Strelitz, 13 and others, the bacillus may, 

 by extension from the larynx, give rise to a true diphtheritic broncho- 

 pneumonia. 



Thus, the localized injury due to the very violent inflammatory 

 reaction elicited by the diptheria bacilli at their point of lodgment which, 

 in the large majority of cases, is in the upper respiratory tract, especially 

 pharynx and tonsils, are the immediately noticeable and visible changes 

 in the disease of human beings. In attempting to make a diagnosis of 

 these by inspection, the clinician should remember that the pseudo- 

 membranous inflammation characterized by its adherence to the 

 submucosa and the bleeding points it leaves on being scrapped, is not 

 pathognomonic of the diphtheria bacilli, but means simply a very 

 violent inflammatory reaction and that, while this condition is most 

 commonly caused by the diphtheria bacillis, a great many other severe 

 injuries or inflammations may give rise to very similar appearances. 

 Thus, a very severe streptococcus infection of the throat may simulate a 

 diphtheritic membrane and escharotics or other chemical or mechanical 

 injuries may give rise to simpler lesions. Another point of considerable 

 clinical importance is the fact that diphtheritic inflammation of the 

 throat may often be associated with other concomitant infectious 

 processes. Streptococcus infections superimposed upon a local diph- 

 theria infection, somewhat changes the appearance, both of the local 

 lesion and of the general clinical picture and is apt to lead to a very much 

 greater severity of the illness. Another common experience is to find, 

 at the site of the inflammation, an ulcerative process, smears from which 

 on staining with Gram's gential violet or carbolfuchsin will show a 

 typical picture of Vincent/s angina with the fusiform bacilli and the 

 spirilla characteristic of this infection. Owing to a number of mis- 



12 Baginsky, "Lehrbueb. d. Kinderkrankheiteri." 

 "Strelits, Arch. f. Kimlerheilk., 1891 



