BACILLUS DIPHTHERIA 569 



takes we have made, it has become our rule whenever we see a case of 

 Vincent's angina to take cultures on Loeffer's medium as for diphtheria 

 diagnosis, since we have on two or three occasions found almost pure 

 cultures of diphtheria bacilli taken from the depths of such anginal 

 ulcers. The systemic symptoms in diphtheria are not always severe 

 since, as we shall see, adults are apt to be particlly protected by the 

 presence of diphtheria antitoxin in their blood and in consequence their 

 disease may be both locally and systemically so mild that diphtheria 

 might not be seriously considered on purely clinical evidence. 



The mechanical injury may actually lead to death. This is par- 

 ticularly due in the care of children in whom extension downward with 

 membrane formation in the larynx may lead to laryngeal obstruction, 

 necessitating tracheotomy or intertubation. While layrngeal obstruc- 

 tion was often the cause of death in children in former years, it has 

 fortunately been rendered much less frequent by antitoxin treatment, 

 by the greater vigilance of doctors and their ability to make an early 

 diagnosis. The responsibility of the physician in this regard is a grave 

 one, since early diagnosis and consequent antitoxin treatment is the 

 only way to prevent such accidents. 



The general symptoms of diphtheria are due to the action of the 

 toxin absorbed from the lesion. These consist in increased temperature, 

 rapid pulse, headache, muscular pains, etc. In severe infections there 

 may be erythematous eruptions. Death in diphtheria may occur as a 

 consequence of secondary bronco-pneumonia, but in uncomplicated 

 cases is usually attributed to circulatory failure. According to experi- 

 ments done by MacCullum 14 in the perfusion of the heart with diph- 

 theria toxin, the toxin does not seem to act directly upon the heart, in 

 spite of the fact that there seems to be definite evidence that the heart is 

 involved in diphtheria. According to the same investigator, there dose 

 not seem to be sufficient gross or microscopic changes in the hearts of 

 people dead of diphtheria to explain death. It is MacCallum opinion's 

 that Passler and Romberg were probably right in stating that the effect 

 of the poison is " chiefly upon the vasomotor control of the blood ves- 

 sels." Injuries to other organs are apparent in albuminuria due to 

 acute interstitial nephritis, and cloudy swelling of parenchyma cells in 

 other organs. In view of the marked changes in the suprarenal bodies 

 in guinea pigs treated with diphtheria toxin, these organs have been 

 especially investigated in diphtheria, and though usually little or no 



14 MacCallum, Textbook of Pathology. 



