u6 AIDS TO BACTERIOLOGY 



(membranous rhinitis) are common. The middle ear and 

 the mucous surfaces of the genitals may also be sites of 

 infection. Traumatic diphtheria may arise through 

 contact of an abraded surface with the organism. Con- 

 junctival infections have been caused by patients coughing 

 or sneezing in the eyes of attendants. In the skin an 

 eruption indistinguishable from eczema is produced. 

 The tonsil plays an important part in the defence of the 

 body and in pre-antitoxin days the mildness and low 

 mortality rate of tonsillar, as compared with other 

 diphtherias, was attributed to this defence. 



Occasionally the organism may produce a septicaemia, 

 but generally only the toxins circulate, the organism 

 remaining more or less localised at the seat of infection 

 (toxaemia). 



In a typical case a white wash-leather-like membranous 

 coating, consisting of a fibrinous exudation, is present, 

 and on detachment leaves a bleeding patch. Absorption 

 of the toxin produces lesions in the heart, nerves, and 

 kidneys, and paralytic sequelae may follow recovery 

 from an attack. Hewlett says that paralytic sequelae are 

 not found when infection of a non-diphtheritic nature is 

 concerned. 



Kanthack and Stephens found that in fatal casein 

 diphtheria bacilli can, almost without exception, be de- 

 tected in the lungs, generally in the cervical and bronchial 

 glands and spleen, and sometimes in the kidney. 



The term ' haemorrhagic diphtheria ' is applied to those 

 cases in which, in addition to other signs of malignancy, 

 haemorrhages appear in the skin at an early stage of the 

 disease, with or without haemorrhages from the mucous 

 membranes (Rolleston, Medical Press, 1909, 390). The 

 mortality is over 80 per cent., reaction to antitoxin 

 is delayed, and all the cases which recover suffer from 

 extensive paralysis. 



A person may have the bacillus in the throat without 

 contracting the disease. It may be found in 20 per cent, 

 or more of contacts. Once lodged deep in the lacunae 

 of the tonsil, the bacillus remains there and the patient 

 becomes a ' carrier.' Pybus records a case that had 

 three attacks of diphtheria in as many years and none 

 after removal of the tonsils. A. G. Macdonald says that 

 the length of carrier-life of the bacillus appears to have no 



