43 Diphtheria 



vaginitis, dermatitis, and conjunctivitis following or asso- 

 ciated with diphtheria. 



In animals artificially inoculated with the diphtheria 

 bacillus the resulting lesions resemble those seen in the 

 human subject, in that they consist of a local infection 

 with a general toxemia. 



Human beings, horses, rabbits, guinea-pigs, mice, kittens, 

 and young pups are susceptible ; rats are immune. When half 

 a cubic centimeter of a twenty-four-hour-old bouillon culture 

 is injected beneath the skin of a susceptible animal, the bacilli 

 multiply at the point of inoculation, producing a fibrinous in- 

 flammation with edema. The animal dies about the third 

 day. When examined post-mortem the liver is found en- 

 larged and sometimes shows minute whitish points, which 

 upon microscopic examination prove to be necrotic areas in 

 which the cells are completely degenerated, and the chrom- 

 atin of their nuclei scattered about in granular form. Similar 

 necrotic foci, to which attention was first called by Oertel, 

 are present in nearly all the organs in cases of death from 

 diphtheria intoxication. No bacilli are present in these 

 lesions. Welch and Flexner * have shown these foci to 

 be common to numerous intoxications, and not peculiar to 

 diphtheria. 



The lymphatic glands are usually enlarged, and the adre- 

 nals enlarged and hemorrhagic. The kidneys show paren- 

 chymatous degeneration. There is no inflammation of the 

 fauces. 



Roux and Yersin found that when the bacilli were intro- 

 duced into the trachea of animals opened by operation, a 

 typical pseudo-membrane was formed, and that diphtheritic 

 palsy sometimes followed. 



Associated Bacteria. Streptococcus pyogenes and Staphy- 

 lococci pyogenes aureus and albus are, in many cases, 

 found in association with the diphtheria bacillus, especially 

 when severe lesions of the throat exist. 



In a series of 234 cases carefully and statistically studied 

 by Blasi and Russo-Travali,f it was found that in 26 cases 

 of pseudo-membranous angina due to streptococci, staphy- 

 lococci, colon bacilli, and pneumococci, 2 patients died, 

 the mortality being 3.84 per cent. In 102 cases of pure 

 diphtheria, 28 died, a mortality of 27.45 P er cent. Seventy- 



* " Bull, of the Johns Hopkins Hospital," Aug., 1901. 

 f'Ann. de 1'Inst. Pasteur," 1896, p. 387. 



