Pathogenesis 431 



six cases showed diphtheria bacilli and staphylococci; of 

 these, 25, or 32.89 per cent., died. Twenty cases showed 

 the diphtheria bacilli and Streptococcus pyogenes, with 6 

 deaths 30 per cent. In 7 cases, of which 3, or 43 per 

 cent., were fatal, the diphtheria bacillus was in combination 

 with streptococci and pneumococci. The most dangerous 

 forms met were 3 cases, all fatal, in which the diphtheria 

 bacillus was found in combination with Bacillus coli. 



In 157 cases of diphtheria and scarlatina studied at the 

 Boston City Hospital by Pearce,* there were 94 cases of 

 diphtheria, 46 cases of complicated diphtheria (29 with 

 scarlet fever, n with measles, and 5 with measles and 

 scarlet fever), and 17 cases of scarlet fever (in 3 of which 

 measles was also present). 



Of the 94 cases of uncomplicated diphtheria, the Klebs- 

 Loffler bacilli were present in the heart's blood in 4, twice 

 alone and twice with streptococci. In 9 cases the strepto- 

 coccus occurred alone ; in i case the pneumococcus occurred 

 alone. In the liver the bacillus was found in 24 cases, 

 alone in 12 and together with the streptococcus in 12; the 

 streptococcus occurred in 27 cases, alone in 14, with the 

 Klebs-Loffler bacillus in 12, and with Staphylococcus 

 pyogenes aureus in i. Staphylococcus pyogenes aureus 

 occurred in 4 cases, alone in 3 and associated with the 

 streptococcus in i. The pneumococcus occurred alone in 

 i case. 



In the spleen the Klebs-Loffler bacillus occurred eighteen 

 times, fifteen times alone and three times associated with 

 the streptococcus. The streptococcus occurred in 24 cases, 

 alone in 21, associated with the Klebs-Loffler bacillus twice, 

 and with Staphylococcus pyogenes aureus once. Staphy- 

 lococcus pyogenes occurred twice, once alone and once with 

 the streptococcus. The pneumococcus occurred twice alone. 



In the kidney the Klebs-Loffler bacillus occurred in 23 

 cases, in 15 alone, in 5 associated with the streptococcus, 

 and in 2 with Staphylococcus pyogenes aureus. The 

 streptococcus occurred in 26 cases, in 19 of which it was the 

 only organism present. Staphylococcus pyogenes aureus 

 occurred in 8 cases, in 4 of which it was in pure culture. 

 The pneumococcus occurred four times, three times in pure 

 culture and once with the Klebs-Loffler bacillus. 



In the 46 cases of complicated diphtheria, the heart's 



* "Jour. Boston Soc. of Med. Sci.," March, 1898. 



