43 2 Diphtheria 



blood showed pure cultures of the streptococcus nine times 

 and the streptococcus associated with the Klebs-Loffler 

 bacillus once. The diphtheria bacillus occurred alone once. 



In the liver, in 10 cases streptococcus occurred alone, in 

 7 cases associated with the Klebs-Loffler bacillus, and in 3 

 cases with Staphylococcus pyogenes aureus. The diphtheria 

 bacillus occurred in pure culture in 5 cases. 



The spleen contained streptococci only thirteen times and 

 mixed with the diphtheria bacillus twice. The diphtheria 

 bacillus was found in pure culture in 5 cases. 



The kidney contained pure cultures of streptococci in 

 10 cases, streptococci associated with diphtheria bacilli five 

 times, and with Staphylococcus pyogenes aureus three 

 times. The diphtheria bacillus occurred alone in 7 cases. 

 Staphylococcus pyogenes aureus and the pneumococcus 

 each alone once and both together once. 



"The clinical significance of this general infection with the 

 Klebs-IyofBer bacillus is not apparent. It occurred gener- 

 ally, but not always, in the gravest cases, or those known as 

 'septic' cases. It is probable that it may be due to a 

 diminished resistance to the tissue-cells, or of the germicidal 

 power of the blood. In this series of fatal cases the number 

 of infections with the streptococcus and with the Klebs- 

 I/ofifler bacillus was about even, though slightly in favor of 

 the streptococcus." 



The mixed infections add to the clinical diphtheria the 

 pathogenic effects of the associated bacteria. The diphtheria 

 bacillus probably begins the process, growing upon the 

 mucous membrane, devitalizing it by its toxin, and pro- 

 ducing coagulation-necrosis. Whatever pyogenic germs 

 happen to be present are thus afforded an opportunity to 

 enter the tissues and add suppuration, gangrene, and re- 

 mote metastatic lesions to the already existing ulceration. 



Diphtheritic inflammations of the throat are not always 

 accompanied by the formation of the pseudo-membrane, 

 but in some cases a rapid inflammatory edema in the larynx, 

 without a fibrinous surface coating, may cause fatal suffoca- 

 tion, only a bacteriologic examination revealing the true 

 nature of the disease. 



Lesions. The pseudo-membrane characterizing diph- 

 theria consists of a combined necrosis of the tissues acted 

 upon by the toxin and coagulation of an inflammatory 

 exudate. When examined histologically it is found that 



