DIPHTHERIA. 293 



point in exactly the same way as the cases of true diph- 

 theria. 



3. u Cases of diphtheria present the ordinary clinical feat- 

 ures of diphtheria, and show the Klebs-Iy6ffler bacilli. 



4. "Cases of angina associated with the production 

 of membrane in which no diphtheria bacilli are found 

 might be regarded from a clinical standpoint as diph- 

 theria, but bacteriological examination shows that some 

 other organism than the Klebs-Loffler bacillus is the 

 cause of the process." 



No more convincing proof of the existence of a power- 

 ful poison in diphtheria could be desired than the evi- 

 dences of general toxemia resulting from the absorption 

 of material from a comparatively small number of bacilli 

 situated upon a little patch of mucous membrane. 



In animals artificially inoculated the lesions produced 

 are not identical with those seen in the human subject, 

 yet they have the same general features of local infection 

 with general toxemia. 



Guinea-pigs, kittens, and young pups are susceptible 

 animals. When half a cubic centimeter of a twenty-four- 

 hour-old bouillon culture is injected beneath the skin of 

 such an animal, the bacilli multiply at the point of in- 

 oculation, with the production of a patch of inflamma- 

 tion associated with a distinct fibrinous exudation and 

 the presence of an extensive edema. The animal dies in 

 twenty-four to thirty-six hours. The liver is enlarged, 

 and sometimes shows minute whitish points, which in 

 microscopic sections prove to be necrotic areas in which 

 the cells are completely degenerated and the chromatin of 

 their nuclei is 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 

 the toxin. The bacilli are constantly absent from these 

 lesions. Welch and Flexner l have shown these foci to 

 be common to numerous irritant poisonings, and not 

 peculiar to diphtheria. 



1 Bull, of the Johns Hopkins Hospital, Aug., 1891. 



