362 DISEASES OF THE G ASTRO-INTESTINAL TRACT. 



to be composed of a network of fine fibrillse, in the meshes of 

 which are red blood-corpuscles, migrated leukocytes, des- 

 quamated epithelial cells, and masses of micro-organisms. The 

 underlying mucous membrane is congested and infiltrated with 

 leukocytes; its epithelial cells are undergoing granular de- 

 generation or coagulation-necrosis (Fig. 158). 



FIG. 158 



Edge of a diphtheritic membrane. Section from the human uvula (Ziegler). a, 

 normal stratified epithelium ; b, subepithelial fibrous tissue of the mucous mem- 

 brane ; c, epithelium that has undergone coagulation-necrosis. Only remnants 

 of cells remain in the coarse fibrinous meshwork. d, oedematous subepithelial 

 fibrous tissue containing fibrin and leukocytes ; e, bloodvessels ; /, hemorrhage ; 

 g, g, groups of the bacteria causing the necrosis. 



The associated lesions are the result of the absorption of 

 toxins the bacilli themselves do not gain entrance to the 

 circulation. The neighboring lymphatic glands are usually 

 greatly swollen ; the kidneys are nearly always aifected, as 

 shown clinically by the albuminuria which is present in the 

 majority of cases the renal epithelium becomes cloudy and 

 swollen, and minute hemorrhages are sometimes seen. Not 

 infrequently there are necrotic foci in the liver, and in nearly 

 all cases some myocardial degeneration. The diphtheritic 

 paralyses are due to degenerative changes in the nerve-centres 

 and peripheral nerves. 



