Pathogenesis 483 



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 pseu do -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 per cent. Seventy- 

 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,J 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 



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



t "Ann. de 1'Inst. Pasteur," 1896, p. 387. 



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



