DIPHTHEKIA 273 



wounds may be attacked. A pseudo-membrane usually 

 forms, consisting of laminae of fibrin entangling a few 

 leucocytes and other cells, and here and there small effusions 

 of blood, together with coagulative necrosis of the under- 

 lying mucous membrane, and the bacilli are for the most 

 part located in the superficial layers of this pseudo-mem- 

 brane (Plate VI. 6), though in all cases in which the disease 

 has lasted for any time they are found in the lungs, spleen, 

 and kidneys, and may occur even in the blood. If the 

 patient recovers from the diphtheritic attack, paralytic 

 sequelae are not uncommon and are due to a peripheral 

 neuritis. Pseudo-membranes may be formed by other 

 organisms, e.g. by the streptococcus and pneumococcus 

 also by the pneumobacillus, and occur in Vincent's angina 

 (p. 296), but it is doubtful whether paralytic sequelae 

 follow any but a diphtheritic infection. 



Some remarkable skin affections of an eczematous or 

 ichthymatous nature have been found by Hare 1 and 

 others to be due to the diphtheria bacillus. 



Another affection which seems to be generally diphtheritic 

 is membranous rhinitis. Whereas true nasal diphtheria is 

 a serious condition, membranous rhinitis is seldom, if 

 ever, attended with any risk to life, sequelae do not occur, 

 and it is rare to obtain a history of infection from cases 

 of it. This is extraordinary and very difficult to explain, 

 for virulent diphtheria bacilli are abundant in the nose 

 and nasal secretion. 



Diphtheroid organisms can occasionally be isolated from 

 well people and those not known to have been in contact 

 with diphtheria cases. The Klebs-Loffler bacillus can be 

 isolated from the throats of nearly 7 per cent, of the 

 presumably healthy population ; 2 in the throats of con- 

 tacts the percentage rises to 33 or more. Murray and 



1 Lancet, 1908, vol. i, p. 282. 



2 See Eyre, Brit. Med. Journ., 1905, vol. ii, p. 1104. 



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