420 Diphtheria 



staphylococci. Howard* studied a case of ulcerative endocarditis 

 caused by the diphtheria bacillus, and Pearcef has observed it in 

 I case of malignant endocarditis, 19 out of 24 cases of broncho- 

 pneumonia, I case of empyema, 16 cases of middle-ear disease, 8 

 cases of inflammation of the antrum of Highmore, i case of in- 

 flammation of the sphenoidal sinuses, i case of thrombosis of the 

 lateral sinuses, 2 cases of abscesses of the cervical glands, and in 

 esophagitis, gastritis, vulvo-vaginitis, dermatitis, and conjunctivitis 

 following or associated with diphtheria. 



A case of septic invasion by the diphtheria bacillus is reported 

 by Uck:e,t who gives a synopsis of the literature of similar cases. 



The disease pursues a variable course. In favorable cases the 

 patient recovers gradually, the pseudo-membrane first disappearing, 

 leaving an inflamed mucous membrane, upon which virulent diph- 

 theria bacilli persist for weeks and sometimes for months. Smith* 

 describes the bacteriologic condition of the throat in diphtheria 

 as follows: "The microscope informs us that during the earli- 

 est local manifestations the usual scant miscellaneous bacterial 

 flora of the mucosa is quite suddenly replaced by a rich vege- 

 tation of the easily distinguishable diphtheria bacillus. Frequently 

 no other bacteria are found in the culture-tube. This vegeta- 

 tion continues for a few days, then gradually gives way to 

 another flora of cocci and bacilli, and finally the normal condition 

 is reestablished." 



Associated Bacteria. — Streptococcus pyogenes and Staphylococci 

 pyogenes aureus and albus are, in many cases, found in associa- 

 tion 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,|| it was found that in 26 cases of pseudo- 

 membranous angina due to streptococci, staphylococci, 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 staph- 

 ylococci; 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 



* "Amer. Jour. Med. Sci.," Dec, 1894. 

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



t "Centralbl. f. Bakt. u. Parasitenk.," original, XLVi, Heft 4, March 10, 1908, 

 p. 292. 



II "Ann. de I'Inst. Pasteur," 1896, p. 387. 



