DIPHTHERIA. 75 



Lieberkiihn. In Peyer's patches the changes were similar to those 

 observed in other lymphatic structures. There was no evidence of 

 denudation of the surface in any part of the alimentary tract. The 

 mucosa of the stomach showed only insignificant lesions. The sur- 

 face of the liver often exhibited small yellow, opaque points and 

 lines which upon section were found to extend down into the organ. 

 These points and lines indicate focal degeneration and death of liver 

 cells. In the majority of instances the liver was congested and 

 showed more or less evidence of fatty metamorphosis. " The kid- 

 neys were not invariably the seat of fatty changes, but it was the 

 rule to find more or less fat (1) in the convoluted tubules of the 

 labyrinth, (2) in the straight tubules, and (3) in the glomeruli. In 

 some instances the fatty metamorphosis of the epithelial cells was 

 extreme. In all cases, practically, the cells were much swollen and 

 coarsely granular, the proteid granules being combined with fat. In 

 rare instances a deposition of lime salts was noted in the straight 

 tubules. These deposits yielded carbonic acid gas on the addition 

 of strong acids. Among the most interesting changes observed was 

 a hyaline transformation of the glomerular capsules and smaller 

 arteries." The lesions observed in the lungs were confined almost 

 exclusively to the vessels, the endothelial cells of the pulmonary 

 branches and the vesicular capillaries showed fragmentary degener- 

 ation. The adrenals were markedly congested with occasional 

 hemorrhages into the tissues, and the same condition was observed 

 in the thyroid gland. Fatty metamorphosis was the most common 

 pathological condition found in the myocardium. The alterations 

 observed in the muscle substance of the heart affected both the 

 nuclei and the protoplasm, being most marked in the former. " The 

 earliest and most common appearance consists of swelling and elon- 

 gation of the nuclei and alteration in their shape, the fibers in the 

 meantime showing little change. Certain nuclei later assume a 

 deeper color, owing chiefly to an intense staining of three or four or 

 more globular bodies in their interior; but soon afterwards the 

 nuclear membrane either degenerates or becomes invisible, and the 

 bodies become free and appear as fragments. The substance of the 

 fibers belonging to the affected nuclei has in the meantime quite dis- 

 appeared or takes on a swollen and an attenuated aspect." 



Councilman, Mallory, and Pearce ' have made a most exhaustive 

 study of the gross and microscopical lesions found in man after death 

 from diphtheria. Many of these pathological changes are evidently 

 due to the toxin because they are found in parts of the body not 

 reached by the bacillus. In the lymph nodes the most characteristic 

 lesion was found to consist in the formation of discrete foci due to 

 cell proliferation combined with necrosis. In all cases they observed 



' Diphtheria, A Study of the Bacteriology and Pathology of Two Hundred and 

 Twenty Fatal Cases, 1901. 



