Pathogenesis 439 



cases of complicated diphtheria (29 with scarlet fever, 11 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-LofHer 

 bacilli were present in the heart's blood in 4, twice alone and twice 

 with streptococci. In 9 cases the streptococcus occurred alone; in 

 I case the pneumococcus occurred alone. In the liver the bacillus 

 was found in 24 cases, alone in 12 and together with the strepto- 

 coccus in 12; the streptococcus occurred in 27 cases, alone in 14, 

 with the Klebs-LofHer bacillus in 12, and with Staphylococcus 

 pyogenes aureus in i. Staphylococcus pyogenes aureus occurred 

 in 4 cases, alone in 3 and associated with the streptococcus in i. 

 The pneumococcus occurred alone in i case. 



In the spleen the Klebs-Lofifler bacillus occurred eighteen times, 

 fifteen times alone and three times associated with the streptococcus. 

 The streptococcus occurred in 24 cases, alone in 21, associated with 

 the Klebs-LoflSer bacillus twice, and with Staphylococcus pyogenes 

 aureus once. Staphylococcus pyogenes occurred twice,- once alone 

 and once with the streptococcus. The pneumococcus occurred 

 twice alone. 



In the kidney the Klebs-LofHer bacillus occurred in 23 cases, 

 in 15 alone, in 5 associated with the streptococcus, and in 2 with 

 Staphylococcus pyogenes aureus. The streptococcus occurred in 

 26 cases, in 19 of which it was the only organism present. Staphylo- 

 coccus pyogenes aureus occurred in 8 cases, in 4 of which it was 

 in pure culture. The pneumococcus occurred four times, three times 

 in pure culture and once with the Klebs-LofHer bacillus. 



In the 46 cases of complicated diphtheria, the heart's blood showed 

 pure cultures of the streptococcus niiie times and the streptococcus 

 associated with the Klebs-LofHer baciUus once. The diphtheria 

 bacillus occurred alone once. 



In the liver, in 10 cases streptococcus occurred alone, in 7 cases 

 associated with the Klebs-LofHer bacillus, and in 3 cases with 

 Staphylococcus pyogenes aureus. The diphtheria bacillus occurred 

 in pure culture in 5 cases. 



The spleen contained streptococci only thirteen times and mixed 

 with the diphtheria bacillus twice. The diphtheria b'acillus was 

 found in pure culture in 5 cases. 



The kidney contained pure cultures of streptococci in 10 cases, 

 streptococci associated with diphtheria bacilli five times, and with 

 Staphylococcus pyogenes aureus three times. The diphtheria 

 bacillus occurred alone in 7 cases. Staphylococcus pyogenes 

 aureus and the pneumococcus each alone once, and both together 

 once. 



"The 'clinical significance of this general infection with the Klebs- 

 LofHer bacillus is not apparent. It occurred generally, but not 

 always, in the gravest cases, or those known as 'septic' cases. It 



