A CASE OF DIPHTHERITIC ENTERITIS
23 elementary in structure, being usually simple endothclial tubes lying in the connective tissue. A considerable part of the tumour has undergone coagulation necrosis, the structure is visible and is as above described, but the staining power is lost. There are large haemorrhages present. The type of the tumour is that which is usually called a mixed tumour of the testis ; the structure is very like that of embryonic tissue. The inguinal, iliac, and lumbar lymph glands are enlarged, firm, and
... hite. Many of them were examined, but in none was there any trace of metastasis of the growth. The enlargement was due to a large-celled hyperplasia with commencing hyaline degeneration." In conclusion I wish to express my thanks to Mr. L. G. Gunn for his able assistance at the operation and to Professor O'Sullivan for the above report. RECENT literature has demonstrated to us the possibility of obtaining the Klebs-Löffler bacillus from the urine of patients suffering from diphtheria, but up to the present I have been unable to find recorded any case of intestinal disease resulting from this organism. The following case was under my care in the City Hospital, Birmingham. The patient, a girl, aged 18 years, was admitted to hospital on June 14th, 1911, with faucial diphtheria, the left tonsil being covered with thick grey adherent membrane ; the right tonsil and uvula were clean. Both nostrils were excoriated, and a thick purulent discharge was present. The submaxillary glands were enlarged and tender. Temperature, 99° F. ; pulse, 90. Antidiptheritic serum (4000 units) was given intravenously on admission, and as some membrane was still present the dose was repeated on the following day. The next day the throat was clean, but the nasal condition being still suspicious a further dose of 2000 units was injected. Recovery was uninterrupted until June 23rd, when a well-marked serum rash was present. On the following day (the 24th) she complained of abdominal pain, felt sick, and vomited bilious fluid. On the next day the pain was more severe, and became localised to the umbilical region, being accompanied by a feeling of fulness. An enema of soap and water given in the evening brought away two pieces of membrane, thick and fibrinous, each about 6 inches long. One, apparently a cast of a portion of the small gut, was hollow, and easily allowed the passage of a glass rod through it. More serum (14,000 units) was given in divided doses during the next three days. On the 28th the temperature, previously normal, rose to 102' 4°, pulse 100, and the patient appeared extremely ill. Enemata on the 28th and 29th resulted in several portions of membrane being voided. On the 29th, with a falling temperature, the patient complained of intense abdominal pain at the umbilicus, the abdomen being distended, motionless, and rigid, and extremely tender on palpation. Percussion gave a tympanitic note all over. On the following day the temperature was normal and the pain had quite disappeared. No further membrane was passed until July 4th, when a small necrosed portion about 3 inches long came away with an enema. The patient's further progress was uneventful and she was discharged cured on July 31st. Bacteriology.-Cultures made by implanting well-washed portions of the membrane on blood sera, and also by smears on blood sera and nasgar media, showed numerous wellmarked polar-staining bacilli by Neisser's method and toluidine blue. Numerous attempts were made to plate this organism without success as each plate was overgrown with bacillus coli. Microscopic preparations made by teasing out the membrane to some extent and staining by the above methods showed large numbers of the Klebs-Löffler bacillus. Birmingham.