The Bacteriological Examination of Nine Autopsies on Cases of Diphtheria Treated with Antitoxin

WM. ROYAL STOKES
1895 Boston Medical and Surgical Journal  
The occurrence in diphtheria of a general infection with one or more of the pyogenic organisms in addition to that with the bacillus diphtherias has only recently been satisfactorily demonstrated. Barbier 2 and others, have pointed out from conclusions based mainly upon the bacterial examination of the throat, and clinical observation, the existence of two distinct forms of diphtheria, one a simple infection with the bacillus diphtherias, the other a mixed infection with one or more of the
more » ... or more of the pyogenic cocci. The objective demonstration, however, at autopsies on diphtheria, of the invasion of the various organs by pyogenic cocci has received but little attention. Geneserich,8 in the examination of 25 autopsies, found the streptococcus in the blood and internal organs of four cases, and in a number of others the staphylococcus pyogenes albus was present. Wright and Stokes,4 in 21 out of 31 cases, or in nearly 70 per cent., found a more or less general invasion of the internal organs by the pyogenic bacteria, of which the streptococcus was the one most frequently observed. Reiche6 has recently examined cultures from the spleen and kidney of 42 cases of diphtheria, in 64 per cent, of which he found streptococci and staphylococci together, and in 41 per cent, of which streptococci were found alone. Ricker 6 has also demonstrated streptococci in pure culture from the liver of a fetus, and in a placenta from a woman six months pregnant, who died of septic diphtheria. These observations are of interest as showing, not only that diphtheria in the majority of cases is not an infection with the bacillus diphtheria? alone, but also because they explain the inefficiency of antitoxin in many cases, for this agent cannot be assumed to act against any other organism than the bacillus diphtheria;. Besides this matter of poly-infection in diphtheria, the occurrence of this bacillus in the various internal organs has only recently been demonstrated as frequent, and is of considerable interest.
doi:10.1056/nejm189512121332401 fatcat:st5nagtwrfbpnmnwegwldgkacm