A study of the various changes which occur in the tissues in acute diphtheritic toxaemia : more especially in reference to 'acute cardiac failure' / by Leonard S. Dudgeon.

Dudgeon, Leonard S., 1876-1938.

Date:: 1906

Credit: A study of the various changes which occur in the tissues in acute diphtheritic toxaemia : more especially in reference to 'acute cardiac failure' / by Leonard S. Dudgeon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$Hesse [8] made an examination of twenty-nine cases of diphtheria, in twenty-five of which interstitial myocar- ditis was present, and in four it was well marked. The change was noticeable in the first week, and more pro- nounced later. Leucocytic infiltration was believed to be due to escape of the leucocytes into the tissues, owing to injury of the capillary walls by the toxin. Papkow (quoted by Welch and Schamberg [6]) found extensive fragmentation of the muscle fibres as early as the third and fourth days. Councilman, Mallory and Pearce [6] found fatty degen- eration, varying in extent, in thirty-six out of sixty cases examined, but only forty of these were recent cases, and of this number twenty-nine showed fatty degeneration. In some instances the fatty change was diffuse, in others of the patchy type. It appeared to accompany or precede the more advanced forms of degeneration which lead to com- plete destruction of the muscular tissue. The muscular elements became swollen, broken and converted into hyaline masses. Vacuolation, fragmentation and fracture of the degenerated fibres were often seen. Proliferation of the cells of the interior of the blood-vessels was found through- out the body. Two kinds of interstitial change were also noted :— (1) Local collection of plasma and lymphoid cells. (2) Interstitial change, secondary to muscle degeneration, which may lead to fibrosis. These observers also state that when fatty degeneration of the heart is present, similar changes will be found in the skeletal muscle. They failed to find any gross lesion in the adrenal gland. Welch and Flexner [19] found congestion, haemorrhage, and focal necrosis in experimental diphtheria, but not in the human subject. Marked parenchymatous degeneration of the muscle fibres of the heart, finally passing into a stage of fatty- metamorphosis, may occur. The muscle fibres are degen- erated, nuclei are broken down or have disappeared, and the fibres themselves cease to be continuous. These alterations$