View report page

35
Thymus.—Normal.
Stomach and intestines.—Normal, slightly congested.
The suprarenals were very dark in colour and appeared somewhat enlarged. On section
marked congestion was found.
The kidneys were very congested and there was a definite pyelitis on both sides.
The liver was dark in appearance and congested on section.
The spleen was small, firm and showed very little congestion.
Bladder.—On opening the bladder a definite congestion and cystitis was demonstrated.
Uterus.—The cervix showed intense congestion and excoriation, and there was evidence
of the remains of fibrinous membrane around the external os.
Brain.—Not examined.
A microscopical examination showed:—
Heart.—Severe toxic myocarditis. Many fibres were vacuolated and had lost their nuclei,
while others showed marked nuclear degeneration. The blood vessels were congested.
Adrenal.—Very congested. There was marked toxic degeneration of the cells of both the
cortex and the medulla.
Kidney.—Congestion, marked tubular nephritis and commencing proliferation of Bowman's
capsule were present.
Liver.—Very congested, and showed marked cloudy swelling.
Lung.—Extreme congestion, no consolidation, a little oedema. Many of the alveoli contained
endothelial cells. The bronchi were normal.
Ovary.—Congestion, particularly of the vessels of the hilum, was present.
Uterus.—Very congested, with some desquamation of the mucous membrane.
Vagina and os uteri.—There was congestion, desquamation of the epithelium and fibrin
formation with granulation tissue.
Microscopical
examination
Apart from the localisation of. the disease the interesting feature of this case
was the satisfactory general condition of the patient in spite of such an extensive
infection of the genitals. The absorption of toxin from the affected area must have
been considerable and yet the patient showed no signs of a severe toxaemia.
Death was due to cardiac failure consequent upon a severe toxic myocarditis.
The weakened heart muscle became dilated, assisted, no doubt, by the suprarenal
exhaustion. The toxic nature of the condition is seen in the severe degenerative
changes in the various organs.
References.
1 van Saun, Anna I., 1923, J. Infect. Die., 33, 124-129.
2 Medical Research Council, 1923, Diphtheria, 230.
3 Unseld, E; 1933, Monatschr. f. Geburtsh. u. Gvnak., 93, 177.
4 Smordinzeff, N. A., 1932, Zentralb. f. Gynak., 56, Aug. 27.
6 Grant, J., 1934, Brit. Med. Journ., I, 1,074.
6 Wallfield, M. J., and Litvak, A. M., 1933, J. Pedial., 3, 756.
7 Ker, C. B., 1929, Infectious Diseases, 392.