Diphtheria in Liverpool during the years 1937–40

The Types Mitis, Intermedius and Gravis of Corynebacterium Diphtheriae

“…There is occasional mention of intermedius deaths complicated by bronchopneumonia (63,155). Wright (204), however, analyzing 475 deaths from diphtheria in Liverpool finds only 2 pneumonia deaths recorded in intermedius infections as compared with 8 out of 53 in mitis infections and one out of 260 in gravis infections. Naturally the mitis strains with their tendency to obstructive lesions of the respiratory tract and consequent operative interference are specially prone to pneumonic lesions and five bronchopneumonias are mentioned in the first 16 recorded mitis deaths (35).…”

“…On the other hand there are many areas in which apart from carriers and a few cases mostly mild all diphtheria has been attributed to one or other of the three types originally described in Leeds (1). Such observations come from northern Germany: Henneberg and Pels Leusden (75) who met only three out of 544 strains which were difficult to classify, and Grossmann (62) who met only five such strains out of 594 (also 26, 64); from Poland (209); from Khartoum (81); from Australia (4, 57, 58); and in England, from Hull (98), from Manchester (150), from Dundee (115), from London (104), and from Liverpool (204), where the most extensive of all recorded investigations of this kind has been carried out. There are a considerable number of observers who while accepting the existence of these types prefer to have them indicated by letters or numbers, as Wright and Christison (202) in England and Hammerschmidt (72) in Germany, who had already (in 1924) described types of the diphtheria bacillus corresponding to mitis, gravis and intermedius in some respects but had not suggested any differences in their pathological significance.…”