17,1 Gomez et al.: Diphtheria in the Philippines 41 
as a result of injection of diphtheria antitoxin; there was no 
throat involvement. 
A practically pure culture of Bacillus diphtherizx, of the short 
variety, type E of Wesbrook, was isolated from the nose but 
not from the throat. This strain was of rather low virulence 
(see No. 16, Table 4). The patient recovered completely after 
having been treated with 8,000 units of diphtheria antitoxin, 
and washings of the nose and throat with alkaline antiseptic 
solutions. 
BACTERIOLOGY 
In only thirty-one of the sixty-two cases studied in San La- 
zaro Hospital was the diagnosis confirmed bacteriologically. 
This is probably due to faulty technic with the early cases of 
the series, for when more attention was paid to the bacteriolog- 
ical work a greater number of positive results was obtained. 
Twenty-one, or 87 per cent, of twenty-four cases admitted to 
San Lazaro Hospital from’ September 26, 1919, to February 23, 
1920, were positive. In twenty of these the bacillus was iso- 
lated in pure culture and the characteristics of the different 
strains studied, as shown in Table 4. 
The cultures were made in Loeffler’s blood serum, and all 
showed Gram positive bacilli with more or less V-shaped ar- 
rangement, characteristic polar bodies specially demonstrable 
by the Neisser Gin stain, producing acid reactions in Hiss’ 
serum water carbohydrate media as follows; strong in the 
glucose, weak in the dextrin, and none at all in the saccharose. 
In practically all cultures the various types of Wesbrook, Wil- 
son, and McDaniel could be identified, but we present in Table 
4 only the most predominant one as seen in smears of from 
eighteen to twenty-four hours old Loeffler’s blood serum culture. 
The virulence test was performed according to the method 
recommended by Kolmer and Moshage; (4) that is, subcutaneous 
injection into a 250- to 300-gram guinea pig of 4 cubic centi- 
meters of a 10 cubic centimeter salt solution emulsion of a 
twenty-four hours old Loeffler blood serum culture. With 
eighteen of the cultures the guinea pig died within two days 
after inoculation showing, on autopsy, characteristic subcuta- 
neous gelatinous edema, which was sometimes hzmorrhagic, 
and intense congestion of the suprarenal glands. In one cul- 
ture (No. 17) the guinea pig died after five days with congested 
adrenals, hemorrhage, and necrosis, but no characteristic sub- 
cutaneous oedema. In another (No. 2) the guinea pig was 
alive twelve days after inoculation, showing no characteristic 
