MICHIGAN ACADEMY OF SCIENCE. 113 



the finding of a unilateral nasal discharge was grounds for a probaljle diagnosis 

 of nasal diphtheria. This was confirmed by the report of the culture, which 

 showed the Klebs-Loeffler bacilli ])resent. 



The use of antitoxine brought about a speedy cessation of the symptoms 

 and the child made an uninterrupted recovery. Here the patient was a 

 child of a physician, whose work had brought him in contact with many 

 cases of diphtheria, and yet the constitutional symptoms were so slight 

 that the grave disease had not been suspected. 



Case III. W. F., age 5 years, was brought into the office by his mother, 

 who said that he had been suffering from a cold in the head for a few days. 

 Here the examination of the nose showed a well marked unilateral discharge 

 with no eA'idences, however, of any meml^rane. There was absolutely no 

 history in this case of any malaise, the child showing no temperature and 

 eating quite heartily. As the boy had been suVjject to colds before, it was 

 thought perhaps that this was a slight coryza, and a culture was not taken, 

 but a simple mild ointment for the nose was prescribed. 



The second day after, the mother returned with the child and said that 

 she fancied that there was something the matter with her own throat. A 

 small patch was visil:)le on the left tonsil of the mother. A culture was 

 taken from this patch. The child of five years was given a second examina- 

 tion, and as the discharge from the left nostril still continued a culture was 

 made from this. Another child, aged 3, in the same family, was then ex- 

 amined and a culture taken from her nose, although there were no symptoms. 

 Reports from the three cultures, from the tonsil of the mother and from the 

 noses of the children, showed Klebs-Loeffler bacilli present in each case. 



The history of infection in this family was interesting, as being evidently 

 of an intermediate nature. The only exposure, that could be traced was 

 as follows: The chauffeur employed by the family was a married man, 

 and his family lived in another part of the city. His own child had had 

 dijihtheria a month before, and he had been home taking care of the child. 

 After the recovery of his child he returned to his work, and the children of 

 his employer were thrown into somewhat close contact with him for some 

 time. 



If we wish to stamp out dii:)htheria, we must make cultures from not only 

 throats which are suspicious but also from cases where the nasal discharge 

 is of such a nature as to warrant suspicion. 



The ])oint which the writer has found of weight in considering a case is, 

 first, the presence of a unilateral discharge. If a foreign body can be ruled 

 out, as it frecpently can by a thorough examination of the nose, the clinical 

 history is of sufficient weight to warrant the taking of a culture. If there 

 is a discharge from each nostril attended by bleeding for which no adec^uate 

 cause can be given, a culture should also be taken. 



If the profession will get after these cases of nasal discharge which present 

 points suspicious of a Klebs-Loeffler origin, we will do much towards stamping 

 out this disease in our communitv. 



Detroit, Michigan, April 20. 1909. 

 15 



