EEVIEW — TEOPICAL MEDICINE, ETC. 



Proiit' has described an outbreak of dysenteric diarrhoea at Bathurst due to the foulinR Diairhflea — 

 of drinking water by the excreta of locusts. These latter consisted of spindle-shaped bodies coaiii^ -^ 



which were composed of the fibrous indigestible parts of the grass matted together, and 

 also of the siliceous spicules found in many grasses. The result of their ingestion was a 

 mechanical irritation like that induced by ground-glass poisoning. 



Diphtheria. Most of the recent papers on this subject seem to deal with treatment, 

 the preventive use of antitoxin, and the bacteriological aspect of the disease. 



Sambon,^ in an ingenious paper, seeks to prove a relationship between diphtheritic 

 affections of man and those of the lower animals. He deals specially with avian diphtheria 

 and states that if the diphtheria of fowls is transmissible to man, then the eggs of these 

 birds must play an important part in its transmission, because diphtheritic patches have 

 been found in the oviducts. The paper is interesting and suggestive, but is severely 

 handled from the veterinarian standpoint by Mettam,^ who states that the historical 

 references and most of Dr. Sambon's quotations will not bear inspection for a moment. He 

 agrees with the opinion of Friedberger and Frohner relating to the transmission of animal 

 diphtheria to man — it is a mere assumption due to ignorance of veterinary pathology. 



In a discussion on "What is notifiable diphtheria?'' Williams* divided the clinically 

 mild and doubtful cases into three groups : — 



1. Patients without ordinary clinical signs of diphtheria, not definitely ill and yet 

 anaemic, with quickened pulses, nasal catarrh, and other local symptoms which bacteriologi- 

 cally prove to be diphtheria. 



2. Cases with any of these lesions but with no general symptoms of ill-health. 



3. Persons who are quite well and have no local lesions but by cultural tests are 

 found to harbour diphtheria bacilli. 



He is inclined to regard cases coming under groups 1 and 2 as requiring isolation and 

 treatment, but as regards 3 he points out that there is no evidence that infected contacts can 

 spread diphtheria until they have developed local symptoms. 



Higley' describes a rapid method (fifteen minutes) of certain diagnosis by examination of 

 stained smears from deposits or false membranes. The material for the smear is obtained 

 by passing a looped needle flattened at the curve lightly over the false membrane. The 

 stains used are : 1. Five drops Kuhne's carbolic methylene blue in 7 c.c. of tap-water. 

 2. Ten drops carbol fuchsine in 7 c.c. of tap-water. Method — -Fix in usual way. Apply 

 No. 1 for 5 seconds. Wash with tap-water and dry between filter paper. Apply No. 2 for 

 one minute, wash, dry, and mount in balsam. Loeffler's bacilli then appear as dark red or 

 violet rods, irregularly stained and often containing polar dots. The colour means nothing, 

 the other points are characteristic. 



Pennington'' has a paper on the virulence of diphtheria organisms in the throats of 

 healthy school children and diphtheria convalescents. He found that 10 per cent, of the 

 former harbour in their throats bacilli morphologically indistinguishable from diphtheria 

 bacilli. One half of these did not affect guinea pigs. About 30 per cent, of them were 

 clearly attenuated, 14 per cent, moderately virulent. In the convalescent cases the great 

 majority of the bacilli were highly virulent. His conclusions seem to be that, in healthy 

 persons unexposed to infection, if diphtheria bacilli are present, they are usually non-virulent, 

 that in healthy exposed people the organisms are markedly virulent and such persons are a 

 fruitful source of infection, and that convalescents from diphtheria carry and disseminate 

 virulent organisms as long as any remain in their throats, a period which may far exceed 

 the duration of the clinical evidence of the disease. He submits that preventive measures 

 should be based on these findings, but admits the practical difficulties of carrying such into 

 effect. It is, therefore, evident that his views differ considerably from those of Williams. 



' Prout, W. T. (April 2oth, 1908), " Unusual Cause of Dysenteric Diirrhoea in the Tropics." Lancet, Vol. I. 



2 Sambon, L. W. (April 18th, 1908), "The Epidemiology of Diphtheria, etc." Lancet, Vol. I. 



= Mettam, A. E. (May 2nd, 1908). Ibid. 



* Williams, P. W. (September 16th, 1905), "Wh.it is Notifiable Diphtheria?" British Malical Journal, 

 p. 647, Vol. II. 



« Higley, H. A. (May 20th, 1905), "Rapid Bacteriological Diagnosis of Diphtheria." Epit. of British Medical 

 Journal, p. 80, Vol. I. 



>> Pennington, M. E. (.Januuary 1st, 1907), "The Virulence of Diphtheria, etc." Journal of Infectious Diseases, 

 p. 36, Vol. IV. 



