HEVIEVV — TROriCAL MEDICINE, ETC. 43 



source of error. As regards (2), there may have been a perfunctory application of the swab Dipun,eria— 

 to the serum ; tlie temperature of incubation may have been wrong and not between 33" C. coiUinu,^ 



and 37" C, as is essential if the bacillus is to grow more rapidly than the accompanying 

 cocci ; the number of colonies examined may be too small , the slide may be greasy : the 

 stain may be old or unfiltered ; the staining may be careless ; the examination may be too 

 limited, i.e. sufficient fields may not be examined. 



After dealing with the characters of diphtheria bacilli and their classificatiou, he 

 concludes by stating that : — 



The greater his knowledge of the circumstances o£ each individual case, the more valuable is the report of 

 the bacteriologist. From a bacteriological standpoint alone a diagnosis of diphtheria, though generally reliable, 

 is beset with difficulties. The bacteriological report must be a factor, and an important factor, in the decision, 

 but the final judgment can only be made by the practitioner in conjunction with the medical officer of health. 



Slater' reports a most interesting case of skin diphtheria of 3 years' standing. The 

 original seat of the disease was the eyes, then the vulva became affected, the bacilli entered 

 the superficial lymphatic circulation and produced a condition like herpes, possibly as the 

 result of a toxic peripheral neuritis. Typical Klebs-Loeffler bacilli were isolated and no 

 treatment had any effect until antitoxin was given, when the result was remarkable. The 

 author does not say if this curious carrier case infected other people. Four other cases of 

 skin diphtheria in the form of ulcers of the toe are narrated by Heelis and Jacob.- The 

 condition at first resembled chilblains, but later a contact developed faucial diphtheria. Skin 

 diphtheria, then, may in some measure explain the origin of certain obscure cases or even 

 epidemics. 



The question of treatment hardly falls to be considered here, but as it is sometimes 

 difficult to obtain or store antitoxin in the Sudan, Leonard Williams'" strong advocacy of 

 biniodide of mercury, given as a mixture containing the perchloride of mercury and iodide 

 of potassium, may be cited. So may the use of 4 per cent, solution of formalin as a throat 

 swab or gargle (Brunton-*)* and of formolyptol both as a spray and as an internal remedy in 

 2 minim doses (Eendle'"'). 



Crookshank'"' advocates the hypodermic administration of adrenalin chloride and 

 strychnine in severe cases of diphtheria marked by vomiting and cardiac depression. He 

 employs tabloids, each containing ov,uth of a grain of adrenalin chlorine and y'riith of a 

 grain of sulphate of strychnine. One or two of these may be given every two, three or 

 four hours. Even in desperate cases it may be of service, all food, other medicine and 

 throat treatment being stopped when vomiting occurs. 



The preventive use of antitoxin, however, calls for some brief notice, as, in such a 

 country as this, provided the serum was available, it would constitute an important method 

 of checking and controlling an epidemic. 



Shackleton^ records a school outbreak where antitoxin proved efficient as a prophylactic. 

 The dose given was 2000 units of Burroughs Wellcome & Co.'s serum, or 1000 units of the 

 Lister Institute serum. Norton'* describes a somewhat similar experience, in which the results 

 vyere most gratifying and there were practically no ill-effects. 



Sittler'-'* has come to certain conclusions as to the length of immunity after injection of 

 diphtheria antitoxin. 



1. The immuuity given by the prophylactic injections lasts from three to five weeks, if the childi'en arc 

 not too often exposed to diphtheria in the interval. 



'■ Slater, A. B. (January 4th, 1908), "A Case of Diphtheria of the Skin of three years' duration treated by 

 Antitoxin." Lancet, p. 15, Vol. I. 



- Heelis, R., and .Jacob, P. H. (March 10th, 1906), "A Series of Four Cases of Cutaneous Diphtheria." 

 British Medical Journal, p. 556, Vol. I. 



" Williams, Leonard (1907), " Minor Maladies." London. 



■* Brunton, T. L. (February 15th, 1906), Clinical Journal. 



" Bendle, C. E.R. (February 18th, 1905), "Formolyptol in Diphtheria." Lancet, p. 460, Vol. I. 



« Crookshank, P. G. (April 25th, 1908), " A Note on the Treatment of Diphtheria." Lancet, Vol. I. 



' Shackleton, W. W. (Sept. 15th, 1906), "The Prophylactic use of Anti-Diphtheritic Serum." Lancet, 

 p. 722, Vol. II. 



" Norton, E. E. (July 13th, 1907), "The Prophylactic use of Antitoxin in Epidemic Diphtheria." Lancet, 

 p. 85, Vol. II. 



» Sittler, P. (September, 1906). Jahrbuch f. Kinderhcilk. 



• Article not consulted in the original. 



