DlPHTHEEIA IN THE TeOPICS 



Is there a coccal form of the Bacillus diphtherice? 



BY 



The Dikectoe 



It is Eogers^ who says " Diphtheria is fortunately much less common in the tropical 

 East than in temperate parts of Europe and America. It does occur in Calcutta, and 

 also in China, being also much more frequent in the cold season and especially rare in 

 the rains." Doubtless it is this rarity which is the cause of the paucity of literature on 

 diphtheria in tropical countries. Curiously enough, however, a paper has appeared in the 

 Journal of Tropical Medicine and Hygiene for November 1, 1910, plaintively asking why more is 

 not heard about diphtheria in tropical countries. In the Eeview Supplement to our Third 

 Eeport I wrote : " In my experience, cases of diphtheria, so far as Khartoum is concerned, 

 are apt to crop up in October, when the summer has been dry. I have never seen an 

 extensive epidemic nor have I ever been able to trace the disease to its source. Apparently 

 it has been introduced from outside, and it is usually of a severe form associated with 

 streptococcal infection. The type of diphtheria bacillus present has, as a rule, been 

 what Westbrook would term Granular C. The disease is undoubtedly rare in the Sudan." Diphtheria in 

 I have looked through Euge's- exhaustive review of diseases in the Tropics in Virchow's 

 Jahresbericlit for the last three years and find scarcely any reference to diphtheria, while in 

 my own references the only paper worth mentioning is one by Castellani,' who discusses the 

 subject much more fully than Eogers, describes a typical severe case in Ceylon, and 

 concludes as follows : — 



" This case, together with the previous observations of Perry, Fernando and da Silva 

 in Ceylon, and Plehn, Cornwall, etc., in other parts of the Tropics, tends to demonstrate that 

 diphtheria is not limited simply to the temperate and sub-tropical zones, but that it is a true 

 cosmopolitan disease, as it occurs also, and probably much more frequently than hitherto 

 supposed, in tropical countries. The different climatic conditions may, perhaps, influence 

 in some instances the characteristic clinical features and course of the disease, and this, if a 

 bacteriological examination is not taken (sic), may render dif&cult the diagnosis, and lead to 

 some cases being overlooked." 



The disease would, however, appear scarcely to merit particular attention but for 

 the fact that on several occasions I have encountered in undoubted diphtheria cases what 

 I believe to be a coccal form of the Klebs-Loeftler bacillus. The only references to any A coccal form 

 similar finding which I can discover are in Park's Pathogenic Micro-organisms * where 'L- V*! • 

 an illustration is given of segmented granular coccus forms grown on LoefSer's serum, bacillus 

 and obtained from cases of diphtheria at a children's home in New York, and in a paper by 

 Trautmann and Dale' with a sequel by Dale" alone on coccoid forms found in culture during 

 the course of an epidemic in Hamburg. 



' Kogers, L. (1910), Fevers in the Tropics. 2nd Ed., London. 



- Bilge, S. (1907-8-9), " Tropenkr.inkheiten." Virchow's Jahresbericlit der gesammten Mcdicin, Band I. 



" Castellani, A. (May 2, 1904), " Diphtheria in the Tropics." Journal Tropical Medicine, Vol. VII. 



* Park, W. H. (1908), Pathoijcnic M icro-orrjanisms. 3rd Ed., London. 



" Trautmann, and Dale, .1. (1910), " Beitrag zum Forineukrois des Diphtheriebacillus." Cent. f. Bakt. : 

 Beilaxje zii AM. 7, Bef. Vol. 47, p. 20.3. 



» Dale, J. (December 7, 1910), "Ueber eine ungewohnlicho Form des Diphtheriebacillus." Cent. f. Bakt. ; 

 Orig. Vol. 56, Nos. 5/6. 



