DIPHTHERIA IN THE TEOPICH 245 



part Gram — . Controls were immediately made — the February 5, 1910 agar culture 

 being subcultured on to serum and agar. 



The former, after 24 hours, showed short, thick Gram + bacilli and some Gram — 

 forms. One Gram — rod with faint terminal polar bodies noted. There was a distinct 

 tendency to coccal formation, such coccal forms being Gram+. 



The latter, after 24 hours, showed bacillary forms like those on the serum. It 

 wa;; found that the agar used for the first subculture had been prepared from Doerr's 

 dry medium and was neutral in reaction, while in the second case the ordinary + 10 

 agar had been employed. Some of this Doerr's agar was then taken and standardised 

 to + 10. A culture of the February 5, 1910 growth on this, showed Gram + and 

 Gram — rods, chiefly the former. Many of the latter exhibited polar bodies and 

 closely resembled typical B. diphtherife. 



Another subculture on neutral agar showed the tendency to coccal formation, 



so apparently the reaction of the medium has something to do with the form assumed, 



albeit Cobbett's work on B. dipJitheriai did not show it to possess any sensitiveness 



in this direction. One should note, however, that, as Edwards' has recently pointed 



out, evidence is accumulating to show that a bacillus indistinguishable morphologically 



from the Klebs-Lceflfler organism and to be distinguished from it culturally only with 



an uncertain degree of accuracy exists more commonly than was supposed. This may 



possibly be the bacillus which Millard found gave a delayed growth in culture, i.e. 



only appearing after 48 hours' incubation, a most important point as regards diagnosis. 



It is perhaps unnecessary to discuss the question at greater length but this paper will 



have served its purpose if it induces observers in the Tropics, at least in dry climates, 



to be on the look-out for abnormal forms of the Klebs-Lteffler bacillus both in the human 



throat and upon the media used for isolation and cultivation. Personally, I believe 



that a coccal form of the true B. diphtheriie does exist in the Sudan and that under 



certain conditions it is capable of changing into the typical beaded and barred rods 



which eventually pass into the clubbed and swollen involution forms so characteristic of 



the Klebs-LoefBer organism. 



Addition.\l Note 



The following are the details of the case from which, in all probability, the infection 

 was originally derived. The clinical notes were kindly sent me by Dr. E. S. Crispin, 

 Assistant Director, Sudan Medical Department. It is of interest from two points of view. 



1. The presence of Klebs-Lceffler bacilli was masked by the presence of a spore- 

 forming organism of a septic type. 



2. This organism was probably responsible for a peculiar ulcerative condition of 

 the mucous membrane of the palate, tongue, gum and cheeks. 



Case of English officer, aged 46, found to be suffering, on November 27, 1909, from a a British 

 follicular tonsillitis of the right tonsil, and a rather large patch on the left. Temperature Officer infected 



at Khartoum 



100 F. 



Treated by formamint and a mixture containing potassium clilorate and cinchona bark. 

 November 28, 1909. No improvement. Temperature 99 F. Patch on left tonsil larger. 



Swab taken and sent for examination. A gargle of potassium chlorate and carbolic 



acid was substituted for the formamint. 



Edwards, A. D. (August, 1910), " The lucreasiug Difficulty of thu Diphtheria Carrier." The Practitioner. 



