1899] MICROSCOPICAL JOURNAL. 269 



and into the back of the nostrils, or they will fail no mat- 

 ter how well adapted by their chemical and physical pro- 

 perties to destroy the bacillus. In like manner the anti- 

 toxin, if used for purposes of immunization, requires to 

 be of proper strength, and given early. It is safe to say 

 that without the use of such measures, and quarantine of 

 proper duration, diphthera will inevitably spread. But 

 even when all these precautions have been employed 

 thoroughly they may fail to eradicate the disease from 

 particular localities. In other words the growth of the 

 bacillus in the throat, whether in typical or atypical forms 

 does not account for the manner in which diphtheria 

 sometimes remains endemic in a particular household or 

 neighborhood in spite of quarantine and throat disinfec- 

 tion. A very notable instance of this sort was reported 

 at the Montreal meeting of the British Medical Associa- 

 tion last year, and again at the American Public Health 

 Association at Ottawa this year. In this case diphtheria 

 has continued to recur in a state school in Minnesota at 

 frequent intervals for ten years in spite of the most elab- 

 orate precautions. In the British Medical Journal for 

 April 16th, 1898, at page 1009, it is stated that an atypi- 

 cal variety of the diphtheria bacillus, supposed to be the 

 cause of the trouble in this school, was found to be con- 

 fined strictly to inmates of the institution, with one ex- 

 ception of 24,000 examinations. In other words there 

 was no endemic prevalence of anything of the sort in the 

 town adjacent, or anywhere else in the state, so far as 

 was known, except in this particular school. Presuma- 

 bly antitoxin, throat disinfection, and quarantine, were 

 all employed with thoroughness commensurate with the 

 interest that such a state of affairs, and its wide publica- 

 tion, would arouse, and yet the disease continued to recur. 

 It would seem evident in such a case that there must 

 be some other method of propagation of the bacillus than 

 iu human throats, and that the culture medium, whatever 



