40 CLINICAL BACTERIOLOGY AND H^EMATOLOGY 



lives within easy reach of the laboratory (so that the swabs 

 may reach it quickly) it is his bounden duty to avail himself of 

 the opportunity thus afforded of getting a free opinion from a 

 specialist. 



But the case of a practitioner living at a distance is some- 

 what different. Suppose the patient is seen on the first day 

 of the illness, an unusual occurrence except in an epidemic. 

 The swab is taken, despatched by post, and reaches the labora- 

 tory on the second day. It is inoculated, and the culture is 

 'incubated and examined on the third day, the result reaching 

 the practitioner about noon on that day. Now the mortality 

 of diphtheria which is treated with antitoxin on the first day is 

 very small certainly less than 5 per cent. while the mortality 

 in cases in which its use is not commenced until the third day 

 is much higher probably from 10 to 15 per cent., or even 

 higher. In other words, from five to ten patients out of every 

 hundred lose their lives if the doctor waits for the result of 

 the bacteriological examination. It is therefore highly advis- 

 able that every practitioner should provide himself with a 

 bacteriological microscope, and should at least examine a film 

 prepared directly from the swab and stained in the manner 

 described below. He should also make cultures or send a 

 swab to the laboratory for examination. 



Swabs and outfits are provided by the laboratory where the 

 examination is made, or can be bought from most manufac- 

 turing chemists and instrument-makers. A swab consists of a 

 steel or copper (aluminium would be better) wire, the extrem- 

 ity of which is covered drumstick fashion with a tightly fitting 

 roll of cotton-wool. The other end is pushed through a cork, 

 and the whole is contained in a stout glass tube. It is steri- 

 lized before use. These swabs may be readily made at home. 

 'A test-tube is fitted with a good cork through which is passed 

 a stout steel knitting-needle. This should be long enough to 

 pass nearly to the bottom of the tube when the cork is in 

 place, and the end which is to be outside the tube should be cut 

 off short. The other must be roughened by a few strokes of a 

 file. A small piece of cotton-wool (unmedicated) is then held 

 between the thumb and finger of the left hand, transfixed with 

 the roughened end of the wire, and twisted round it. The 

 swab is now placed loosely in the tube and sterilized by dry 

 heat (see ante, p. 3). It is allowed to cool in the sterilizer, and 



