DIPHTHERIA CARRIERS 325 



bacilli disappear within a few days of the disappearance 

 of the membrane. Graham Smith found that in 9,000 

 cases of diphtheria recorded 30 per cent, are free from 

 diphtheria bacilli in three weeks, in another 20 per cent, 

 they linger for four weeks, in 16 per cent, for five weeks, 

 11 per cent, for seven weeks, and 1 per cent, for fifteen 

 weeks ; occasionally they persist longer. The writer 

 isolated them for so long as five months (and virulent to 

 the last) ; and a case is recorded in which they persisted 

 for no less than fifteen months after the attack. In all 

 cases two or three examinations should be made at short 

 intervals with negative results before the bacilli can be 

 pronounced to be absent, and no case should be discharged 

 from hospital until the absence of bacilli has thus been 

 proved. When bacilli persist, treatment with antiseptic 

 sprays or gargles, combined with irrigation of the nose, 

 may be tried, though usually it fails. Irrigation of the 

 nose is important, for the bacilli probably extend to the 

 post-nasal space, where they are untouched by a throat 

 spray or gargle. Other modes of treatment have also 

 been adopted. A polyvalent anti-microbic agglutinating 

 diphtheria serum has been prepared, dried, and com- 

 pressed into tablets, one of which is dissolved in the 

 mouth every two hours, and fifteen minutes after solution 

 the naso-pharynx is flushed with physiological salt solu- 

 tion. While this treatment sometimes succeeds, it often 

 fails. Kaolin, spraying with cultures of M . pyogenes, var. 

 aureus, and vaccines of the diphtheria bacillus have been 

 used. The writer has tried the use of subcutaneous 

 inoculations of diphtheria endotoxin (2-5 5-0, and 7-5 

 mgrm.) at intervals of seven to ten days. Of forty-four 

 cases treated in this way, thirty-four cases (77 per cent.) 

 cleared up after the second or third dose. 



With regard to the value to be attached to the bac- 

 teriological examination for diphtheria, while the finding 



