40 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



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 somewhat 

 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 laboratory 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 advisable that every prac- 

 titioner 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 manufacturing 

 chemists and instrument-makers. A swab consists of a steel or 

 copper (aluminium would be better) wire, the extremity 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 sterilized 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. 6). It is allowed to cool in the 

 sterilizer, and the cork is pushed home into the tube as soon as it 

 is cold enough to handle. These swabs will keep indefinitely, 

 and a stock of them should always be kept at hand, as they are 



