DIPHTHERIA 4I 



very handy for other purposes. After use the cotton-wool should 

 be burnt off in a Bunsen burner or spirit-lamp, and another piece 

 applied and the whole resterilized. 



If a practitioner should see a supposed case of diphtheria when 

 he is unprovided with a swab he can readily extemporize one 

 which will answer sufficiently well out of some cotton-wool (non- 

 medicated), a wooden skewer or pen-holder, and a glass phial. 

 The wool is wrapped round the tip of the skewer, and (after the 

 swab has been taken) the latter is placed in the phial in such a 

 position that the cotton-wool does not touch the glass ; the place 

 between the skewer and the neck of the bottle is plugged with 

 cotton-wool. It is not absolutely necessary to sterilize the swab, 

 although it is a very great advantage to do so if time permits. 



The method of taking the swab is of great importance, and must 

 be carried out in full detail. It is necessary that the patient 

 should not have had an antiseptic gargle or application for at 

 least two hours previously. It is also advisable tQ allow him to 

 drink some beef -tea or boiled water [not milk, for this may contain 

 certain bacilli which closely resemble those of diphtheria) imme- 

 diately before the process. This will serve to cleanse the parts. 



Requisites. — i. A good light. 



2. The swab in its tube. 



3. A tongue depressor. The form which is hinged so as to 

 bend at a right angle is most convenient. 



4. A vessel containing antiseptic lotion or boiling water. 

 Method.— 1. Place the patient so as to face the light. If a 



small child, he should be held on his nurse's lap, with a blanket 

 wrapped round his chest so as to restrain his arms. 



2. Loosen the cork in the tube so that the swab may be with- 

 drawn with one hand, and place it at a convenient spot on your 

 right side. 



3. Get the patient to open his mouth, insert the tongue 

 depressor (held in the left hand), and get a clear view of the 

 area chiefly affected. Do not proceed with the process (if it can 

 be avoided) until you have done this. 



4. Take the cork between the finger and thumb of the right 

 hand and pass the swab into the patient's mouth, taking great 

 care not to touch his lips, tongue, or palate. Press it firmly 

 against the area which you wish to examine, and rotate it between 

 the finger and thumb so as to remove some of the secretion, and, 

 if possible, some of the membrane. Withdraw the swab, again 



