92 TAe Philippine Journal of Science 1920 
• As mentioned before, the hospital had been having an epi- 
demic of diphtheria, which at this time was being replaced by- 
sore throat of streptococcus origin. Many of the diphtheria 
cases, as proven by bacteriological findings, were of a very 
atypical character, and many cases proven not to be diphtheria 
had many of the local manifestations of the disease. It may 
be said here that, in not a few diphtheria cases, no membrane 
was present, the throat showing only marked oedema and con- 
gestion. We soon found that a very reliable early sign in 
diphtheria was oedema of the uvula. Some cases resembled 
a mild follicular tonsillitis, but in these cases the cervical ade- 
nitis was usually prominent. On the other hand the strepto- 
coccus throat often resembled that of diphtheria, frequently a 
thin membrane being present over the tonsils; but very rarely 
did we find the membrane extending to the pillars, as was the 
case in diphtheria. 
In the case under consideration, the local process manifesting 
itself as described in the throat, and being guided by the apparent 
toxemic condition of the patient, 22,000 units of diphtheria 
antitoxin were administered, after first endeavoring to desen- 
sitize the patient. The following day the report on the throat 
culture was returned from the laboratory. It showed strepto- 
coccus in nearly pure culture, which was later demonstrated to 
be a strain of the streptococcus hemolyticus. Blood count 
showed erythrocytes, 4,500,000; white count, 14,000; polymor- 
phonuclears, 75 per cent; hemoglobin, 82 per cent. The tem- 
perature was not unusual. 
■* On the afternoon of this day, the patient had a severe chill 
which was followed by a condition of clonic convulsions, lasting 
about an hour. Blood culture was taken, and spinal puncture 
performed. The spinal fluid was clear and showed a normal 
cell count and negative globulin. The local manifestations in 
the throat were somewhat improved, and continued to improve 
throughout the disease. No ulceration or deep-seated involve- 
ment occurred. 
The next day the condition of the patient was very much 
worse. Toxic symptoms were pronounced. The temperature 
reached 104° and showed marked remissions. The leucocyte 
count was 17,000. The blood culture was reported to have a 
growth. This growth was later proven to be streptococcus, and 
in such quantity as to fill nearly one-quarter of the flask. 
The case now resolving itself into a bactersemia and septicaemia, 
