^°jui^^92o: }        Experience  of  a  Pharmacist,  Etc.  445 
ticulation  that  the  hemolytic  streptococcus  has  invaded  may  be 
considered  as  irretrievably  lost  and  any  bone  tissue  it  has  touched 
will  for  months  and  years  carry  traces  of  the  infection.  Naso- 
pharyngeal cultures  for  the  hemolytic  streptococcus,  of  the  officers, 
nurses  and  ward  masters,  all  those  having  occasion  to  dress  wounds, 
were  taken  at  frequent  intervals. 
When  the  wound  no  longer  discharged  freely  and  there  were  in- 
dications of  granulation,  smears  were  taken  at  intervals  of  several 
days  to  determine  the  average  number  of  organisms  per  field.  When 
this  figure  did  not  exceed  five  it  was  safe  to  attempt  suture,  however, 
under  no  circumstances  should  a  wound  be  closed  showing  the  pres- 
ence of  streptococci.  We  prepared  a  limited  number  of  autogenous 
vaccines  from  wounds.    Their  use  has  not  been  very  extensive. 
Located  among  the  hills  under  fairly  ideal  climatic  conditions, 
our  organization  was  selected  as  a  center  or  clearing  house  for  gassed 
patients  and  tuberculosis  suspects.  A  man  who  is  severely  gassed 
develops  into  the  clinical  picture  of  tuberculosis  and  the  treatment 
is  practically  the  same.  So  great  was  the  number  of  specimens 
of  sputa  submitted  to  the  laboratory  that  we  were  compelled  to 
limit  the  number  to  be  examined  daily  to  fifty.  Ten  specimens  of 
each  patient  were  submitted;  if  no  tubercle  bacilli  were  detected 
in  that  time,  no  further  specimens  were  submitted  for  thirty  days. 
A  positive  report  automatically  placed  the  patient  in  Class  D — 
those  incapacitated  for  any  further  service  in  the  A.  E.  F. 
During  the  winter  we  generally  had  a  half  dozen  or  more  cases 
of  clinical  diphtheria  in  isolation,  none  ever  proving  fatal.  Like 
everywhere,  the  culture  and  isolation  of  carriers  is  a  problem.  Three 
cases  developed  simultaneously  among  two  hundred  Bosche  pris- 
oner convalescents  who  were  quartered  in  a  barn.  At  that  time 
it  would  have  been  impossible  to  take  that  number  of  cultures, 
therefore  the  only  ones  cultured  were  those  having  inflamed  areas 
in  the  throat. 
Sporadic  cases  of  epidemic  cerebro-spinal  meningitis  developed 
from  time  to  time,  the  majority  proving  fatal.  Our  routine  pro- 
cedure in  the  examination  of  spinal  fluid  was  to  make  a  Pandy  test 
for  globulin;  a  leucocyte  and  differential  leucocyte  count;  cultures 
for  pneumococci  on  Lofflers'  blood  serum;  for  streptococci  on  dex- 
trose agar,  and  for  meningococci  on  dextrose  sheep's  serum  agar. 
A  Wasserman  test  was  also  made.  The  culture  of  contacts  was  a 
much  greater  problem  than  in  diphtheria,  satisfactory  cultures  being 
