the disease is diphtheria. Some of the material from the suspected person's throat is obtained by rubbing the latter with a rod having a piece of sterilized cotton wound around its end, and then the cotton is rubbed over a sterilized mixture of blood-serum contained in a closed test-tube, so as to transfer any microorganisms from the cotton to the serum. The test-tube is placed in an incubating oven and within twenty-four hours the character of the growth of micro-organisms may be decided. In one year Dr. Park and his assistant, Mr. A. Beebe, made bacteriological examinations of 5,611 cases of suspected diphtheria, and the bacilli of true diphtheria were only found in 3,255 cases, or fifty-eight per cent, twenty-seven per cent of the cases being pseudo-diphtheria, and fifteen per cent being of a doubtful character. This seems to prove conclusively that every case suspected of being diphtheria must be examined bacteriologically by an expert.
The affected person should be regarded as infectious from the moment the diphtheria bacilli are found to be present upon the mucous membranes, and, while the bacilli usually disappear with or soon after the disappearance of the local signs, yet in some cases they may remain in an active and virulent state for weeks and even months after the patient has apparently recovered. Therefore no patient should be discharged as recovered until at least two or three bacteriological examinations, made at different times, have failed to reveal the presence of the Klebs-Loeffler bacillus in the secretions of the air passages.
Diphtheria is most rapidly communicated by direct contact between the sick and healthy persons. Coughing, sneezing, spitting, kissing, holding the patient's hands, the use of utensils in contact with the patient, drink or food in the sick-room, and clothing, books, and toys may be the media for carrying the bacilli. From this it may be appreciated that the diphtheria patient must be isolated either in a separate room in the house or in an isolation ward, and that there must be thorough disinfection of all articles in contact with the patient, as well as a local antibacillary treatment of the nose and throat to remove the bacilli and thus limit the possibility of their dissemination.
When diphtheria is prevalent the best prophylactic measures are cleanliness, dryness, ventilation, and proper light in dwelling rooms; cleanliness of the nose and mouth that may be secured by thorough daily irrigation with a one-per-cent solution of common salt or a two-and-half-per-cent solution of common baking soda, used as hot as can be borne, with careful brushing of the teeth and medical care of the tonsils if enlarged or diseased; and, finally, cold ablutions of the neck.
The difficulty heretofore referred to of distinguishing, by the
