occur in the Madras Presidency. In the month of October I was asked by Major Donovan, I.M.S., to examine a swab from the tliroat (»f a sus- pected case of diplitheria in a European child. No fragments of membrane were visible on the cotton, and 61m preparations made from the liquid squeezed out of it sliowed no bacilli in any way resembling those of diphtheria. In- oculation on white of egg, on agar and in broth gave rise to colonies of staphyh)cocci and streptococci only. Blood serum, being a trouble- some medium to prepare and one which I do not often require, was not available at the time. Still, diphtheria bacilli, if present in the swab, should have grown on the white of egg, and not finding any merely lent confirmation in my mind to the above-mentioned tradition. The case, nevertheless, Major Donovan informs me, clinically resembled true diphtheria in every respect, and unfortunately ended fatally within a few days.
To be ready, however, in the event of further attacks 1 cbtaiiied a supply of hydrocele fluid, which was collected aseptically in the operating theatre of the General Hospital, and inspissated it after the manner of blood serum at a temper- ature of 65** C. This gives a beautifully trans- parent, slightly opalescent medium, on which organisms which prefer serum grow readily. It is moreover obtainable in large quantities and is easily kept sterile from beginning to end, unlike blood brouglit from a distant slaughter- house. Stock laboratory cultures such as typhoid, Malta fever, Shiga's bacillus and anthrax do not flourish on it, whereas streptococci rhinos- cleroma, the Elebs-Loeflier and Hofmaun's bacilli grow well. A few days later I received from Major Donovan two other swabs taken from the throat of the English nurse who had been caring for the child, and now began to develop a membranous tonsillitis herself. From these colonies of streptococci, staphyloccci, the Klebs-Loeflier and Hofmann's bacilli were ob- tained on white of egg and the hydrocele slopes. The streptococci were diflScult to eliminate, and several days elapsed before a pure culture of the Klebs-LoefSer bacillus could be isolated and sown in alkaline glucose broth to test for the formation of acid. Plate cultures in hydrocele agar were employed.
The significance of the various organisms found in diphtheritic throats has not so far been definitely decided, and it is not yet possible to reconcile the results of equally reliable investigators in different countries. Briefly the present position is this. All observers are agreed that three types of bacilli may be distinguished :
(1) The true Klebs-Loeflier bacillus, which is polymorphic, virulent, acid-forming and shows granules with Neisser's stain.
^2) A bacillus morphologically indistinguish- able from (1), which also forms acid in alkaline glucose broth, but is non-virulent. This has
been described as an attenuated Klebs-LoefSer bacillus.
(3) Hofmann's bacillus, which somewhat re- sembles the Klebs-Loeflier in its morphological and cultural aspects, but does not form acid when grown in alkaline glucose broth, is non- virulent nnd shows no granules with Neisser's stain.
The controversial points are —
(a) Is (2) a distinct non-virulent bacillus, or is it at times capable of assuming virulency ?.
(b) Does (3; ever give rise to clinical diph- theria in the absence of (I) ?
(c) Is (3) invariably distinct from (1) and (2), or can it be transformed under certain con* ditions into (1) ?
(d) Are transitional forms between (1) and (3) met with or not?
My original culture on white of egg produced the long form of the genuine Klebs-Loeffler bacillus, the beading and clubbing of which were very well disj)layed by methyl violet. In sub- cultures on hydrocele slopes it quickly became rather shorter and more regular in shape, was often curved and retained the beading. It also exhibited the characteristic blue granules when stained by Neisser's method. It never formed threads, but the bacilli lay side by side or in irregular masses. When thinly distributed V, W and broad arrow figures were frequently noticed. Grown in alkaline glucose broth, it turned the medium strongly acid in 24 hours.
It grew well in ordinary brotii, and Ice. of a 24 hours old broth culture injected subeutane- ously wa.s fatal to a guinea-pig weighing 420 grams in 22 hours. Four hours before the ani- mal's death there was distinct oedema and red- ness over a considerable area round the seat of injection.
Post-mortem. Much fluid was found in both pleural and peritoneal cavities, and the supra- renal bodies were deeply congested and even hfiBmorrhftgic.
There is, therefore, no room for doubting that the nurse was suffering from diphtheria, though it proved to be a mild attack, and contracted it presumably from the child, and that, if suitable media had been rea<ly or further swabs had been taken from the child, the Elebs-Loeffler bacillus would have been recognised in that case also.
Whence the infection came in the first place it is impossible to say. The child had been in Madras for about six weeks and previously to that in Ootacamund. Several of the senior oflScera of the I. M. S. who have had extended experience both in the hills and in the plains have assured me that they do not remember ever to have seen a case which they have con* sidered clinically to have been undoubted diph- theria. I have myself on previous occasions examined swabs from a few patients in the General Hospital, Madras,, but with negative^ results. Old records are SUllF^ufficiently ex^r'^
