Clinical sketches illustrative of practical medicine and surgery / ed. by Noble Smith.
- Date:
- 1895
Licence: Public Domain Mark
Credit: Clinical sketches illustrative of practical medicine and surgery / ed. by Noble Smith. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
19/54 page 9
![0 L()ffler bacillus, but which are found to be non-virulent when tested on animals. These pseudo-bacilli are only rarely met with, their exact nature is doubtful, and their occurrence does not constitute a practical objection to the bacteriological method of diagnosis. The occasional error which they may iiossibly intro- duce is one on the safe side. The Public Health Service of New York now gives the greatest facilities for the bacteriological diagnosis of diphtheria. At a number of stations a ‘ culture outfit can be obtained. This is a small box in which are two test tubes, the one a tube of sterilised blood- serum, the other containing a sterilised swab. The phj sician, having made the inoculation in the manner described above, returns the tube to the station, where it is incubated and examined, and the next morning a report is forwarded to him. II hen shall we have a like condition of things in this country? ,_Many laboiatories d'c. now provide the necessary ‘ culture- outfits,’ and undertake the examination of the inoculated tubes and furnish leports thereon for a small fee. For further information on the method of diagnosis described the reader is referred to two papers in the Aledicul liecovd (New Vork); (1) September 15, 1894, p. 321, Biggs; (2) September 29, 1894, p. 385, Park and Beebe.] ANTITOXIN TEEATMENT OF DIPHTHERIA By the time this article appears in print it is pro- bable that every practitioner throughout the country will be well informed of the progress of this new method of treatment; antitoxin being noiv recognise not only as a legitimate remedy, but as one which no medical man is justified in neglecting to- make use of. IVe propose now to sketch, as far as maybe useful, the present aspect of the matter, and describe the points which may be helpful in the application of the treatment. Preparation of antitoxin.—It is doubtless well known to our readers that the horse is the animal which is most suitable for the purpose of the prepara- tion of antitoxin. How the preparation is made.—Horses are inocu- lated with the toxin, and gradually made to stand stronger doses. When the animals can bear con- siderable doses of the toxin without showing signs of ill health, the serum of the blood becomes the anti- dote or cure or remedy for diphtheria. Dr. Sims II oodhead gave a lecture upon the diagnosis and antitoxin treatment of diphtheria at the Examination Hall of the Royal College of Physicians and Surgeons on Friday, December 7, 1894. He urged the importance of an early diagnosis of di- phtheria. The bacilli are almost invariably found on the surface of the false membrane, although some- times more deeply; but seldom, if ever, in the mucosa. The Ifetropolitan Asylums Board have taken this matter up very enthusiastically, and Dr. Sims Wood- head, as director of the Research Laboratories, is sending out to the hospitals under the management of that Board small cases containing apparatus for collecting specimens for examination. The contents of these cases are as follows : {a) a test tube (plugged with sterilised cotton wadding) in wdiich is a quantity of suitable solidified nutrient medium carefully steri- lised ; {h) a second tube also plugged with cotton wadding, in which is held a small soft steel rod, roughened at the end, around w’hich is fastened a pledget of cotton wadding, the whole being carefully sterilised by dry heat. When a case of diphtheria is to be examined, all that is necessary to be done is to take these tubes from the box, take out the wire with the pledget of cotton wool, and press it gently but firmly against the membrane in the throat, or at the place from which the membrane has disappeared. The serum tube is then opened, and the pledget is drawn carefully once or twice from bottom to top of the in- clined serum surface. The cotton wadding iilug is returned, the wire with the pledget is replaced in the empty tube, and the box is packed up and sent at once for investigation at the Laboratories. In those cases in which fragments of the membrane can be easily detached, it is advisable with a platinum spatula, previously heated and allowed to cool, to remove a fragment and to place this in the tube along with the iron wire and its pledget. Such a fragment may be used in case the first inoculation fails to give the necessary results. The serum tube is placed in the incubator, and is examined at intervals until grow’ths make their appearance, eight to twenty hours at the latest, so that the ease, even when inoculations are to be made, can be reported upon within twenty- four hours of the receipt of the material’ The lecturer further described the success winch has already attended this treatment, especially in Paris, where the deaths have been reduced to the extent of 30, and in some cases to 50, per cent. In the foregoing paper by Dr. Hewlett a somewhat similar method is described.— En.](https://iiif.wellcomecollection.org/image/b2247383x_0021.jp2/full/800%2C/0/default.jpg)
