A NOTE ON SEPTIC CARRIERS.

579 novocain bottle, and the sporothrices of Gougerot to the sporothrix of Beurmann ; this organism is and Jeanseln. Type III. (Torula Stoddart) contains no therefore quite distinct from members of the yeast yeasts obtained from control material. It is composed group so far studied. It is worthy of note that by the of two lymphadenoma yeasts and five other specimens complement-fixation test the sporothrix of Schenck of pathogenic yeasts from the National Collection of I is indistinguishable from that of Beurmann. TABLE II.

CONCLUSIONS.

By using washing of the test complement-fixation antigen

the yeast as be applied in the identification of various members of the yeast and sporothrix groups. (2) Specimens of thrush from ten successive cases, obtained (Oidium albicans), results. the complement-fixation identical By gave test all belong to one serological type. (3) Specimens of yeasts obtained from other sources have been studied, and are shown to fall into five types. (4) The sporothrices of Beurmann and Schenck appear to be and quite distinct from yeasts so far studied. The sporothrices of Gougerot and - Jeanseln appear be identical with black yeasts obtained from other 1.

a

saline

can

identical,

to

sources.

Stoddart ;

Gordon.

was carried out under the direction of Dr. Mervyn My thanks are due to him for permission to publish the results, and to his laboratory assistant, Mr. Type Cultures. Type V. is that of a yeast isolated from J. Haegerty, for invaluable practical help. a case of lymphadenoma, which has proved to have REFERENCES. pathogenic properties of considerable interest. Two 1. Schutze, A.: Zeit. f. Hyg. und Infect.-krankheit., 1903, other lymphadenoma yeasts and two specimens from xiv., 423. control material belong to this group. Type VI. 2. Same Author: Zeit. f. Immunitätsforsch., 1911, viii., 11. consists of two specimens only, both obtained from 3. Lichtenstein, S. : Arch. f. Anat. u. Physiol., 1914, p. 525.

I., Darbyshire ; II., Thrush; IIL, IV., Skipp. A. V., Barber ; VI., Rowe ; VII., Beurmann.

lymphadenoma cases. 3. The sporothrices of No

yeast

was

Beurmann and Schenck.to react with an antiserum

found

The work

4. Balls, A. K. : Jour. Immunol., 1925, x., 797. Mueller, J. H. and Tomcsik, J. : Jour. Exp. Med., 1924, xl., 343. 6. Tomcsik, J. : Zeit. f. Immunitätsforsch., 1930, lxvi., 8.

5.

CLINICAL AND LABORATORY NOTES SEVERE

DIPHTHERIA.

AN ACCESSORY METHOD OF TREATMENT.

BY B. A.

PETERS, M.D. CAMB.,

MEDICAL SUPERINTENDENT, HAM GREEN SANATORIUM AND HOSPITAL, BRISTOL, AND LECTURER IN FEVERS, UNIVERSITY OF BRISTOL.

Four to eight grains of thyroid are given daily and 20 minims of tinctura iodi mitis by mouth in milk four-hourly. These two drugs are given until the urine is free of albumin ; this sometimes takes three or four weeks, These drugs are extremely well borne, and no evidence of intoxication has shown itself, if the albuminuila is taken as If the patient is inclined to vomit in the second a guide. week the subcutaneous injection of a pint of 3-6 per cent. glucose will usually check it. one ounce.

undoubtedly saved desperately patients, and appears to THE accessory method of treating of paralysis. No more forms deadly is here outlined has been tried on a severe epidemic with encouraging results, the fatal case of diaphragmatic paralysis has occurred in death-rate being only 2-3 per cent., exactly half that this series. The preceding 600 cases provided four of the immediately preceding 600 cases. It is based such cases, although many of these received intraThe intravenous injections are someon the theory that diphtheria toxin (like other true venous serum. times and difficult, frequently need the exposure of acts as a toxins) positively-charged colloid, causing flocculation or gelation of the blood and tissueI a vein under 2 per cent. novocain. We are using proteins, and that the pathology of the disease is, at two 20 c.cm. record syringes, which are filled and least in part, explicable by the collection of these attached alternately to the needle in the vein. In floccules in the capillaries of important viscera. We the early stages of diphtheria the blood clots very think we have confirmed this theory by the dark rapidly in the damaged vein, so that the addition to ground examination of capillary serum in severe the glucose of sodium citrate (grs. 5 to the ounce) is. i cases. Antitoxin only neutralises toxin ; it does not an advantage. restore the floccules to their normal state of dispersion and electrical charge. The use of peptising ’! A NOTE ON SEPTIC CARRIERS. (as agents suggested by McDonagh’s work) would be BY LACHLAN GRANT, M.D., C.M., D.P.H. EDIN., a reasonable method of overcoming this. The treatment in

number of diphtheria which diminish the 730 cases during a

our

hands has ill

In severe cases in addition to the administration of full F.R.F.P.S. GLASG., doses (30,000 to 40,000 units) of antitoxin, of which part is BACTERIOLOGIST, DISTRICT COMMITTEES ARGYLL COUNTY COUNCIL, given intravenously, 6 to 7 ounces of 20 per cent. glucose CONSULTING MEDICAL OFFICER, BRITISH ALUMINIUM solution is given intravenously on admission. This produces COMPANY, KINLOCHLEVEN. an immediate improvement in the patient’s condition.

Occasionally a rigor may follow its use, but this never seems to do harm. The patient is also given one or two doses of contramine (0-125 g.) intramuscularly on succeeding days. The following mixture is given four-hourly by mouth until the urine is alkaline to litmus : sod. bicarb., grs. 30 ; pot. bicarb., grs. 5 ; calcii carb., grs. 7; aq. menth. pip. to

A

COMMON

group of diseases with which medical

practitioners have to deal is that of boils and local inflammatory and pustular skin infections, which occur more particularly on the fingers, hands, wrists9

580

forearms, back of the neck, and other skin

areas, the aid of prolonged rest for the mothers, the open papers1I have ulcers have responded to suitable treatment. It fully discussed the probability that some of these ought to be of interest to state that the men affected troublesome and painful local infections result from were outdoor manual workers, liable to abrasions and the daily use of the present type of toilet and wash- other surface injuries. hand lavatory basins. Most people wash their hands HAND-BASIN CONTAMINATION. and faces several times daily in stationary water This note is published with the suggestion that contained in the common unsterilised basins. They when these suppurative inflammatory infections deposit in this water and on the walls of the basin persistently recur, and where there is no systemic the dust and dirt particles from the skin surfaces, condition such as glycosuria or a chronic furuncular which carry minute harmless or harmful " bacterial state and where, in spite of pure water cleansings, passengers." By the usual bacteriological methods success is not achieved, it might be helpful to make these latter can be shown to be present in the polluted fuller and tactful inquiries in order to discover if basins. It is thus plain that by washing in such a there is not some carrier or harbourer of septic concentrated, contaminated fluid-medium, any micro- conditions in the home. Similar casual inflammatory organisms present are applied and reapplied, again attacks in families may also result from the presence and again, to the washed ( ) surfaces of the parts of septic teeth, chronic sinusitis, tonsillar infections, usually supposed to be correctly and properly otitic abscesses, leucorrhaeal discharges and furuncleansed. The result is that they are, to a large cular conditions generally. It is obvious that pus extent, deposited on the towels during the wiping from patients suffering from such diseases must and drying process. All this is surely quite unhygienic daily enter the wash-hand basins, contaminating and insanitary. After such washings it is little them and rendering them bacteriologically unclean. wonder, whenever we get a wound of the skin, an Against infection from such sources the only effective abrasion, or an epilated hair leaving an open follicle, precaution is to avoid washing in the stationary that staphylococcal, streptococcal or other pathofluid, and to use pure running water for all the daily genic organisms frequently enter the open and ablutions. This can be easily carried out by using exposed injured surface. These may then set up a combined elevated hot and cold water tap with a the complete infective and inflammatory process. or single medium-sized jet inlet. Such modern At any rate, one must admit there is every possi- spray and improved water faucets have already been fully bility of this happening. described by the writer in previous articles. Towels RECURRING BOILS. can always be boiled, but the sterilisation of every Recently instances have been noted where several wash-hand basin after each usage is an absolute members of the same family suffered at intervals impossibility. from recurring boils, or a too-ready inflammation of Hence the necessity for the raised flow as a simple even simple wounds sustained in the course of the preventive remedy for these and other largely day’s work, and it naturally occurred to me to go avoidable organismal infections. By the downward In several flush the dust and dirt particles, harbouring the more fully into the medical history. instances an obvious origin for these inflammatory pathogenic bacteria, are carried off direct to the waste and soil pipe. In this way there is no reapplicarepetitions was soon apparent. ’ In the case of two patients from the same house- tion of any infected microscopic suspended matter. hold, both of whom suffered within the past three This method is so obviously correct that it seems years from numerous boils, several wrist infections- almost incredible that such faucets are not installed one of a severe type with abscess formation necessi- forthwith in every home and institution where gravitating incision, following a transverse wound of the tation water is laid on. Instead, the old-fashioned, wrist-I found that the mother had a long-standing, primitive and dangerous toilet and lavatory basins, chronic and open varicose ulcer of the lower leg, with their close-up taps, are being used and fitted about 2 in. by 3t in. in size. In another male for washing in the stationary water. This, as already case with persistent periodic boils, it was discovered pointed out, favours the direct application of any that the mother had a large, chronic, septic leg sore. aggressive bacteria present, not only to the halfThese two poor and middle-aged women informed cleansed skin areas but to the naso-oral orifices as me they were quite distressed at their sons’ frequent well. These microbic organisms, being " considerloss of work and wages through boils and abscesses ately " rubbed in during the cleansing processes, which developed, in spite of repeated morning saline tend to inoculate the system, and any wounds or laxatives, a common method of prevention in abrasions of its cutaneous surface, with the possible many families. They did not realise that their risk of subsequently setting up one of the acute or own unhealthy integumentary systems were the chronic, local or general infectious diseases. likely carriers and distributors of the virulent ’ REFERENCES. organisms which caused these periodical infections ;I 1. Medical Caledonian

and at the nasal orifices.

In other

cultures from the chronic ulcers gave the usual

staphylococcal growths.

Medical Journal, World, 1929, xxxi., 38 ; 1929, xiv,, 47. 2. Medical Press, 1929, clxxviii., 98 ; Scottish Health Magazine, 1929, i., 183; Scottish Plumbers’ Magazine, 1929, vi., 55 and 44 ; Caledonian Medical Journal, 1929, xiv., 46.

In the treatment of these cases prophylactic aseptic daily cleansing by every member of the family was advised, and special mention was made of downward flushings from an elevated water tap. GONORRHŒA IN THE FEMALE CHILD. With one patient, in whose house no gravitation SOME POINTS IN TREATMENT. water-supply was laid on, the difficulty was overBY HAROLD G. BROADBRIDGE, M.B., B.S. LOND., come by washing at a nearby water spout-a natural CLINICAL ASSISTANT, GENITO-URINARY DEPARTMENT, running tap. Clean towels and garments were also LONDON HOSPITAL. recommended and, subject to careful local and general attention, with the occasional exhibition of a polyvalent IN treating gonorrhoea in female children it is staphylococcal vaccine, the boils and inflammations were cured, and for the past year difficult to obtain an even and thorough application there have been no recurrences. Meanwhile, with of a lotion or paint to the mucous membrane of the