The diagnosis and management of doubtful cases of diphtheria : being an address delivered before the Medical Officers of Schools Association on November 26th, 1903 / by F. Foord Caiger ; issued by the Medical Officers of Schools Association.

  • Caiger, F. Foord.
Date:
1904
Catalogue details

Licence: In copyright

Credit: The diagnosis and management of doubtful cases of diphtheria : being an address delivered before the Medical Officers of Schools Association on November 26th, 1903 / by F. Foord Caiger ; issued by the Medical Officers of Schools Association. Source: Wellcome Collection.

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    DOUBTFUL CASES OF DIPHTHERIA. o o in respect to purely nasal diphtheria, which is very likely to escape detection altogether, especially when, as is usually the case, the patient presents but little if any indication of illness. It is to the purely nasal cases that I am referring. Instances in which the nasal cavities are involved, either by extension, or concurrently with the fauces, are, as is well known, characterised by more than average severity. These nasal cases are a distinct source of danger to the community by reason of the insidious character of the affection, and in many cases their existence has only been revealed after the lapse of a considerable period of time by their having infected other persons with severe and even fatal diphtheria. The havoc which may result from a single unrecognised case of nasal diphtheria in a school, insti¬ tution, or ward in a children’s hospital may be easily imagined, and need hardly be seen to be appreciated, and in any inves¬ tigation into the source of an apparently sporadic outbreak of diphtheria, the importance of carefully examining the con¬ dition of the nasal cavities of those who have been in contact with the sick cannot well be over-estimated. Although a considerable amount of assistance in the diagnosis of doubtful cases of diphtheria is usually to be derived from a careful consideration of the clinical appearances, it is hardly going too far to say that at the present day the nature of a doubtful attack is practically determined by the result of bacterio¬ logical examination. Now, without intending for a moment to minimise the immense importance of bacteriological exami¬ nation in the hands of an expert observer, it cannot be denied that the insufficiency of our present knowledge on certain im¬ portant points connected with the bacteriology of diphtheria, apart from a fallacy which is inseparable from the method itself, materially detracts from the complete reliability of the bac¬ teriological test. I refer more particularly to the difficulty which is frequently experienced in the identification of the bacillus, owing to our uncertainty as to the limits of intranormal variation, both in respect to its form and virulence. The fact has long been recognised that in diphtheritic as in doubtful and even healthy throats, bacilli are not infrequently found, which, more or less, closely resemble the diphtheria bacillus, but which are innocuous when injected into animals. It has been customary to refer to such organisms collectively as “ pseudo-diphtheria ” bacilli, without regard to certain important differences which are now recognised as existing between them. The term has proved an unfortunate one, as tending to cause confusion and its use should certainly be restricted. Indeed, it would be better that the term “ pseudo-diphtheria ” were dropped alto¬ gether. The organism which has been most frequently referred