The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    1036/1182 (page 978)
    spoon to discover bacilli.* It is therefore important in all cases to con- sider the duration of the disease before drawing a conclusion from a nega- tive culture. If the case is one of laryngeal disease without pharyngeal exudation, a negative culture from the pharynx in the early stage is not uncommon, although a little later bacilli may be coughed up and found in the pharynx in abundance. Hence negative results are most frequent late in pharyngeal and early in laryngeal cases. A single negative culture is never to be taken as conclusive, although in most conditions other than those mentioned it may be so regarded. The next question for consideration is how far one is justified, from the microscopical appearances of bacilli and from their mode of growth, in deciding that they are virulent, without resorting to the test of animal inoculations. The consensus of opinion among bacteriologists at the pres- ent time is that, for diagnostic purposes, all bacilli present in suspicious throats, having the morphological and cultural characteristics of diph- theria bacilli are to be regarded as virulent unless the contrary is proved, the latter being very infreqnent. This is equally true of bacilli from both mild and severe cases, for it is well known that the most virulent bacilli are often found in cases clinically of a mild type. Non-virulent hacilli resembling the Loeffler bacillus.—There may be found in throats two forms of bacilli which resemble the diphtheria bacil- lus and which may occasionally be a source of error. The first is the non- virulent diphtheria bacillus, a form which corresponds in every other characteristic with the Loeflfler bacillus, but which lacks virulence as shown by animal tests. The exact status of this form is not yet fully determined. The view most widely accepted is that of Roux and Yersin—viz., that they are simply diphtheria bacilli which have lost their virulence. The other form, though in many particulars resembling the Loeffler bacillus, differs from it in being shorter, plumper, and more uniform in size, and in pro- ducing an alkali in broth cultures ; to this the term pseudo-diphtheria bacillus \ (Plate XVIII, 6) has been given. It is more frequently seen than the form just described and like it is non-virulent. Both these forms of bacteria are rare in throats where a suspicion of diphtheria exists. The presence of virulent bacilli in the throats of healthy persons.— That virulent bacilli may be harboured for an indefinite period in the throat * Dr. Martha Wollstein, pathologist to the Babies' Hospital, has reported to me the following case illustrating this point: The first swab from a doubtful exudate upon the tonsil revealed the Loeffler bacillus. The case was reported to the Board of Health, ■who a day or two later took a culture frona the throat, the exudate having at that time disappeared, and reported the case as negative. On the following day Dr. Wollstein made a second culture from the tonsillar crypts, finding as before the Loeffler bacilli in great numbers. Such cases indicate how great caution must be observed in drawing conclusions from negative cultures, especially if made late. \ An unfortunate term, as this bacillus has nothing to do with the form of angina classed as pseudo-diphtheria, which is generally due to the streptococcus.