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novocain bottle, and the sporothrices of Gougerotand Jeanseln. Type III. (Torula Stoddart) contains noyeasts obtained from control material. It is composedof two lymphadenoma yeasts and five other specimensof pathogenic yeasts from the National Collection of I

TABLE II.

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

Type Cultures. Type V. is that of a yeast isolated froma case of lymphadenoma, which has proved to havepathogenic properties of considerable interest. Twoother lymphadenoma yeasts and two specimens fromcontrol material belong to this group. Type VI.consists of two specimens only, both obtained fromlymphadenoma cases.

3. The sporothrices of Beurmann and Schenck.-No yeast was found to react with an antiserum

to the sporothrix of Beurmann ; this organism istherefore quite distinct from members of the yeastgroup so far studied. It is worthy of note that by thecomplement-fixation test the sporothrix of Schenckis indistinguishable from that of Beurmann.

CONCLUSIONS.

1. By using a saline washing of the yeast as

antigen the complement-fixation test can be appliedin the identification of various members of the yeastand sporothrix groups. (2) Specimens of thrush(Oidium albicans), obtained from ten successive cases,gave identical results. By the complement-fixationtest all belong to one serological type. (3) Specimensof yeasts obtained from other sources have been studied,and are shown to fall into five types. (4) The sporo-thrices of Beurmann and Schenck appear to be

identical, and quite distinct from yeasts so far studied.The sporothrices of Gougerot and - Jeanseln appearto be identical with black yeasts obtained from othersources.

The work was carried out under the direction of Dr. MervynGordon. My thanks are due to him for permission topublish the results, and to his laboratory assistant, Mr.J. Haegerty, for invaluable practical help.

REFERENCES.

1. Schutze, A.: Zeit. f. Hyg. und Infect.-krankheit., 1903,xiv., 423.

2. Same Author: Zeit. f. Immunitätsforsch., 1911, viii., 11.3. Lichtenstein, S. : Arch. f. Anat. u. Physiol., 1914, p. 525.4. Balls, A. K. : Jour. Immunol., 1925, x., 797.

5. Mueller, J. H. and Tomcsik, J. : Jour. Exp. Med., 1924, xl.,343.6. Tomcsik, J. : Zeit. f. Immunitätsforsch., 1930, lxvi., 8.

CLINICAL AND LABORATORY NOTES

SEVERE DIPHTHERIA.AN ACCESSORY METHOD OF TREATMENT.

BY B. A. PETERS, M.D. CAMB.,MEDICAL SUPERINTENDENT, HAM GREEN SANATORIUMAND HOSPITAL, BRISTOL, AND LECTURER IN FEVERS,

UNIVERSITY OF BRISTOL.

THE accessory method of treating diphtheria whichis here outlined has been tried on 730 cases duringa severe epidemic with encouraging results, thedeath-rate being only 2-3 per cent., exactly half thatof the immediately preceding 600 cases. It is basedon the theory that diphtheria toxin (like other truetoxins) acts as a positively-charged colloid, causingflocculation or gelation of the blood and tissue Iproteins, and that the pathology of the disease is, atleast in part, explicable by the collection of thesefloccules in the capillaries of important viscera. Wethink we have confirmed this theory by the darkground examination of capillary serum in severe

cases. Antitoxin only neutralises toxin ; it does not i

restore the floccules to their normal state of disper-sion and electrical charge. The use of peptising ’ !agents (as suggested by McDonagh’s work) would bea reasonable method of overcoming this.

In severe cases in addition to the administration of full doses (30,000 to 40,000 units) of antitoxin, of which part isgiven intravenously, 6 to 7 ounces of 20 per cent. glucosesolution is given intravenously on admission. This producesan immediate improvement in the patient’s condition.Occasionally a rigor may follow its use, but this never seemsto do harm. The patient is also given one or two doses ofcontramine (0-125 g.) intramuscularly on succeeding days.The following mixture is given four-hourly by mouth untilthe urine is alkaline to litmus : sod. bicarb., grs. 30 ; pot.bicarb., grs. 5 ; calcii carb., grs. 7; aq. menth. pip. to

one ounce. Four to eight grains of thyroid are given dailyand 20 minims of tinctura iodi mitis by mouth in milkfour-hourly. These two drugs are given until the urine isfree of albumin ; this sometimes takes three or four weeks,These drugs are extremely well borne, and no evidence ofintoxication has shown itself, if the albuminuila is taken asa guide. If the patient is inclined to vomit in the secondweek the subcutaneous injection of a pint of 3-6 per cent.glucose will usually check it.The treatment in our hands has undoubtedly saved

a number of desperately ill patients, and appears todiminish the more deadly forms of paralysis. Nofatal case of diaphragmatic paralysis has occurred inthis series. The preceding 600 cases provided foursuch cases, although many of these received intra-venous serum. The intravenous injections are some-times difficult, and frequently need the exposure ofa vein under 2 per cent. novocain. We are usingtwo 20 c.cm. record syringes, which are filled andattached alternately to the needle in the vein. Inthe early stages of diphtheria the blood clots veryrapidly in the damaged vein, so that the addition tothe glucose of sodium citrate (grs. 5 to the ounce) is.an advantage.

A NOTE ON SEPTIC CARRIERS.

BY LACHLAN GRANT, M.D., C.M., D.P.H. EDIN.,F.R.F.P.S. GLASG.,

BACTERIOLOGIST, DISTRICT COMMITTEES ARGYLL COUNTY COUNCIL,CONSULTING MEDICAL OFFICER, BRITISH ALUMINIUM

COMPANY, KINLOCHLEVEN.

A COMMON group of diseases with which medicalpractitioners have to deal is that of boils and localinflammatory and pustular skin infections, whichoccur more particularly on the fingers, hands, wrists9

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forearms, back of the neck, and other skin areas,and at the nasal orifices. In other papers 1 I havefully discussed the probability that some of thesetroublesome and painful local infections result fromthe daily use of the present type of toilet and wash-hand lavatory basins. Most people wash their handsand faces several times daily in stationary watercontained in the common unsterilised basins. Theydeposit in this water and on the walls of the basinthe dust and dirt particles from the skin surfaces,which carry minute harmless or harmful " bacterial

passengers." By the usual bacteriological methodsthese latter can be shown to be present in the pollutedbasins. It is thus plain that by washing in such aconcentrated, contaminated fluid-medium, any micro-organisms present are applied and reapplied, againand again, to the washed ( ) surfaces of the partsusually supposed to be correctly and properlycleansed. The result is that they are, to a largeextent, deposited on the towels during the wipingand drying process. All this is surely quite unhygienicand insanitary. After such washings it is littlewonder, whenever we get a wound of the skin, anabrasion, or an epilated hair leaving an open follicle,that staphylococcal, streptococcal or other patho-genic organisms frequently enter the open andexposed injured surface. These may then set upthe complete infective and inflammatory process.At any rate, one must admit there is every possi-bility of this happening.

RECURRING BOILS.

Recently instances have been noted where severalmembers of the same family suffered at intervalsfrom recurring boils, or a too-ready inflammation ofeven simple wounds sustained in the course of theday’s work, and it naturally occurred to me to gomore fully into the medical history. In severalinstances an obvious origin for these inflammatoryrepetitions was soon apparent. ’

In the case of two patients from the same house-hold, both of whom suffered within the past threeyears from numerous boils, several wrist infections-one of a severe type with abscess formation necessi-tating incision, following a transverse wound of thewrist-I found that the mother had a long-standing,chronic and open varicose ulcer of the lower leg,about 2 in. by 3t in. in size. In another malecase with persistent periodic boils, it was discoveredthat the mother had a large, chronic, septic leg sore.These two poor and middle-aged women informedme they were quite distressed at their sons’ frequentloss of work and wages through boils and abscesseswhich developed, in spite of repeated morning salinelaxatives, a common method of prevention inmany families. They did not realise that theirown unhealthy integumentary systems were thelikely carriers and distributors of the virulent ’

organisms which caused these periodical infections ; Icultures from the chronic ulcers gave the usualstaphylococcal growths.

In the treatment of these cases prophylacticaseptic daily cleansing by every member of thefamily was advised, and special mention was madeof downward flushings from an elevated water tap.With one patient, in whose house no gravitationwater-supply was laid on, the difficulty was over-

come by washing at a nearby water spout-a naturalrunning tap. Clean towels and garments were alsorecommended and, subject to careful local andgeneral attention, with the occasional exhibition ofa polyvalent staphylococcal vaccine, the boils andinflammations were cured, and for the past yearthere have been no recurrences. Meanwhile, with

the aid of prolonged rest for the mothers, the openulcers have responded to suitable treatment. Itought to be of interest to state that the men affectedwere outdoor manual workers, liable to abrasions andother surface injuries.

HAND-BASIN CONTAMINATION.

This note is published with the suggestion thatwhen these suppurative inflammatory infectionspersistently recur, and where there is no systemiccondition such as glycosuria or a chronic furuncularstate and where, in spite of pure water cleansings,success is not achieved, it might be helpful to makefuller and tactful inquiries in order to discover ifthere is not some carrier or harbourer of septicconditions in the home. Similar casual inflammatoryattacks in families may also result from the presenceof septic teeth, chronic sinusitis, tonsillar infections,otitic abscesses, leucorrhaeal discharges and furun-cular conditions generally. It is obvious that pusfrom patients suffering from such diseases must

daily enter the wash-hand basins, contaminatingthem and rendering them bacteriologically unclean.Against infection from such sources the only effectiveprecaution is to avoid washing in the stationaryfluid, and to use pure running water for all the dailyablutions. This can be easily carried out by usinga combined elevated hot and cold water tap with aspray or single medium-sized jet inlet. Such modernand improved water faucets have already been fullydescribed by the writer in previous articles. Towelscan always be boiled, but the sterilisation of everywash-hand basin after each usage is an absoluteimpossibility.

Hence the necessity for the raised flow as a simplepreventive remedy for these and other largelyavoidable organismal infections. By the downwardflush the dust and dirt particles, harbouring thepathogenic bacteria, are carried off direct to thewaste and soil pipe. In this way there is no reapplica-tion of any infected microscopic suspended matter.This method is so obviously correct that it seemsalmost incredible that such faucets are not installedforthwith in every home and institution where gravi-tation water is laid on. Instead, the old-fashioned,primitive and dangerous toilet and lavatory basins,with their close-up taps, are being used and fittedfor washing in the stationary water. This, as alreadypointed out, favours the direct application of anyaggressive bacteria present, not only to the half-cleansed skin areas but to the naso-oral orifices aswell. These microbic organisms, being " consider-ately " rubbed in during the cleansing processes,tend to inoculate the system, and any wounds orabrasions of its cutaneous surface, with the possiblerisk of subsequently setting up one of the acute orchronic, local or general infectious diseases.

REFERENCES.

1. Medical World, 1929, xxxi., 38 ; Caledonian Medical Journal,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.

GONORRHŒA IN THE FEMALE CHILD.SOME POINTS IN TREATMENT.

BY HAROLD G. BROADBRIDGE, M.B., B.S. LOND.,CLINICAL ASSISTANT, GENITO-URINARY DEPARTMENT,

LONDON HOSPITAL.

IN treating gonorrhoea in female children it isdifficult to obtain an even and thorough applicationof a lotion or paint to the mucous membrane of the