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THE STRAND DISTRICT, LONDON. 143
cow or the milkman. The questions which seem to me
to require answering are—
(1.) What are the conditions which favour the
growth of the bacillus ?
(2.) What steps should be taken for its prompt
recognition ? and
(3.) For the prevention of the further spread of
the disease?
The solution to both the first and the last of these
questions depends upon the prompt recognition of the
disease, because, unless the diagnosis is correct, any
conclusions which may be drawn must necessarily be
fallacious. Without demonstrating the presence of the
bacillus of diphtheria in each case, it is frequently
impossible to say that a membranous inflammation of
the throat is the true disease, and on the other hand
cases have been recorded in which the bacillus has
been found, while the symptoms and appearances were
not at all characteristic. The necessity for making
certain has been recognised by the New York Health
Department, who have issued a circular* to medical
men there, explaining the arrangements made for
this purpose. They say: "The differential diagnosis
"between true and false diphtheria can be made by
"bacteriological examinations within twelve hours, while
"without their assistance it is difficult or impossible.
"The Health Department is now prepared to make
"use of bacterial cultures in all cases of suspected
"diphtheria." The circular then proceeds to say that
the medical man in charge may obtain the necessary
culture tube free of cost from various centres, to which
*Journal of Laryngology, October, 1893.