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36
in isolated towns only, but it has been reported from many towns
in almost every part of the kingdom.
Another recent development has been the bacteriological
differentiation of types. Professor MacLeod and his co-workers
in 1931 described three types of diphtheria bacilli—the gravis,
mitis and the intermediate. That these types exist is agreed, and
it is also generally acknowledged that the clinical type of disease is
closely correlated to the particular Corynbacterium isolated from
the patients. The soil alone does not determine the character of
the symptoms. The severity of the symptoms depends upon several
factors which are independently variable,—individual immunity,
virulence of the organism, and the stage at which antitoxin is given.
From an administrative as well as the treatment point of
view, the former methods appear in a great many instances to have
failed. The early administration of serum, the swabbing of contacts,
and the separation of carriers formerly controlled the spread
of the disease and averted a fatal issue. Antitoxin given within 48
hours of the onset of symptoms would result in neutralizing the
toxin. But the graver form is an intensely rapid disease.and antitoxin
given as early as 24 hours after the onset of the symptoms is
frequently of no avail. It has been stated that serum prepared from
Park 8 strain is effective against the bacillus gravis as well as the
bacillus mitis, if injected early; that is, if the antitoxin is administered
soon after the dose of toxin has been given.
Large amounts of toxin or culture of gravis and mitis strains
have been injected into guinea 'pigs and ordinary antitoxin given
at intervals of two hours after infection saved all animals ; after
eight hours it saved none. In the intervening periods there was no
significant difference between the percentage saved in the gravis
and the mitis group of animals.
In spite of this, many if not most clinicians now admit that
recently there have been admitted to hospital a large number of
severe cases which formerly were few and far between and that the
increase of these severe cases was found to coincide with the appearance
of the gravis and intermediate type of bacilli in the throat.
In these severe cases antitoxin does not have the same beneficial
effect even when it is administered early. We have seen cases in
which the disease has progressed so rapidly that death has occurred
within 24 hours and even 12 hours of the time a doctor was called
in. The following cases may be given as examples. A girl of 7
years of age, from a good home and where a doctor was always called
in early for almost every illness was taken ill of diphtheria. On
Saturday she went to a party and afterwards to a pantomime. On