ure of membranous croup and its relationship to
true diphtheria, that when the diagnosis between the two is uncertain
the safest plan is to treat the case as one of diphtheria.

In children, diphtheria may occur on the vulva, vagina, prepuce, or
glans penis, and give rise to difficulty in diagnosis, which is only
cleared up by demonstration of the bacillus.

#Treatment.#--An attempt may be made to destroy or to counteract the
organisms by swabbing the throat with strong antiseptic solutions, such
as 1 in 1000 corrosive sublimate or 1 in 30 carbolic acid, or by
spraying with peroxide of hydrogen.

The antitoxic serum is our sheet-anchor in the treatment of diphtheria,
and recourse should be had to its use as early as possible.

Difficulty of swallowing may be met by the use of a stomach tube passed
either through the mouth or nose. When this is impracticable, nutrient
enemata are called for.

In laryngeal diphtheria, the interference with respiration may call for
intubation of the larynx, or tracheotomy, but the antitoxin treatment
has greatly diminished the number of cases in which it becomes necessary
to have recourse to these measures.

Intubation consists in introducing through the mouth into the larynx a
tube which allows the patient to breathe freely during the period while
the membrane is becoming separated and thrown off. This is best done
with the apparatus of O'Dwyer; but when this instrument is not
available, a simple gum-elastic catheter with a terminal opening (as
suggested by Macewen and Annandale) may be employed.

When intubation is impracticable, the operation of tracheotomy is
called for if the patient's life is endangered by embarrassment of
respiration. Unless the patient is in hospital with skilled assistance
available, tracheotomy is the safer of the two procedures.

TETANUS

Tetanus is a disease resulting from infection of a wound by a specific
micro-organism, the _bacillus tetani_, and characterised by increased
reflex excitability, hypertonus, and spasm of one or more groups of
voluntary muscles.

_Etiology and Morbid Anatomy._--The tetanus bacillus, which is a perfect
anaerobe, is widely distributed in nature and can be isolated from
garden earth, dung-heaps, and stable refuse. It is a slender rod-shaped
bacillus, with a single large spore at one end giving it the shape of a
drum-stick (Fig. 26). The spores, which are the active agents in
producing tetanus, are highly resistant to