Diphtheria in a Surgical Wound

Mrs. M., aged 23 years, healthy-looking female, pregnant 5 months, was operated on by us during September, 1931, for tuberculous caries of the left rib. oix inches of this rib were removed from its chondrocostal junction backwards: the entire macroscopically diseased area with a clear two inches of apparenttynealthv pone as well was removed. The wound healed by first intention. Six weeks later a cold abscess developed under the posterior extremity of the scar which burst spontaneously. A second operation was not agreed to. Dressings with iodoform emulsion were continued and the_ opening of the sinus was covered ^ith ordinary dressings. For some time the patient was lost sight of. Later, on enquiry, it was elicited that the husband used to procure sterilised dressings and cover the wound himself. About the first week of December, 1931, the patient was brought to me lying on a stretcher in a helpless condition. The cause was found to be an acute complication around the opening of the sinus in the form of acute dermatitis. The skin around for about a radius of 2J inches was swollen and hyperamic with erosions and vesicles with sodden cuticle over them (not unlike ordinary secondary eczema that occurs in and around neglected wounds). Some of these patches of sodden cuticle suggested membrane formation in patches.