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March 19, 1917, E. B., boy, aged 5 years, of German descent, was brought to my office with the history of a fall three weeks before, resulting in a wound of the ulnar side of the palm just below the wrist. This was said to have "healed up" and "opened again" one week before he was seen. He was pale and looked ill, but there was no elevation of temperature. The nose and throat did not show any acute lesion. Inspection of the hand revealed a wound 1½ inches long and from one-eighth to one-half inch wide, covered by a firm gray membrane. A culture revealed diphtheria bacilli. March 20, I called at his home and injected 5,000 units of antitoxin. The membrane disappeared from the wound in two days. March 27, the temperature rose to 103.6 F., and there were pains in both knees and the right ankle. The
Bicak JF. WOUND DIPHTHERIA COMPLICATED BY RHEUMATIC FEVER. JAMA. 1917;LXIX(1):38. doi:10.1001/jama.1917.25910280001013