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Diphtheria returns are kept under continuous observation, and on any suspicion of school
influence showing itself my Assistant visits the school, and all children giving any sign of ill-health,
such as aural or nasal discharge, enlarged glands, undue pallor, or a history of recent absence, have
a small portion of mucus removed from throat or nose by a sterilized platinum wire, and placed on
the surface of a tube with sterile blood serum. This is then cultivated in an incubator at 98° F.
for 15 to 18 hours. The cultures are then examined microscopically, and any showing suspicious
forms are then stained with Neisser's stain. Except in very rare cases this is deemed
sufficient. Only cases showing Klebs-Loeffler bacilli are counted as diphtheria, the pseudobacilli
we neglect.
Where a doubt arises, the Medical Officer of Health is communicated with informally and
the child excluded till free; no actual notification of diphtheria, however, is made.
During the first year 758 cultures were examined, Klebs-Loeffler bacilli being detected in
58 (7.3 per cent.), and pseudo-bacilli in 27.3 per cent. cases of children actually in school. During
the past year, 890 cultures have been examined, and Klebs-Loeffler bacilli found in 60 cases, and
the pseudo-bacilli in the same proportion as before. So that since the laboratory was started there
have actually been 118 children thus detected in school, "carriers" of diphtheria.
This work can only be done in urgent cases where school infection is feared. When a telegram
has been sent to the school to have these children excluded, our work is finished, but it would be to
the benefit of the public health that these cases should be followed up by the Sanitary Authorities.
In some parts of London this is done very badly, or not at all. There are London Boroughs
where the Sanitary Authority makes no arrangement for bacteriological testing of such cases by the
Medical Officer of Health. The very unequal way in which sanitary work, in this respect,
is being done in London points to the need of one Sanitary Authority for the whole metropolitan
area.

The results of the work carried on thus have been, on the whole, eminently satisfactory. The
necessity for school closure for diphtheria has become very rare in London. It would only be