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144 ON THE SANITARY CONDITION OF
he will return it after inoculating it from the suspected
throat, and the tubes will be daily sent on to the
department from the local centre, or an officer of the
Board on receiving a request will attend and make
the inoculation. By noon on the following day the
medical man receives the result of the culture by
telephone or through the post.
There is no reason why this example should not be
followed in this country. The expense of carrying it
out would be trifling compared with the outlay entailed
when a throat affection is true diphtheria, or is supposed
to be so. In London, the Metropolitan Asylums Board
would be the proper authority to take this matter up,
and arrangements might be made with some central
bacteriological laboratory to provide the culture tubes
and make the cultivations. A supply of tubes might
be kept at the offices of the Boards and Yestries, and
each Medical Officer of Health would deliver them to
medical men applying, and would receive the report of
the bacteriologist next day and convey it to the medical
man in charge.
But I would go further than this, and require
that no case should be allowed to be removed from
isolation, either in hospital or at home, until it had
been proved that the throat were free of the bacillus,
because it has been shown that virulent diphtheria
bacilli may be found for an indefinite time after the
apparent cure of the malady, and infection may be spread
thereby. Especially in cases treated at home, I am
inclined to the opinion that the patients are allowed to
mix with healthy persons at too early a stage, but,
without the definite evidence given by finding the