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time was lost in waiting for the result of the examination of a
swab. On the other hand, I know some men who, when called in
to a doubtful case invariably give a dose of anti-toxin, send me on
a swab, and take charge of the patient until the twelve to eighteen
hours necessary for the full examination of the swab have elapsed,
before notifying the case, and except in some exceptional cases—
such as boarding-schools—this is the course that 1 would venture
to suggest as being the ideal one.
As regards the prophylactic use of anti-toxin, which in my
opinion is of the greatest importance, I would again remind my
professional brethren that I am always at their service, more particularly
in the poorer parts of the District, if through stress of
work or other causes they are unable to make another visit and
carry out what may sometimes prove to be a rather disagreeable
series of small operations.
BACTERIOLOGICAL WORK.
Diphtheria.
All the bacteriological work is done in my own laboratory,
including the preparation of media, cultivation of growths, etc.
livery swab is "planted," and grown in an incubator; and in
cases of urgency I have lately adopted a method of diagnosis from
the "direct" smear, advocated by Dr. Ponder, County Bacteriologist
for Kent, which gives satisfactory results in a number of
cases.
I examined 1,002 swabs from cases of suspected Diphtheria
and from contacts during the year, with the following result :—
Hoffman's Bacillus
Swabs. Positive. Negative. (Included in Negative.)
1,002 110 892 70
This gives a percentage of 10.97 positive swabs, as against 10.73
last year, and 10 85 in 1910.
Although the general opinion is that Hoffman's Bacillus is not
pathogenic, I must confess that I look on it with the greatest
amount of suspicion, and I do not allow any child shewing it to
return to school until two consecutive swabs taken at about one
week's interval prove negative.
Pulmonary Tuberculosis.
Ninety specimens of sputum were sent to me for examination :
Sputum. Tubercle Bacillus present. Tubercle Bacillus absent.
90 38 52
giving a percentage of 42.22 positive results, against 37 per cent,
last year.