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they co-operate with the Public Health Department by sending
the patients into the Isolation Hospital in the majority of cases at
the earliest possible moment, and thus giving, especially young
children, the best chance of recovery.
No delay occurs in Ilford in the bacteriological examination
of swabs. A throat swab can be left at the Public Health Office
at any time and the doctor receives the result before noon next
day. In addition, the medical practitioners of the town are aware
that in any doubtful case they can avail themselves of my
assistance for the purpose of diagnosis. The value of the
bacteriological examination of swabs must not be too highly rated.
The ordinary case of diphtheria should be diagnosed by the
appearances in the throat of the patient.
Bacteriological examination should be limited to doubtful,
not severe cases, and even in the former, further investigation of
the organisms found may be required to discover whether they
are, in fact, diphtheria organisms, which will cause an attack of
diphtheria in a human being, or are organisms simulating
diphtheria organisms but which have not their poisonous effect.
There are, however, cases of diphtheria which are atypical, and
which, although mild and not likely to prove dangerous to the
patients themselves, will spread the disease to other persons, and
it is in such cases that the bacteriological examination of a swab
from the throat or nose may be of special value, although in many
of such cases a further examination of the organisms found, in
the way I have described, may be necessary.
Many of the deaths which occur from diphtheria in some
districts are considered to be due to two factors : (1) that the
medical practitioners rely too much on the examination of a swab,
and (2) that the results from the examination of the swabs are
unduly delayed. Frequently the swabs have to be posted, with a
delay of two or three days before the result is obtained. If the
patient in the meantime has received no anti-toxic serum and1 the
case is at all a serious one, the delay may lead to a fatal issue.
The vital statistics as regards infant mortality and maternal
mortality are not so encouraging. There has been a decided rise
in the infant mortality rate from 43.2 in 1924 to 52.5 in 1925.
The neo-natal mortality rate, or the mortality of children during
the first four weeks of life at the same time rose from 19.5 to 24.9.
The death-rate of children during the latter 11 months of life was
23.6 in 1924, and in 1925 27.6, showing that the greatest increase
occurred in infants during the first month of life. The number of
deaths due to premature births rose from 9 in 1924 to 18 in 1925.
These figures emphasise that it is still necessary to spend more