From the first table it will be seen that this work is markedly increasing, which is perhaps the result of two factors: (1) More cases are probably now in progress than at the time when the examinations were begun; (2) physicians are rapidly coming to know that they can receive an early bacteriological diagnosis, and to appreciate its value.

It will be noted from the second table that more than one-third of the examinations made were from Owatonna. Most of these cases were from the state public school, and were under the professional care, first of Dr. Mary E. Bassett, and later of Dr. J. H. Adair.

The number of examinations made is not to be taken as an index of the number of cases of diphtheria occurring, for in this report are included examinations and repeated re-examinations of not only cases which were suggestive of diphtheria, but specimens collected from healthy individuals who had been possibly exposed to the disease. Dr. Adair, realizing the necessity of stamping out a disease which seemed to have become endemic, has been indefatigable in his efforts to locate the possible source of infection.

The zeal of Dr. Adair, together with the display of intelligent interest on the part of the management of the school, has given material for investigation of the varying forms of the bacillus diphthe riae in a place in which it has been long resident, and presumably widespread.

*These examinations were made with the consent of the St. Paul Board of Health, and for the convenience of physicians to whom this laboratory is more easily accessible than that of the local board.

All cultures showing any peculiarity in biology or morphology have been preserved, and a large amount of such material is now in the laboratory demanding investigation., The impossibility from lack of time and sufficient assistance of doing this work at present as well as the persistence of a few cases of the disease in this locality, would seem to render it necessary to postpone a complete report until a later date.

It may be here mentioned, that specimens of water from various supplies at Owatonna, earth, sink-cleanings, milk, etc., were all examined for the presence of B. diphtheriae, with negative results.

Of the large number of examinations made from cases in Minneapolis, a great many were from the city hospital; the others were from cases occurring in the practice of physicians, from many of whom complaints were forthcoming in reference to the necessity of personally coming, or sending, to the laboratory for the obtaining of culture boxes, or return of specimens. These complaints prob ably arise on account of an apparent misunderstanding of the relation of the city of Minneapolis to the state board of health. Under the existing law Minneapolis has no legal right to expect the state board of health to help in the administration of her local regulations pertaining to diphtheria or other diseases.

It was to be expected, perhaps, that the Minneapolis department of health, in the absenec of any bacteriological laboratory of its own, should have approached this laboratory to ask that some agreement be arrived at whereby the physicians of Minneapolis could be sup plied with culture boxes for the collection of specimens from cases of suspected diphtheria. It would apparently be only proper that various depots throughout the city should be established, from which physicians could obtain culture boxes for use, and to which they could be returned after use for transmittal to this laboratory.

The work of distribution and return of boxes to the laboratory, as well as reporting of diagnoses arrived at, should fairly fall to the city health department, where this board is willing to extend the courtesy of doing the necessary laboratory work.

As the Minneapolis health department has made no request, official or otherwise, for any such arrangement, and has given no official recognition to the work of this laboratory in its capacity of affording a common-sense basis for quarantine regulation, it would perhaps be as well that the bacteriologist of the state board of health be instructed to ascertain if it be not possible to come to some such arrangement for the simplification of the work of the laboratory on the one hand and the manifest benefit to the physicians and the department of health of Minneapolis on the other.

Under existing circumstances much valuable time is daily lost by the constant interruptions caused by the giving out of culture boxes, receipt of specimens, or the necessity of repeated efforts to send telephonic reports to physicians, all of which work should be done by the city board.

The examinations made generally throughout the state seem chiefly to have been of value to the local physicians, as affording certain diagnoses in doubtful cases.

Very little information has been obtained of the local conditions and from that available it would appear that a great necessity exists for the universal adoption of bacteriological examination as the only reliable means of diagnosing diphtheria. Subsequent examinations should be insisted on in all cases in which a positive diagnosis is given, until such examinations show the absence of B. diphtheriae, when quarantine may be raised.

Until compliance with these conditions is insisted upon by this board, in cases from which specimens are sent in for diagnosis, the work of this laboratory will have very little importance in the arrest of the spread of this disease, and will be largely but a convenience to physicians, as easily affording them a diagnosis upon which to base treatment, which should be but a part of its object.

Should observance of these conditions be demanded, the work done in this laboratory, and in the laboratories of local health boards, would furnish an accurate index of the health of the state, so far as this disease is concerned.

In the cases examined from Owatonna, Austin and the city hos pital of Minneapolis, as well as some occurring in the practice of a few physicians, the request for subsequent examinations, where positive diagnoses have been given, has been complied with. Nothing further than a request has been made before bringing the matter before the board.

Some interesting observations have been made in regard to the persistence of B. diphtheriae in the throats of patients after the disappearance of clinical symptoms, as follows:

In two cases occurring at Owatonna (initials C. O. and G. O.) the micro-organism was present eighty-three and ninety-four days respectively from the time of admission to the hospital. In the case of C. O., the specimen taken on the day of admission showed the bacillus present, while in G. O., probably owing to the faulty method of transmittal, it could not be shown until the arrival of the next specimen three weeks later, the delay in sending having arisen from a misleading diagnosis of not diphtheria, made locally, based on a microscopic examination of material taken directly from

the throat, without cultural control. In two cases, occurring in the practice of a Minneapolis physician, the bacilli were still present at the end of seventy-six and sixty-four days, and the investigation is not yet complete. In these cases, corrosive sublimate (1 in 1,000) was and is still being used locally in the throat.

The early disappearance of B. diphtheriae has been illustrated in some cases in which it could no longer be demonstrated after ten days from the commencement of the symptoms. Antitoxine had been used in the treatment of these.

The occurrence of B. diphtheriae in the throats of persons who showed no symptoms was exemplified in several cases occurring at Owatonna, as well as in the case of a nurse attending a diphtheria patient in Minneapolis.

These observations, corroborating, as they do, the experience of many laboratories, do not serve to demonstrate the futility of bacteriological investigation in showing the presence of the conta gium, but rather tend to point out the necessity of careful isolation of the patients and the placing of restraint upon the movements of those brought into close contact with them.

The inability, through press of routine work, of complete tabulation and interpretation of the results of the examinations made, together with the present lack of opportunity to follow up the cultural and pathogenic investigation of the bacteria isolated from these many sources, preclude the immediate publication of anything in the nature of a scientific account of this work and the lessons to be learned from it.

No apology is then made for at present eliminating what is hoped may be given in proper form at a subsequent date.

THE DIAGNOSIS OF TYPHOID FEVER.

The universal interest aroused by Widal's announcement, in June last, of a possible early diagnosis in this disease, was intensified by the simplification of the process as pointed out by Johnston in September.

The simplicity of the method for arriving at such important knowledge in a disease so difficult of clinical diagnosis was sufficient reason for its immediate investigation in this laboratory. At Dr. H. M. Bracken's suggestion, the laboratory agreed to coöperate with him in the application of the test to such cases as could be brought under observation.

The results of this investigation Dr. Bracken has already made public at the last meeting of the Minnesota Academy of Medicine, and with his permission that paper as embodying the work of the laboratory is here laid before you. (See page 279.)

In the work done in this connection assuredly the results obtained in this laboratory verify those already published in regard to the importance of the method as a means of aiding and controlling clinical diagnoses, but observations have not been sufficiently numerous nor extended to justify any further report than the foregoing. Investigations concerning other aspects of the question are being carried on, of which, if results warrant it, publication will be made.

With the sanction of the board, this method of diagnosis should now be placed at the command of the physicians and health boards throughout the state, if it be the opinion that such a proceeding will aid the work of the board in the detection, and consequent suppression, of this disease.

SPUTUM EXAMINATION FOR PRESENCE OF B. TUBERCULOSIS.

Of the eighty-four examinations made to January 1st the speci mens came from the following places:

The following is a copy of the report sent out to each physician: MINNESOTA STATE BOARD OF HEALTH, BACTERIOLOGICAL LABORATORY (UNIVERSITY OF MINNESOTA), MINNEAPOLIS. REPORT OF EXAMINATION OF SPUTUM FOR TUBERCULOSIS. Case No.....

Patient's Name.

T'hysician's Name..

Health Officer's Name..

Previous Case No..

Remarks

.Received.

Address..

Address.

.Address.

Reported

.Result of Examination.

Should the necessity arise for the examination of other fluids, or of tissues, for the presence of B. tuberculosis, special information and sterilized receptacles will be provided on request.

As will be easily understood, the data placed at the disposal of the board are useless under present legislation, by which human tuberculosis, when proven, is neither quarantinable nor reportable to the local health officer.

The matter of doing, or refusing to do, this work was left to the discretion of the laboratory by the action of the board at the July meeting, but the exercise of this discretion involves a large amount of correspondence, and the possibility of occasionally giving offense.