I, herewith, present the biennial report of the work done by the Division of Pathology and Bacteriology of the Laboratory of Hygiene from July 1, 1924, to June 30, 1926, giving the following figures:

Total number of specimens examined

Bacteriological

Wassermann

Clinical pathology

Animal pathology

Postmortem examinations

Pathological tissues

18,491

9,972

6,788

708

50

29

944

A detailed and classified report will be found at the conclusion of this report.

The total number of outfits prepared and sent out to the various institutions, drug stores and physicians was 22,781.

The number of routine examinations made by this department has remained about constant, but considerable time has been given to isolating organisms for diagnosis. from body fluids and exudates. The examination of speci

mens for the infectious diseases has been the major occupation of the department.

DIPHTHERIA

The number of specimens submitted to this department for diagnosis of diphtheria showed considerable decrease. Three hundred positives were found against five hundred during the preceding two years. This decrease no doubt is due to the more complete knowledge of diphtheria and a more complete power over the disease through the use of toxin-antitoxin as a preventative.

TYPHOID

This disease has shown a considerable decrease. Much time has been spent culturing urine and faeces of convalescent patients in order to eliminate the carrier who is a great menace to the public. In locating these carriers the laboratory does a very important work. A routine Widal reaction is made for all patients on entrance to the New Hampshire State Hospital.

GONORRHOEA

The number of examinations made for gonorrhoea has increased, but the number of proven cases has remained constant, the increase of examinations being accounted for by the physicians sending two or three smears on known cases for release from quarantine.

TUBERCULOSIS

Tuberculosis examinations show a considerable decrease over the preceding two years, 1,000 less specimens being submitted and 200 less positive sputums were examined.

PATHOLOGY

HUMAN PATHOLOGY

The pathological work has increased, 944 specimens were examined. Of these 101 were malignant growths (cancer).

The tissues are prepared by the celloidin method. Twelve days are required before diagnosis when the report is sent to the physician. The department is oftentimes handicapped by the lack of co-operation of the physicians in sending specimens without histories of the cases. A history should be sent with every specimen.

CLINICAL PATHOLOGY

This work includes examination of urine, faeces, stomach contents, pleural fluids, abdominal fluids, spinal fluids, blood smears for differential counts and for diagnosis of anemia and malaria. Most examinations are chemical and microscopical, a few being bacteriological.

ANIMAL PATHOLOGY

Specimens submitted were from dogs, cattle, hens, pigs, and meat. The major portions of the specimens were submitted to us by the Department of Agriculture.

SEROLOGY

The serological work has increased rapidly. In 1920, only thirty Wassermann tests per week were made while at the present time we are doing approximately ninety Wassermann tests per week, a large percentage of these being a check on treatment.

The proper interpretation of results by the clinician is very important. A negative result does not mean that syphilis can be excluded. In primary syphilis the reaction does not appear until the human organism is able to develop antibodies. This time varies with different patients, occuring occasionally as early as the second or third day after the appearance of the chancre and sometimes not until the secondary signs are present.

If treatment is started immediately a primary lesion is found. Very often it produces a prompt reversal from a positive to a negative, while during subsequent treatments the test again becomes positive.

In cases of long standing where time has allowed the spirochete to make a more generalized invasion of the body, a positive reaction is often rendered negative with great difficulty. In some cases known as "Wassermann-fast" a negative seems to be unobtainable. Very frequently patients, who are under treatment for syphilis, have the impression that with a single negative Wassermann reaction they are cured. The first negative Wassermann means very little and for the physician to pronounce a patient cured upon serological grounds alone is wrong. A physical examination of the patient's mouth, throat, glands, aorta, and central nervous system should be made. The laboratory side should include repeated Wassermann reactions upon the blood. Wassermann tests upon the spinal fluid and provocative Wassermann reactions.

During the winter months a large number of bloods for Wassermann reactions arrive at the laboratory hemolized. This is caused by the blood freezing in transit during the cold weather. To prevent this condition, the tube should be tightly wrapped in cotton, and forwarded to the laboratory by first class mail.