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26
In the diagnosis of typhoid fever there is also frequent difficulty, and nearly
always long delay.
In these circumstances your Vestry sanctioned the submission of specimens
of secretion in doubtful diphtheria cases, and of blood in doubtful typhoid
cases to bacteriological examination at a maximum cost of 3s. 6d. per case.
Some of the difficulties attending the working of the clauses of the Public
Health (London) Act, 1891, referring to notification, isolation, and disinfection
in infectious diseases will be overcome by this procedure, for the purpose of
which a system has been organised and is now at work.
A tin case or diagnosis box containing an outfit has been sent to every
medical practitioner in the District. The box has two compartments, one
holding a sterilised test-tube containing a swab on a stem, the other holding
a test-tube containing two sterilized and plugged capillary tubes; both testtubes
are closed with cotton wool stoppers and packed in cotton wool. In the
top of the cover of the diagnosis box is permanently fixed an information
notice to the following effect:—
Information Notice.—Diagnosis Box, No.
Every Medical Practitioner is supplied with a Diagnosis Box containing two
sterilised tubes fitted. When charged, in accordance with the directions
(enclosed herewith), the Diagnosis Box, with the Identification Form (enclosed
herewith) duly filled in, should be forthwith sent to the Medical Officer of
Health, in the stamped and addressed envelope (enclosed herewith); and an
uncharged Diagnosis Box, with addressed envelope, Identification Form,
Directions, &c., enclosed, will be transmitted by return. A report of the
bacteriological examination will be communicated as soon as possible to the
Medical Practitioner, and no charge made.
Inside the cover of the Diagnosis Box, which keeps it in place when shut,
is loosely laid an Identification Form to the following effect:—
Identification Form.
No. of Diagnosis Box Date
Medical
Practitioner
Patient
Name
Address
Name Sex Age
Address
Disease Suspected
On the lid of the box is scratched—St. Pancras, and the number of the box,
and the same number is also filled into the Information Notice and Identification
Form.
The Diagnosis Box is then closed and wrapped in the two following
Forms:—
Directions as to Diphtheria.
In the Diagnosis Box the sterilised cork tube is for membrane and secretion.
It is advisable to send membrane as well as secretion, where possible, and they
should be obtained before the application of local remedies, if possible. If