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suffering from pulmonary tuberculosis or else from tuberculous glands with no open
wounds who do not appear to require treatment in residential institutions. One
additional school will be provided in 1928. The work of these schools is dealt with
in the section of this report dealing with the school medical service.
Diphtheria.
Report of the Bacteriological Laboratory.
To meet all the requests for bacteriological investigation, heavier than in any
previous year, a total of over 13,800 of various tube and plate culture media,
some 2,800 more in number than in 1926, were prepared by the two laboratory
assistants. A total of 11,020 throat and nose cultures from 10,745 children were
examined, yielding morphological diphtheria bacilli (K.L.B.) in 1,021, or 9.26 per
cent. From 40 chronic carriers K.L.B. were isolated in pure culture, and sent to the
Clinical Research Laboratories for the virulence test by animal inoculation. 28
cultures were reported non-virulent, and 12 virulent.
Ringworm.
Hair specimens from 1,872 children were examined and in 653 (34 8 per cent.)
parasitic fungus was found.*
Consultations
Consultation visits at the request of medical officers of health and private
practitioners to assist in the diagnosis, particularly of encephalitis lethargica and
epidemic cerebro-spinal fever, were paid by Dr. J. A. H. Brincker or Dr. J. G. Forbes.
Encephalitis lethargica.—Of seven cases in which encephalitis was regarded at
consultations as not improbable, lumbar puncture was performed in one and four
were confirmed by the subsequent course. But in two cases removed later to
hospital for observation and operation, the disease proved to be cerebral tumour,
one case being cerebral syphilis, now recovered.
Three cases of suspected encephalitis, not supported at consultation, were due
to neurosis and temporary indisposition in two; the third case on removal to
hospital was found to be suffering from paratyphoid fever.
Cerebrospinal
fluids.
Cerebrospinal meningitis.—One case of fulminating form was confirmed as due
to the meningococcus by lumbar puncture and examination of the cerebrospinal
fluid. Removal to hospital eventually resulted in complete recovery.
One case of suspected cerebro-spinal fever was recognised at consultation as
German measles.
For help in diagnosis, particularly of notifiable diseases, such as cerebro-spinal
meningitis, encephalitis and poliomyelitis, 122 specimens of fluid obtained by lumbar
puncture from 109 cases were examined and reported on (as compared with 103
specimens from 93 cases in 1926). These included fluid from 46 cases at St. James'
Hospital, Balham, 45 cases at the Fulham Hospital, 16 cases at the Highgate Hospital,
and 2 cases seen in consultation at the patients' homes, which may be grouped as
follows:—
1. Encephalitis lethargica,—19 specimens of fluid from 17 cases with the provisional
diagnosis of this condition. The subsequent course of the 17 cases showed
that only five were suffering from encephalitis in acute or chronic form.
2. Tuberculous meningitis.—Examination of the fluid was of assistance in the
diagnosis of 19 cases, from which 22 specimens were sent. Tubercle bacilli were
found in 14 of the 19 cases, i.e., 73.5 per cent., including one in doubt, in which
histological section of post mortem material from the brain showed abundant tubercle
bacilli.
3. Cerebro-spinal meningitis.—16 specimens of fluid from 12 cases were
examined, and the diagnosis was made on the cytological and bacteriological changes
found, including the presence of the meningococcus in film or culture.
4. Other forms of meningitis.—Of 12 specimens from 11 cases of acute meningitis,
the organism found was identified as the pneumococcus in five, streptococcus
in two, and in the four others, B. influenzae, pneumobacillus, diplococcus crassus,
and staphylococcus aureus respectively.
* See page 145 of this report.