London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1934

[Report of the Medical Officer of Health for London County Council]

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(A Preliminary Report.)
By R. H. Fish, M.B., M.R.C.S., M.R.C.P., Senior Assistant Medical Officer, High
Wood Hospital for Children.
The use of gastric lavage as a means of detecting tubercle bacilli in the sputum
of children suspected of pulmonary tuberculosis was first described by Meunier1 in
1898. During recent years the method has been practised by a considerable number
of different workers, and its value is becoming increasingly recognised. The main
principle involved is the extraction of swallowed sputum from the stomach after
coughing. The product of the lavage is treated so as to reduce its bulk to a minimum;
it may then be examined in direct smears, or tubercle bacilli may be sought for by
culture on a suitable medium and by inoculation of a guinea-pig. Some of the
results obtained by different exponents of the method are set out below.
Armand-Delille2 examined "homogenised" gastric lavage from 500 children
by the direct smear method, and was able to demonstrate tubercle bacilli in 60 per
cent, of children with radiological shadows suggesting pulmonary tuberculosis. He
also used the method of obtaining sputum by tickling the back of the child's throat,
and found this much less effective. Poulsen3 obtained 53 positives among 110 tuberculous
suspects ; Wallgren4 obtained 47 among 95 children with erythema nodosum
and positive Mantoux reactions. Both the latter workers used guinea-pig inoculation.
Also using the guinea-pig method, Opitz demonstrated tubercle bacilli in
the gastric lavage in 28 out of 30 cases of "epi-tuberculosis," 1 out of 7 cases of
"interlobar pleurisy," 3 out of 24 cases of "hilus tuberculosis," 7 out of 12 cases of
tuberculous meningitis, 2 out of 6 cases of tuberculous knees, and 1 out of 3 cases
of enlarged cervical glands. Others who have obtained similar results are Druker5,
Ivereszturi6, Friedlander7, Bie8 and Collis9; further details of their work will be
found in an excellent account of the whole subject given by Collis and Brockington9.
Work at
High Wood
Gastric lavage was first introduced into High Wood hospital by Dr. C. D.
Agassiz, late medical superintendent, towards the end of 1932. In collaboration
with Dr. E. W. Farquharson, late house physician, he investigated a considerable
number of cases by this method. The present writer has been carrying on this
work, but it is not yet completed. It is proposed to publish a final report of the
present investigation, as well as the results obtained by Drs. Agassiz and Farquharson,
in collaboration with the latter workers, at a later date. The following account is
based on the present writer's results onlv.
The work is being undertaken with three main objects in view. These are as
(1) To determine to what extent, if any, the method of gastric lavage is
of assistance in the diagnosis of pulmonary tuberculosis in children.
(2) To determine the relative value of the three methods of detecting
tubercle bacilli in the product of the lavage, viz., direct examination of smears,
culture, and guinea-pig inoculation.
(3) To advance knowledge of the pathology of certain special types of
juvenile tuberculosis by determining to what extent tubercle bacilli have access
to the bronchi in these cases.
With regard to the last of these three objects the work at present centres mainly
round cases of the type showing, on radiological examination of the chest, either
increased hilar shadows on one or both sides, or a shadow extending outwards from
the hilum into the lung. Other types of cases that have been investigated are
miliary tuberculosis, pleural effusion, pulmonary fibrosis, and erythema nodosum.
In no instance had the sputum been found positive previous to the date of the
lavage, although in three of the cases tubercle bacilli were detected in it some time
afterwards. Owing to the heterogeneous nature of the cases and their relatively