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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15
me throughout. I owe a large debt of gratitude to Dr. Agassiz and Dr. Farquharson,
as the experience gained through knowledge of their work has greatly lightened my
own task. I am grateful to Dr. J. E. McCartney, Dr. H. A. Ash, and Dr. Evelyn
Holmes, both for the work they have done themselves at the Southern group laboratory
and for the advice they have given me with regard to my own share; and also
to Miss F. I. Alford, laboratory technician at High Wood hospital, for her invaluable
assistance with the routine work.
References.
1 Meunièr, H. Presse Md., 1898, VI, 81.
2 Armand-Delille, P. F. Hull. de I'Acart. de Med., 1930, CIV, 732.
3 Poulsen, V. Amer. Jour. Dis. Child., 1931. XLI, 783.
4 Wallgren, A. Amer. Jour. Dis. Child., 1931, XLI, 816.
5 Druker, P. Acta Pæd.., 1930, II, 415.
8 Kereszturi, C., Mishulow, B. A., Schick, B., and Behner, D. Jour. Amer. Med. Assoc., 1932,
XCVI1I, 1879.
7 Friedlander, A. Jahrb. f. Kinderh., 1930, CXXVII, 178.
8 Bie, V. Ugesk. f. Looger, 1931, XXII, 587.
9 Collis, W. R. F., and Brockington, C. F. The Lancet, Jan. 21, 1933.
Appendix.
Technical Details of the Method Used in the Present Investigation.
(1) All cow's milk is excluded from the diet for 48 hours before the morning of
the lavage. In young children a dried milk mixture is given as a substitute.
(2) On the two davs preceding the lavage the following mixture is given t.d.s.:—
R
Pot. Iod gr. ii
Ammon. Carb. gr. i
Vin. Ipecac. m. iii
Glycerine m. x
Aqua ad 3i
(This dose for children under 5 years—larger doses for older children.)
(3) First thing in the morning before any food is given, the child is encouraged
to cough for 20 minutes.
(4) He is then given four to six ounces, according to age, of boiled water to
drink.
(5) Fifteen minutes later a stomach tube is passed, with aseptic precautions
in order to avoid possible introduction of tubercle bacilli from the hands of the
operator, and the fluid which regurgitates by the natural retching of the child is
collected in a sterile flask. It is not found that aspiration with a syringe assists the
operation to any appreciable extent.
(6) The product of the lavage is centrifuged. The deposit is treated with three
times its bulk of 4 per cent, sodium hydroxide and incubated for thirty minutes,
during which time it is shaken repeatedly ; this procedure destroys organisms other
than tubercle bacilli. The material is then neutralised to litmus paper with 8
per cent, hydrochloric acid and re-centrifuged. Part of the deposit is used for
making a film on a slide which is stained by Ziehl-Neelsen and examined direct for
tubercle bacilli; part is used for culture on Jensen's modification of Loewenstein's
medium prepared at the Southern group laboratory in McCartney screw-capped
bottles. The remainder is made up to 1 c.c. bulk with supernatant fluid and injected
under the skin of the abdominal wall of the guinea-pig, the needle pointing towards
the inguinal glands. The pig is killed as soon as appreciable glandular enlargement
can be detected. Failing this it is left for three months. In a certain number of
cases, where the material was sent to the Southern group laboratory for examination,
the guinea-pigs were killed after one month irrespective of glandular enlargement.
A diagnosis of tuberculosis is not made unless definite tubercle bacilli are seen
in stained material from the glands or other organs affected in the animal.