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The G.P. was very appreciative of the plan, the Consultant was very agreeable
to it and he in fact was the partner in the team who had the difficult task to
actually examine and cure the patient. The patient accepted the plan without
any hesitation.
The patient was admitted to the fever hospital on 15th September, 1969. On
admission no physical abnormalities were found. The carrier state was confirmed
by the isolation of Salmonella typhi from two specimens of her stool, the
bacillus being sensitive to Ampicillin, Tetracycline, Streptomycin, Humatin,
Chloramphenicol and Colomycin. Strangely enough, her Widal agglutinations did
not show a high titre to the VI antigen. Urine specimens did not grow Salmonella
typhi. A cholecystogram was performed but this showed no evidence of gall stones
or gall bladder disease.
The patient was started on following therapy on 25th September:
1. Ampicillin - 1 gram twice daily intramuscularly
2. Ampicillin - 1 gram 8 hourly orally
3. Probenecid - 1 gram twice daily to act as a renal blockade and raise the
blood level of Ampicillin
She was given this regime for one week and discharged on 2nd October, 1969
on following medication: Ampicillin orally one gram 8-hourly and Probenecid
orally one gram twice daily for eleven weeks. The patient was made aware that
the success rate for this treatment is 75%. It was not considered necessary to
carry out a cholecystectomy.
Immediately after this home treatment seven stools were examined and later
a further three with a month's interval and they all proved to be negative. For
all practical purposes the carrier had now been cured from her typhoid carrier
state and she was informed accordingly on 2nd June, 1970.
There was also a second person who had been registered as a typhoid carrier
because she had produced several positive stool specimens within two months after
her typhoid fever attack but never since in spite of six stool examinations
during the next month and two stool examinations annually for two years. In
1969 she had a thorough test with six stool examinations at two weeks interval
and they were all negative. This carrier was considered to have been a temporary
carrier only and was taken off the list of carriers during 1969. Thus two
persons were relieved of the unpleasant stigma of a typhoid carrier and ceased
to be potential dangers to other people in the community.
TUBERCULOSIS
Of the 115 primary notifications of tuberculosis 86 were in respect of
pulmonary tuberculosis and 29 in respect of non-pulmonary tuberculosis.
The number on the Department's tuberculosis register at the beginning of
the year was 1,689. After adding primary notifications and transfers in and
subtracting deaths, transfers out and recovered cases etc., the number on the
register fell to 1,605 hy the end of the year.
The number of cases receiving extra nourishment at the end of the year
totalled 133.
VENEREAL DISEASES
The Department runs a scheme of contact tracing which appears to be quite
successful. A full-time officer having a nursing qualification is employed and
her time is divided between the Health Department, the hospital clinics and actual
contact tracing in the appropriate amounts. Her work is far from easy involving
as it sometimes does sitting in "pubs" and even clubs of a somewhat doubtful
character in the West End. The Council has appreciated her difficulty and has
made certain concessions to help her with her work.