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Annual Report of the Medical Officer of Health—1898 25
SECTION III.—SPECIAL REPORTS.
Special Report upon the Bacteriological Diagnosis of doubtful cases of
Diphtheria and of Typhoid Fever.
In compliance with a resolution adopted by your Vestry on the 8th ultimo, I
herewith beg to submit the following Special Report.
The directions contained in your resolution relate to the two diseases, diphtheria
and typhoid or enteric fever. Clearly, the tests referred to may be applied before,
during, and after an attack, and have a special value in each of those stages.
Before the Attack.—In using the term "before," I mean it to apply to those
cases in which the disease, though present, cannot be detected, with certainty, by any
means yet known to medical science. This fore-running or doubtful stage occurs in diphtheria
and typhoid fever more often than in any other malady with which we are called
upon as sanitary administrators to deal. In handling diseases of so highly infectious
a nature it is evident that there is an especial danger attached to non-detection at the
onset of an attack. In the case of diphtheria, it is just as contagious during the
early days as at any other period. Hence, any trustworthy means of diagnosis is of
the utmost value, not only to the patient, but also to others with whom he may be
brought into contact. A similar remark does not apply with equal force to typhoid
fever, but, nevertheless, it is an important point to be able to say with certainty about
the end of the first week of the illness that an attack is or is not typhoid fever, the
more so as it occasionally happens that the medical attendant may not be able to
decide the point even after the lapse of a fortnight.
During the Attack.—Here the tests are only of value in determining the
nature of doubtful cases. It may be at once said that the chief value of both these
bacteriological methods of diagnosis applies chiefly to ill-defined attacks. No one
who is skilled in practical medicine could fail to recognize at a glance a well-marked
case either of diphtheria or of typhoid fever. The most experienced man in the
world, however, will be undecided for some time in a certain proportion of attacks of
both these maladies. The bacteriological method would therefore be of value in
settling differences of opinion between medical men, and in the case of typhoid fever
would at once determine the proper and only safe line of treatment.
After the Attack.—In diphtheria the absence of the special microbe that causes
the disease marks the stoppage of the infectivity of the patient. This can now bo
ascertained by exact bacteriological examination. As regards diphtheria the question
is of particular importance, as a patient in a town environment is far more likely to
be a centre of disease when recovering from diphtheria than from typhoid.
METHODS OF TESTING.
In the case of diphtheria both secretion and membrane from the patches that
form in the throat are collected and sent to the laboratory. The throat of the patient
is touched with a little swab of wool, which is replaced in a sterilised tube, and sent
to the Medical Offier of Health by post in an appropriate package.
In the case of typhoid fever a drop or two of blood is drawn off from a prick in
the patient's finger by means of a small sterilised glass tube, the euds of which are
6ealed, and the whole forwarded to the laboratory.