[Report 1925] / Medical Officer of Health, Cheltenham Borough.

  • Cheltenham (England). Borough Council.
Date:
1925
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1925] / Medical Officer of Health, Cheltenham Borough. Source: Wellcome Collection.

    23/76 (page 21)
    “ All the cases were women inasmuch as it was a women’s ward. At the same time in the men’s ward the same general conditions following similar operations were to be observed, but as there was nothing unusual about this it was not proposed to test their blood, with a view to diagnosing paratyphoid fever by the Widal reaction, and although I am inclined to think this a reasonable decision, the opportunity of endeav- ouring out of this incident to unfold the real value of the blood test, especially in regard to the occurrence of the “ B ” bacillus in a class of cases so peculiarly circumstanced, was not folio .ved up. It must be allowed that had there been no surgical operation, and the same symptoms had shown themselves of continued temperature, etc., two or three of these cases might ultimately have been diagnosed as paratyphoid from physical signs and symptoms, and the question is, whether the same might not be said of many such surgical cases in general. A proportion of these cases were operated upon for appendicitis, or other inflammatory or disturbed condition of the alimentary tract, and there is no great improbability in the suppositian that Paratyphoid “ B ” bacillus was present in the bowel before operation. All the cases recovered, in fact some of them were sufficiently convalesced to be discharged from hospital, and were discharged before I received the notifications. These I saw in their homes, but did not think it necessary to take any action in regard to them. “ Each member of the staff of the ward affected, that is the sister, nurses and maids of the ward had their blood tested, and the blood of one of the nurses was found to react strongly against the “ B ” bacillus, but she had been in the hospital continuously employed for over 3 years, and had suffered no illness whatever in the least suggestive of an attack of any kind of typhoid fever during her life. “ Being pushed no further the business began and ended as above related. Five months have elapsed at the moment of writing this note since the occurrence, without any further case of paratyphoid being notified in the district. The examination of the stools for paratyphoid bacilli was not practised here in any of the cases, and since no further case has arisen, such examinations, and the treatment of any positive cases found would have been for no advantage, though probably very incommoding to the persons most nearly concerned, and costly in labour and money. The fact is, I believe, that the proposition as to the value and necessity of making bacteriological observations of this kind, and following them up by a logical action in accordance, with the supposition that the proven presence of some particular bacillus in the contents of the intestine must be evidence of the infectiveness of the subject, and a danger to the community by reason of the spread of paratyphoid fever, amounts to an overstatement not in correspondence with the degree of understanding yet obtained of this matter, and emphatically contradicted by the records kept by medical officers of health, with very rarely occurring exceptions, when, exactly as in the case of Diphtheria, Scarlet Fever, and other diseases, a single case, the one in a thousand perhaps, assumes a specially infectious character. But the discovery of such an exceptional case, when there is evidence of the need to search for it, is one thing. It is quite another, and an unwarrantable tiling, to practice a wide experimentation upon suspected contacts of any ordinary case of Typhoid or I’aratyphoid, as the results are bound to be incommensurate, in their protective value, with the great labour involved, and particularly