CO885-(21-23) — Page 118

PUBLIC RECORD OFFICE

Reference :-

C.O. 885

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO.

22 PUBLIC RECORD OFFICE, LONDON

Law 11 of

1900.

Sec. 13.

5S

When a Medical Officer treats a case with the symptoms usually attributed to vomiting sickness he should prepare and submit to the Senior Medical Office a carefully filled in history form giving all particulars called for, and send up also the specimens of blood, &c., as directed in the form.

When post-mortem examinations are ordered in cases attributed to vomiting sickness, and the Medical Officers making the dissections are not satisfied from the post-mortem appearances that the persons died from any recognised diseases or,well ascertained causes, they should transmit direct to the Senior Medical Officer the post-mortem forms carefully filled in, and also transmit the specimens mentioned in the form to the Pathological Laboratory.

These reports will be in addition to, and not in substitution for, any report required by law to be furnished to the Coroner.

A special fee of 10s. 6d. for the history and 10s. 6d. for the post-mortem report will be paid by the Senior Medical Officer from the Vote "Vomiting Sickness and Typhoid. (If it proves insufficient I have no doubt that savings may be made on other votes sufficient to make up the deficiency.)

The right is reserved to the Senior Medical Officer to refuse to pay for histories or post-mortem reports which do not contain information bearing on the question of vomiting sickness.

The police will have to be instructed to order post-mortems in cases of alleged vomiting sickness when the District Medical Officers consider it necessary to do so.

Dr. Scott should make the post-mortems whenever it is possible for him to do so.

15 July, 1912.

'Enclosure 3 in No. 46. POST-MORTEM REPORTS FORM.

Sex

Name

Date (and hour) of death

autopsy

Age

Colour

P. C.

Brief history of case, giving symptoms as far as possible in chronological order

External: Note any discoloration of skin or conjunctiva: any hæmorrhage, petechial or otherwise.

Respiratory System:

Pleura. Any dulness, petechiae, &c. Fluid, if present, colour and amount

R L

Trachea and lungs

R

Ꮮ

Lymphatic glands, note whether enlargement of those at bifurcation of

trachea. If enlarged, incise.

Circulatory: Pericardium. Note as in case of pleura.

Heart. Note if myocardium shows any hæmorrhages, also the colour and

consistence of muscle.

Abdominal Viscera: Peritoneum. Note as in case of other serous membranes

Liver: Note size, colour, weight (if possible) consistence gall bladder, nature

of contents.

Spleen: Size, colour, weight, consistence (if surface colour altered, whether

same change extends to depth).

Stomach Contents, character of mucous membrane.

Intestines: Whether any worms; whether lymphoid tissue unduly prominent;

if ulcers, note site, extent, &c.

Pancreas: Size, colour, &c.

59

Kidneys R: Surface, capsule, whether hæmorrhages, or adherent, &c.

Section

Surface, &c.

L

Section

R

Adrenals:

L

Bladder: If full or empty; if former, colour, &c., of contents.

Cranial Contents: (Note, of course, any injury to cranium)

Meninges: Note whether any dulling; if so, state site (basal or vertical, &c.) and extent. Note any congestion, and whether any hæmorrhage, pete- chial or otherwise. Note particularly the fluid, whether clear or turbid, and if latter, whether uniform or flaky. Note colour. Brain and ventricles: Whether latter distended; note nature of fluid. Spinal meninges: These must be examined in every case in which the cerebral meninges appear healthy. If the latter are pathological, the specimen from them will suffice, and the spinal need not be examined. State whether any obvious cause of death has been revealed by the autopsy. Specimens to be sent to the Pathological Laboratory.

(1) Cerebro-spinal fluid (or that from cerebral ventricles) inoculated on to

culture tube provided. See over.

(2) Intestinal parasites (if not known) in 5 per cent. formalin, in tube pro-

vided.

(3) Small pieces of any abnormal tissue noticed; send in equal parts of methylated spirits and water, or in whisky or brandy if no methylated at hand. Where the patient is alive when seen, a tube of blood as for Widal's test should be taken, and also smears of blood. Also some 3-4 cc. of the cerebro-spinal fluid. Method of obtaining, see below.

To collect blood for Widal's reaction: congest a finger from the proximal to just above the distal interphalangeal joint; with a Hagedorn or other needle (sterilised) prick a little above or to the side of the root of the nail. If blood does not flow freely it can be made to so by flexing the terminal joint. Having broken both ends of the blood tube, apply one end to the drop of blood. When one-third to one half a tube full has been collected the tube is very gently warmed from the upper level of the blood to the clean end (the blood must not be heated), which is then sealed in the flame. As the air cools, the blood is drawn away from the end by which it entered, and this end is sealed in its turn.

To make a thin blood smear: Let a clean slide touch a drop of blood (not the finger itself) about half-inch from the end. Then with the short edge of another slide held at angle of about 45, or with a needle held horizontally on the slide, touch the drop and wait a second or so till the blood has extended by capillary attraction nearly the breadth of the first slide, and then draw the upper slide-(or needle, if that is used) once along the lower slide.

To obtain a specimen of cerebro-spinal fluid: This is not at all difficult and is of paramount importance in this investigation. A line joining the upper points of the iliac crests crosses the spine at the upper edge of the spinous process of the 4th humbar vertebra. With the patient lying on the left side, the knees drawn up. identify the space between the 3rd and 4th vertibra. Clean this part. Enter a hypodermic needle (or preferably one a little longer) through the centre of this inter space, one centimetre (one third of an inch) to the right of the middle line, and direct it forwards, slightly upwards and slightly inwards.

Note whether the fluid appears to flow as if it were under pressure. Allow the first few drons to escape, and then let some flow directly on to the medium in the tube provided. Remove the india-rubber cap on the tube, heat the wool plug to sterilise it, and remove it, keeping it in the hand, and allow the cerebro-spinal fluid to drop into the open tube. As soon as a few drons have fallen on to the surface of the medium, remove the tube, hold the neck of the wool plug in a flame, in order to destroy any extraneous organisms which have settled on them from the air, replace the wool plug and the rubber cap, and despatch to the laboratory.

The fluid from the cerebral ventricles at the post-mortem can be withdrawn by means of a sterile hypodermic syringe and the tube of medium be inoculated in a similar manner, taking care to keep out extraneous contamination as above, by