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The bacteriology of puerperal sepsis
1934.
PUBLIC
artificial sensitisation in the non-tuberculous subject seems remote, with any type of tuberculin. There is, however, considerable evidence that, in the tuberculous subject, the application of tuberculin may produce a temporary increase in general sensitivity, or more particularly in local sensitivity at the site of application. This occurrence was noted 25 years ago in connection with the ophthalmic reaction of Calmette, and the modern double intradermal test used in cattle appears to depend on a similar process. Where quantitative values are sought from the intradermal method, by progressive increase of the tuberculin concentration, it is probably important that no injection should be made at the immediate site of a previous test.
The Bacteriology of Puerperal Sepsis. communication dated April 13th, 1934, I NSir a George Newman, Chief Medical Officer of the Ministry of Health, advises medical officers of health of the discontinuance of the arrangements made early in 1932, for the carrying out at a central laboratory, of bacteriological investigation in cases of puerperal sepsis. Investigations under these arrangements have confirmed the importance of carriers of infection in the various forms of puerperal fever due to the streptococcus pyogenes. Because of the value attaching to bacteriological investigation in the problems which confront the medical officer of health in relation to such matters as the conduct of maternity homes and the suspension of midwives, and since administrative difficulties not infrequently arise from bacteriological uncertainty with regard to the nature and source of puerperal infections, Sir George Newman expresses the hope that every opportunity will be taken to obtain assistance on these points from bacteriologists attached to adequately equipped local laboratories. On the occurrence of pyrexia in a lying-in woman, isolation and separate nursing of the patient should be arranged immediately,, and swabs taken from the cervix, throat and nose. Simultaneously search should be made for any possible source of the infection, e.g., sore throat, tonsillitis, laryngitis, antral or s k i n infection in the persons who conducted the labour or were otherwise in contact with the patient during the subsequent 48 hours. Swabs from throat and nose and from any obviously infected site should be taken from all contacts, whether or not associated with clinical mani-
HEALTH.
249
festations of disease. It should be remembered that as contact with hands and instruments is the most likely mode of infection of the genital tract, particular attention should be directed to infections or abrasions of tile skin in anyone who has had such contact with the patient. Ordinary diphtheria swabs may be used for taking specimens except from the cervix, where a longer swab, mounted on malleable aluminium wire, is preferable. In swabbing the cervix a speculum should be used. The examination of the swabs may lead to the detection of the same bacteriological strain in a patient and in someone who has been in contact with her, or to the establishment of the identity of the strain from the cervix with that from the throat or nose of the patient herself. As a result, appropriate treatment can be applied and necessary administrative action taken to prevent further spread of the infection. The assistance of the Ministry of Health will continue to be available as formerly. If the medical officer of health desires to obtain such help he should inform the Ministry without delay, giving a short report of the cases of infection which have occurred and the bacteriological results, if any, which have been obtained, and stating on what particular point assistance is desired.
The Health, Comfort and Convenience of Industrial Workers. N a number of industries or processes, I accommodation for clothing and washing is required by the Factory Acts or b y regulations or welfare orders made under the Acts; but where no statutory requirement exists, many employers are desirous of making provision for the comfort of their workers, and local health officers as well as factory inspectors are frequently asked for advice upon the subject. For the information of these officers and of employers and others concerned as to the manner in which such arrangements can best be provided, the Home Office have issued a third edition of the Welfare Pamphlet No. 8.* The matters discussed include accommodation for clothing put off during working hours; facilities for washing and baths ; the supply of drinking water ; and the provision of suitable and adequate sanitary conveniences. Full and most helpful details with regard to construction, planning and so on of the various * H.M. Stationery Office. Price 9d. net.
PUBLIC
artificial sensitisation in the non-tuberculous subject seems remote, with any type of tuberculin. There is, however, considerable evidence that, in the tuberculous subject, the application of tuberculin may produce a temporary increase in general sensitivity, or more particularly in local sensitivity at the site of application. This occurrence was noted 25 years ago in connection with the ophthalmic reaction of Calmette, and the modern double intradermal test used in cattle appears to depend on a similar process. Where quantitative values are sought from the intradermal method, by progressive increase of the tuberculin concentration, it is probably important that no injection should be made at the immediate site of a previous test.
The Bacteriology of Puerperal Sepsis. communication dated April 13th, 1934, I NSir a George Newman, Chief Medical Officer of the Ministry of Health, advises medical officers of health of the discontinuance of the arrangements made early in 1932, for the carrying out at a central laboratory, of bacteriological investigation in cases of puerperal sepsis. Investigations under these arrangements have confirmed the importance of carriers of infection in the various forms of puerperal fever due to the streptococcus pyogenes. Because of the value attaching to bacteriological investigation in the problems which confront the medical officer of health in relation to such matters as the conduct of maternity homes and the suspension of midwives, and since administrative difficulties not infrequently arise from bacteriological uncertainty with regard to the nature and source of puerperal infections, Sir George Newman expresses the hope that every opportunity will be taken to obtain assistance on these points from bacteriologists attached to adequately equipped local laboratories. On the occurrence of pyrexia in a lying-in woman, isolation and separate nursing of the patient should be arranged immediately,, and swabs taken from the cervix, throat and nose. Simultaneously search should be made for any possible source of the infection, e.g., sore throat, tonsillitis, laryngitis, antral or s k i n infection in the persons who conducted the labour or were otherwise in contact with the patient during the subsequent 48 hours. Swabs from throat and nose and from any obviously infected site should be taken from all contacts, whether or not associated with clinical mani-
HEALTH.
249
festations of disease. It should be remembered that as contact with hands and instruments is the most likely mode of infection of the genital tract, particular attention should be directed to infections or abrasions of tile skin in anyone who has had such contact with the patient. Ordinary diphtheria swabs may be used for taking specimens except from the cervix, where a longer swab, mounted on malleable aluminium wire, is preferable. In swabbing the cervix a speculum should be used. The examination of the swabs may lead to the detection of the same bacteriological strain in a patient and in someone who has been in contact with her, or to the establishment of the identity of the strain from the cervix with that from the throat or nose of the patient herself. As a result, appropriate treatment can be applied and necessary administrative action taken to prevent further spread of the infection. The assistance of the Ministry of Health will continue to be available as formerly. If the medical officer of health desires to obtain such help he should inform the Ministry without delay, giving a short report of the cases of infection which have occurred and the bacteriological results, if any, which have been obtained, and stating on what particular point assistance is desired.
The Health, Comfort and Convenience of Industrial Workers. N a number of industries or processes, I accommodation for clothing and washing is required by the Factory Acts or b y regulations or welfare orders made under the Acts; but where no statutory requirement exists, many employers are desirous of making provision for the comfort of their workers, and local health officers as well as factory inspectors are frequently asked for advice upon the subject. For the information of these officers and of employers and others concerned as to the manner in which such arrangements can best be provided, the Home Office have issued a third edition of the Welfare Pamphlet No. 8.* The matters discussed include accommodation for clothing put off during working hours; facilities for washing and baths ; the supply of drinking water ; and the provision of suitable and adequate sanitary conveniences. Full and most helpful details with regard to construction, planning and so on of the various * H.M. Stationery Office. Price 9d. net.