Report on an outbreak of enteric fever in the Malton Urban District / by W.V. Shaw.

  • Shaw, W. Vernon (William Vernon), 1874-1937.
Date:
1933
Catalogue details

Licence: Public Domain Mark

Credit: Report on an outbreak of enteric fever in the Malton Urban District / by W.V. Shaw. Source: Wellcome Collection.

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    this was reported to the Master, who at 4.15 p.m. sent a note to Dr. Walker, who visited at 7.30 p.m. On X’s record card, which was kept not in the ward but in the Master’s office, is a note under date 23rd September in Dr. Walker’s writing—“ Hyperpyrexia ? from diarrhoea, some pain in epigastrium, nothing abnormal found.’: X was ordered No. 10 diet which consists of tea and bread and milk ; an extra pint of milk was ordered four days later. The condition described is borne out by the evidence of the assistant nurse, who alleges that X had several loose stools on the day of admission and that he got out of bed and used either the commode or the adjoining water-closet. It is immaterial, however, inasmuch as the contents of the commode, as also those of the bed slipper, were habitually emptied into the ward water-closet pan. Dr.. Walker did not again visit the Institution until 26th September, when the entry on the card reads—“ To be treated as typhoid. Still complaining of fixed pain over epigastrium, no cough, no signs of pneumonia or pleurisy.” There are no other clinical notes and the temperature charts which I saw^ in the ward on the occasion of my first visit were subsequently missing and could not be found. The only other entries on the record card are dated 8th, 11th and 21st October, and relate to certain additions to the diet. Dr. Walker’s entries were made in the Master’s office, the record card was never in the ward and the nurses aver that not only did they never see it but they knew nothing of the suspected nature of the illness until told by his deputy, Dr. Parkin, on 28th Sep¬ tember, to treat the “ case as one of infectious disease.” No sug¬ gestion of the patient’s removal to the York Isolation Hospital, as provided for by an existing agreement, was made nor were the other patients in the ward placed elsewhere. The only change in procedure after the 28th September was that X was given verbal orders, which he disregarded, to stay in bed and to use a bed slipper and urine bottle. It is stated that these utensils were used but not exclusively, and that they were disinfected by the addition of a proprietary disinfectant fluid which was allowed to remain in contact with their contents until such time as the nurse had finished the patient's toilet. The contents were then emptied into the ward water-closet pan. Following his visit on the 28th September, Dr. Parkin visited for Dr. Walker on 1st, 2nd, 3rd, oth, 7th, 10th and 12th October, and on the 2nd he had taken a specimen of X’s blood for the agglutination reaction. The result wras negative, but as the clinical condition continued indefinite a second sample w^as examined later and a positive result reported on 9th October. On that date the notification of “ enteric fever ” wras signed by Dr. Walker, and on 10th October Dr. Parkin is reported to have told the charge nurse that X had enteric fever and was to be treated accordingly. He was not, however, removed from the common ward and the situation remained as before. X wras a difficult patient and there is no doubt that he was in the habit of getting