Report of the Medical Officer of Health, Cairo City.

  • Egypt. Cairo City Health Inspectorate.
Date:
[1916]
Catalogue details

Licence: Public Domain Mark

Credit: Report of the Medical Officer of Health, Cairo City. Source: Wellcome Collection.

    115/186 (page 107)
    Judged by this, the occurrence of the disease would seem to give rise to the least risk to life between the ages of eleven and twenty for both sexes, the mortality being lowest in the group eleven to fifteen years in the case of the male, and in that of sixteen to twenty years in the case of the female. Above this, each group shows a gradually increasing case mortality, which is high for both sexes in patients over forty years of age. The case mortality amongst young children is below the average rate. It is highest as regards those in the youngest group of zero to five years, and gradually diminishes to the ages of least case mortality. In these hospital cases the female case mortality is somewhat lower than the male. Duration.—Independently of relapses, the disease was of variable duration, though as a rule it lasted about three weeks. Occasionally, milder cases, with a duration of as little as seven days, were met with, whilst cases which dragged on considerably beyond the usual three weeks were not uncommon, many cases of protracted fever with slow lysis lasting for five or six weeks. Complications.—The complications most generally met with were pulmonary and bronchial abnormalities, which in mild forms constituted not infrequent concomitants of the disease. The most common of these was bronchitis, but broncho-pneumonia was not infrequent. Parotitis, phlebitis, gangrene of both lower extremities, laryngitis, epididymitis, nephritis, insanity, and abortion were all met with. Diagnosis.—The distinction of the disease from typhoid fever was mostly based on laboratory tests consisting in the negative Widal reaction and the absence of typhoid bacilli from the blood, urine, and stools in the disease under consideration, though clinically the marked prominence of the headache in this disease raised suspicions of its nature. The mental condition, the absence of the characteristic smell, the full abdomen associated with acute tenderness and pain, the general absence of any characteristic rash, the tendency usually to a prolonged lysis, and the frequency of relapses served to differentiate this disease from typhus fever. Experimental Investigations.—For the reasons already given in the report, the ex¬ perimental investigations into the nature of the disease were somewhat handicapped by the circumstances obtaining at the time of the occurrence of the epidemic, and by the difficulties attending post-mortem examination in this country. In the few cases, however, in which limited autopsies were possible, no appearances were found throwing any light on the nature of the disease, though in this connection it must be remembered that no very extensive examinations could be carried out, as circumstances only permitted of a somewhat unsatisfactory inspection of the abdominal organs in these cases through a small incision made in the abdominal wall. This, however, was sufficient to show the absence, at least in the cases examined, of any pathological condition of the intestine beyond an occasional slight congestion. Numerous attempts were made during the course of the epidemic to isolate a causal organism, and efforts were directed towards obtaining cultures of such, on various media, under both aerobic and anaerobic conditions, but without success. No organism was isolated from either the blood, urine, or faeces, or from splenic smears from a few fatal cases in vrhich a partial post-mortem was permissible, which justifiably could be considered the causal agent. The negative Widal results were naturally based on a series of trials in each case, made at different periods, both during the course of the illness and after the defervescence, and not on single attempts. Owing to circumstances resulting from the war, monkeys were not obtainable for experimental purposes in the initial stages and during the height of the epidemic. Later, a few animals were received and inoculated with blood from patients suffering from the disease. All developed an illness clinically indistinguishable from that which would have been produced in monkeys by the inoculation of typhus blood. On this alone, however, it would be unjustifiable to presume identity with typhus, as the clinical features upon which was based the distinction in the human cases were not such as would clearly indicate themselves in a monkey.