Specimens for laboratory examination.

Appx. XXI.

          (c ) The exact nature of the examination required, and the reasons
rendering it necessary.

          (d ) In any case of suspected poisoning, a clinical summary. This
summary should state particularly the length of time which
elapsed between the consumption of the article and the
onset of symptoms, the symptoms observed in the order
of their occurrence, the present condition of the patient
or patients and the condition of other persons who have
partaken of the article or of similar articles from the same
consignment.

       These reports will be signed by the officer who actually took the
sample, and may be countersigned also by the officer at whose request
the sample was taken.

       10. Reports on analyses carried out at the Military Food Laboratory
will be sent to the officer at whose request the sample was taken, a
copy being sent to the A. D. M. S. of the District concerned.

C.—PATHOLOGICAL MATERIAL FOR LABORATORY EXAMIN-
ATION.

SPECIMENS FROM SUSPECTED ENTERIC CASES.

       1. Blood culture. —This is a most valuable method of diagnosing
cases. It is important to consider the date of onset of disease, and
not of admission to hospital only. Blood culture should also be carried
out in every relapse as soon as the temperature rises. Glassware
and the skins of patients in India are difficult to sterilise owing to
the presence of sporing organisms. A sterile syringe kept entirely
for blood culture work and for no other purpose, should be employed.
The skin should be thoroughly washed with soap and water over the
bend of the elbow, and the area painted with a solution made by
dissolving 0.5 per cent. each of brilliant green and crystal violet in
50 per cent. alcohol. Cover the area with sterile gauze and leave 10-15
minutes. This solution renders the skin quite sterile.

       At least 3 c.c. of blood should be inoculated into the bile, and the
rubber cap then covered with melted paraffin.

       2. Agglutination tests. —At the same time as blood is taken for culture
2 c. c. of the blood should be placed in a sterile tube and allowed to
clot firmly. Once the serum has separated it should be pipetted into
a Wright's capsule, and forwarded to the laboratory for Widal test.

       Subsequent samples of serum should be forwarded to the laboratory
at intervals, e.g. , 10th, 14th, 18th, 22nd day of disease. It is to be
remembered that one single agglutination test is of no value in diag-
nosis in an inoculated individual. Tests on 26th and 30th day of disease
in addition to above tests may yield information of great value, and
should be carried out in suitable cases.

       3. Collection of blood serum. —Two methods can be employed for
obtaining serum for agglutination tests, viz. , collection in a Wright's
capsule or by means of vein puncture.

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