ACUTE CHOLECYSTITIS IN CHILDREN AS A COMPLICATION OF TYPHOID FEVER

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OUTDOOR MEDICAL OFFICERS OF THE MINISTRYOF HEALTH.

WE call attention again to the proposed appoint-ments on the outdoor staff of the Ministry ofHealth set out in our advertising columns. Theyrefer to 18 medical officers for England and3 for Wales. A committee has been set up toconsider applications for these appointments andto make recommendations to Dr. Addison. Thiscommittee includes medical men of high standingfrom different parts of the country, one of whom is tobe its chairman, with a nominee of the Civil ServiceCommissioners and two representatives of theMinistry of Health. The personnel of the com-mittee will not be announced until after it hasmade its recommendations. The decision tomake the appointments is the result of pro-longed thought and negotiation. It embodies theconception of medical referees set forth in thewell-known circular (M.25) of the British MedicalAssociation, and the selected men will represent thereferee-consultants for whom provision was madein the summer of 1914, when the scheme was heldover on account of the war. These whole-timeofficers are to have functions which are primarilyadministrative, but at first their duties may be

largely clinical, because they are to take the placesas official referees of the consultants who have beenacting in this capacity under private arrange-ments with the Approved Societies. They are toact as expert advisers to the authority responsiblefor the clinical service, and will probably havesupervisory powers in the administration of theservice. These officers are already referred to inthe new Medical Benefit Regulations as the medicalofficers to whom reports are to be furnished, andwith whom consultations will be arranged on anypatient in respect of whom a practitioner seeksspecial advice. The appointments are of the utmostimportance to the medical profession as the firststep in the further organisation of the MedicalService. We may regard them as forming a linknot only with the local health authorities whenthese should finally be determined, but with thehospital and specialist services which are to be

provided in the near future.

ACUTE CHOLECYSTITIS IN CHILDREN AS A

COMPLICATION OF TYPHOID FEVER.

THE constant infection of the gall-bladder atsome stage of typhoid fever, and the important r6leof the typhoid bacillus in -the production of chole-cystitis and gall-stones, have been recognised forsome years, but the cases of empyema of the gall-bladder or acute cholecystitis that require surgicaltreatment or prove fatal are few. In childrenacute cholecystitis of any kind is rare. In theJohns Hopkins Hospital Bulletin for January Mr.M. R. Reid and Mr. J. C. Montgomery have reportedthe following case :-A girl, aged 8 years, was admitted on Dec. 20th, 1918.

Abdominal symptoms had begun a week before after anillness of eight weeks, marked by fever, delirium, head-ache, and diarrhoea. On admission she was emaciatedand complained of pain in the abdomen and a largeabdominal mass. The temperature was 98’8°F. and thepulse 100. The abdomen was distended, especially onthe right disc, and the venules in the skin were promi-nent. A large smooth mass, extending from the ribs tothe level of the anterior iliac spine on the right side,could be seen and felt. The temperature varied duringthree days from 99° and 104°. Various diagnoses weresuggested-retroperitoneal sarcoma, sarcoma of the liver,

abdominal abscess, appendix abscess. An affection ofthe gall-bladder was discussed, but thought unlikely onaccount of the huge size of the mass. On Dec. 23rdan operation was performed. A distended gall-bladdercontaining almost a litre of pus was found. It wasremoved, and after convalescence the patient rapidlygained weight. Cultures from the gall-bladder yieldedthe typhoid bacillus in pure culture. A week after the

operation the urine also yielded a culture of the

typhoid bacillus. The gall-bladder showed typical acutehsemorrhagic cholecystitis with necrotic areas.

Mr. Reid and Mr.Montgomery have been able tofind recorded only 17 other cases of typhoid chole-cystitis in children, although their search goesback to 1835. In the 18 cases the patients werechildren under the age of 15, who either died from,or were operated on for, cholecystitis complicatingtyphoid fever. In 11 cases acute cholecystitis didnot develop until eight months after recovery fromthe disease ; in the others the complication occurredduring the illness. Eight of the patients diedwithout operation, and all of these cases were

reported before 1893, since when 10 cases have beentreated surgically, with one death. The authorsinsist on the importance of distinguishing betweengall-bladder complications of typhoid fever that doand do not require surgical treatment. Slight painand tenderness in the region of the gall-bladder,with slight spasticity of the rectus, are not veryunusual in typhoid fever, and the vast majority ofthe patients recover. But immediate operation isindicated in acute suppurative cholecystitis, as

rupture of the gall-bladder may occur. Chole-cystectomy appears to be the best treatment.

PSYCHOLOGY AND REALITY.

IN these days psychology is taking on a newaspect in that the science is, as the more academicfollowers of it may think, demeaning itself by therecognition of utilitarian purposes, and the con-ception of its practical side is being extended toembrace problems concerning such varied mattersas the influence of fatigue, systems of memory-training, advertising, the investigation of crime,and the laying of bricks. Quite an extensiveliterature is growing up round the application ofpsychological methods to industry, and for a longperiod we, being perhaps lacking in the kindnessof heart and simple faith which characterisesome psychologists, have watched the develop-ments which are taking place with curiosity asto the stage at which the altruistic tone woulddisappear. That the working man should lendhimself to a scheme of examination into his

capacity which might mean his being displaced bysomebody who could do his job better, or whichmight provide a logical basis for paying him lessis surely unlikely; but hitherto there has beensurprisingly little recognition of this fact in thevarious treatises which deal with the mostprofitable ways of running the industrial machine.To the British Journal of Psychology for March, 1920,Mrs. S. S. Brierley contributes a paper whichpresents this aspect of the matter.

"

The attentionof psychologists," we are told, " has recently beendrawn to the widespread opposition to the intro-duction of psychological methods into industry,existing among organised labour." Even amongeducated workers, as Mrs. Brierley shows, there isopposition to the principles of

" scientific manage-

ment," and whether this opposition is merelyselfish, or represents a genuine doubt as to the

1 The Present Attitude of Employees to Industrial Psychology.