36
STATISTICAL RETURNS OF THE LUNATIC ASYLUMS.
Solution, twice daily, is now practised from the beginning. The solutions are left
as possible in the bowel; the foot of the patient's bed is raised on blocks 18 inches
high, and patient is made to lie on his right and left side alternately.
Serum treatment was tried in the present year for the first time. So far
fifteen cases have had one or more doses of serum, with good results, as will be
seen by reference to Table IX. The impression left is that serum works well and
rapidly in acute cases with fever, but that its effect is transient, and that several
doses are required to produce any permanent effect on the disease. Both Kasauli
and Lister Institute sera were used. The great expense of anti-dysenteric serum
(Rs. 3-12-0 per dose) practically rules it out as a routine measure.
Many of the Madras cases either begin with conditions of glossitis and
stomatitis, or develop these conditions during the course of the disease. The stools
then become frothy, copious and very offensive, and a condition indistinguishable
from sprue becomes established. Iodine internally and Bulgarian milk have been
tried for these cases, but as a rule the patients go on for months or years, in a
stuporose condition, swallowing large quantities of fluid nourishment, and absorb-
ing little. The final P.M. reveals an alimentary canal thinned and denuded of
epithelium from the mouth to the cæcum, and the inevitable signs of dysenteric
ulceration in the colon and sigmoid. The question as to how far " Sprue " is a
legacy of bacillary dysentery seems to call for investigation.
Inoculation with polyvalent or autogenous vaccine was tried in 1911 as treat-
ment in 37 cases. The difficulty of obtaining autogenous vaccine in cases of
dysentery is very great, as it is only exceptionally that the bacilli can be isolated
from the stools, and a mixture of " house " strains was found more convenient.
The results were so bad (vide tables 7 and 8) that this method of treatment
was abandoned. It must be added, however, that it was used on most unfavour-
able cases, and also, in all probability, the dosage used was too large. A trial is
now being given to inoculation with small doses beginning with one million
bacilli—and the effects are being carefully watched.
CONCLUSIONS.
The general impression which the experience of the last 3½ years at Madras
and the examination of Indian asylum records leave upon one's mind is exactly
that which Dr H. S. Getting's delvings into the history of Wakefield asylum left
upon his—namely, the extraordinary preservation and ineradicability of asylum
dysentery. One is driven to believe that individuals who have suffered from
bacillary dysentery, especially if ulceration and thickening of the bowel have
occurred, remain " carriers " for years, if, indeed, they ever " recover " from the
disease, that the immunity conferred by an attack is a short-lived one, and that
conferred by inoculation, if any, is little better. That a chill or a slight lowering
of the vitality of the carrier will precipitate another exacerbation of a disease
never completely eradicated, and furthermore that there is a definite relationship
between bacillary dysentery and sprue.
Regarding the bacteriology of the disease, different bacilli have been described.
Shiga, Kruse, Flexner, Morgan, Hiss, McWeeney, Strong, and the investigations
at El Tor have described different forms—the differences depending upon the
fermentations of the various sugars and the production of Indol. Mr. Kesava
Poi found considerable differences in the various strains isolated from different
patients in Madras. But broadly speaking, it may be said that the chief difference
between English and Madras asylum dysentery is the greater prevalence of the
extremely toxic " Shiga " type bacillus, which does not ferment mannite, in the
Indian cases, and consequently greater severity of the disease in the latter country.
In this connexion the writer would like to confirm the observation of Sir Leonard
Rogers that there is a fulminating type of bacillary dysentery, indistinguishable
clinically from Asiatic cholera. Several such cases occurred in Madras, and were