NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
The case at first was thought to be one of pneumonia, as there were slight
physical signs at the base of both lungs. The lung condition, however, soon
cleared up and at no time was it sufficient to account for the continued fever
and the prostrate condition of the patient. Death took place from cardiac failure
on the thirteenth day of illness.
On the eleventh day of the illness the serum agglutination reaction with M.
Melitensis was tested by us. At that time the only strain available was the
stock. With an emulsion of this race a complete reaction was obtained in
dilution of 1 in 1200.
Case XIII .—Mian Jan ; aged 23, Sepoy, 27th Punjabis, Multan. Patient
was admitted into hospital on 17th April 1905 suffering from fever. The fever,
which was of a remittent type (vide chart XIII) continued uninterruptedly for
nearly seven weeks, when the patient was sent " away " or " placed on " on sick
leave. There were no joint pains at any time. During the second week, when
the evening temperature daily rose to about 103° F., there was considerable
abdominal pain accompanied by vomiting. This, however, soon passed off under
treatment.
The agglutination reaction of the serum with M. Melitensis was estimated
on two occasions, first at the end of the second week, and again at the beginning
of the fourth week. The result, the same on both occasions, was as follows:—
Dilution of serum.
Stock.
Multan I.
1—80
.
.
.
.
.
. Complete sedimenta-
tion.
Complete sedimenta-
tion.
1—160
.
.
.
.
. . Complete
,,
Complete , ,
1—320
.
.
.
.
. Complete
,,
Complete
,,
1-640
.
.
.
.
. Well marked „
Complete
,,
1—1280 .
.
.
. . Trace of ,,
Well marked „
Case XIV .— Abdulla ; aged 48, prisoner in Ferozepore Jail. Patient
was admitted into hospital on 1st March 1905. On admission it was noted
that there was slight fever accompanied with cough. The throat was some-
what congested. There was no enlargement of the spleen. The patient was
under observation for more than ten weeks, when he left hospital on being
discharged from Jail. During all this time the fever continued. (Vide chart
XIV.) There were no marked symptoms. At times there were slight cough and
expectoration, but no physical signs of disease could be detected in the lungs.
The sputum was examined on several occasions for tubercle bacilli, but the
17
result of these examinations was always negative. No complaint of pain in the
joints was made.
At the beginning of the tenth week the blood was sent to us for examination.
The following was the result of the serum agglutination test with M. M elitensis:—
Dilution of serum.
Stock.
Multan I.
1-40
.
.
. . . .
Complete sedimenta-
tion.
Complete sedimenta-
tion.
1—80
.
.
. . . Complete
,,
Complete , ,
1 — 1 6 0
.
.
.
.
.
.
.
.
Well marked „
Complete
,,
1—320
.
.
.
.
.
. .
No
, ,
Trace of
,,
1—640
.
.
.
.
.
.
No
,,
No
,,
It was unfortunate that this patient was discharged from hospital before a
splenic puncture could be done.
Case XV .—Mr. J. D.; aged 22, Lahore. Patient was admitted into
hospital on the 5th May 1905 suffering from fever. For temperature vide
chart XV. The fever, which was of a markedly remittent type, continued
for more than ten weeks, when the patient passed out of observation. Neither
the spleen nor liver was enlarged. Constipation was troublesome at intervals
throughout the illness. During the fifth week the left wrist-joint became swollen
and painful. No other joints were affected.
At the beginning of the ninth week the serum agglutination reaction with M.
Melitensis was tested with the following result:—
Dilution of serum.
Multan I.
.
.
.
.
.
.
.
.
Complete sedimenta-
tion.
1—160
.
.
. .
. .
.
. . .
Well marked „
1 - 3 2 0
.
.
.
.
.
.
.
.
.
.
No
,,
Case XVI. —Mrs. P., aged 28, Lahore. Patient was admitted into
hospital on 26th May 1905 with a history of having suffered from fever for
twelve days before admission. During the third week patient was very ill, the
temperature on one occasion running up to over 105° F. (vide chart XVI).
The spleen was slightly enlarged; the liver remained normal. Constipation was
very troublesome throughout the illness, an enema as a rule being required to
18
procure an evacuation. Quinine was without effect. There were no joint pains
complained of at any time.
The serum agglutination reaction with M. Melitensis was estimated in the
middle of the seventh week. The following was the result :—
Dilution of serum
Multan I.
1 — 8 0
. . . . . . . . .
Complete sedimenta-
tion.
1—160 . . . . . . .
Complete
,,
1-320
.
.
.
.
.
.
.
.
No
,,
Case XVII.—Amalak Shah, aged 17, an albino. Patient first came
under medical observation on the 19th June 1905. He stated that he had been
suffering from fever for a day or two before this date. He was resident in Murree.
For temperature vide chart XVII. It will be seen that on occasions a high tem-
perature, over 105° F., was recorded ; its remittent nature was fairly well marked.
Profuse perspiration was a prominent symptom throughout. About the middle
of the fourth week he first complained of pain in the joints ; at this time the
right hip was affected and later on the joints of the toes became involved.
Further, he complained of pain in the muscles of the thighs and back. Con-
stipation and diarrhœa alternated. At one time faint sibilant rales were heard
over both lungs. This bronchitis, however, soon passed off.
The serum reaction with M. Melitensis was tested in the middle of the third
week with the following result :—
Dilution of serum.
Stock.
Multan I.
1 – 8 0
.
.
.
.
.
.
Complete sedimenta-
tion.
Complete sedimenta-
tion.
1–16o
.
.
.
.
. .
Complete , ,
Complete , ,
1–320
. . .
.
.
.
Complete ,,
Complete
, ,
.
.
1–640
.
.
.
.
Complete
,,
Complete
,,
1–1280 .
. .
.
Well marked ,,
Complete
,,
1–256o .
.
.
.
. No
,,
Well marked ,,
This case completes the record of the cases of Mediterranean fever which
have come under our observation at the present time. We have, however, still
19
to draw attention to one or two questions which have appeared during the course
of the investigation.
In the first place, it is important to note the great differences in the agglu
- tination value of the sera in the different cases. A complete reaction in some
cases was obtained in no higher dilution than 1 in 40, while in other cases a
complete reaction was observed in a dilution of 1 in 1200 or even higher. The
significance of these variations has been already pointed out by Birt and Lam
b13
and by Bassett-Smith. 1 4
In the second place, it is of interest to note that M. Melitensis was iso-
lated from the spleen at various stages of the disease. In most instances the
temperature was still high and the illness in a more or less acute stage. But
in case VI the temperature was falling and came to normal eight days after-
wards ; in case V the spleen was punctured on the first day of apyrexia ; while in
case VII the temperature, which had only been raised for seven days, had been
subnormal for eight days before M. Melitensis was isolated from the spleen.
In the third place, case VII is of great interest. It will be remembered that
this man was in hospital suffering from " remittent fever" from 5th September
to 2nd November 1904. It is probable, in view of the facts which we shall refer
to in a moment, that this illness was Mediterranean fever. For six months
after this illness he was free from fever and able to do his duty as a sepoy in the
regiment. After this interval he was again admitted into hospital suffering
from fever, which only lasted for seven days. There were at this time no other
symptoms. Now, the fact that M. Melitensis was isolated from the spleen eight
days after the temperature came to normal is positive proof that this fever of
short duration was an attack of Mediterranean fever. The question, then, is at
once raised, as to whether this last illness was a relapse after six months' interval
or a fresh infection. If it were a relapse, we have to assume that the causal
bacterium had remained alive in the spleen or other internal organ for six months
without giving rise to any symptom. If, on the other hand, it were a fresh
infection, we have to conclude that one attack of Mediterranean fever does not
confer immunity for any length of time. This latter conclusion is quite contrary
to all clinical experience. We are, therefore, inclined to support the other view,
namely, that we were here dealing with a relapse.
In the fourth place, there is an interesting point in the epidemiology of this
disease which is raised by an analysis of our cases.
Of the 17 cases which we have recorded above, 11 occurred in one regiment,
namely, the 27th Punjabis. We have seen that one of these cases was probably
a relapse, the original attack having occurred some months previously. The
remaining ten cases were admitted into hospital between the 4thMarch and
18th May 1905, but seven of these ten cases were admitted during the month
20
of March. At first sight it would appear easy to trace a common source of
infection for these cases. But a careful investigation by the medical officer in
charge of the regiment failed to bring forth any likely method of common infection.
The men belonged to different companies, to different races in fact, slept in
different barracks and practically never met.
When this small epidemic occurred the regiment was stationed at Multan in
the Punjab. They arrived there from Ferozepore, also in the Punjab, on the 29th
January 1905. On careful inquiry it was found out that shortly before leaving
Ferozepore several cases of continued fever, some with a history of neuralgia and
pain in the joints, had been treated in hospital. No chart or detailed records of
these cases were available, but the bloods of a few of them were found to sediment
M. Melitensis. These cases are as follows :
—
(1) Subadar Bhooroo.—He had been in hospital for 34 days suffering from
fever and severe sciatica. His serum, tested six months afterwards, completely
sedimented Multan I in dilution of 1 in 80.
(2) Mancha Singh. —This man had been in hospital on three separate
occasions suffering from fever with neuralgia and pains in the joints, namely :
—
From ( a) 8th June 1904 to 22nd June 1904;
(b)30th June 1904 to 26th August 1904;
(c)28th October 1904 to 5th December 1904.
The serum, tested five months after the last relapse, completely sedimented
Multan I in dilution of 1 in 80.
(3) Surprag Khan.—This man was in hospital suffering from remittent fever
from 21st July 1904 to 26th August 1904.
The serum, tested nine months afterwards, gave a complete reaction with
Multan I in dilution of 1 in 40.
(4) Udho. —This man was in hospital suffering from fever, which was diag-
nosed as ague, from 25th July 1904 to 18th September 1904.
The serum, tested nine months afterwards, completely sedimented Multan I
in dilution of 1 in 80.
(5) Lal Singh. —This man was in hospital from 22nd November 1904 to 5th
January 1905 suffering from continued fever, which was also diagnosed as ague.
The serum, tested four months afterwards, gave a complete reaction with Multan I
in dilution of 1 in 80.
Further, the medical officer who was in charge of the regiment in Feroze-
pore was invalided to England after having suffered from a long, continued
remittent fever, which was regarded as being of malarial origin.
There can be no doubt, therefore, that the regiment while in Ferozepore
suffered considerably from Mediterranean fever and that cases were occurring just
before it left that station.
21
This regiment on its departure to Multan was succeeded in the same barracks
in Ferozepore by the 15th Sikhs, which, however, did not arrive till the 4th
April, more than two months after the 27th Punjabis had left. The 15th
Sikhs came from the Samoena, on the Afghan frontier, where they had been
stationed for a little over a year. During this time the records show that
no cases at all resembling Mediterranean fever were treated in hospital, although
while in Peshawar in 1903, before going to the Samoena, two cases, both
clinically typical of the disease and in which the serum agglutination reaction
with M. Melitensis was positive, had occurred. Such being the facts, it was,
therefore, of the greatest interest to find a case of Mediterranean fever among
the 15th Sikhs occurring about three weeks after the regiment had arrived
in Ferozepore, namely, case X. We have made repeated enquiries from the
medical officer of this regiment, and have examined the bloods of several
cases of fever which have occurred recently, but this is the only case of
Mediterranean fever which has been discovered. 1 5
T h e r e i s n o d o u b t t h a t t h i s
man became infected in Ferozepore. But the infection left behind by the 27th
Punjabis cannot have been of a serious or widespread nature at the time of the
arrival of the 15th Sikhs, otherwise we should have expected to find a more
or less considerable epidemic breaking out among the new-comers. The
probable explanation of this exemption is, we imagine, to be found in the fact
that more than two months had elasped between the departure of the one
regiment and the arrival of the other. This explanation receives support from
the observation of Horrocks,16 that M. Melitensis survives for 43 days in soil
allowed to dry naturally and for 72 days in a damp soil.
In conclusion, it is our pleasant duty to have to thank the following officers,
without whose assistance the present investigation would have been impossible :—
Major Adie, I.M.S., Captains Corry, I.M.S. Kerans, I.M.S. and Trafford,
I.M.S., and Lieutenant McGillivray, I.M.S.
NOTE.—Since this paper was written nineteen other cases of continued fever have been investigated by
us. The sera of all these patients gave a good reaction with M. Melitensis. They occurred in the following
stations : in Ferozepore five cases in the 14th and 15th Sikhs; in Rawalpindi eleven cases in the 31st
Punjabis ; in Mian Mir one case in a British soldier ; in Jullundur one case in a native follower ; in Delhi
one case in the 28th Punjabis. M. Melitensis was isolated from the spleen of the Delhi case. It is evident,
therefore, that Mediterranean fever is both common and widespread, at any rate in the Punjab.
The part which goats play in the epidemiology of the disease had not been suggested when this paper
was sent to press.
22
Notes and References.
(1) The Lancet, March 6th 1897, p. 656.
(2) British Medical Journal, April 10th, 1897.
(3) The Lancet, September 9th, 1899.
(4) Indian Medical Gazette, September 1900, p. 337.
(5) Indian Medical Gazette, September 1900, p. 367.
(6) Indian Medical Gazette, March 1901.
(7) Zeitschrift für Hygiene ; Vol. XLVI, 1904, p. 261.
(8) Loc. Cit.
(9) Comptes Rendus de la So ciété de Biologie, T. 59, 1905, p. 240.
(10) Indian Medical Gazette, June 1904, p. 236.
(11) Reports of the Commission for the investigation of Mediterranean fever under
the supervision of an Advisory Committee of the Royal Society. Parts I & II, London,
Harrison & Sons, 1905.
(12) British Medical Journal, February 5th, 1897.
(13) Loc. Cit.
(14) British Medical Journal, September 20th, 1902, p. 861.
(15) Three cases of Mediterranean fever have occurred in the 15th Sikhs since this
paper was sent to press. These occurred in September 1905, that is, five months after the
regiment arrived in Ferozepore.
(16) Reports of the Commission for the investigation of Mediterranean fever, Part I,
p. 14.
G. I. C. P. O.—No. 1839 S. C.—1122-06.—.1,145-
Case XVI Mrs. P., Age 28.
Case XVII. Amalak Shah, Age 17 .
Monkey I.
Monkey II.
Case XI. Mr, M., Age 32.
Case XII. Sohun, Age 32.
Case XIII. Mian Jan, Age 23.
Case XIV. Abdulla, Age 48
.
Case XV. Mr. J. D., Age 22.
Case VIII. Labh Singh, Age 23.
Case IX, Gulab Khan, Age 19.
Case VI. Bishan Singh (1), Age 20.
Case VII, Bishan Singh (2), Age 34.
Case X. Dalhara Singh, Age 22.
No. 22.
(NEW SERIES. )
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
MEDITERRANEAN FEVER IN INDIA : ISOLATION OF
THE MICROCOCCUS MELITENSIS.
BY
CAPTAIN GEORGE LAMB, M.D., I.M.S.
AND
ASSISTANT SURGEON M. KESAVA PAI, M.B., C.M. (Madras).
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
BY THE SANITARY COMMISSIONER WITH THE GOVERNMENT
OF INDIA, SIMLA.
CALCUTTA:
OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING, INDIA.
1906.
Price ten annas or 1s.
REPORT
ON THE
Vaccine Operations
CONDUCTED BY THE SPECIAL VACCINATION DEPARTMENT
CENTRAL PROVINCES
FOR
THE YEAR 1868
NAGPORE
Printed at the Chief Commissioner's Office Press,
1869.
REPORT
ON THE
Vaccine Operations
CONDUCTED BY THE SPECIAL VACCINATION DEPARTMENT,
CENTRAL PROVINCES
FOR
THE YEAR 1888.
NAGPORE:
Printed at the Chief Commissioner's Office Press,
1869.
BOOK CIRCULAR No XXX.
FROM
THE ASST. SECY. TO THE CHIEF COMMISSIONER,
Central Provinces,
To
ALL COMMISSIONERS OF DIVISION,
Central Provinces.
Dated Nagpore. the 6th July 1869.
SIR,
I am desired by the Officiating Chief Commissioner to
forward Report by the Superintendent General of Vaccination, on
the working of the Vaccine Department in the Central Provinces for
the year 1868, together with Mr. Morris' Review thereon, for general
information and guidance.
I have the honor to be,
Sir,
Your most obedient Servant,
J. W. NEILL,
[Not translated.]
Offg. Asst. Secretary.
No. 1974/197
FROM
THE ASST SECY TO THE CHIEF COMMISSIONER,
Central Provinces.
To
THE SUPDT. GENERAL OF VACCINATION,
Central Provinces.
Dated Nagpore, the 6th July 1869.
SIR,
I am directed to acknowledge the receipt of your report
on the operations of the Vaccine Department during the past year.
2. The districts in which the work of the department was chiefly
carried on were Wurdah and Baitool, but a portion of your establish-
ment was also employed for a time in that part of the Chanda district
which adjoins Nagpore and Wurdah.
3. The districts of Baitool, Wurdah and Chanda had never been
visited by you, so that you entered upon a new field. The total num-
ber of persons vaccinated by your establishment was 43,484. Of these,
22,399 belonged to Wurdah, 17,098 to Baitool, 3,393 to Chanda, and
the remaining persons vaccinated belonged to Chindwara and
Mundla. The percentage of successful cases was 79.34.
4. During the past season, therefore, more has been done than
in any previous year, but the percentage of successful operations has
been somewhat lower than in 1868. This may be in part due to the
great heat of the weather during the past season.
5. From your report it appears that neither in Wurdah nor in
Baitool did you meet with any serious opposition. The prejudice of
the people against vaccination seems to have been removed with-
out much difficulty, and the opposition shown was of that passive
kind which almost invariably attends the introduction of any new
thing among a nation so conservative and tenacious of ancient habits
and customs as the Hindus. In the Hingunghat Tehseel of the Wur-
dah district alone do you mention anything like active opposition,
but even that you appear to have overcome by a personal visit.
6. The Officiating Chief Commissioner is glad to learn that in
the Wurdah and Baitool districts you have had no reason to complain
of any want of assistance on the part of the Native Government offi-
cials. They are undoubtedly able to do much in dispelling ground-
ess alarm and explaining the true object of vaccination.
2
7. Apart from the establishment under your special care, opera-
tions were carried on by Civil Surgeons aided by Municipal Vaccin-
nators. The number of persons vaccinated by them amounted to
64,827, and 80 per cent of the operations are returned as successful.
8. In the Sumbulpore district again, a separate establishment
was entertained, which vaccinated 23,416 persons, 93 per cent of the
operations being successful; you express yourself in every way
satisfied with what has been done in Sumbulpore, and the Officiating
Chief Commissioner is glad to learn that the people of that district
have shown themselves so ready to accept vaccination. The careful
supervision exercised by Mr. Harrison has no, doubt tended to secure
the success of the establishment.
9. The number of district operations performed exceeds by 50
per cent the number performed last season. In para. 30 of your re¬
port you point out how, in many cases, the returns of Municipal or
District Vaccinators are still incorrect and unreliable. The reason
of this appears to be that Civil Surgeons continue to extend the ope-
rations of Vaccinators beyond a circle which they can themselves
supervise. They should be very careful to select only thoroughly re-
liable men to send to places which they are not able to visit frequently.
10 The temptation to send in a favourable return is undoubtedly
very great to a Native Vaccinator, but because their returns are in
some instances found incorrect the Officiating Chief Commissioner
would not condemn the labours of all these men, or say that Muni-
cipal Vaccinators are likely to do more evil than good. Mr. Morris
thinks you go perhaps too far when you say that " one failure that is
positive and palpable will outweigh 100 successes that cannot be
clearly demonstrated," if you would by this signify that because 1
person out of every 100 said to be properly vaccinated is attacked by
small-pox, the people will disbelieve that the escape of the ninety-
and-nine is in any way due to their having been vaccinated ; and the
connexion between making false returns and receiving bribes is not
so very close. Many a man might reconcile the former to his con-
science who would shrink from the latter.
11. The Officiating Chief Commissioner thinks that a mistake
is not unfrequently made in assuring natives that vaccination is an
absolute and infallible prevention against small-pox, for cases are on
record in which persons vaccinated have contracted the disease. The
Sanitary Commissioner in his Annual Report has quoted from a letter
from the Deputy Commissioner of Chindwara, reporting an outbreak
of small-pox in Chindwara itself, where the majority of the children
attacked had been previously vaccinated ; and the Commissioner of
Nagpore has, the Officiating Chief Commissioner learns, reported to
you a similar instance that occurred at Khodamaindee, in the Nagpore
district
12. The Sanitary Commissioner has given his opinion that in
cases of the occurrence of small-pox after vaccination the inefficacy
of the operation is owing to its having been performed too lightly.