31
REPORT OF THE KING INSTITUTE, GUINDY
Dr. Venkataraman has made a close study of the clinical aspects of the cases as well as
a thorough bacteriological investigation into ætiological nature. A scrutiny of his findings
are in entire agreement with the findings of other workers on problems of this nature.
Lieut.-Col. Acton, I.M.S., has contributed very important findings towards the obscure
nature of bowel complaints in India—vide Annual Report of the Calcutta School of Tropical
Medicine for 1929. His recent findings of organisms, such as, fæcal streptococci, B. pesudo
carolinus, B. morgani, B. fæcalis alkaligenes, B. pyocyaneus, and non-agglutinable strains of
B. flexner as ætiological factors in the causation of symptom syndrome of Sprue and Sprue
-
like diseases, atonic diarrhœa (Hance). The importance of Col. Acton's findings is that
autogenous vaccine prepared from one or other of these organisms brings about a complete
cure even in most protracted cases.
Dr. Hance in his report read before the Medical Congress in January 1930 comes to
similar conclusions except that he attributes to hæmolytic streptococci a more incriminating
role.
In view of the findings of these workers which have been corroborated in their entirety
by the findings of Dr. Venkataraman on the Golden Rock cases which unfortunately are very
few in number, viz., 14 the line of further work suggested is as follows:—
That a bacteriological unit be stationed at Golden Rock to work for at least nine months
in the year, the period to include one rainy season. The reason for this recommendation is
that the unit will then have scope for work of a representative nature during the period
when bowel complaints are at their worst. It is common knowledge that a single bacteriologi--
cal examination or even three or four examinations is a futile attempt when dealing with this
type of infection.
Col. Acton has found that eight to ten examinations and these carried out on consecutive
days are absolutely essential before the ætiological factor can be made manifest. This was not
possible in the present series of cases. Considering the beneficial results obtained from a
close bacteriological survey which results in the preparation of autogenous vaccines it will be
seen that not unless and until bacteriological work is undertaken in connection with this
class of cases can any remedial measures be suggested towards controlling the disease.
Until arrangements can be made towards establishing a bacteriological laboratory
I would suggest that all such cases be treated with stock vaccines prepared from strains
associated with the disease and recently isolated at Golden Rock with such other strains as
are available at the King Institute. The utility of such vaccines is, I think, now beyon
d refute and would be a valuable measure in breaking the vicious chain of reinfection.
In the Golden Rock population we have an excellently controlled unit where if work is
done on the lines suggested I am of opinion that a valuable contribution towards the ætiology
and treatment of bowel complaints could be evolved.
APPENDIX III.
A REPORT ON ANAEROBIC STREPTOCOCCI IN "CLIMATIC BUBO" AND GENERAL
GLANDULAR ENLARGEMENTS
BY
MILITARY ASSISTANT SURGEON J . H. THEODORE, M.B.F., D.T.M., I.M.D.
A bacteriological investigation into cases of "Climatic Bubo" and general glandular
enlargements of unknown ætiology was undertaken in collaboration with the Director, at the
request of Col. Bradfield, First Surgeon, Government General Hospital, Madras. At the time
of the investigation three cases were available. Each of these, though of a distinct type,
nevertheless, bore features suggesting a common ætiology. It may be stated that the first
idea of the investigation was to confirm the findings of A. Clerici in Italy who obtained a
cutaneous reaction, after intradermal inoculation of an antigen prepared from the pus of
"Climatic Bubo" cases (Lancet, June 29th, 1930) but as will be noted to our surprise an
organism was isolated in the course of a routine bacteriological examination of the materials
—incised lymph glands given us by Col. Bradfield.
The following is a summary of the cases investigated :
—
Ca s e 1.—Dr. R., age 30, had a sore on his left index finger after operation on a soft sore
case. He was operated on for enlarged right axillary glands twice, and came in with
enlarged glands in the neck, which were dissected out. Incubation period was definitely one
week. Wassermann reaction was negative.