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REPORT ON THE WORKING OF THE KING INSTITUTE, GUINDY
APPENDIX NO. V.
REPORT INTO THE OUTBREAK OF CHOLERA IN THE COIMBATORE JAIL
BY
MAJOR J. A. CRUICKSHANK, I.M.S., AND CIVIL ASSISTANT SURGEON S. RAMAKRISHNAN.
In accordance with verbal orders received from the Surgeon-General, I arrived at
Coimbatore on the evening of June 26th. Assistant Surgeon S. Ramakrishnan with the
laboratory equipment which had been at Kaity arrived late that night, the equipment was
got to the jail on the morning of the 27th and the laboratory was immediately established in
a room in the Jail Hospital. The equipment from the King Institute arrived on the morning
of the 27th. I immediately commenced an investigation into the epidemic and personally
investigated the possible sources of the infection. At the same time I started an inquiry
into the possibility of there being carriers in the jail and had the water-supply thoroughly
examined. Having satisfied myself that the epidemic had died down and that the prevent
-
ive measures which had been carried out were sufficient to render its recurrence unlikely,
I left Coimbatore on July 2nd leaving Assistant Surgeon Ramakrishnan to complete the
investigation on the lines I had laid down.
There were 36 cases of suspected cholera in the Jail Hospital on the 27th, many of whom
had been there some days and had reached the convalescent stage and were not passing
frequent stools. The establishment of the diagnosis being the first necessity, I immediately
proceeded with the bacteriological examination of such stools as were available choosing, as
far as possible, the more recent cases as being most likely to yield positive results. In all,
cultures were made from eight cases, in peptone water, and organisms isolated by plating on
Aronson's medium and cultivating in agar tubes. In these ways isolated colonies were
obtained which were tested microscopically, with high titre serum and by all other tests with
the result that on the 29th I was able to say that we had isolated true cholera vibrios from four
out of the eight cases examined. Short details of the cases are given below.
Case 1.—Admitted to hospital for fever on 22nd June 1922, developed diarrhœa and
vomiting on 23rd and was placed in the cholera ward. Died on 13th July 1922. Cholera
vibrios isolated.
Case 2.—Admitted on 25th with purging and vomiting and was very collapsed. Improved
under treatment. Culture negative.
Case 3.—Admitted on 24th with diarrhœa and vomiting. Hiccough started on 27th.
Died on 30th. Cholera vibrios isolated.
Case 4.—Admitted on 26th with history of severe purging and vomiting. Had dysen
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tery in convalescence. Culture negative.
Case 5.—Admitted on 25th from invalid gang. Severe vomiting, diarrhœa, and
collapse. Started hiccough on 28th. Died on 30th. True cholera vibrios isolated.
Case 6.—A convict warder with similar symptoms was admitted on 25th. Had dysentery
in convalescence. Cultures negative.
Case 7.—Convict warder admitted on 25th. Very severely ill with vomiting, purging
and collapse. Improved under treatment. Culture negative.
Case 8.—Boy in warder's lines inside jail became ill on the afternoon of the 27th and
was removed to the Civil Hospital. Cultures yielded true cholera.
In addition, a post mortem examination was made of a case on the morning of the
28th. The case had been in the dysentery wards since 22nd and was transferred to
the cholera ward at 5 a.m. on the morning of the 28th after which no stool was passed. He
died at 10 a.m.
Post mortem.
The gut was glistening and especially the small gut was slightly conjested ; the contents
were thick mucus not at all like the typical contents of the gut in a cholera case. No
ulceration was seen. Cultivations from the gut yielded a pure culture of true cholera
vibrios.
The main clinical features of the cases were the sudden onset of colicy pains, vomiting
and diarrhœa and the bad cases rapidly becoming collapsed, cold and pulseless. In the fatal
cases death occurred in one to two days usually. Cramps occurred in a few cases as did
suppression of urine, but the latter symptom was rare. Hiccough occurred in some of the
bad cases. The stools were not as a rule typically " rice water."
No cases of cholera have occurred amongst the general population of the jail since
the morning of the 28th instant. Two cases from the dysentery ward were found to be