REPORT ON THE WORKING OF THE KING INSTITUTE, GUINDY
No statistics could be taken with a view to determine the percentage of relapses. `There
were one or two cases where the fever was reported to have been continuous.
Laboratory findings.
As has been stated elsewhere, the epidemic was showing signs of abatement at the time
I arrived at Tanjore. It will be seen from chart I, that the epidemic started in September
1921, and that the mortality rates gradually rose until it reached the climax, viz., 300 in
January 1922, when it began to decline very slowly until March. But the rate dropped down
suddenly to about 100 in April 1922.
The number of cases in a pyrexial stage, whether of a primary or relapse nature, that
came under my observation, subsequent to the 10th April was therefore necessarily limited
by this fact. Table I gives a list of the 29 cases that were examined during or between
pyrexial attacks with such particulars relating to the duration of the fever, as could be
gathered from the ignorant relatives. The first of these cases was really convalescing after
a relapse of fever and an examination of his peripheral blood yielded a negative result:—
The six cases examined during the first day of the fever, had just contracted it for the
first time. All of them proved negative in respect of their blood examinations.
Two cases (Nos. 6 and 22) seen on the second day of the primary attack and one (case
No. 20) seen on the second day of relapse showed spirilla.
Two cases with the first attack and one case of relapse were seen on the third day. All
the three were positive.
Five cases of fever, in the fourth day of its course one of which was a case of a relapse,
all showed the presence of spirilla.
Blood films from 5 cases on the fifth day of its course (4 with the first attack and one
with a relapse) were all positive for spirilla.
Of three cases examined on the sixth day of fever (one of which was a relapse) 2 were
negative while the positive finding was obtained from one of the two first attacks.
Case No. 28 was examined on the second day of remission after the primary attack of
fever and the blood examination was negative.
Case Nos. 3 and 10 which were in a state of collapse on the sixth day after relapse also
yielded a negative finding for spirilla.
One case No. 15 in respect of which a history of continued fever for 20 days with
jaundice and marked œdema of the lower extremities was obtained, proved negative on micros-
copic examination.
An analysis of the results obtained during this investigation shows that the spirochætes
do not appear in the peripheral circulation as a rule, till the second day of the onset of the
fever or the relapse, as the case may be. They evidently multiply and are found in fairly
l a r g e n u m b e r s i n v a r i a b l y d u r i n g t h e t h i r d , f o u r t h a n d f i f t h d a y s a f t e r t h e o n s e t o f t h e f e b r i l e
attack. From the limited evidence available of cases seen subsequent to the fifth day of the
febrile attack it is not hazardous to infer, that the spirilla begin to disappear from the
peripheral circulation, after the sixth day of the onset of the first symptoms.
Animal Experiments.
Smears were first taken from cases Nos. 7, 8 and 9 on the list. These were my first
positive finds during the enquiry. Having done this on the morning of the 12th, I proceeded
to the villages in the evening and obtained 1 c.c. of blood from each of the three cases and
injected half c.c. subcutaneously into each of three mice.
The mouse injected from case No. 8 died soon after injection, manifestly as a result of
shock. The mice injected from cases 7 and 9 were sent to the King Institute on the following
day in charge of a responsible messenger.
Cases Nos. 10, 12 and 13.—Smears were examined and mice inoculated at the same time
on the 13th, as the village was at some considerable distance from the headquarters. The
smears from cases 10 and 12 proved to be negative on examination at the laboratory while
that from case 13 showed the presence of spirilla. Smears taken from the peripheral blood
of the two mice inoculated from cases Nos. 10 and 12 were negative on six successive daily
examinations. Smears from the mouse inoculated from case No. 13 was positive for the first
time on the 16th and again on the 17th but the mouse died on the 17th during transit to
Guindy. About 1 c.c. of blood from each of these cases was collected at the same time into
a sterile glass (capsule) which was sealed and taken to the laboratory. A smear made from
the serum which had separated out from each of these three bloods, was examined 3
days later. The serum from case No. 13 alone showed spirilla while the other two were
negative.
Case No. 16.—Having found on the 14th that this yielded a positive result for spirilla, I
took a monkey to the bed side of the patient and having withdrawn about 2½ c.cs. of blood
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