28
REPORT OF THE KING INSTITUTE, GUINDY
have suffered from the disease during the height of its prevalence, but had made a complete
recovery. These were generally unwilling to submit themselves for examination. An
account of their illness was obtained from 20 of these and studied; as also the history of the
disease, with such particulars as could be obtained from their relatives, of 17 persons
known to have died from it.
The observations made on the cases more thoroughly investigated, included, besides a
careful physical examination, the estimation of the percentage of Hæmoglobin, examination
of stained blood films and a differential leucocyte count in a certain number, and micros
-copical and cultural examinations of the stool. Arrangements were made to inspect the
whole stool from a number of them, who were given fresh earthenware pans to deposit
their stool in and instructed to send the same in as fresh a state as possible to the Labora
-tory.
4.
Summary of observations.—There was a striking uniformity in the histories of the
cases. In a majority of them the disease started in September and October last (in very
few during November and in none after December) with symptoms of flatulent distension of
the abdomen and the passage of a number of stools (generally 5 or 6 a day) which in a
small proportion only of the cases was watery. They did not remark that they were too
excessive or copious. After lasting for a few days (the actual period varied from 2 or 3
to 10 or 20 days) the symptoms abated to a greater or lesser extent, but only to recur again
and again after intervals which were also variable. The flatulent distension of the abdomen
was the most troublesome feature in all cases; most of the patients were conscious of
unpleasant borborygni; anorexia and weakness persisted even during the intervals of
quiescence. A number of them complained of soreness of the mouth, and pain and tingling
when spicy articles of food were taken; in a few cases, as I saw, the tongue was red and
inflamed at the edges. A few, particularly those that proved fatal, developed signs of
dysentery towards the end. Oedema over the legs, and in some cases, oedema of general
distribution together with ascites appeared after a number of relapses in the fatal cases.
The entire course appeared to have been afebrile.
Physical examination did not reveal any constant or characteristic abnormality other
than a more or less severe grade of anæmia and slight wasting among those who presented
themselves at the Laboratory. The circulatory, respiratory, and the nervous systems were
noted to be normal. The urine of a few cases examined was normal. Eosinophilia was the
rule, probably the result of Ankylostomiasis.
Of the eight cases that were bed-ridden, four had considerable anasarca and ascites;
slight pleural effusion was also present in one. Two others had oedema over the legs only.
Slight dilatation of the heart could be made out in each case, but there was nothing else
characteristic. Besides a trace of albumin there was nothing wrong with the urine.
Ninety-five specimens of stool from 60 cases were examined. Ankylostome ova were
present in 65 specimens (45 cases), E. histolytica cysts in 6 and cysts of other amoebæ in 8.
From cultures of stool made, only once was B. Dysenteraiæ Flexner isolated. Besides
B. fæcalis alkaligenes which was obtained twice, some members of the Proteus group
occasionally and four strains which fermented Glucose and Mannite with the formation of
acid and gas and produced no change in Lactose, Saccharose, Dulcite and Inulin, no
organisms other than B. coli were recovered from the stool in the course of these examina
-tions.
5.
Discussion.— The cases occurred with about equal frequency among vegetarians and
non-vegetarians. There were a number of cases among persons who exclusively used water
from tube-wells for all domestic purposes as well as among those who used water drawn from
open superficial wells, or tanks.
The combination of the symptoms of dyspeptic distension of the abdomen, recurrent
diarrhœa, anæmia and soreness of the mouth would seem to suggest a diagnosis of Sprue.
But in no case was the appearance of the patient characteristic of that disease; emaciation
was by no means marked in many; the course of illness was much too short and the stool was
not very copious or frothy nor did it lose the normal colour; the diarrhœa was not parti
-cularly confined to the morning hours. Besides, the simultaneous onset in a large number
of the population of a small village is not the usual feature of Sprue.
The uniform apyrexial course, the lateness of the oedema and the small number of cases
in which it actually set in are against the outbreak being one of Epidemic Dropsy. There
were no signs of peripheral neuritis or dilatation and disordered rhythm of the heart which
one expects to meet with in Beri Beri.
Severe Ankylostomiasis could probably explain the anæmia and the dyspeptic symp
-toms of some of the cases. But recurrent diarrhoea is not a feature of Ankylostomiasis;