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REPORT ON THE WORKING OF THE KING INSTITUTE, GUINDY
APPENDIX No. III.
REPORT ON THE WORK OF THE MOBILE UNIT AT ALIPURAM JAIL,
BELLARY
BY
MILITARY ASSISTANT SURGEON J . H. THEODORE
AND
CIVIL ASSISTANT SURGEON N . SESHADRINATHAN.
Under instructions from the Director, King Institute, I proceeded to Bellary with the
necessary outfit on the 12th October 1923 to investigate the causation of an epidemic of
" gastro-enteritis " occurring in the Alipuram Jail.
Periodic outbreak of this disease have been reported by the Medical Officer of the
j a i l . T h e f i r s t o u t b r e a k c o n s i s t e d o f a b o u t 2 1 c a s e s d u r i n g t h e m o n t h s o f J a n u a r y a n d
February 1923 with one death. All had diarrhœa and vomiting and then collapse. The
diarrhœaic stools very much simulated cholera. Subsequent to the outbreak cases of mild
diarrhœs were very common.
In investigating the etiology of these cases the Medical Officer of the jail put down the
following as probable predisposing causes :
—
1. The presence of a large number of latent and chronic dysenteries in the jail popu
-lation, resulting in a weakening of the resisting power of the bowels against germs.
2. Sudden changes in the weather, sudden rainfall, great variations between the
maximum and minimum temperatures during the day.
3. Monotonous dietary, including woody greens, etc.
Food poisoning as a cause was eliminated by having a thorough control over the issue of
articles of dietary.
Water was carefully chlorinated and protected at the distribution head. The troughs
from which the final distribution took place were, however, open and the convicts were
allowed to dip their drinking vessels indiscriminately into them. This would be a likely source
of spreading any bowel infection. Different samples of water were taken at the various
stages of water-supply to the jail and sent to Guindy for examination. The water analysis
report contained the following remarks : " With regard to the distribution trough itself,
the sample drawn on 11th November 1923 showed heavy bacterial pollution ". The report
further stated that there were evidences of recent foetal contamination. This was evidence
enough to prove that the disease was spreading through contamination of the water.
The Clinical symptoms of the gastro-enteritis cases.— The attacks came on with pain and
burning sensation in the epigastrium, and vomiting and purging were severe in some cases.
Collapse was a very common feature. It was not confined to the very severe cases. Some of
the cases after passing two or three semi-solid motions showed collapse and air hunger pro--
bably toxaemic in nature. They exhibited other symptoms common to a severe gastro-
enteritis ; such as cramps, restlessness, etc. In many cases the symptoms were those which are
associated with food poisoning in its varied aspects.
Before the arrival of the unit the Medical Officer of the jail had been sending specimens
of stools from gastro-enteritis patients in glycerine medium to Guindy, with a view to the
isolation of any specific organism. No positive result was obtained from the Institute. It
was then decided by the Director that an investigation on the spot would bring about better
success and the mobile unit was dispatched. The description given by the Medical Officer
tended to show that the causative germ might probably be an obscure organism. Witmore's
Bacillus, an organism described by Dr. Stanton, as producing a type of gastro-enteritis in
Malaya, was suggested by the Director as a possible cause.
When the unit arrived there were no cases of gastro-enteritis and because there was some
resemblance between the mild diarrhœa and the acute gastro-enteritis cases, I began a
systematic bacteriological investigation of these mild cases, by plating fresh stools on
McConkey's and by inoculation into peptone water. Out of the eleven cases examined, from
three, B. Dysenteriæ Flexner was isolated.
The first case of gastro-enteritis after the arrival of the unit occurred on the 16th October
1923. A fresh specimen of the stools was obtained and inoculated into peptone water and
examined for cholera vibrios—also on McConkey's plate and on ordinary agar plate. Neither
cholera vibrio nor any other specific organism was obtained from the cultures.
From this date onwards till the 5th November, eight cases were thoroughly investigated
without any positive result. A vibrio isolated from the stools was sent to Guindy ; it did not
prove to be true cholera.
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