xiv
By far the most interesting case treated was that of a European child, one year old,
suffering from acute dysentery of a very toxic type. B. Dysenteriae (Flexure group-Strain
Mount) was isolated from the stool at the end. of the first week and an autogenous vaccine
prepared. Soon after the first dose of 2·5 millions was given the temperature which had run
high from the beginning of the illness showed a marked drop and the child which was in a
typhoid condition made a rapid and uninterrupte recovery after the administration of two
further doses of five and ten millions given at intervals of 48 and 72 hours respectively.
NOTES ON A CUTANEOUS STREPTO-COCCCS AFFECTION.
By
Assistant Surgeon T. Seethapathy Aiyar, L.M. & S.
In February 1911, Lieut.-Col. Giffard, I M.S., Superintendent of the Government Maternity
Respitel, sent some agars smeared with serous exudation from a case of what appeared to be
Pemphigus Neanotorutn, and suggested that, a strepto coccus might be the causative organism.
On cultivation small dew-drop colonies of a strepto-cocous, with here and there a few colonies of
staphylo-coccus aureus developed. Before a vaccine could be made the child expired. This
gave an impetus to further study of the etiology and treatment of the affection as found in
children and adults.
The skin-eruption (known as " Karappan " in Tamil) is fairly common in Indian children
under six years, and is sometimes also found among adults. It is mostly confined to the extre-
meties and scalp, but is occasionally found on the trunk, and very rarely on the face. The
eruption takes the form of serous vesicles or pustules of the size of a pea and later the form of
bullœ (recognised as moist eczema) exuding a thin clear fluid. In a few cases the vesicles are
confined to a particular area of the skin and by coalescing form into a soft ulcerous patch. The
affection is not generally accompanied with any constitutional disturbance or local pain. Some-
times an inflammatory areola is seen around the eruption which is specially noticeable on
white skins. When the eruption occurs in the extremeties there is often swelling of the
lymphatic glands in the groin or axilla. In acute cases, it appears all over the body and simu-
lates a mild form of small-pox : sometimes it takes on a chronic course lasting for about a year.
On healing it leaves behind black pigmented areas of skin ; hence the Tamil name " Karappan ".
In mild cases it subsides only giving rise to a few eruptions on different parts of the body. On
the scalp the disease shows itself as a more extensive inflammation, exuding an offensive fluid.
which mats the hair into knots. In such severe conditions there is commonly slight fever,
accompanied with shivering and glandular swellings in the neck.
Cultural Findings.
On smearing the surface of ordinary nutrient agar or better sérosité agar with any of the
various exudations found in the lesion and incubating the tubes at 37º centigrade a growth of dew-
drop like colonies mostly in a pure state but sometimes associated with a few colonies of
s t a p h y l o c o c c u s P y o g e n e s A u r e u s i s s e e n a f t e r 2 4 h o u r s . E a c h c o l o n y i s t r a n s p a r e n t a n d o f t h e s i z e o f a
pinhead. Broth cultures of the same examined under microscope reveal a strepto-coccus brevis
which stains with all ordinary aniline dyes and is gram-positive. Though not yet thoroughly estab-
lished it seems to correspond to streptococcus faecales according to Gordon's classification. It
grows more luxuriantly on. serosite media than on ordinary nutrient media. The organism does
not produce any marked pathogenic effect on rabbits. The different strains isolated from the
affection were subjected to a test for identity along with other strepto-cocci isolated from septic
fever and boils. The organisms were smeared all over agar slopes, allowed to grow for two
days and the resulting growth ß were then removed. Other strains were then inoculated on the
agars thus treat ed. In most cases, scanty or no secondary growth took pl tee, so, as far as this
test may be relied on many of the organisms isolated would appear to be of the same nature.
Vaccine Therapy.
A vaccine was made of the organism in the usual way of making bacterial vaccines. As the
growth is rather scanty a large number of serum agar slopes aie inoculated with the organisms
and allowed to grow for 48 hours in the incubator. The growth is then emulsified and heated.
to 60° centigrade for about half an hour. Special care has to be taken over counting and
E t a n d - a r d i s i n g t h e v a c c i n e a s i t i s e x t r e m e l y p o t e n t . A f i r s t d o s e o f n o t m o r e t h a n t w o a n d a h a l f
milt ons has to be tried as higher doses may cause great exacerbation of the condition. Each
successive dose may be increased by two or three million cocci till fifteen millions are reached.
Three to four days after the first injection, in the absence of exacerbation, a surprising subsi.
dance of the eruption takes place. It dries up with scale formation which can be easily
removed with the help of a warm bath.
Notes on cases treated.
1. Child—female ; age 2 years, 3 months; serous and pustular eruption all over the body
and also in the soilp. Carbolic and zinc ointment had no effect. An autogenous vaccine was
made, and a first dose of ten millions was administered which was followed by a severe
e x a c e r - b a t i o n . A f t e r a b o u t t e n d a y s w h e n t h i s h a d s u b s i d e d a L i t t l e , a s m a l l d o s e o f t w o a n d a h a l f
millions was tried with good effect. Two more administrations cured the affection.