25
gonococcal vaccine treatment. Captain W. L. Forsyth, I.M.S., Medical Officer. Central Jail,
Salem, observed that when the vaccine was administered in the sub-acute stage of the urethritis,
joint affections could be prevented, and if these did occur ankylosis did not set in. The vaccine
was however of no use when the synovial membrane was thickened and ankylosis had set in. The
best results were obtained by often repeated small doses slowly increased to the sub-pyrexial
dose.
The Officer Commanding the Station Hospital at Poonamallee from an analysis of 83 cases
draws the following conclusions:—
(1) In acute urethritis vaccines do not out short the course of the disease.
(2) When administered in the acute stage complications are prevented.
(3) In acute urethritis small doses appear to act as well as large doses.
(4) Vaccines produce the most excellent results in cases of epididymitis.
(5) In all eases (except one) of gonorrhoeal rheumatism vaccines have acted rapidly and
well.
(6) In the one case of arthritis treated it has given good results.
(7) In acute cases a starting dose of 2½ million is given, followed in 5 days by 5 million.
No complications have resulted after this treatment.
TABLE XXI.
S e r i a l n u m b e r .
Case
number.
Medical officer.
Disease.
Vaccine made.
Result.
1
28
. . .
Prostatitis . . .
Streptococcus and
staphylococcus.
Improved.
2
36
Second Surgeon, General
Hospital, Madras.
Gonorrhoeal arthritis
of knee.
Streptococcus isolated
from vaginal dis
-charge.
Not used.
3
66
. . .
Prostatitis . . .
Streptococcus and
staphylococcus.
Improved.
4
98
Captain J. Forrest, I.M.S.,
Masulipatam .
Urethritis . . .
Streptococcus brevis
No effect.
5
163
District Medical and Sanitary
Officer, Cocanada.
Prostatorrhœa . . .
Streptococcus . . .
Do.
6
228
First Surgeon ,General hospital,
Madras.
Gonorrhoeal ureth-
ritis and arthritis.
A diphtheroid bacillus. Improved.
7
230
Officer Commanding Station
Hospital, Poonamallee.
Urethritis . . .
Do.
Not used.
Dysentery and Hepatitis—Intestinal infections.— Most of the vaccine work in dysentery was
carried out in connection with the periodical outbreaks of dysentery in the Government Lunatic
Asylum, Madras. The disease has been prevalent in a more or less epidemic form in the Asylum
for many years. The ætiology of these epidemics was for various reasons not sufficiently known
till 1911 when the first few bacteriological examinations of the dejecta were made. Though in
many instances the disease ran the typical course of acute dysenteric colitis, in not a few cases
the complaint either gradually or rapidly merged into a severe form of enteritis with diarrhœa,
offensive stools and rapid deterioration of the general health, the mortality being heavy enough
to produce a marked effect on the death-rate of the Asylum during certain years. In a certain
number of the cases a characteristic glossitis with a cracked or inflamed looking condition of
the tongue, mouth and lips with progressive loss of weight preceded the attacks, and in others
the presence of ova of different intestinal parasites as the anchylostomes of flagellates and rarely
of Balantidium coli, etc., was noted. Amœbæ were also seen microscopically in a number of the
samples of the mucous discharge. It was consequently considered possible that more than one
factor was concerned in the ætiology of these epidemics, especially in view of the very dirty
habits of the insanes and the well-known predisposition in certain types of insanity to attacks of
enteritis and diarrhœa, due to different exciting causes.
The results of bacteriological investigation during three successive years have now sufficiently
proved that these epidemics are mostly, if not entirely, bacillary in origin. In. the year 1911
eleven samples of stools were examined, the dysentery bacillus being isolated from six of these
specimens. The method of cultivation on McConkey's plates has been described in the vaccine
notes of 1911, but the point is that all the eleven specimens were collected in the Asylum, packed
there in ice, presumably up to a number of hours after collection and transmitted to the labora
- t o r y t h r o u g h a c o o l y . C o n s e q u e n t l y i n t h e m a j o r i t y o f i n s t a n c e s m a n y h o u r s m u s t h a v e è l a p s e d
between the passing of the stool and the cultivation of the mucus. Autogenous anti-dysenteric
vaccine made from some of these cases had a good curative effect on the respective patients and
a mixed bacillary vaccine made from all the isolated strains gave excellent results in the
curative treatment of dysenteric cases in the Asylum in 1911 and 1912. In the latter year six
samples of stools were received for bacteriological examination, out of which four gave growths of
B. Dysenteriæ. The polyvalent vaccine made from the strains of 1911 and 1912 failed for some
reason to produce any curative effect on a number of cases which broke out in 1913 and, at the
.instance of the Superintendent of the Asylum, an investigation was undertaken during the last
7