vii
The results are remarkably different this year from those shown in the two
preceding years. The number sent for examination was slightly lower, 7 per cent.,
but the percentage showing the organism fell from 25 per cent. to 7 . 3 per cent.
During the two previous years the longest consecutive run of negative cases was
nine. This year there were runs of 29 and 14 consecutive negative cases. The
source of the material and the technique of the examination were the same in all three
years, so it seems necessary to look for an explanation of the change in results
elsewhere. It has been suggested that the method of transmission to the laboratory
might be the cause. Previous to February 1912, the specimens were placed in
formaline as soon after the extrusion of the fœtus as possible. They were thus
adequately preserved and were sent to the laboratory as occasion offered. When
however we wished to use such of the livers as showed the presence of spirochætae
for making antigen, to be employed in the Wassermann test, this procedure became
impossible as the formaline would destroy the antigen. After that date the livers
were at once placed in ice and sent to the laboratory. It is possible that the cold
caused the break-up of the parasite, or that the degree of cold was not sufficient to
completely stop the onset of putrefaction; and it is known that parasites of this type
are extremely sensitive to such changes and rapidly become disorganised. On the
whole the latter supposition seems the most probable, as up till the end of April, when
the weather was not extremely hot, the normal number of positive cases had been
obtained under the modified conditions. From the beginning of October, after five
consecutive months had passed without a single positive case appearing, it was deter-
mined to test this question. A small portion of the liver was placed in. formaline for
diagnostic purposes and the remainder packed in ice. Sufficient time has not elapsed
to prove the point but curiously enough the first case sent under these modified con-
ditions proved to be positive.
In the face of such a variation, however caused, it would not be profitable to
discuss the figures.
Diphtheia.— The tendency noted last year for the number of specimens to rise
is maintained this year also the three years 1910–12, the number of specimens
sent were 3, 13 and 20; and the number of positive finds 1, 2 and 8. From these
figures it would appear that diphtheria is on the increase or that it is not so rare as
had been supposed, and more cases are being recognised now than formerly.
Vaccine Therapy. —This branch of the work has gone on expanding in a remark-
able manner, and has taxed the energies of the staff devoted to it, to the utmost.
The number of doses sent out has nearly doubled, 3,004 as against 1,600 last year, and
the number of autogenous vaccines prepared has all but trebled, 189 as against 64.
It is a pity that in regard to the latter it has not been possible to obtain. information
as to the results of the treatment. Steps are being taken to remedy this by sending
out case sheets with the vaccines which will be filled in by the medical officers and
returned to the Laboratory, as soon as the treatment is finished. As regards hospitals
also it is proposed to limit treatment with autogenous vaccines to in-patients. Infor-
mation as to what class of case is most likely to be benefitted, as to what material to
send, how to obtain and send it, so that the isolation of the organisms concerned may
be rendered more certain, is of great importance and can hardly be too widely dis-
seminated among the medical men of the Presidency. A special appendix (appendix
II) dealing with these points has been prepared by Assistant Surgeon M. Kesava
Pai, M.D .
Bacterial vaccines for Prophylactic use.— Only antityphoid vaccine was issued
for use in this manner. Rather fewer doses, 181, were sent out, but the number of
practitioners indenting for it was very much greater.
Educational. —Twenty-five candidates attended the Vaccination class in 1912
and all obtained qualifying marks in the examination held at the end of the course.
Civil Apothecary Dunlop, from Tuticorin, attended the laboratory in July for a
few days' training in the taking, preparation and examination of clinical material.
Eight Civil Assistant Surgeons were instructed in the technique of anti-plague
inoculation.