27
discharge from the ulcers is absent the comparative number of dysentery bacilli will naturally
dwindle down still further and unless a special medium be devised to grow them to the exclusion
of the other intestinal organisms-it must be almost impossible to isolate them from the stool. It
was therefore arranged to make cultivations from the fœcal discharge in the initial stage of the
attack before the onset of the diarrhœa and to make the cultivations from the fresh stool in the
Asylum itself so that the chances of the organism dying out as a result of keeping or of
fermentative changes in the stool might be obviated.
On the whole 22 cultivations were made from 14 patients. The three negative cases (1,
3 and 14) were in the stage of chronic diarrhœa. Case 11 also a negative case, was one of
chronic recurring colitis. The stool contained mucus which showed amœbæ microscopically
and B. Dysenteriæ could not be isolated. Unfortunately the patient did not pass any dysen
-
teric stools next day, the attack of colitis being a slight one and hence no second cultivation
could be made. It is however quite possible that he was an amœbic case. All the other cases
were definitely proved to be bacillary in origin though by mere microscopic examination
without a cultural test cases 8, 10 and 12 would almost certainly have been diagnosed as
amœbic dysentery. Case 5 is specially interesting as it shows how easy it is to miss the
B. Dysenteriæ in cultivations when the specimen of stool is not fresh and the mucus is little or
absent. An analysis of the above cases is sufficient proof that most of the cases were undoubt
-
edly bacillary in nature. The history of some of them, where recurring attacks have occurred
from time to time with perfectly healthy intervals between the attacks, seems to point to a
possibility that they are dysentery carriers and get themselves infected at intervals from some
part of the alimentary tract. With this idea and with a view to prevent further outbreaks
of the disease in the asylum it was arranged first to give the dysentery patients after recovery,
a series of two or three prophylactic doses of their autogenous vaccines to enable them by artificial
immunization against their own strains to develop sufficient bactericidal power againt these
strains and to cease to be bacillus carriers, a menace to themselves and to the other inmates of
the asylum. At the same time a general prophylactic campaign against bacillary dysentery
was carried on by injecting the other inmates of the asylum with prophylactic doses of a
polyvalent anti-bacillary vaccine prepared from all the strains isolated in the asylum during
the three years 1911-1913.
TABLE XXIII.
Number.
Name.
Result of Culture.
Remarks.
1 Balaram Behari . . .
Negative . . .
Diarrhœa stage.
2 Vadivelu . . .
B. Dysenteriæ (Flexner type),
isolated.
Attack of 48 hours' duration. Blood and
mucus passed.
. . .
Do.
Seventh day of attack ; still some mucus in
stools.
3 Ramayya . . .
Negative . . . Diarrhœa stage. Three weeks' attack.
4 Bhamsamony . . . B.Dysenteriæ (Shiga type),
isolated.
Attack of 48 hours' duration. Blood and
mucus passed.
. . .
Do.
Fourth day of attack ; still mucus in stools.
. . .
Do.
Seventh day of attack ; passing mucus still.
. . .
Do.
Eighth day ; still passing mucus.
5 Ramadoss . . . Negative . . . Fourth day. Specimen many hours old. No.
mucus.
. . . Do. . . . Seventh day. A few streaks of blood and
mucus. Specimen not fresh.
. . .
B. Dysenteriæ (Shiga type),
isolated.
Ninth day. Blood and mucus in stool.
6 Pothinathan . . . B. Dysenteriæ (Flexner type),
isolated.
Old case of dysentery. Relapsed. Second day
of attack. Blood and mucus present.
. . .
Do.
Third day of relapse. Mucus and blood
passed.
7 Rama Cooty . . . B. Dysenteriæ (Flexner type),
isolated.
Acute attack. Third day. Mucus present in
stool.
. . .
Do.
Sixth day. A little mucus and blood still
passed.
8 Shaw . . .
B. Dysenteriæ (Flexner type),
isolated.
Second day of attack. Mucus and blood
present. Amœbae found.
9 Bob Lawrence . . .
B. Dysenteriæ (Shiga type),
isolated.
Dysentery of four days' duration. Mucus and
blood present.
10 Chidambara Mudali . . . B. Dysenteriæ (Flexner type),
isolated.
Second day of attack. Mucus present. No
blood. Microscopically dead forms of
amœbæ.
11 Clemo . . . Negative . . . Second day of attack. Some mucus passed.
No blood. Amœbæ found.
Chronic
recurring case.
12 Kampa . . .
B. Dysenteriæ (Flexner type),
isolated.
Third day of attack. Mucus and blood pre
-
sent. Dead amœbæ
seen.
13 Audiammah . . . B. Dysenteriæ (Shiga type),
isolated.
Third day of attack. Mucus and blood
present.
14 Nazar-ud-din . . . Negative . . . Chronic case. No mucus.
It is yet too early to judge what has been the effect of the prophylactic injections but
there has been a perceptible decline in the number of admissions for dysentery and colitis
since their administration.