+ Fermentation without gas formation.
- No fermentation.
28
TABLE XXIV.
Fermentation Reactions.
Name of patient.
G l u c o s e .
L a c t o s e .
G a l a c t o s e .
M a l t o s e .
M a n n i t e .
S a c c h a r o s e .
R a f f i n o s e .
D u l c i t e .
A d o n i t e .
I nul i n.
V o g e s a n d P r o s k : r a c t i o n .
I n d o l .
M o t i l i t y .
—
Bob Lawrence . . .
+
-
+
-
-
-
-
-
- - -
-
-
Group 1, Shiga type.
Bhamsamony . . .
+
-
+
-
-
-
- -
- - -
-
-
Audiamma . . .
+
- + -
- -
- -
- - -
-
-
Ramadoss . . .
+
-
+ +
-
-
-
-
-
- -
-
-
Group 2, Shiga type.
Kandaswami Pillai . . .
+
-
+
- + -
-
-
- - -
-
-
Group 3, Flexner type.
Rama Cooty . . .
+
-
+
-
+
-
-
-
-
- -
-
-
Chidan bara Mudali . . .
+
-
+
-
+
-
-
-
-
- -
-
-
Vadivelu . . .
+
-
+ + +
-
-
-
- - -
+
-
Group 4, Flexner type.
Shaw . . .
+
-
+
+
+
-
-
-
-
- -
+
-
Kampa . . .
+
-
+
-
+
-
+
-
-
- -
-
-
Group 5, Fl exner type.
Pothinathan . . .
+
-
+
-
+
-
+
-
-
- -
-
-
It will be seen from the above table of the fermentation reactions of the 11 strains isolated
during the year, that seven of these were of the Flexner type and four of the Shiga type.
These results are not identical with those obtained in the English Asylums where the Flexner
type seems to be the only one that is found in Asylum epidemics.
Of t h e 2 1 s t r a i n s o f B. Dy s e n t e r i æ i s o l a t e d i n t h e Ma d r a s L u n a t i c As y l u m d u r i n g t h e
last 3 years 11 were of the Flexner type and 10 of the Shiga type. The fact that a large
portion of the infections is due to the Shiga bacillus may account for the comparatively high
mortality that has been observed in the Madras Asylum from dysentery and colitis, the Shiga
bacillus being well known to be much more toxic than the Flexner type.
The result of agglutination reactions with the sera of the patients and their respective
strains were not very satisfactory and this was probably due to the serum having been tested too
early in the disease. The experience of different observers has varied considerably as regards such
reactions in dysentery. Some have found them unreliable for purposes of diagnosis, whilst
others have obtained fairly consistent results with the sera of the patients not only with their
respective strains, but with homologous stock strains of the dysentery bacillus. With the sera of
patients in the Madras Asylum agglutination in dilutions of 1 in 160 or even more has been
obtained with the patients' own strains, though in some of the cases a normal serum has shown
an agglutinating power against the strains though not in the same high dilution. In some cases
there was no agglutination with the patient's serum and his own strain even in as low a dilution
as 1 in 20. As already stated these unsatisfactory agglutination reactions may have been due
to the serum having been extracted too early in the disease.
The investigation has therefore proved
—
(l) That most if not all the cases of dysentery and colitis in the Madras Lunatic Asylum
are bacillary in origin. Confirmatory evidence in favour of this view is afforded by the follow
-
ing observations:—
( a) Amoebic liver abscess has been quite unknown in the Asylum for years, ( b) emetin
injections have not met with any appreciable amount of benefit in the treatment of the cases, (c)
microscopic examination of the dejecta for Amoeba Hystolytica has given negative results in the
great majority of cases. In some cases where amoebæ were reported to have been observed in
the stool the dysentery bacillus has been isolated indicating that these amoebæ were not amoebæ
dysenteriæ. ( d ) B. Dysenteriæ vaccines have given good results in the treatment of cases in the
outbreaks of 1911-1912.
(2) That the infections were from the Shiga as well as the Flexner types of the dysentery
bacillus, the former being probably responsible for the comparatively high mortality.
(3) That the bacillus is easily isolated from the stool in the initial stage when blood and
mucus are passed, but is detected with difficulty or not at all in the later stages of diarrhœa.
(4) That consequently a large number if not all the cases of enteritis and diarrhœa in
the Asylum are presumably cases of bacillary dysentery in the later stages of the attack. In such
eases it may be found possible to isolate the organism from cultures taken directly from the ulcers
post mortem.
(5) That the rational method of prophylaxis is to deal with the dysentery carriers by
s e g r e g a t i o n a n d a r t i f i c i a l i m m u n i z a t i o n w i t h v a c c i n e s a n d t o p r o t e c t a l l t h e o t h e r i n m a t e s o f t h e
Asylum if possible by a prophylactic polyvalent vaccine.
I am deeply indebted to Captain P. Heffernan, I.M.S., Superintendent of the Asylum, for
very kindly giving me all facilities in conducting the above investigations.