6
Water for cholera-like vibrios.—At the instance of the Collector of Chingle-
put, in which Collectorate cholera was widely disseminated, an attempt was
.made to examine the well and tank water in every village in which the disease
made its appearance. To be of any use at all the result of the examinations
would need to be reported within 12 hours of receipt of the sample. As it is quite
impossible to declare in such a limited time that an organism isolated from water
conforms in all particulars to the true germ of cholera, recourse was had to a
simple examination for cholera-like vibrios. It is now generally recognised that
the presence of vibrios in a tropical drinking water-supply is one of grave signi--
ficance, even though it has not been possible to identify any of these vibrios with
the actual germ of cholera. If such germs are present in the water, cholera is not
very far off. Seventy-four of such samples were examined with the result that
15 or 20 per cent. showed the presence of these suspicious vibrios. In no case
was it possible to completely identify these organisms with actual cholera bacilli,
but I was informed by the Collector of Chingleput that in some cases the closure
of the water-supply, incriminated by our reports, resulted in the cessation of
cholera cases in the locality.
In t he examination for Treponema Pallidum in the tissues of macerated
fœtuses sent from the Maternity Hospital, the percentage of positive finds fell,
but if we regard those negative cases, in which the blood of the mothers gave a
positive Wassermann's reaction as being of syphilitic causation, the percentage of
cases due to syphilis rises from the 25 per cent. of previous years to 45 . 5 per cent.
which is probably much nearer the truth.
Vaccine Therapy.—There was a slight decline in the number of doses of bac-
terial vaccines issued. The fall took place entirely in the number of autogenous
vaccines made and doses of them issued. This decline was so marked as to mask
an actual increase in the number of doses of stock vaccines issued. The number
of autogenous vaccines made fell from 230 to 193 and the doses of them issued
from 1,396 to 1,151. The varieties of stock vaccines issued fell from 13 to 12, but
the doses of them issued rose from 5,691 to 5,830. Under Indian conditions this
may be regarded with less regret than would otherwise be the case. The move-
-ments of Indian patients are so little susceptible to control that in a considerable
number of cases the patient leaves hospital before an autogenous vaccine can be
got ready. At best an autogenous vaccine cannot be made and its sterility con-
trolled under four days and it may be longer. As a result of this we see that out
of 193 autogenous vaccines made no less than 31 or 16 per cent. are returned as
having not been used at all. A farther 49 or 25 per cent. are shown as not known
or have had no return at all made about them. It may be assumed that in a con-
siderable number of these latter the vaccine was, as a matter of fact, not used at
all. Probably then not less than 25 per cent. of the labour, time and material
employed in making these autogenous vaccines is wasted. This is of course a great
pity, but it would be a greater pity if this wastage resulted in restricting the
number of vaccines made and thus limiting the benefits available for others. Con--
siderable difference of opinion exists as to whether these vaccines can be efficiently
prepared by persons who do not see the cases both before and during treatment.
Too much stress need not be laid on this since it is obvious that there are many
more medical and surgical practitioners who wish to use vaccines than there are
men with the special training required to prepare them, just as there are many
more hospitals and localities where they are used than there are laboratories with
equipment adequate for their preparation.
That every large hospital, of over 500 beds say, might be the better of a
trained bacteriologist on its staff, cannot be gainsaid, but he would be so fully
employed in elaborating material that he would have little time to observe and..
control its subsequent use. As regards the effects produced by the vaccines he
would have to rely, in the vast majority of cases, on his colleagues. Free sym-
pathetic discussion between the makers and users of the vaccine is probably the
way in which sound knowledge of the subject can best be advanced and discussion
is more likely to be sympathetic and free when the bacteriologist only visits the
wards at the request of his colleagues.