59
As in previous years isolations from out stations were poorer than those
in which a laboratory is located. Lack of organization among the subordinate
hospital staffs in details of collection of specimens again being considered to be
the main cause. The enlarged clinical side rooms established at Jhelum and
Wellington have thoroughly justified their existence. Sub-cultures of all
organisms isolated are sent to the parent District Laboratory for confirmation
which is also responsible for the supply of media, etc. In the case of Jhelum
the percentage of positive isolations from bacillary exudate specimens was
88 . 9 and from indefinite exudate specimens 45 . 5. These figures are better
than those obtained in several large laboratories.
At Wellington the causative organism was isolated from 67 . 6 per cent
of cases of dysentery showing a typical bacillary exudate.
Types of dysentery organisms isolated.—Isolations of Andrews types of B.
flexner increased by 265 over 1937, the Boyd strains on the other hand
decreased by 22 but totalled 16 per cent. of positive isolations as compared
with 17 per cent. last year. A total of 450 Boyd strains however were isolated.
Type D 1 appears to be less common than other types and was almost entirely
confined to the Northern Command.
Work has been carried out during the year at the Enteric Laboratory,
Kasauli, on the preparation of mono-valent type specific sera for the accurate
typing of dysentery organisms. It had been hoped to issue this serum to all
Laboratories but it has been decided for the present to restrict the use of such
sera to the Enteric Laboratory only.
During the year all unidentified organisms having the morphology and
bio-chemical reactions of the flexner group of dysentery bacilli were forwarded.
to Kasauli for investigation even though they were cultivated from normal
stools. The Officer in charge, Enteric Laboratory, Kasauli makes the following
remarks concerning these organisms in his annual report. It must be appre-
ciated, apart from the Flexner-Boyd common types and some of the rarer
types, that there are many other bacilli with the same morphology and bio-
chemical reactions that may have no true etiological relationship to bacillary
dysentery. It is a well known fact that true dysentery bacilli may be cultivated
from the stools of a patient over a very varying period and that in some cases
they cease to be excreted after a few hours. Nevertheless, following an acute
attack of dysentery a number of non-lactose fermenting bacteria are freqently
found in the stools. The majority of these Gram-negative bacilli will be
found to ferment glucose and mannite with the production of acid and gas, but
on occasions others will be found that are of the anaerogenes type yet have
no serological relationship to any of the Flexner-Boyd group and only in a
very few cases with each other. It is considered that such organisms, in
most cases, have no more importance than the para-colon group and are
merely indicative of some changed reaction in the bowel.
The distribution of the various strains of dysentery bacilli throughout
the four Commands during 1938 is shown by laboratories in Table No. 57 and
the percentage of each group in each Command in Table No. 58.
E 2