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Northern Command who head the list of successful isolations issued instruc
-tions that this method was to be employed by all laboratories in the Command.
Each hospital was initially supplied from the nearest military laboratory with
a sufficient number of bottles containing the buffered glycerine and saline
solution; and as each bottle containing a specimen of stool was received at
the laboratory a fresh bottle containing sterile solution was sent back to the
hospital. In this way it was ensured that hospitals always had available a
suitable stock of filled bottles, while the cleaning, sterilizing and refilling were
carried out in the laboratory.
The above scheme achieves two aims:—
(a) The laboratory does not have to deal with foul smelling bed pans.
( b ) I t i s e a s y f o r m e d i c a l p e r s o n n e l i n t h e w a r d s o f h o s p i t a l s t o p i c k o u t
a piece of mucus and place it in the bottle of glycerine and saline
immediately a stool is passed at any hour of the day or night.
All concerned can then await their convenience in sending the
specimen to the laboratory.
It has been recommended that the above procedure be adopted in other
Commands and it will be interesting to see if in the future the percentage of
isolations increases to the same extent as has occurred in Northern Command.
As in previous years isolations from out-stations were poorer than those
in which a laboratory is located, the adoption of the above method of despatch
of specimens to laboratories may in the future produce better results.
Type of Dysentery organisms isolated. —A total of 1,395 Andrew's types of
B. flexner were isolated during the year, this is an increase of 141 when com
- p a r e d w i t h 1 9 3 8 . T h e B o y d s t r a i n s a l s o s h o w e d a n i n c r e a s e i n n u m b e r o f
isolations and totalled 468. Type D. 19 this year was far less common than
others and was only isolated on one occasion by a Laboratory in Southern
Command.
Work has continued in the Enteric Laboratory, Kasauli, on the preparation
of mono-valent type specific sera for the accurate typing of dysentery orga
- n i s m s . T h e u s e o f s u c h s e r u m h a s a g a i n t h i s y e a r b e e n r e s t r i c t e d t o t h e E n t e r i c
Laboratory. During the year all unidentified organisms having the morpho
- l o g y a n d b i o c h e m i c a l r e a c t i o n s o f t h e f l e x n e r g r o u p o f d y s e n t e r y b a c i l l i w e r e
forwarded to Kasauli for investigation. Of those forwarded a total of 19 were
eventually identified and 8 were considered not to be true dysentery organisms.
Four cultures of B. dysenteriae Newcastle were forwarded from Quetta. All
four cases occurred within a very short period of each other.
The Officer in charge, the Enteric Laboratory, makes the following re
-marks concerning the organisms sent to him for identification:
—
"While mannite constitutes the fundamental test for distinguishing the
flexner-sonne group from the Shiga-Schmitz group, it occasionally happens
that certain strains, particularly on primary isolation; fail to ferment man
nite, yet are antigenically identical to one or other of the flexner group.
This failure to ferment mannite is not however permanent, and usually
disappears on repeated subculture. It can be readily understood that many
of the organisms that have been classified in the past as in-agglutinable mem
- b e r s o f t h e S h i g a - S c h m i t z g r o u p r e a l l y w e r e o f t h i s t y p e .
As regards the organisms not considered to be true dysentery, the majority
proved to be late lactose fermenters of the paracolon group; and their inclu
- s i o n w a s d u e i n p a r t t o i n s u f f i c i e n t l y l o n g i n c u b a t i o n , a n d i n p a r t , p o s s i b l y ,
to the sugar media having been prepared from a low grade peptone.