The St. Louis Republic. [volume] (St. Louis, Mo.) 1888-1919, 1901-11-19
REPORT OF THE
BACTERIOLOGISTS.

The full report of the experts follows:
| St Louis. Mo. Nov. Is IsOI.-R NJ. Funk
/ houser NJ. d. Coroner. City Of St Louis: Dear
Doctor-We. the undersigned appointed by you
| to investigate the cause Of the recent outbreak
| Of tetanus following the use of diphtheria anti
| toxin. produced by the City Health Department
I Of the city Of St Louis. herewith submit the
1 following report:
Our original plan was to have each OF us carry
out his invs vsstgations entirely independent Of the
Others and to combine our conclusions in a sin
gle report. 1t was impossible. however, for us
to carry on the investigation in this way. on
account Of the small quantities of serum In some
OF the bottles. and. n consequence. all Of the
serrm has been tested by conformity and also.
in far as it was possible, independently. All
material obtained by from autopsies has been
studied by each Of u.s. and the results in every
IL steLce have tailed The experiments have been
directed to IearS:
F.rst-v neither pathological LESSONS could he
den orstrated. revealing the characteristic picture
Of tCtanus.
stccI d-whether tetsnus could be produced
from the pathological material obtained at autop-
sles and during life.
1lird-Whether the serum delivered August "a
was the cause Of the outbreak
Fourth-Whether all serum dated August "a
had the same toxic properties.
Fifth-Whether the disease caused by an
Infection an intoxicstion.
Sxth-whether any difference could be noticed
between the serum dated August q and the
s' rum dated September -.
scvonti'-What the toxic strength Of the serum
was.
II fortunate that appointment occurred
at a time when the outbreak was at its height
We thus had an opportunity TO a number OF
the patients intra vitanl. and so convince our
selves from the clinical observation Of tho cor
rectness Of the diagnosis made We saw alto
gether about ten patients. and. with one excep-
tion. could fully confirm the diagnosis. The eN-
ception a OF Doctor Friedman in
which the only symptom pointing to tetanus was
incomplete trsnus, evidently due to an enor-
swelling Of all the regional glands. The
case give recovered
An instructive series Of three cases of tetanus
seen in the family Of Mr.. Goldstein, in
which. according to the age and size OF the pa
tients. a gradual increase in the severity of the
symptoms observed. All of the three patients
were, we were informed, injected with the
same amount Of serum. All three cases are at
present on the road to recovery. The incubation
period in these cases coming under our personal
knowledge varied from five to seven days. death
ensuing in the fatal three to five days later
taking for granted that the Infection or intoxica-
tion took its origin from the injections Of the
diphtheria antitoxin made in all Of the cases In
no case were any wounds or other Interruptions
Of the continuity Of the epithelial surface Of the
body observed except in those caused by the en-
trance Of the canula. and these points were with
out any infiammatory reaction in any of the
cases.
OF the official autopsics made on number cr
the patients that succumbed to the diseasa We
attended fve-Jacob Centurio. Aielin and Name
Keenan,. Emma Ernst and Viola Baker. These
autopsies were made at a comparatively short
time after death. post-mo-tem change
could have interfered with the thorough ex1m;-
nation. Only in the case OF the Ernst child
balming fluid had already been injected. and the
investigation was therefore, confined to the b. ain
and the spinal cord alone. The reports of tHc
findings are already in your hands. We emphasize
here that only in two cases Jacob Centurio an
Mamie Keenan, changes other than Of a te:art.
nature found. In the first case there
ample microscopic evidence of a simultaneous
scaIlatne infection, characteristic desquamatioG,
.iesU at nfe
while in the second case. lesion of the kidney
0atty inftrstion OF the tubular epltheun1l AMI
the liver extensive fatty changes) were appar-
ent and most likely due TO the action of tho
diphtheria toxin. With the exception OF these
two cases no microscopic pathological changes
could he found aside from a very general ana
uniform engagement Of all the viscera, sometimes
of the lungs. and always OF the central nervous
system This engagement was always pro-
nounced in the venous system: in some cases ex-
tsnsive capillary injection. and the S0graA-