A study of the evidence as to the source of the infection which caused the cases of tetanus at Mulkowal, Punjab, India, during inoculation against plague in October, 1902 / by James Cantlie.

  • Cantlie, James, Sir, 1851-1926.
Date:
1907
Catalogue details

Licence: In copyright

Credit: A study of the evidence as to the source of the infection which caused the cases of tetanus at Mulkowal, Punjab, India, during inoculation against plague in October, 1902 / by James Cantlie. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    24/32 (page 54)
    culture (his Experiment 8) (p. 44) but to give tetanus to an animal or man. For, as'I had mentioned to the Commission, Vaillard and Rouget have shown fourteen years ago that two or three tetanus germs conveyed with a particle of earth were sufficient to give tetanus to a guinea-pig. In the Mulkowal cases the inflam- mation caused by the prophylactic was there to act as a predisposing factor; and in each 1| cc. dose of Lieutenant-Colonel Semple’s bottle No. 4 there were numerous tetanus germs, as a drop taken from the 4 cc. of fluid left in the bottle gave a culture in Experiment 8. The drop contained, therefore, at least one bacillus; but most probably there were many more than one to start the culture with ; for the latter did not take long to develop; “a typical growth of tetanus was present on the third day.” (2) and (3) The Odour of a Tetanus Culture. Vide above, “ Mr. Ilaff kine’s observations on Dr- Elliot’s evidence,” pp. 37 and 38. W Effect on Animals of Tetanus Contaminated Prophylactic. (a) Vide Experiment 3, Appendix A, Indian Com- mission’s Report (p. 43) : -fa cc. of an ordinary tetanus culture failed to affect a guinea-pig ; whereas, in the case of a tetanus culture grown in prophylactic, -gL part of a loopful gave tetanus to a guinea-pig on the fourth day (Experiment 5, Appendix B). (b) A numerical comparison is possible from the following (vide Experiment 2, Appendix B, of the Commission’s Report) : According to the Lister In- stitute’s calculation, the dose of l\ cc. injected, in the experiment just referred to, into the first thirteen animals, corresponded to ¥ of that amount of original fluid, i.e., to cc- {vide Lister Institute’s Report, Section 3) (p. 45). These may have been the animals that were first and most severely affected. After the injection of these thirteen doses, i.e., of 19| cc. of fluid, there should have remained in the 20 cc. syringe, J cc. of that 3-600 fold diluted virus. This amount was then further diluted to make up a volume of 9 cc. by a second refilling of the syringe, and the dilution so effected brought the dose of original fluid, as given to each of the remaining six animals, down to xF-ioo cc. These six animals in- cluded probably those that manifested symptoms later, and of a milder type, as well as the two that escaped altogether. Now, in addition to being diluted, the doses of that virus were further reduced by the action of carbolic acid which preceded the dilutions, and which, besides affecting the fluid itself, eliminated all those germs as had not yet formed spores. Of such, in a seven days old culture, there is present still a considerable proportion. The above specified doses are to be compared with the dose of cc. of the ordinary culture (Indian Commission’s Report, Appendix A, Experiment 3), which failed to affect a guinea-pig, and the dose of Jy cc. which gave a guinea-pig tetanus on the third day (same Appendix, Experiment 4). This ordinary culture had not been acted upon by carbolic acid. (c) The above comparisons refer to the activity of the Mulkowal germ grown in prophylactic, as revealed in the doses in which it w?as capable of taking effect. The rapidity with which it acted is shown in the following experiments : From a dose of cc. of such a culture a guinea-pig was found dead the next day (Appendix B, Experiment 1) (p. 43); while double the above dose of Lieutenant-Colonel Semple's ordinary culture only rendered a similar animal ill on the third day (Appendix A, Experiment 4). A culture of the Mulkowal microbe, had such been developed in bottle 53 N, should, therefore, have left to the Mulkowal patients a very short incubation period, a matter which is considered in the text of this letter, under C (p. 50). (5a) The Culture found in the Remnants of Fluid in the Mulkowal Bottle. The following was seen by Lieutenant-Colonel Semple in full bottles of prophylactic when they were contaminated with tetanus only seven days before : Experiment 5, Appendix A, Indian Commission’s Report (p. 43): “Numerous tetanus bacilli were preseut in stained specimens.” Experiment 6, same Appendix : “ Numerous tetanus bacilli and also micrococci were present in stained specimens.” Bottle No. 1, Appendix B: “A rich growth of tetanus germs w7as found, also other bacilli.” On the other hand, compared to the cultures just referred to, the sample of fluid found in the Mulkowal bottle showed what, in Lieutenant-Colonel Semple’s view, was only “ a poor growth of tetanus ” {vide the Commission’s Report) (p. 41). In his original report on that bottle, he said : “ A preparation made direct from the contents and stained showed a few7 tetanus bacilli (also micro- cocci).” Vide also the description given by Lieutenant- Colonel Semple at the Commission’s sitting in Bombay: on January 26th, 1903, and incorporated by the Commission in the evidence which I was giving at that moment (the India Office print, communicated to the Lister Institute, p. 19) : “ Major Semple observed that when he examined the remnants of the fluid microscopically he found a couple of microbes in a field ; in another none ; in another a few.” {5b) Vide p. 50. Instead of a dose of ^ cc. being fatal to a guinea-pig in twenty-four hours (Appendix B, Experiment 1, Indian Commission’s Report),1 as was the case with a culture from a full bottle, double the above dose taken from the Mulkowal bottle ren- dered a guinea-pig ill after twenty-four hours, and ' Page 43.