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
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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.

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    greatly curtailed. Now, in both these respects, the Mulkowal patients exhibited clinical manifestations coinciding with those of average, not acute, cases in India, arising from an invisible infection introduced during an accident or operation, and running a re- latively slow course. Fourthly: The bottle was recovered and examined fifteen days after the accident, and instead of the rich and toxic culture above referred to, it was found to contain a poor culture of tetanus, of reduced toxicity, and mixed up with a common micrococcus. Now tetanus bacilli, being anaerobes, give the rich and toxic culture mentioned above when they are intro- duced into a bottle full of prophylactic. When they find themselves in a few drops of fluid left in a bottle, and are thus exposed to the air, they do not grow at all, or else give a poor culture and of little toxicity if aerobic microbes present in the fluid partially use up the oxygen. This again points to the tetanus microbes found in the Mulkowal bottle not having been there, whilst the bottle was full of fluid, but having been introduced at a time when the bottle was at once emptied of most of its contents. Lastly, as will be mentioned subsequently, the bottle was dealt with at Mulkowal in an extraordinarily faulty manner. (5) The Indian Commission started, however, with the assumption that the contamination of the syringe, or the contamination of the bottle at the time of inoculation, was not likely to cause nineteen cases of tetanus, and upon this assumption they rejected all the evidence brought out by the enquiry, and pro- nounced that the bottle was contaminated in Bombay. (6) The Lister Institute ascertained by experiment that the Commission’s assumption was not maintain- able, and that the accident could have been caused locally ; but it abstained from expressing an opinion and giving a pronouncement on the actual origin of the accident. When pressed subsequently for a definite and prec-Le statement the Institute authori- ties, on November 9th, 1905, replied in the following words :— From Dr. Charles J. Martin, M.E., D.Sc., F.R.S., Director. To The Under-Secretary of State for India. “In reply to your letter of November 2nd, 1905 (R and S, 2658), I am directed to state that the Institute is of opinion that the fluid used at Mulkowal probably became contaminated with tetanus before the time of opening the bottle at Mulkowal, but it also agrees with the Commission (extracts from the Report of the Punjab Plague Inoculation Commission, p. 2547,' 5th line) that the possibility of contamination having effected an entrance at Mulkowal cannot be excluded.” The reader will observe that the opinion of the Lister Institute authorities is directly opposed to the fundamental assumption and the finding of the Indian Commission. In yet another communication from the Lister Institute, dated May 5th, 1906, they refer to the subject in the following terms: — “ In further reference to your letter, R and S 409, of March 9th, 1906, I have now the honour, by direction of the Governing Body of the Lister Insti- tute, to submit to you the following observations on the letters from Mr. Haffkine, of February 14th, 1906, and March 10th, 1906. “ The Governing Body of the Institute, w7hile of opinion that the probabilities were in favour of the view that the tetanus impurity was primarily in the fluid, did not feel justified in asserting this as a proved fact in view of the possibility of contamination at Mulkowal. “ The Governing Body regret that in their report of November 24th, 1904,2 they inadvertently referred to their conclusion as the same as that of the Commission. The sentence in the Government report that gave rise to this idea was, “ That it (the contamination) might have affected an entrance at Mulkowal, cannot be disputed; thus, by way of illustration, the stopper or the forceps might have been dropped on the ground and applied to the mouth of the bottle with contami- nation adhering, or spores settled between the rubber stopper and the rim of the bottle might have dropped in as the stopper was pulled out.” The Governing Body overlooked the fact that the Commission subse- quently considered this possibility as one cancelled by other considerations. But in this respect the Govern- ing Body are bound to say that they cannot fully concur, and while holding to their view of the proba- bility, they think Mr. Haffkine has a right to claim the benefit of the doubt, especially in view of the fact elicited that the forceps used for drawing the cork at Mulkowal were dropped on the ground, and subse- quently re-used by the operator on the same cork. “The Governing Body also regret that in the first paragraph of the section of their report dealing with the probable origin of the tetanus virus (p. 3)8 to which Mr. Haftkine draws attention in his letter of Feb- ruary 14th, the words “ the fact ” were drafted into the sentence. The words should have been omitted and the sentence should have run, “ But that a botile, presumably tightly corked, should contain enough tetanus growth to destroj7 nineteen people, and yet not be accompanied by sufficient smell to arouse the suspicion of Dr. Elliot, who, according to his evidence, remembers smelling this particular bottle, is difficult to comprehend.” Mr. Haffkine is certainly entitled to this correction, though the argument in his favour was already clear from the context.” It is evident that the Lister Institute refrained from a declaration of the conclusions which were obvious and must appear to every one inevitable, viz., that the bottle of prophylactic was not originally contaminated as it left the laboratory ; that the con- tamination is directly attributable to the opening of the bottle by a forceps that had been dropped on the ground during that operation ; and that the accident was due to the contaminated forceps not having been flamed before being applied again to the bottle. J. C. 2 P. 45. 1 P. 41 in this Journal.
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