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

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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$THE DOCUMENTS ON THE MULKOWAL ACCIDENT. SUMMARY OF MR. HAFFKINE’S EVIDENCE. No. 258, dated February 4, 1903. From W. M. Haffkine, Esq., C.I.E., Director-in-Chief, Plague Research Laboratory, Parel, Bombay, to the Secretary, Commission of Enquiry into the Mulkowal Tetanus Case. In connection with my evidence to the Commission on the case under consideration, I have the honour to [forward attached papers, and to] summarise their contents as follows :— __ *v* t 't' 'K b' Referring to the Mulkowal misfortune, 1 enumerated in my evidence the facts which go against attributing the tetanus contamination to the Laboratory. As to what was the real origin of the tetanus there, it is not possible for me to say at present. Speaking in the abstract, it might be a needle contaminated on the outside, or having a contaminated nozzle, and which escaped effective sterilisation, and was used for those nineteen persons alone ; or a contaminated por- tion of carbolic lotion used for washing the needle in ; or a particular pad which was contaminated, and used only on those persons. Contamination might have got into the bottle either from the needle, or by a gust of wind suddenly raising a heavy dust, or by an assistant stoppering the bottle with a contaminated finger for shaking it, &c. The objection I mentioned ac/ainst a tetanus culture having been drawn into the syringe is maintainable in regard to such a culture as found by Major Semple.1 If, on the other hand, con- tamination teas introduced just before the syringe was filled, the amount of it may have been such as to admit of the rinsing of the syringe rendering it innocuous; and so on. It is impossible for me to make more than guesses on all these points. It would be very important, if that is possible, to find out which of the enumerated or other possibilities actually occurred, or to think out, as we are always trying to, which of such possiblities may occur, so as to add to the technique of the opera- tors such precautions as may obviate similar occur- rences. At the same time, the objections mentioned in my evidence, to admitting that the tetanus con- tamination occurred in the Laboratory, must stand independent of our ability or otherwise to find out how it actually occurred. The absence of smell at the time of testing the bottle in Mulkowal, and the presence of that smell when ex- amined in Kasauli, point to the contamination having occurred after the bottle teas opened in Mulkowal. Regarding the possibility of conferring tetanus by minute quantities of tetanus virus, I beg to refer to Vaillardand Rouget’sexperiments {Annales de I'Institut Pasteur, 1902, pp. 406 and 417): cultures made of tetanus-producing earth revealed the presence of some two or three tetanus microbes in a particle of earth sufficient to cause tetanus to a guinea-pig. From, the same publication (pp. 415 and 416), it will be seen that several animals infected with such contaminated earth may exhibit a disease of equal severity^ The fact, therefore, that in the cases in Mulkowal the incubation period did not differ more 1 Vide p. 57 under (9). than it did, does not render necessary the conclusion that the disease was caused in them by absolutely equal doses of virus or toxin. EVIDENCE GIVEN BEFORE THE COMMISSION OF ENQUIRY BY DR. A. M. ELLIOT, INOCULATING OFFICER. At Mulkowal I had two syringes and four needles in ■ use. I had used one of the syringes the previous evening ; I had used both on the 27th. I cannot tell of which of the two I had used first at Mulkowal. I bad used these four needles on the 27th and 29th. I disinfected the four needles every day, and used two out of the four. At the close of the operations of the 27th I gave both the syringes and the four needles to the com- pounder, who was supposed to clean them out. I did not see him clean them out. When we first started inoculating on October 10th I saw him clean them out. I had to teach him the routine I wished to be observed, and I did the cleaning at first myself. My procedure1 was as follows: I removed the needle from the syringe, and put it in the carbolic lotion which had been prepared that day; it was different from that used to swab the patients’ arms. This carbolic lotion had only been used during the day to dip the lint in for putting on the seat of inoculation, placing the spare needles in it, and rinsing the syringe. Then I filled my syringe with carbolic lotion, and put the needle I had just been using on the syringe again, and I squirted the lotion through the needle once. Both syringes were treated in the same way, and the needles. Then the needle was removed from the nozzle of the syringe, and it was placed in its case. I removed the needle with my hand. I then took the needles from the lotion with my hand, and placed them in the case. The syringe was also placed in the case. This is how I taught the compounder to do the work. The cases containing the syringes and needles were replaced in the box. On October 30th I got syringes and needles, which on the previous day of use had been presumably treated in that manner by the compounder. I have a distinct recollection of the 30th. I did my work then in the open under trees on the out- skirt ; it was surrounded by houses on three sides; it was about 30 feet by 40 feet; the backs of the houses looked over it; there were cattle on the other side. There were no animals excepting my horse, which was being walked about; I bad ridden up, the compounder had walked across ; the square was hard ground; I do not remember seeing droppings of animals. My bottles2 and instruments were placed on a table brought over from my camp; it was carried by coolies . . . One coolie carried it. By the time I arrived everything was ready; this was done by the compounder. Everything was lying on the table, the syringes and needles in their cases ready for me to take them out; the cases were not open. The oil was in a small metai vessel . . . and a spirit lamp 1 At the close of each day’s operations. - Apparently bottles of carbolic lotion, ride below.$