THE DISCUSSION ON MONS. HAFFKINE'S PAPER ON ANTI-CHOLERAIC INOCULATIONS. With
exception speakers in
one
different
the remarks made
by the with Mons.
connection
Haffkine's communication to the Indian Medical Congress on anti-choleraic inoculations were dis-
tinguished by hopeful
views entertained for the
future of this form of
preventive
inoculation:
Like the members of the Congress our readers will doubtless be interested in what was then
said, and accordingly we propose to give the report in extenso. It will be seen that Mons. Haffkine very raised
effectually dealt with the objecby Surgeon-Lieutenant-Colonel
tions
Lawrie, pointing septicemia really was
made in
out
in
a
clear
meant and the
attempting
to
apply
manner
what
mistake which such
a
term to
the anti-choleraic process.
Surgeon-Colonel Harvey, who was the first speaker, was of opinion that after the observations
which had been made, there could be little doubt that the inoculations were protective during an epidemic and for a certain period after the epidemic.
The
be solved was
questions which
were
lasting
or
now
remained to
whether the influence produced not, and, if not lasting, whether it
could be made so. The observations at Lucknow were against the idea of a lasting effect, but at the
same
time it should not be
forgotten
that
the vaccines used in Lucknow were very weak In Chittagong and in Gaya, where he himself had been
present
inoculations, he had seen obliged to put aside tubes of vac--
at the
Mons. Haffkine
'
Feb.
THE DISCUSSION ON ANTI-CHOLERAIC
1895.]
INOCULATIONS.
71
imperfectly developed that it was useless question of the comma bacillus as if all scientists admitted that it was the cause of cholera, but he to employ them for the inoculations, and, owing to the circumstances under which the vaccines might mention that at the Congress held at had to be prepared in out-of-the-way places, it Budapesth Professor Metchinkoff maintained that cine
so
had been found difficult to obtain vaccines fixed required strength. It was evident that the method was still in the developmental stage, and he thought that every one in India and at the
every medical officer in the country Mons. Haffkine every facility for
ought to give
continuing
work.
the
comma bacillus was not the cause of cholera. Mons. Haffkine had also referred to the Delta of the Ganges as the home of cholera. It was un-
always blame this part of the country. possible for cholera to come from
fair to
Was it not
his other parts such Mecca to Europe,
Surgeon-Lieutenant-Colonel Gregg, Sanitary
Commissioner of Bengal, said that some time ago he applied to the Health Officer of Calcutta
from Hurdwar
as or
India.
or
from
from Mecca to
perhaps
Simpson said that the preceding had mentioned Professor Metchinkoff as
Dr. W. J.
speaker
would have hesi- an antagonist of the comma bacillus theory. tated to have done so if he had had to undergo the This was a misconception, for Metchinkoff was operation by a less skilful operator than Dr. one of the greatest supporters of this theory. to be inoculated.
He
possibly
After the first inoculation he had a Dr. Simpson proceeded to say that he would temperature, a feeling of malaise here refer to an observation in support of Mons. slight the seat of the inoculation followed Haffkine's system. Some time ago the Chairman at and pain severe headache, especially on the of the of a Suburban Municipality informed him of
Simpson.
rise of
by head,
top
a
feeling
of sickness,
drowsiness,
and
slight
thirst, which continued about 30 hours.
cholera
broken out in a particular village several deaths, and asked him to send a causing medical officer to vaccinate the villagers against cholera. The request was complied with immediately, and a short time after a letter was received from the Chairman expressing thanks for
having
Five was inoculated for the second time he later days without his experiencing any particular effect. He made this communication for the benefit of those who still hesitated to be inoculated and who feared its effects. There was actually no- the steps which had been taken and giving the information that after the inoculations no more thing to cause hesitation. Davies said that he would cases had occurred in the village. Dr. Simpson
Surgeon-Captain
added that he would be happy to attend to like to ask some theoretical questions regarding of this kind any where near Calcutta, the life of the comma bacilli and the develop- applications and would send officers with all the necessary ment of cholera as an epidemic. Had it been to perform the inoculations. that the comma bacilli could increase in appliances
observed
Professor Hankin, in reply to Dr. Davies, said virulence ? for instance that a race of these he had been hard at work during the last eight at a certain unable time be to would microbes months endeavouring to discover the exact artia serious disease and then, later, by some produce modification in their development or otherwise ficial conditions apart from those induced by n
which would enable them to kill. He thought that if this was so possibly the first were young and immature or undeveloped races, while the latter were old and fully developed. If it were like this many circumstances in the history of cholera
acquire strength
epide-
explained. One could understand epidemics of cholera are mild and
mics would be how
some
others
severe
and how
some
epidemics
start
in a mild form and afterwards become virulent circumstances which are also to be observed in scarlet fever, small-pox and diphtheria. Dr.
Cooper, Parsee medical man, said that which had been read represented the
the papers
a
o
passing through
animals under which
bacilli increase
decrease in
was
or
unable at the
mation "
loped rated,"
on
the
present
subject.
virulence,
time to
comma
but he
any inforFor the word " undeve-
give
"
he
preferred to use the word unregeneand the question was whether particular
forms of microbes
regenerated
or unregeneupon words, but the simple possibility of cholera microbes, under some unknown conditions, regaining their lost
rated.
This
was
virulence and As to the of vibrios
species,
so
were
not
or
the
was
play
rise to a fresh outbreak. whether the different forms
giving
question
this
a
varieties of a question of words. In
comma
purely
a
were
INDIAN MEDICAL GAZETTE.
72
[Fkb.
1895.
brought to his notice that morning by Surgeonknowledge the doctrine Lieutenant-Colonel J. O'Brien. A patient under of evolution was universally accepted, and it his care for compound fracture of the leg of was known to be nothing more than a matter of the
present
state of our
O
several weeks' standing got general dermatitis evidence whether two forms or families were to and when the dermatitis subsided the wound was be regarded as belonging to different species or found to be so much improved that it forthwith varieties. As a matter of fact, if the offspring | commenced to heal and speedily got well. The of any particular form is not known it is usual same kind of effect was observed in the Koch cure to regard the form as belonging to a different for tuberculosis. The local effect was in certain species. If the offspring, on the other hand, is cases beneficial, but the constitutional effect known, it is usual to regard the two forms as could not always be kept within safe limits; in fresh varieties. In the case of microbes, owing fact the case showed itself to be dangerous. In to their not possessing classes, this mode of defithe same manner Haffkine's inoculations were nition could not be observed. It would be very now brought forward as a cure or preventive convenient to regard the different forms of miThese inoculations produced a for cholera. crobes as belonging to the same species, if they of illness, generally slight and harmless period produced the same disease. There was no doubt as compared with that produced by Koch's tuberthat the different forms of vibrios that had been culin but like that, a form of blood-poisoning. worked up by Dr. Cuningham were nothing The question arose,?Could septicaemia in any more than degenerated varieties of the cholera form be a preventive of cholera, and if so, to microbes. what extent 1 If mild attacks of blood-poisonSurgeon-Lieutenant-Colonel Lawrie said that ing or septicaemia could be proved to protect we must not allow admiration for Hons. Haffkine entirely or to any appreciable extent against to obscure our vision or consideration of actual cholera, there would be some ground for claimfacts, and he ventured to bring before the notice ing protection to the same extent by Haffkine's of the members of the Congress a few facts with inoculations or vaccinations. But nothing like regard to the inoculations for cholera for the pur- this had yet been proved. It appeared to him pose, it was hoped, of furthering our progress in that cholera was much too complicated and the direction in which Mons. Haffkine is working. serious a condition to be accounted for by a Mons. Haffkine had stated a well-known fact, cause so simple and easy to deal with as the that animals cannot contract cholera. The quescomma bacillus. Bacteriologists themselves were tion then was, What was the condition produced not agreed as to the identity of the microbe, in animals by inoculation with the attenuated and cholera cases are certainly met with everydecoctions or cultivations of the comma bacillus ? where in which the comma is not even a conIt must be some form of septicaemia, not neces- comitant of the disease. Lastly, in order to sarily infective, and it had to be borne in mind make out the semblance of a logical case for the that almost all forms of septicaemia may be in comma bacillus, Mons. Haffkine was bound to their nature very mild and harmless or very show that it was present in the organism prior It was known that severe and uncontrollable. to the commencement of the symptoms of the in septic poisoning in man or in animals diardisease it was said to cause. There was little rhoea is often a prominent symptom and is also doubt cholera might be driven away by a pure a common cause of a fatal termination of the water-supply. What it was in dirty or infected disease. The vexed point that had to be deter- water which gave rise to cholera, was a point of mined was whether septic poisoning in any form the last importance which he for one was conwas ever curative or preventive of other diseases. tent to leave to bacteriologists to discover. Three examples occurred to him in which it Dr. Arthur Powell said he entertained doubts had been proved to exert a curative effect. It as to the protection afforded by Haffkine's inthat in indurated ulcer was long ago discovered oculations, owing to the fact that persons were of the leg accidental attacks of erysipelas caused sometimes attacked more than once with cholera. the thickening to disappear and the ulcer to He himself had seen second and third attacks. heal, which led to blistering in ulcers of this He, however, was of opinion that the system kind as a safe and effective imitation of the ouo-ht to be thoroughly tried, and when Mons The second example was unsafe erysipelas.
|
|
Feb.
1895.]
THE DISCUSSION ON ANTI-CHOLERAIC INOCULATIONS.
amined and in every tissue.
Haffkine visited
73
To such microbes
Assam, which he understood he the bacillus of anthrax, of gastro-enteritis would do next month, he (Dr. Powell) would belong of fowls, of pig measles, of swine of the bring to him as many people to be inoculated as cadaveric infection of students of pest, influenza, of it was possibly in his power. the Chinese plague, of Malta fever, and of the Mons. Haffkine, on the invitation of Dr. Cromtyphoid of mice. In these cases the blood is in bie, the President, said that he would offer a few a state of sepsis or of suppuration, and it is explanations to the remarks made by previous only these diseases which are called septicaemic speakers. In the first place it was necessary to diseases. in lupus does not act by Erysipelas say that it was an error to connect the quessepticcemia, nor can tuberculin, which does not tion of septicaemia with that of the inoculations. contain living microbes, act on lupus by producThe inoculations were not based on septicaemia. ing septicaemia. No substance, no poison, About 10 years ago, in a controversj7, which organic or inorganic, however deleterious it may was then carried on relating to the bacteriology be, can produce septiccemia. of cholera, the question of septicaemia had arisen, Now in regard to cholera the question of sepbut that question had been long set at rest. To ticaemia had been raised by Dr. Klein, of London, make himself
understood perhaps it was necessai*y to explain what septicaemia really is. Among pathogenic microbes three different groups have been seased
distinguished by their relation to the dibody. First there are microbes which,
when introduced into the
point
duce
where
they
an
have
following circumstances:?While seek-
as to the comma bacillus being of cholera, the action of these microbes were tried on animals, and Koch published his method of infection of animals by the
ing
the
for
proofs
cause
organism, remain at mouth, with the introduction of soda been placed and prostomach and the injection of opium
localised infection. The microbes grow and multiply exclusively at the seat of inoculation; a
under the
peritoneal cavity. Under these guinea-pigs contract a disease in which bacilli multiply in the intestines, but
into the into the
conditions
the comma there secrete their poison or toxin which is in which absorbed into the general system and produces \ the microbe can also be found in the blood. Dr. the general s37mptoms of the disease. To such I Klein therefore objected to this result as a proof microbes belong the bacillus of tetanus which of comma bacilli being the cause of cholera, on the lives only on the surface of the wound, and in man cholera is a localised infecthat ground at the seat of its introduction; the bacillus tion with the microbes in the intestines and never of diphtheria which remains exclusively on the into the blood, whereas in guineapenetrating affected mucous membrane; the bacillus of Koch's method did not reproduce cholera, pigs pneumonia which confines itself to the lungs, but gave a septicaemia. The fact of comma and the comma bacillus of cholera which lives bacilli giving septicaemia to guinea-pigs under in the intestines. These microbes never pene- these conditions is not, however, an objectrate into the blood. Again, there is a second tion to their being the cause of cholera. series of microbes which penetrate into the Microbes do not behave in the same manner tissues of the affected organism and, not spread- in different of and there are animals, species ing uniformly, live in small isolated groups. These some which in one species will produce a localmicrobes cause the tuberculous diseases such as ised disease and in another a septicaemia. Thus
they
consumption, glanders, leprosy, actinomycosis, the pneumo-bacillus of Frankel gives in man farcy of the Guatemala bullocks, diseases pro- pneumonia a localised disease, while in the duced by aspergellus fumigatus and other fungi, rabbit and the mouse it produces a septicaemia &c. These microbes also do not penetrate into and in sheep a localised disease similar to pneuof
microbes are those the blood. The last group which invade the circulatory system. When introduced in any part of the body, ? whether under the skin or in the muscles, or in the Jungs into the intestines, they do not remain there for any length of time, but very soon reach the vessels, multiply in the blood, and after a short time can be found in every drop of blood exor
The comma bacillus therefore man. well may very give to man a localised infection of the intestines and, at the same time, when monia. in
transferred into and
give
No
a
one
tion has
guinea-pigs spread by the blood
general
given the subject his attenentertained the idea that the anti_
who has
ever
infection.
INDIAN MEDICAL GAZETTE.
74
choleraic inoculations have
anything
septicaemia. Comma bacilli taneously killed in contact
are
to do
with
almost instan-
with human
of microbes can be found in the blood, and Koch's disease in guinea-pigs constitutes the very objection used against the doctrine of Koch. Persons who have not had the opportunity of the
studying
confuse the details and
question
word septicaemia from the conreferred to, to the question of antitroversy choleraic inoculation. To say that this treatment is based on septicemia, it is necessary to demonstrate, after inoculation, the presence of microbes transfer
the
blood, a demonstration which has never been made, nor has the slightest suspicion that these inoculations produce a septiccemia ever iu the
to
occurred
arur
competent
authority.
With reference to the question of second and third attacks of cholera, Mens. Haffkine did not think that such a fact would be an objec-
against the possibility of producing an immunity artificially. Be this as it may, the question of immunization by one attack uf cholera is far from having been elucidated. It tion
be solved
cannot
being
attacked
instances
can
a
by
several instances of
second
be
or
quoted
third time. as
men
Similar
regards small-pox.
1895.
versation how many cases of second attacks of cholera he had come across, he was obliged to
blood, acknowledge
and the difference which is observed in this respect between cholera in man where no trace
[Feb.
that he could not remember
having
observed any. Mons. Haffkine was collecting information regarding the fatality of second or third attacks of cholera. He had observed that
though it is not rare to meet physicians who know of such attacks it is rare to come across fatal cases. First attacks in cholera are on the average fatal in one case out of two or 50 per cent., whereas second or third attacks seem to be fatal in 1 out of 20 or 30, i.e., from 5
Surgeon-Colonel Harvey., the Inspector-General of Civil Hospitals in Bengal, and Surgeon-Lieutenant-Colonel Roe, the Sanitary Commissioner of the Punjab, had mentionto
3 per cent.
ed to him that
they
had
never
come
across
a
third attack of cholera, single case and were in doubts whether a single observation of second
of this kind had
or
been made.
ever
At present,
general impression cannot be used to oppose exact laboratory experiments. Surgeon Lieutenant Colonel Crombie, the therefore,
a
-
President of the Section, said that he could not allow the discussion to close without saying to Mons.
Haffkine how
admired the
much all of his
those present
work and
the devotedness and disinterestedness with which he was carrying it out. Mons. Haffkine had come to India at his own cost and it was only
magnitude
protection of one attack of small-pox has later on that the Government gave him some been proved not by isolated instances, but by assistance. He was carrying on his the comparison of the liability to the disease pecuniary work without regarding sufficiently his own between a large number of men who never have health which had suffered by the strain, but had small-pox and those who have previously which Dr. Crombie trusted would soon be
The
attack.
had
one
had
never
In cholera such
been made.
comparison
a
The idea of
attack of
an
cholera not protecting against a second attack rested soleljr on a general impression derived from isolated
He would quote an instance. The Chairman of the Calcutta Municipality, after receiving Dr. Simpson's first memorandum on anti-choleraic inoculation and his recommendation to introduce the system into Calcutta, asked the their
cases.
leading
opinion
on
medical the
men
subject.
in
the town
Dr.
O'Brien
replied that he did not believe in the protective effect of these inoculations because of second and third attacks in cholera. A short time after this Dr. O'Brien, with true sincerity, wrote a second setter to the Chairman, saying that he had met Dr. Simpson and Mons. Haffkine, and that when he had asked himself in the course of the con-
regained. The President concluded by hoping that everyone in India would do all in his power to assist Mons. Haffkine and spare him as much trouble
as
possible.
exception speakers in
one
different
the remarks made
by the with Mons.
connection
Haffkine's communication to the Indian Medical Congress on anti-choleraic inoculations were dis-
tinguished by hopeful
views entertained for the
future of this form of
preventive
inoculation:
Like the members of the Congress our readers will doubtless be interested in what was then
said, and accordingly we propose to give the report in extenso. It will be seen that Mons. Haffkine very raised
effectually dealt with the objecby Surgeon-Lieutenant-Colonel
tions
Lawrie, pointing septicemia really was
made in
out
in
a
clear
meant and the
attempting
to
apply
manner
what
mistake which such
a
term to
the anti-choleraic process.
Surgeon-Colonel Harvey, who was the first speaker, was of opinion that after the observations
which had been made, there could be little doubt that the inoculations were protective during an epidemic and for a certain period after the epidemic.
The
be solved was
questions which
were
lasting
or
now
remained to
whether the influence produced not, and, if not lasting, whether it
could be made so. The observations at Lucknow were against the idea of a lasting effect, but at the
same
time it should not be
forgotten
that
the vaccines used in Lucknow were very weak In Chittagong and in Gaya, where he himself had been
present
inoculations, he had seen obliged to put aside tubes of vac--
at the
Mons. Haffkine
'
Feb.
THE DISCUSSION ON ANTI-CHOLERAIC
1895.]
INOCULATIONS.
71
imperfectly developed that it was useless question of the comma bacillus as if all scientists admitted that it was the cause of cholera, but he to employ them for the inoculations, and, owing to the circumstances under which the vaccines might mention that at the Congress held at had to be prepared in out-of-the-way places, it Budapesth Professor Metchinkoff maintained that cine
so
had been found difficult to obtain vaccines fixed required strength. It was evident that the method was still in the developmental stage, and he thought that every one in India and at the
every medical officer in the country Mons. Haffkine every facility for
ought to give
continuing
work.
the
comma bacillus was not the cause of cholera. Mons. Haffkine had also referred to the Delta of the Ganges as the home of cholera. It was un-
always blame this part of the country. possible for cholera to come from
fair to
Was it not
his other parts such Mecca to Europe,
Surgeon-Lieutenant-Colonel Gregg, Sanitary
Commissioner of Bengal, said that some time ago he applied to the Health Officer of Calcutta
from Hurdwar
as or
India.
or
from
from Mecca to
perhaps
Simpson said that the preceding had mentioned Professor Metchinkoff as
Dr. W. J.
speaker
would have hesi- an antagonist of the comma bacillus theory. tated to have done so if he had had to undergo the This was a misconception, for Metchinkoff was operation by a less skilful operator than Dr. one of the greatest supporters of this theory. to be inoculated.
He
possibly
After the first inoculation he had a Dr. Simpson proceeded to say that he would temperature, a feeling of malaise here refer to an observation in support of Mons. slight the seat of the inoculation followed Haffkine's system. Some time ago the Chairman at and pain severe headache, especially on the of the of a Suburban Municipality informed him of
Simpson.
rise of
by head,
top
a
feeling
of sickness,
drowsiness,
and
slight
thirst, which continued about 30 hours.
cholera
broken out in a particular village several deaths, and asked him to send a causing medical officer to vaccinate the villagers against cholera. The request was complied with immediately, and a short time after a letter was received from the Chairman expressing thanks for
having
Five was inoculated for the second time he later days without his experiencing any particular effect. He made this communication for the benefit of those who still hesitated to be inoculated and who feared its effects. There was actually no- the steps which had been taken and giving the information that after the inoculations no more thing to cause hesitation. Davies said that he would cases had occurred in the village. Dr. Simpson
Surgeon-Captain
added that he would be happy to attend to like to ask some theoretical questions regarding of this kind any where near Calcutta, the life of the comma bacilli and the develop- applications and would send officers with all the necessary ment of cholera as an epidemic. Had it been to perform the inoculations. that the comma bacilli could increase in appliances
observed
Professor Hankin, in reply to Dr. Davies, said virulence ? for instance that a race of these he had been hard at work during the last eight at a certain unable time be to would microbes months endeavouring to discover the exact artia serious disease and then, later, by some produce modification in their development or otherwise ficial conditions apart from those induced by n
which would enable them to kill. He thought that if this was so possibly the first were young and immature or undeveloped races, while the latter were old and fully developed. If it were like this many circumstances in the history of cholera
acquire strength
epide-
explained. One could understand epidemics of cholera are mild and
mics would be how
some
others
severe
and how
some
epidemics
start
in a mild form and afterwards become virulent circumstances which are also to be observed in scarlet fever, small-pox and diphtheria. Dr.
Cooper, Parsee medical man, said that which had been read represented the
the papers
a
o
passing through
animals under which
bacilli increase
decrease in
was
or
unable at the
mation "
loped rated,"
on
the
present
subject.
virulence,
time to
comma
but he
any inforFor the word " undeve-
give
"
he
preferred to use the word unregeneand the question was whether particular
forms of microbes
regenerated
or unregeneupon words, but the simple possibility of cholera microbes, under some unknown conditions, regaining their lost
rated.
This
was
virulence and As to the of vibrios
species,
so
were
not
or
the
was
play
rise to a fresh outbreak. whether the different forms
giving
question
this
a
varieties of a question of words. In
comma
purely
a
were
INDIAN MEDICAL GAZETTE.
72
[Fkb.
1895.
brought to his notice that morning by Surgeonknowledge the doctrine Lieutenant-Colonel J. O'Brien. A patient under of evolution was universally accepted, and it his care for compound fracture of the leg of was known to be nothing more than a matter of the
present
state of our
O
several weeks' standing got general dermatitis evidence whether two forms or families were to and when the dermatitis subsided the wound was be regarded as belonging to different species or found to be so much improved that it forthwith varieties. As a matter of fact, if the offspring | commenced to heal and speedily got well. The of any particular form is not known it is usual same kind of effect was observed in the Koch cure to regard the form as belonging to a different for tuberculosis. The local effect was in certain species. If the offspring, on the other hand, is cases beneficial, but the constitutional effect known, it is usual to regard the two forms as could not always be kept within safe limits; in fresh varieties. In the case of microbes, owing fact the case showed itself to be dangerous. In to their not possessing classes, this mode of defithe same manner Haffkine's inoculations were nition could not be observed. It would be very now brought forward as a cure or preventive convenient to regard the different forms of miThese inoculations produced a for cholera. crobes as belonging to the same species, if they of illness, generally slight and harmless period produced the same disease. There was no doubt as compared with that produced by Koch's tuberthat the different forms of vibrios that had been culin but like that, a form of blood-poisoning. worked up by Dr. Cuningham were nothing The question arose,?Could septicaemia in any more than degenerated varieties of the cholera form be a preventive of cholera, and if so, to microbes. what extent 1 If mild attacks of blood-poisonSurgeon-Lieutenant-Colonel Lawrie said that ing or septicaemia could be proved to protect we must not allow admiration for Hons. Haffkine entirely or to any appreciable extent against to obscure our vision or consideration of actual cholera, there would be some ground for claimfacts, and he ventured to bring before the notice ing protection to the same extent by Haffkine's of the members of the Congress a few facts with inoculations or vaccinations. But nothing like regard to the inoculations for cholera for the pur- this had yet been proved. It appeared to him pose, it was hoped, of furthering our progress in that cholera was much too complicated and the direction in which Mons. Haffkine is working. serious a condition to be accounted for by a Mons. Haffkine had stated a well-known fact, cause so simple and easy to deal with as the that animals cannot contract cholera. The quescomma bacillus. Bacteriologists themselves were tion then was, What was the condition produced not agreed as to the identity of the microbe, in animals by inoculation with the attenuated and cholera cases are certainly met with everydecoctions or cultivations of the comma bacillus ? where in which the comma is not even a conIt must be some form of septicaemia, not neces- comitant of the disease. Lastly, in order to sarily infective, and it had to be borne in mind make out the semblance of a logical case for the that almost all forms of septicaemia may be in comma bacillus, Mons. Haffkine was bound to their nature very mild and harmless or very show that it was present in the organism prior It was known that severe and uncontrollable. to the commencement of the symptoms of the in septic poisoning in man or in animals diardisease it was said to cause. There was little rhoea is often a prominent symptom and is also doubt cholera might be driven away by a pure a common cause of a fatal termination of the water-supply. What it was in dirty or infected disease. The vexed point that had to be deter- water which gave rise to cholera, was a point of mined was whether septic poisoning in any form the last importance which he for one was conwas ever curative or preventive of other diseases. tent to leave to bacteriologists to discover. Three examples occurred to him in which it Dr. Arthur Powell said he entertained doubts had been proved to exert a curative effect. It as to the protection afforded by Haffkine's inthat in indurated ulcer was long ago discovered oculations, owing to the fact that persons were of the leg accidental attacks of erysipelas caused sometimes attacked more than once with cholera. the thickening to disappear and the ulcer to He himself had seen second and third attacks. heal, which led to blistering in ulcers of this He, however, was of opinion that the system kind as a safe and effective imitation of the ouo-ht to be thoroughly tried, and when Mons The second example was unsafe erysipelas.
|
|
Feb.
1895.]
THE DISCUSSION ON ANTI-CHOLERAIC INOCULATIONS.
amined and in every tissue.
Haffkine visited
73
To such microbes
Assam, which he understood he the bacillus of anthrax, of gastro-enteritis would do next month, he (Dr. Powell) would belong of fowls, of pig measles, of swine of the bring to him as many people to be inoculated as cadaveric infection of students of pest, influenza, of it was possibly in his power. the Chinese plague, of Malta fever, and of the Mons. Haffkine, on the invitation of Dr. Cromtyphoid of mice. In these cases the blood is in bie, the President, said that he would offer a few a state of sepsis or of suppuration, and it is explanations to the remarks made by previous only these diseases which are called septicaemic speakers. In the first place it was necessary to diseases. in lupus does not act by Erysipelas say that it was an error to connect the quessepticcemia, nor can tuberculin, which does not tion of septicaemia with that of the inoculations. contain living microbes, act on lupus by producThe inoculations were not based on septicaemia. ing septicaemia. No substance, no poison, About 10 years ago, in a controversj7, which organic or inorganic, however deleterious it may was then carried on relating to the bacteriology be, can produce septiccemia. of cholera, the question of septicaemia had arisen, Now in regard to cholera the question of sepbut that question had been long set at rest. To ticaemia had been raised by Dr. Klein, of London, make himself
understood perhaps it was necessai*y to explain what septicaemia really is. Among pathogenic microbes three different groups have been seased
distinguished by their relation to the dibody. First there are microbes which,
when introduced into the
point
duce
where
they
an
have
following circumstances:?While seek-
as to the comma bacillus being of cholera, the action of these microbes were tried on animals, and Koch published his method of infection of animals by the
ing
the
for
proofs
cause
organism, remain at mouth, with the introduction of soda been placed and prostomach and the injection of opium
localised infection. The microbes grow and multiply exclusively at the seat of inoculation; a
under the
peritoneal cavity. Under these guinea-pigs contract a disease in which bacilli multiply in the intestines, but
into the into the
conditions
the comma there secrete their poison or toxin which is in which absorbed into the general system and produces \ the microbe can also be found in the blood. Dr. the general s37mptoms of the disease. To such I Klein therefore objected to this result as a proof microbes belong the bacillus of tetanus which of comma bacilli being the cause of cholera, on the lives only on the surface of the wound, and in man cholera is a localised infecthat ground at the seat of its introduction; the bacillus tion with the microbes in the intestines and never of diphtheria which remains exclusively on the into the blood, whereas in guineapenetrating affected mucous membrane; the bacillus of Koch's method did not reproduce cholera, pigs pneumonia which confines itself to the lungs, but gave a septicaemia. The fact of comma and the comma bacillus of cholera which lives bacilli giving septicaemia to guinea-pigs under in the intestines. These microbes never pene- these conditions is not, however, an objectrate into the blood. Again, there is a second tion to their being the cause of cholera. series of microbes which penetrate into the Microbes do not behave in the same manner tissues of the affected organism and, not spread- in different of and there are animals, species ing uniformly, live in small isolated groups. These some which in one species will produce a localmicrobes cause the tuberculous diseases such as ised disease and in another a septicaemia. Thus
they
consumption, glanders, leprosy, actinomycosis, the pneumo-bacillus of Frankel gives in man farcy of the Guatemala bullocks, diseases pro- pneumonia a localised disease, while in the duced by aspergellus fumigatus and other fungi, rabbit and the mouse it produces a septicaemia &c. These microbes also do not penetrate into and in sheep a localised disease similar to pneuof
microbes are those the blood. The last group which invade the circulatory system. When introduced in any part of the body, ? whether under the skin or in the muscles, or in the Jungs into the intestines, they do not remain there for any length of time, but very soon reach the vessels, multiply in the blood, and after a short time can be found in every drop of blood exor
The comma bacillus therefore man. well may very give to man a localised infection of the intestines and, at the same time, when monia. in
transferred into and
give
No
a
one
tion has
guinea-pigs spread by the blood
general
given the subject his attenentertained the idea that the anti_
who has
ever
infection.
INDIAN MEDICAL GAZETTE.
74
choleraic inoculations have
anything
septicaemia. Comma bacilli taneously killed in contact
are
to do
with
almost instan-
with human
of microbes can be found in the blood, and Koch's disease in guinea-pigs constitutes the very objection used against the doctrine of Koch. Persons who have not had the opportunity of the
studying
confuse the details and
question
word septicaemia from the conreferred to, to the question of antitroversy choleraic inoculation. To say that this treatment is based on septicemia, it is necessary to demonstrate, after inoculation, the presence of microbes transfer
the
blood, a demonstration which has never been made, nor has the slightest suspicion that these inoculations produce a septiccemia ever iu the
to
occurred
arur
competent
authority.
With reference to the question of second and third attacks of cholera, Mens. Haffkine did not think that such a fact would be an objec-
against the possibility of producing an immunity artificially. Be this as it may, the question of immunization by one attack uf cholera is far from having been elucidated. It tion
be solved
cannot
being
attacked
instances
can
a
by
several instances of
second
be
or
quoted
third time. as
men
Similar
regards small-pox.
1895.
versation how many cases of second attacks of cholera he had come across, he was obliged to
blood, acknowledge
and the difference which is observed in this respect between cholera in man where no trace
[Feb.
that he could not remember
having
observed any. Mons. Haffkine was collecting information regarding the fatality of second or third attacks of cholera. He had observed that
though it is not rare to meet physicians who know of such attacks it is rare to come across fatal cases. First attacks in cholera are on the average fatal in one case out of two or 50 per cent., whereas second or third attacks seem to be fatal in 1 out of 20 or 30, i.e., from 5
Surgeon-Colonel Harvey., the Inspector-General of Civil Hospitals in Bengal, and Surgeon-Lieutenant-Colonel Roe, the Sanitary Commissioner of the Punjab, had mentionto
3 per cent.
ed to him that
they
had
never
come
across
a
third attack of cholera, single case and were in doubts whether a single observation of second
of this kind had
or
been made.
ever
At present,
general impression cannot be used to oppose exact laboratory experiments. Surgeon Lieutenant Colonel Crombie, the therefore,
a
-
President of the Section, said that he could not allow the discussion to close without saying to Mons.
Haffkine how
admired the
much all of his
those present
work and
the devotedness and disinterestedness with which he was carrying it out. Mons. Haffkine had come to India at his own cost and it was only
magnitude
protection of one attack of small-pox has later on that the Government gave him some been proved not by isolated instances, but by assistance. He was carrying on his the comparison of the liability to the disease pecuniary work without regarding sufficiently his own between a large number of men who never have health which had suffered by the strain, but had small-pox and those who have previously which Dr. Crombie trusted would soon be
The
attack.
had
one
had
never
In cholera such
been made.
comparison
a
The idea of
attack of
an
cholera not protecting against a second attack rested soleljr on a general impression derived from isolated
He would quote an instance. The Chairman of the Calcutta Municipality, after receiving Dr. Simpson's first memorandum on anti-choleraic inoculation and his recommendation to introduce the system into Calcutta, asked the their
cases.
leading
opinion
on
medical the
men
subject.
in
the town
Dr.
O'Brien
replied that he did not believe in the protective effect of these inoculations because of second and third attacks in cholera. A short time after this Dr. O'Brien, with true sincerity, wrote a second setter to the Chairman, saying that he had met Dr. Simpson and Mons. Haffkine, and that when he had asked himself in the course of the con-
regained. The President concluded by hoping that everyone in India would do all in his power to assist Mons. Haffkine and spare him as much trouble
as
possible.
