ENTERIC FEVER. Surgeon-Major G. S. RANKING, m.d., i.m.s. TriE question of the sources of infection in enteric fever is one of the utmost importance, and any researches tending to throw light upon By
INDIAN MEDICAL GAZETTE.
C&60
it are of special interest to lis in India at the present time when enteric fever is assuming
with its prevalence Jn former years, may be fairly described as jalarming. Even making all possible allowance for ^improved methods of diagnosis, there can be no .question that enteric fever is 011 the increase, .and the main object to which our efforts for its suppression must be directed, is to discover, if ^possible, the conditions, or some of the conditions, which tend to favour the spread of the disease. Unfortunately the bacteriology of this disease is in rather a chaotic state, and the relationship borne by the so-called bacillus typhosus of .Ebertli and Gaffky to enteric fever is, for the less clear than it seemed to
proportions wliicli, compared
present, apparently The present position, indeed,
be.
amounts to
than this ; that there is a bacillus hardly more or less constantly associated with enteric fever ; but whether this organism is a separate distinct bacillus of essentially pathogenic nature, or merely a form of the bacterium coli, rendered pathogenic by a modified environment, as is claimed by Rodet and Roux, must for the present One be held to be a matter of uncertainty. of all resource difficulty attending great search in this direction is the undoubted fact .that a large number of bacilli are known to occur in water, which are exceedingly difficult to differentiate either from each other or from Jhe so-called true typhoid bacillus. These ?pseudo-bacilli exhibit certain differences it is true, and the probability is that in course of time a satisfactory method will be discovered of differentiating with certainty all these forms j the result of which will most probably be to firmly establish the claim of Eberth's bacillus to be the causa causans of Enteric, at any rate so far as the enteric fever of temperate latitudes is concerned. It still remains an open question \vhether the " enteric fever " observed in India ,13 the identical disease which bears the same name in Europe. Upon this point competent clinical observers and skilled pathologists hold divergent views; and it is a question which time alone can settle, as the number of cases examined thoroughly, both clinically and pathomore
logically, becomes large enough conclusion. Iu the meantime there is
110
to
warrant
inherent
a
There is
so
[Dec. much evidence iu
contention that enteric fever is
support
1892. of the
propagated by
infection from food, more especially by contamination of water-supply, that this latter seems to be by far the most important point to which the attention of sanitary officers should be directed. Given the presence of the enteric bacillus in water, the infection of the susceptible among those who use the water appears to be a certainty; and it is hardly necessary to point out that every fresh case may, and almost certainly does, become the centre of a fresh series of cases. Next to the question of pure water, indeed handin-hand with it, goes the question of proper dis-; posal of excreta. Nothing but cremation will suffice. The disposal of excreta of enteric pa-t tients by the ordinary method of burial cannot but be regarded as dangerous in the last degree as leading to contamination both of air and water. Hoffmann's work shews conclusively that this is the case, even if there were not commonsense probabilities to guide us. However excellent dry earth may be as a deodorizer of excremeutitious matters, it is in 110 sense a disinfectant of bacilli, and spores live and flourish in it ready to be transported either into water of adjacent wells and rivers, or into the air by aspiration, a very common source of contamination in India, where rain is so frequently followed by powerful sunshine. There is 110 question as to the efficacy of fire as a disinfectant, and but for the great expense attending it we imagine cremation of all organic refuse would be insisted : upon. It becomes a question for serious consider-, ation whether, in the interests of the community, and iu view of the importance to Eugland of the health of the army in India, cremation, at any rate of infected excreta, should not be carried out as a routiue procedure. Till this is
done,
it is
euteric fever will go
than probable thatincreasing iu ever-ex-
more
011
ratio. The same would apply to cholera but for the happy chance that the cholera germ cannot stand drying, aud has no spores. This does not apply to the enteric germ which retains its vitality when dry, aud has highly resis-
tending
taut spores.
NOTES OF SOME OBSERVATIONS ON THE WATER
improba-
bility that, in a climate whose mean temperature is so much above that of more temperate latitudes, there may be pathogenic bacilli giving rise to symptoms similar to those of enteric fever as known in Europe, and attaching similar structures, and yet differing from the bacillus typhosus both in morphological and cul-
tural characteristics It is as a contribution to the work necessary to clear up this all-imporfant question that the following results of work done by Surgeon-Captain Horrocks, M.S., and t1 e writer, are put forward.
OP THE INFANTRY
LINES, LUCKNOW.
In consequence of the considerable prevalence of enteric fever in the British troops, an investigation was considered desirable into the quality of the water-supply ; and by.the^ kind permission of Surgeon-Colonel Walsh. Administrative Medical Officer, Oudh and Rohilkhund Districts, and with the co-operation of Brigade-Surgeon-Lieutenant-Colonel H. Skey Muir, in charge of the Station Hospital, to whom I am; indebted for facilities in collecting samples of the water, thefollowing examination was carried out by the writer with, the assistance of Surgeon-Captain Horrocks, M.S., Medical Offieer in charge of the cases of enteric fever in the S tation" Hospital, Lucknow. A preliminary chemicalt examination^ of the various waters showed them to be from a chemical, standpoint of very good quality. Into these results' it is not-necessary to enter more fully. The water -of foui* wellff was examined bacteriologically in the. usual way.ulO? thesa-
Due.
361
RANKING ON ENTERIC FEVER.
1892.]
{a) Round-ended bacilli 2 ^ long x '5 ^ broad and (&) oval rods staining at both ends 2 ^ long xl fx broad. It appears, then, that both these forms are present in this colony. CF. case III Gostello.
four, only one gave any positive result, and it is to this well alone that the following notes are applicable. School Well No. 12, dated 2ith January 1892.?An agar-
gelatine plate prepared from the water. After three days there was no liquefaction of the medium, but a large number of colonies were visible as small points varying in size from a pin?s of an inch in diameter, point to about some brown in colour, others pale yellow or almost colourless. Under a low power (A.A. 160 mm. Oc. 6 Zeiss) these brown colonies appeared as dark brown circular colonies, having a granular structure with clearly defined margin ; and the lighter ones as pale yellowish brown central growths circular or ovate in shape with a periphery of a lighter tint almost white, stippled, and with ill-defined irregular border: in size the central portion measured on an in diameter : the diameter of the whole colony average 10 inclusive of the periphery being 35
Second Series of Plates. Three agar gelatine plates made from the School wellwater, and numbered respectively 1, 2, 3. On the third day, Plate No. 1 showed a single circular zonulated colony, the centre and outer margin being white, and the intermediate zone grey. No liquefaction in the vicinity of this colony. Plate No. 2 was entirely free from growth. Plate No 3 had three colonies identical iu appearance with those found in Plate No, 1, No liquefaction of the medium. On the following day, the fourth from inoculation, 5th February 1892, this plate shewed 28 colonies, small, white, opaque, and circular, resembling silkworm eggs: with commencing liquefaction of the medium. The three colonies observed the day before had not altered in appearance, and under a low power were simply granularlooking with the zonulation distinctly marked. Plate No. 1, dated 4th February 1892.?The colony above described was seen, when examined under a low power (A. A.), to be circular with an irregular margin towards which there was a general radiation from a central brown boss, the portion of the colony between the centre and the periphery was made up of a number of minute brownish masses with intervening spaces, giving the whole a finely reticulated appearance. On the following day, 5th February 1892, this colony was differentiated into two distinct zones. " " colonies silkworm egg There were also 33 minute olive dark seen to be were under a low green, which, power, green or brown in colour, some distinctly reniform, others showing a slight indentation at one point of the margin, General structure indistinctly granular, margin sharply marked. Under a high power (iV 160 mm. Oc. 6) these "silkworm " egg colonies were seen to be composed of?Round-ended slightly fusiform bacilli, smaller forms oval, with a lighter central portion (Spiller). The larger forms stained equally
p.
Examined under a high power [T^ oil immersion 160 mm. Oc. 6 Zeiss.] the following appearances were recorded: (?) Dark brown colonies with well-defined margin not proliferatat ing the edges, and apparently homogeneous throughout. ?Round-ended bacilli, measuring 2 fx to 3 jx in length x *5 p in breadth, sporing along their whole length, thus having a beaded" appearance : unequally stained. These bacilli were motile. The stain used was an alcoholic solution of Spiller's purple. ?
.
(&). Palo yellow colonies, with lenticular or circular central portion and paler yellow almost white margin finely dotted in appearance. Very short rods measuring 1 fx in diameter, and on first examination
appearing to be
micrococci.
(c) Lenticular brown colonies not proliferating at margin. Small bacilli of varying stages of development, the smallest looking at first sight like a micrococcus, but seen, on careful focussing and by the aid of a higher power, to have parallel contours. Marked polar staining, no spore observed. In length from 1 /x to o n and in breadth 1 fx, (d) Brownish yellow colony with central darker portion, very like (I) in general appearance. Round-ended motile bacilli. Staining unequally, the stain aggregating at the poles. Bacilli 2 their whole fx to 3 ^ in length x *5 /x in breadth sporing along .
length, having a
beaded appearance.
[ Vide (a) ].
It would thus appear that colonies (a) and (d) are different forms of colonies of the same bacillus, while (5) and (e) were undoubtedly the same bacillus, the appearance of a micrococcus observed in both (b) and (c) being deceptive, and due to the breadth of the microbe being in that stage of growth equal to the length. The polar staining was a phenomenon observed in all the colonies (?) (&) (c) and (d).
Varying in size from 1^ long X '5 fi broad X long '75^ broad. 3^ 160, G Oc.) Large iclrite colony zonulated,?U. M. Round-ended bacilli forming chains, individual bacilli some oval staining at the ends only, 1 n x '5/jl to 3p x "75/*; 1. 8fx long X '5fj. broad. Water Plate 2.?On the fourth day (5th February 1892),
throughout. to forms
It appears, then, that there are here two organisms? that forming colonies (?) and (d) (1 to 3 x *5) [*? that forming colonies (Z>) and (c) = (1 to 3 x 1) /i. Subculture 1.?A bouillon tube inoculated from colony (d)?IY d (D. V.1) Subculture 2.?An agar-gelatine tube inoculated from, ~
"
" colonies. Similar in showed three of the silkworm egg all respects to those of Plates (1) and (3). The 5th February 1892.?A fresh plate made from the large zonulated colony of Plate 1, and labelled "W.P.I D.V. 1."
bouillon tube IV d (D. V.)1 =IV d The 30th
^
IY d A
January
The 7th 1892.
Microscopical Appearance.
yellowish growth on surface having a very faintly green tinge extending for a slight depth into the medium. No growth in the depth. No liquefaction. U.M. (Ti2 160, 6 Oc). (ff) Small round-ended bacilli 1 ^ to 2 long x '5 fx broad, not sporing. (&) Round-ended bacilli (some almost oval forms). 2 ^ in length x 1 stained only at the poles. ^ broad, Here we have both forms again, those forming colonies (?) and (d) and those forming (b) and (c). IV d D.V.1 Microscopical Appearance. Bouillon cloudy, whitish, no film on surface. (TV, 160, 6 Oc.) U. M. Somewhat oval rods with an unstained central portion. Some of the smaller forms are with great difficulty distinguished from micrococci. Varying from (lxl) to (2 x 1) ^ Here the other bacillus (if it be really more than a developmental differential form) is not seen though carefully
looked for. Plate IV.?Re-examined.
Colony (a) sharp-edged (t?2,
brown circular colony. 160 rn.m. 6 Oc). U. M.
February
ly liquefied.
large colony.
1892.? Water Plate No. 1.?Was entireW P. 1 D V 1
As was also
large
coI'on'y
.
This latter
ex-
amined U.M. fs, 160, 6 Oc. shewed oval bacilli 2^ iong x .5 jx broad, staining only at the ends, and a few larger fusiform bacilli. The 9th February 1892.?"Silkworm egg" colonies larger in size and now distinctly yellow. No liquefaction of
medium.
Third Series. The 19 th February 1892.?Fresh plate made from "School well before Filter." Labelled W. P. School well. The 20th February 1892.?W. P. School well shows a large number of colonies, some minute white specks (colonies a) and some larger white flat colonies with a distinct central point of d arker tint (colonies b). Colonies (J) liquefy the medium powerfully. U.M (A A v Oc. 6, 160 mm).
(a). Dark brown or olive green colonies, with sharply-defined margin, indistinctly granular in texture, almost of uniform colour throughout, measuring on an average 20/u in diameter. Colonies (b). Zoned colonies, circular, with a dark brown central boss, measuring 8^ in diameter, gradually fading off towards the periphery, which is of a pale brown with finely 47 Colonies
a
362
INDIAN MEDICAL GAZETTE.
granular appearance ; the whole colony measures on au aver35/x U.M. (TV, l CO mm. Oc. 6.) Colonies (a). Very short rods, looking at first sight like micrococci \p. in diameter. Colonies (&). Not examined as they were exactly the same as those recorded in W.P. 1 D.V. 1
age.
15
The 22ncL
February
large colony
of 7-2-92.
1892.?W. P. School well.
The whole
29-2-92 plate was now of a yellowish white appearance. No solitary colonies visible. Strong fishy odour given off when the plate was opened (N. B. On the 23rd it became strongly
Abstract op results of culture from Spleen of " Fever in six fatal cases of ?' Enteric Lucknow Station Hospital.
The 20th February 1892,?An agar gelatine tube inoculated from one of the small colonies (a) and labelled School well ^ \
\
'
19-2-927"
The 2 2nd
February
-
v
'
7
19-2-92.
Extensive white growth on surface?none in depth U.M. (^g, 160 mm. Oc. 6). Stained with gentian violet. f Short bacilli showing polar staining looking in many cases like diplococci lju x "75/i.
j
At first it was thought these organisms were really and a higher power j micrococci, but careful focussing i showed them to have parallel contours, and to be
(a) ^
Lbacilli.
(Z?). A few faintly stained thin bacilli 2ju to 4ju long X "4ju broad, round-ended, and some having a faintly beaded appearance. The 22nd from W.
February 1892.?An agar-gelatine plate made
jL_School
well
and labelIe(J w p School well D y 19-2-92. Plate. The 23rd February 1892.?W.P. School well D.Y. 19-2-92. Plate Whole plate greyish, owing to an enormous development of scattered white colonies. Gelatine liguefying. U.M. A.A. A large number of small yellowish brown colonies with Stained with gentian violet (^g, ICO distinct margin. mm. Oc. 6). llound ended bacilli, marked polar staiuing, measuring from 1ft to 2[* long x "S/t in breadth. Majority Wi>fi long Leptothrix forms made up of large numbers of theserods, the polar staining giving a beaded appearance to the which might be mistaken for spores. Stab culture made from this plate into gelatine peptone 1U).(W. P. School well D.V. J
threads, .
.
tube labelled
j
} D.V.
19.2,92.
The 24th February 1892.?Thermometer 70? F. ( W. P. School well D. V. 1 y 19-2-92. Plate.) { Yellowish White growth spreading at puncture on surface of gelatine peptone where it is seen to be pure white, and in the depth; no liquefaction. The 26th February 1892.?Growth extending; there is now liquefaction of the medium at the upper part. Examined U.M. --j?, 100 mm. Oc. 6. Gentian violet ?
mixed culture. (?) Thin bacilli, 3{J. long X *4/x broad, sporing along its whole length so as to have a beaded appearance. (b) Small polar stained bacilli in large numbers, lyit to 'iju long X "5/^ broad. Bacilli (a) resemble closely those forming the fiat white colonies originally seen in .
P.^
School ^
an(j iiqUefyiag the medium.
very like the bacilli found in colonies No. IV, of 27th January 1892.
They are (a) and (d) of Plate
General Result. If the result of the cultivation of the water is compared with the six fatal cases of " Enteric" elsewhere recorded in this paper, there will be seen to
be
a
Case No, 1.?Private E. Smith, Royal Irish died 23rd December 1891.
)
1892.? /W. P. School well
striking morphological
resemblance
between the bacillus cultivated from these fatal cases, and one of the bacilli isolated from the
1892.
water, both in their growth in puucture cultivations and in plates. While too much stress cannot be laid on this resemblance, there is enough evidence to point to the water as a possible source of infection ; while the persistence of this bacillus in all these cases is strong presumption in favour of its being pathogenic. Its identity with, or affinity to Eberth's bacillus must be left an open question for the present.
ammoniacal).
/'W.P.
[Dec.
Regiment,
Cultures of spleen on Agar Gelatine Peptone. Whitish growth on surface and along the puncture line, consisting of round-ended bacilli single and in long threads, many Uacilli sporing, the spores being situated at one end of the rods. Indiv idual bacilli measuring 2/x to 3ft long by 1 /-?
rather less in breadth. Bacilli motile. These bacilli shewed a tendency to stain at the poles. In plate cxdtures this bacillus formed colonies which to the naked eye appeared as minute white points ; under a low power (A.A. Oc. 6) colonies yellowish, granular, with indented edges, the central portion being oval or circular and of a darker colour than the rest of the colony, in some cases leaving an olive green tinge, but being usually brownish yellow.
or
On potato.?Surface of potato somewhat glazed, but otherwise unchanged: and in one case a yellow growth consisting of bacilli 2fx to 3/x long X *75/.t broad, apparently the same bacillus. The potato cultures are not, it appears, very reliable.
Case jWo. 2.?Private White, East Lancashire Regiment, died 20tli January 1892. Culture of spleen and liver on Agar Gelatine Peptone. White punctate growth along puncture line, consisting of round-ended bacilli, single and in long threads. Motile. Individual bacilli 2/ji to 3/* long by '75/x to \/i in breadth. Staining at the poles. As the growth went on in the tubes there was an evident of the several points of the growth to spread lateral y into the medium, eventually giving a beaded Still later these took on a appearance to the growth. distinctly feathery appearance. In plate cultures.?Colonies white, dotted. Under a low power colonies yellow, circular, with slightly irregular margins, and central darker portion oval or circular. On potato.?Potato absolutely unchanged in appearance. Same bacilli found as above noted, with polar staining even more strongly marked.
tendency
Case No. 3.? Gunner Gostello, K Battery, R, H. A.,
died 19th January 1892. spleen on Agar Gelatine Peptone. Wedge-shapedflocculent white growth along puncture line consisting of round-ended bacilli varying from 2ji long X '75^ broad to long threads 10fx or 20ft in length. Bacilli freely sporing, some only at one end, others in their whole length. In plate cultures.?Colonies white, dotted. Under A.A, colonies brownish yellow circular, with irregular margin, central portion darker than the periphery. On potato.?Potato unchanged in appearance. Same bacilli found to be present. Some sporing at one end only. Polars staining very marked. Case No. 4.?Bugler Boyle, Highland L. Infantry, died 2nd February 1892. Culture of spleen on Agar Gelatine Peptone. White growth along puncture spreading in the shape of a flask and somewhat beaded, owing to bulbous outgrowths from the central core. Consisting of round-ended bacilli 2/* to 4/x in length by -5ft to *75ft in breadth. Polar staining very Cultures of
marked. No plate cultures
were
obtained of this case.
Dec.
1892.]
HORROCKS'S CLINICAL NOTES ON CASES OF ENTERIC FEVER.
Case No. 5.?Private Jennet?, 1 6th Lancers, died 29 th January 1892. White Culture of spleen on Agar Gelatine Peptone. growth consisting of round ended-bacilli 2/j. to 3/li long by ,'on to '75/x broad. Showing marked polar staining. No plate cultures.
'
Case No. 6.?Private Sullivan, Minister Fusiliers, died ]st
February
1892.
"White Culture of spleen on Agar Gelatine Peptone. growth. Bacilli round-ended ; motile, 1 ft to 3/x long by -4/u. to "5fj. broad. Staining in some cases throughout; in others our./ only at the poles. Developed a distinctly fisliy odour, No plate cultures. V
/
363
INDIAN MEDICAL GAZETTE.
C&60
it are of special interest to lis in India at the present time when enteric fever is assuming
with its prevalence Jn former years, may be fairly described as jalarming. Even making all possible allowance for ^improved methods of diagnosis, there can be no .question that enteric fever is 011 the increase, .and the main object to which our efforts for its suppression must be directed, is to discover, if ^possible, the conditions, or some of the conditions, which tend to favour the spread of the disease. Unfortunately the bacteriology of this disease is in rather a chaotic state, and the relationship borne by the so-called bacillus typhosus of .Ebertli and Gaffky to enteric fever is, for the less clear than it seemed to
proportions wliicli, compared
present, apparently The present position, indeed,
be.
amounts to
than this ; that there is a bacillus hardly more or less constantly associated with enteric fever ; but whether this organism is a separate distinct bacillus of essentially pathogenic nature, or merely a form of the bacterium coli, rendered pathogenic by a modified environment, as is claimed by Rodet and Roux, must for the present One be held to be a matter of uncertainty. of all resource difficulty attending great search in this direction is the undoubted fact .that a large number of bacilli are known to occur in water, which are exceedingly difficult to differentiate either from each other or from Jhe so-called true typhoid bacillus. These ?pseudo-bacilli exhibit certain differences it is true, and the probability is that in course of time a satisfactory method will be discovered of differentiating with certainty all these forms j the result of which will most probably be to firmly establish the claim of Eberth's bacillus to be the causa causans of Enteric, at any rate so far as the enteric fever of temperate latitudes is concerned. It still remains an open question \vhether the " enteric fever " observed in India ,13 the identical disease which bears the same name in Europe. Upon this point competent clinical observers and skilled pathologists hold divergent views; and it is a question which time alone can settle, as the number of cases examined thoroughly, both clinically and pathomore
logically, becomes large enough conclusion. Iu the meantime there is
110
to
warrant
inherent
a
There is
so
[Dec. much evidence iu
contention that enteric fever is
support
1892. of the
propagated by
infection from food, more especially by contamination of water-supply, that this latter seems to be by far the most important point to which the attention of sanitary officers should be directed. Given the presence of the enteric bacillus in water, the infection of the susceptible among those who use the water appears to be a certainty; and it is hardly necessary to point out that every fresh case may, and almost certainly does, become the centre of a fresh series of cases. Next to the question of pure water, indeed handin-hand with it, goes the question of proper dis-; posal of excreta. Nothing but cremation will suffice. The disposal of excreta of enteric pa-t tients by the ordinary method of burial cannot but be regarded as dangerous in the last degree as leading to contamination both of air and water. Hoffmann's work shews conclusively that this is the case, even if there were not commonsense probabilities to guide us. However excellent dry earth may be as a deodorizer of excremeutitious matters, it is in 110 sense a disinfectant of bacilli, and spores live and flourish in it ready to be transported either into water of adjacent wells and rivers, or into the air by aspiration, a very common source of contamination in India, where rain is so frequently followed by powerful sunshine. There is 110 question as to the efficacy of fire as a disinfectant, and but for the great expense attending it we imagine cremation of all organic refuse would be insisted : upon. It becomes a question for serious consider-, ation whether, in the interests of the community, and iu view of the importance to Eugland of the health of the army in India, cremation, at any rate of infected excreta, should not be carried out as a routiue procedure. Till this is
done,
it is
euteric fever will go
than probable thatincreasing iu ever-ex-
more
011
ratio. The same would apply to cholera but for the happy chance that the cholera germ cannot stand drying, aud has no spores. This does not apply to the enteric germ which retains its vitality when dry, aud has highly resis-
tending
taut spores.
NOTES OF SOME OBSERVATIONS ON THE WATER
improba-
bility that, in a climate whose mean temperature is so much above that of more temperate latitudes, there may be pathogenic bacilli giving rise to symptoms similar to those of enteric fever as known in Europe, and attaching similar structures, and yet differing from the bacillus typhosus both in morphological and cul-
tural characteristics It is as a contribution to the work necessary to clear up this all-imporfant question that the following results of work done by Surgeon-Captain Horrocks, M.S., and t1 e writer, are put forward.
OP THE INFANTRY
LINES, LUCKNOW.
In consequence of the considerable prevalence of enteric fever in the British troops, an investigation was considered desirable into the quality of the water-supply ; and by.the^ kind permission of Surgeon-Colonel Walsh. Administrative Medical Officer, Oudh and Rohilkhund Districts, and with the co-operation of Brigade-Surgeon-Lieutenant-Colonel H. Skey Muir, in charge of the Station Hospital, to whom I am; indebted for facilities in collecting samples of the water, thefollowing examination was carried out by the writer with, the assistance of Surgeon-Captain Horrocks, M.S., Medical Offieer in charge of the cases of enteric fever in the S tation" Hospital, Lucknow. A preliminary chemicalt examination^ of the various waters showed them to be from a chemical, standpoint of very good quality. Into these results' it is not-necessary to enter more fully. The water -of foui* wellff was examined bacteriologically in the. usual way.ulO? thesa-
Due.
361
RANKING ON ENTERIC FEVER.
1892.]
{a) Round-ended bacilli 2 ^ long x '5 ^ broad and (&) oval rods staining at both ends 2 ^ long xl fx broad. It appears, then, that both these forms are present in this colony. CF. case III Gostello.
four, only one gave any positive result, and it is to this well alone that the following notes are applicable. School Well No. 12, dated 2ith January 1892.?An agar-
gelatine plate prepared from the water. After three days there was no liquefaction of the medium, but a large number of colonies were visible as small points varying in size from a pin?s of an inch in diameter, point to about some brown in colour, others pale yellow or almost colourless. Under a low power (A.A. 160 mm. Oc. 6 Zeiss) these brown colonies appeared as dark brown circular colonies, having a granular structure with clearly defined margin ; and the lighter ones as pale yellowish brown central growths circular or ovate in shape with a periphery of a lighter tint almost white, stippled, and with ill-defined irregular border: in size the central portion measured on an in diameter : the diameter of the whole colony average 10 inclusive of the periphery being 35
Second Series of Plates. Three agar gelatine plates made from the School wellwater, and numbered respectively 1, 2, 3. On the third day, Plate No. 1 showed a single circular zonulated colony, the centre and outer margin being white, and the intermediate zone grey. No liquefaction in the vicinity of this colony. Plate No. 2 was entirely free from growth. Plate No 3 had three colonies identical iu appearance with those found in Plate No, 1, No liquefaction of the medium. On the following day, the fourth from inoculation, 5th February 1892, this plate shewed 28 colonies, small, white, opaque, and circular, resembling silkworm eggs: with commencing liquefaction of the medium. The three colonies observed the day before had not altered in appearance, and under a low power were simply granularlooking with the zonulation distinctly marked. Plate No. 1, dated 4th February 1892.?The colony above described was seen, when examined under a low power (A. A.), to be circular with an irregular margin towards which there was a general radiation from a central brown boss, the portion of the colony between the centre and the periphery was made up of a number of minute brownish masses with intervening spaces, giving the whole a finely reticulated appearance. On the following day, 5th February 1892, this colony was differentiated into two distinct zones. " " colonies silkworm egg There were also 33 minute olive dark seen to be were under a low green, which, power, green or brown in colour, some distinctly reniform, others showing a slight indentation at one point of the margin, General structure indistinctly granular, margin sharply marked. Under a high power (iV 160 mm. Oc. 6) these "silkworm " egg colonies were seen to be composed of?Round-ended slightly fusiform bacilli, smaller forms oval, with a lighter central portion (Spiller). The larger forms stained equally
p.
Examined under a high power [T^ oil immersion 160 mm. Oc. 6 Zeiss.] the following appearances were recorded: (?) Dark brown colonies with well-defined margin not proliferatat ing the edges, and apparently homogeneous throughout. ?Round-ended bacilli, measuring 2 fx to 3 jx in length x *5 p in breadth, sporing along their whole length, thus having a beaded" appearance : unequally stained. These bacilli were motile. The stain used was an alcoholic solution of Spiller's purple. ?
.
(&). Palo yellow colonies, with lenticular or circular central portion and paler yellow almost white margin finely dotted in appearance. Very short rods measuring 1 fx in diameter, and on first examination
appearing to be
micrococci.
(c) Lenticular brown colonies not proliferating at margin. Small bacilli of varying stages of development, the smallest looking at first sight like a micrococcus, but seen, on careful focussing and by the aid of a higher power, to have parallel contours. Marked polar staining, no spore observed. In length from 1 /x to o n and in breadth 1 fx, (d) Brownish yellow colony with central darker portion, very like (I) in general appearance. Round-ended motile bacilli. Staining unequally, the stain aggregating at the poles. Bacilli 2 their whole fx to 3 ^ in length x *5 /x in breadth sporing along .
length, having a
beaded appearance.
[ Vide (a) ].
It would thus appear that colonies (a) and (d) are different forms of colonies of the same bacillus, while (5) and (e) were undoubtedly the same bacillus, the appearance of a micrococcus observed in both (b) and (c) being deceptive, and due to the breadth of the microbe being in that stage of growth equal to the length. The polar staining was a phenomenon observed in all the colonies (?) (&) (c) and (d).
Varying in size from 1^ long X '5 fi broad X long '75^ broad. 3^ 160, G Oc.) Large iclrite colony zonulated,?U. M. Round-ended bacilli forming chains, individual bacilli some oval staining at the ends only, 1 n x '5/jl to 3p x "75/*; 1. 8fx long X '5fj. broad. Water Plate 2.?On the fourth day (5th February 1892),
throughout. to forms
It appears, then, that there are here two organisms? that forming colonies (?) and (d) (1 to 3 x *5) [*? that forming colonies (Z>) and (c) = (1 to 3 x 1) /i. Subculture 1.?A bouillon tube inoculated from colony (d)?IY d (D. V.1) Subculture 2.?An agar-gelatine tube inoculated from, ~
"
" colonies. Similar in showed three of the silkworm egg all respects to those of Plates (1) and (3). The 5th February 1892.?A fresh plate made from the large zonulated colony of Plate 1, and labelled "W.P.I D.V. 1."
bouillon tube IV d (D. V.)1 =IV d The 30th
^
IY d A
January
The 7th 1892.
Microscopical Appearance.
yellowish growth on surface having a very faintly green tinge extending for a slight depth into the medium. No growth in the depth. No liquefaction. U.M. (Ti2 160, 6 Oc). (ff) Small round-ended bacilli 1 ^ to 2 long x '5 fx broad, not sporing. (&) Round-ended bacilli (some almost oval forms). 2 ^ in length x 1 stained only at the poles. ^ broad, Here we have both forms again, those forming colonies (?) and (d) and those forming (b) and (c). IV d D.V.1 Microscopical Appearance. Bouillon cloudy, whitish, no film on surface. (TV, 160, 6 Oc.) U. M. Somewhat oval rods with an unstained central portion. Some of the smaller forms are with great difficulty distinguished from micrococci. Varying from (lxl) to (2 x 1) ^ Here the other bacillus (if it be really more than a developmental differential form) is not seen though carefully
looked for. Plate IV.?Re-examined.
Colony (a) sharp-edged (t?2,
brown circular colony. 160 rn.m. 6 Oc). U. M.
February
ly liquefied.
large colony.
1892.? Water Plate No. 1.?Was entireW P. 1 D V 1
As was also
large
coI'on'y
.
This latter
ex-
amined U.M. fs, 160, 6 Oc. shewed oval bacilli 2^ iong x .5 jx broad, staining only at the ends, and a few larger fusiform bacilli. The 9th February 1892.?"Silkworm egg" colonies larger in size and now distinctly yellow. No liquefaction of
medium.
Third Series. The 19 th February 1892.?Fresh plate made from "School well before Filter." Labelled W. P. School well. The 20th February 1892.?W. P. School well shows a large number of colonies, some minute white specks (colonies a) and some larger white flat colonies with a distinct central point of d arker tint (colonies b). Colonies (J) liquefy the medium powerfully. U.M (A A v Oc. 6, 160 mm).
(a). Dark brown or olive green colonies, with sharply-defined margin, indistinctly granular in texture, almost of uniform colour throughout, measuring on an average 20/u in diameter. Colonies (b). Zoned colonies, circular, with a dark brown central boss, measuring 8^ in diameter, gradually fading off towards the periphery, which is of a pale brown with finely 47 Colonies
a
362
INDIAN MEDICAL GAZETTE.
granular appearance ; the whole colony measures on au aver35/x U.M. (TV, l CO mm. Oc. 6.) Colonies (a). Very short rods, looking at first sight like micrococci \p. in diameter. Colonies (&). Not examined as they were exactly the same as those recorded in W.P. 1 D.V. 1
age.
15
The 22ncL
February
large colony
of 7-2-92.
1892.?W. P. School well.
The whole
29-2-92 plate was now of a yellowish white appearance. No solitary colonies visible. Strong fishy odour given off when the plate was opened (N. B. On the 23rd it became strongly
Abstract op results of culture from Spleen of " Fever in six fatal cases of ?' Enteric Lucknow Station Hospital.
The 20th February 1892,?An agar gelatine tube inoculated from one of the small colonies (a) and labelled School well ^ \
\
'
19-2-927"
The 2 2nd
February
-
v
'
7
19-2-92.
Extensive white growth on surface?none in depth U.M. (^g, 160 mm. Oc. 6). Stained with gentian violet. f Short bacilli showing polar staining looking in many cases like diplococci lju x "75/i.
j
At first it was thought these organisms were really and a higher power j micrococci, but careful focussing i showed them to have parallel contours, and to be
(a) ^
Lbacilli.
(Z?). A few faintly stained thin bacilli 2ju to 4ju long X "4ju broad, round-ended, and some having a faintly beaded appearance. The 22nd from W.
February 1892.?An agar-gelatine plate made
jL_School
well
and labelIe(J w p School well D y 19-2-92. Plate. The 23rd February 1892.?W.P. School well D.Y. 19-2-92. Plate Whole plate greyish, owing to an enormous development of scattered white colonies. Gelatine liguefying. U.M. A.A. A large number of small yellowish brown colonies with Stained with gentian violet (^g, ICO distinct margin. mm. Oc. 6). llound ended bacilli, marked polar staiuing, measuring from 1ft to 2[* long x "S/t in breadth. Majority Wi>fi long Leptothrix forms made up of large numbers of theserods, the polar staining giving a beaded appearance to the which might be mistaken for spores. Stab culture made from this plate into gelatine peptone 1U).(W. P. School well D.V. J
threads, .
.
tube labelled
j
} D.V.
19.2,92.
The 24th February 1892.?Thermometer 70? F. ( W. P. School well D. V. 1 y 19-2-92. Plate.) { Yellowish White growth spreading at puncture on surface of gelatine peptone where it is seen to be pure white, and in the depth; no liquefaction. The 26th February 1892.?Growth extending; there is now liquefaction of the medium at the upper part. Examined U.M. --j?, 100 mm. Oc. 6. Gentian violet ?
mixed culture. (?) Thin bacilli, 3{J. long X *4/x broad, sporing along its whole length so as to have a beaded appearance. (b) Small polar stained bacilli in large numbers, lyit to 'iju long X "5/^ broad. Bacilli (a) resemble closely those forming the fiat white colonies originally seen in .
P.^
School ^
an(j iiqUefyiag the medium.
very like the bacilli found in colonies No. IV, of 27th January 1892.
They are (a) and (d) of Plate
General Result. If the result of the cultivation of the water is compared with the six fatal cases of " Enteric" elsewhere recorded in this paper, there will be seen to
be
a
Case No, 1.?Private E. Smith, Royal Irish died 23rd December 1891.
)
1892.? /W. P. School well
striking morphological
resemblance
between the bacillus cultivated from these fatal cases, and one of the bacilli isolated from the
1892.
water, both in their growth in puucture cultivations and in plates. While too much stress cannot be laid on this resemblance, there is enough evidence to point to the water as a possible source of infection ; while the persistence of this bacillus in all these cases is strong presumption in favour of its being pathogenic. Its identity with, or affinity to Eberth's bacillus must be left an open question for the present.
ammoniacal).
/'W.P.
[Dec.
Regiment,
Cultures of spleen on Agar Gelatine Peptone. Whitish growth on surface and along the puncture line, consisting of round-ended bacilli single and in long threads, many Uacilli sporing, the spores being situated at one end of the rods. Indiv idual bacilli measuring 2/x to 3ft long by 1 /-?
rather less in breadth. Bacilli motile. These bacilli shewed a tendency to stain at the poles. In plate cxdtures this bacillus formed colonies which to the naked eye appeared as minute white points ; under a low power (A.A. Oc. 6) colonies yellowish, granular, with indented edges, the central portion being oval or circular and of a darker colour than the rest of the colony, in some cases leaving an olive green tinge, but being usually brownish yellow.
or
On potato.?Surface of potato somewhat glazed, but otherwise unchanged: and in one case a yellow growth consisting of bacilli 2fx to 3/x long X *75/.t broad, apparently the same bacillus. The potato cultures are not, it appears, very reliable.
Case jWo. 2.?Private White, East Lancashire Regiment, died 20tli January 1892. Culture of spleen and liver on Agar Gelatine Peptone. White punctate growth along puncture line, consisting of round-ended bacilli, single and in long threads. Motile. Individual bacilli 2/ji to 3/* long by '75/x to \/i in breadth. Staining at the poles. As the growth went on in the tubes there was an evident of the several points of the growth to spread lateral y into the medium, eventually giving a beaded Still later these took on a appearance to the growth. distinctly feathery appearance. In plate cultures.?Colonies white, dotted. Under a low power colonies yellow, circular, with slightly irregular margins, and central darker portion oval or circular. On potato.?Potato absolutely unchanged in appearance. Same bacilli found as above noted, with polar staining even more strongly marked.
tendency
Case No. 3.? Gunner Gostello, K Battery, R, H. A.,
died 19th January 1892. spleen on Agar Gelatine Peptone. Wedge-shapedflocculent white growth along puncture line consisting of round-ended bacilli varying from 2ji long X '75^ broad to long threads 10fx or 20ft in length. Bacilli freely sporing, some only at one end, others in their whole length. In plate cultures.?Colonies white, dotted. Under A.A, colonies brownish yellow circular, with irregular margin, central portion darker than the periphery. On potato.?Potato unchanged in appearance. Same bacilli found to be present. Some sporing at one end only. Polars staining very marked. Case No. 4.?Bugler Boyle, Highland L. Infantry, died 2nd February 1892. Culture of spleen on Agar Gelatine Peptone. White growth along puncture spreading in the shape of a flask and somewhat beaded, owing to bulbous outgrowths from the central core. Consisting of round-ended bacilli 2/* to 4/x in length by -5ft to *75ft in breadth. Polar staining very Cultures of
marked. No plate cultures
were
obtained of this case.
Dec.
1892.]
HORROCKS'S CLINICAL NOTES ON CASES OF ENTERIC FEVER.
Case No. 5.?Private Jennet?, 1 6th Lancers, died 29 th January 1892. White Culture of spleen on Agar Gelatine Peptone. growth consisting of round ended-bacilli 2/j. to 3/li long by ,'on to '75/x broad. Showing marked polar staining. No plate cultures.
'
Case No. 6.?Private Sullivan, Minister Fusiliers, died ]st
February
1892.
"White Culture of spleen on Agar Gelatine Peptone. growth. Bacilli round-ended ; motile, 1 ft to 3/x long by -4/u. to "5fj. broad. Staining in some cases throughout; in others our./ only at the poles. Developed a distinctly fisliy odour, No plate cultures. V
/
363
