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THE TUBERCULOSIS CONFERENCE.
TRANSMISSION OF TYPHOID FEVER BY THE MOTHEh.’,3 MILK.
653
employment to the inhabitants. These relapsing fever, is also prevalent. There has been people, driven from their homes and some talk recently about the adoption of intertheir employment, with no effects but the clothes national measures at ports and on land frontiers they wore, flocked into the large towns and intensi- in Europe to prevent the introduction of typhus fied there the already existing overcrowding. Food into other countries, but the best means of presupplies were scanty, doctors and nurses were in venting the spread of typhus is strict cleanliness inadequate numbers to meet the calls made. upon of person and clothing, so as to avert any chance them, medical stores and disinfectants were prac- of infestation of the body by the louse, the tically unobtainable, hospital accommodation for incriminated transmitting agent of the typhus the sick was not available, disinfecting or delousing virus. The cessation of hostilities in Europe has apparatus could not be provided, and the shortage set the Red Cross organisations free to carry out afforded
unfortunate
of fats caused a famine in soap. In these circum- their humanitarian work and to become, for the stances, and considering that many persons were present as regards Poland, the Good Samaritan of living and’sleeping in the same clothes for months, Europe. having no change of raiment, it is little wonder TRANSMISSION OF TYPHOID FEVER BY THE that infestation by body vermin became almost had MOTHER’S MILK. Even those who private means, general. people and kept their bodies and clothing clean, also ran IN the Jou1’nal of the American Medical Assorisks as lice were found daily in the railway carriages ciation of Sept. 20th Dr. H. Heiman has reported a It was not surprising, therefore, and tramcars. case, which he read at the thirty-first annual meetthat a widespread epidemic of typhus developed. ing of the American Pediatric Society, of transespecially in the larger towns, such as Warsaw and mission of typhoid fever by the mother’s milk :Lodz. It may be added that the war had left the A married woman, aged 29 years, who was nursing an sanitary administration of Poland in a chaotic infant, was admitted into Mount Sinai Hospital, New York. state, and in consequence quite unable to cope with Two weeks before she began to suffer from pain in the head so formidable an outbreak of disease. While in and back, fever, and chills. Diarrhoea had been present for several The spleen was felt three inches below the 1916 and 1917 the reported typhus cases in Poland costal days. and rose margin spots were present. The temperature had been respectively 34,516 and 43,840, the ran the usual course, and in the fifth week of the disease number rose in 1918 to 122,000, and in the first gradually fell from 105° F. to normal. There was leucopenia ; the leucocytes numbered 4200, with 68 per cent. of half of 1919 to 99,251. and 32 per cent. of lymphocytes. The Widal polynuclears Although typhus is generally a disease of the reaction was positive and the blood contained typhoid colder months of the year the outbreak of 1919 bacilli. A culture of the breast milk revealed actively motile maintained epidemic proportions during the summer typhoid bacilli. Two days after the mother’s admission the aged 8’ monchs, was taken to hospital. It had been months, and in all probability, unless effective infant, breast-fed until two weeks before, when it was weaned action be taken, the incidence will be still more because of the mother’s illness. Four weeks before admisserious and the consequences still more disastrous sion the temperature rose to 101c, but the infant in the coming winter. The sad plight of the Polish seemed as well as usual. In 10 days it apparently recovered completely. But a sudden rise of temperature people came, during the summer, to the knowledge to 105° follows. Both ear-drums were incised, but the of the League of Red Cross Societies, which in fever continued. There was no vomiting or diarrhoea. admission the infant appeared acutely ill with rapid August sent a commission, consisting of inter- On and flilshed cheeks. There were no rose spots. national representatives from the four Great respiration The spleen was enlarged, the lower pole being felt one inch Powers-namely, Great Britain, France, Italy, and below the costal margin. Blood examination showed the United States-to investigate the typhus 8000 leucocytes per c.mm., with 74 per cent. polymorphoand 26 per cent. of lymphocytes. Blood culture epidemic and to’ draw up measures to suppress it; nuclears revealed typhoid bacilli, and the Widal reaction was positive. also to prepare plans for relieving the present sufferings of the Poles and to devise measures for Dr. Heiman has been unable to find recorded any preventing the spread of typhus to Western Europe. case of transmission of typhoid fever by the The cost of carrying out these objects will be heavy, mother’s milk. He has discovered, however, a case for it will be necessary to provide doctors and reported by C. H. Lawrence in the Boston Medical nurses in sufficient numbers to meet the situation ; and Surgical JO’Ltrnal of July 29th, 1909, in which hospitals will have to be erected, disinfecting typhoid bacilli were present in the milk of a nursing apparatus purchased, as well as soap, medical mother, aged 23 years, who was suffering from the supplies and equipment, as also food and clothing disease. But in this case the infant escaped for the destitute. We understand that the League infection. of Red Cross Societies is prepared to do all this, THE TUBERCULOSIS CONFERENCE. and in this connexion it may be observed that the THE National Association for the Prevention of chief objects of the League are " to cooperate with others in all measures for improving public health, to Tuberculosis is holding its seventh annual conferprevent disease, and to mitigate suffering throughout ence at the Central Hall, Westminster, on Thursday the world." No better opportunity could present to Saturday of next wepk, Oct. 16th-18th. The first itself for carrying out these objects than is now such conference was held in Whitechapel in 1909, afforded by the unhappy condition of fever-stricken and thereafter alternately in London and some Poland. The inter-allied medical commission has large provincial centre, until the highly successful now returned to Paris and has reported that the conference at Leeds in July, 1914, just before the typhus epidemic has been very widespread and war broke out. Since then no meeting has been that the number of deaths has been very great. held, and the reassembling after an interval of five The campaign against the disease has not made years gains in importance from two considerations: much progress, however, owing to insufficient (1) the extreme urgency assumed by the whole personnel and inadequate supplies; special want problem of tuberculosis during the war ; and (2) the was experienced of sheets, blankets, drugs, and proposal of the British Red Cross to cooperate other essential equipment. It appears also that with the National Association in its peace-time among the various maladies present just now in activities in regard to tuberculosis. The conference Poland another louse-borne epidemic disease,will open at 10.30 A.M on Thursday, Oct. 16th, with ____
____
AGGLUTINATION IN DYSENTERY.
654
address by Dr. Addison, Minister of Health. The sessions on that and the following day will be devoted to a discussion on the completion of tnberculosis schemes in relation to: (1) the Ministry of Health ; (2) local authorities and Insurance Coman
of Florand, Bezançon, and Paraf (1918), who found that 26 bacteria of the dysenteric group were not agglutinated by any serum or only in 1 in 200 or lower dilutions; of Lancelin and Rideau (1918), who reported that agglutination with Flexner and Shiga, Kruae organisms when obtained, was only in low dilutions (1 in 150 and 1 in 50)-raise the important question as to how far agglutination tests are reliable as a means of identifying and classifying
mittees ; (3) pensions boards; (4) general practitioners ; (5) Red Cross and other voluntary activities ; and (6) training of doctors and nurses. Distinguished visitors from France, Italy, and the United Scates are expected to take part. Lord dysenteric organisms. It is evident that we Glenconner, Sir Arthur Stanley, and Sir Robert to occupy the chair in succession. The session on Saturday morning, with Sir G. Sims Woodhead presiding, will be occupied by addresses on tuberculosis work for the Red Cross, the Order of St. John, and other voluntary workers. Social functions are being arranged for Thursday and Friday evenings, and all who are interested in the subjects under discussion will be gladly ’ ! welcome.
Philip are remaining
____
AGGLUTINATION
IN
DYSENTERY.
THE observations contained in a paper published by Dr. A. Distaso, Dr. E. Goodall, and Dr. H. A. Scholberg, on the " Agglutination Results with Certain Dysentery Organisms Placed
are still far from the true of these puzzling anomalies, and even the correct interpretation of agglutination results and laboratory classification of the whole group of dysentery bacilli. The observations recorded bear out, but do not explain, the difficulties encountered and problems raised by the discovery of inagglutinable strains familiar to most laboratory workers. The results of further investigations promised by the authors, and those of others with similar experience in agglutination phenomena, will be awaited with interest, and in the meantime we hope that their observations may stimulate fruitful research and criticism. A clarification of the response to agglutination tests yielded by the various strains of the Flexner group has been attempted by means of diagrammatic rapresentation. The total agglutinin content elicited by the whole group may be shown as a square divided into sections of varying size according to the amounts of specific agglutinins corresponding with the individual members of the group; the prevailing strain occupying the larger portion of the square, and the other strains, in proportion to their prevalence, the remaining sections of the square., A similar type of mosaic diagram representing a number of component agglutinins might be made use of to signify the more puzzling phenomena presented by the inagglutinable strains and those which either excite but llttle response or yield agglutination results not true to type-e.g., those instances quoted in which a Shiga serum agglutinated both Flexner and Y bacillus, indicating the coexistence of more than one specific agglutinin belonging to a different group. Such conditions may be described as analogous to the complex properties" of chemical bodies. The composite agglutinin molecule," called forth by the whole dysenteric group, may be capable of being split up into a number of atoms corresponding to the individual dysentery strains of the whole group, and the readiness of response to agglutination of the members of the group might be taken to vary according to the strength of the bond existing between the component parts or " atomsof the " agglutinin molecule" contained in the particular serum. Some such help in visualising the complicated processes whichunderlie agglutination is much needed by the average thinker.
explanation maybe from
and Heterologous Sera,"form of work which deserves the close attention of others similarly engaged in the study of bacillary dysentery. The authors of the paper applied tests to 20 organisms in killed cultures, including 7 Flexner strains, 6 Shiga, 3 Y bacillus, 3 strains of Strong’s bacillus, and an unknown organism not closely related to the dysenteric group. 1 c.cm. of a dilute suspension of the killed culture used in each test was injected into the ear-vein of a rabbit on two occasions at an interval of seven days. Seven days after the second injection blood was withdrawn from the rabbit and the serum tested against a suspension of the organism injected, in dilutions of the serum offrom 1 in 50 to 1 in 500. The agglutinations were carried out macroscopically, the results being noted after the test-tubes had been kept in the It incubator at 37’50 C. for 16 to 20 hours. was found that 4 of the 20 organisms (20 per cent.) -a Flexner (original), a Shiga, a Y bacillus, and the unknown organism-were agglutinated by their corresponding sera in a dilution of 1 in 2000; 5 (25 per cent.), including 2 Shiga, a Flexner (typical), a Y, and a Strong’s bacillus, were agglutinated in dilutions of 1 in 500; 9 of the tested organisms (45 per cent.) in dilutions below 1 in 500, but in 4 of these there was agglutination only in dilution of 1 in 25. Further, the 4 sera which agglutinated their homologous organisms in high dilution (1 in 2000) were tested against the 19 heterologous organisms, with the result that no agglutinations took place in 1 in 2000 dilution; in two instances only a positive result was obtained in 1 in 500 GROUP STUDY IN OPHTHALMIC RESEARCH. dilution, a Shiga serum agglutinating 6 of the 19 UNDER the above heading Dr. F. Park Lewis read organisms (3 Flexner strains, 2 Y, and 1 Strong), and a Flexner serum (original) agglutinating two a paper before the Ophthalmological Section of the Flexner strains. A trace of agglutination, but very American Medical Association last June1 on a rarely a positive result, was obtained in some subject which for long has been felt, both in instances with low dilutions. Absorption tests America and in this country, to be one of primary which were applied to the two sera con- importance, not only to ophthalmologists, but to the cerned showed that the agglutinin produced whole medical profession, and indeed to the public by the heterologous organism was the same at large, though as yet hardly any steps have been The as that produced by the homologous organism. taken to remedy the evil complained of. The authors’ results and those to which they allude: practice of specialism is justified by the particular
against Homologous an important piece
"
1
Journal of
Pathology and Bacteriology, 1919, xxii., 257-261.
1
"
Journal of the American Medical Association, June 28th,
1919.
653
employment to the inhabitants. These relapsing fever, is also prevalent. There has been people, driven from their homes and some talk recently about the adoption of intertheir employment, with no effects but the clothes national measures at ports and on land frontiers they wore, flocked into the large towns and intensi- in Europe to prevent the introduction of typhus fied there the already existing overcrowding. Food into other countries, but the best means of presupplies were scanty, doctors and nurses were in venting the spread of typhus is strict cleanliness inadequate numbers to meet the calls made. upon of person and clothing, so as to avert any chance them, medical stores and disinfectants were prac- of infestation of the body by the louse, the tically unobtainable, hospital accommodation for incriminated transmitting agent of the typhus the sick was not available, disinfecting or delousing virus. The cessation of hostilities in Europe has apparatus could not be provided, and the shortage set the Red Cross organisations free to carry out afforded
unfortunate
of fats caused a famine in soap. In these circum- their humanitarian work and to become, for the stances, and considering that many persons were present as regards Poland, the Good Samaritan of living and’sleeping in the same clothes for months, Europe. having no change of raiment, it is little wonder TRANSMISSION OF TYPHOID FEVER BY THE that infestation by body vermin became almost had MOTHER’S MILK. Even those who private means, general. people and kept their bodies and clothing clean, also ran IN the Jou1’nal of the American Medical Assorisks as lice were found daily in the railway carriages ciation of Sept. 20th Dr. H. Heiman has reported a It was not surprising, therefore, and tramcars. case, which he read at the thirty-first annual meetthat a widespread epidemic of typhus developed. ing of the American Pediatric Society, of transespecially in the larger towns, such as Warsaw and mission of typhoid fever by the mother’s milk :Lodz. It may be added that the war had left the A married woman, aged 29 years, who was nursing an sanitary administration of Poland in a chaotic infant, was admitted into Mount Sinai Hospital, New York. state, and in consequence quite unable to cope with Two weeks before she began to suffer from pain in the head so formidable an outbreak of disease. While in and back, fever, and chills. Diarrhoea had been present for several The spleen was felt three inches below the 1916 and 1917 the reported typhus cases in Poland costal days. and rose margin spots were present. The temperature had been respectively 34,516 and 43,840, the ran the usual course, and in the fifth week of the disease number rose in 1918 to 122,000, and in the first gradually fell from 105° F. to normal. There was leucopenia ; the leucocytes numbered 4200, with 68 per cent. of half of 1919 to 99,251. and 32 per cent. of lymphocytes. The Widal polynuclears Although typhus is generally a disease of the reaction was positive and the blood contained typhoid colder months of the year the outbreak of 1919 bacilli. A culture of the breast milk revealed actively motile maintained epidemic proportions during the summer typhoid bacilli. Two days after the mother’s admission the aged 8’ monchs, was taken to hospital. It had been months, and in all probability, unless effective infant, breast-fed until two weeks before, when it was weaned action be taken, the incidence will be still more because of the mother’s illness. Four weeks before admisserious and the consequences still more disastrous sion the temperature rose to 101c, but the infant in the coming winter. The sad plight of the Polish seemed as well as usual. In 10 days it apparently recovered completely. But a sudden rise of temperature people came, during the summer, to the knowledge to 105° follows. Both ear-drums were incised, but the of the League of Red Cross Societies, which in fever continued. There was no vomiting or diarrhoea. admission the infant appeared acutely ill with rapid August sent a commission, consisting of inter- On and flilshed cheeks. There were no rose spots. national representatives from the four Great respiration The spleen was enlarged, the lower pole being felt one inch Powers-namely, Great Britain, France, Italy, and below the costal margin. Blood examination showed the United States-to investigate the typhus 8000 leucocytes per c.mm., with 74 per cent. polymorphoand 26 per cent. of lymphocytes. Blood culture epidemic and to’ draw up measures to suppress it; nuclears revealed typhoid bacilli, and the Widal reaction was positive. also to prepare plans for relieving the present sufferings of the Poles and to devise measures for Dr. Heiman has been unable to find recorded any preventing the spread of typhus to Western Europe. case of transmission of typhoid fever by the The cost of carrying out these objects will be heavy, mother’s milk. He has discovered, however, a case for it will be necessary to provide doctors and reported by C. H. Lawrence in the Boston Medical nurses in sufficient numbers to meet the situation ; and Surgical JO’Ltrnal of July 29th, 1909, in which hospitals will have to be erected, disinfecting typhoid bacilli were present in the milk of a nursing apparatus purchased, as well as soap, medical mother, aged 23 years, who was suffering from the supplies and equipment, as also food and clothing disease. But in this case the infant escaped for the destitute. We understand that the League infection. of Red Cross Societies is prepared to do all this, THE TUBERCULOSIS CONFERENCE. and in this connexion it may be observed that the THE National Association for the Prevention of chief objects of the League are " to cooperate with others in all measures for improving public health, to Tuberculosis is holding its seventh annual conferprevent disease, and to mitigate suffering throughout ence at the Central Hall, Westminster, on Thursday the world." No better opportunity could present to Saturday of next wepk, Oct. 16th-18th. The first itself for carrying out these objects than is now such conference was held in Whitechapel in 1909, afforded by the unhappy condition of fever-stricken and thereafter alternately in London and some Poland. The inter-allied medical commission has large provincial centre, until the highly successful now returned to Paris and has reported that the conference at Leeds in July, 1914, just before the typhus epidemic has been very widespread and war broke out. Since then no meeting has been that the number of deaths has been very great. held, and the reassembling after an interval of five The campaign against the disease has not made years gains in importance from two considerations: much progress, however, owing to insufficient (1) the extreme urgency assumed by the whole personnel and inadequate supplies; special want problem of tuberculosis during the war ; and (2) the was experienced of sheets, blankets, drugs, and proposal of the British Red Cross to cooperate other essential equipment. It appears also that with the National Association in its peace-time among the various maladies present just now in activities in regard to tuberculosis. The conference Poland another louse-borne epidemic disease,will open at 10.30 A.M on Thursday, Oct. 16th, with ____
____
AGGLUTINATION IN DYSENTERY.
654
address by Dr. Addison, Minister of Health. The sessions on that and the following day will be devoted to a discussion on the completion of tnberculosis schemes in relation to: (1) the Ministry of Health ; (2) local authorities and Insurance Coman
of Florand, Bezançon, and Paraf (1918), who found that 26 bacteria of the dysenteric group were not agglutinated by any serum or only in 1 in 200 or lower dilutions; of Lancelin and Rideau (1918), who reported that agglutination with Flexner and Shiga, Kruae organisms when obtained, was only in low dilutions (1 in 150 and 1 in 50)-raise the important question as to how far agglutination tests are reliable as a means of identifying and classifying
mittees ; (3) pensions boards; (4) general practitioners ; (5) Red Cross and other voluntary activities ; and (6) training of doctors and nurses. Distinguished visitors from France, Italy, and the United Scates are expected to take part. Lord dysenteric organisms. It is evident that we Glenconner, Sir Arthur Stanley, and Sir Robert to occupy the chair in succession. The session on Saturday morning, with Sir G. Sims Woodhead presiding, will be occupied by addresses on tuberculosis work for the Red Cross, the Order of St. John, and other voluntary workers. Social functions are being arranged for Thursday and Friday evenings, and all who are interested in the subjects under discussion will be gladly ’ ! welcome.
Philip are remaining
____
AGGLUTINATION
IN
DYSENTERY.
THE observations contained in a paper published by Dr. A. Distaso, Dr. E. Goodall, and Dr. H. A. Scholberg, on the " Agglutination Results with Certain Dysentery Organisms Placed
are still far from the true of these puzzling anomalies, and even the correct interpretation of agglutination results and laboratory classification of the whole group of dysentery bacilli. The observations recorded bear out, but do not explain, the difficulties encountered and problems raised by the discovery of inagglutinable strains familiar to most laboratory workers. The results of further investigations promised by the authors, and those of others with similar experience in agglutination phenomena, will be awaited with interest, and in the meantime we hope that their observations may stimulate fruitful research and criticism. A clarification of the response to agglutination tests yielded by the various strains of the Flexner group has been attempted by means of diagrammatic rapresentation. The total agglutinin content elicited by the whole group may be shown as a square divided into sections of varying size according to the amounts of specific agglutinins corresponding with the individual members of the group; the prevailing strain occupying the larger portion of the square, and the other strains, in proportion to their prevalence, the remaining sections of the square., A similar type of mosaic diagram representing a number of component agglutinins might be made use of to signify the more puzzling phenomena presented by the inagglutinable strains and those which either excite but llttle response or yield agglutination results not true to type-e.g., those instances quoted in which a Shiga serum agglutinated both Flexner and Y bacillus, indicating the coexistence of more than one specific agglutinin belonging to a different group. Such conditions may be described as analogous to the complex properties" of chemical bodies. The composite agglutinin molecule," called forth by the whole dysenteric group, may be capable of being split up into a number of atoms corresponding to the individual dysentery strains of the whole group, and the readiness of response to agglutination of the members of the group might be taken to vary according to the strength of the bond existing between the component parts or " atomsof the " agglutinin molecule" contained in the particular serum. Some such help in visualising the complicated processes whichunderlie agglutination is much needed by the average thinker.
explanation maybe from
and Heterologous Sera,"form of work which deserves the close attention of others similarly engaged in the study of bacillary dysentery. The authors of the paper applied tests to 20 organisms in killed cultures, including 7 Flexner strains, 6 Shiga, 3 Y bacillus, 3 strains of Strong’s bacillus, and an unknown organism not closely related to the dysenteric group. 1 c.cm. of a dilute suspension of the killed culture used in each test was injected into the ear-vein of a rabbit on two occasions at an interval of seven days. Seven days after the second injection blood was withdrawn from the rabbit and the serum tested against a suspension of the organism injected, in dilutions of the serum offrom 1 in 50 to 1 in 500. The agglutinations were carried out macroscopically, the results being noted after the test-tubes had been kept in the It incubator at 37’50 C. for 16 to 20 hours. was found that 4 of the 20 organisms (20 per cent.) -a Flexner (original), a Shiga, a Y bacillus, and the unknown organism-were agglutinated by their corresponding sera in a dilution of 1 in 2000; 5 (25 per cent.), including 2 Shiga, a Flexner (typical), a Y, and a Strong’s bacillus, were agglutinated in dilutions of 1 in 500; 9 of the tested organisms (45 per cent.) in dilutions below 1 in 500, but in 4 of these there was agglutination only in dilution of 1 in 25. Further, the 4 sera which agglutinated their homologous organisms in high dilution (1 in 2000) were tested against the 19 heterologous organisms, with the result that no agglutinations took place in 1 in 2000 dilution; in two instances only a positive result was obtained in 1 in 500 GROUP STUDY IN OPHTHALMIC RESEARCH. dilution, a Shiga serum agglutinating 6 of the 19 UNDER the above heading Dr. F. Park Lewis read organisms (3 Flexner strains, 2 Y, and 1 Strong), and a Flexner serum (original) agglutinating two a paper before the Ophthalmological Section of the Flexner strains. A trace of agglutination, but very American Medical Association last June1 on a rarely a positive result, was obtained in some subject which for long has been felt, both in instances with low dilutions. Absorption tests America and in this country, to be one of primary which were applied to the two sera con- importance, not only to ophthalmologists, but to the cerned showed that the agglutinin produced whole medical profession, and indeed to the public by the heterologous organism was the same at large, though as yet hardly any steps have been The as that produced by the homologous organism. taken to remedy the evil complained of. The authors’ results and those to which they allude: practice of specialism is justified by the particular
against Homologous an important piece
"
1
Journal of
Pathology and Bacteriology, 1919, xxii., 257-261.
1
"
Journal of the American Medical Association, June 28th,
1919.