74936669.htm

REPORT ON THE WORKING OF THE KING INSTITUTE, GUINDY

APPENDIX No. VIII.

REPORT ON THE OCCURRENCE OF CEREBRO-SPINAL FEVER IN THE
BELLARY CENTRAL JAIL

MILITARY ASSISTANT SURGEON J. H. THEODORE, I.M.D.

Under orders from the Director of the King Institute, I proceeded to the Central Jail,
Bellary, on 20th March 1923. The Medical Officer of the jail had reported that five cases of
cerebro-spinal fever had occurred in the jail, between 25th February 1923 and 10th March
1923.

The following data gathered from the report of the Medical Officer were significant of
an epidemic that called for scrutiny from a bacteriological standpoint on which preventive
measures to arrest the epidemic could be based:—

Data from the Medical Officer's report.

        (1) Five cases of cerebro-spinal fever between 25th February 1923 and 10th March
1923, all fatal, three of these occurred in one day, i.e., 1st March 1923.
        (2) Cases clinically atypical; classical signs absent.
        (3) In four out of the five cases malarial parasites were present in the blood.
        (4) The cases followed in the wake of an unusually heavy incidence of pneumonia.
        (5) There was no evident connection in the occurrence of the cases.

Under instructions from the Director, I examined the following points in connection with
epidemic:—

I. Confirmation of Diagnoses.—Of the five cases that had occurred, bacteriological
specimens had been prepared from three cases; and of these one was a post-mortem specimen
and two were specimens of cerebro-spinal fluid obtained by lumbar puncture. These three
specimens were produced for scrutiny and the following are the results:—

Nature of specimen.	Result.
1. Post-mortem scraping of meninges; specimen stained with fuchsin and methylene blue. No gram stained specimen available.	Pus cells plentiful; a few intracellular and extracel- lular, diplococci present; morphologically resembl- ing meningococci.
2. Cerebro-spinal fluid obtained by lumbar puncture stained with fuchsin and methylene blue. No gram stained specimens available.	Pus cells plentiful; a few extra and intracellular diplo- cocci morphologically resembling meningococci present.
3. Cerebro-spinal fluid obtained by lumbar puncture stained with Leishman's stain fuchsin and methy- lene blue. No gram stained specimen available.	Pus cells plentiful; extra and intracellular diplococci plentiful; morphologically resembling meningococci.

It will be noticed from the above details that none of the specimens produced were
treated by Gram's method of staining and so the differentiation from a possible pneumococcal
infection could not be made. This differentiation is important both from an epidemiological
and therapeutic standpoint. I am of opinion however from cumulative evidence gathered
that the epidemic is one of cerebro-spinal meningits due to D. Intracellular.

II. The part played by malaria in precipitating the epidemic.—None of the specimens of
blood taken from the five cases were available for examination. The number of cases of
malaria occurring in the jail showed a slight increase when compared with the admission for
malaria for the corresponding period last year. But these figures are no indication of the
incidence of malaria unless they can be compared with the corresponding population figures
for the respective periods. When viewed from the fact that the strength of the jail is above
normal at present, the following figures show clearly that malaria is not present in an
abnormal degree:—

Out-patients.
	1922.	1923.
January	16	37
February	10	44
March	26	26 (in 20 days).
Hospital admissions.
January	25	Nil.
February	10	8
March	Nil.	3

Although at first sight, there appears to be a very distinct increase in malaria this year,
a close scrutiny will reveal that this increase is not absolute. For if the figures both among
the out-patients and the in-patients are compared it will be found that in January last year
there were 16 out-patients and 25 in-patients, when this year the out-patient figure of 37 is in