View report page

Report of the Medical Officer of Health.
113
the above amount, mallein does not appear to be so definite in its action. The following chart
shows the temperature observations at intervals of four hours during five days, inoculation being made
on the first and fourth days.
Mallein
reaction in
human
glanders —
Temperature
chart.
(4a, 4b) Cuti-reaction and "ophthalmoreaction." These are modifications of the preceding
test, in which a smaller amount of mallein is rubbed into a scarified surface of the skin, or a few
drops are instilled into the eye. A local reaction is produced only in glandrous subjects. In horses
these modifications have not been found universally satisfactory, but in a few human cases good
results have been reported, whilst numerous controls on normal people have been negative. Still by
analogy with the corresponding methods of diagnosing tuberculosis too much stress cannot be laid
on these modified methods.
(5) Agglutination. This is similar to the method now used for diagnosing typhoid fever. The
serum of healthy men often agglutinates B. mallei in low dilutions, but the blood-serum of those cases,
comparatively few in number, of human glanders which have been so tested give a reaction when diluted
100 fold. By analogy with horses, it is evident that it can be used as a diagnostic reaction.
The blood serum of healthy horses will react when diluted many hundred times, but glandered horses
react with the blood diluted 2,000 fold and more. In Prussia the reaction is made use of and all
animals are killed as glandered whose blood reacts in 1,500 fold dilution and over. The technique
has been much improved in recent times, and the reaction can be obtained within a few hours with
stock emulsion of B. mallei and a centrifuge.
(6) "Complement-deviation" method. The test is analagous to that now universally adopted
for the diagnosis of syphilis, in which disease its value is indisputable. Briefly, the method depends
on the fact that certain specific anti-bodies are formed in the system as a result of infection with
bacteria. These anti-bodies will combine with the specific infecting bacteria in the presence of a third
body, found in the blood of all animals and not specific, which is known as "complement." Further,
if red blood corpuscles of one animal, e.g. a sheep, are injected into another animal, e.g. a rabbit, the
blood serum of the rabbit has formed in it a substance known as haemolysin, which will, outside the
body, dissolve the specific corpuscles (namely, those of the sheep), but also only in the presence of
complement.
The technique is complicated but very accurate, and necessitates only the withdrawal of a little
blood from the patient through a slight puncture of the skin.
The blood serum is then heated to destroy its own complement, and mixed with an appropriate
and standardised extract of glanders bacilli, and also some guinea-pig's blood serum to act as complement.
This is allowed to stand at blood temperature for one hour, and then mixed with a
standardised haemolysin (contained in rabbits' blood serum also previously heated) and sheep's blood
corpuscles, and again placed for one hour at blood temperature. If no solution of corpuscles occurs,
so that they sink to the bottom of the test tube, it is then deduced that no complement remained,
and that it must have previously combined with the glanders bacilli which could only occur in the
presence of a serum from a glandrous patient, which would contain the appropriate anti-body, and
so the serum which is in question must have been derived from a glandrous animal.
There is some little divergence of opinion as to the practical usefulness of this method, but careful
Continental workers have demonstrated its great value. In Berlin and Bromberg, etc., excellent