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52
Annual Report of the London County Council, 1913.
scattered abscesses were found in both lungs, the base of the right lung being chiefly affected.
A large retroperitoneal abscess was discovered on the anterior aspect of the sacrum. Cultures
from both these situations yielded a growth of the bacillus mallei."
Case 2.—The patient, a mechanic aged 43, was admitted for acute rheumatism. His work
did not bring him in contact with horses and he did not live near any stables. He was taken
ill a few days before admission with an acute pain in the right ankle joint. A small abscess
formed and was opened on the outer aspect of the right leg ; other joints became involved, particularly
the knee joint, right shoulder and left ankle. Inflammatory foci appeared on various
parts of the body, but slowly disappeared without suppuration. No definite diagnosis up to this
date had been made though several possibilities had been suggested. At various times the case
was thought to be one of acute rheumatism, acute gout, and then phthisis, and later a diagnosis
of gonorrhœal pyæmia was suggested. Blood was taken from a vein, but remained sterile on
all the media. Pus taken from the wound on the right leg contained streptococcus pyogenes.
Smears taken from the urethra showed the presence of gonococci. The patient rapidly lost
ground ; an abscess formed on the right leg and was opened, a quantity of pus escaping. In
this a gram-negative bacillus was found which proved on further investigation to be the bacillus
mallei. Five weeks after admission a papule appeared on the left side of the neck which soon
became vesicular and in thirty-eight hours the whole face was covered with pustules and the
eyelids were very œdematous, the condition simulating small pox. The bacillus mallei was
also found in these pustules. The patient died six weeks after admission."
Case 3.—The patient, aged 14, was admitted as being a possible case of cerebro-spinal
meningitis. From inquiries made it was discovered that the patient a fortnight before he became
ill had been looking after a horse which was suffering from ulcers, and that a dog which was
kept in the same stables had died from an unknown disease. At the autopsy, "the brain and
medulla were normal and only in the cerebellum a small patch of grey-greenish viscous pus was
found. Cultures from all the various organs were taken and also from the pus in the cerebellum.
Most of the cultures remained sterile; some showed post-mortem bacteria. The cultures from
the pus in the cerebellum grew the bacillus mallei."
In addition to the foregoing, an interesting account of the experiences of a veterinary surgeon of
the Indian Civil Veterinary Department, Mr. S. H. Gaiger, who underwent forty-five operations for
glanders, including twenty-seven under a general anæsthetic, appeared during the year. The account
is given in an article published in the Journal of Comparative Pathology and Therapeutics in September,
1913. The following is a synopsis of Mr. Gaiger's statement:—
In March, 1911, he was at work on an obscure case of disease in an Arab pony in India, which
he ultimately proved by bacteriological means to be glanders. After he had been at work on the case
for about a week Mr. Gaiger became ill during the night of 3rd March with severe headache and a
temperature of 102 deg. F. There appeared to be no reason to connect his illness with his laboratory
work. On 5th March he felt acute pain between the diaphragm and liver, it appeared that the
peritoneal surfaces were inflamed. This pain ceased to be acute in a few days. It was the first internal
symptom and he considers that it pointed to the bacillary infection having taken place through the
alimentary canal. Mr. Gaiger asserts that infection did not take place by accidental inoculation and
no lesions of the respiratory tract have ever been observed. For about three weeks from the date of
the onset of his illness he had intermittent fever and the case was diagnosed as malaria and was treated
accordingly. Pain in the intercostal muscles on the right side was then felt and suggested pleurisy, but
careful medical examination revealed nothing and the pain became less acute in a few days and in duecourse
both peritoneal and pleural pains completely and finally disappeared. The first external lesion
was observed on his left hand on 25th March when a very painful deep-seated swelling appeared. The
swelling became hard and painful, necessitating the use of morphia for three nights. Afterwards an
incision was made, but no pus had accumulated. Later, pus was extracted and a culture taken from the
wound gave a growth which was said to be a bacillus "most like glanders, but yet showed differences."
Two inflamed places later appeared on the forearm on the course of one of the lymphatics and frequent
operations were performed on the hand and the lesions on the forearm. Cultures from one of the abscesses
on the forearm were incubated at the Veterinary College Laboratory. After twenty-four hours no
growth was visible, but after forty-eight hours the growth was luxuriant and Mr. Gaiger was struck by
the resemblance to glanders cultures. Cultivation on potato was "diagnostic." One tube of the culture
was sent to a Research Institute and they named the bacillus "53 A" and made a vaccine, but only
five doses were used at very irregular intervals and this treatment was not given a fair trial. It is stated
to have had no apparent effect on the course of the disease. On 14th June the case was diagnosed
as tuberculous caries of the second metacarpal and an X-ray photo of the hand was taken showing
changes in the metacarpal which could be seen by comparison with the sound metacarpals. Part of
the shaft of the metacarpal was removed and Mr. Gaiger, in the light of after experience, considers
that this operation was a mistake and was the indirect cause of the loss of his whole arm six months
later. He states "that his whole experience shows that the bacillus mallei does not attack bones or
joints. It will eat away connective and lymphatic tissue, but will leave everything else untouched."
Mr. Gaiger came to London on 10th July and went into hospital. The lesions in the forearm
had then healed and those in the hand were all narrow sinuses leading to the bare bone which could be
detected easily with a probe. "Fresh cultures were made on agar, and then on potato, and a guinea pig
was inoculated. The evidence was submitted to authorities, who would admit no doubt that the
organism was the bacillus mallei." Further operations were performed and in September a further