332 on the boat she was very ill with an undiagnosed complaint, from the effects of which she was only recovering when she first attended the hospital...

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332 on the boat she was very ill with an undiagnosed complaint, from the effects of which she was only recovering when she first attended the hospital. From the historv it was concluded that the illness from which the patient suffered on the boat must have been the original typhoid infection, and it was confidently expected that plentiful agglutinins would still be remaining in the blood. Serum was accordingly obtained and tested in dilutions of from 1/250-1/2500 against the Lister Institute agglutinable typhoid emulsion. To my great surprise no agglutination was obtained. At the same time a catheter specimen of urine was obtained and cultures were taken from the operation wound, which was now almost healed ; no growth of B. typhosus was obtained from either source. The absence of agglutinins from the patient’s serum seemed so inexplicable under the circumstances that a further agglutination test was performed with the original organism, with the same result as before. Furthermore, one agar slope culture of the organism was used to absorb 2 of a 1/10 dilution of the Lister Institute agglutinating serum (already diluted 1/10). The absorbed serum was then put up in dilutions of whole serum of from 1/250-1/5000, against a known agglutinable typhoid strain, when it was found that the agglutinins had been completely removed within these limits. All doubt as to the identity of the organism with B. typhosus was finally removed by this result, which was confirmed by Dr. H. Schutze of the Lister Institute, who very kindly typed the organism independently. On the strength of these findings the M.O.H. of the district in which the patient lived was notified, and shortly afterwards a report was received from him that examination of the patient’s fseces had resulted in the isolation of an organism shown by agglutination tests to be B. typhosus. Various attempts were made to get the patient to report again to the hospital, with a view to ascertaining if her serum would agglutinate her own organism, but unfortunately she had moved from London and her experiences since her identification as a typhoid carrier had not encouraged her to go out of her way to deal with medical men. The points in this case to which attention is par-

are : (1) the occurrence of a typhoid abscess in the breast, having, so far as could be made out, no association with underlying bone ; (2) the fact that the patient, although a carrier, was unaware that she had ever had typhoid fever ; and (3) the absence of typhoid agglutinins in the patient’s own

ticularly drawn



IN view of the return to Natal in 191S of a large number of our troops from the campaign in Egypt, I drew the attention of the Defence Department to the large number of fresh-water snails in the Durban suburbs which might act as intermediary hosts for the Egyptian form of Schistosoma rnansoni, which up to that time was unknown in South Africa except on the Rand, amongst native labourers who had been

imported from the tropics. In August, 1919, I motored Dr.

Annie Porter of the South African Institute for Medical Research to several pools at Mayville and Sydenham, and we collected about 350 snails from one pool where Physopsis cifricakia was heavily infested with schistosomes and Limnwa natalensis with the larvæ of fasciola. In the Medical Journal for South Africa, January, 1920, Dr. Annie Porter stated that she had found both Schistosoma hcenzatobiztnz and Schistosoma mansoni in these two common species of fresh-water snail, and in Parasitology, September, 1920, Dr. E. C. Faust reported both parasites in the material I sent him from Physopsis africarzu. On June 14th, 1921. a boy was brought to me for treatment who had suffered from constant hæmaturia of 18 months’ duration. but no other symptoms, since bathing in these pools at Sydenham. Microscopic examination of the centrifugalised deposit of urine passed revealed the presence of both lateral and terminal-spined ova. the latter being much more numerous. Both forms were about the same size, being from 0’12 to 0.15 by 0-06 mm. in diameter :the lateral spine was about twice the size of the terminal one.

In view of the moreserious nature of infection with S. mansoni every endeavour should be made to eradicate the snails from these heavily-infested pools. Since the introduction of white duck on the pool where Dr. Porter and myself collected so many in August. 1919, this water has remained free from them. Durban.





THE follovdng case is reported as being the first instance in Buganda proper of an infection of man by B. anthracis. Human infections have been reported by Spearman in 1917 from Jinja, in the Eastern Province, and by Taylor from Ankole, the great cattle country in the Western Province of Spearman’s case was not Uganda Protectorate. subjected to a full bacteriological examination, but Taylor isolated an organism in pure culture which corresponded,in so far as it was tested, to R. anthracis. The disease in animals has been known for some time to the Veterinary Department, in East Africa at any rate, and Taylor, as the result of a careful inquiry in Ankole. found that anthrax was well known to the Banyankole herdsmen. The history of the present case is briefly as follows :On Feb. 15th, 1921, a Muganda bricklayer, engaged on

the construction of the venereal hospital at Mulago, was sent to hospital with a rough diagnosis of abscess of the jaw. Suspicion was aroused by the trifling character of the pain in comparison with the intensity of the swelling and oedema. On the edge of the right jaw there was a slightly raised tuberculated oval ring, some 1½ byinches in extent ; ,there were no vesicles. The centre was slightly depressed and considerably darker than the skin in general. A dense infiltrated area surrounded the ring and extended for about an inch all round, fading into the oedema. The latter was so intense as to be almost fluctuating ; it extended from the zygoma to the clavicle, and caused a certain amount of obstruction to respiration. There was siirprisingly little pain. The temperature on admission was 100’ F. The patient, whose work had nothing to do with hides or cattle, stated that he had bought and cut up some of the flesh of a bullock which was alleged to have been gored by another-probably a Luganda term for " death from unknown causes." Three davs later he noticed a small papule on his cheek which he scratched, and it had gone on increasing in size from that time up to his admission to hospital some six days later. On admission the pustule was at once excised and the wound painted with pure carbolic, partly closed by stitches, and a wet carbolic dressing applied. The temperature at once fell, and remained practically normal until his discharge three weeks later ; the oedema subsided and had almost disappeared at the end of a week. A smear examined immediately after the excision showed typical anthrax bacilli in pure culture. They occurred singly or in short chains of two or three.

Bacteriological Report. received 16/2/20 in saline ; section prepared, revealing large bacilli scattered through tissues bordering on wound ; bacilli Gram-positive. The blood-stained saline showed numerous similar bacilli in very long chains, the ends being cut off square. A portion of the material was repeatedly washed in sterile saline and rubbed on agar slopes, which were incubated at 37° C., aerobically and anaerobically. Vigorous growth resulted, under both conditions, of mixed culture of Gram-positive cocci and the large bacillus. The bacillus was easily isolated in pure culture. The organism answered to the classical description of the anthrax bacillus. The square-cut ends were most obvious in preparations lightly fixed with heat. In 36-48 hour cultures spore-formation was observed : spores central. Bacillus immobile ; tended to form very long chains in liquid culture media ; liquefied gelatin in funnel-shaped manner, the 25 per cent. gelatin used in this climate hiding the finer characters of the growth. Grew well on agar, aerobically Tissue

1 See reference in THE LANCET,

1919, ii.,

p. 636.