On the application of the serum test to the differential diagnosis of typhoid and Malta fever : and on the further application of the method of serum diagnosis to the elucidation of certain problems in connexion with the duration of immunity and the geographical distribution of disease / by A.E. Wright and F. Smith.

Wright, Almroth, 1861-1947.

Date:: [date of publication not identified]

Credit: On the application of the serum test to the differential diagnosis of typhoid and Malta fever : and on the further application of the method of serum diagnosis to the elucidation of certain problems in connexion with the duration of immunity and the geographical distribution of disease / by A.E. Wright and F. Smith. Source: Wellcome Collection.

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$Having sufficiently illustrated this last point we may now subjoin in tabular form the results which we have obtained by the application of this method of serum diagnosis. The results which are tabulated below were obtained by testing the reaction of the serum in the capillary sero- sedimentation pipettes which have been described and illus¬ trated above. , In the tables which are subjoined a voluminous sedimentation is indicated by the sign 4- / a slighter but still perfectly characteristic sedimentation is indicated by the sign a negative result is indicated by the sign 0. Table I._Cases Diagnosed as “ Malta Fever ” which showed Reaction on the Micrococcus Melitensis of Bruce. 5 No. of case. Period elapsed since illness. Table IV.—Cases Diagnosed “Typhoid Fever ” which showed no Reaction on either the Typhoid or Malta Fever Organism. Degree in 'which serum was diluted. - — Years. 1 Months 1 iu 10. j 1 in 25. j 1 in 50. I in ICO.! 1 in 200. It _ 5 * * 0 0 21 _ 6 4- + + — — 3 6 + + + + 4- 4 _ 8 + 4- 4- 4- 4- 5 1 1 8 4- + 4- + 4- 6! 1 1 9 + 4- 4- 4- 4- 7 3 j — 4- * * 0 0 8$ Now ill. 4- + 1 + 4- 4- No. of case. Place in which illness occurred. Period elapsed since illness. A < Years. Months. 1, 2, 3, and 4 Sabathu, India. | _ 1 8, 8, 6, and 6 5 Nowshera, India. j 7 6 Lucknow, India. 10 7 Line of march, India. • 5 8 Rangoon, Burmah. — 6- 9 Shwebo, Burmah. j - 9- 10 Caunanore, India. 10 11 Hong-Kong. 1 _ 9- 12 Benares, India. 1 8 13 Umballa, India. & 14 Natal, South Africa. 17 . . Table V.—Cases diagnosed “Malarial Fever,” or not speci¬ fically diagnosed, 'which showed Reaction on the Malta Fever Organism. t Said to have been a very slight attack. I Higher dilutions not tried. |i Marked effect in this case up to 1 in 300. 4 Gives a positive reaction up to, but not above, a 1000-fold dilution. Table ll.—Cases diagnosed “ Typhoid Fever ” which showed Reaction on Typhoid Bacillus. O) in cd O o a No. of case. 1 2 3 4t 5 6 7t 8 9 10 11 12 13) 14 15 Period elapsed since illness. Degree in which the Serum was diluted. It 2 31 Place in which ill¬ ness occurred. Period elapsed since illness. Sedimenting effect. -A Years, 'j Months. J 1 in 10. 1 1 in 25. 1 in 50. - 1 inlCO. s <M’ a • r-4 *“H Nowshera, India — 11 i + + + 4- + Hong-Kong. — 1 6 * * 0 0 0 Meean-Meer. Now ill. 1 + I + | + + 4- Years. Months 11 in 10.1 1 in 25. 1 1 2 6 6 12 5 6 6 6 6 7 9 9 10 2 8 4- + 1 in 50. 1 in ICO. 1 in 2C0. 0 0 + 0 0 4- t India was the only foreign station in which the patient had served, j Distinct effect up to 1000-fold dilution. Table VI.— Case diagnosed “ Malta Fever” whichshowed no Reaction on the Micrococcus Melitensis, but which shower a Distinct Effect on the Typhoid Bacillus. i + * * 4* + + * # 4- 1 * * + 1 o 1 0 + 0 0 o o | o o I 0 0 0 0 No. of case. Place in which ill¬ ness occurred. 1 Period 1 elapsed, j Degree to which the serum was diluted. r ‘ \ \ • , rri cn r-* S 1 Sj O * | a S' O r—* d r—i 1 in 25. d lO .2 r~* 1 in 100. j 1 in 200. •* ¥t 0 0 1 0 j 1 Malta. Ill at time + j + 4- * 0 _U 4- * 0 0 of exami- + -* 0 0 J 0 I _ nation. 1 4- 0 0 0 0 0 0 t Higher dilutions not tried. table III.—Cases diagnosed “ Typhoid Fever” which had no effect on the Typhoid 'Bacillus, but showed a distinct Reaction on the Malta Fever Micrococcus. No. of case. Place in which illness occurred. Period elapsed since illness. __*-N Years. Months Degree to which the serum was diluted. 1 in 10. 1 in . 1 in 25. : 50. 1 in | 1 in 100. ; 200. Aldershot. 2* Sabathu, India. — 3*t Ditto. 9 7 7 4- 4- 4- + 4- 4- 4- 4- + # Xndia was the only foreign station in which the patient had ser\ed. t Higher dilutions not tried.. with Surgeon-Major Semple, elicited on the survival of the micro¬ coccus Melitensis in the spleen of monkeys who have perfectly recovered from Malta fever, both these interpretations appear to us to be equally admissible. . Tr , , ,. ■ 3 We are deeply indebted to Surgeon-Captain L. Hughes for sending us a culture of this micro-organism. The culture which was sent to us was obtained in Malta from a fatal case of the disease. A not inconsiderable number of interesting facts are dis¬ closed by a study of these tables. The following are perhaps- the more important of these :—(1) Consideration of Table I. discloses the fact that the micrococcus Melitensis, which was discovered by Surgeon-Major D. Bruce, is in reality, as he asserted it to be, the true cause of Malta fever. Out of nine clinically more or less well-characterised cases which were examined by us, the eight which are tabulated here have shown a perfectly characteristic reaction to the micrococcus Melitensis. The only one of the nine cases which failed to react was that of a patient who had suffered from Malta fever five years previously to the date of our examination. We may I not unreasonably surmise that the specific power of sediment¬ ing the micro-organisms of Malta fever may, in this case, have passed away. (2) Consideration of Tables III. and V. discloses the fact that Malta fever is, as Bruce and others have long surmised, a disease which is not by any means confined to the Mediterranean basin. We have here what we take to be definite evidence of its existence in three stations in Northern India. We have, further, what we take to be probable evidence of its existence in Hong-Kong. (3) Table III. shows that a certain number of cases which ar& from their clinical symptoms diagnosed to be typhoid fevei, are in reality cases of Malta fever. (4) Table IV. shows tha^ a considerable number of cases which are from their clinica* characters diagnosed to be typhoid are in all probability neither cases of typhoid fever nor cases of Malta fever. It is-$

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