A Polyvalent Vaccine in the Treatment of Bacillary Dysentery in East Africa.

THE research on which this paper is based, was carried out between September 1916, and April 1917, while the writer was in charge of the Carrier Depot Hospital, Nairobi, British East Africa. Dysentery was the most serious disease met with amongst the porters of the Military Labour Bureau in the early days of the East African Campaign, and was the main cause of death and invaliding even as late as the latter six months of 1916, although stringent sanitary measures had done much to diminish its incidence. Apparently at first it was thought that the disease was amoebic in type, and treatment consisted almost entirely in the administration of emetine. Dr Pirie, Government Pathologist at Nairobi, was the first to point out that this idea was wrong, and in the first eight months of 1916, he conducted a series of bacteriological examinations of the stools of 56 cases of dysentery and showed that in only two cases were amoebae found while dysentery-like bacilli were actually isolated in 35-7 per cent., the main type isolated resembling B. Shiga, or frequently B. Morgan*. It was just at the conclusion of Dr Pirie's work in June 1916, that the writer took over charge of the Carrier Hospital at Nairobi. From that time the stools of every patient admitted to hospital for dysentery or diarrhoea, were examined by the writer for protozoa, at least twice, and often thrice, as a routine practice, and it was soon apparent from the number of negative results that the conclusions of Dr Pirie were justified, and that we were dealing with an outbreak of dysentery of the bacillary type and not of the amoebic type. This was also borne out by the failure of emetine in the treatment of the disease. As a result of this work the routine administration of emetine ceased, and reliance was placed mainly on saline treatment, though all the usually recommended lines of treatment for bacillary dysentery were tried at one time or other. Still the death rate did not improve as it should have done, and a very large number of cases became more or less chronic. At last it occurred to the writer that a vaccine based on the results of Dr Pirie's research might improve matters, and Dr Ross, the Director of Laboratories,