on the results obtained by the weil-felix reac tion …findings with the results given by the...

25

ON THE RESULTS OBTAINED BY THE WEIL-FELIX REACTION FOR 'l'YPHUS FEVER AT THE GARRISON OF BARU DURING THE PERIOD MARCH-JULY, 1919, INCLUSIVE.l

By .CAPTAIN F: E. REYNOLDS.

Yorkshire Hussars attached Royal Army Medical C01118. Officer Commanding 28th Mobile. Bacteriological Laborato1·Y.

INTRODUCTION. TECHNIQUE. '

CONTENTS.

REACTION OF Bacillus proteus vulgaris, X 19, WITH NORMAL SERUM AND WITH NORMAL SALINE SOLUTION;

CASES OF TYPHUS FEVER-AcUTE.

,CASES OF TYPHUS FEVER-C;NV~LESCENT. CASES OF ·DISEASES OTHER THAN TYPHUS FEVER. CONCLUSIONS.

SUMMARY.

ApPENDIX L--,-Chart showing: Number of Patients admitted to Hospital with 'ryphus Fever. Number of Patients who died of Typhus Fever. Number of Patients, remaining in Hospital with Typhus Fever.

ApPENDIX H .. -Details of Results of Weil-Felix Reaction in Cases of Typhus FeverAcute.

ApPENDIX HL-Details of Results of Weil-E'elix Reaction in Cases of Typhus Fever -Convalescent.

ApPENDIX IV.-Details of Results of Weil,Felix Reaction in Cases of Diseases other than Typhus Fever.

INTRODUCTION.

THE series consists of 32 cases of typhus fever examined during the acute stage of the. disease; 20 cases .examined during convalescence from typhus fever ;' and 2l cases of diseases other than typhus fever in which the temperature was raised and in 12 of which the patient showed signs imd symptoms such that the clinician wished typhus fever to be excluded.

Cases of typhus fever (acute) . 32 . Cases of typhus fever (convalescent) 20

52 , Cases of diseases other than typhus fever 21

Total 73

The number of " control "cases, that is of cases of disease other than typhus fever, namely, 2l cases, is small. This is because nb atten1pt was made. to collect blood as it. routine from such cases, it being understood, that this aspect of the question was being worked up in' other laboratories in the Force. But it would seem ,of value to record the findings in these

1 This paper'was submitted as a Report to Colonel O. M. Wenyon, C.M.G., etc.; A.M.S., Consulting Bacteriologist, Army of Black Sea. We wish to record here our appreciation of and gratitude for the stimulus and invalu~ble help received from Colonel Wenyon in all our work during. the time we served under him in the Army of the Black Sea. .

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26 Results obt'ained by' the Weil-Felix· Reaction for TyphtLS

twenty-one cases investigated by us. . The reaction was carried out m thirteen other cases, but; except that these were certainly not cases of typhus fever, a definite diagnosis as to the condition could not be given from the clinical and laboratory data obtained. These thirteen cases are not.included, therefore, in this report. . .

The cases examined during the acute stage of typhus fever and some of the cases examined. during. convalescence were under the charge of Major Giyn~, RA.M.C.,. 40th Field Ambulance, Baku. The remaining cases were patients admitted 'to 25th Oasualty Clearing Station Hospital, Baku, and six caRes of malaria investigated at the Military 'Detention Hospital) Detachment 40th Field Ambulance) at Petrovsk.

It is understood that Major Glynn, R.A.M.C., is pr~paring a report dealing with the clinical aspect of those cases which were under his, charge' at 40th Field Ambula,nce, ~and correlating the clinical conditions and findings with the results given by the Weil-Felix Reaction,

We wish to acknowledge our indebtedness to the Senior Medical Officer,Baku, for supplying the chart showing the case incidence of typhus

, feyer among the troops cq,mprising the garrison at Baku during the period covered by this Report; also to Major Glynn,R.A.M.C., and the other divisional and medical officers who were in charge of the cases comprising the series for giv'ing us every fa;cility and help' in ,carrying out our investigations: . ,

\

TECHNIQUE.

The technique employed in carrying' out the reaction was the same as that used for .all our agglutination tests~ The ,test was performed in test tU,bes of ordinary size (6 inches byi inches). Each tube contained one cubic centimetre of serum of the dilution required and each ,batch of tests was controlled by normal serum in dilutions 1/20, i/50, 1/100 and by a t,ube containing one cubic centimetre normal saline (N aCl 0'85 percent).

A young culture,' about twentyJour hours 'old, of Bacillus proteus vulgaris, "strain X 19," on, an agar slope was emulsified in cO' 5 cubic centimetre to 0'75 Qubici centimetre normal saline" the amount of saline -depending upon the luxuriance of the growth. (During the~ourse of these experiments and as a routine, an agar slope of ,B. pt'oteus vulgaris, X 19,

'was put, up each day in order to keep the strain" acclimatized" to artificial media.) Of the: emulsion, two drops were added to each tube, the drops

, being of such size as to give a' distinct milkiness to'the contents of the tube. The tubes were' then incubated at 37° C. for two hours. At the end of this time, the results were noted and the tubes placed aside at room temperature until the following day when the final results were read.1

I 'W ~il and Felix recommend that the results be read seventeen hours after the tubes have been removed from the ,incubator. In a number of ef'periments the 'findings after seventeen hours,twenty.four hours, thirty. six hou.!:s, and forty-eight hours were compared. I!l ,all the'c~ses, the findings remained the same. " "




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F. E.' Reynolds 27

Experiments showed that the agglutinatiop titre of an undiluted serum for B. proteus vulgaris, X 19, remained the same for at· least three' to four days. Our practice, in view of this, was to test the agglutination of the serum in dilutions 1/'20,,1/50, 1/100, 1/'200 and thus be able to give a diagnosis positive 01; otherwise. If othe titre of the serum had not b~en determined by _ these dilutions, on the following day, dilutIons of 1/200, 1/400, 1/500,1/800,1/1,000, J/2,000' were,put up. If necessary, on the third Q(LY, further dilutions and namely 1/'2,000, 1/4,000,1(5,000,1/8,000,1/10,000 w~re tested. 'Our method of obtaining one cubic centimetre serum' III these dilutions is shown in the following scheme:- "

Serum O·le.c. undiluted

le.e. Yzo

Normal.saline 1·ge.e. I·Se.e.

Remaining in tube 1 c.c. serum diluted: 1/20 1/50 '

I C.c. 1'50' etc. etc.

" 0·3c.c. thrown away

1/100 1/500

In reading the results, agglutination Ill' dilution of 17100 was taken as indicating a posi,tive reaction. '

REACTION OF Bacillus protmls vulgaris; X19, WITH. NORMAL SERUM AND

WITH NORMAL SALINE" SOLUTION.

As stated in the preceding paragraph, with each batch of sera to be tested two 'controls werep!lt up, namely, one of norma! serum in dilutions 1/'20,1/50,1/100, and th~e other with normal saline solution. These controls were put up on forty different occasions.\ .

On 37 out of the 40 occasions, the author!s blood serum was used in the control, and on the remaining 3 occasions, blood serum which had been taken for other purposes an~ from healthy individuals was used.

Of the 40 controls, with the normal'serum in dilution 1/'20, 13 gave no agglutination, 17 gave a trace of agglutination, 7 gave slight agglutination, and '2 gave niarked agglutination. . With the serum in dilutions 1/50, 1/100 agglutination was never observed.

Of the forty controls with normal! saline solution, agglutination (socalled It auto-agglutination ") was~riever observed.

I.-'-CASES OF TYPHUS FEVER, ACUTE, THIRTY-TWO CASES.

Th\'l re~ults,obtained in examining fifty-seven specimens of blood serum froni thirty-two cases 'of typhus fever III which the first test was made during the acute stage of the disease are 'shown in the followi~g table ;-




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28 . Results. obtained by the WeiZ':' FeZix Reaction 'for Typhus

,TABLE 10

Number of Result 1st Test 2nd Test Day Of disease specimens I----~~-_ -~--_:_-,--I--~---

examined I:ositive Negative Positive Negative Positive Negative

-'------------' ---.-----------,-2nd 1 .. 1 1 3rd 1 1 .. 1 - '" 4th ',2 1 ,I 1 1 5th 6 4 2 4 2 6th 10 7, 3 7 3 7th 4· 3 1 3 1 .-. 8th 3 3 1 2 9th 1 1 1

lOth' " 7 7 1 6 11th 8 8 1 7 12th 3 3 2 1

,13th 4 4 3 1 14th 3 3 3 15th 1 1 1 16th 1 1 1 18'th 1 1 1

,19th 1 1 1

It would appear from the above.that the time ~hen the result of the reaction is desired mostly by the clinician is on the fifth, sixth or seventh day of the disease, although in many of the cases 'in which the blood was tested for the first time on thes!;) days (6, 10 and 4 cases respectively) the diagnosis of typhus fever was almost certain from the clinical signs and symptoln.s. ,"

'During the second to seventh' days inclusive of the disease, the blood of 24 patients was examined-; ,of these, 16 cases (66'7 per cent) were positive, and 8 cases (33'3 per cent) were negative. '. .

From tIle eighth to nineteenth days inclusive of the disease, the blood of 8 patients was examined for the first time, and ,the blood of 25 patIents was examiIfed' for the second time; .in all these 38 cases the test was

, . positive (100 per cent). 'In the eight cases in which the first examination of the blood was'

made during the second to seventh days inclusive of the disease and with negative results, the' second test gave positive findings. These cases are shown in' detail in Table II (p. 29)._

, Two cases were tested on the third and fourth days respectively of the 'disease, and with positive results :- . .

Case No. 2, Mo. (Ind~an), third day of dise~se, titre 1/200; Case No. 3, s. (B1'itish), fo~rth day of disease, titre 1/800. .

There would arise naturally somE, doubt as to whether the blood of these patients was taken as early in the disease as stated and especially so in the case of the Indian: ,Case No. 2, Mo;, was a dhobi (washerman) at the, 25th Casualty Clearing Station Hospital, Baku; he reported sick

_on Mar,ch 18, 1919, and stated that on the previous day he had felt perfectly well and fit for his work. Inquiries made among, the other




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" F E. Reynolds 29

dhobis working in'the_same building confirmed the patient's statement. On the day prior to his reporting sicK he had not complained to them of feeling unfit in any way and he had carried out his usuatduties. On March '20, 1919, typhus fever was suspected and blood was-taken forthe Weil-Felix Reaction. It would appear, therefore, that the, day on which the blood was taken wa~ without doubt the third day of the disease.

Case No. 3, S., was a sapper in the Royal Engineers. Careful inquiries could, not elicit that he had felt uFlfit-in any way prior to March 10, 1919. The blood was taken on March 13, 1919.

The following Table II and Table III have been compiled to show the agglutination titres of the sera of the thirty-two cases of~yphus fever;-

'TABLE H. - E,IGHT OASES IN WHICH 'FIRST TEST WAS NEGATIVE AND SECOND TEST WAS POSITIVE.

1st test 2nd test -ICase No.

Day of disease Titre of serum Day of disease Titre of serum

------------------------'1. Wi, .. .. .. '2nd 0 13th 1/1,000 4. 01. .. . . 4th 1/20 10th J/800 5. Ed .. , .. ., 5th 1/20 10th 1/2;006 6. Ev ... ... .. " 5th 1/20 10th 1/2,000

11. Li. .. .. ., - 6th 1/20 11th 1/4,000 17. Pe ... .. .. 6th

I

1/50 10th 1j800 18. A. .. .. ., 6th 0 11th ' 1/200 21. K. .. .. ., 7th 1/50 12th 1/1,000

TABLE IH,-TWENTY-FOUR OASES IN WHICH BOTH FIRST TEST AND 'SECOND TEsr (WHEN DONE) WERE POSITIVE.

1st test 2nd test -Case No.

Day of disease Titre of serum Day of disease Titre of Serum

-------------------------2. M. .. .. .. '3rd 1/200 8th 1/1,000 3. S. .. .. .. 4th 1/800 8th 1/1,000 7. Gr ... .. ., 5th 1/1,000 11th 1/1,000 8. m ... .. .. 5th 1/100 9th- 1/500 9. Z. .. .. .. ' 5th 1/100 .. ..

10. Pu ... .. ., 5th 1/400 14th ,1/2,000 12: Lo ... .. ., - 6th 1/200 11th 1/4,000, 13 .. Mo ... ' .. .. 6th 1/100 11th 1/2,000 14. T. .. .. ., 6th - 1/200 10th 1/2,000 15. Pr ... .. ' . 6th ~/200 10th 1/1,000 16. H~ .. .. .. 6th 1/400 11th 1/800 19. Bi. ' .. ., ., 6th 1/500 14th 1/4,000 20. W ... .. ., 6th 1/100 15th 1/1,000, 22. 1. .. .. ." 7th 1/200 11th 1/800 23. M. .. .. .. 7th 1/2,000' 18th 1/800 24. Do ... .. .. 7th 1/8,000 14th , 1/1,000 25. N. S. .. .' 8th 1/4,000 19th ,1/2,000 26. F.K. .. ., 10th 1/200 - -27. Ha ... .. .' 11th 1/4,000 - -28. sau. .. .' ' 12th 1/8,000 - -29. Ud. Si. .. ., 12th 1/200 ' 16th 1/800 30. Pi. 13th 1/4,000

- -.. .. ..

I

-31. ·Wa. .. .. 13th 1/500 ,- -32. Ma ... .. ., 13th 1/2,000 - -

0

"




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30 Results obtained by the Weil-Felix- Reaction jar Typhus

From Tables II and III it will be seen that two tests ~ere made III

twenty-five out of the thirty-two cases of typhus fever. Of these '25 cases, during the interval between. the firs't and second tests, the agglutinin contents of the patient's serum as shown l;Jy its agglutinating power had fallen in ? cases (Cases 23, '24, 25); had remained the' same in 1. case (Case 7); had risen in 21 cases.

A comparison of the agglutinin contents of the sera, as shown by its agglutinating' power, at. the stages of ~he disease when tests were made is shown by, the following table compiled from the fifty-seven specimens from the thirty-two cases of typhus fever:- '

,Day of disease

TABL~ IV.

Number, of specimens

Titre of serum:

_. ____ U"':": -":' I-"-"-I~wo I "'00 ~'"' I "'"'J~':OO 1~":I~',ooo "''': ~.,ooo • 2nd • ... ',1 . . . . . . ,~1 . .. I . . . . ' .. ' . . . . . . 3rd .. .. .. .. .. .. .. .. 1 .. .... ..' .. 4th 1 .. 1 5th 2 2.. 1 .. ' 6th 1 1 1 2 : 3 1· -1 7th' 1 1 .. 8th :':, 9th

iOth 11th 12th 13th 14th 15th 16th 18th 19th

.. I ..

'I 1 '1

1

1

.. 1 2

1 , 1

1

.. 2

1 1 1 1 1 1

3 1

1 1

.. 1

1

3 .. 1 1

I :: 1

... ,

1

.. Of the, thirty-tw~ cases of typhus fever six cases died. The following table shows the titres of the sera of these cases :---:

TABLE, V.

1st test 2nd test Day after onset Case No. of ditiease on

.. which death Day of disease Titre of serum Day of disease 'Titre of serum occurred

---------------------

3. S. .. .. .. . 4th / 1/800 8th 1/1,000 12th 6. Ev. .. .. . . 5th 1/20 10th 1/2,000 16th 9. Z. .. .. .. 5th 1/100 - - 8th

10. Pu. .. .. . . 5th, 1/400 14th 1/200 14th 30, Pi. .. .. . . 13th 1/4,000 - - 21st 31. Wa. .. .. . . 13th 1/500 - - 21st ,

Of these,fatal cases, four died as a direct result of typhus fever, namely, Cases 3, 9, 10 .and ~n.




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F. E. ,Reynolds 31

Case No. 6, Ev., was making good progress when he h!1d an apparent relapse and died on March, 18, 1919, sixteen days after onset of typhus fever. Death was dUB to hffimorrhagic pneumonia occurring in the course of the typhus fever. ' ~", .

Case No. '30, Pi., developed inflammation of the glands in the neck; ,these broke down forming abscesses. The patient died on March 18, 1919, twenty-obe days after the onset 'of typhus fever, as the result of the septic absorption during his ,weakened condition.

Case No. 10, Pu.. Specimens of the blood serum, fluid from pericardial sac, and cerebrospinal fluid were taken. at the autopsy held seventeen hours after death and fourteen days after the commencement of the disease. A comparison of the agglutination titres of each fluid was made

. with the following results ;-

,Dilut~0ns I 1/20. '1/50 1/100 1/200 1/400 I 1/590 1 1/800 {~1,OOO 1/2,000 I NaCl

p

---;;;00' '~I++++ ++++ ++++ ++++ ++++1++++ +++ ++ :-:;:-f-;",nt', I P,ri,."di.l 1++ ++ ++ ++ ++++ ++ ++ +++ I +++ ++ + t"" 0

flUid _I ' " o e re b ro- 1++++ +++ ++ trace 0 0 0 ,0 0

spinal fluid!, ' ,

'N

, I I, ormal~loodser~~I~a:-l-o-, -, -.-. -1-'-.-.,---' .-. -1-·-· -1·-·:-'-··-1-'-.. --.-·-·-

++++ = complete agglutination and precipitation. o = no agglutination or precipitation.

As this was the last of the fatal cases of typhus fever further investigations along these lines could not be carried out.

Case No. 32, Ma.' '1'he following case would seem cif great interest as showing the value cif the Weil-Felix reaction in typhus fever. ' '

44635 Driver Ma., 35th Mule Corps, was admitted to 25th Casualty Clearing Station Hospital" Baku, with high temperature. The question of' typhus fever arose, and on March 28, 1919, the sixth day after the onset of the illness, a specimen Of the blood was taken for the Weil-Felix Reaction. In dilution of 1/20 the serum gave a-- trace of agglutination

,and no agglutination was obtained in dilutions of 1/50, 1/100, 1/200'. The control with normal serum on this day gave the same results. The patient· was transferred, however, to 40th Field Amb:ulance, 13aku, as a pqssible ,case of typhus fever:' After transfer,. the diagnosis of malaria was made and Plasm'odium vivax was found in films of the peripheral blood. In order to complete .our routine a second vVeil-Felix test was made on April 8,1919, seventeen days after the onset of malaria,with the same results as regards the patient's serum and normal serum as were given

- . by the first test. ' . ' After running 'a course for some time, typical of malaria, other clinical




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32 Results obtained by the Weil-Felix Reaction for Typhus

sigu's'and symptoms arose whichcaus'ed Major Glynn, RA.M.C., to think that since .admission to 40th Field Ambulance the patient had developed typhus fever .. On April 19, 1919, the blood was taken again and tested for the Weil-Felix Reaction. The serum gave an agglutination titre of 1/2,000. So far as could be ascertained from the clinical data, April ] 9, 1919, was thethi~teenth day of the patient having typhus fever,

The findings are tabulated as follows:-

. 1 I ; Diluti!,ll of patient's serum . I 'I Dilution of

takin~ typhus . NaC Date of I Day of \normal serum

b~O~~ feve~ ~~I_l~~ ~I:...I~~~~I~~.~~~ 1/,1009 1/2'0~11,~/20 I~ 28.3.19 - trace 0 0 .. .. .. 0 .. .. trace 0 0

1

1 \

trace 0 0

tr~~e I + 8.4.19 2nd I trace O. 0 .. .. .. 1 0 ..

19.4.19[1,3th ++++ ++++ ++++ ++++,++++ ++++ ++++ ++

++++ = complete agglutination and precipitation. o '7' no agglutination or precipitation.

. ,

n.-CASES OF TYPHUS FEVER, CONVALESCEN:T,-TWENTY CASES.

These may be divided into two groups, namely :-(a) Patients still in hospital .. . . (b) Patients returning to United Kingdom

Total

12 cases 8

20 cases

(a) Patients still in Hospital-Twelve Cases.

o

The blood was taken on dates varying from the twentieth .to· the thirtieth day after onset of the disease. In all cases the resul'ts o'f the

Weil-Felix Rcacti::,::,:::::::, w,"oj' ~!rggg i:~! ~:,~:s 1/8,000 " 1 case

. 1/10,000 " 1

33. 34. 35. 36. 37. 38.

Total 12 cases

These'results are shown in the following table :~ ~ABLE VI.

Case No.

J ... C ... E ... Mo. La. Er. ..[

Day ~fter onset I Titre of serum' of disease

20th' 1/2,000 21st 1/2,000 21st· 1/8,000

. 22nd 1/1,000 24th 1/1,000 25th 1/10,000

Case Ko.

39. Hu. 40. Gil. 41. T ... 42 . SI. 43. Wi.

1144

. Ba.

Day after onset I' Titre of, serum of di:;ease

26th 1/500 27th 1/2,000 27th 1/2,000 29th 1/2,000 30th 1/2,000 35th 1/2,000

o




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F. E. Reynotds 33

. (b) Patients ret'urning to United Kingdom-Eight Cases. , These patients had had typhus fever in Persia and, were being evacuated

to the United Kingdom by way of Baku. The blood was taken on dates varying from the forty-third day (six,weeks one day) to the one hundred and. twenty-fourth day (seventeen weeks five days) after onset at the disease.' ,

Six, of the cases gave positive findings; the' remaining.-iw.o cases gav~ . Ilegative findings (ti~re 1/50). ,

, _ {1/50 in 2 cases, . ' .1/100'" 1 case

The agglutmatlOn tItres were 1/200 ,,,2 cases _

, ,,1/400 ,,3 - "

Total 8 cases

The results are shown in the following table :

TABLE VII.

, 'case;o Day ~fter onset Titre of serum I1 - Case' N,O, Day af~"r onset I' 'Titre of serum', . .. of dIsease of dIsease

, , I ------'---'------' - ---------' ------I--~'-'-' 45. Ca. 43rd 1/400 49. B... 83rd I 1/200 46. H.;. 58th 1/200 50. Tu. 86th 1/100 47. Ju. 67th 1/400 51. Bl. 1l2th i ~ Ij50 48. ,W ... ' •. I 81st 1/50 1152. De. 124th 1/400

The above results'would indicate that the reaction persists fOl' varying times after the onset of the disease; whereas in one case the result after eighty-one days was negative, a, positive result was obtained in an~ther case after one hundred and' twenty-four days. Moreover, in these eight cas~s it will be no,ticed that there was no relationship between the length ,of time after onset of the disease and the agghitimition titres of the' different sera. But when-compar'ed with the titres of the twelve cases still in hospital (Table' VI) and whose blood was taken between the twentieth and thirty-fifth day~ after onset, the present series shows, with one exception, viz., Case 39 Hu, a very marked lowering of the -agglutina-

- tion titre. " ~

IlL-CASES OF DISEASES OTHER THAN TYPHUS FEVER-TwENTY-ONE CASES.

This series of cases consisted of :-

3

{' Plasmodium fa1ciparum ..

Malaria PI d' , ( primary asmo tum vJvax 1 relapse

Enteric fever , , Acute apical pneumonia .. Relapsing fever ' . , Acute epidemic jaundice ',' Pulmonary tuberculosis and carcinoma Pleural effusion,

Total

2 5 _ 6

13 cases '3 " 1 case

1 " 1 " 1 " 1 '"

21 cases




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'34 Results obtained by the Weil-Felix ,Reaction for Typhus

The clinical diagnosis of' these cases was' confirmed by 'la~oratory "findings, by autopsy; or by operation (case of.pleural effusion).

In dilution of the serum of 1/20 no agglutination was 'obtained in 7 cases, a trace of agglutination in' 11 cases, slight agglutination in 2 cases, ~~d distinct agglutin~ticm in 1 case. In dilution of the serum of ,1/50, a trace of agglutination was obtained ip. 1 case only. ' '

Details ofihecasesaregiven in the following table ;-TABLE VIII.

Dilution of serum Case No; Diagnosis Day of

, ' I 1/20 1/50, 1/100 , disease ' I '

-, --' -, --.1---'---------' ,--- -,--' --------53. SUo .. Malaria-;-M.T: .. I' 9th 0 '0 0 54. B... '" M.T. .. I 14th' trace 0 0 55. M.. . "B. T. 2nd 0 ' 0 0 5.6. Ar. B. T; 3rd trace 0 0 57. An. "B. T. 3th trace 0 ' . 0 ' 58. Pe; ' .. !. " . B~ T. ' 5th 0 0 o. 59. Ma. .. I " B. T. 6th trace 0 0 60. Re. .. I 'B.T.6th + , 0 0 61. Ra. . .1" B.T. 7th trace 0 0 62. W.. . .. I " B. T. '8th trace 0 0 63.Li.. • .. I B. T. '8th 0 0 0 64. Ga,' .. I " B. T. 10th trace 0 \' 0 65. - K. 1. .. I " B. T. 36th trace 0 0 66. V... ;. Enteric fever.·.. 6th 'trace 0 0 - " 10th 0 0 0

,67. W. St. 17th 0 0 0, 68. Br. " .. ,'.. ..,,24th 0 0 0 ' 69. Wt. ',' Acute api~~l pneumonia " 16th ++ 'trace 0 70. D.. • .. Relapsing fever . . • . 8th + 0 0 71. Ni. Si. .. Acute epidemic jaundice .. 17th trace' 0 0 72. ' P!),. S,L, •• I Car9inoma, pulmonary tuber· 17th day of traee '0 0

I culosis . symptoms 73.. L. St. .. jPleural effusion .' .. :. i 4th , o o o

',Full details of the results of the' Weil-Felix Reaction in all the cases investigatedOare given in Appendices Il, III and IV of this Report.

CONCL DSIONs. , ,

Frorri>this series of investigat'io.ns it may be concluded that :~ (1) Agglutination obtained by serum in dilution 1/100 indicates typhus

fever. (2) After about th~ eighth day from onset of 'the djsease, if I no agglu

tination 'is given by the serum in dilution 1/100, acute typhus fever is excluded. ' . ' '

(3) A positive reaction is given by the si)i'um for a varying number of weeks after an attack of typhus fever. There is no relationship in djfferent ca~es between .the time after t~18_ attack and tlie agglutination titre qf the serum.

But in ~ra'Ying these conclusions it must be understood that wedonot wishto dogmatize. 'To be able to do so, an investigation of a larger series of cases would have been necessary. '




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F. E. Reynolds 35

SUMMARY.

, (1) ,The series i ,co:Qsisted of 73 pases'; of these, 32, were cases of acute' typhus fever, 20 were' cases convalescent from typhus fever, arid 21 were cases of diseases other than typhus fever.' .

(2) With controls on forty different occa~:;ions with normal serum in dilution 1/20 no agglutination was obtained on 13, a trace of agglutination on 17, slight agglutination 'on 7; and, marked agglutination on 2. With normal serum in dilution 1/50, no agglutination was eV'er obtained.

(3) With controls on forty, different occasions with normal saline :solution, agglutination (" auto-agglutination''') was never obtained.

(4) During the first seven days after onset of typhus fever, the sera of 24 patients were tested; 16 cases (66'7 per cent) were positive, and 8 cases (33'3 percent) were negative, . The 8 negative cases gave a positive finding by the second test carried out on the tenth to thirteenth days inclusive.

(5) From the eighth to the nineteenth days inclusive of the disease, the sera of 8 patients were examined, for the first time,' ,and the sera of 25 patients were examined for the second time ; ,positive results' were obtained

. in all 33 cases (100 per cent): " . (6) In 25 out of 32 cases of acute typhus fever, two tests were made;

during the. interval between ,the first and second tests, the agglutination titre of the serum had fallen in 3 cases (12 per cent), and remained the sam'e,in 1 case (4 per cent); and had risen in 21 cases (84, per cent). \,'

(7) In 25 out of 32 cases,of acute typhus .fever in which two tests were made, the highest agglutination titre obtained was 1/200, ;tcase; 1/500, 1 case; 1/800, 5 cases; 1/1,000, 7 r.ases; 1/2,000, 6 cases; 1/4,000, 4 cases,; 1/8,000, 'I case., , . "

(8) In 12 pa~ients convalescent from typhus fever, the sera obtained on dates varying from the ,twentleth to the thirtieth day after onset of the ~ disease gave agglutination titres of 1/500 to 1/10,000.

(9) In 8 patients convalescent from typhus fever the sera obtained on . dates varying from the forty-third to the one hundred and twenty-fourth day after onset 6f the disease gave negative results (1/50) in 2 cases, and' in 6 cases agglutination. titres of 1/100 to 1/400. .

(10) In 21 cases of patients suffering from diseases other than typhus , fever, the serum in dilution 1/50 gave a trace of agglutination in I' case only; in no case was agglutination obtained in dilution of serum of 1/100.

(11) . From this series of cases it, would appear that agglutination obtained by serum diluted Ijl0Q indicates typhus fever; a· 'negative result with dilution of serum 1/100 after about the' eighth day after onset of the disease excludes acute typhus .fever; a positive reaction is given by the serum for a val'yingtime after the onset of the disease; in 2 cases it was negative on the eighty-first and one hundred and twelfth day respectively, and in 6.cases it was positive on dates varying from the forty-third to the one hundred and twenty-fourth day.

, I




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APPENDIX IV. DETAILS OF RESULTS Olj'THE'WEIL-FELIX REACTION IN 'CAS~~S OF DISEASES OT'HER.THAN TYPHUS FEVER.

CaRe \ '. No. Regtl. No. Rank Name Unit

I Date of . taking

blood

Day of disease

Dilution of patient) serum Dilution of normal f

serum NaCl Diagnosis Remarks

1/20 1/50 1/100 1/200 1/20 1/50 l/lCO ----------- ._----------------------- --,- ------- -- -------------- ----------.-'53 14190 Lee. (Actg. R. S. .. R.A.F.

Cpl.) \54 206860 Cpl. . . W.~. B. '" •.

55

56 57 58

59 60 61 .62 63

64

65 66

2nd Lt. J; MacI.'

- Interp. A. A. . . 218492 Actg. Opl. An. . .

- Capt... T. E. C. P.

44635 Dvr. .. Ma. • • - Lieut... J. F. R.

60023 Pte. •. W. Ro ...

ig~i~~ A~'tg. opi. ii\Ji. :: Capt. •• Ga ..

40th Fld. Am: : R.A.F. ..

35th Mule Corps 9th Worcs. .. 7th N. Staffs ... R.A.M.C. ..

'R.A.F. ..

'.'

4615 Sepoy 505 Pte.

· . Kh. Is... 72nd Punjabis · . V. .. Maltese Labour

Corps

27.7.17

27.7.19

27.7.19

24'.5.19 27.7.19 27.7.19

28.3.19 21.4 19 29.3.19 21.3.19 27.7.19

23.7.19

31.3.19 3.7.19

9th

14th

3rd 3rd 5th

6th 6th 7th 8th' 8th

10th

36th 6th

67

68

69

18386 · . W. St. .. R.M.L.I. , Stoker' .. Br. •. R.N.

{

20.3.19

27.3.19 21.3.19

10th-

17th 24th

Pte.

70, 657579 Sepoy

71

72

73

2946

4426 Rfm.

15318 Pte.

.. F. W. .. 7t)I Glos.

"IR.D. ' .. .. S. N . .. 19th Punjabis

.. Si. P., .. 2j4th Gurkhas

.. L. St. .. R.M.L.I.

21.4.19'

19.6.19

5.4.19

6th

8th

7th

29.3.19 17thdayof symptoms

20.3.19 10th

o

'Trace

0,

Trace o o

Trace +

Trace

" o

Trace

"

o o

++ +

Trace

'0

o

° o o o O· o o o .0

o o o o o o

Trace

o

o.

o o

o -o

o

o o o

'0 o o o o

0,

o o o

o o

,0

o

o

o o

o o o

o· o o

o o o o o o

o o

o o o o

o o

o o

o

o

o \'

o o o

Trace +

Trace

" '0

o o

Trace

,,\

o Trace

+ Trace

o

Trace

o o o

o o o o o o o o

o

o o

o

o o

o o o

o 0

o 01

o 0

o 0 I O· 0 o 0

o 0 0'1 0 o 0 o Q o 0

o 0

o 0 o 0

I 0 ' 6

o o

,0 o

I

Malaria-M,T ...

M.T .. .

" B.T .. .

B.T .. . B.T .. . B.T .. .

,B.T ... B.T .. . B.T .. . B.T.; . B.T ...

B.T ...

" B.T ... Enteric fever ..

Primary ; gameto-cytes; schizonts

Primary; rings,;. gametocytes

Primary ;amreboid forms; schizonts; gametocytes

Relapse Primary, Primary; rings; amre

boidforms Relapse .

" ." Pri~ary; amreboid

forms; schizonts Primary; amreboid

forms Relapse Bacill7£s typhosus

" " isolated from blood

. . B. typhosus' isolated from stool

" o

o

'0

.. B. typhosus isolated, from.stool

o I R. apical pneumonia-acute

Relapsing fever o Spir.ochaJia recur·

o rentis in blood

Acute epidemic Autopsy April 5, 1919 jaundice -

Malignant disease

Pleural effusion

May 12, 1919

++++ +++ ++

=, complete agglutmatlOn and preCIpItatIOn. =' marked " " " = distinct agglutination.

+ = slight o = no




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I I I l p--. --

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DwChr Dn. Orrthr A.7. @~.Mhs r m b . . Deathr ,Hereh Ors2hr A@ ', Dt.vAs ,lly h r . * JuneNtL 'D*athS hp NIL 6 / NIL &?L

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j ( !I :WPENDIX IT.

oom lobe qglulirution and pmcipilntioo. 11 +222 m a r L utinat~on md pmipibLiou. I ++ - dleGncL 9mtin.tlan.

] I + - alight a$rins&ioo. , U P no u~luLiusLiou l / l

j ; i




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ApPENDIX lit. DETAILS m' RESULTS m' 'I'HE WElL-FELl X REACTION IN OASES OF TYPHUS FEVER-OONVALESCENT.

,

>. I Dilution DJ' Dilution of patient's> serum normal serum d Case

Name Date of Day

'" No. Rpgtl.1'\o. Rank Unit taking of

1/800 \ 1/1,000 1 i I ~

blood disea,se 0 0 0 S - - - 1/20 _ 1/50 1/100 1/200 _ 1/400 l/IiCU 1/2,000 ]/4,000 1/5,0001/8,0[,0 1/10,000 S!. S '"' . , I -- -------- -'--.- -""'-_. -- --- ---- --- --'-

~++I~+------ ------ /-,- -- -- -.

I 33 T4(065455 Dvr. J. .. R.A.S.O. 21.3.19 20th ++++ ++++ ++++ ++++ ++++ ++++ + .. . . .. I .. Trace 0 0 0 34 27127 -Pte. A.Oo .. 9th 18.3.19 21st ++++ ++++ ++++ ++++ +++ ;t++ ++1++ + .. ..

r':~e' ..

" 0 0 0

Wores.

+++:+++ 0

35 32723 " D. C. E ... ,7th Glos. 18.3.19 21st ++++ ++++ ++++ ++++ ++++ c+++ +++1 ++ + " "

0 0 0 36 35924 " . U. M. " 9th 21.3.19 22nd ++++ ++++ ++++ ++++ -+++ -+++ ++, + o I •• " -" I " "

0- 0 0 Wores. , -

I'" 1 " 37 90957 Dvr. E. ILLa. R.F.A. 18.3.19 24th ++++ ++++ ++++ '+++ +++ ++ + I Trace 0 .. .. "

0 0 0 38 16410 Pte. W. J.Br. 9th 18.3.19 25th ++++ ++++ ++++ +++ +++ +++ +++ ++ + + + Trace! Trace

" 0 0 >0

- Worcs. 39 - Sepoy Kh. Ru. 84th 2.6.19 ,26th ++++ ++++ ++++ ++++ +++ + 0 0 0 .. .. •• i " "

0 6 0 Punjabis I

40 50032 Pte. Gil. .. 40t,h ]'ld. 18.3.19 27th ++++ +++ +++ +++ ++ ++ ++ + + .. .. .. I .. "

0 0 0 Am.

1++++ I 41 241255 "

j. R.T. 9th 18.3.19 27th ++++ +++ ++-+ +++ ++ + + • Trace .. .. .. I .. "

0 >0 0 Wores. I

; I 42 28125

" J. G. SI. 9th 18.3.19 29th ++++1++++ +++ +++ ++ ++ ++ + " " . . ~~ .. I ... "

0 0 0 Wores. i

43 Lieut. F. E. Wi. 9th 18.3.19 > 30th I 0' 0 0 - ++++++++ +++ +++ +++ '++ + + " .. .. . . .. - " Wores.

1++++++++ \ --: 44 7299 Pte. F .. Ba. .. 98th Bty. 18.3.19 35th +;++ +++ +++ +++ ++ + + .. . . " .. , . 0 0 0 I R.FA. 1 I

45 11991 "

F. Ca. .. 9th. 20.3.19 43rd 1+++ +++ ++ + Trace 0 0 / ·0 0 .. " .. .. "

0 0 0 / Worcs.

,

I 1 46 202775 "

E. S. H. 9th 4.4.19 58th 1++++ ++++ +++ Trace 0 0_ 0 0 0 .. .. .. .. 0 0 0 0 Warwicks_ I

47 89946 "

S. Ju. .. R.A.M.C. ~0.3.19 67th +++ ++ + " Trace 0 0 [ 0 -0 .. .. - .. .. Trace 0 0 0

48 _ 270947 " J. O. W. R.A.S.C. 4.4.19 81st + Trace 0 0 0 0 0 I 0 0 .. .. .. .. 0 0 0 0

49 - 25706 "

F. B. .. 7th Glos. 20.3.19 83rd ++ ++ +' Trace 0 0 0 0 0 .. .. .. .. Trace 0 0 0 I

50 241472 "

W. Tu ... 7th 20.3.19 86th ++ ++ Trace 0 0 0 0 I 0 0 .. - .. .. .. "

0 0 0 N. Staffs.

I' I 51 47:.127

" A.Bl. R.A.M.C. 20.3.19 112th ++ Trace 0 0 0 0 0 0 0 .. .. .. ..

" 0 0 0

52 25861 "

A. De. :. "

20,3.19 124th ++ ++ + Traoe Traoe- ·0 0 0 0 .. .. .. .. "

0 0 0

-- ++++ == ccmplete agglutlllatlOn and preClpltatlOn. +++ = marked " + + = distinct agglutirtation. + = slight " o = no "




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on the results obtained by the weil-felix reac tion …findings with the results given by the...

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