NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
27
in most cases of enteric fever and the diagnosis is made absolutely certain. This
method has been practised at certain hospitals in India with success, e.g.,
Meerut, Kasauli, Poona, and Jullunder. As the technique becomes better known
it will be more universally adopted, because it is simple and certain.
In Table II of the Appendix the results obtained by the serum sedimenta-
tion test and the blood culture in bile are given, vide page 107, Appendix.
From a study of this table it will be seen that the bacilli enter the blood-
stream at a very early stage in the disease. The clinical signs called enteric
fever begin to develop at the same time as the bacilli enter the blood. The
disease is, indeed, a blood-poisoning. The fact that an early invasion of the
blood occurs in enteric fever makes blood culture an extremely valuable means
of making a prompt diagnosis.
It is further demonstrated that it is possible to cultivate the bacillus before
the agglutinins have appeared in the blood in sufficient quantity to make a
certain diagnosis by the Widal test.
Again in this relation the question of group agglutination (between typhoid
and paratyphoid) has to be considered. In a certain percentage of cases it is
often difficult to say which is the main infection. Cultivation of the bacillus
from the blood generally settles this difficulty.
The following table shows the result of the examination of blood by the
serum agglutination test and the blood culture method in cases in which a
marked group agglutination occurred:—
Name, rank,
number, and regiment.
Date.
WIDAL REACTION.
BLOOD.
B. TYPHOSUS.
B. PARATYPHOSUS.
40
8 0 160 320 1000
A.
B.
B. TY -
PHOSUS.
B. PARATY-
PHOSUS.
20 40 80 20 40 80
A. B.
6962, M., Pte., Oxford
L. I.
20th July
1907.
+ + + + — — — — — — — —
+
23950, Gr. K., 9th
M. B., R. G. A.
(convalescent).
13th May
1907.
+ + — — — —
— — — — — — —
+ in
fæces.
2250, Dr. C. E. W.,
11th Batty., R. F.
(convalescent).
28th August
1906.
+ +
+ —
— — —
— — + +
+
+
7501, Pte. Y., 2nd
East Surrey.
9th Septem-
ber 1906.
+ + — — — —
+ in
urine.
Z. A., 5th Mule Cadre. 12th Decem-
ber 1906.
+ + —
— — —
+ + + + — —
—
+
E 2
In the case of Private M. a very puzzling reaction occurred. An organism,
Bacillus paratyphosus A., was cultivated from the blood-stream and fæces.
The agglutination test, however, showed a high reaction with Bacillus typhosus,
but practically none with Bacillus paratyphosus A. or B. The reason of this
" apparent" group reaction was explained later. A daily examination of the
fæces and urine during convalescence was made and in the ninth week a few
colonies of B. typhosus were detected in the stools. The case, therefore, was
cone of mixed infection.
Case of Dr. C. shows that the agglutination titre was the same both for B
typhosus and paratyphosus B. Cultivation of the blood proved that the organism
was B. typhosus.
From a consideration of the above cases it will be readily understood that
the universal adoption of the blood culture method for making a diagnosis of
enteric fever in hospitals should be aimed at, and if it is combined with a serum
sedimentation test, very few cases of enteric should pass unrecognised. Should
the case be at an early stage the blood culture will show the presence of B.
typhosus ; if it is at a later stage a definite agglutination reaction will be got.
VIII.—PARATYPHOID INFECTIONS IN INDIA.
Up to the present in India there have been no recorded observations on
paratyphoid infections based on cultural examinations. During this enquiry
-several cases have come under our observation, and these are now placed on
record. The number of infections due to B. paratyphosus which we have met
with is small as compared with those occasioned by B. typhosus.
Paratyphoid infections are produced by two organisms, Bacillus para-
typhosus B. (Schottmüller) and Bacillus paratyphosus A. (Brion Kayser).
In Europe B. paratyphosus B. appears to be far more widely distributed than
B. paratyphosus A. Most of the cases recorded in Germany have been due to
infection by B. paratyphosus B. Our experience in India, on the contrary,
shows that the B. paratyphosus A. is a commoner cause of infection. Thus of
the six cases of paratyphoid infections which we have studied, four have been
caused by B. paratyphosus A. and only two by B. paratyphosus B. As the
subject is new and of some interest, a summary of the observations which we
made on the cases is given.
Case 1.—Infection caused by B. paratyphosus A.—No. 7277, Pte. B. age 23
years, service 5 years 8 months and 1 2 days, Durham Light Infantry, was
admitted to the Station Hospital, Kasauli, on May 4th, 1906, complaining of
9
pains in the head and back, with loss of appetite and nausea. He began to
feel ill on May 1st.
State on admission. —Face pale, skin moist, lips dark, eyes bright, pupils
dilated, demeanour listless and apathetic, tongue coated with a dirty yellow fur,
except at the sides and tip, which were red. Breath had a musty smell, bowels
loose, motions yellow and watery, urine normal, body well-nourished, no rash
visible. Heart, lungs and liver normal. Spleen not enlarged. Abdomen
resonant on percussion, no pain or tenderness, gurgling quite perceptible in
right iliac fossa. Temperature 100, pulse 75, respirations 20. Since his
arrival in Kasauli from Lucknow on April 6th, 1906, he had not left the station.
He denies having ever taken any food or drink outside barracks. None of the
men in his barrack room lately had enteric, nor had any of his friends from other
rooms. He does not remember to have used any latrine except that belonging
to his barrack room. He had been "vaccinated" for enteric in May 1902.
Prior to admission he had always been in good health.
May 8th, 1906. —A few rose spots were observed on the skin over the
abdomen to-day. The blood was examined and an organism cultivated ( vide
description given below). Widal reaction to B. typhosus negative.
May 12th, 1906. —The spots seen on May 8th have disappeared and a fresh
crop has appeared. Epistaxis to a slight extent occurs daily.
May 21st, 1906. —The temperature was normal to-day for the first time.
May 25th, 1906. —Slight relapse set in, which may have been the result
of constipation, from which he has been suffering for the last two days.
June 1906.—Patient passed a partly formed stool.
June 16th, 1906. —Examination of the blood showed that it was sterile. No
Widal reaction to typhoid.
June 20th, 1906. —Patient convalescent. Bowels regular, formed motions
being passed naturally every day.
June 27th, 1906. —The patient is now out of bed; feels well but weak. He
is rapidly gaining strength, however, while his appetite and appearance improve
daily.
The temperature ranged between 99° and 103°,F. from May 4th to 20th,
1906. It did not touch normal at all during this period. It became normal on
May 21st and remained so until May 24th, when it rose to
100°. The tempera
ture continued elevated until May 31st, when it touched normal. After this
there was an evening rise to 100° but dropping to normal each morning until
June 11th, when the temperature became normal and remained so.
The following table shows the result of the enumeration of the blood cells,
the percentage of hæmoglobin, the Widal reaction for Typhoid and Paratyphoid
30
bacilli, and the presence or absence of bacilli in the peripheral blood :—
Date 1906.
R. B. C. W. B. C.
PERCENTAGES.
H b . %
WIDAL REACTION.
Bacilli in
blood.
P. N. S. M. L. M. E.
Typhoid. Paratyphoid B.
May 6th .
. ...
. . . . . .
. . .
. . .
. . .
. . .
—
—
+ (pure
culture).
19th .
. ...
...
...
. . .
. . .
. . .
. . .
. . .
. . .
—
30th .
.
...
...
. . .
. . .
...
. . .
..
. . .
. . .
+ (pure
culture).
June 2nd .
. 4,560,000 7,810
76
13
1 1 0
90
. . .
. . .
...
5th .
. 6,480,000 6,390
77
6 17
0
80
. . .
. . .
...
14th .
. ...
. . . . . .
. . .
. . .
...
...
. . .
— —
The following table shows the result of the examination of the urine and
fæces:—
Name, rank, number
and Regiment.
Date of
examination.
URINE.
FÆCES.
B. typhosus.
B. paratyphosus.
B. typhosus.
B. paratyphosus.
A.
B.
A.
B.
7227, Private B.,
Durham Light
Infantry.
6th May 1906
—
—
—
—
— —
The following table shows the characters of the organism cultivated from
the blood of Private B.:—
Private B.
B. paratyphosus A.
Stock
B. paratyphosus A.
Microscopic characters .
. Motile rods; gram negative . Motile rods ; gram negative.
Ordinary broth.
. Diffuse cloudiness; no scum Diffuse cloudiness ; no scum.
Ordinary agar.
.
. Whitish growth .
.
. Whitish growth.
Potato .
.
.
.
.
. Moist, transparent growth . Moist and transparent growth.
Ordinary milk .
.
.
.
. No change
.
.
. No change.
Litmus milk .
.
. No clothing, slight red
. No clotting, slight red.
Private B.
B. paratyphosus A.
Stock
B. paratyphosus A.
Litmus lactose nutrose
.
. . No change
.
.
. No clotting, slight red.
Litmus glucose nutrose
.
.
. Red .
.
.
.
. Red.
Litmus whey .
.
.
.
. Slightly red
.
.
. Slightly red.
Neutral red agar
.
.
.
. Gas and fluorescence pro-
duced.
Gas and fluorescence produced.
Litmus mannite nutrose .
.
. Red .
.
.
.
. Red.
Indol production after 14 days
. Nil. .
.
.
.
. Nil.
Serum reaction (Titre 1—2,000)
. Complete 1—2,000
.
. Complete 1—2,000.
Case II.—Mixed infection (Bacillus paratyphosus A. and Bacillus
typhosus).—
No. 6962, Private C. M., 1st Oxford Light Infantry. Service 5 years
7 months.
Admitted—15th July 1907.
Patient was in hospital for pain over the dorsal vertebræ for one week from
9th May 1907 ; no fever. Discharged cured. On 14th July 1907 came to
hospital again with pain in the back, temperature 99°. There was tenderness on
pressure over the dorsal vertebræ. The skin was very hyperæsthetic and the
patient could not bear to be touched at the level of or below the twelfth dorsal
spine. This area extended right round the body and down the buttocks.
Bowels slightly loose.
22nd July 1907. —Complained of severe pain in abdomen. Rigidity of
muscles on palpation, maximum point of pain over cæcal region ; stools loose.
23rd July 1907. —Pain is most severe over the gall bladder and the region
of cæcum.
25th July 1907. —Pain is still severe over the gall bladder. The muscles
are very resistant over this area. Liver or splenic dulness not increased. Rose
spots on abdomen. Spinal pain much diminished.
27th July 1907.—The temperature is normal. The patient had colic in the
night.
30th July 1907. —Progressing satisfactorily.
2nd August 1907.—Now quite convalescent. Slight diarrhœa.
The temperature on July 14th was a little above 100º F. in the evening ;
next day it rose to 103° F. The temperature continued to range between
100º and 103º F. until July 27th, when it became normal in the morning. It rose to
32
100° F. in the evening, but came to normal next morning ; after this date the
temperature remained normal.
The following table shows the result of the examination of the blood :—
NAME.
Date.
WIDAL REACTION.
B. para-
typhosus A. in
blood.
B. typhosus.
B. paratyphosus A.
8 0
1 6 0
320
1000
20
40
8 0
Private M.
. .
20th July 1907
.
+
+
+
-
. . .
. . .
...
+
22nd July 1907
+
±
-
...
-
-
-
...
26th July 1907
.
+
+
+
±
...
. . .
...
. . .
28th July 1907
.
± ±
-
-
...
...
. . .
-
4th August 1907 .
+
±
-
-
. . .
...
. . .
. . .
The following table shows the result of the examination of the fæces and
urine of Private M. :—
NAME.
Date of observation.
B. PARATYPHOSUS A. IN
Fæces.
Urine.
July 1907.
Private M.
. 20th
.
.
.
.
. . .
...
22nd
.
.
.
-
. . .
24th
.
. . .
+ + +
-
25th
. . .
+ + +
-
26th
. .
-
-
27th
.
.
.
-
-
28th
. . .
-
-
29th
. . .
-
-
30th
.
. .
. . .
. . .
31st
.
.
...
. . .
September 1907.
9th.
. . .
...
15th
.
.
.
...
. . .
16th
.
. .
+ (B. typhosus)
. . .
18th
. . . .
+ ,, ,,
. . .
33
NAME.
Date of observation.
B. PARATYPHOSUS A. IN
Fæces.
Urine.
September 1907.
Private M. .
.
. 22nd
. . .
—
. . .
24th
. .
—
...
30th
.
.
...
. . .
See also Case No. 6, Table 1, of Appendix.
The following table shows the characters of the organisms separated from
the blood and stools of Private M. :—
Private M.
B. paratyphosus A.
Stock
B. paratyphosus A.
Stock
B. typhosus.
Microscopic charac-
ter.
Motile rods ; gram negative
. Motile rods ; gram
negative.
Motile rods ; gram ne-
gative.
Ordinary agar
. Good growth
.
.
Good growth
.
. Good growth.
Ordinary broth
. Uniform turbidity, no scum
. Uniform turbidity, no
scum.
Uniform turbidity, no
scum.
Potato .
.
. Moist, transparent growth
. Moist transparent
growth.
Moist transparent
growth.
Litmus mannite
nutrose.
Red.
.
.
Red
.
.
Red.
Milk
.
. No change
.
. No change
.
No change.
Litmus milk .
. No clotting, red
.
No. clotting, red
. No clotting, red.
Litmus lactose
nutrose.
Red.
.
.
Red .
.
. Red.
Litmus glucose
nutrose.
Red.
.
.
Red .
.
.
Red.
Litmus whey
. Slightly red .
.
Slightly red
. Very slightly red.
Neutral red agar
. Gas fluorescence
.
.
Gas fluorescence
. No change.
Litmus saccharose . No change
.
No change
. No change.
34
Private M.
B. paratyphosus A.
Stock
B. paratyphosus A.
Stock
B. typhosus.
Litmus maltose
nutrose.
Gas fluorescence
.
.
. Gas fluorescence
. Red.
Litmus dextrine
nutrose.
Red
.
.
.
.
. Red
.
.
. Red.
Indol production
after 14 days.
Nil
.
.
.
.
.
Nil. . .
.
Nil.
Serum reaction
(specific serum for
B. paratyphosus A.
titre limit I—
2,000).
Complete reaction 1—2,000 . Complete reaction I—
2,000.
Nil.
Remarks.
This case is a very interesting one. At first, examination of the blood and fæces showed the pre-
sence of B. paratyphosus A. alone, but the agglutination titre was high to B. typhosus and low to B. para-
typhosus A. About 6 weeks after convalescence had begun, a few colonies of B. typhosus commenced to
appear in his stools for the first time. He was, therefore, suffering from a mixed infection. A possible
explanation of such a case might be, that this patient was a "chronic bacilli carrier" of bacillus typhosus
of some standing and that this infection was complicated by an invasion with B. paratyphosus A.
Case III.—Infection caused by B. paratyphosus A. —No. 23950
Gr. K., 9th Mountain Battery, R. G. A., age 22, has a total service of 11
years and service in India 8 years. He was stationed at Umballa. In March
1907 he passed through an ordinary attack of what was regarded clinically as
enteric fever. He was sent up to Kasauli to convalesce, and, as is done in the
case of all enteric convalescents at that station, a systematic examination of his
blood, urine and fæces was made. It was found that he was a "chronic bacilli
carrier." The organism was not bacillus typhosus, but bacillus paratyphosus A.
The following table shows the result of the serum agglutination test in
Gr. K. :—
NAME.
Date of observation.
WIDAL REACTION.
B. PARATYPHOSUS
.
A. IN
B. typhosus.
B. paratyphosus A.
Fæces.
Blood.
20
40
8 0
20
40
8 0
Gr. K.
.
. 13th May 1907 . +
+
±
+
...
...
+
—
31st May 1907 .
. . .
. . .
. . .
...
. . .
...
. . .
...
11th June 1907 .
±
. . .
...
. . .
. . .
. . .
+
. . .
20th June 1907 . ...
. . .
...
...
. . .
. . .
—
. . .
35
The following table shows the characters of organism separated from the
fæces of Gr. K.—
Gr. K.
B. paratyphosus A.
Stock
B. Paratyphosus A.
Microscopic characters
. Motile rods ; gram negative .
. Motile rods ; gram negative.
Broth
.
.
.
. Diffuse typical growth .
.
. Diffuse typical growth.
Ordinary agar .
.
. Growth typical
.
.
.
. Growth typical.
Potato
.
.
. Moist typical growth
.
.
. Moist typical growth.
Litmus mannite nutrose . Slightly red .
.
.
.
. Slightly red.
Milk.
.
.
.
. No change .
.
.
.
. No change.
Litmus milk .
.
. Slightly red. No clotting
.
. Slightly red. No clotting.
Litmus lactose nutrose
. Unchanged .
.
.
.
. Unchanged.
Litmus glucose nutrose
. Red .
.
.
.
.
. Red.
Litmus whey .
.
. Slightly red .
.
.
.
. Slightly red.
Neutral red agar
.
. Gas and fluorescence
.
.
. Gas and fluorescence.
Indol, after 14 days .
. Nil .
.
. .
.
. Nil.
Serum reaction B. paraty-
phosus A. (titre 1—2,000).
Complete 1—2,000
.
.
. Complete 1—2,000.
Case IV.—Infection caused by B. paratyphosus A. —Driver Z. A., age 28,
5th Mule Cadre, was admitted on 29th October 1906 to Meerut cantonment
hospital. The initial pyrexia lasted for 12 days, the highest point touched
being 104°. The temperature did not become normal until the 9th day
; t h e n f o r t h e n e x t t h r e e d a y s i t w a s i n t e r m i t t e n t . I t r e m a i n e d n o r m a l
until the 19th day. On the 20th day it rose to 99º; then fell to normal, but rose
next evening to 104°. It remained high, varying between 102° and 104º, until
the 31st day of the disease, when it gradually became lower and touched normal
on the 35th day. It remained about normal until the 40th day, when it rose and
F 2
36
remained between 103° and 104° until the 52nd day, when it gradually fell. It
became normal on the 56th day, and remained so.
The patient had a hæmorrhage from the bowel on the 45th day. He was
very much reduced by this long illness. He had two relapses after the original
attack. Apart from the pyrexia and the hæmorrhage from the bowel there was
nothing noteworthy in his clinical history. The chief interest lay in the re-
sults of the bacteriological investigation of his case.
The following table shows the result of the examination of the blood of
driver Z. A. :—
NAME.
Date of observa-
t i o n .
W I D A L R E A C T I O N .
B. paratyphosus
A. in blood.
B. typhosus.
B. paratyphosus.
A .
B.
Driver Z. A.
. . 12th December
1 9 0 6 .
1—40
Complete.
1 — 320
Complete.
1—10
+
The following table shows the characters of the organism separated from
the blood of Z. A. :—
Dri ver Z. A.
B. paratyphosus A.
Stock
B. Paratyphosus A.
Stock
B. typhosus.
Microscopic characters. Motile rods ; gram nega-
tive.
Motile rods ; gram nega-
tive.
Motile rods; gram nega-
tive.
Broth
.
.
. Uniform turbidity, no
scum.
Uniform turbidity, no
scum.
Uniform turbidity, no
scum.
Ordinary agar
.
. Good growth
.
. Good growth
.
. Good growth.
Litmus mannite nutrose Red
.
.
.
. Red
.
.
.
. Red.
Litmus glucose nutrose Red
.
.
.
. Red
. .
.
. Red.
Litmus lactose nutrose No change
.
.
. No change
.
.
. No change.
Litmus whey
.
. Stronger red
.
. Stronger red
.
. Slight red .
. .
37
Driver Z.A.
B. paratyphosus A.
Stock
B. paratyphosus A.
Stock
B. typhosus.
Litmus milk
.
. Motile rods ; gram nega-
tive.
Motile rods ; gram nega-
tive.
No clotting, red.
Milk
.
.
. No change .
.
. No change .
.
. No change.
Neutral red agar
. Gas fluorescence .
. Gas fluorescence .
. No change.
Potato
.
.
. Moist transparent growth Moist transparent growth Moist transparent
growth.
Litmus saccharose
nutrose.
No change .
.
. No change .
.
. No change.
Litmus dextrine nutrose. Red .
. .
. Red .
.
.
. Red.
Indol, after 14 days . Nil
.
.
.
. Nil
.
.
.
. Nil.
Serum reaction B.
paratyphosus A. titre
1—2,000.
1—2,000 complete .
. 1—2,000 complete .
. Nil.
Case V.—Infection caused by B. paratyphosus B. —No. 7501, Pte. Y. of
the 2nd East Surrey Regiment, was sent up to Kasauli to convalesce after
an attack of enteric fever. A systematic examination of his urine and fæces was
made and showed that he was excreting B. paratyphosus B. in considerable
numbers in his urine.
The following table shows the result of the examination of the blood of
Pte. Y.:—
NAME.
Date of observation.
WIDAL REACTION.
B. Paratyphosus
B. in blood.
B. typhosus.
B. paratyphosus.
A.
B.
Pte. V. .
.
. 5th September
1907.
1—20
Complete.
—
—
...
38
The following table shows the result of the examination of the fæces and
urine of Pte. Y.:—
NAME.
Date of observation.
B. PARATYPHOSUS B. IN
Fæces.
Urine.
Pt e. Y.
.
.
.
.
9th May 1906
...
+
. . .
12th May 1906
. . .
+
...
Remarks.
This case is of interest as showing that although it was regarded clinically as an ordinary case of enteric
fever, the bacteriological examination showed that the man was suffering from a paratyphoid infection and
he continued to excrete B. paratyphosus B. in his urine for a long period after freedom from fever. This
was the only case in which we have cultivated B. paratyphosus B. from a patient.
Case VI.—Infection caused by B. paratyphosus B. —A specimen of blood
taken from a lady at Nowshera, who was suffering from what appeared to be an
atypical attack of enteric fever, was sent for examination. It was found that
her serum agglutinated B. paratyphosus B. in very high dilution, about 1—1500.
The examination was repeated with another specimen of blood and the same
result obtained.
In this case we were not able to make a cultural examination, but from the
high serum agglutination titre, there can be little doubt of the nature of the infec-
tion.
IX.—RESULTS OF EXAMINATION OF BILE.
An important observation to confirm was, whether or not the B. typhosus
is excreted in the bile of cases of enteric fever ? To obtain material to work
out this problem a request was sent to all military hospitals in India to send
samples of bile from fatal cases of enteric fever. Also a similar request was sent
to the large civil hospitals in Bombay, Madras, Calcutta, and Lahore.
Should the B. typhosus be found constantly and in large numbers in the bile
of cases of enteric fever, it will strongly support the view outlined above, namely,
that the bacilli deposited in the liver from the blood stream infect the bile in the
biliary channels and the bile being a very favourable medium for its develop-
ment the bacillus typhosus grows very richly. This culture of B. typhosus is
39
poured into the intestinal tube with the bile and so gains an exit in the fæces to
the external world.
The bacillus typhosus can give rise to cholecystitis. In the case of Corporal
W., at Mhow, the medical officer in forwarding the bile sample stated that
"the gall bladder was nearly empty and the bile withdrawn looks like thin
yellowish-green pus. The gall bladder when subsequently opened was intensely
inflamed." The sample had the appearance of pus and was plated as usual on
Drigalski Conradi plates. Our examination next day showed an almost pure
growth of B. typhosus. In several of the cases of enteric fever which we have
observed, both during the acute phase of the disease and during convalescence,
signs and symptoms have appeared which clearly pointed to an affection of the
gall bladder. The occurrence of this condition during convalescence lends addi-
tional support to the view that it is in the biliary channels that the B. typhosus
continues to exist.
The intermittent discharge of bacilli in fæces is, probably, dependent on
infection of the bile stream from time to time by the bacilli deposited in the
liver.
The results of the examination of the samples received up to date fully
confirm the view above stated. We have found in the bile of fatal cases of
enteric fever the bacillus typhosus in very large numbers and frequently in pure
culture.
The following table shows the result of the examination of samples of bile
collected from fatal cases of enteric fever :—
Name, number, rank and Regiment.
Date of death.
Date of
examination of
bile.
Bacillus typhosus in bile.
No. 6259 Pte. C. H., 1st Gloster
Regiment.
16th August 1907 . 19th August 1907 .
—
No. 6441 Pte. M. T., Cameronians . 16th August 1907
. 20th August 1907 .
+ + +
No. 7431 B. A., 2nd South Staff
R e g t .
Not known
.
. 25th August 1907 .
—
No. 7696 Pte. P., 1st R. S. F. .
. 22nd August 1907 . 25th August 1907 .
+
+
No. 5240 T., 1st Royal Dragoons . 23rd August 1907 . 27th August 1907 .
—
No. 8707 Corpl. S., H. L. I.
.
. 24th August 1907 . 30th August 1907
.
+ + +
N o. 7628 Pte. J. G., 1st Northamp-
ton.
30th August 1907 .
1st September 1907
+
No. 5526 Pte. H., 1st Lanc. Regi-
ment.
28th August 1907 . 30th August 1907 .
+ + +
No. 6991 Pte. A., XIII Hussars
. 4th September 1907 6th September 1907
+ +