NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Medical Officers of the Army of India.
3
having been hardly any choleraic admissions during the latter part of the cold
weather and the normal fall in prevalence of the disease having taken place
towards the close of the hot weather.
The following table shows the total number of cases from which materials
of any kind were obtained during each month from January to September :—
January
.
. .
.
. . .
.
.
.
0
February
.
.
.
.
.
. .
.
.
.
3
March
.
.
.
.
.
. .
.
.
.
9
April
.
.
. . .
.
.
.
.
. 1 1
May
.
.
.
.
.
.
.
.
.
.
6
June
.
.
.
.
.
•
.
.
.
.
3
July
.
.
.
.
.
.
.
.
.
3
August
•
.
.
.
.
.
.
.
.
.
1
September
.
.
.
.
.
.
.
.
.
.
I
3 7
It is curious to observe how even in such a limited number of cases the
monthly distribution agrees with the data which we possess regarding the gen-
eral normal seasonal prevalence of the disease.
It will be seen that the total number of cases of supposed choleraic nature
from which materials of any kind were obtained was 37. One of them, however,
that occurring in August, was subsequently ascertained not to be of a choleraic
nature, and in regard to one or two of the others, a suspicion that the same was
the case certainly exists. These cases will receive special notice further on.
Samples of fresh alvine evacuations were obtained in 28 cases. In 26 of
these curved schizomycetes were recognisable. In two of them none could be
detected. In both of these the flocculi which were prepared for examination
appeared to be composed of almost pure mucus containing numerous blood
corpuscles and curiously polynucleate mucus corpuscles but hardly any schi-
zomycete organisms of any kind.
The numbers as well as the characters of the commas present in the
remaining 26 cases varied very greatly. In ten cases they were very abundant,
and in several of these the material approached a pure cultivation in its charac-
ters. In seven of the ten cases the commas were characteristic in appearance
resembling , those developed in artificial cultivations. In two they were charac-
terised by their length, slenderness, and slight degree of curvature. In one they
were quite unlike those occurring in any other instance, consisting of very large,
relatively thick, strongly curved bodies. In the remaining 16 cases they were
present in varying but relatively small numbers and of characteristic appearance.
2. Intestinal contents.
Specimens of Iliac mucus were examined in five cases.
In all cases commas were present. In four cases very few were present
IA
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Scientific Memoirs by
and straight bacilli of various kinds abounded. In the specimens derived from
the remaining case the conditions were reversed commas being present in very
great numbers and few specimens of any other form being associated with them.
In connection with this subject it may be well to note that in none of the
cases from which these materials were obtained was there any conspicuous signs
of congestion of the intestinal mucous membrane, and that in two of them not
the faintest evidence of any such condition could be detected.
•
3. Blood.
Specimens of blood were obtained from eight cases—in four during life and
in the others during the course of post mortem examination. The samples in the
first class of cases were taken from the tips of the fingers which had been pre
-viously carefully cleansed with spirit and solution of corrosive sublimate. The
needles employed for puncture were heated to redness immediately previous to
being employed and the blood was received in freshly drawn capillary pipettes.
In those cases where the blood was obtained after death the samples were
taken by means of passing the extremities of freshly drawn closed capillary
pipettes through the walls of the right auricle and subsequently breaking of the
points within the cavity.
Numerous preparations were made from the materials thus obtained, but in
no instance could the presence of schizomycete organisms of any kind be de
-tected in them.
B.—Results of Cultivations of Choleraic Materials.
I
. Cultivations of alvine evacuations.
Plate cultivations of this nature were carried out in 18 cases and in 13 of
these colonies of characteristic commas made their appearance. In the remain
-ing five cases no commas could be detected. In one of these cases the substra-
-tum of the cultivation was of acid reaction, in one the material from which the
cultivation was derived was certainly not of truly choleraic nature, and in two
others it appeared to be very probable that the same was the case, the reaction of
the evacuation being of a strongly acid character in one of them, and the micros
-copical features of the other being very exceptional and unlike those ordinarily
present in choleraic materials. In one case only in which there could be no
reasonable doubt as to the choleraic nature of the disease, and in which the cul
-tivation was conducted in an alkaline substratum did commas fail to appear.
The proportions which the colonies of commas bore to those of other forms of
schizomycete organisms varied very greatly in different instances. In some
cultivations only one or two colonies could be detected among numerous others
of different nature; in other cases they were present in large numbers; and in
one, at all events, an almost pure cultivation of commas occurred.
Medical Officers of the Army of India.
2. Cultivations of materials obtained from the intestinal cavity after death.
Cultivations of Iliac mucus were carried out in four cases.
In three instances crops of characteristic commas were obtained. In two
of them colonies of commas were developed in large numbers. In the third case
they were very scanty, whilst colonies of minute, straight bacilli abounded.
In one case no commas could be detected. In this the substratum of the
cultivation was of an acid reaction, but this condition was also present in one
of the cultivations which yielded an abundant crop of commas.
3. Cultivations of blood.
Eighteen distinct tube cultivations of blood obtained from the eight cases of
cholera previously alluded to were carried out, three or four punctures being
made in each tube. In 16 tubes no development of any kind occurred. In the
remaining two, which both belonged to the same case, a growth of what ulti
-mately proved to be Micrococcus luteus took place along the lines of puncture
and gradually spread thence over the . surface.
4. Cultivations of other choleraic materials.
In three cases tube cultivations of juice from the liver and kidney of cases
of cholera were attempted. The material for cultivation was obtained by means
of carefully cleansing the surface of the organs with spirit and solution of cor
-rosive sublimate, introducing the extremity of a freshly drawn, closed capillary
pipette through the cleaned area into the subjacent tissues, and then breaking
the tip and applying pressure around it. In two cases the cultivations were not
attended with any result. In the remaining case the cultivation of kidney juice
behaved in the same fashion, while schizomycete organisms of various forms ap--
peared in that of liver juice. These, however, were unquestionably of salivary
origin and connected with the fact that strong suction had been applied to the
distal extremity of the pipette in the attempt to obtain a sufficient supply of juice.
Certain points in connection with the cultivations of materials of intestinal
origin call for somewhat closer consideration here than they have met with in
the course of the above general statement of results. These specially relate to
those cases in which no development of commas occurred as the result of cul
-tivations. Taking the entire series of primary plate cultivations of intestinal
materials, it will be seen that they amounted to 22, that a development of
commas occurred in 16, and that in six of them no commas were detected. It
has been already pointed out that in one case the material cultivated was not of
choleraic origin, that in two cases the nature of the material was doubtful, and
that in two the nature of the substratum might be regarded as accounting for
the phenomenon, so that only a single case remains in which an apparently
unequivocal choleraic material cultivated in a seemingly favourable substratum
failed to produce a recognisable crop of commas.
5
8
Scientific Memoirs by
be either apparently or really devoid of actual commas and may at the same
time be capable of serving as the source of cultivations containing them, and on
the other hand that they may contain actual commas and yet fail to reproduce
such bodies on cultivation under circumstances favourable to the development
of those associated with choleraic media.
II—On the presence of Curved Schizomycete organisms
in non-choleraic materials.
A.—On the occurrence of curved schizomycete organisms in normal alvine
evacuations.
An extended series of observations was carried out in regard to the ques-
tion of the presence and characters of commas in such materials.
These included—I, Examinations of fresh materials ; 2, Cultivations.
I. Results of examinations of fresh, normal alvine materials.
Thirty-three distinct samples were subjected to examination, the specimens
being prepared in the same fashion as the choleraic Ones. In all of these
without exception curved schizomycete organisms were present in varying
numbers. The principal difficulty in regard to these materials lies in the enor
-mous multitudes of multifarious schizomycete organisms present in them, which
seem in truth to constitute the greater part of their mass and tend to crowd the
preparations in bewildering profusion.
It therefore becomes necessary to dilute them in order to obtain satisfac-
tory preparations or materials suited for cultivation. This dilution in the pre
-sent instance was effected by means of freshly sterilised salt solution of 0.8 per
cent. strength.
The number of commas present varied very considerably in individual in
-stances, and in any case was very inconsiderable in relation to that of other
schizomycete forms. They also showed very considerable variation in form.
Many of them were long, slender, only slightly curved and with acutely pointed
extremities. These resembled very closely the commas present in the case
previously described as having ultimately proved to be of non-choleraic nature.
Others, however, presented characters seemingly identical with those of the
commas in typical choleraic media.
In some cases, minute vibrionic or spirillar forms were present in very con
-siderable numbers, and in others large active and energetic specimens of
Amœba coli and Trichomonads abounded.
2.—Results of cultivations of normal alvine materials containing commas.
In 18 cases primary plate cultivations were instituted. The substratum
in the most of these was neutral or faintly alkaline, but in a certain number of
Medical Officers of the Army of India.
9
varying degrees of acidity. Colonies of various kinds were developed in abun
-dance and in many cases presenting macroscopic features identical with those
of commatous origin. Specimens were prepared from all colonies which appeared
in any way to present distinctive features. The numbers of preparations from
individual plates in consequence amounted in some cases to as many as ten, but
in spite of this in not a single instance were commas of any kind to be detected.
The forms most commonly developed in the cultivations consisted of short
straight rods and micrococci, but in certain instances an abundant development
of elongated bacilli occurred, the colonies of which were of superficial habit with
peculiar lichenous, foliated margins. The variety of forms developed was
curiously limited in relation to the multifarious nature of those present in the
original materials. Cultivations were not, however, limited to primary plates, for
having become more and more convinced of the polymorphic nature of the
choleraic commas, and of the apparent relation which the appearance of special
forms bears to variations in the conditions in which cultivations are carried out
—the habit of growth acquired in one medium appearing to persist to a certain
extent for some time in others of different constitution—repeated cultivations of
materials derived from the primary plates were made on other plates and in
tubes. The number of successive cultivations made in this way in individual
instances was very considerable, in one case as many as seventeen successive
ones being carried out, but, in spite of continued subjection to conditions
favourable to the development of the commas associated with choleraic media, in
no instance did such development occur here. The nature of the substratum
and the course of cultivation were varied in different ways, the media being in
some cases solid, in others liquid, the reaction being varied, the primary cultiva
-tions being sometimes carried out in liquids, the original materials for inoculation
being sometimes employed whilst fresh, at others only after having been kept
for varying periods, but in all cases the result was alike, there was no develop
-ment of commas.
These results would appear to indicate either that bodies of the nature of
the commas present in choleraic materials are entirely absent from normal
alvine evacuations whether in actual or potential condition, or that, if they be
present, that they are incapable of further development under conditions
favourable to those of choleraic origin. They also point out the absolute neces
- s i t y o f c u l t i v a t i o n e x p e r i m e n t s , s h o w i n g , a s t h e y d o , t h a t t h e m e r e p r e s e n c e o f
curved schizomycetes can neither determine their true nature, nor the character
of the medium in which they exist.
B.—On the occurrence of curved schizomycetes in the intestinal canal of
Guinea-pigs.
Only one or two observations regarding this point were carried out. As has
been pointed out by Dr. Klein, curved schizomycete organisms form a character
-
2
istic feature in the contents of the, cæcum of healthy guinea-pigs. They appear
to be normally present in very considerable numbers. Only one series of
cultivations from materials of this nature was attempted and in it no develop
-ment of commas, resulted.
C.—On the occurrence of curved schizomycete organisms in water.
The occurrence of commas in water has been frequently pointed out by
other observers, and what I have to do here is merely to indicate the connection
existing between certain conditions in the water of tanks in and around Cal
-cutta with the presence of very large numbers of commas which resemble those
associated with choleraic materials in size and form, and so far at all events
in nature in being cultivable in agar-agar jelly.
At almost any season many of the tanks in and around Calcutta are more
or less covered by a scum of Euglenæ, which is of a bright brick-red color in
the morning, of a vivid green in the evening, and which is much less conspicuous
and defined during the day than it is from sunset to sunrise. These variations
in its characters are dependent on recurrent periodic changes in the condition
of the component Eugleæ. The definition and specially the dry dusty aspect
of the scum in the evening and early morning are due to the fact that at these
times the vast majority of the Euglenæ are aerial and not aquatic organisms,
the cells containing the then encysted and passive protoplasts being raised in
various degrees above the surface of the water, and in the majority of cases being
entirely removed from contact with it and projecting freely into the air. The
relative inconspicuousness of it during the day is, on the other hand, due to the
fact that they are then submerged and swimming free in the water. The
changes in color are dependent on alterations in the relative amounts of red oily
coloring matter, and specially in alterations in its distribution within the bodies
of the protoplasts. The scum is not, however, solely composed of living
E u g l e - n æ , b u t , o n t h e c o n t r a r y , c o n t a i n s m a s s e s o f t h e e m p t y c y s t s a n d s t e m s w i t h
dilated bases belonging to previous cycles of the encysted condition of the
organisms. Bright, dry weather tends to induce constantly increasing thickness
in this scum due to the fact that, under such circumstances, the normal cycle of
developmental changes of form goes on recurring with unbroken regularity, and
that accordingly, quite apart from any coincident processes of multiplication
connected with the encysted condition of the organisms, there is necessarily
a constantly recurrent addition of increments of dead matter in the form of
empty cysts and stems. Heavy downfalls of rain, on the other hand, tend to
cause it to disappear, due to the fact that they both break up the sheets of
empty cysts and stems, and by driving the Euglenæ down into the water tend
to prevent their normal assumption of an aerial habit. So long, however, as
conditions remain favourable to the regular periodic succession of the diurnal and
nocturnal phases in the life history of the Euglenæ a steady increase in the scum
Medical Officers of the Army of India.
goes on. Any scum of this nature, composed in considerable proportion of dead
organic materials affords a favourable site for the development of both saprophy
-tic and parasitic organisms, and we accordingly find it crowded with infusorial,
monadinic, and schizomycete forms. Among the latter curved forms are fre
-quently, and, under certain conditions, apparently normally present in very
large
numbers.
In order to obtain these commas with certainty and in large quantity, it is
only necessary to procure a considerable mass of the scum, which can always
be done readily at almost any time from the middle of the cold weather until
the onset of the rains, and to introduce it into a jar of water. The conditions
are here unfavourable to the continued life of the Euglenæ, and they conse
-quently gradually die off, while a very thick scum consisting of their bodies in
various stages of decomposition mingled with masses of their empty cysts and
stems accumulates on the surface, so as sometimes to attain a thickness of
about a quarter of an inch.
If portions of this be removed and their under-surfaces examined, they will
be found to be more or less coated by a stratum of clear gelatinous material
which is crowded with curved schizomycetes of various forms, but many of
which precisely resemble those associated with choleraic media in their morpho
-logical characters.
In two instances in which cultivations of this material were carried out in
feebly alkaline agar-agar jelly, a development of distinct commas occurred. The
subject was, however, unfortunately not pursued further at that time (April) due
to press of other work, and when again recurred to during the rains had to be
abandoned due to the impossibility of obtaining good supplies of the material at
that time. With the return of the cold weather it will, however, be again pos
-sible to take it up and as common gelatine media will then be available for
cultivations, the physiological characters of the commas may be more accurately
compared with those of the choleraic ones than would have been possible at
times when agar-agar jelly has to be substituted for them. In the meantime
the results, so far as they go, must be regarded as enforcing the necessity of
caution in coming to hasty conclusions in regard to the interpretation to be put
on the phenomenon of the presence of cultivable commas in sources of water supply.
I I I . — O n v a r i a t i o n s i n t h e f o r m a n d c o u r s e o f d e v e l o p m e n t o f t h e
Curved Schizomycetes associated with choleraic materials in
connection with variations in the conditions to which they
are exposed.
In taking up this part of my subject I am well aware that the conclusions at
which I have arrived, whilst in accordance with the views of many botanical workers,
are in direct conflict with those of the majority of pathological bacteriologists,
and that I am therefore laying myself open to much adverse criticism in publishing
2A
rejuvescence and the development of a single, large comma only, corresponding
with the convex surface of the parent.
All these points could be very readily made out in connection with the larger
specimens of the various forms, and when once this had been done the fact that
similar processes took place in the case of the smaller ones also, appeared evi-
dent on careful examination under sufficiently high magnifying powers.
The material containing all these various forms was next employed to ini-
tiate a series of tube cultivations, in substrata of various reactions with the
following results:—
Cultivation I.—Substratum alkaline. —The resultant crop consisted pri-
marily in greater part of typical slender commas, many of them being of very
minute size. A certain number of small round and elliptical cocci were also
present and in many of these vacuolation and appearances corresponding with
various stages in the process of resolution into pairs of commas were clearly
evident.
Cultivation II.—From cultivation I; substratum strongly acid.—The growth
in this case was mainly composed of cocci. These were either isolated, or asso
-ciated in pairs, or in series so as to form compound bodies of rod-like form. Very
few typical commas were present, but many of the longer cocci showed more or
less evident concavo-convex contours. Many of the cocci and some of the dis-
tinct commas were vacuolate.
Cultivation III.—From cultivation II; substratum strongly acid —The
growth here resembled in its characters that of the previous cultivation, but the
proportion of distinct commas was even smaller. Vacuolation was prevalent.
Cultivation IV.—From cultivation III; substratum alkaline. —In this cocci
of various forms abounded, many of them shewing various stages of vacuolation
and resolution. Very minute commas in many cases associated in pairs were also
present in large numbers.
Cultivation V.—From cultivation IV; substratum alkaline. The growth in
its general characters resembled that of the previous cultivation. Some com-
mas of fair size were, however, present among the minute ones.
Cultivation VI.—From cultivation V; substratum alkaline. —The results
here were very instructive, commas of various sizes were present in enormous
numbers mingled with a certain number of coccal forms in various stages of re-
solution into pairs of commas.
Cultivation VII.—From cultivation VI; substratum strongly acid. —The
characters of the growth here were similar to those in cultivation II.
Cultivation VIII.—Also from cultivation VI; alkaline and so much diluted
as to remain permanently fluid. —The growth in this consisted of a splendid crop
of long vibrionic filaments composed of commas adhering to one another by
their extremities mingled with a certain number of isolated commas. Various
other series of cultivations gave results similar to those detailed above, and
careful and repeated examinations of preparations derived from them have only
20
Scientific Memoirs by Medical Officers of the Army of India.
other hand short filaments arise as the result of similar processes of longitu
-dinal division and divergence in concavo-convex bodies, they will necessarily
be of bilateral type.
But filaments of either type may also very possibly arise secondarily as the
result of processes of torsion at the points of union of adjacent commas, so that
in any case it must remain uncertain how far the characters presented by any
given filament ought to be regarded as of primary developmental value, or as
mere indices to previous exposure to certain external influences.
Microscopic examinations of Intestinal, Splenic, Hepatic, and Renal tissues
were only carried out in one or two instances. The number was much too
limited to permit of any definite conclusions being arrived at, but in no case did
there appear to be any evidence of the presence of special schizomycete orga
-nisms in the substance of the tissues.
CALCUTTA,
25th September 1885.