NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Explanation of Plates.
(Except where otherwise noted, all magnified by Zeiss 1/12th objective and
No. 4 ocular.)
PLATE 1.—Figs. A. to K.—Stages in Development of Quartan Parasite.
A. I.—Small parasite, amœboid, pigmented, lying on hæmocyte.
2 a, b, c.—Amœboid changes in one parasite
2 d.—The same, after leaving red cell.
3.—Globular sterile form.
B.
1 and 2.—Show amœboid changes of shape in older forms, the stages drawn
at intervals of from 2 to 5 minutes.
C.—Shows increase in size, amœboid movements still marked.
D. 1, 2, 3.—Bodies becoming circular, pigment peripheral or in figure of 8 con-
figuration.
4.—Free, sterile form.
E.—Parasites larger, circular, fill almost entire red cell.
F. 1.—Pigment collected in centre.
2.—Segmentation commencing.
3.—Segmentation more advanced, nuclei forming.
4.—Forme en rosace, segmentation complete.
5.—Fan-shaped form of segmentation.
6.—Free, sterile form.
G.—Similar forms to those in A.; healthy young parasites.
H. 1, 2 and 3.—Show very active amœboid changes in three parasites, forma-
tion of processes which break off, pigment more concentrated than
normal (off. fig. C.).
5 and 6—Free spherical forms, unaffected.
I.—Small, shrunken, necrotic-looking parasites, no movement of cytoplasm or
pigment.
J.—Free, spherical bodies still persisting after cessation of symptoms.
K.—2 a to 2 e.—Show small amœboid parasite about 12 hours old leaving
hæmocytc.
3, 4 and 5.—Show envelopment and digestion of the same by a large
phagocyte, which at 5 has become a melaniferous cell.
Fir. L. to N.—Stages in Development of Tertian Parasite.
L. 1.—Small amœboid parasite filling about 1/5th of red cell.
2 a , b and c.—Show changes in shape of a similar slightly larger body.
M. 1 to 4.—Large, motionless forms, red cell much enlarged, ought to be paler
than in plate. Pigment actively moving.
5.—Free, spherical body.
6 . — F l a g e l l a t e d b o d y .
N. 1.—Segmentation commencing, and pigment in coarse granules concentrated
towards one side.
2.—Pigment in centre, segmentation more advanced.
3.—Segmentation nearly complete.
4 . — S p o r u l a t i o n c o m p l e t e , n u c l e i m a r k e d .
O.—Structure of Tertian Parasite (stained with Hæmatoxylin and Eosin—
see text).
1.—Young parasite, about 6 hours old, peripheral layer of cytoplasm
darkly stained, and nuclear chromophil granule marked.
2.—Older form, differentiation into peripheral and central portions disap-
pearing, pigment developed, chromophil granule has disappeared.
3.—Two parasites in one cell.
4.—Cytoplasm quite regularly stained, pigment uniformly distributed.
5.—Irregularly stained parasite, with unstained areas.
6 and 7.—Commencing formation of chromophil granules, and melanin grains
commencing to concentrate into coarser groups, previous to sporing.
8.—The same, more advanced.
9.—Nuclear points fully formed, cytoplasm still shows no segmentation.
10.—Segmentation commencing.
1 1 . — F o r m a t i o n o f s p o r e s c o m p l e t e .
PLATE I.
STAGES OF DEVELOPMENT OF QUARTAN PARASITE.
STAGES OF DEVELOPMENT OF TERTIAN PARASITE.
R e g . N o . 6 0 0 , S a n . , C o m r . , I n d i a . — A u g . 9 7 . — 2 5 0 .
L i t h o . , S . I . O . , C a l c u t t a .
Plate II.
A.—Stages in Development of Quotidian Parasite.
1, 2, 3.—Very young forms, actively amœboid, frequently (2 and 3) ring
shaped.
4.—Older, pigment developed ; red cell, small, dark and shrunken.
5.—About 24 hours, pigment in centre, segmentation commencing.
6.—Young crescentic body, pigment near one pole.
7.—Older crescent, with remains of red cell, and velum forming.
8 to 14.—Bodies of crescentic series.—8, fusiform with red pigment ; 9,
crescent with red pigment in centre and double contour ; 10 and
11, spherical with double contour, pigment in rings, and budding ;
12 and 13, spheres with double contour, and dark pigment massed
in centre ; 14, flagellated body.
15—.Leucocyte containing small parasite.
16.—Leucocyte containing melanin particles.
B.—Structure of Parasites of Malignant Remittent (stained with Hœmatoxylin
and Eosin,—see text).
1 to 4.—Young unpigmented parasites, with marked chromophil spot.
5.— Melanin commencing to be formed.
6.—Two parasites in same cell.
7 to 10.—A few hours older, vacuoled, pigment more developed.
11 to 15.—Adult forms ; pigment concentrated preparatory to sporing.
16.—Pale spherical body of crescentic series.
17.—Sporing form, with pigment in centre and marked chromophil body in
each spore.
18 to 22.—Crescents in red cells, which still stain with eosin.
23 to 30.—Various forms of crescentic bodies, uniformly stained.
31.—Melaniferous multinuclear leucocyte, stained with Ehrlich Biondi
fluid.
C.—Capillary from motor cortex of cerebrum, with contained parasite-bearing
red cells (stained with Acid Hæmatoxylin, differentiated and neutra-
lised).
D.—Cells from Red Marrow of Rib (Acid Hæmatoxylin and Eosin).
1.—Two young parasites in one hæmocyte.
2.— Mature sporing form.
3.—Sporulation commencing.
4.—Small body of crescentic series.
5.—Crescent.
6.—Nucleated red cell.
7.—Eosinophil leucocyte.
8.—Large phagocytic marrow cell.
E. —Cells from Splenic Pulp. (Acid Hæmatoxylin and Eosin).
1.—Small nucleated ring-shaped parasite.
2.—Older form, with melanin scattered through cytoplasm.
3.—Mature parasite.
4.—Crescent.
5.—Nucleated red cell.
6.—Melaniferous leucocyte.
7.—Melaniferous splenic macrophage.
F. —Section of Liver in Malignant Remittent Fever.
Shows irregular dilatation of hepatic capillaries ; nuclei and contour of
liver cells indistinct from cloudy swelling, and numerous melaniferous
cells lying in capillaries.
PLATE II.
QUOTIDIAN AND IRREGULAR FEVERS.
Reg. No. 600, San., Comr., India.—Aug. 97.—250.
Litho., S. I. O., Calcutta.
Plate III.
Fig. 1.—Section of coat of Ileum, stained with acid Hæmatoxylin and magni-
fied 35 diameters.
At ast h e m u c o s a i s s e e n t o b e d a r k a n d n e c r o s e d , w i t h i t s e p i t h e l i u m
completely shed; the submucous coat is densely infiltrated, intensely con-
gested and full of punctiform hæmorrhages ( b). The vessels are much
dilated ( d), and contain many melaniferous leucocytes. The muscular coat
( c ) is fairly normal.
Figs. 2 and 3 .—Sections of the same, stained by Weigert's method with aniline
methyl violet solution, 500 and 1,000 diams. respectively.
Shows general characters of bacillus which was present in large numbers
throughout intestine.
Photo-etching.
Survey of India Offices, Calcutta, December 1896.
PLATE III.
PHOTO-MICROGRAPHS OF SECTIONS OF SMALL INTESTINE IN CASE OF "PESHAWAR FEVER".
On the influence of variations of the ground-water level on
the prevalence of Malarial Fevers.
BY
SURGEON-CAPTAIN LEONARD ROGERS, M.B., B.S., LOND., F. R. C. S., ENG., I.M.S.
IN a paper read before the Calcutta Medical Society in January 1896,
I showed that the number of fresh cases of malarial fever in the men of the
11th Bengal Infantry rose and fell with the rise and fall of the ground-water level
of the lines in which they were living, to such a degree that the curve illus-
trating the four rises and falls of the ground-water, which occurred during
the course of the rains, was closely followed by the curve of the fever
prevalence. The two were practically parallel, and on two occasions a fall
of only seven inches, when the water was 16 and 8 feet respectively from
the surface of the ground, during three and four daily periods, was accom-
panied by falls of the fever to ½a n d 1 / 3
r e s p e c t i v e l y o f i t s r a t e d u r i n g t h e
preceding rises, facts which could only be explained on the supposition
that the infection was due to the inhalation of plasmodium malariœ which
had been carried up into the atmosphere by the displacement of ground air
by the rising water. The further fact that an examination of the blood of
76 consecutive cases of the fever, in each of which one specimen of blood
was examined with an oil emersion lens for an equal time, showed that the
organism was found in 50 per cent. of the cases which began during periods
when the ground-water was rising, but in just under 20 per cent. of those which
occurred when the water was falling, doubtless due to the parasite being present
in larger numbers in the former series of cases, (as an analysis of the symptoms
proved that all the cases were of the same nature), also supported very
strongly this explanation of the curves. In order to further test the question,
the figures of the monthly fever rate for the last ten years among the men
of the various regiments which were stationed in Doranda, together with the
monthly rainfall of the same period, were obtained, and the charts which
accompany this paper were worked out and have revealed several points of
interest which I propose to briefly point out in this communication.
The upper diagrams represent the monthly number of admissions for
fever in the several years, while underneath them will be found the monthly
rainfall. It will be seen at a glance that, with the exception of the year 1892,
the great bulk of the fever occurs in the rainy season, and a closer examination
shows that, although the rains nearly always begin in June, the fever does not
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increase to any marked extent until July. This is due to the fact that, at the
beginning of the rains, in this place, the ground-water is always from 35 to 40
feet from the surface of the ground, and, in the year 1895, was still 28 feet down
at the end of June in spite of almost to inches of rain having fallen during that
month. As soon, however, as there has been heavy rain in July on the top of that
of June, the fever begins to rise and continues to be prevalent as long as, or rather
longer than, the rain lasts, declining again in October, or even in September
in such years as the rains terminate early, as in 1891 and 1887, but going
on into November or December in years in which the rains continue later
than usual as in 1889 and 1893, in the latter of which there was very heavy
rain in September.
A further study shows that there are two main factors on which the
amount of fever in any given year depends. These are, firstly, the amount
of the rain, and, secondly, the regularity or irregularity of its distribution.
On these depend the height to which the ground water will rise and the
rapidity and amplitude of its variations of level; and, if my supposition that
the amount of fever in any given year in this place will depend on the amount
of displacement of the ground air, carrying up the organisms into the atmos-
phere, is correct, then the amount of fever should depend on the amount and
irregularity of the distribution of the rainfall. Let us see whether this is the
case or not.
If the years 1887 and 1892 be compared, it will be seen that the charts
of the rainfall show much the same character, inasmuch as there was no
very excessive fall in any month, but the fever rate was very high in the
former year, while there was practically no fever at all during the rains in the
latter. If, however, the quantity of rain be noted, it will be seen that in 1887
the rainfall was considerably in excess, amounting to over 70 inches, while in
1892 it was less than normal, being only 52 . 53 inches. The water must, then,
have risen much higher in the former year, It will also be noticed that
the rains began very early in 1887, namely in May, so that the ground-water
must have been very high during July and August, while, on the other hand,
the rains stopped early, and so the fever rapidly fell in September and October.
Again, if we compare 1892 with 1894, it will be seen that in the latter
year, not only was the rainfall in excess, but it was also unevenly distributed,
so that there was over 19 inches in both July and August. Here, then, we
have both factors well marked, and it is worthy of note that, in this year, the
fever is higher than any other year of the series, and that there was 12 times
as much fever this year as there was in 1892 ; and, if only that in the rainy
seasons be counted, which, for reasons which will appear later, gives the most
correct comparison, then it was 30 times as much. The practical absence of
fever in the rainy season of 1892 remains to be explained, as it is very extra-
56 Scientific Memoirs by
infections. The following explanation of the cold weather incidence of the
fever in Doranda supports this supposition.
If the charts be examined from year to year as one continuous record, it
will be found that the amount of fever in the early months of one year is, in the
majority of instances, in proportion to its prevalence during the rainy season
of the year before. Thus after the high rate of fever during the rains of 1887,
there was a correspondingly large amount in the early part of 1888, and on the
other hand, after the very low prevalence of fever in the rainy season of 1892
there was an equally low rate in the first half of 1893. There are, however, two
very marked exceptions to this rule, namely, when the comparatively slight
prevalence of 1888 was followed by a high cold weather rate in 1889, and when
the very high rate of 1894 was followed by very little fever early in 1895.
These instances form, however, a true case of the exceptions proving the rule,
for, in January of both 1889 and 1895 and also in 1892, the regiments were
changed, and as is shown in the accompanying table the fever in these, and also
in 1886 and 1892, was actually proportionate to the amount of fever that the
incoming regiments had had in the previous rainy season in other provinces.
Again, in the rains of 1895, just 25 per cent. of the men of the 11th B. I. suffered
from fever, that is 1 in every 4, yet of those who had fever in December 1895,
and January 1896 out of 22 cases, no less than 15 or very nearly 3/4 of them
had had fever in the previous rains, and several of them had had it two or three
times.
Regiment.
Reached Doranda.
Previous station.
Former fever rate.
Fiver first 6 month
i n D o r a n d a .
IX B. I.
January 1889.
Barrackpore and
Chittagong.
48o per 1,000
58 cases.
XII. B. I.
January 1892.
Benares
267·1 per 1,000
20 cases.
XI. B. I.
January 1895.
Bareilly.
116.3 per 1,000
9 cases.
It is also worth noting that two or three dry years in succession, as in 1889
to 1892, have a decreasingly small fever rate, while two wet years such as 1893,
1894 show a progressively high rate.
The above facts then prove that the great majority of the cases of fever
which occur in winter in Doranda are recurrences and not new infections, and
the whole yearly incidence of fevers here are easily explained on the theory that
I have advanced. That malarial fevers are commonly got through the inhalation
of air containing the organisms has of course long been known, especially in con-
nection with the drying up of marshy ground, but the above observations seem
to show that this is the usual mode of infection also in places on higher
Sc. Mem Part X.
Lith by A. C.Mukerjei.
DIAGRAM ILLUSTRATIVE OF FLUCTUATIONS IN THE LEVEL OF THE GROUND—WATER
AND IN PREVALENCE OF FEVER IN REGIMENTS IN DORANDA.
Report on the results of experiments on the action of various
reputed antidotes to Snake-venom conducted during the
season 1895-96.
BY
BRIGADE• SURGEON-LIEUTENANT-COLONEL D. D. CUNNINGHAM,
C.I.E., F.R.S.
As the most important of the experiments which have been conducted
during the course of the past season have been devoted to the investigation of
the efficacy of the so-called antivenenes of Calmette and Fraser, and the effects
following the habitual introduction of cobra-serum and of cobra and daboia-
venoms into the bodies of animals, it appears to be desirable to deal with them
in the first place and to leave the question of the action of various other
alleged remedies, which have been tested, to be briefly noticed in the conclusion
of this paper.
In testing the efficacy of the antivenenes, the instructions which are
issued along with them as remedies for cases of snake-bite were not precisely
followed, as they appear to be of a nature calculated to induce erroneous
conclusions in regard to the actual value of the materials as antidotes to
minimal or slightly supra-minimal doses of venom, such as those which were
employed in the greater number of the experiments. Calmette's instructions
include not merely the injection of antivenene away from the site of inocula-
tion of the venom, but also the introduction of relatively large quantities of
solutions of bleaching powder at and around the latter, and Professor Fraser's,
the application of ligatures above the site of inoculation and free incisions at and
around it. Now such recommendations are naturally most judicious in relation
to the treatment of cases of snake-bite, in which the great aim is to reduce
the amount of venom actually entering the system from lethal to sublethal
proportions by any available means, but if carried out in cases where the
object in view is to test the actual efficacy of antivenene and its power to
conflict with minimal and slightly supra-minimal lethal doses of venom,
they must necessarily serve as sources of error, because the subsidiary measures
alone are capable in many cases of reducing such doses to sublethal pro-
portions, and consequently, in cases where they are employed and recovery
follows, it must always remain uncertain how far the result can fairly be
ascribed to the antidotal property of the antivenene. This is at once evident
in regard to Calmette's subsidiary measures, when it is borne in mind that the
local application of solutions of bleaching powder to the sites of introduction
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of cobra-venom is in most cases sufficient to secure recovery after the admin-
istration of minimal lethal doses of the latter, even in instances in which
a considerable interval of time has elapsed between the period of inoculation
and that of treatment, and that, when the interval between the two periods
is brief enough, the treatment suffices to secure recovery even after the
administration of double minimal lethal doses of venom. Solutions of bleaching
powder have undoubtedly the power of reducing the lethal properties of any
cobra-venom with which they may come into direct contact, and hence
their local application in the site of inoculation is very likely to be followed
by recovery in cases in which the amount of venom introduced has not
exceeded a minimal lethal dose, or even a double minimal lethal one, so
long as the treatment is carried out before sufficient time has elapsed to allow
of any considerable absorptive removal of the venom from the site of inocu-
lation. In the case of minimal lethal doses, the treatment is likely to be
successful when applied at any time before the whole of the venom has been
absorbed : in that of supra-minimal lethal ones, it is likely to prove efficacious
when applied ere a sufficient period of time has elapsed to allow of the
absorption of a lethal quantity. The subsidiary measures recommended by
Fraser—ligature and free local incisons—must necessarily also tend to give
rise to confusion when introduced into experiments primarily intended to
test the actual antidotal property of antivenene, as the application . of ligatures
above the site of inoculation of the venom must tend to retard absorptive
removal of the latter, whilst free local incisions will favour its escape in
quantities which may well suffice to reduce a minimal or slightly supra-
minimal lethal dose to a sublethal one. Taking these considerations into
account, the procedure adopted in carrying out most of the following experi-
ments consisted simply in the introduction of minimal or slightly supra-
minimal lethal doses of venom of ascertained toxic property and the ante-
cedent, coincident or subsequent inoculation of various quantities of anti-
venene.
As an additional precaution against the introduction of sources of error
in estimating the antidotal value of the remedy, except in the case of certain
of the experiments especially devoted to testing the duration of the protection
afforded by antivenene, animals, which survived treatment with venom under
the influence of the remedy, were not again made the subject of experiment with
venom of the same nature. It would, of course, have been unnecessary to adopt
such a precaution had it been clearly proved that the protective and curative
property of antivenene is dependent on its exerting a direct chemical action on
the venom, by means of which it deprives it not only of its toxic property, but
also of its power of inducing a reactive, systemic elaboration of antivenene.
But, so long as the precise rôle which the antidote plays in effecting protection
Medical Officers of the Army of India.
61
and cure remains undetermined, it is clear that a possible source of error in
the exact interpretation of results must necessarily be present in all cases
where an animal is made the subject of repeated experiments. The access of
venom to the system in non-lethal doses certainly induces a reactive elabora-
tion of antivenene in the system ; so that, unless the administration of
extraneous antivenene entirely suppresses such elaboration, the results in any
one of a series of repeated experiments on one animal must necessarily be
affected by the systemic manufacture of antivenene attending all the preced-
ing ones, and hence any curative or protective results which may manifest
themselves cannot be wholly credited to the treatment with the extraneous
antivenene. It is possible to convert normally lethal doses of venom into
sublethal ones by means of treatment with antivenene, but it certainly does
not necessarily follow that any corresponding reduction should take place in
the systemic manufacture of antivenene normally attending the access of an
amount of venom equivalent to that of which the toxic property has been
reduced ; or, in other words, antivenene may give us a short cut in establishing
immunity by repeated treatment with venom.
A.—Results of experiments on the action of Professor Fraser's
Antivenene.
The samples of the remedy which were employed were derived from a
supply of antivenene sent out to this country through the India Office by
Professor Fraser, which arrived in Calcutta in November 1895. As it
included specimens of both the liquid and the dry preparations, the experiments
naturally fall into two series, according as they deal with the former or the
latter.
I.—RESULTS OF EXPERIMENTS ON THE ACTION OF LIQUID
ANTIVENENE AS AN ANTIDOTE TO COBRA-VENOM.
(a) EXPERIMENT IN WHICH COBRA-VENOM WAS DISSOLVED IN THE
ANTIVENENE.
Experiment I.—A fowl received an injection of 0.00075 gramme (an
amount equivalent to a minimal lethal dose of the stock of venom employed)
of dried cobra-venom dissolved in 1 C.C. of liquid antivenene. About two hours
later it became very dull, and remained so for some hours. No further symp-
toms of intoxication, however, appeared, and on the following day it was quite
well.