NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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The several links in the above chain of identifications seem nearly equally
strong and connected; for observers have been competent, and in itself the
hmatozoon is peculiar enough to be readily recognised, having in each of
the instances quoted preserved a similarity of form, dimensions, structure
and movements which seems never to have surpassed the limits of a possible
normal or incidental variation. In both rodent and equines the numbers
visible at a time, their relation to the ordinary blood elements, changes on
keeping and behaviour with re-agents, have been also practically identical;
the entire evidence being as valid as that commonly accepted when widely-
separated observations are inter-compared. I doubt, indeed, if by simple
inspection the infected rat's blood could be distinguished certainly from
that of the "surra" mule, dog, or monkey. This is not to affirm that
no visible differences actually exist, but that in each instance characteristics
have been maintained amidst differences not more frequent or considerable
than might be anticipated from the varying conditions of observation.
Secondly, as to biological aspects. The vital properties of the blood-para-
site as concerns the organism itself will be alluded to under the next heading;
and respecting its influence upon the state of the infected hosts, both rodent
and equine, the following remarks are offered. As regards rats, the testi-
mony of Lewis and Crookshank has been concurrent with my own experi-
ence narrated above, being to the effect that the health of the infested rodent
does not seem impaired either generally or specially, as contrasted with that of
other captured rats whose blood was free from visible contamination. I further
ascertained that no alterations of temperature occurred with the presence, sud-
den disappearance, and absence of the hæmatozoon. Apart from the general
nutrition, no special function seemed disturbed; and at autopsies no particular
organic lesion was noted. When infested rats died spontaneously, it was
not differently or more obscurely than happened in the case of the non-infected
similarly deceasing. On the other hand, the entire history of any individual
not being known, it was not certain that a true normal standard of comparison
had been available: moreover, the first entry of the parasites into the blood was
never witnessed, and the influence of repeated infection was not learnt; in such
small animals blood-observations were necessarily limited in number and volume,
and much may have been overlooked: moreover, as to sickness and decease,
the inevitable daily manipulations and punctures, added to injuries inflicted
during capture, constraint, and change of diet, would of themselves cause a dis-
turbance of the system possibly interfering with a correct diagnosis; and, in
sum, I was not disposed to regard my own results as final.
In his comment on the infested hamster, Dr. Koch, noting the occurrence
of spontaneous sickness and death, with on autopsy no lesion in explanation,
insists rather upon the contaminated state of the blood; nothing, however, is
Medical Officers of the Army of India.
61
said of comparison with non-infected animals dying in confinement, or of experi
-mental inoculations. Results being so far negative, there is next to state that
mere obscurity of symptoms and lesion does not preclude the possible existence
of a veritable blood-poisoning; the biological proof of which would be the
artificial infection of a healthy animal of the same or near species. As regards
healthy rats, according to my experiments these did not suffer by inoculation with
the tainted rat-blood hypodermically made; nor did cats, dogs, or monkeys; nor did
the rabbit inoculated through the peritoneal sac; nor the horse as tested by
Mr. Steel in both these methods and also by intra-venous injections. In not
one of these instances was there any communication to the healthy animal of
either visible or occult blood-contamination, as proved by the unaffected gene
-ral state of the recipient and by the absence in its blood of an organism
like the rat's hæmatozoon. Here the last of my experiments on the monkey
by intra-peritoneal injection possesses a special significance, since it demon
-strated that the hæmatozoon which seems innocuous to the rat is also harmless
to the monkey, so far as may be judged from a single datum carefully acquired.
Adverting now to the biological properties of the same blood-parasite as
manifested amongst equine animals (also the camel), and in the dog and
monkey when inoculated from equines, a notable difference becomes apparent.
Thus it has been found by Dr. Evans and Mr. Steel (and since by Mr. Gunn,
A.V.D. ) that in the horse and mule the presence of this hæmatozoon is con
-stantly and exclusively accompanied by a serious general disorder which in
its symptoms is more or less protracted and emaciating, at intervals febrile,
icteric and hæmorrhagic, intractable by remedies, and in its termination
fatal, without the production of any strictly pathognomonic lesion excepting
that of the blood. Observers agree that this malady is not contagious or infec
-tious in the ordinary sense: naturally occurring it is endemic, seasonal
and limited, so far as appears, to the horse, mule, and camel; it may prevail,
extensively, and has been popularly recognised by various names, of which
"surra" is one, that of "equine relapsing fever" being a designation proposed by
my friend Mr. Steel (see below). From the statements made it follows
that the disease is a general one, not less characteristic in its symptoms than
in its visible blood-contamination; and though not naturally communicated by
contact or proximity, both these features may, I next note, be artificially
reproduced by inoculation of the infected blood hypodermically and otherwise
in other healthy animals. On this point the data are concisely as follows:—-
Dr. Evans' transmission of the disease to the horse by subcutaneous injection (2)
and through the stomach (2), to the dog by subcutaneous injection (1) and
through either mother's milk or stomach (1 experiment): Mr. Steel's transmis
-sion to the mule (several times) and pony (1) subcutaneously and by stomach,
to the dog subcutaneously (1) and to the monkey also (1). To this
Medical Officers of the Army of India.
63
after an interval of 4 days; and subsequently other febrile recurrences (parasites
seen after a month) with emaciation and debility, feebleness in the limbs, ulcers,
and necrosis of the bones of the feet, and final exhaustion upwards of two
months after inoculation: at the autopsy no marked positive changes, only some
petechiæ on surface of lungs. This animal was brought from Rangoon to
Madras during its illness, and may have suffered, as monkeys often do, from
confinement and the voyage: its temperature chart for 30 days is given by Mr.
Steel, blood-scrutinies being made for 13 days in succession at first and again
later on.
Some other inferences from the records, as they stand, are the following:—-
Incubation period after inoculation, varied as to the subject, being in the
horse 4—6 days, in the mule 4—10 days, in the dog 11 or 12 days, in the monkey
about 3 days; also varied as to the method of infection, being shortest after
intra-venous injection and subcutaneous inoculation, and somewhat delayed
after simple ingestion of the tainted blood given in quantity. Sometimes a
depression of temperature occurred during this period. A local swelling might or
might not follow the hypodermic operation. There was one successful infec
-tion of a mule with blood taken from a mule naturally diseased, but not
at the time of experiment showing the parasite in its fresh state: organisms
appeared in the subject on the 10th day, along with pyrexia high and
intermitting, and subsequently death on the 40th day. Mr. Steel thinks it pos
-sible that in stained preparations of the inoculating material some evidence of
the presence of the hæmatozoon might have been seen. Dr. Evans found that
when the tainted horse-blood was freely diluted with water, the organisms had
disappeared after 24 hours, and this mixture proved inocuous to two healthy
horses when administered by mouth: and Mr. Steel ascertained that thoroughly-
dried tainted mule's blood was inoperative on inoculation. A fatal result seems
always to have ensued in watched animals,—amongst equines in 5—7 weeks: a
dog lived 7½ weeks; a monkey over two months: the post-mortem appearances
being occasionally recorded as not essentially peculiar. Second or successive
series of inoculations from the first individual were not apparently attempted.
Mr. Steel's essays include an unsuccessful administration of gastric and intestinal
contents of tainted mule per mouth to a healthy animal. Also unsuccessful
inoculation-experiments (three) on an Amrut bullock, old and emaciated: and
similar unsuccessful inoculations on a young goat (three), the animal becoming,
however, much emaciated, in spite of good feeding and voracious appetite, after
the last essay.
The last part of my Notes refers to the probable nature and analogues of this
blood-parasite and to the character and affinities of the equine "surra" disease.
As regards the hæmatozoon, minute elongated bodies, of simple homo-
geneous structure and provided with cilia or a flagellum, might, I suppose, be
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probably also a distinct "seasonal'' variation of prevalence. Strict search on the
lines now indicated seems to me promising as regards detection of the source
or sources of these infections.
An external origin of the parasite, direct or mediate, being in high degree
probable, regarding its mode of entry into the circulation, the successful experi
-ments of Veterinary Officers proving that the "surra" infection is directly commu
-nicable by way of the stomach, have an obvious practical bearing; and so, too,
the equally prompt success of hypodermic inoculation, which shows the suffi
-ciency of minute wounds of the skin and, presumedly, of the mucous membranes
generally, as a favouring local condition. The apparent absence of conveyance
of the same morbid state through mere skin-contact, and through air-infection
by way of the respiratory tract, should also be considered. It is not known if
rats inhabiting the stables of infected horses or mules are primarily or specially
affected; but Mr. Steel's negative experiments, quoted above, would tend to
show that equines did not derive their disease from the bite of tainted rodents.
The hæmatozoon of the rat seems more difficult of communication than the
"surra" monad, yet I have shown that it or its germs may be introduced into the
circulation, e.g. , of the monkey, by way of the peritoneal lymph-sac; my own
impression from the data (see above)being that a certain limited development
had taken place in the monkey's blood, though this is uncertain since entire
blood-discs, while preserving their vital properties, can pass freely along the
same lymph-channel (Dr. W. Murray in the Brit. Med. Jour., 29th Jan. 1887), and
such are broader and less mobile structures than the full-grown parasite in ques
-tion. Another conjecture arose from my finding in some rats, at the lower part
of the ileum, many active monads apparently identical with species of Cercomo
-nas, and in the duodenum amidst bile-stained mucus, numerous larger ones
resembling Trichomonas sp. , whose proximity to the common bile-duct
suggested the possibility of entry into the liver. (where C. has been met with),
and thence into the circulation. As it happened there were no organisms in the
blood of these rats, further remarks would be merely speculative; and I need
only add that the concurrence of extraneous, intestinal, and blood monads, with
a conceivable connection of the series, inter se, forms a topic analogous to that
of such bacterial infection as the "spirillar" of human relapsing fever elsewhere
alluded to by me.
Equally cursory in the scarcity of relevant facts must be any comment on
the growth and reproduction of this hœmatozoon. The parasitic habit might be
expected to modify these processes, as it does mere structure. Accsording to
Leuckart the flagellate monads commonly are reproduced by division (longitudi
-nally), or by conjugation, encystation, and the formation of countless spores
possessed of much tenacity of life; and in individual cases there has been seen
a quiescent state leading to the production of abundant minute swarm-spores.
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showed traces of the parasitic organisms. Analogous hereto was the failure at
my hands of dried spirillum-blood to infect, although traces of that bacterium
could be seen in the material used; and this circumstance induces me to remark,
briefly, that the conditions of infection must really be complex, since three
separate factors are necessarily concerned, namely, (1) a certain state of the in
-fecting agent, (2) a certain mode of transmission, and (3) a certain state of
recipient or new host.
The final topic I propose to glance at is the character and affinities of
the equine disease which is associated with the hæmatozoon under review. The
excellent descriptions published of "surra" as prevalent at the E. and W.
extremes of India, do not differ more than might be anticipated from innate
variability and incidental circumstance. From them it may be gathered that
here is a sub-acute, febrile and usually fatal malady; presenting no other special
lesion than that of the blood, arising endemically and not spreading by con
-tagion or infection; commonest during and after the rainy season, with no other
particular relation to atmospheric states or to the soil: in a given locality the
distribution of disease may be irregular, and the outbreaks do not seem to last
longer than a few seasons at a time, sporadic cases probably persisting or being
introduced afresh. The entire clinical history is not fully known, on account of
the non-continuous course of symptoms: at first were noticed fever, with jaun
-dice, petechiæ of visible mucous membranes (eye and vagina), anasarca, some
-times albuminuria, always great prostration of strength and rapid wasting; death
by exhaustion alone at the end of a few weeks; and at autopsy so specific coarse
lesion seen (Evans). Afterwards it was clearly made out that the pyrexia
assumes the form of pronounced (max. t. 105°-7° F.) and well-defined exacerba
-tions of 2—7 days' duration, which are separated by apyretic intervals lasting
about as long—the first incubation-period experimentally learnt being 4—7 days;
and it is only during these successive "relapses" that the hepatic derangements
and blood extravasations become prominent; thrombosis and embolisms may
occur: anœmia is very marked (Steel). The duration of the disease, so far
as ascertained, varies from about 2 months to perhaps a year; a long latency
of the malady seems improbable (Evans) artificially induced disease may
end acutely in 21 days or in a month or so (Steel). There are clinical
modifications which need not be discussed here; antecedents and sequelæ
are not fully made out. The mortality-rate is extremely high, recoveries being
apparently unknown. Anatomical lesions seem to be connected with the morbid
blood-state, and include localised hyperæmias of the intestinal mucosa, in
the stomach sometimes stasis and sphacelus; petechial extravasations; serous and
gelatinoid effusions in lymphatic areas, with occasional glandular intumescence:
granular and fatty degeneration of solid tissues. The diagnosis of this disease
is wholly due to the labour of sagacious experts; by means of the thermometer
Scientific Memoirs by Medical Officers of the Army of India.
form of those so laboriously acquired for " anthrax ;" and as for encouragement
to work in India, it seems to me hard to conceive a more promising field of re-
search than the one which has been the subject of the present remarks.
NOTE.—Respecting the aspect of blood and bacillus of animals inoculated with the attenu-
ated anthrax-virus, I have not met with definite statements : if the organism can be seen to
flourish in the blood, whilst producing no other than an occult effect, then the analogy and
comparison with the monad-data would be complete : such completeness is not, however,
essential to the argument above. It seems that reduction of the virulence of anthrax by
transmission through different species of animals is not yet a realised notion ; but as by
successive inoculations an attenuated bacillus can be raised to full strength, possibly the
monad-virus has undergone such augmentation from its lower to highest degrees. Lastly,
in employing analogy riot against facts so much as in their explanation, no canon of
science has been violated ; and it is generally admitted that the verified anthrax-data have
a bearing far beyond the range of the single subject to which they pertain.
78
Observations on Bacteria in Cholera.
BY
SURGEON-MAJOR G. BOMFORD, M.D.,
BENGAL MEDICAL SERVICE.
(With Plates VII and VIII.)
The following is a brief statement of the results of microscopical examin-
ation of the tissues in nine cases of cholera, which have died at the the General
Hospital, Calcutta, during the past twelve months (June 1886 to June 1887),
showing, in each case, the duration of illness, the stage the disease had reached,
the tissues examined, and the bacteria, if any, found. The patients were all
adult European seamen, and the post-mortem examination was made in less than
an hour after death in every case.
CASE I.—Duration-23 hours. Stage—collapse. Tissues examined—medulla oblongata
kidney and ileum. A few streptococci, generally distributed throughout
the kidney amongst the blood corpuscles in the vessels and extravasa-
tions (Fig. 8). No bacteria elsewhere.
CASE 2.—Duration—about 48 hours. Stage—collapse, but secretion of urine restored.
Two portions of the ileum examined, but they contained no bacteria in
their substance.
CASE 3.—Duration—64 hours. Stage—secondary fever, and urine restored. Kidney
and ileum examined. No bacteria.
CASE 4.—Duration-22 hours. Stage—collapse with suppression of urine. Tissues
examined—ileum, kidney, liver, and spleen. Large curved bacilli were
abundant both within and without the crypts of Licberkuhn and in the
adenoid tissue surrounding them. A few also below the muscular is
mucosæ (Fig. I). No bacteria in the other tissues.
CASE 5.—Duration—69 hours. Stage—collapse and urine suppressed. Tissues ex-
amined—kidney, lung, ileum, and colon. There were abundant small
curved bacilli, more or less mixed with straight bacilli and micrococci,
in the crypts of the ileum, but none outside the crypts or in the adenoid
tissue (Figs. 2, 3, and 4). A few micrococci in the blood vessels of the
submucous tissue. Large, very slender, filiform bacilli in a congested
patch in the colon (Fig. 6). Streptococci in the vessels and amongst
pus corpuscles in the air cells of the lung (Fig. 7). No bacteria in the
kidney.
CASE 6.—Duration—150 hours. Stage—secondary fever, but urine not restored.
Tissues examined—stomach, supra-renal capsule, kidney, spleen, and
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medulla oblongata. In a congested patch in the stomach there were
abundant short straight bacilli, many of which presented deeply stained
spots (spores ?) in their interior. No bacteria in the other tissues.
CASE 7.—Duration—28 hours. Stage—collapse. Tissues examined—kidney and
ileum. No bacteria.
CASE 8.—Duration—206 hours. Stage—secondary fever with delirium, urine restored.
Ulcers of the stomach only examined. Abundant straight bacilli, pre-
senting deeply stained spots, or spores, in their interior, on the surface,
and in the depth, of the ulcers and the mucous membrane surrounding
them (Figs. 9 and 10).
CASE 9.—Duration—155 hours. Stage—secondary fever, urine restored. Tissues
examined—vermiform appendix and purulent focus in the lung. Nu-
merous spirilla in the crypts at the root of the appendix (Fig. 5), and
micrococci in the lung.
From this statement it will be seen that some portion of the intestines
was examined in seven cases, and that in four of these no bacteria were
found in the substance of the mucous membrane. In the three other cases
bacteria were present in the depth of the mucous membrane, but they differed
remarkably in character or distribution in each case (Fig. I). In No. 4 of the
table the bacilli were of large size, distinctly curved, and abundant, not only in
the interior of the crypts of Licberkuhn, but also on their exterior surface, and
in the adenoid tissue surrounding them. They had also penetrated in many
places below the muscularis mucosa into the sub-mucous tissue. In No. 5 the
bacilli were smaller and more curved, and in portions of the ileum from the
neighbourhood of the ileo-cacal valve they were very abundant throughout the
whole length of the cavity of the crypts, but there were none on the exterior of
the crypts or in the adenoid tissue (Fig. 2). In the spaces between the villi and
on their free surfaces, as also, in most cases, just within the mouth of the crypt,
the curved bacilli were more or less mixed with micrococci and minute straight
forms, but in the deeper parts of the cavity they were almost pure (Figs. 3 and
4). In the vessels of the sub-mucous tissue there were a few minute micrococci.
In the colon of the same case there were several slightly raised, smooth, deeply
congested patches, in which the microscope showed the crypts had been com-
pletely destroyed and the whole depth of the mucous membrane infiltrated with
leucocytes, blood-corpuscles, and peculiar filiform bacilli which were very
numerous and penetrated down to the muscularis mucosæ, but not below it.
These were very long and narrow, tapering to a fine point at either end, and
stained faintly and unevenly along their length, so that they presented an irre-
gular beaded appearance (Fig. 6). They have some resemblance to forms des-
cribed by writers as involuted cholera bacilli In No. 9 only the vermiform
appendix was examined, but in the crypts at its attached end there were numer-
ous spirilla as well as detached curved bacilli (Fig. 5).