NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
156
Scientific Memoirs by
not only displays wider polymorphic aspects, but also maintains a relationship
to symptoms so indirect as to render its significance both restricted and pecu--
liar, as compared with other infecting-organisms of either acute fever ( e.g., the
spirillum) or chronic disease (bacillus). It is unfortunate, so to speak, that in
malarious disorders some febrile periods should prove dubious in their blood-
signs ; since a valid test was needed for analysis of a common fever-type here,
sometimes called the “typho-malarial.” My experience, hitherto, is conveyed
in the two lists above (p. 140) : and Dr. Laveran states that he found the
microbe of paludism disappear with onset of a ‘typhoid’ complication, at its
close re-appearing with the return of ague : doubtless prolonged research is
needed, and will be made. Regarding the blood-manifestations of a primary
malarial infection, enquiry at Bombay was not practicable ; in Algeria Dr.
Laveran found the microbe identical at both first and recurring attacks of
ague : information is required regarding changes in the red blood-corpuscles,
at first.
Subsequently, it is conceivable that, with infection for a time latent and
quiescent, no other sign might be available than some lasting visceral lesion
earlier arising, and it is true that at Bombay the microscrope frequently failed
to supplement the ordinary means of diagnosis ; yet upon review, I think it
probable such failure was incidental, and that an infection not abrogated will
always be detectible through its attendant blood-changes. In practice, positive
aids to diagnosis were as follows:—( a. ) Free pigmented organisms; namely,
spherules bare or flagellate, and the crescents : both these forms being patho-
gnomonic, a single parasite of either, once detected, becomes decisive evidence
of a malariou staint, whatever the attendant symptoms. Yet with such taint,
no fixed elation appears of form of organism with kind of symptom ; and free
organisms were absent in my cases at apyretic intervals (No. I), and even during
some intercurrent paroxysms (No. 3), no quinine being yet given : hence their
non-detection, under some conditions, has no absolute clinical significance.
Absence may be difficult to prove, and as yet the elements of certainty are
wanting. The minuter pigmented plasma-particles which were probably inci--
pient organisms, did not occur alone.—( b. ) Altered blood-corpuscles.I .
Red-
discs displaying on their surface one or more pallid, pigmented spots, moving
and growing, are decisive affirmative evidence, and were seen in case 1 (pre-
febrile), and case 7 (post-febrile period), along with free parasites. It is stated
that they may occur alone, as sole sign of infection ; being the nregarded, in
even scanty numbers, as valid testimony : and according to some European
authorities, they are constant enough to serve as a means of diagnosis of actual
malarial agency. These data have seemed, at Bombay, to need some qualifica--
tion, a full verification at least not being attained. Red-discs thus altered appear
to represent an early stage of the free organisms, but may not be traceable
Medical Officers of the Army of India. 161
bolic bye-products of the parasites. Phagocytes did not, for some hours at
least, seem at all inconvenienced by the spherules they so eagerly engulfed, even
when flagellated.
A correct identification of the ague-organism is desirable, if only as a clue
to its detection outside the human body, and thereby readier eradication from
the environs of dwellings. Of late it has been successively termed an alga, a
fungus, sporozoon, and infusorium ; if rightly the latter, water or a liquid medi--
um would obviously be needed for its growth and would serve for common
vehicle ; in the state of sporo-cyst desication might be survived, and convey--
ance by dry air-currents : dissemination by evaporation would be unlikely, less so
transit in solid vapour-particles. Hitherto, the organism has not been recognised
outside the human body ; yet, being highly polymorphic, it might need to pass
some stage of development in the exterior, possibly in certain soils or in stag--
nant water, under the influence of free organic nutriment, heat, and moisture.
Contagia from without enter the frame by various channels, and, multiplying, are
dispersed by lymph or blood-channels ; so operating, possibly other organisms
besides cocci and germs or spores, as bacilli through ingesta and by way of lymph-
follicles in the mucosa of the ileum. Expanding such notion, even infusoria
from without, common and innocuous in the intestinal canal and ducts, might
under modifying circumstances find a passage into the circulation and there
display a certain virulence. And not to speculate further, it seems to me that
the efficacy of measures for the removal or prevention of ‘malaria’ and the
avoidance of infection, as ordinarily practised, is rendered not less intelligible
than before but more so, by the demonstration in ‘ague’ of a seemingly patho--
genic hæmatozoon, morphologically allied to organisms which exteriorly flourish
under mal-hygienic conditions remediable by drainage, cleanliness and ventila--
tion. Elementary animal forms abounding far less than rudimentary plants,
amongst them the pathogenetic species (always exceptional) must be compara--
tively very rare ; their effects on man and equines ( e.g. ) being, however, not
dissimilar to those of some bacterial infections, as regards general features of
persistency and latency, with a tendency to periodic exacerbations under excit--
ing conditions alone as yet controllable therapeutically.
( b ) Doubtless, the malarial infection maintains the same inclusive charac--
ters in both East and West ; but whilst in Europe the discrimination of other
concurrent infections has freely advanced, in India there holds still the concep--
tion of malaria as a well-nigh sole and universal cause of fever and cachexia.
Upon review of my data, comparative and actual, I note that the manifestations
Of malaria are marked by a long intermitting persistence, with a localisation
limited and but little irritative : thereby differing severally from those of typhus,
typhoid and spirillar amongst the acute, and from tuberculosis, syphilis, and
leprosis amongst the chronic infections of man. Protozoic human blood-
162 Scientific Memoirs by
contaminations being hitherto unknown, it has been impossible to conjecture
how such might differ in detail from the bacterial. A hematoid (filarial) blood-
contamination shows, indeed, the tendency to persist with exacerbating intervals,
but its nature and parasitism are essentially diverse ; and a fit comparison can
be made only with the trichomonous infection of equines, described elsewhere
as being attended with wasting, recurrent pyrexia, and occasional lesion limited
to the vascular area proper. Study of the spirillum fever led me to remark
that that pyrexial symptoms, clinically insisted on, are really more contingent
than the visible blood-state ; and this statement will apply, upon evidence sub-
-mitted, even more forcibly, to the malarial disease. The datum seems, indeed,
to be comprehensive, and accordingly ‘ague’ may be defined as a zooic blood-
contamination prope cum febre : pyrexial events, however prominent, being but
subordinate incidents, whose conditions of occurrence become the proper sub-
ject of curative medicine : biology here blending, as it were, with pathology
and therapeutics.
In the absence of autopsies, I have no fresh information respecting the
fundamental splenic and hepatic lesions of the malarial infection : from other
sources (vide Note above, p. 152) it appears that pigmented organisms, free
and involved within phagocytes, accumulate in the organs named ; and their
power of reproduction persisting, thence a source of future growths and clinical
manifestations. Such accumulation seems to be a special febrile concomitant,
attended with vascular and changes clinically detectible : for at
non-febrile periods organisms visibly abounded in the blood for days, without
the abdominal organs being unusually swollen or tender. Particular implication,
in ague, of the spleen and liver, may be due mainly to their office in the forma-
tion and destruction of blood-corpuscles, which here are the peculiar site of
parasitic infection : yet it is noteworthy that the lymphatic system of glands,
even the bronchial, is not simultaneously excited ; and hence a question if entry
of the infecting agent by the prima via and portal venous apparatus be not
also indicated here (and in some other acute infections) by such predominant
irritation of certain abdominal organs.
The production, in ague, of dark pigment seems indicative, not only of a
special character of the hæmatozoa, but also of a concurrent metabolism
extrinsic to them. Within organisms, the minute pigment-particles appear
very early, and move and multiply so quickly as almost to suggest their living
nature : enlarging somewhat, their regular form is maintained with an activity
more evidently imparted ; and thence in ordinary cases, no more is seen than
the ready disappearance of pigment along with other marks of blood-contami-
nation. But in severe attacks the formation of ‘melanine’ is so copious as to
lead to the production of comparatively large, opaque, irregular or angular (or
quasi-crystalline) masses, which impart a striking aspect to the leucocyte or
Medical Officers of the Army of India.
163
spleen-pulp cell in which they are imbedded. Such masses were so seldom seen
free that their formation in the liquor sanguinis appeared doubtful ; and I
considered it more likely that such densely pigmented cells belong to the spleen,
from thence entering the circulation where their presence may, it is held, lead to
embolisms of serious or even fatal degree. It appeared to me physically impos-
sible that these large pigment-clumps were formed by aggregation of particles
derived from dead parasites ; and I inferred that even if, as they seem, they be
of the same material, their origin was a common and concurrent one from
hæmoglobin : in the spleen each of such pulp-cells taking up and destroying
numerous infected red blood-corpuscles. The data now mentioned are worthy of
note, and they also serve to confirm the opinion expressed above, that the col-
lateral events of visible infection, co-temporarily occurring, may be of chiefest
clinical import.
Secondary fever.—The spirillar investigation (Work, pp. 171 and 420) led
m e to recognise pyrexial states following closely on the specific, and similar
enough to permit of confusion, which are yet distinct in not presenting the same
visible blood-infection ; and I considered such consecutive, residual or sequelar
pyrexia to be the effect of secondary quasi-septic contamination, or possibly of
a re-action of the nervous system. Demonstrated so far for the typical spirillar,
secondary events of this kind may be usual in other infections ; and in the
malarial, they appear to be represented by the so-called amphibolic stage of
ague, long since noted by Wunderlich and his English commentators. At the
native hospitals here, confirmed malarious subjects are seen presenting smart,
yet not distressing febrile paroxysms, samples of which in my hands seemed
unattended with pigmented blood-organisms, and therefore were regarded as of
such secondary character : care being, however, needed to distinguish them
from negative intercurrent paroxysms in the visibly infected, such as witnessed
in case No. 3. How far the more prolonged fever of equally idiopathic aspect,
which is often seen in malarious subjects, can be viewed as of this secondary,
or sequelar, character remains for the present undecided ; the spleen may be
moderately involved, but the blood contains no pigment organisms ; and quinine
has no peculiar efficacy; signs of enteric fever are absent. This class of cases
represent one form of the so-called ‘malarial remittents,’ which amongst natives
take the place of ‘continued fevers,’ so-termed in rather antiquated phrase ; and,
upon review, the data at my disposal indicate that in such cases the absence of
visible dotted parasites is not warrant enough to negative an antecedent con-
nection, at least with genuine malarial infection.
Medical Officers of the Army of India.
167
if not in favour of the prior indigenous name of “Marsh” poison, at least of a designation
referring to definite conditions of soil, moisture, and water-supply. Not long since, the
late sagacious Professor of Military Medicine at Netley wrote respecting the new re
-searches in Europe, as follows : ‘Should future investigations by independent observers in
other malarious regions confirm these conclusions, it would be difficult to over-rate their
importance’ (Maclean in QUAINE’S DICTIONARY, Part II, p. 914) ; and now it may be seen
how far, as regards India, such confirmation has been realised.
Government of India Central Printing Office.—No. 1 S. C.—5-3-88.—270.
Description of Plate.
PLATE I.—SCHIZOMYCETES, MYCOIDEA, AND NYMPHÆA BLIGHT.
FIG. 1. Organisms in the blood of a horse x 680.
„
2. Spirillar variety of choleraic comma-bacilli x 1270.
„
3. Blighted leaf of Nymphæa stellata. Nat. size.
„
4. Vertical section through a portion of a leaf of Cinnamomum iners affected
by Mycoidea x 190.
„
5. Leaf of Cinnamomum iners viewed from above, showing a patch affected by
Mycoidea. Nat. size.
,,
6. Same leaf from below. Nat. size.
„
7. Vertical section through a patch affected by Mycoidea, showing algal cells extend-
ing from the superior, subepidermal thallus through the greater part of the
thickness of the leaf x 360.
, ,
8. Portion of the same section, showing superior subepidermal thallus and an emer-
gent filament x 360.
„
9 . Portion of the same section showing a mass of algal cells projecting deeply into
the tissue of the under-surface of the leaf and giving off emergent filaments
x 360.
Lithographed at the Survey of India Offices, Calcutta, May 1887.
1
Lithographed at the Survey of India Offices, Calcutta, May 1887.
Description of Plate.
PLATE II.—A NEW GENUS BELONGING TO THE FAMILY
USTILAGINEÆ.
FIG. 1. Vertical section of a leaf of Nymphæa stellata showing spores in substomatic
spaces x 360.
„ 2. Section through the entire thickness of a leaf showing distribution of spores
x 119.
, ,
3. Section through the upper part of a healthy leaf, showing large substomatic space
x 360.
„ 4. Fine mycelium giving origin to thicker fertile filaments bearing young spores
x 680.
„ 5. Vertical section through entire thickness of a healthy leaf of Nymphæa stellata
showing subepidermal spaces, great spaces over the inferior epidermis and
idioblasts x 119.
„ 6. Fine mycelial filaments with simple haustoria and thicker sporiferous hyphæ.
„ 7. Head of a promycelial filament with sporidiiferous cells.
„ 8. Germinating spore still connected with the Mycelium x 970.
„ 9. Spore with promycelium.
„ 10. Sporiferous filaments and spores in various stages of development x 970.
„ 11. Conjugating pair of sporidia x 970.
„ 12. Sporidia bearing secondary sporidia, and still attached to the promycelium.
„ 13. Spore, promycelium, and conjugating sporidia.
„ 14. Conjugating sporidia.
„ 15. Portion of epidermis with promycelia emerging from the stomata x 680.
„ 16. Terminal portions of promycelium showing septation and sterigmata.
11
Lithographed at the Survey of India Offices, Calcutta, May 1887.
Description of Plate.
PLATE III.— NEW GENUS OF ENTOPHYTIC
FIG. 1. A leaf of Limnanthemum indicum affected by the alga. Nat. size.
„ 2. Portion of one of the algal patches x 190.
„ 3. Two young algal cells seen through the epidermis x 360.
„ 4. Vertical section through the upper part of a normal leaf x 360.
„ 5. Vertical section through the upper part of a leaf containing algal cells x 360.
,, 6. Portion of subepidermal palisade tissue containing two resting algal cells x 360.
„ 7. Free resting cell from sediment of water containing affected leaves x 360.
, , 8. Young zoosporangium with multinucleate protoplasm x 680.
„ 9. Free zoospore x 970.
„ 10. Zoosporangium with retained zoospores x 680.
„ 11. Conjugation of zoospores x 970.
Lithograpbed at the Survey of India Offices, Calcutta, May 1887.
Description of Plate VI.
FIG. i. Flower of Wrightia coccinea.
„ 2. The same showing fly entrapped.
„ 3. Stamen enlarged showing the "wings". (a) Inner surface, (b) Outer surface.
„ 4, The " trap " formed by the stamen's perianth cut away.
„ 5. The same, two of the stamens removed, to show the interior of the cone.
„ 6. Diagram to show the adaptation of the wings (horizontal section).
PLATE V I.
THE FLY CATCHING-APPARATUS OF WRIGHTIA COCCINEA.
Printed. at the Lithographic Office, Survey of India Department, Calcutta. July 1887.
Description of the Illustrations.
PLATE IV.
FIGURES 1 AND 2. Spirillum of the rat x 800 diameters : Temperature of the rat
101.6° F.
FIG. 1.—Fresh blood on watching ; temperature of the rat 103°F. " The organisms
have the aspect of veritable spirilla, moving actively amongst the fibrine
bands and in clear serum spaces, yet not easily seen even with the 1/10
inch immersion." ( Extract from Note-book. ) A white corpuscle is shown
to the right above ; below at * are some dried and stained organisms
showing a tendency to divide, and one with a central dark spot.
2.—Blood after 20 hours, inclosed in sealed cell. " In open spaces are seen
2—4 spirilla in active constant movement (chiefly rotation), quite dis-
tinct from the languid and intermittent movement of the bacteria
which are also present ( from Note-book ) (a ) Micrococci, ( b) Bacillar
rods, (c) The spirillar organisms.
C H A R T N O . 1 . — B i - d a i l y o b s e r v a t i o n s o f t e m p e r a t u r e a n d b l o o d - s t a t e o f t h e r a t
showing the above spirillar contamination. Memo.— W h e n s p i r i l l a r
organisms " doubtfully seen," then other minute bodies detected,
often having the aspect of such organisms either immature or else
disintegrating.
" NO. 2.—A sample of ordinary temperature ranges in a rat having healthy-look-
ing blood.
" N O . 3 . — A s a m p l e o f t e m p e r a t u r e r a n g e i n a n e w l y - c a p t u r e d r a t h a v i n g o n t h e
first three days monads in the blood, and subsequently suffering from
swelling of the feet and paraplegic symptoms.
" N O . 4 . — T h e e n t i r e t e m p e r a t u r e a n d b l o o d d a t a o f t h e e x p e r i m e n t a l m o n k e y , i n t o
whose blood the rat's monads had found their way after intra-peri-
toneal injection. Day 1, is the evening of experiment ; on day 2, there
are two positive observations, and two also on day 3, after which no more
monads visible. The " uneasiness " of the monkey on the first 3 or 4
days was not more than accountable by the mild irritation of puncture,
and the temperature-range seemed hardly disturbed.
PLATE IV.
SPIRILLUM OF THE RAT.
Chart No. I.
SPIRILLAR RAT.
August-September 1885. Daily observations of Temperature and Blood-state.
MEMO. on Blood. + Spirillum present. ? Sp. doubtfully seen.—Sp. absent, on morning or evening of
observation days; beginning with day of capture, when first scrutiny made.
No. 2.
No. 3.
No. 4.
July
HEALTHY-LOOKING RAT.
July TRICHOMONOUS RAT.
September TRICHOMONOUS MONKEY.
No foreign organisms in Blood.
+ Trichomonas present, — T. not visible in Blood.
Lithographed at the Survey of India Offices, Calcutta, December 1887.
Description of the Illustrations.
PLATE V.
Figures 1 to 4 form a series, all magnified 500 diameters : Figures 1 and 2 are
hæmatophytes, and figures 3 and 4 are hæmatozoa, as described in the text.
The blood-disc introduced in each figure will serve to aid intercomparison of the
organisms.
FIGURE 1.—Bacillus anthracis (copied from Ziegler).
FIGURE 2.—Spirillum (Spirochæta) Obermeieri, aspects seen in blood during life ;
straight and unfolded, also clustering and adhesion to red-discs
(human).
„
3.—Tricho-monas sanguinis (rat) common aspects, when semi-quiescent.
„
4.—Filaria sanguinis hominis (Lewis).
FIGURES 5 and 6.—Flagellated organisms from the rat's blood.
„
5 . — X 1 0 0 0 d i a m e t e r s : ( a ) from osmic acid preparations in which the uni-
lateral membrane is clearly indicated and a bright speck near the tail
ends. The blood-disc gives relative dimensions. ( b ) from aniline-
stained preparations, in which the lighter stained edge corresponds
to the same lateral membrane ; the flagellum is not wholly tinted (dated
Feb. 1885).
„
6 . — X 8 o o d i a m e t e r s . C h a n g e s u n d e r g o n e b y r a t - m o n a d s i n f r e s h b l o o d
diluted with 75 per cent. solution of common salt in water, hermetically
sealed and kept at 70° to 8o°F. For description see the text : ( a )
from a series of trials made in February 1885; ( b ) from other experi-
ments made in September following, some slight difference being
apparent.
F I G U R E S 7 a n d 8 . — O r g a n i s m s f r o m t h e b l o o d o f d i s e a s e d a n i m a l s a f f e c t e d w i t h ( s u r r a ) .
„ 7.— x 1000 diameters. From aniline-stained preparations : to the right are
four of the " monads " with two red discs (one shrivelled) and a larger
nucleated white cell ; to the left are some smaller plasmic (?) particles*
x 1200 diameters as seen with 1/12 inch oil-immersion lens of Powell and
Lealand, London, in February 1885, and then designated as possibly
incipient flagellated organisms.
* They were sometimes found radiating round red-discs, or joined end to end, so as to appear of great
length, when their ends may unite ; or joining laterally so as to seem thickened, doubled, or branching ; or
clustering at various angles so as to form meshes or clumps ; or intermingled variously. Below is seen the
attachment of the monads to red-discs, so striking in the fresh state.
F I G U R E 8 . — x 8 0 0 d i a m e t e r s . O r g a n i s m s f r o m i n o c u l a t e d a n i m a l s , a s n a m e d i n t h e
figure. The differences apparent amongst the monads of mule, dog, and
monkey did not seem at all considerable, constant, or characteristic ;
and it was considered that they hardly, if at all, surpassed a natural
variation, easily surmised and understood.
PLATE
Lithographed at the Survey of India Offices, Calcutta, December 1887.
Description of Plate VII.
FIG. 1.—Large comma bacilli in the adenoid tissue and Licberkuhn's crypts, and
also below the muscularis mucosa, of the ileum. Case 4.
„ 2.—Small comma bacilli in the interior of Licberkuhn's crypts and extending
into the space between the bases of two villi in the ileum of Case K.
„ 3.—Group of bacilli from the space between the villi in Case 5, more magnified.
than in Fig. 2.
„ 4.—Another group from the deeper part of the cavity of the crypt.
„ 5.—Spirilla in a Licberkuhn's crypt (transversely divided) from the vermiform
appendix of Case 9.
„ 6.—Filiform bacilli in the substance of the colon of Case 5.
PLATE VII.
P h o t o - e t c h i n g f r o m t h e o r i g i n a l p e n a n d i n k d r a w i n g s - S u r v e y o f I n d i a O f f i c e s , C a l c u t t a , S e p t e m b e r 1 8 8 7 .
I
Description of Plate VIII.
FIG 7.—Micrococci within and without a small blood vessel from a purulent focus in
the lung of Case 5.
„ 8.—Micrococci amongst the blood corpuscles in a vessel of the kidney of Case 1.
„ 9.—Spotted bacilli infiltrating the mucous membrane surrounding an ulcer of the
stomach in Case 8.
„
10.—The same bacilli more magnified.
G. Bomford, del.
Photo-etching From the original pen and ink drawings-Survey of India Offices Calcutta. September 1887.