NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
145
down the centre of the lane at the back. This gutter had evidently not been
cleansed for some time past as it was very filthy; in fact it was an elongated
open cesspool.
Khadakvásla water is laid on to the house, and there is a tap upstairs in the
cook-room not far from the privy.
I also visited the Napier Hotel.
Juan Fernandez occupied the corner room in the servants' quarters which
are situated between the cook-room and one of larger row of buildings occupied
by visitors to the hotel. In this room at the time of my visit a Goanese
cook was ill with fever. The floor of the room is damp from the water leaking
from the bathing place in the adjoining room. The gully at the back of the
cook-room is unpaved and was so wet that it was impossible to go into it. The
narrow passage between the servants' quarters leading to other ranges of
servants' quarters was also very wet. The servants' privy was not clean, the
cesspool at the back being full of night-soil and extremely filthy. The proprietor
of the hotel promises to take immediate steps to improve matters. The con-
dition of the house in the Sadar Bázár has been brought to the notice of the
Assistant Quarter Master General, Poona Division.
" C. M. 16. Sassoon General Hospital.
No. 8 Clinical Medical Ward.
Name.— Juan Fernandez.
Date.— 19th August 1882.
Age.
Years.
19
Months.
Disease.
Enteric Fever
Duration of
Disease.
15 days .
Occupation.
Cook ..
Locality
of Residence.
Camp
Caste.
Christian (Goa-
nese).
Diet, Extras, and
Wine.
Date.
1882.
19th Aug.
Symptoms.
Is a young emaciated boy, came in with
fever and looseness of the bowels ac-
companied with pain in the abdomen,
chiefly in the right iliac region. His
skin is hot and dry. Temperature 102·4°.
Pulse 120, weak. The tongue is clean
at the tip and edges; behind it is
slightly covered with a white fur. But
there are no sordes on the teeth and
gums. Has great thirst. Appetite im-
paired. The face is pale and anxious.
His pupils are somewhat dilated. He
is restless, delirious, and greatly ex-
hausted. There is no well-marked rash
on his body. He purged 3 times since
his admission with pain in abdomen.
Motions are watery, copious, and of a
pea-soup colour. Has tenderness on
pressure all over the abdomen, but more
severe chiefly in the right iliac region
and there is also tympanites. He is
unable to bear the slightest pressure on
the abdomen. Nothing wrong could
be detected with his liver or spleen.
Has slight cough. Sputa scanty and
frothy. On percussion there is some
dulness on the right side of the chest
in the mammary region. On ausculta-
Prescriptions.
R.
Spt. vin. gallici mixture
ozs. 1. every 3rd hour (4
doses) .
Quinine sulphas grs. 8.
Acid hydrochloric dil.
ms. 20.
Infusion cinchona ozs. 4
ft. oz. 1. every 3rd hour.
Ext. carnis dra. 1.
Warm water oz. ½ Mix.
ozs. 2. every 2nd hour.
Turpentine stupes to the
abdomen.
Vespere.
R.
Turpentine oz. ½.
Sago conjee ozs. 2.
Mix. enema to be given
now gently.
Diet.
Milk.
B 357—37
RECORD'S OF TEMPERATURE, PULSE, RESPIRATION, EXCRETÆ, &c.
Name Juan Fernandes. Age 19. Caste Christian. Disease Enteric Fever.
Occupation Cook.
B. 357. Govt. Photozinco: Office, Poona 1883.
147
Date.
1882.
12 noon ...
4 P.M.
8 P.M.
24th Aug . .
12 A.M. ...
2 P.M. ...
4 P.M. ...
6 P.M. ...
8 P.M. ...
25th Augt.,
7 A.M.
9 A.M.
12 A.M. ...
2 P.M.
Symptoms.
thirst is less this morning. Appetite
just the same. The lips are dry ; passed
his water in bed. His cough is less.
sputa scanty. The spleen is enlarged.
Just given tea and milk, also a dose of
brandy. Purged once at 9 A.M. ; the
stool was of the same character.
Temperature 100 8°; pulse 128.
Temperature 101 6°; pulse 114. Bowels
moved once; stool was of the same
character ; gave him stimulant mixture,
turpentine mixture, sago conjee, milk
and tea, &c., regularly and alternately.
Respiration 48.
Temperature 100 4°; pulse 114.
Temperature 98 0°; pulse 120, very weak ;
respiration 44. Purged 3 times in bed
during the night; the stools were of
the same character ; passed his water ;
tenderness on the abdomen is less. The
tympanites is much less. The tongue
is clean and moist at the tip and the
edges, but coated behind. He was de-
lirious last night, and the condition is
unchanged this morning. He took his
tea with milk fairly this morning. Has
less thirst ; appetite is just the same.
The cough is much less.
Temperature 100 2.°T
emperature 99 4°; bowels moved once.
Temperature 98 2°; pulse very weak.
Temperature 97 6°; pulse very weak.
Temperature 97 7°; pulse very weak.
Temperature 96 4 ; pulse 108, very weak;
respiration 46. Slept for some time
during the night. His skin is cold and
moist. Tongue is clean and moist at
the edges, but dry in the centre. The
tenderness is somewhat less on the ab-
domen as well as tympanites. Bowels
did not move since yesterday from 2 P.M. ;
passed his water freely; appetite is just
the same. The cough is much less.
He is somewhat delirious this morning.
Temperature 96 7°; pulse 108, very weak.
Temperature 96 2°; pulse feeble.
Temperature 96 0°; pulse feeble. Skin cold
and covered with perspiration. Byes
sunken ; tongue dry and is in a sinking
state.
Prescriptions.
Cont. poultice.
Cont. mixt. expect.
Cont.
Cont.
R.
Brandy oz. ½.
Warm water oz. ½. every
2nd hour, Beef Tea dr.
2, Hot water pt. 1.
M.ft. ozs.2 every 3rd hour.
Omit turpentine mixture
Cont. Beef Tea.
Cont. brandy mixture oz. 1
every 3rd hour with
egg and sugar.
Diet.
Beef
Tea
M.Souppt.1
The patient died at 3 P.M. of 25th August 1882.
The post-mortem examination was performed at 8 15 A.M. of the 26th
instant.
On opening the body, the abdomen presented evidences of intesti-
nal congestion, and vascularity of the omentum and layer of the
mesentery. The mesenteric glands were enlarged and infiltrated
and about 12 ozs. of serous fluid was found in the peritoneum.
The stomach and intestines were opened. The stomach was found
nearly empty and healthy in appearance. The duodenum was
healthy throughout its course; its internal surface was deeply stain-
ed with bile pigment. The jejunum presented marked increased
vascularity and its internal coat presented marks of softening.
149
Previous to that time, however, I have observed cases of so-called remittent fever, some
of which would, I now believe, have been correctly described as enteric fever complicated
with malaria.
I am not in a position to state whether or no there is any connection between infantile
remittent fever and enteric fever.
I have the honour to be,
Sir,
Your most obedient Servant,
HENRY COOK, M.D., Surgeon Major,
In Medical Charge, Jail Hospital, Dhárwár.
"No. 107 OP 1882.
FROM
ASSISTANT SURGEON NUSERWANJI DHANJIBHAI,
IN MEDICAL CHARGE, GOKAK EXTRA-MURAL GANG;
To
THE SECRETARY TO THE SURGEON GENERAL
WITH THE GOVERNMENT OF BOMBAY.
Gamp Dhoopdall, 4th October 1882.
SIR,
With reference to your Circular No. 4587 of the 31st August 1882, I have the honour
to report that during the last ten years I have observed about 12 cases of undoubted enteric
fever among the native population and in a few cases treated as remittent fever there were
reasons to suspect enteric fever. The fever ran a course of 21, 28 or more days. I have
seen great distension of the abdomen with hœmorrhage in two, eruption in two, and per-
foration of the bowel in three cases. The eruption consisted of successive crops of a few small
livid spots lasting three or four days. The other symptoms, persistent high temperature,
frequency and feebleness of the pulse, diarrhœa, tenderness and gurgling in the right iliac
region, languor, drowsiness, loss of muscular power, &c., were present in most cases. The
temperature gradually rose every day for the first five or six days, attaining the maximum
in the evening and falling 1° or 2° F. in the morning; sometimes the daily rise of tempera-
ture was stopped by the administration of large doses of quinine or salicylic acid for a few
days and again continued in spite of them. As nearly half of the cases had returned from
Bombay a few days before the attack and two with fever I was unable to trace any connec-
tion with the dejecta of a person who had previously suffered from enteric fever, impure
water, or insanitary condition of residence.
I have the honour to be,
Sir,
Your msot obedient Servant,
NUSERWANJI DHANJIBHAI, Assistant Surgeon,
In Medical Charge, Gokák Extra-Mural Gang."
"No. 19 of 1882.
FROM
THE ASSISTANT SURGEON,
VICTORIA DISPENSARY;
To
THE SECRETARY TO THE SURGEON GENERAL
WITH THE GOVERNMENT OP BOMBAY,
BOMBAY.
Navsári, 26th November 1882.
SIR,
With reference to Circular No. 4587, dated 31st August 1882, I have the honour to
state as follows :—
Within the last 10 years I have seen three well-marked cases of enteric fever.
B 357—38
TEMPERATURE CHART OF LIEUTENANT W. G. GIFFORD 2 ND SOMERSETSHIRE REGIMENT AGE 2110/12 SERVICE 10/12 YEAR LANDED IN INDIA 17 TH NOVEMBER 1882 DATE OF ATTACK 30 TH NOVEMBER 1882
ADMITTED TO OFFICER'S SANITARIUM COLABA 8 TH DECEMBER 1882 7 P. M. INVALIDED TO ENGLAND 6 MONTHS FROM 21 ST JANUARY 1883.
Govt. Photozincographic Office, Poona 1883.
156
" Abstract of Case of Surgeon R. L., I. M. D.
Age—23 years. | Service—10 months.
Fever s. c. (Typhoid).
Arrived in Bombay from England on 17th November 1882 in good health and resided
at the Colába Hotel.
He first felt unwell on the 18th January 1883, chilly and feverish, with a strong pre-
sentiment that he was going to have an attack of typhoid fever. He performed a post-
mortem examination on a patient who died of typhoid fever in the Station Hospital, Colába,
on the morning of the 27th December, and daces that as the origin of his illness. He was
seen by me and placed on the sick list on the morning of the 13th January 1883.
He was then feverish and out of sorts, foul tongue, bowels constipated; temperature
99 6°, and in evening 103 6°.
On 15th January he was removed to the Officers' Sanitarium, Colába, in a dooly.
On 17th January bowels were moved 3 times by ol. ricini ½ oz. Morning tempera-
rature 102° and evening at 9 P.M. 104 6°.
On 20th January bowels got more relaxed, and for the next three days there was
diarrhoea, 4 and 5 stools in the 24 hours, some light green like paint, others light and frothy,
and others yellow curdy-looking. Their character did not improve till the 31st January,
when there was one semi-solid of a whitish colour, and from that date they became healthy.
On the 20th a tickling cough commenced, the temperature ranged from 101° to 104 8° till
the 31st January. Tongue generally foul with red edges and dry tip.
On the 28th January there were a great many petechiæ on the right forearm like pur-
pura. On the 30th January 1883 moist crepitant rales were heard over right lung accom-
panied with muco-purulent sputa which on 2nd February became nummular in character.
The rales were heard over left lung also on the 31st January.
On the morning of the 1st February he awoke out of a good sound sleep, bathed in a
cold clammy sweat, and his temperature down to 97°, bub the latter gradually rose in the
afternoon to 102 4° at 10 P.M.
The cough and night sweats were somewhat troublesome, but from the 6th February
convalescence continued, and he daily improved.
He was greatly reduced in flesh and strength and complained of weakness in the right
leg and thigh, which were swollen and hard.
He passed an Invaliding Board on the 6th March, and proceeded to Australia on the
10th of same month on 3 months' sick leave.
Treatment for Fever.—Diaphoretics, carbolic acid in pill gr. 1 ter die, quinine and
hydrobromic acid. Acid drinks, milk and soups.
For Cough.—Inhalation of carbolic acid, linseed poultices and sinapisms, bark and
ammonia; belladona gr. ¼ doses for night sweats. During convalescence Easton's syrup
and good nourishment. Brandy 2 ozs. a day from 4th February to 15th February,
R. KEITH, M.D., Surgeon-Major, A. M. D.,
In Medical Charge, Officers' Sanitarium, Colába, Bombay."
TEMPERATURE CHART OF SURGEON R. LYONS, I. M. D. AGE 23. SERVICE 10/12 YEARS. LANDED IN INDIA 17 TH NOVEMBER 1882. DATE OF ATTACK 10 TH JANUARY 1883.
ADMITTED TO OFFICERS' SANITARIUM COLABA 15 TH JANUARY 1883.
3
Months' Sick leave to Australia from 9 th March
1883.
Govt. Photozinco: Office, Poona 1883.
IP/QB, 10
No. 15.
(NEW SERIES.)
SCIENTIFIC MEMOIRS
BY
OFFICERS OF 'THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
ON A PARASITE FOUND IN PERSONS SUFFERING FROM ENLARGEMENT
OF THE SPLEEN IN INDIA.—(THIRD REPORT.)
BY
LIEUT. S. R. CHRISTOPHERS, M.B., I.M.S.
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
BY THE SANITARY COMMISSIONER WITH THE GOVERNMENT
OF INDIA, SIMLA.
CALCUTTA:
OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING, INDIA.
1905 .
Price Annas 10 or 1s.
No. 15.
(NEW SERIES. )
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
ON A PARASITE FOUND IN PERSONS SUFFERING FROM ENLARGEMENT
OF THE SPLEEN IN INDIA.—(THIRD REPORT.)
BY
LIEUT. S. R. CHRISTOPHERS, M.B., I.M.S.
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
BY THE SANITARY COMMISSIONER WITH THE GOVERNMENT
OF INDIA, SIMLA.
CALCUTTA:
OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING INDIA
.
1905.
Agents for the Sale of Books published by the Superintendent of Government
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KARL W. HIERSEMANN, Leipzig.
ON A PARASITE FOUND IN PERSONS SUFFERING FROM ENLARGEMENT
OF THE SPLEEN IN INDIA,—(THIRD REPORT).
The development undergone by the parasite in citrated blood
at a low temperature.
T HE correct zoological position of the parasites described in my previous
reports is extremely uncertain. They have been variously classed as
Piroplasmata—the view held by Laveran and Mesnil and by Major Donovan,
I.M.S. ; as Trypanosomata —the view of Major Leishman, R.A.M.C., and of
Marchand and Ledingham ; as protozoa of an unknown nature—the view first
put forward by Major Ross, I.M.S., and later taken up by others ; and as the
spores of a microsporidian.
Captain Rogers, I.M.S., recently announced that, by adding blood, obtained
by splenic puncture from cases of splenomegaly caused by the parasites, to a
small quantity of sterile citrate of sodium solution and keeping it at a temper-
ature of 22°C. for two or three days he had succeeded in observing the
development of the parasites into trypanosomes.* He found that, when the
citrated splenic blood was kept at blood heat, the parasites very quickly dis-
appeared, but when kept in a cold incubator at 27°C., they retained their usual
shape and characters for several days. Moreover, they increased markedly in
numbers, and numerous dividing forms were present. At a temperature of 27°C.
the parasites lived for only three or four days, and he therefore reduced the
temperature of the incubator to 22°C. This temperature was found to be
most suitable for the development of the parasites, and he reported that in the
cultures obtained from two cases "unmistakeable trypanosoma" appeared,
together with smaller pear-shaped flagellated bodies and other intermediate forms.
"The most marked of the cases showed completely developed trypanosoma
with thick flagella, macro-nucleus and micro-nucleus, after incubation for one
day, while the living forms were also seen in the blood culture, moving
rapidly among the corpuscles" . . . . . "The other case in which the
trypanosoma have developed was a case of kala azar from Assam, and after
incubating for five days at 22°C., we found in the citrated blood a number of
intermediate forms and a few fully developed trypanosoma."*
Observers who had put forward the opinion that the bodies are a stage in the
development of a trypanosome looked upon Captain Rogers' discovery as a
* British Medical Journal, September 17th, 1904, page 648.
2
confirmation of this view of their nature, but it was apparent from an examination
of the illustrations attached to his article that the bodies which Captain Rogers
regarded as fully-developed trypanosomes differed considerably from ordinary
trypanosomes found in animals. They possessed no undulating membrane, the
micro-nucleus or centrosome was situated at the end of the parasite from which
the flagellum emerged, and the flagellum appeared to pass out of the parasite
directly from the micro-nucleus. In a later communication* Captain Rogers
recognized these differences, and stated definitely that in no instance was an
undulating membrane present, nor did the flagellum pass forwards towards the
macro-nucleus.
So far as I am aware, no other observer than Captain Rogers has yet
described the extra-corporeal development of the bodies, and it is therefore
advisable to summarize the main facts noted by him. His procedure appears to
be very simple, the technique being described as follows :—
"The blood obtained by splenic puncture was immediately ejected into small
sterile test-tubes containing a little sodium citrate to prevent the blood from
coagulating, and these were then incubated at varying temperatures, portions of
the culture being removed with a platinum loop from time to time for examina-
tion with the microscope."
From a private communication I learnt that the strength of the solution of
sodium citrate used was considerable, viz., 10 per cent.
Two types of development are noted by Captain Rogers* : —
(1) Development at 27°C. " The divisional forms which occur in great
numbers in cultures at 27°C. are of two kinds : the first is a simple sub-division
of the small oval parasites into two, both the macro- and the micro-nucleus
first dividing and then the body of the cell splitting into two, the cleavage
beginning at one end, so that just before they separate they remain only
attached by the other poles."
"These forms can be found in small numbers by long search in films of
blood obtained by splenic puncture when numerous parasites are present, but they
form only a very small proportion of the total number of organisms seen. On the
other hand, in cultures they are present in very much larger numbers, several in
various stages being often seen in a single field of the microscope."
"The second mode of division is a multiple one. The macro- and micro-
nuclei divide a number of times instead of only once, the outline of the cell
becomes less definite, until eventually the appearance is reached in which a
number of very small nuclei arranged in pairs of a small and large kind enclosed
in a zooglea-like material is seen. Next these enlarge gradually and each pair
become surrounded by a faint capsule, which becomes more and more distinct
* Quarterly Journal of Microscopical Science, November 1904.
3
with the growth of each young form until the characteristic groups of the oval
bi-nucleated fully grown spleen parasite result, which are not very rarely seen in
good specimens of spleen puncture blood."
(2) Development at 22ºC. "On next reducing the temperature of the cold
incubator down to about 22ºC. and making further cultures in a new series of
cases of citrated spleen blood, further and more important changes were soon
found."
The various stages of development at 22ºC. are given as follows:
—
Stage of development after 24 hours. —"At the end of one day at 22ºC. the
organisms have already increased considerably in size, while the macro-nucleus
is also larger, this being a striking feature. On the other hand, the micro-nucleus
has not altered, but still remains small and rod shaped. The forms shown in
line VII* also show that the macro-nucleus, in addition to being larger, is begin-
ning to present a granular appearance, while it does not stain so darkly as in the
original spleen parasites. Further, the protoplasm of the cell is also increasing in
amount and now takes on a bluish staining, and has a very finely granular
appearance. These are the only changes met with as a rule on the first day."
Stage of development after 48 hours. —"By the end of the second day
much more marked changes are met with. In the first place, there is a still
further and very marked increase in the size of the organism, still affecting
especially the macro-nucleus and the protoplasm. Secondly, and of much greater
interest is the appearance of double forms such as are not met with on the first day.
These show every degree from apposition at one point of their circumference of
two of the large oval forms through closer and closer degrees of contact up to
nearly complete fusion of the two cells. At first I took these stages for a
method of division, but as a further study showed that the later development into
elongate and flagellate forms always takes place in pairs or rarely threes, I have
come to the conclusion that these early double forms are really a kind of conju-
gation, such as is known to occur in other protozoa preparatory to the evolution
of new stages in their life history."
Stage of development after 72 hours.—"The third day is characterized by the
elongation of the conjugating pair of organisms and the first appearance of
flagellate forms, though sometimes the latter may not be found until the fourth
day. The commonest appearance of these pyriform bodies is that in which the
micro-nuclei have passed to the thinner ends from which the flagella will eventually
arise." . . "In case 47 some early flagellate forms were found on the third day."
. . . . . . . . . . . "The remaining forms shown in line IX
have all reached the elongate stage, although still without flagella."
Stage of development after 96 hours. —"In the figures of line X are shown
* These references are to the plate which illustrates Captain Rogers' article in the Quarterly Journal
of Microscopical Science.