NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CURATIVE TREATMENT OF SURRA IN EQUINES
87
following pages it is proposed to present a critical résumé of all available information
bearing on these two questions.
I.—TREATMENT OF EQUINE SURRA BY THE INTRAVENOUS INJECTION OF
" BAYER 205".
Unfortunately, most of the published papers under this head have been seen only
in abstract, and the information contained in these is too scanty to admit of any
definite opinion being formed in regard to the extent of success that may be
expected from the use of the drug when administered intravenously alone.
Nevertheless, these abstracts furnish valuable indication as to the dosage of " Bayer
205 " that may be safely given to equines, and this is a matter the importance of
which can hardly be overestimated when it is remembered that it is held to be
one of the cardinal principles of the science of chemotherapy that, for curative
purposes, it is a good plan to employ the maximum tolerated dose, in accordance
with Ehrlich's well-known diction, " Therapia sterilisans magna ".
Baermann [1922], in the Dutch Indies, would appear to have been the earliest to
use " Bayer 205 ", intravenously alone, in the treatment of equine surra, and accord-
ing to this worker, drug intervention at the appropriate stage of the disease may
result in a cure in 50 to 75 per cent. of cases. He further states that healthy horses
may be given 3 grms. of the drug per 50 kg. body-weight, but that the total dose
should not exceed 10 grms., since, if too large doses be given, this may lead to the
production of podo-dermatitis, oedema and erythema. In actual cases of the
disease, the dose recommended by him is from 2 to 2.5 grms. per 50 kg. body-weight,
this being repeated at short intervals until 3 or 4 doses have been given. In a later
paper, Baermann [1923] states that horses naturally infected with surra may require
a course of treatment comprising 4 to 6 doses of 5 to 6 grms. each. Edwards [1928]
cites Baermann as having " used the drug intravenously either in a single dose of
5 to 10 grms. or in three to five doses totalling 8 to 25 grms. administered at short
intervals ".
About the same time as Baermann published his results, Rodenwaldt and
Douwes [1922], in the Dutch East Indies, carried out what would appear to be an
extensive series of trials with " Bayer 205 " in the treatment of the same disease.
As a result of these trials, the authors concluded that for the curative treatment
of equine surra, the drug should be employed in a single large dose of about 5 grms.
per 200 kg. body-weight or in a series of 0.5 grm. doses given on alternate days.
until a total of 10-15 grms. has been administered, but the authors note that the
administration of the drug in these doses was frequently followed by the production
of toxic symptoms. Similarly, it is stated in the Annual Report of the Department
88 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ III, I
of Agriculture, Dutch East Indies, Java, for 1922 (presumably on the basis of results
reported by Rodenwaldt and his collaborators) that in view of the toxicity of " Bayer
205 ", " no higher doses could be used than ½ grm. per 150—200 kgm. on alternate
days for 20 days (10 grms. altogether) ".
Yakimoff and his collaborators [1929] describe a case af equine trypanosomiasis
(presumably caused by Trypanosoma evansi or an allied parasite) treated with
" Fourneau 309 " (which is regarded by certain workers as being identical with
" Bayer 205 ") at the rate of: 0.0125 grm. per kg. body-weight, the actual dose
given being 5 grms. The drug was given intravenously and the injection was
followed by certain toxic symptoms which, however, rapidly disappeared, and the
condition of the animal returned to normal in 3 or 4 days' time.
Edwards [1928], in India, carried out thirteen trials (at Muktesar) to test the
value of " Bayer 205 ", when injected intravenously alone, in the treatment of
experimental cases of equine surra. The results of these trials are summarized in
the following Table :—
TABLE I.
Treatment by intravenous injection alone.
Serial No.
1
2
3
4
5
6
Animal
Mare No. 2
Horse No. 52
Horse No. 19
Horse No. 3
Horse No. 64
Horse No. 67
Date of
infective
inoculation
15th July 1925
2nd Aug. 1925
16th July 1925
15th July 1925
9th Sept. 1925
14th Nov. 1925
Dose of " Bayer
205 " in grms.
per 1,000 lb.
body-weight
5.0 Aug. 15th
1.0 Sept. 21st
1.0 Aug. 27th
1.0 Sept. 8th
1.0 Aug. 5th
5.0 Aug. 28th
2.5 Aug. 5th
5.0 Sept. 24th
5.0 Oct. 23rd
5.0 Nov. 19th
Result
Died Sept. 23rd
Died Sept. 25th
Died Aug. 29th
Died Sept. 4th
Cured
Cured
Remarks
Relapsed 21st Sept. 1925.
Intravenous intrathecal
injection
given
in
extremis.
No tryps. in the circulat-
ing blood since 9th
September 1925 but
spinal fluid showed
parasites just before
death of animal.
Relapsed 28th August
1925.
No tryps. in circulating
blood since 5th August
1925 but spinal fluid
swarming with para-
sites.
No relapse since date of
first injection.
No relapse.
Infected
intrathecally.
CURATIVE TREATMENT OF SURRA IN EQUINES
89
TABLE I—contd.
Treatment by intravenous injection alone—contd.
Serial No.
7
8
9
10
11
12
13
Animal
Donkey No. 13
Donkey No. 41
Pony No. 74
Pony No. 80
Pony No. 79
Horse No, 59
Horse No. 46
Date of
infective
inoculation
20th Oct. 1925
8th Oct. 1925
27th Nov. 1925
27th Nov. 1925
27th Nov. 1925
30th July 1925
5th Oct. 1925
Dose of " Bayer
205 " in grms.
per 1,000 lb.
body-weight
5.0 Oct. 21st
5.0 Oct. 13th
2.5 Dec. 5th
2.5 Jan. 4th
5.0 Mar. 30th
5.0 Dec. 5th
5.0 Jan. 4th
5.0 Dec. 5th
5.0 Jan. 4th
1.0 Aug. 22nd
1.0 Sept. 2nd
0.2 Sept. 20th
5.0 Nov. 13th
Result
Cured
Cured
Died Mar. 31st,
1926.
Cured
Cured
Died Sept. 20th
1925.
Cured
Remarks
No
relapse.
Infected
intrathecally.
(Later—22nd March 1926
—died of debility.)
On 13th October 1925
tryps. noticed in cir-
culating blood at the
rate of 1 per field and in
centrifuged spinal fluid
sediment at the rate
of 40 per field. The
animal had been in-
fected intrathecally.
Tryps. noticed in cir¬
culating blood since
16th March 1926. The
animal
had
been
infected intrathecally.
Never
relapsed. The
animal
had
been
infected intrathecally.
Never relapsed.
The
animal
had
been
infected intrathecally.
Tryps. noticed in circulat-
ing blood during the
entire course of treat-
ment, but cerebro-
spinal fluid negative
for parasites.
" Showed moderate
clinical symptoms of
surra " before drug in-
jection on 13th Nov.
but no tryps. were visi-
ble in spinal fluid,
although those were pre-
sent in the circulating
blood on this date.
An examination of the foregoing Table shows that out of 10 animals which
received the drug at the rate of 5 grms. per 1,000 lb. body-weight, 7 were cured
of surra, but that death occurred in the case of the remaining three and also in
90 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ III, I
three others that received smaller doses of the drug. Of the three former animals,
however, Horse No. 19 and Pony No. 74 may be left out of consideration, for
they received an injection of the drug at the rate of 5 grms. per 1,000 lb. body-
weight only when they were in extremis. The true percentage of recoveries at the
higher rate of dosage was therefore 87.5.
Reference may also be made here to an experiment recently carried out upon
six horses at Muktesar, to test the efficacy of a single large dose of ' ' Bayer 205 "
given intravenously alone. The six animals were artificially infected with surra
on 30th September 1931 and 8 days later, when they had fully developed the infec-
tion (as evidenced by the occurrence of parasites in the blood, accompanied, in some
cases, by swelling of the limbs and paleness of the mucous membrane of the eyes),
four of the six animals received each an intravenous injection of the drug at the
rate of 8 grms. per 1,000 lb. body-weight and two others at 5 grms. each.
Thereafter the condition of all the six animals quickly returned to normal, and
none of these has relapsed up to the moment of writing, that is, during a post-treat-
ment observation period of more than five months, so that, according to recent
authorities, they may now be declared as having been definitely cured.
Coming to cases of natural surra in India, Howard [1926] tested the efficacy
of the intravenous injection of " Bayer 205 " on four horses which exhibited the
clinical symptoms of surra but did not show the actual parasites in the blood. The
four animals received the drug in doses of 1 to 3 grms. but no visible effect "
was produced. Another horse that showed the parasites in the blood was injected
intravenously with 2 grms. of the drug, and although this was followed by the
disappearance of the parasites, the animal became gradually weaker in the hind-
quarters and had to be destroyed. It may be mentioned that all the five horses had
been previously treated with tartar emetic.
In some of the recent Reports issued by the Civil Veterinary Department in the
Punjab, mention is made of " Bayer 205 " having been used on a large scale in the
treatment of natural surra under field conditions in that province. No mention
occurs in the Reports as to the manner in which the drug was employed or the
scheme of dosage adopted, but, as far as can be gathered, it was used intravenously
alone, and the following extract is illustrative of the extent of success achieved in
the course of these trials :— " 487 surra cases were treated at the centres, including
100 camels and 387 ponies, of which 94 camels and 354 ponies (91.4 per cent.)
were discharged as cured. Enquiries show that, out of 129 cases discharged as
cured during the previous season's work, there were only 9 relapses " (Report for the
year 1929-30, p. 20). In the Report of the Punjab Veterinary College for 1929-30
(p. 27), reference is made to "three new methods of treatment" that were
" tried with a view to reduce the time taken
Treatment according to
CURATIVE TREATMENT OF SURRA IN EQUINES
91
Method I extends over 29 days including 5 intravenous injections.
„
„
II
III
„
„
„
„
21
16
„
„
„
„
5
4
„
„
„
„
„
It is presumed that "Bayer 205 " is the drug (with or without the addition of
tartar emetic) intended for use in all the three methods of treatment mentioned
here.
Through the courtesy of the Director of Veterinary Services, Punjab, this Insti-
tute has recently been furnished with a valuable statement showing the results of
surra treatment carried out upon privately-owned ponies in that province, during
the past six years, by the simple intravenous injection of " Bayer 205 ". The
following figures are extracted from this statement:—
Year
1926-27
1927-28
1928-29
1929-30
1930-31
1931 up till
December
Total
Total num-
ber admit-
ted for
treatment
89
114
109
387
1,448
1,908
4,055
Total num-
ber dis-
charged as
cured
73
100
102
354
1,296
1,609
3,534
Died while
under
treatment
12
11
7
31
139
89
289
Not run full
course of
treatment
4
3
—
1
13
—
21
Relapsed
after full
course of
treatment
—
8
—
—
—
5
—
Some information concerning the dosage of the drug is furnished by Kahan Singh,
in the Report of the Sohawa (Punjab) Laboratory for the year 1925-26. The recom-
mendation made by this worker is as follows :—
1st day.
7th day.
14th day.
21st day.
28th day.
35th day.
100 c.c. of a 2 per cent. solution.
Ditto
ditto
ditto.
100 c.c. of a 3 per cent. solution.
Ditto
ditto
ditto.
100 C.C. of a 4 per cent. solution.
100 c.c. of a 5 per cent. solution.
From the foregoing Table, it would appear that the full course of. treatment accord-
ing to this method is to extend over a period of more than a month, the total
amount of drug injected during this period being 19 grms. In a report published in
92 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ III, I
1928, Kahan Singh gives the protocols of three ponies treated by this method,
although they received only the first five injections of the series. One of the treated
horses was discharged as cured; one died after the completion of the treatment and
the third succumbed during the course of the treatment. In an earlier communica-
tion, the same author [1927] publishes the protocols of four other horses treated in
accordance with a somewhat different scheme of dosage. These protocols are of
sufficient interest to merit reproduction :—
Animal
Pony No.
3
Pony No.
4
Pony No.
5
Pony No.
6
Age
in
years
4
5
2½
6
Condition
Before
treat-
ment
Poor
Poor
Poor
Very
poor
After
treat-
ment
Fair
Good
Good
Fair
Total
amount
of
" Bayer
205"
given (in
grms.)
5
19
19
5
Number
of
injec-
tions
2
6
6
2
Interval
between
injec-
tions
(in days)
15
7
7
15
Result
? Cured
Cured
Cured
Cured
Remarks
Animal
untraceable.
Rabbit
subinoculated
18 days after comple-
tion of treatment and
kept under observation
for 30 days (? with
negative results).
" Still alive and in good
condition."
" Still alive and in good
condition."
"Still alive and in fair
condition."
Reference may be made here to a small series of trials carried out at the Bombay
Veterinary College to test the efficacy of the " intravenous alone " method for
natural cases of equine surra. Particulars of these cases have been available
through the courtesy of Mr. K. Hewlett, Principal of the College, who, in a com-
munication dated the 23rd November 1931, writes as follows :—
" 1. Nine cases of equine surra have been treated under my direction by the
injection of Naganol intravenously.
2. The dose used was 50 c.c. of 10 per cent. solution for 1,000 lb. body-weight.
These injections were made at intervals of 10 days except in the first case treated
when an interval of 14 days was allowed between the injections.
3. Three cases were treated with absolute success being discharged as cured
after 3 weeks. They have been kept under observation in the case of one for over
a year and in the case of the other two for over two years and are now still
working.
CURATIVE TREATMENT OF SURRA IN EQUINES
93
4. Four cases were treated with success being discharged as cured within three
weeks. They were however unsound animals and were sent to the Pinjrapole
where two lived for four months and two were lost sight of. None of these had a
relapse as far as our information goes.
5. Two cases died within 24 hours after the first injection.
6. The animals noted in paragraphs 4 and 5 were all debilitated animals and
not suitable subjects for treatment at all.
7. In all cases the Trypanosomes disappeared from the peripheral blood within
24 hours of injection."
II.—TREATMENT OF EQUINE SURRA BY THE INTRAVENOUS INJECTION OF
" BAYER 205 " COMBINED WITH OTHER DRUGS.
A number of workers have recorded having obtained very encouraging results
from the use of " Bayer 205 " when used in combination with other drugs, e.g.,
atoxyl and tartar emetic. Except for reasons of cost, there appear to be hardly
any a priori grounds for considering that such a combination should possess any
superiority over any of the drugs used alone. As a matter of fact, some workers
in the Punjab, who have been lately advocating the use of " Bayer 205 " in com-
bination with tartar emetic, have apparently been led to do so by consideration of
cost alone, as would appear from the following statement:—" To reduce the expen-
siveness of the treatment by ' Bayer 105 ' it was suggested to reduce the number
of its doses, and add in its place the doses of tartar emetic, which, like this drug,
has also proved most useful in the treatment of surra" [Kahan Singh, 1927].
However, one other reason that has evidently led to the use of these two drugs in
combination is the drastic nature of the trypanocidal action of tartar emetic which,
as has been mentioned by more than one worker, is liable to produce fatal conse-
quence if injected in the full therapeutic dose in heavy infections.
A detailed consideration of the results obtained by various workers from the
use of " Bayer 205 " in combination with other drugs would be outside the scope
of this paper which is primarily intended to be a résumé of the present position
concerning the value of " Bayer 205 " when used alone. Nevertheless, these results
furnish some indication as to the dosage of the drug that may be employed with
safety, and it is needless to say that, in the uncombined form, the drug would
admit of being used in considerably larger doses.
Perhaps, the most extensive trials as yet carried out with " Bayer 205 " in
combination with other drugs are those of Bubberman, Douwes and Van Bergen
[1925], in the Dutch East Indies. These workers used " Bayer 205 " in combina-
tion with tartar emetic or atoxyl, in fractional or large doses. When used in frac-
tional doses, the dosage of " Bayer 205 " ranged from ½ to 2 grms. and in one
94 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ III, I
instance a total of 10 grms. each of " Bayer 205 " and atoxyl was administered in
this manner. In the large-dose treatment, the drugs were administered in doses of
3 grms. each. In a recent paper, Bubberman [1931] recommends the treatment of
infected horses by the " simultaneous injection of 3—3½ grms. Naganol and
3—3½ grms. atoxyl per 150—200 kg. body-weight " and the author believes that
" if treatment is begun in the early stages of infection, 60 per cent. of recoveries
may be expected in equines ".
Bakker [1925] records having treated two infected horses with " Bayer 205 "
and tartar emetic and two others with atoxyl in addition to these drugs. The
" Bayer 205 " was administered in doses ranging from 1 to 4 grms. until a total
of 4 to 9.2 grms. had been given. The tartar emetic was administered in doses of
½ or 1 grm. until a total of 3 to 4 grms. had been reached, whilst the doses of
atoxyl given were 2½ and 3 grms. with totals of 3 and 5½ grms. Two of the treated
horses developed paresis about 2 months after treatment, but without the occur-
rence of trypanosomes in the blood. The remaining two horses regained condition
and did not relapse during a post-treatment observation period extending over some
months.
According to Hornby [1931], " the best results [in the treatment of equine
surra] are obtained with ' Bayer 205 ' alone or in conjunction with another drug, as
tartar emetic, antimosan, sulfarsenol, etc.".
Of workers in the Indian region, Mitchell in Burma would seem to favour the
combination of " Bayer 205 " with tartar emetic, for according to him " Naganol
+ Tartar Emetic will give a temporary immunity lasting a couple of months ". He
further writes : " It is hoped that repeated inoculations on these lines on two or more
occasions will carry the animals through the dangerous period (rains) and aid in
reducing the mortality resulting from the disease " (Annual Report of the Veteri-
nary Department of Burma for the year ending March 1930).
During the past five years, some trials have been carried out in the Punjab in
the treatment of natural cases of equine surra, using " Bayer 205 " in conjunction
with tartar emetic, and the results would appear to have been very satisfactory, as
is illustrated by the fact that, in one instance, " 14 out of 17 ponies [i.e., 82.4 per
cent.] subjected to this method of treatment were cured and discharged " [ Kahan
Singh, 1928]. In this connection, the following six protocols (kindly supplied by
the Director of Veterinary Services, Punjab) are of interest as furnishing some
indication of the actual method of treatment employed in individual cases :—
1. Horse No. 23. Age 10. Very poor. Paralyzed.
8.IX.30. Injected 100 c.c. of a 2 per cent. solution of " Bayer 205".
13.IX.30. Injected 100 c.c. of a 1 per cent. solution of tartar emetic.
CURATIVE TREATMENT OF SURRA IN EQUINES
95
18. IX. 30. Injected 100 c.c. of a 1 per cent. solution of tartar emetic.
23. IX. 30. Injected 100 c.c. of a 2 per cent. solution of " Bayer 205 ".
28. IX. 30. Injected 100 c.c. of a 1 per cent. solution of tartar emetic.
3. X. 30. Injected 100 c.c. of a 1 per cent. solution of tartar emetic.
8. X. 30. Injected 100 c.c. of a 2 per cent. solution of "Bayer 205".
Cured and discharged.
2. Mare No. 59. Age 4. Condition poor.
24. IX, 9. X, 24. X. Injected on each of these dates 100 c.c. of a 2 per
cent. solution of " Bayer 205 ".
29. IX, 4. X, 14. X, 19, X. Injected on each of these dates 100 c.c. of a 1
per cent. solution of tartar emetic. Cured and discharged.
3. Colt No. 49. Age 4 months. Condition very poor.
20. IX, 5. X, 20. X. Injected on each of these dates 25 c.c. of a 2 per
cent. solution of " Bayer 205 ".
25. IX, 30. IX, 10. X, 15. X. Injected on each of these dates 25 c.c. of
a 1 per cent. solution of tartar emetic. Cured and discharged.
4. Horse No. 189. Age 9 years. Condition very poor.
31. X, 15. XI. 30. XI. Injected on each of these dates 100 c.c. of a 2
per cent. solution of " Bayer 205 ".
5. XI, 10. XI, 20. XI, 23. XI. Injected on each of these dates 100 c.c.
of a 1 per cent. solution of tartar emetic. Cured and discharged.
5. Mare No. 198. Age 6 years. Condition very poor.
3. XI, 18. XI, 7. XII. injected on each of these dates 75 c.c. of a 2
per cent. solution of " Bayer 205 ".
8. XI, 13. XI, 23. XI, 28. XI Injected on each of these dates 75 c.c.
of a 1 per cent. solution of tartar emetic. Cured and discharged.
6. Pony No. 228. Age 2½ years. Condition very poor.
15. XI, 30. XI, 15. XII. Injected on each of these dates 50 c.c. of a 2
per cent. solution of " Bayer 205 ".
20. XI, 25. XI, 5. XII, 10. XII. Injected on each of these dates 50
c.c. of a 1 per cent. solution of tartar emetic. Cured and discharged.
The form of treatment with a combination of these two drugs, as very recently
outlined by Abdulla Khan [1932], for horses weighing from 600 to 800 lb., is as
follows :—
1st day. 100 c.c. of a 2 per cent. solution of " Bayer 205 " intravenously.
6th day. „
„ 1 per cent.
„
tartar emetic intravenously.
96 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ III, I
11th day. 100 c.c. of a 1 per cent. solution of tartar emetic intravenously.
16th day. As on the first day.
21st day. As on the sixth day.
26th day.
Ditto.
31st day. As on the first day.
(In all, 6 grms. of " Bayer 205 " and 4 grms. of tartar emetic.)
III.—TREATMENT OF EQUINE SURRA BY THE COMBINED INTRAVENOUS-INTRATHECA
INJECTION OF " BAYER 205 ".
Edwards' [1928] original trials with this method were carried out upon 19
horses (for reasons stated below, Mare No. 68 and Horse No. 70 may be excluded),
and the results obtained by him are summarized in the following Table :—
TABLE II
Treatment by combined intravenous-intrathecal injections.
Serial No
1
2
3
4
5
6
7
8
9
10
11
12
Animal
Horse No. 26
Horse No. 35
Mare No. 68
Horse No. 60
Horse No. 21 A
Donkey No. 35
Donkey No. 4
Donkcy No. 36
Donkey No. 11
Donkey No. 17
Mare No. 57
Horse No. 28
Data of
infective
inoculation
5th Oct. 1925
5th Oct. 1925
4th Sept. 1925
4th Sept. 1925
29th Aug. 1925
14th Oct. 1925
20th Oct. 1926
6th Oct. 1926
20th Oct. 1925
20th Oct. 1925
5th Oct. 1925
22nd Sept. 1925
Dose of "Bayer 205" in grammes
per 1,000 lb. body-weight
Intravenous
5.0 Nov. 7th
5.0 Oct. 23rd
5.0 Sept. 23rd
5.0 Oct. 23rd
5.0 Sept. 23rd
5.0 Oct. 23rd
5.0 Sept. 23rd
5.0 Oct. 23rd
5.0 Oct. 21st
5.0 Oct. 21st
5.0 Oct. 14th
5.0 Oct. 21st
5.0 Oct. 21st
5.0 Oct. 26th
5.0 Dec. 21st
5.0 Nov. 13th
5.0 Dec. 21st
Intrathecal
0.02 Nov. 7th
0.02 Oct. 23rd
0.02 Sept. 23rd
0.02 Oct. 23rd
0.02 Sept. 23rd
0.02 Oct. 23rd
0.02 Sep. 23rd
0.02 Oct. 23rd
0.02 Oct. 21st
0.02 Oct. 21st
0.02 Oct. 14th
0.02 Oct. 21st
0.02 Oct. 21st
0.02 Oct, 26th
0.02 Dec. 21st
0.02 Nov. 13th
0.02 Dec. 21st
Result
Cured
Cured
Cured
Cured
Cured
Cured
Cured
Cured
Cured
Cured
Died on 2nd Febru-
ary 1926 of suspec-
ted chistosomia-
sis.
Cured
Remarks
Relapsed 14th October 1925.
Tryparsamide used for intra-
thecal injection.
Never relapsed between injections.
Ditto.
Infected intrathecally.
Ditto. Tryps. not seen in spinal
fluid at " the time of drug
injection (fluid very blood-
tinged).
Infected intrathecallv. Tryps.
present in spinal fluid up to the
day of treatment.
Infected intrathecally.
Ditto.
Relapsed about 11th December
1925. Tryps. in spinal fluid on
26th October 1925, but none on
1st February 1926. No parasites
in circulation since 21st Decem-
ber 1925.
Relapsed 19th December 1925,
with tryps,
in circulating
blood, but spinal fluid not evi-
dently examined on this date.
Tryps. in spinal fluid on 13th
November 1025.