NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
29
or that of Oriental Sore, will flagellate in any insect other than their true inver-
tebrate host, and I am able further to show that the parasite of Kala Azar will
not flagellate in the stomach of an insect which ingests suitable pabulum rich
in blood. In October 1911 Captain Cragg, kindly gave me a female
Conorrhinus rubrofasciatus which was caught in his house at night. This bug
was fed on myself, and during November, December and January, laid a large
number of eggs, many of these were separated and a number of the first nym-
phal instars were bred out ; as this bug is naturally infected with a crithidia it
is important to carefully exclude it, and this was at once accomplished by
breeding out the young stages apart from the parent bug. These nymphs were
fed on R. on January 30th and again on 31st, and the first bug was dissected
on the 1st ; it was found to have ingested about 500 parasites, and they were
still lying in the leucocytes which were unchanged. The next was dissected
on the 2nd. and now it was found that the parasites had degenerated. in the
leucocytes, and that there was not a trace of any development ; in others exa-
mined later the parasites had entirely disappeared. The first nymphal instar of
this bug is about as large as the adult of Cimex, and it ingests about twice as
much blood, in fact it is a voracious blood-sucker, becoming so distended as to
be almost unrecognisable. Here we have an insect whose midgut when disten-
ded with blood closely simulates the culture tube containing rich nutrient fluid,
and yet though it may ingest hundreds of parasites they never flagellate but at
once degenerate. This observation not only proves that this insect can never
carry this parasite in nature but clearly shows that the parasite of Kala Azar
will not flagellate in still another blood-sucking insect. As a result of these
observations I am justified in concluding that the bed-bugs Cimex rotundatus
and. Cimex lectularius are the true invertebrate hosts of the parasite Kala Azar,
The Biological Position of the Parasite,
I have so far not attempted to give a detailed reason for my having pre-
viously placed this parasite in the genus Herpetomonas Kent, for the reason
that up to the present I was unable to study its complete extra-corporeal life
history. Now however I am in a position to examine all the evidence in favour
of this view. At present these parasites are placed in a most anomalous posi-
tion as regards their relationships and affinities, for the genus Leishmania,
Ross, has so far as I am aware never been defined since Ross created it in 1903 ;
for reasons that are obvious, his definition cannot hold to-day. It is not then to
be wondered that they are placed. by some authorities close to the Piroplctsmata,
and. at present all that can be said regarding their nature is that they are
E 2
30
flagellates. I have now shewn that one of these parasites is more than a mere
flagellate, and that it is a true insect parasite, in that it undergoes its complete
life history in the alimentary tract of an insect, and that human blood ingested
by this insect is injurious to its development. This fact strongly suggests that
it was originally a harmless parasite of the bed-bug, and that as this insect has
slowly become sanguivorous in its habits, the life history of the parasite has
thus become modified ; and that it is no longer found in its natural state in the
bug. It can however still maintain itself in the bug, but only under very
special conditions, that is, when the bug only feeds once on a person infected
with Kala Azar. Here we have a remarkable adaptation of a parasite to the
altered habits of its host. Are we however justified in considering this to be
the probable origin of this human parasite ? In order to answer this question it
is necessary to see whether there is at present any known species of insect
flagellate whose life history is showing signs of modification. There is fortu-
nately a good example to be found in the case of the crithidia* ( C. melophagia
Flu.) which is parasitic in Melophagus ovinus for Miss Porter who has carefully
studied its life history finds that it may be transmitted from one ked to another
by means of the post-flagellates passed out in the excreta of the insect, but that
this is not now the regular method of the transmission of this flagellate ; it now
nearly always passes from one insect to another by hereditary transmission. It
is however interesting to know that this parasite may still be transmitted by
the simplest means. Another instance is I believe to be found in the herpeto-
monads of mosquitoes. These flagellates almost invariably undergo their post-
flagellate stage in the hind guts of their hosts, but they may occasionally round
up in the midgut ; this is a very suggestive observation for it will explain how
such a parasite may become transferred to other hosts. It is only recently that
the life histories of these insect flagellates have been studied with any degree of
precision, and I have little doubt that when such forms occur in blood-sucking
insects as for instance C. conorrhini in Conorrhinus rubrofasciatus, they will
enable us to settle the question regarding the origin of the parasite of Kala
Azar, for here we have an insect which at the present time is altering its habits
and becoming a blood-sucker.
The parasite of Kala Azar is then a true insect flagellate and like all these
forms it has three phases in its life history, pre-flagellate, flagellate, and. post-
flagellate ; in its pre flagellate stage it is a round or oval body which divides by
simple longitudinal fission, or by multiple segmentation. In its flagellate stage
it multiplies by rosette formation and later by longitudinal division, which may
* I am entirely in agreement with Miss Porter and Dr. Swingle that the flagellate found in M. ovinus is a
true insect parasite, and that it has no connection with any trypanosome which may occur in the blood of a
sheep.
31
be equal or unequal. In its post-flagellate stage the flagellates shorten and
their flagella are shed, they then divide several times and finally come back to
-the round or oval stage containing a nucleus and blepharoplast. From a refer-
ence to my definition of the genus Herpetomonas given in 1908, it will be seen
that the parasite of Kala Azar corresponds exactly to it, and I have already
shewn. that there are several species which are distinguishable from it, I can
therefore see no reason for creating a new genus for it. As the parasite of
sleeping sickness passes one stage of its life history in the blood and organs of
man, and its multiplicative stage in an invertebrate, Glossina palpalis, so in the
same way the parasite of Indian Kala Azar passes one stage of the life history
in the blood and organs of man and its multiplicative stage in an invertebrate,
Cimex rotundatus ; there would however be no justification for placing the
parasite of Sleeping Sickness in any other genus but the Trypanosoma . By
placing the parasite of Kala Azar in the genus Herpetomonas its relationships
and affinities are exactly defined, and there can be no possible con fusion regard-
ing its nature. It should therefore in future be known as Herpetomonas dono-
vani , Laveran and Mesnil.
Kala Azar in Madras.
Since Donovan's discovery of the disease in Madras, it is now known to be
one of the important causes of mortality ; owing however to the fact that it is a
chronic disease, it is apt to be lost sight of, and the vast majority of those
attacked have no idea whatever that they are victims of this deadly disease.
Unfortunately it is impossible to even guess the number of those who annually
die of it. The reason for this is simple, it is an insidious disease, developing
slowly and taking months before it proves fatal ; it is frequently overlooked,
and it is commonly diagnosed as typhoid ; death may result from exhaustion,
dysentery, pneumonia, peritonitis, or from heart failure, the result of advanced
emaciation. Death is then stated to be due to one or other of these causes.
I have no doubt therefore that the available statistics relating to this disease
represent only a small number of those who actually die of it. Recently these
sufferers have been disinclined to enter a hospital, for it is now becoming
known that very little can be done for them, so that even hospital statistics
do not represent the extent of the disease in Madras. It is prevalent in certain
streets of George Town, in Royapuram, in Vepery, Puraswakam, in Choolai,
in Triplicane, and I have seen cases from other parts of the Town. It is then
widely distributed. In order to find out the real extent of the disease in
Madras, and as to whether it is spreading, the co-operation of the people them-
selves is most desirable ; the Indian practitioners who doubtless see most of the
cases could render valuable assistance in mapping out the distribution and
32
extent. Public lectures of a simple nature describing the disease, its parasite
and the danger of allowing bugs to feed on a patient, would help in diffusing
knowledge regarding this fatal malady. To those who are anxious to avoid it, I
have no hesitation in saying that the bed-bug is the transmitter, and great care
should be taken to prevent bugs from feeding on a patient with marked
dysentery, as such a patient generally has large numbers of parasites in his
circulating blood.
The main conclusion to be drawn from these new observations is as follows :-
The parasites taken up by a bug, in its last feed from an infected person,
are the only ones which can develop, and they can only complete their develop-
ment, provided the bug does not again feed before the final post-flagellates are
formed. This statement may have however to be modified later. I need hardly
say that many more experiments will be carried out in order to clear up some
points which are yet obscure, for instance, it is important to know whether
bugs fed. on a case whose blood contains a few parasites, will shew a heavy
infection with flagellates ; also whether the parasite can complete its develop-
ment, in any stage of the bug, and during the Madras hot weather temperature.
It is hoped also to carry out some immunity experiments in order to see whether
a healthy person's blood will destroy the flagellates, and as to whether this will
lead to some satisfactory form of treatment. Experiments will also be carried.
out with animals, the dog for instance, to again see whether it is the natural
reservoir of the parasite in Madras. Transmission experiments with both Cimex
votundatus and Cimex lectularius and the parasite of Oriental Sore are now in
progress and from the new facts discovered as a result of the further study of the
allied parasite, I have now every hope of transmitting this parasite by the
bed-bug.
33
NOTE.
Since the above memoir was written, I have succeeded in infecting a white
rat, by inoculating it intra-peritoneally with 3 c. c. of emulsion, made from a
spleen, removed. post mortem from a patient who died of Kala Azar. The rat
died two hours after it was given a second inoculation of 1 c. c. of a similar
emulsion ; this being 15 days after the first inoculation. Its liver and spleen
were considerably enlarged and contained large numbers of the typical
parasites. None were found in the bone-marrow. It will be remembered. that
Laveran and Petit have carried out a very similar experiment with Herpeto-
monas Wanturn Nicolle, but the white rats they inoculated never showed any
parasites in their organs ; this in my opinion suggests that the two parasites
are totally distinct species. I have also inoculated monkeys, dogs, jackals,
rabbits, guinea-pigs, cats, a calf, a pig and a goat, but at present these animals
show no signs of having contracted the disease. The above animals, as well
as other white rats, similarly inoculated, will be kept under observation for a
long time so that there will then be no doubt as to whether they are suscep-
tible or not.
34
EXPLANATION OF PLATES.
Figure
1. A large mononuclear shewing the early changes towards disintegration;
it contains a single unchanged parasite. Cimex lectularius.
„
2. A polymorphonuclear leucocyte also disintegrating; it contains a single
unchanged parasite. Cimex lectularius.
„
3. A similar cell. Cimex lectularius.
„
4. Another polymorphonuclear leucocyte. Cimex lectularius.
„
5. A large mononuclear leucocyte, it contains a parasite which shews the
earliest changes towards development. Cimex lectularius.
„
6. A free parasite also shewing early developmental changes. Cimex
lectularius.
„
7. A much enlarged parasite lying at the margin of a disintegrated leuco-
cyte. These are the forms which it is important to observe in the
insect which is suspected to be the probable carrier. Cimex lectu-
larius.
„
8. A free parasite, the protoplasm stains blue and is granular, the nucleus
is enlarged and kidney shaped, and the blepharoplast is thickened
and elongated. Cimex rotundatus.
Figures 9, 10 and 11. Free parasites, the same as that depicted in figure 8. Cimex rotun-
datus.
Figure
12. A still further enlarged parasite, the nucleus has divided, the blepharo-
plast is elongated, and the parasite itself about to divide. Lying
between the blepharoplast and the margin of the cell is the thickened
myoneme which is stretched out and shews the several strands.
Cimex rotundatus.
„
13. A similar parasite, the blepharoplast has here however divided before the
nucleus. Cimex rotundatus.
„
14. Another similar form. Cimex rotundatus.
„
15. Two enlarged parasites which have resulted from the division of a para-
site similar to that shewn in figure 14, in one the flagellum is just
about to be extruded. Cimex rotundatus.
„
16. Two young flagellates attached by the whole length of their bodies;
such a pair would originate from the parasite depicted in figure 13.
Cimex rotundatus.
„
17. Another pair of young flgellates attached only by their posterior ends
Cimex rotundatus.
„
18. A young growing parasite shewing the thickened flagellar myoneme,
the appearance of a vacuole is not seen. Cimex rotundatus.
„
19. Another similar parasite, here however the flagellar myoneme has the
appearance of a vacuole with a brush of filaments lying in it. Cimex
rotundatus.
35
Figure
20. Another similar parasite, the flagellum is seen as a single band lying
across the vacuole. Cimex rotundatus.
„
21. Similar flagellate, two flagella are grow ing out. Cimex rotundatus.
,,
22. A larger form, both flagella have now freed themselves. Cimex rotun-
datus.
,,
23. A round flagellate, the nucleus has divided, and the blepharoplast is
about to divide. Cimex rotundatus.
,,
24. Twin flagellates about to divide further. Cimex rotundatus.
„
25. A young flagellate dividing. Cimex rotundatus.
„
26. An elongated flagellate about to divide. Cimex lectularius.
,,
27. Twin flagellates dividing further. Cimex lectularius.
„
28. Spindle-shaped flagellate shewing multiple segmentation. Cimex lectu-
larius.
„
29. Multiple segmentation in the flagellate stage. Cimex rotundatus.
„
30. Young elongated flagellates attached by their poles. Cimex lectu-
larius.
„
31. A group of three elongated flagellates. Cimex lectularius.
„
32. Twin flagellates shewing multiple segmentation into six. Cimex lectu-
larius.
,,
33. Large round parasite shewing multiple segmentation into eight. Cimex
lectularius.
„
34. A large spindle-shaped flagellate. Cimex lectularius.
„
35. The typical adult flagellate stage of Herpetomonas donovani Cimex
lectularius.
„
36. Two small flagellates with long flagella. Cimex lectularius.
„
37. The early stage of multiple segmentation. Cimex lectularius.
Figures 38 and 39. Small flagellates undergoing multiple segmentation. Cimex lectularius.
Figure
40. Three flagellates which were attached to a cell by their flagella. Cimex
lectularius.
,,
41. A large round flagellate, its nucleus has divided up, its blepharoplast
is still undivided, and it has a single long flagellum. Cimex lectu-
larius.
„
42. Two long flagellates. Cimex lectularius.
„
43. Another pair of mature flagellates. Cimex lectularius.
„
44. A spindle-shaped flagellate shewing a part of its posterior end breaking
off. Cimex lectularius.
„
45. A small rosette. Cimex lectularius.
„
46. A large rosette containing about twenty-eight parasites. Cimex lectu-
larius
„
47. An early post-flagellate, the parasite is rounding up and dividing.
Cimex lectularius.
„
48. Another similar parasite. Cimex lectularius.
F
36
Figure
49. Another post-flagellate form, the posterior end is still pointed. Cimex
lectularius.
„
50. A long flagellate about to round up, its flagella have already partly
broken off. Cimex lectularius.
Figures 51 to 66. Various small post-flagellates, they shew the light staining protoplasm ,
granular nuclei, and the remains of flagella, several are dividing
again. Cimex lectularius.
„
67 to 73. The final post-flagellate stage. Cimex lectularius.
All the figures were drawn with the aid of a camera lucida, with Leitz 1-16 achromatic
objective, a No. 8 compensating eyepiece, except figures 2, 3, 4, 5 and 46, which were drawn
with a No. 4 eyepiece. It will be noted that most of the drawings were made from Cimex
lectularius.
37
LIST OF REFERENCES.
Patton, W. S. Preliminary Report on the Development of the Leishman-Donovan Body in
the Bed Bug. Scientific Memoirs by Officers of the Medical and
Sanitary Departments of the Government of India. New Series,
No. 27, 1907.
„
„ The Development of the Leishman-Donovan Parasite in Cimex rotundatus.
Scientific Memoirs by Officers of the Medical and Sanitary Departments
of the Government of India. New Series, No. 31, 1907.
Rogers, L. Preliminary Report on the Development of Trypanosoma in cultures of the
Cunningham-Leishman-Donovan Bodies of Cachexial Fevers and Kala
Azar. The Lancet, July 23, pages 215 to 216.
„
„
On the Development of Flagellated Organisms ( Trypanosomes) from the
Spleen Protozoic Parasites of Cachexial Fevers and Kala Azar.
Quarterly Journal of Microscopical Science. New Series, No. 9, 191.
Christophers,
S. R.
On parasites found in persons suffering from enlargement of the Spleen in
India (Third Report). Scientific Memoirs by Officers of the Medical and
Sanitary Departments of the Government of India. New Series, No. 15.
Leishman, W. B.
and Statham,
J. C. B.
The Development of the Leishman Body in Cultivation. The Journal of
the Royal Army Medical Corps. Vol. 4, No. 3, 1905.
Manson, P., and
Low, G. C.
The Leishman-Donovan Body and Tropical Splenomegaly. British
Medical Journal, pp. 183—186, 1904.
„
„
The Leishman-Donovan Body in ulcerated surfaces : a possible route of
its escape from the human body. British Medical Journal, page 11,
1904.
Statham, J. C.B. Journal of the Royal Army Medical Corps, Vol. 4, No. 3, page 326, 1905.
Manson, P.
The Lane Lectures on Tropical Diseases, page 146.
Critien, A.
Kala Azar in Malta. British Medical Journal, page 198, 1911.
Rogers, L.
Further Work on the Development of the Herpetomonas of Kala Azar and
Cachexial Fever from Leishman-Donovan bodies. Proceedings of the
Royal Society. Series B, No. 517, 1906.
Leishman, W. B. Critical Review. Kala Azar and Tropical Sore. Quarterly Journal of
Medicine, No. 17, 1911.
Prashad, D. N. Kala Azar in Patna. Indian Medical Gazette, August 1910.
Cochran, S.
The Superficial Lymph-Nodes as a Source of Leishmania for Diagnosis of
cases of Kala Azar. Jour. Trop. Med., January 1912, page 9.
Bentley, C. A. Notes upon Kala Azar and the new parasite. British Medical Journal
September 17th, pp. 653—655.
Fantham, H. B. Herpetomonas pediculi. Nov. Spec. Parasitic in the Alimentary Tract of
Pediculus vestimenti, the Human Body Louse. Proceedings of the Royal
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Donovan, C.
On Kala Azar in Madras. Transactions of the Bombay Medical Congress,
pp. 159—166, 1909.
38
Donovan, C. Kala Azar in Madras, especially with regard to its connection with the
dog and the bug ( Conorrhinus ) The Lancet, pp. 1495—1496.
Nicolle, C., and
Comte, G.
Origine canine du Kala Azar. Comp. Rend Acad de Sciences, April 6th,
pp. 788—791, 1908; Arch. Inst. Pasteur de Tunis, April, pp. 59—62.
1908; Bull. Soc. Pathol. Exot, May, pp. 299–301, 1908.
Basile, C.
Sulle Leishmanissi del cani e sull' ospite intermedis del Kala Azar infantile,
Rendiconti, R. Accad. die Lincei. Nov. pp. 523—527, 1910 ; Sulla-
transmissione della Leishmanissi Rendiconti. R. Accad. die Lincei,
January, pp. 50—51, 1911 ; Sulla Leishmanissi e sul suo modo di trans-
missione. Rendiconti R. Accad die Lincei, Feb. pp. 278—282, 1911.
„
Sulla Leishmanissi e sul suo modo di transmissione. Rendiconti R. Accad
dei Lincei, March 1911, pp. 479—485.
„
and
Visentini.
Sulla identita della Leishmanissi (culture su mezzo n. n. n. dei parassiti
della Leishmanissi nel cane) Rendiconti R. Accad dei Lincei, April
pp. 590—591, 1911.
Basile, C.
Sulla Lieshmanissi c sul suo modo di transmissione. Rendiconti R. Accad
dei Lincei, June, pp. 955—959, 1911.
Sangiorgi, G. Sulla presenza di forma di Leishmania infantum (Nicolle) nella pulce ( Pulex
serraticeps ) dei cani randagi di Catania Pathologica, Jan., pp. 23—24,
1911; Ancora sulla presenza di forma di Leishmania nel Pulex serraticeps.
Pathologica, March, pp. 89—90, 1911 ; Transmissione naturale della
Leishmanissi da Cane per mezzo della Pulex serraticeps Pathologica,
May, pp. 231—233, 1911.
Basile, C.
Sulla Leishmanissi c sul suo modo di transmissione. Rendiconti R. Accad
dei Lincei, July, pp. 72—73, 1911.
Franchini, G.
La vita e lo sviluppo della Leishmania Donovani nelle cimici, nelle pulci e
nei pidocchi. Studi intorno
alle malattie Tropicali dell Italia
meridionale c insulare e delle Colonie 1911, p. 1; Note on Leishmania
and mosquitoes. The Leishmania Donovani can live and develop in the
intestinal tract of the anopheles. The Lancet, Nov. 1911, pp. 1268
—1269.
Gabbi, U.
The pulci canina et umana non propagano il Kala Azar. Malaria e
malattei dei Paesi Caldi, 1911, October, pp. 285—288.
Porter, A.
The structure and Life History of Crithidia Pulicis n. sp. parasitic in the
Alimentary tract of the Human Flea. Pulex irritans. Parasitology
i. v. No. 3, 1911. The structure and Life History of Crithidia
Melophagia (Flea), an ectoparasite of the sheep ked, Melophagus ovinus.
Quart. Journ. Mic. Sci. 4v, pp. 189—224.
Swingle, L. D. The Transmission of Trypanosoma Lewisi by Rat fleas ( Cyratophyllus sp.
and Pulex sp.) with short descriptions of three new herpetomonads.
The Journal of Infectious Diseases, March 1911, pp. 125—146.
Wenyon, C. M. Oriental Sore in Bagdad, together with observations on a Gregarine in
Stegomyia Fasciata, the Hæmogregarina of dogs and the flagellates of
House flies. Parasitology Oct. 1911 ; Leishmania and mosquitoes.
The Lancet, Nov. 1911, pp. 1362—1363.
SUPDT. GOVT. PRINTING INDIA, 8 HASTINGS STREET, CALCUTTA.
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35 40
Pholoĝravure. Scale of
S u r v y o f I n d i a O f f i c e s , C u l c u t t a . , 1 9 1 2 .
Indian Demp Drugs Commission .
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1894.
Price Two Rupees Eight Annas.
I P / DA, /. V 32.d.
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EVIDENCE OF WITNESSES
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