NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
3 58
plan out and commit different crimes, which they
hate when sober. They do not remember any-
thing done by them. It is often heard that mur-
ders have been committed in such a state. Hurt
and grievous hurt are small matters for these
people.
54. Thieves and other bad characters use them.
They plan out some device, and by this intoxica-
tion they fix their attention to it exclusively.
55. As far as I have ascertained, it is known
that robbers compel travellers to smoke ganja and
charas. As the travellers are not used to them,
they fall almost senseless and they are robbed.
Sometimes dhatura is also mixed with them.
Dhatura causes more pain, convulsions and sense-
lessness.
521
Kulu, Simla, Abbottabad or Sialkot, and if any dis-
crepancy is found it is rectified. The seal of the
Government is then affixed on the consignments of
charas. Permits are then prepared in triplicate
form. One copy of it is kept by the Ahlmad clerk
in his permit book; the second is given to the trader
(lit. owner), and the third is despatched to the
district into which the charas is to be conveyed.
95. Evidence* of MALIK KHAJAN SINGH, Excise Contractor, Rawalpindi.
As regards the use of the hemp drugs, charas,
ganja and bhang, I beg to state as follows :—
(a) Charas is neither prepared nor produced in
this district. It is imported from Kashmir,
Ladakh, Yarkand, and occasionally from Kabul,
and sold here and in other places. It is only smoked
and not eaten or drunk, and no sooner it is smoked
than the consumer gets intoxicated. It is generally
consumed by fakirs, sadhus, jogis, sanyasis, and
by some Hindus and Muhammadans also. The brain
is highly injured by its use, as it produces much
aridity, which sometimes results in insanity.
On account of the blood being dried up the con-
sumer becomes emaciated, and he generally becomes
unfit for work and spends his time in takias and
other such places in laziness.
Charas is an exceedingly noxious thing, its use
is day by day on the increase, and it rests with the
Government to put a check to it.
The imposition of a fair duty upon the imported
charas would not only prevent its increase, but
would also gradually decrease it.
(b) As regards the use of bhang, I beg to
submit that its use is less injurious than that of
charas, so that bhang, if moderately used, is quite
harmless. Indeed, bhang and its seeds are ad-
ministered in the treatment of certain diseases.
The existing system regarding the sale and gather-
ing of wild hemp is capable of being improved by
the issue of an order to the effect that everybody
should not be allowed to pluck and store it up,
as the people have opportunities to do at present.
Such a rule will, as a matter of course, cause a
decrease in the excessive use of bhang, which is
injurious.
(c) Ganja is neither produced nor consumed
in this district.
* Translation.
G. I. C. P. O.-No. 174 F. 4 C. D.—22-11-94.—1,512.
vol. v.
4
Inbian Temp Drugs Commission.
VOL. V.
EVIDENCE OF WITNESSES
FROM
NORTH–WESTERN PROVINCES AND OUDH
AND PUNJAB
TAKEN BEFORE THE
INDIAN HEMP DRUGS COMMISSION.
CALCUTTA:
OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING , INDIA.
1894.
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THE DEVELOPMENT OF THE PARASITE OF
INDIAN KALA AZAR
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THE DEVELOPMENT OF THE PARASITE OF•
I N D I A N K A L A A Z A R
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The Development of the Parasite of Indian Kala Azar (Herpetomonas
Donovani. Laveran and Mesnil.) in Cimex rotundatus, Sign. and in Cimex
lectularius, Linn. with some observations on the behaviour
of the Parasite in Conorrhinus rubrofasciatus, de Geer.
I N 1907 I described, in two memoirs, my experimental work on the etiology
of Indian Kala Azar, and I have since then devoted my spare time
to the study of the flagellates of the genus Herpetomonas, both in blood.
sucking and. non-blood. sucking insects, for I was convinced that these studies
would enable me to solve the problem of the method of transmission of the
human parasite ; I hoped some time later to have another opportunity of
continuing and completing my work on the etiology of Kala Azar. In
January 1912 I was placed on special duty in order to devote my whole time
to this work. A suitable case for feeding experiments was soon found in the
General Hospital, Madras, and a further discovery has been made, which
goes far towards solving the Kala Azar problem. In the present paper I
will describe these observations, but before doing so it will not be out of
place to review my previous work on this subject, and then to summarize all
the recent work on the infantile form of Kala Azar.
In my first memoir on the development of the parasite in Cimex
rotundatus, I gave a short account of Rogers' discovery of the flagellate stage
of the parasite, of Christophers' confirmation of this in Madras, and of the
similar work of Leishman and Statham in England. I then discussed the
various hypotheses which had been advanced to explain how the human body
might be primarily infected by the parasite. Manson and. Low's observations
on a case of Kala Azar in London led them to conclude that the parasite
could not be transmitted by means of the peripheral blood, as they failed to
find any parasites in films made from the finger blood, and they suggested
that the parasite may escape from the ulcers in the intestinal tract and be
passed out in the fæces. Statham, however, refuted this hypothesis for he
carried out a series of examinations and cultural experiments with the fæces
of a case of Kala Azar, and failed to find the parasite ; my observations made
along the same lines confirmed Statham's results. Later Manson again ad-
vanced the hypothesis that the parasite probably leaves the human body in the
discharges from ulcerated surfaces, intestinal or cutaneous, and that it may
be ingested by some foul feeding fly in which it may undergo multiplication,
and later be deposited when the fly came in contact with broken skin surface.
2
Critien revives this hypothesis, and. in a recent note draws attention to the
possibility of the parasite being transmitted by way of the intestinal tract,
for he states he has recovered it from the fæces of a case of Kala Azar.
Before it is possible to seriously consider this hypothesis, it is necessary
to at least attempt to explain how the parasites, which may be passed out in the
human fæces, can again find their way back to a clean person. It is well
known that these parasites will not develop into flagellates in any medium
infected with bacteria, so that it is difficult to understand how they can ever
become flagellates in the human discharges. This being the case, those.
parasites which are passed out must either be ingested by a fly, or they must
immediately be transferred to some broken skin surface on an uninfected
person. Now any foul feeding fly such as Musca nebulo, Fabr. already
contains bacteria in its intestinal tract, and I have carried out a series of
experiments by feeding both wild and bred house flies (Musca nebulo) on
splenic juice obtained from a patient suffering from Kala Azar, and found.
that the parasites degenerate in a few hours, and could not be recovered in
their excrement. It is difficult then to understand how a fly can play any
part in the transmission of the disease. If it is true that the parasite is directly
transferred to another person, there would then be no necessity for it to
flagellate when removed. from the human body ; it is possible that this may
take place in the case of animals. I have, however, no doubt that this method
of infection never takes place in the case of man.
The other hypothesis, suggested. first by Christophers, and later by Rogers,
that the parasite is ingested by a blood-sucking insect, has now been amply
supported by feeding experiments. That the parasite may pass into the.
stomach of a blood-sucking insect it is necessary for it to be present in the
circulating blood. Donovan and Christophers, early in their investigation,.
recorded having found the parasite in the white blood cells in films of finger
blood, and I have been able to confirm their observations. In 1906 I found.
the parasite in 38 out of 45 cases examined in the General Hospital, Madras
; I further pointed out that there were certain phases in the disease when
the parasites were present in large numbers in the circulating blood. These
periods are characterised by the onset of severe dysenteric symptoms pointing
to extensive ulceration of the large intestine. It should be noted that these
dysenteric attacks may supervene at an early stage of the disease, and the
patients may recover from them, a relapse later ending fatally. In many cases.
it was noted that during these attacks the parasites could be found in large
macrophages, and as many as 300 have been found in a single blood film. With
regard to the presence of the parasite in the circulating blood, it is necessary to
quote a recent statement made by Leishman. Commenting on the method of
3
demonstrating the presence of the parasite by the examination of the peripheral
blood, he says :— " The explanation for the general failure of this method in
Kala Azar is two-fold : the parasites, if present at all, are very rare, since they
are encountered in cells and not free, the intense leucopenia which is usually
found adds greatly to the difficulties of the search. In the Indian form very
few positive results have been mentioned, with the striking exception of
Donovan's success at Madras ; as already mentioned, he has demonstrated.
their presence in the peripheral blood in 93 . 2 per cent. of his recent Madras
cases. On the other hand, Prashad records 213 examinations of finger blood
with only one positive result, and the latter's experience is in accord with
that of most observers." This statement is not a fair comment on the work
which has been done in India on this part of the subject, for no mention is
made of Christophers' observations or those of the writer noted above. Since
my earlier observations I have only once failed. to find the parasite in the
blood of an undoubted case of Kala Azar and then it was subsequently found.
by Donovan. This work requires experience, and no weight can be attached to
Prashad's failures until it is known whether he has had special training in this
work. To one who is accustomed to finding the parasite in practically every
case, statements such as those quoted above are of no value. In the General
Hospital, Madras, the parasite has now been found in a large number of
cases at every stage of the disease, and the students are taught to diagnose
each case by finding the parasite in films of finger blood ; if this can be done
by students, it can surely be accomplished by experienced observers. In a
recent paper Cochran states that as he has failed to find the parasite in the
peripheral blood in cases of Kala Azar in Anhwai China, he has resorted
to the excision of lymph glands, from which smears are made in which the
parasite can be readily demonstrated. He states that the examination of
these films may occupy from five to twenty minutes. It may be of interest
to this observer to know that the writer is able to look over a blood film with
a No. 6, 7 or 8 dry objective in much less than five minutes, and can recognise
the parasite without using an oil immersion lens. I would strongly recom-
mend this observer to accustom himself to find the parasite with a dry objective
in a film containing a large number, such as a smear of splenic juice or that
of a lymph gland. The dangerous operation of splenic puncture for diagnostic
purposes has long since been given up in Madras, and I feel sure that gland.
excision would never be tolerated in this country ; both operations are unneces-
sary and unjustifiable.
The presence of the parasite in large numbers in the circulating blood
during dysenteric attacks is of peculiar interest, for Bentley long ago pointed
out that during the height of an epidemic in Assam, cases with dysentery
4
were soon followed by fresh ones in the same house, or among the attendants.
I have frequently found in Madras that a second case has occurred in the
same house in which a patient died as the result of severe dysentery, and.
I have recorded two instances of a number of cases in the same house, several
of which had severe dysentery which proved fatal.
Experiments with Blood - sucking Insects.
In 1907 I recorded the following feeding experiments, and as these appear
to have been lost sight of, it is well to again draw attention to them.
EXPERIMENT WITH LICE, PEDICULUS CAPITIS.
As the result of the examination of 149 lice, I came to the conclusion that
this insect could not possibly be the natural carrier for I was unable to find the
parasite undergoing any developmental changes in its alimentary tract.
PEDICULUS VESTIMENTI.
About fifteen lice were dissected after having fed on a suitable case, but I
was unable to find any changes towards development. It is interesting to note
that Fantham has recently described the life history of a species of herpeto
-monas ( H. vestimenti, Fantham) from the alimentary tract of this louse. It is
hoped that workers in other parts of the world, who undertake experiments with
this louse will carefully keep in view this harmless flagellate.
EXPERIMENTS WITH MOSQUITOES. CULEX FATIGANS.
One hundred and fifty-seven female mosquitoes were fed on suitable cases
and dissected at varying intervals with negative results. In Madras this
mosquito is naturally infected with a herpetomonas (H. culicis Novy), and it is
important to note that the infection is acquired by the larvæ. A complete
account of this flagellate will shortly be published.
NEOCELLIA STEPHENSI.
Forty specimens of this anopheles were fed on a case in whose peripheral
blood there were many parasites, and they were dissected with negative results.
This mosquito is the common anopheles of George Town, one of the endemic
foci of Kala Azar, and it was found to be infected naturally with a flagellate
which was also present in the larvæ. Reference will be made to this parasite
in connection with Franchini's recent experiments.