NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
189
Case X.—Jalpaiguri. September 1907.
Police Constable.
Length of residence in Duars. —On survey duty in Duars for six months.
History.—Himself, Wife, and daughter all suffered much from fever. States that as a result
of taking quinine he had freedom from fever for a time. A month before attack
he began to suffer again. Ten days before his attack he had fever, and also for the
three days preceding the Black-water Fever. On account of a police case he had to
go up to Jalpaiguri. About 7 A.M. on the day of his case he took quinine.
Going to the police station he was taken ill, about 11 A.M., with Black-water
Fever.
Seen by us on second day. No parasites but two pigmented cells seen in counting 500
leucocytes.
A count of leucocytes gave :—
Polymorphonuclears
..
..
..
.. ..
48.4%
Large mononuclears
..
..
..
..
..
26.6%
Small mononuclears
..
.. .. .. ..
24%
Eosinophiles
.. .. .. .. ..
1%
Case XI.—Monabari garden. October 1907.
Bengali Babu. Age 50.
Native country.—Dacca.
Length of residence in Dooars.—18 years.
History.—Before coming to Monabari he was seven years at Bagracote where he states
he did not get much fever. During the three months he spent at Monabari he had
constant fever, not less than two attacks every month.
Black-water Fever occurred on the evening of Saturday six hours after taking 10 grains
of quinine. Urine at first was very dark but it cleared up in less than twenty-
four hours.
Seen by us on the second day Sixteen hours after the onset of the attack. No malarial
parasites but 15 pigmented cells seen in account of 500 leucocytes. Cells containing
included red cell shadows were also present.
Leucocytes were as follows :—
Polymorphonuclears
. .
. .
...
..
61%
Large mononuclears ..
..
. .
. .
33%
Small mononuclears
.. ..
..
. .
6%
Eosinophiles
..
. .
..
. .
0
Had a second attack six months later. Vide case XXVII.
227 H. D.
3
B
190
Case XII.—Pathajora garden. October 1907.
Malpaharia Sirdar.
Native country.—Santal Parganas.
Length of residence in the Duars. —15 years.
History.—Had been working lately at water works at the foot of the Pathajora
gorge. He got severely chilled and got bad fever for which he was given
quinine. There was no history of a rigor but severe vomiting and for twenty-
four hours he passed reddish black urine.
Seen by us on the third day when the hæmoglobinuria was over. He was anæmic and
slightly jaundiced. The temperature was still high. The spleen was enlarged.
No parasites and no pigmented leucocytes. Engulfed shadow corpuscle present.
A count of leucocytes gave :—
Polymorphonuclears
..
..
. .
..
4
9%
Large mononuclears
.. ..
. .
..
24.6%
Small mononuclears
..
..
.. ..
21%
Eosinophiles
. .
.. .. ..
5.4%
Case XIII.—Nagrakata garden. October 1907.
European child. Age 3 years.
History.—Had two attacks one on the 14th October and one on the 22nd October, in
both of which there was very transient hæmoglobinuria and the child very
slightly ill. It being noticed that the urine was red samples were on each
occasion sent to Doctor Stone who noticed the nature of the condition.
Blood examined on the first day showed quartan parasites and pigmented leuco-
cytes.
Case XIV.—Jalpaiguri. November 1907.
Police Constable. Second attack following that recorded as Case X.
Seen by us on the third day. No malarial parasites. Four pigmented leucocytes seen in
a count of 500 cells. Engulfed red cells including one apparently unaltered
present in mononuclears cells.
Leucocytes count as follows :—
Polymorphonuclears
.. .. .. ..
59.4%
Large mononuclears
.. .. .. ..
26.4%
Small mononuclear
.. .. .. ..
8.6%
Eosinophiles
.. .. .. ..
5.6%
191
Case XV.—Moortee garden. February 1908.
Bengali Babu.
Length of residence in Duars.—7 years.
History.—States that his wife and himself had been constantly getting fever.
Seen by us on 4th day when hæmoglobinuria was over. Urobilin present in urine. No
malarial parasites and no pigmented leucocytes. A few engulfed red cell
shadows seen in mononuclear cells.
Leucocytes count gave :—
Polymorphonuclears
..
..
..
. .
54.2%
Large mononuclears
..
..
..
. . .
24.8%
Small mononuclears
..
..
..
..
20.8%
Eosinophiles
..
..
..
. .
2%
His wife seen at the time had also urobilin in her urine.
Case XVI. —Chota Nagpur, December 1907.
European. Age 27.
In " Timber."
History.—Formerly a planter in the Duars. Has lately been living at Kalunga
above Purulia, Chota Nagpur. Was quite well up to ten months ago when he
began to get fever characterised by vomiting. At first these . attacks lasted
three or four days. They then became more frequent but the attacks were
not so bad. Had fever a few weeks before his present attack. On the night
of his attack he was travelling to Calcutta, and, feeling seedy, took quinine. This
was about 9 P.M. In the night he was attacked with Black-water Fever,
and was admitted into hospital next morning. Temperature 104. He exhibited
all the characteristic signs of the disease. Urine hæmoglobinous. Spleen 3½
inches below the costal margin.
Seen by us after the hæmoglobinuria was over, but two films taken during the
hæmoglobinuria were kindly given to us by Major Rogers, I.M.S.
Blood. —No malarial parasites or pigmented leucocytes. Occasional included red cell
shadows seen in mononuclear cells. Four nucleated red cells seen whilst counting
800 leucocytes.
A count of 2,000 leucocytes gave :–
Polymoiphonuclears
..
..
..
. .
56.3%
Large mononuclears
..
..
..
. .
17.7%
Small mononuclears
..
..
..
. .
25.3%
Eosinophiles
.. .. .. ..
.4%
192
Associated conditions. —One other European lived at Kalunga. He also was stated
by the patient to suffer from constant fever.
Case XVII —Baradigi garden. December 1907
Bengali Babu. Age 28.
Native country.—Ferakpur.
Length of residence in Duars.—8 years with intervals on leave at home.
History.—Had. " jaundice " in the Dooars four years ago. This came on suddenly
after fever and left him very weak. Last return from home December 1906.
Was ten months in Central Duars where he only remembers having fever once.
He has been six weeks at Baradigi where he states he has had no fever. On
13th December 1907 was feverish, and was given 15 grains of quinine on this and
the following day. This last dose he took about 3 P.M. On 16th December 1907
he felt fairly well, until shortly before 3 P.M. when he passed some reddish black
urine. With this he had ague," headache, anti a temperature of 104. He
passed dark urine four times during the night.
On morning of 17th December 1907 his temperature was 99 and the urine was clear, but
with a sediment. Early in the morning was given -5 grains quinine. He was
seen about 11 A.M. by Dr. McCutcheon who took blood films and noted the
temperature to be 103. About 12-30 P.M. the patient is stated to have passed
some more slightly red urine.
On morning of 18th December 1907 the temperature was normal.
Seen by us on the 19th. Mucus membranes anæmic, yellowness of conjunctivæ distinct.
Spleen three fingers-breadth below costal margin.
B l o o d .
— I s o t o n i c p o i n t N / 1 3 N o m a l a r i a l p a r a s i t e s , b u t p i g m e n t e d l e u c o c y t e s p r e s e n t .
On the 19th large endothelial plaques and mononuclear cells, many of them
containing shadow corpuscles, were very conspicuous.
Leucocyte count gave
17th December 1907.
19th December 1907.
Polymorphonuclears
48.9.%
62.3%
Large mononuclears
. . . . . .
30.8%
22.3%
Small menonuolears
..
..
20.1%
12.7%
Eosinophiles
..
..
..
.2%
2.4%
Case XVIII.—Baradigi garden. December 1907.
Bengali Babu. Age 30.
Native country.—Nadya.
Length of residence in Duars.—9 years,
193
History .—No history of previous attacks. Has had enlarged spleen for ten years or
more. Was recently home for eight months. Has been back in the Duars for 15
months, six at Sissibari, one at Bentguri, ,some months near Darjeeling, and
two months at Baradigi. Since return from home has been getting fever once
a m o n t h o r s o . A t S i s s i b a r i h a d f i v e a t t a c k s .
13th December 1907.—Felt a little fever and ague for which he took 10 grains of
quinine.
14th December 1907.—Felt all right.
15th December 1907.—Was all right and working in the tea-house, but at 3 P.M. passed
reddish black urine and had ague. His temperature shortly after was 105. He
passed dark urine three times up to 10 P.M.
16th December 1907.—Urine clear. Temperature in the morning 97, at evening 100.
17th December 1907.—Seen by Dr. McCutcheon, who took a blood film. His temperature
on this and the next day was normal in the morning but rose to 100 in the evening.
Seen by us 19th December 1907.—Anæmia not marked. No distinct yellowness.
Spleen five fingers below the costal margin. Blood taken on the 17th showed no
parasites or pigmented cells, nor were engulfed shadow corpuscles seen. Large
mononuclears numbered in a count of 1,200 leucocytes 18 per cent. Some
myelocytes were present.
Case XIX. —Bentguri garden. January 1908.
Mahomedan Bearer, age 32.
Native country.—Mongyr District.
Length of residence in Duars. -12 years.
History. Went home on leave on account of fever and spleen. Suffered severely
whilst at home from fever. Came back to Bentguri five months ago, and has
been living at the Assistant's bungalow, until six weeks ago when he moved with
his master to the Manager's bungalow.
He is believed by his master to have had previous attacks, but he himself denies this.
28 th December 1907.—Had slight fever and took 10 grains of quinine. States he has
had no quinine since except two doses of spleen mixture which he took four days
before the onset of the present attack.
7 th January 1908.—In the evening about 6 P.M._had a little fever and was given 10
grains phenacetin by his master.
8th January 1908.—In the morning felt all right and worked till 10-30 A.M. At this
time he had a severe rigor lasting about two hours with an intermission during
which he sweated profusely. Urine passed at 1-30 P.M. and in the afternoon
hemoglobinous. His temperature at 2 and at 4 P.M. was 102.
227 H. D.
3c
194
Seen by us about 8 P.M. Spleen two finger-breadths below costal margin. Tempera-
ture 101. Splenic puncture gave a small quantity of blood very rich in cells.
Blood.—Serum separated from clot, deep yellow colour, with a reddish tinge. No
solution of the clot in serum, or deepening of red colour of serum took place even
after many hours. On morning of 9th January 1908 serum is lighter in colour .
H æ m o g l o b i n æ m i a d o u b t f u l .
Isotonic point on morning 9th :—N/13
Hæmosozic value at 9 A.M., 9th January 1908
..
.. 1.06%
Films of peripheral blood taken 8 P.M. on 8th January 1908 show no parasites and
no pigmented leucocytes. No parasites or pigmented leucocytes were found in the splenic
films.
A count in each case of 600 gave as follows :—
8 P.M.
9 A.M.
4-30 P.M.
8th January 9th January 9th January
1908.
1908.
1908.
Polymorphonuclears
. .
. . 83%
67.5%
54%
Large mononuclears
..
.. 9.6%
8%
13%
Macrophages
..
..
.. 1.3%
. .
. .
Small mononuclears ..
..
.. 6%
18%
30%
Eosinophiles
. .
..
.. 0%
6.5%
3 %
Measurement of red cells showed as follows :—
8 P.M.
4-30 P.M.
8th January 9th January
1908.
1908.
Large cells measuring 140
..
..
.. 49%
17.5%
Medium cells measuring 120
..
..
.. 4 6 %
7 0 %
Small cells measuring 100 ..
..
..
.. 5 %
7.5%
Examination of splenic films showed two somewhat doubtful malignant rings but no
pigment. The following type of cells are distinguishable :-
1. Large macrophage type. Protoplasm light coloured containing small vacuoles, diffuse
reddish stippling and a few larger reddish granules. Many of these cells contain decolour-
ised red cells and greenish masses. Throughout the film are many globular masses formed of de-
tached protoplasm of this and the next type of cell.
2. Large cells with rounder nuclei and with protoplasm which takes a deeper stain and is
firmer in consistence.
3. Small mononuclear cells with voluminous clear hyaline protoplasm, similar to small
mononuclear leucocytes.
195
4. Small mononuclear cells with scanty deeply staining protoplasm. Lymphocyte type.
5. Still smaller cells with very deeply staining protoplasm containing a few red granules.
6. Polymorphonuclear leucocytes and transitional cells.
Some stromata of red cells are seen resembling those sometimes present when blood is
treated with hypotonic salt solutions.
Hœmolysis experiments.
Black-water Fever serum
.. normal corpuscles
.. normal serum .. nil.
, ,
. . washed normal corpuscles ..
..
. .
. . nil.
, ,
. . washed corpuscles of a malarial
..
marked
subject.
agglutination
Black-water Fever corpuscles washed serum of malarial subject ..
. .
nil.
Urine—
First sample passed 1-30 P.M., 8th January 1908.—When first seen a somewhat impure
rosy red. Showed marked oxyhæmoglobin bands with a faint band in the red
and a broad band in the blue end of the spectrum. Next morning the band in
the red (indicating met-mæmoglobin) was much more marked.
Second sample dark brown hæmoglobin bands present with distinct band in the red.
Hœmosozic value of urine : —
Urine passed 1-30 P.M., 8th January 1908
..
. . .251 per cent. salt,
Urine passed morning, 9th January 1908
..
.. .834 per cent. salt.
Associated conditions.—The patient was one of four servants who had been living with
their master at the Assistants' `bungalow, but had recently come to live in the
servant lines at the Manager's bungalow, the master having changed his quarters
temporarily on account of constant fever.
The Assistants' bungalow was situated in the bend of a small rivulet swarming with
anopheles and within 50 yards of large cooly lines.
The condition of the other people living here was :—
Mr. J.—Had fever recently, is taking quinine, blood anæmic.
Bearer.—Intensely anæmic. Enlarged spleen. Simple tertian infection.
Syce.—Intensely anæmic. Enlarged spleen. Simple tertian infection.
Waterman.—Fever at the time. Scanty malignant tertian rings. Enlarged spleen,
It was evident that all these people at the Assistants' bungalow had been subjected lat-
terly to .malarious conditions of great intensity,
196
Case XX. —Hyapatha garden. January 1908.
Bengali Babu. Age 20.
Length of residence in Duars.—5 years.
H i s t o r y .
— N o h i s t o r y o f p r e v i o u s a t t a c k s . H a s b e e n t e n m o n t h s a t H y a p a t h a . T h r e e
months ago had " liver " and was yellow in the eyes. He has had enlarged
spleen for one year.
13th January 1908. —At 11 A.M. had fever with ague and nausea. Did not attend work
after this on account of sickness.
14th January 1908.—Took three tabloids of quinine, 5 grains each.
15th January 1908.—Took four tabloids of 5 grains each.
16th January 1908.—Took two tabloids at 8 a.m. and a dose of spleen mixture at 9 a.m.
At 10 a.m. had ague. At 2-30 p.m. passed dark red urine and continued to pass
urine of a dark ruby red all day.
Seen by us at 7 p.m. Complains of epigastric pain. Spleen below costal margin. Pulse
full and of high tension. Coagulation of blood markedly increased. Tempera-
ture 104.8.
Splenic puncture was performed within a few minutes of our anival.
Blood—
Coagulation markedly increased.
Hæmoglobinæmia shown by receiving blood into one per cent. salt and
centrifugalisation.
Serum separated from clot of an intense orange colour, bands of oxyhæmo-
globin being visible on spectroscopic examination.
Isotonic point—
N / 1 0
N
/ 1 2
N
/ 1 3
N
/ 1 4
N
/ 1 5
tint
tint
tint increased tint marked H.
Hœmosozic value.—1.12 per` cent. salt.
17th January 1908—Passed hæmoglobinous urine all day.
Isotonic point.—9 A.M.
N / 1 0
N
/12
N/ 13
N
/14
N
/ 1 5
tint
tint increased tint increased tint marked H.
227 H.D.
3D
197
Hœmosozic value.—1.258 per cent. salt.
Coagulation not so noticeably rapid as yesterday.
Serum separated from clot markedly yellow with orange tint. Hæmoglobinæmia shown
by receiving blood into n/10 citrate and centrifugalising.
Temperature varies between 101.6 and 104, falling after 5 p.m. to 98.8.
18 th January 1908.—Hæmoglobinous urine passed up to 12-50 P.M. After this the urine
contained albumen and urobilin but no hemoglobin.
Isotonic point .—9 A.M.
N
/ 1 2
N / 1 3
N / 1 4
N / 1 5
N
/ 1 6
tint
tint
h
hh
inc H.
1.50/
4 0 %
Hœmosozic value.—1.02% salt.
Coagulation delayed. Buffy coat present.
Hæmoglobinæmia not demonstrable. Yellow coloration much less intense.
Spleen about the same size. No noticeable enlargement of liver.
19th January 1908.—Urine contains much pink urates. No hæmoglobin but much urobilin
albumen present. Blood shows 17% large mononuclears and many endothelial
plaques.
Isotonic point.—6 P.M.
N
/ 1 2
N / 1 3
N
/ 1 4
N
/ 1 5
N / 1 6
Nil
Nil
h
hh
inc H.
22nd January 1908.—After several days convalescence temperature rose this afternoon to
100 and the urine became brown, but no urobilin could be detected. Spleen only
just palpable. Polychromasia and presence of large cells extremely conspicuous
No mononuclear increase. Some leucocytosis.
Went home for 21 days after his attack and was seen again on 20th May 1908. States
that he had no fever until the previous day. Fever commenced at 10 A.M.
continued all night until 3 P.M. yesterday at which time he took 15 grains quinine.
20th May 1908.—No noticeable anæmia. No enlargement of the spleen to be made out.
No parasites.
Isotonic point—
.476%
. 4 5 4 %
.434%
.4%
Nil
Nil
trace
hh
198
Emulsion of washed corpuscles hæmolysed by Class A. serum. Antibody 20 c.m. not que
protective against 150 c.m. S.R.C. serum.
Examination of splenic blood taken 4½ hours after passing the first sample of urine.
No malarial parasites.
Pigment (simple tertian) in endothelial cells and mononuclear leucocytes.
Phagocytosis of altered and apparently normal red blood corpuscles a very conspicuous fea-
ture. Small cells with crescentic nuclei containing each a single often quite normal looking
blood corpuscle are abundant. These cells have but little protoplasm and what there is
is extended around the engulfed cell.
• In some of the cells the protoplasm shews some fine red granules. The cells vary some-
what in size, the larger ones approaching in appearance mononuclear leucocytes but the most
numerous are small and nearly globular in shape.
The included red cells are generally quite unaltered a little paler than the free cells in the
eighbourhood ; others are pale with a faint yellowish tinge or show a rim of darker staining
substance around the periphery. The closest scrutiny failed to show in these cells either
malarial parasites or any indication of contained bodies.
Cells resembling these are seen, which in spite of the small quantity of protoplasm they
possess have engulfed two, three, or even four red cells, and others of the same type are seen
packed with a dozen or more red cells in various stages of decolouration.
Of macrophages there are two types :—
1. Cells of the nature of those just described which appear to be free cells and are gen-
erally more or less globular.
2. Large endothelial plaques often having two nuclei and containing besides red cells
various vacuoles and included masses.
In both types of cell the red cells vary from normal to small dark cells and cells in various
degrees decolourised.
Occasionally a shrunken cell of a greenish tinge is seen. A differential count of 2,200 cells
in the spleen gave :—
Large macrophages
..
..
..
..
.. 5.5%
Small mononuclear cells of various types ..
..
.. 49.8%
Large mononuclears leucocytes ..
..
.. .. ..
4.4%
Polymorphonuclear leucocytes ..
..
..
.. 13.7%
Eosinophile leucocytes ..
..
..
..
.. . 7 %
Large cells with basophilic protoplasm ..
..
..
1.8%
Cells of doubtful nature, free nuclei, etc. ..
..
..
24.0%
99.9%
Large macrophages containing red cells ..
..
..
1.7%
Small mononuclear cells containing red cells ..
..
.. 1.3%
199
The condition of the included red cells is shown by the following
Unaltered cells
Large macrophages
..
3
Small mononuclear phagocytes 37
Partially altered cells
Large macrophages
.. 10
Small mononuclear phagocytes ..
9
Vacuoles derived from engulfed
red cells.
Large macrophages
.. 22
Small mononuclear phagocytes
5
Small mononuclear cells which appear to be of the same type as the small phagocytes al-
ready noted .were numerous. They appeared very frequently to have been in active amœ-
boid movement when fixed by the drying of the film.
Blood—
Count of red cells gave on different dates
—
16th January 19th January 22nd January
1908.
1908.
1908.
Polychromasic cells
Nil.
2 %
1 8 %
Large corpuscles
46%
34%
23%
Medium corpuscles
52%
40%
53%
Small corpuscles
2%
2 4 %
4 %
Counts of 500 leucocytes gave
16th January 17th January 18th January 19th January 22nd Jan
uary
1908.
1908.
1908.
1908.
1908
Polymorphonuclears 63.7%
61.7%
57.4%
49.4%
73. %
Large mononuclears
23%
28.7%
22%
25.5%
9%
Small mononuclears
9.3%
9.5%
14%
19. 8%
9%
Eosinophiles
1.8%
2.1%
1. 6%
3 %
5%
Macrophages
2%
. . . .
5%
. . . .
3%
Urine.—Estimation of amount of hœmoglobin.
Time.
Specific
gravity.
Albumen
grammes
per litre.
Urine
Quantity.
Percent-
age Hæmo-
globin.
Total
Hæmo-
globin
(bloo
d equi-
valent).
2-30 P.M., 16th January 1908 ..
..
..
1.05
60 c.c.
10%
6 c.c.
11 P.M
,,
..
..
1018
.6 750 c.c.
6.6%
50 c.c.
9 A.M., 17th January 1908
..
..
1017
.6 550 c.c.
6.6%
37 c.c.
7 P.m
,,
..
..
1018
.7 550 c.c.
6.6%
37 c.c.
200
Time.
Special
gravity.
Albumen
grammes
per litre.
Urine
Quantity.
Percent-
age Hæmo-
glbin.
Total
Hæmo -
globin
(blood
equi-
valent).
12 P.M. 17th January 1908 ..
..
1020
.7 350 c.c.
6.6%
23 c.c.
12 NOON, 18th January 1908 ..
..
1018
.5 450 c.c.
5% 22.5 c.c.
12-50 P.M.
,,
. . . .
1020
.3 300 c.c.
2.5%
8 c.c.
TOTAL .. 183.5 c.c.
Urobilin slown by zinc test.—Zinc urobilin bands visible on ten-fold dilution in all the
samples.
Urine deposit
—
2-30 p.m. , 16th January 1908.—Casts not noticeable. Deposit chiefly formed of minute
globular masses.
11 p.m., 16th January 1908.—Deposit similar to last but contains a small number of
epithelial cells.
9 a.m. , 17th January 1908.—Deposit contains many cells. Cells with double nuclei
common. Cells appear to be kidney epithelium.
7 p.m. , 17th January 1908.—Deposit largely composed of such cells and cell débris.
12 noon , 18th January 1908.—Many cells and granular urates.
Phosphates.—Much increased in latter samples.
Case XXI.—Ellenbari. February 1908.
European. Age—35.
Length of residence in Duars— 5 years.
History.—Was at Faskowa, Eastern Duars. Went home ; returned in November
1907. Has taken quinine since coming out on Mondays and Fridays. Says he
was previously quite fit, but was noticed by his medical adviser to have been
looking latterly " very seedy." He states himself that he has had a heavy
cold which has made him feel weak in his legs (temperature ?).
21st February 1908.—Late at night took his ordinary dose of quinine.
22nd February 1908, 4 a.m.—Had a rigor and passed hæmoglobinous urine.
Seen by us at 10 A.M. on the same day. Spleen several inches below costal margin.
Complains of severe epigastric pain. Yellow tint just noticeable.
Blood. —Serum of an intense yellow colour with orange tint. Blood received in 5 per
cent. citrate and centrifugalised showed hæmoglobinær.