NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
13
macrophages seen in the organs in cases of malaria. In one of the cases malarial
pigment actually occurred in some of these cells along with the bodies under
discussion. I have never seen such large cells in fatal cases of malaria, and their
great development appears to be a feature of infection with the new parasites.
In sections the bodies lying in the cell protoplasm showed very distinctly the
two chromatin masses and a clear space. This space appeared at first to be a
vacuole in which the parasite lay, but it is undoubtedly the body of the parasite
itself. The chromatin masses frequently occupied exactly opposite poles.
The outline of the intervening space was always in this case remarkably circular.
The appearance always strongly suggested a body resistant to shrinkage and
change of shape.
The bodies were frequently seen singly or in small clusters in a pink stroma.
This stroma could nearly always be made out to be a severed process of a
macrophage.
No bodies were found in red blood corpuscles (stained bright red by the
method employed) or lying free.
Bodies were occasionally seen lying in leucocytes in the lumen of branches
of the portal vein. They were never numerous in this situation.
The epithelium of the small bile ducts was unchanged. The bodies were
not present in the bile.
In films and sections of the spleen similar cells to those in the liver capil--
laries were very conspicuous and contained the great majority of the parasites.
Large mononuclear cells containing parasites were more abundant than in the
liver. Occasionally a single parasite was seen in close connection with the end-
othelium or stroma cells. In the red cells no forms could be detected. Free
forms were never seen,
In films of the red bone marrow the bodies were not so numerous in any of
the cases as in the liver and spleen. In smears made with care to avoid as far
as possible rupturing the large cells, the bodies were almost confined to the macro-
phages, some of which contained an immense number of them. They were also
contained in large mononuclear cells and isolated specimens were present in the
polymorphonuclear cells and finely grained myelocytes. No forms could be seen
in undoubted red cells. Megaloblasts were present.
The constant presence of intestinal lesions and the marked character of the
changes found make the examination of the intestine of great importance. Smears
were taken of mucous membrane at the edge of ulcers and from congested
patches, as well as from the small red granulations noted in the description of
autopsy No 3. In this autopsy the tissues were preserved within one hour of
death so that they had changed but little.
The examination of sections shows that, prior to ulceration, there is a form.
ation of granulation tissue in the mucosa, which may eventually be entirely
replaced by new tissue. The latter then encroaches upon the crypts and surface
epithelium, destroys them, and either projects as fungating granulations of
14
various sizes, or undergoes necrosis, thus leading to the formation of ulcers
reaching to the muscular coats.
In a number of smears made from projecting granulations and from the
mucous membrane in the early stages of infiltration I have found the parasites-
in large numbers. They occur (as in the spleen, liver, and bone marrow) in
large cells with round or oval nuclei. In some of the films these cells, were
almost as numerous as in the spleen, and many of them were .so crowded with
the parasites that their nuclei could be seen only with difficulty. In many
instances they appeared to be lying in close connection with the crypts, and in.
some sections they were situated in the tissue in the immediate neighbourhood
of crypts undergoing destruction.
The intestinal ulceration, which is so marked a feature of infection with the
new parasite, appears, therefore, to be closely analogous with the condition found
by Wright in cases of tropical ulcer. Moreover, the formation of new tissue
characterised by the presence, in such diverse situations as the skin and large
intestine, of large cells containing the parasites, has a close resemblance to the
morbid processes found in the granulomata
In all the cases a very large curved micro-organism was present in great
numbers, and in one case this body vas seen in nearly pure culture in the crypts.
These micro-organisms have a single chromatin mass placed near the centre of
the body. One end is generally more pointed than the other and gives to the
body somewhat the appearance of a sporozoit. I have seen these bodies divid-
ing by transverse fission; they appear to be bacteria. In the unstriped muscle
of the submucosa, especially near the bases .of ulcers, were seen many collections
of bodies 1-2 micromillimetres in diameter staining an intense blue and lying in
elongated spaces to one side of the nucleus of the muscle fibre. They appeared
polygonal in shape and did not look like other cocci seen in the tissue. We were
unable to demonstrate any chromatin in them and are unaware of their nature.
The endothelium of the vessels in one case was much thickened and showed
a curious hyaline appearance.
In the small intestine no parasites were found nor any condition worthy
of note Smears from the lymphatic glands in the retroperitoneal tissue were
examined, but no parasites were found.
No parasites were found in the kidneys in the one case in which these
were examined. The supra-renal bodies, the brain substance, the bile, peritoneal
fluid and the lungs appeared free from the bodies.
Particular attention was given to the muscles. Muscle fibres from the
larynx, œsophagus, psoas, levator ani arid pectorals and intercostal muscles were
spread upon slides and stained by the modified Romanowsky method. The
nuclei of the muscle fibres were beautifully displayed, but no parasites or other
unusual conditions were seen.
Large masses of muscle as well as the œsophagus and intestines were
examined with a lens but no bodies resembling sarcocysts were seen.
15
6. A comparison of the bodies with certain species of Piroplasma.
I have been able to compare the bodies in question with a species of piro-
plasma common in calves in Madras.
Major Donovan first pointed out to me the presence of this parasite in calves
of t he di st ri ct . I have si nce found 6 out of 2 4
a p p a r e n t l y h e a l t h y c a l v e s
infected. Of these all but one showed small bacillary forms and forms some-
what resembling the malarial parasite. In one calf large typical pear shaped
forms were also present. I have also found in the pariah dogs of Madras
a species of piroplasma in which large forms are present.
In both species the large forms show what appear to be essential differences
to the bodies occurring in the human infection.
(a ). Forms are readily demonstrated in the red cells. They occur sing
-ly or in twos or in fours and the bigeminal division is most dis-
- t i n c t .
(b). They have a granular protoplasm staining blue and their outline is
not suggestive of a body with a capsule.
( c ) There is no appearance at all like the highly distinctive double
chromatin masses. In cases of infection with the malignant tertian
malarial parasite small forms are often seen containing two chromatin
masses (fig. 28), but the appearance and arrangement of these is
totally unlike that of the new parasite. In piroplasma of the calf and
of the dog the chromatin resembles much more that of a malarial
parasite than it does that of the new bodies.
(d ) In piroplasma various stages of the parasite have always been seen
by me in the same animal. In the large forms of piroplasma, fission
takes place in a way unlike that seen in the new human parasite. In
piroplasma the forms stretch across the cell to form first a long ellipse
and then separate by the formation of a constriction. In piroplasma
it is easy to see development in progress. In the human parasite the
small number of division forms compared to the number of bodies
present is remarkable.
( e) The complete absence of the new human parasite in the peripheral
blood in apparently all cases, is unlike piroplasma, which is found
readily enough in some form or another in the peripheral blood.
As a result of my researches I have shown that the distribution of the
parasite in the body is very limited. Even in the liver and spleen it is chiefly as
a result of an intense phagocytosis that we see the bodies. The resistance of
the bodies to intracellular digestion appears to lead to the storing up of the
parasite in the large macrophages of the liver and spleen. Apart from the
above two organs and the bone marrow I have found the bodies only in the
mucous membrane and sub-mucosa of the large intestine (especially in the tissues
16
in the immediate neighbourhood of ulcers), in the blood from the portal vein
and in punctiform hæmorrhages.
The origin of the bodies seems to me very obscure, and I am not satisfied
that they are a form inhabiting the red cell at any stage.
I can trace only a superficial resemblance to piroplasma in cattle and in the dog.
Since Laveran has given so decided a verdict I can only say that the differ
ences between the two forms appear so great that strong evidence of their affinity
must be forthcoming before the new parasite can be placed in the genus Piro-
plasma.
If the parasite were present in the red blood cells, if it presented a distinctly
pear shaped form, and if there were evidence of binary fission, the grounds for
doing so would no doubt be sufficient. But most of the bodies resembling red
cells are undoubtedly the fragmented protoplasm of leucocytes and macropha-
ges, and the fact that the bodies are present in red cells cannot be said to have
been proved. The pear-shaped form seems to be but one aspect of bodies which
have a shape something like a cockle-shell. The binary fission of the bodies
seems to me to be quite different from that seen in piroplasmata.
Until the relation or want of relation between the bodies and the red blood
cell is clearly proven I think it premature to make any remarks as to their zoolo-
gical affinities. The unyielding shape, the apparent possession of a cuticle, and
the arrangement of the two chromatin masses, seem to me to point to an organism
very distinct from one of the genus Piroplasma, and to be very suggestive of the
spores of a Microsporidian.
7. The nature of the so-called " Zooglea Mass."
Manson and Low have described the substance in which the parasites are
frequently contained as a " Zooglea mass." That the substance is the proto-
plasm of the large cells in the liver and spleen capillaries is evident from the
examination of sections. That these large cells are not themselves parasitic
is I think demonstrated by their resemblance to the macrophages in malaria and
by the presence in specimens from one case of malarial pigment in these cells
along with the bodies in question (Fig. 27 ).
Papers referred to in the text.
1. Leishman in the British Medical Journal of May 30th, 1903.
2. Donovan in the British Medical Journal of July 11th, 1903.
3. Donovan in the Indian Medical Gazette of January 1904.
4. Laveran and Mesnil, Comptes rendus des séances de l'academie des
sciences, 7th December 1903.
5. Ross in the British Medical Journal of November 14th, 1903.
6. Marchand and Ledingham in the Lancet of January 16th, 1904.
7. Manson and Low in the British Medical Journal of January 23rd, 1904.
8. Wright, Protozoa in a case of tropical ulcer (Delhi sore). The Journal
of Medical Research, Vol. X, No. 3. (New series, Vol. V, No. 3). December
1903.
17
Explanation of Plate.
Fig.1.—Small form of parasite without vacuole or secondary chromatin
body. Rarely seen.
Fig. 2.—Small form of parasite.
Fig. 3 . — L a r g e f o r m o f p a r a s i t e .
Fig. 4.—Parasite showing rod shaped small chromatin mass.
Fig. 5.—Parasite showing small chromatin mass as a dot only.
Fig. 6.—Parasite showing " tail" joining chromatin masses.
Fig. 7.—Cockle shell shape with vacuole.
•
Fig. 8.—
Ditto
with,pink staining body substance and no vacuole.
Fig . 9.—Pear shaped form.
Fig. 10.—Form with faintly staining large chromatin mass.
Fig. 11.—Form showing bilobed chromatin mass.
Fig.12—
Ditto
heart-shaped chromatin mass.
Fig. 13.—Similar form to the last; seen in another direction.
Fig. 1 4.—Form with double large chromatin mass.
Fig.15.—Longitudinal division into two forms.
Fig. 16 .—Transverse division into two forms.
Fig. 17.—Developmental form showing the formation of 3 bodies.
F ig. 18.—Developmental form showing the formation of many bodies.
Fig. 19 .—Forms apparently in altered red blood corpuscles.
Fig. 20.—Forms in bodies after treatment of blood with hypotonic ammo-
nium oxalate solution.
Fig. 21.—Pigment in apparent red cell.
Fig. 22.—Showing formation of apparent red cell bodies from macrophages
and leucocytes.
Fig. 23.—Parasites in polymorphonuclear leucocytes.
Fig. 24.—Parasite in a myelocyte.
Fig. 25.—Parasites in a large mononuclear leucocyte.
Fig. 26.—A macrophage containing the parasites.
Fig. 27.—A macrophage containing malarial pigment in addition to the
parasites.
Fig. 28.—Malignant tertian malaria. Young form showing two chromatin
dots.
Fig. 29.—Small forms of bovine piroplasma.
Fig. 30.—Large forms of bovine and canine piroplasma.
Fig. 31.—Section of liver stained by the modified Romanowsky method
showing macrophages in the liver capillaries.
Fig. 32.—Macrophages in the liver capillaries containing parasitic bodies.
Fig. 33.—Section of spleen showing the parasites in macrophages and in
large mononuclear cells; a parasite is seen in connection with an
endothelium or stroma cell.
No. 8.
(NEW SERIES.)
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
A PRELIMINARY REPORT ON A PARASITE FOUND IN PERSONS
SUFFERING FROM ENLARGEMENT OF THE
SPLEEN IN INDIA.
BY
LIEUT. S. R. CHRISTOPHERS, M.B., I.M.S.
(On special duty.)
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:
1904.
Price one rupee and eight annas.
NOTES
ON
VACCINATION
IN THE
CENTRAL PROVINCES
FOR THE SEASON
1899-1900.
Nagpur:
PRINTED AT THE SECRETARIAT PRESS.
1900.
[Price, One Shilling and Six Pence.]
[Price, One Rupee.]
NOTES
ON
VACCINATION
IN THE
CENTRAL PROVINCES
FOR THE SEASON
1899-1900.
Agents for the sale of Books published by the Central Provinces Administration.
IN LONDON.
E. A. ARNOLD, 37, Bedford Street, Strand, W. C.
CONSTABLE & Co., 2, Whitehall Gardens, S. W.
SAMPSON LOW, MARSTON &Co., St. Dunstan's House, Fetter Lane, E. C.
P. S. KING & SON, 9, Bridge Street, Westminster, S. W.
LUZAC & Co , 46, Great Russell Street, W. C.
KEGAN PAUL, TRENCH, TRUBNER & CO., Charing Cross Road, W. C.
B. QUARITCH, 15, Piccadilly, W.
ON THE CONTINENT.
FRIEDLANDER&SOHN, 11, Carlstrasse, Berlin.
OTTO HARRASSOWITZ, Leipzig.
KARL W. HIERSEMANN, Leipzig.
ERNEST LEROUX, 28, Rue Bonaparte, Paris.
MARTINUS NIJHOFF, The Hague.
IN INDIA.
THACKER, SPINK & Co., Calcutta and Simla.
NEWMAN & Co., Calcutta.
THACKER & Co., LD., Bombay.
HIGGINBOTHAM & Co., Madras.
SUPERINTENDENT, AMERICAN BAPTIST MISSION
PRESS, Rangoon.
TABLE OF CONTENTS.
Cause of delay in submitting the
Notes...
...
...
Area in which Vaccination work was
performed...
...
Vaccination
Establishment...
...
...
Total number of operations performed in the Khalsa and Feudatory States ...
Vaccination operations in the Khalsa... ...
Districts in which an increase or decrease occurred in the average number of
operations performed by each
Vaccinator...
...
Increase or decrease in primary operations in different
districts...
...
Children under one year of age available for vaccination, and the number
successfully
vaccinated...
...
...
Successful primary operations on infants... ... ...
Re-vaccination in the
Khalsa...
...
...
Vaccination operations in the Feudatory States... ...
Number of children under one year of age in Municipal towns available for
vaccination, and the number of successful operations performed on them.
Combined expenditure on Vaccination in the Khalsa and Feudatory States ...
Expenditure on Provincial
Vaccination...
...
...
Expenditure on Vaccination in Feudatory
States...
...
...
Number of operations performed by Hospital Assistants...
Inspection of operations... ...
Inspection of operations in the Khalsa... ...
Inspection of operations in Feudatory
States...
...
...
Calf vaccination : number of calves operated
on...
...
...
Details of Vaccination in the various
districts...
...
...
Method adopted for the preservation of lymph in the various districts of the
Province...
...
...
Mortality from small-pox as compared with proportion of persons protected by
vaccination...
...
...
Diagram illustrating mortality from small-pox compared with proportion of
population protected by
vaccination...
...
...
General
Remarks...
...
PARAS.
1
2
3&4
5 to 9
10 & 11
12
13 to 15
16
17 & 18
19
20
21
22 & 23
24 & 25
26 & 27
28 & 29
30
31 to 37
38
39
40
41
42&43
44
45&46
NOTES ON VACCINATION
IN THE
CENTRAL PROVINCES
FOR THE SEASON 1899-1900.
Cause of delay in submit-
ting the Notes.
The Notes were due in the Secretariat on the 10th June. The cause of delay
in their submission is due to the late receipt of the returns
from some of the Feudatory States (several of them
not having been received till July) and to the non-
receipt up to date of complete returns from the Sakti State. As, however,
the Notes cannot be delayed any longer, the statements have been closed without
them.
Area in which Vaccination
work was performed.
2. The area in which vaccine operations were
performed in 1899-1900 remained about the same as in
1898-99.
Vaccination Establishment.
3. The strength of the Khalsa and Feudatory State
Vaccination establishment was as follows :—
Year.
1898-99
...
...
...
1899-1900
Difference
...
PROVINCIAL.
Native
Superintend.
ents.
25
25
=
Vaccinators.
212
212
=
FEUDATORY STATES.
Native
Superintend-
ents.
3
6
+ 3
Vaccinators.
62
62
=
4. The Khalsa vaccination establishment remained the same as in the
previous year; while the number of Native Superintendents was increased by three
in the Feudatory States.
Total number of operations
performed in the Khalsa and
Feudatory States.
5. The total number of operations performed by Vaccinators in the Khalsa and
Feudatory States during the past two years is given in
the following table:—
Khalsa...
Feudatory States..
Total..
TOTAL NUMBER VACCINATED.
1898-99.
346,563
88,611
435,174
1899-1900.
396,394
88,141
484,535
Differ-
ence.
+49,831
— 470
+ 49,361
TOTAL PRIMARY VACCIN-
------.
1898-99.
294,289
76,743
371,032
1899-1900
354,655
82,049
436,704
Differ-
ence.
+ 60,366
+ 5,306
+ 65,672
TOTAL RE-VACCINATIONS.
1898-99.
52,274
17,868
64,142
1899-1900.
41,739
6,092
47,831
Differ-
ence.
—10,535
—5,776
—16,311
2
6. The total number of operations performed both in the Khalsa and
Feudatory States was 484,535, or 49,361 more than in the previous year. The
figures for the past five years are compared as under:—
1895-96... ... ...
1896-97...
...
...
1897-93... ... ...
1898-99...
...
...
1899-1900... ... ...
449,720
397,036
384,476
435,174
484,535
7. Primary operations numbered 436,704 against 371,032, and re-vaccina.
tions 47,831 against 64,142 during the previous year, showing an increase of
65,672 in the former, and a decrease of 16,311 in the latter.
8. The average number of operations performed by each Vaccinator both in
the Khalsa and Feudatory States was 1,767, or 179 more than in the previous
year.
9. The percentage of successful primary cases was 96.50 against 96.00, and
that of re-vaccination 82.73, as compared with 82.22 in the previous year.
Vaccination operations in the
Khalsa.
10. The total number of persons vaccinated by Khalsa Vaccinators was
396,394 (201,437 males and 194,957 females) as com-
pared with 346,563 (181,026 males and 165,537 females)
in the previous year, or 49,831 more than in 1898-99. Of the total number, 28,160
were vaccinated in famine relief camps.
11. The average number of operations performed by each Vaccinator was
1,868, or 233 more than in the previous year.
Districts in which an increase
or decrease occurred in the
average number of operations
performed by each Vaccinator.
12. In the following districts an increase is shown
in the average number of operations, primary and
re-vaccinations, performed by each Vaccinator:—
Nimar... ... ...
Bhandara...
...
...
Chhindwara... ...
Narsinghpur...
...
Damoh...
...
Hoshangabad... ...
Balaghat... ...
Saugor...
...
Jubbulpore...
...
Raipur...
...
...
Mandla... ... ...
Sambalpur...
...
...
Chanda...
...
...
Wardha...
...
...
+ 1,945
+ 1,158
+ 662
+ 642
+ 526
+ 410
+ 361
+ 333
+ 302
+ 296
+ 187
+ 157
+ 154
+ 73
The districts in which a decrease took place are:—
Betul
...
Nagpur...
Seoni
...
...
...
Bilaspur...
...
...
— 1,095
— 809
— 149
— 134
3
Increase or decrease in
primary operations in different
districts.
13. The following table shows the actual increase or decrease in the
number of primary operations performed by Khalsa Vac-
cinators in each district during the season 1899-1900 as
compared with the season 1898-99:—
Nimar
...
...
...
Bhandara
...
...
...
Raipur
...
...
...
Jubbulpore
...
...
...
Hoshangabad...
Mandla
...
...
Narsinghpur... ...
Saugor
...
...
...
Chhindwara... ... ...
Betul
...
...
...
Damoh
...
...
Chanda
...
...
...
Seoni
...
...
...
Balaghat
...
...
...
Sambalpur
...
... ...
Wardha
...
... ...
Nagpur... ... ...
Bilaspur
...
...
...
+ 11,675
+ 9,617
+
7,390
+ 5,128
+ 4,942
+ 4,325
+ 4,183
+
4,090
+ 3,925
+ 3,398
+ 3,243
+ 3,131
+ 2,596
+ 2,159
+
1,314
+
1,123
— 11,321
—
552
14. The above figures go to show that, irrespective of the widespread
scarcity and distress which prevailed among the general population during the
last season, and the fact that a portion of the vaccination establishment was
employed on famine, cholera and plague duty for a considerable period during the
season, excellent work has been done by Khalsa Vaccinators.
15. The decrease in the Nagpur District is due to the vaccination staff
having been employed on plague duty up to the 16th January 1900, on which
date they were relieved and sent out to their respective circles for vaccination
work; and in the Bilaspur District to a portion of the staff being attached to
Relief-camp hospitals as Hospital Assistants or Compounders.
Children under one year
available for vaccination, and
the number successfully vacci-
nated.
16. Out of 353,992 children under one year available
for vaccination, 263,584 were successfully vaccinated, as
the following figures show:—
1.
2.
3.
Number of births in 1899-1900... ...
Deduct number of deaths under one year in 1899.1900...
Children available
...
Total number of children under one year successfully
vaccinated
...
468,197
114,205
353,992
263,584
Successful primary opera-
tions on infants.
17. The successful primary operations performed
on infants under one year during the past five years,
are:—
1895-96
...
...
...
1896-97...
...
...
1897-98...
...
...
1898-99...
...
...
1899-1900... ... ...
209,317
202,750
162,141
200,587
263,584
18. On the whole, the result of primary operations in the Central Provinces,
as performed by the Khalsa staff in 1899-1900, was very satisfactory.
Re-vaccination in the Khalsa.
19. The total number of re-vaccinations performed by the Khalsa staff was
41,739 as compared with 52,274 in the previous year,
the successful cases being 33,941 against 41,377 in the
previous year. Of the total number of re-vaccinations performed, 9,350 were
carried out in famine relief camps. The decrease occurred in eight districts, and
the largest falling-off in Betul, the latter fact being explained by the Civil Surgeon
as due to comparison with the abnormal figures of the former year. In connection
with this point, I would draw attention to the remark contained in paragraph 20 at
page 5 of my Triennial Report for the period ending 31st March 1899.