NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Medical Officers of the Army of India.
4
different Species of Comma-Bacilli after some days' cultivation in Agar-agar.
tivations.
4
Species ε .
5
Species ζ
6
Species η .
7
Species θ.
Shining; polished ; very
adhesive.
Shining ; polished ; very
adhesive.
Shining; polished ; with an
ochreous tinge ; ropey.
Shining but not smooth ; slight-
ly adhesive.
Thick ; smooth ; shining ;
adhesive.
Thick; smooth ; shining;
ropey.
Thick ; smooth ; shining;
ropey.
Slightly rough and wrinkled ;
slightly adhesive.
Smooth ; polished ; excessively
ropey.
Smooth ; polished ; with an
ochreous tinge; ropey.
Smooth ; polished ; exces-
sively ropey.
Smooth; polished; very adhe-
sive.
Thick ; not quite smooth ;
ropey.
Thick; creamy ; very ropey. Thick ; creamy; excessively
ropey.
Thick ; smooth ; moist; ropey.
Thick ; smooth; a slight ochre-
ous tinge ; excessively
ropey.
Thick ; smooth; a slight ochre-
ous tinge ; ropey.
Very thick ; smooth ; decid-
edly ochreous ; excessively
ropey.
Thick; smooth ; adhesive.
Very thick ; smooth ; slightly
ochreous ; ropey.
Very thick ; smooth; sightly
ochreous ; ropey.
Very thick ; smooth; slightly
ochreous ; ropey.
Thick; smooth ; slightly ochre-
ous; adhesive.
Very thick; quite smooth ;
very ropey.
Very thick; quite smooth ;
very ropey.
Very thick ; quite smooth ;
very ropey.
Nearly smooth ; rather dry ;
slightly adhesive.
Thick; smooth; with aniochre-
ous tinge ; ropey.
Thick ; smooth ; with an
ochreous tinge ; ropey.
Thick ; smooth ; with an
ochreous tinge ; ropey.
Thick ; smooth ; adhesive.
Very thick ; smooth ; ropey. Very thick ; slightly rough ;
adhesive.
Very thick ; perfectly smooth;
ropey.
Thick ; quite smooth ; very
adhesive.
Very thick ; perfectly smooth;
with an ochreous tinge ;
very ropey.
Perfectly smooth ; very
ropey.
Very thick; perfectly smooth;
very ropey.
Thick; perfectly smooth ; with
a faint ochreous tinge ; very
adhesive.
Very thick ; smooth ; with
an ochreous tinge; ropey.
Smooth ; thick ; with an
ochreous tinge ; very adhe-
sive.
Excessively thick ; smooth ;
a well marked ochreous
tinge ; excessively ropey.
Smooth ; thick, with an ochre-
ous tinge ; very adhesive.
Thick ; smooth ; of a decided
ochreous tinge ; very ropey.
Thick ; smooth ; with a faint
ochreous tinge ; ropey.
Very thick ; smooth ; a
strong ochreous tinge ; ex-
cessively ropey.
Thick ; smooth, with a faint
ochreous tinge ; very adhesive.
Thick ; perfectly smooth ;
ropey.
Thick ; perfectly smooth ;
with an ochreous tinge ;
very ropey.
Very thick ; a decided ochre-
ous tinge ; quite smooth ;
excessively ropey.
Thick ; perfectly smooth ; with
an ochreous tinge ; ropey.
Thick ; smooth ; with a decid-
ed ochreous tinge through-
out ; ropey.
Thick ; polished; white ;
very adhesive.
Thick ; polished ; ropey.
. Very thick ; smooth ; with an
ochreous tinge ; ropey.
G
42
Scientific Memoirs by
S e r i e s .
Date.
Age of
cultivation.
1
Species α .
2
Species β.
3
Species γ.
XV
Oct. .6th . 5 days
. Thin ; perfectly smooth and
polished; a mere trace of
adhesiveness.
Dry ; wrinkled; a trace of
adhesiveness.
Nearly smooth ; slightly dry-
looking ; diffluent.
XVI
Oct. 11 th . 5 days
. Shining ; polished ; almost
quite smooth; non-adhe-
sive.
Dry and wrinkled ; a trace
of adhesiveness.
Thick ; shining ; nearly
smooth ; non-adhesive.
XVII
Oct. 21st . 5 days
. Almost smooth ; shining;
non-adhesive.
In great part roughened by
minute elevations ; slight-
ly adhesive.
Rough and in great part dry-
looking; slightly adhesive.
XVIII
Oct. 25th . 4 days
. Thin; smooth ; shining;
white ; non-adhesive.
Rough all over ; somewhat
adhesive.
Shining but covered by mi-
nute elevations; a mere
trace of adhesiveness.
XIX
Oct. 31st . 6 days
. Very thin ; perfectly smooth;
shining; polished ; non-
adhesive.
Very much thicker; dryish;
rough in greater part ;
slightly adhesive.
Thick ; rough over greater
part, but shining and moist;
non-adhesive.
XX
Nov. 5th . 5 days
. Very thin; perfectly smooth;
shining; slightly adhe-
sive.
Considerably thicker ; rough
and dry centrally ; slight-
ly adhesive.
Shining ; polished ; not quite
smooth centrally ; slightly
adhesive.
Medical Officers of the Army of India.
43
4 Species ε.
5 Species ζ .
6
Species η.
7
Species θ.
Nearly smooth ; very adhe-
sive.
Thick ; smooth ; polished ;
ropey.
Almost quite smooth ; very
adhesive.
Thick ; smooth ; polished ; very
adhesive.
Very thick ; smooth ; some-
what dry ; adhesive.
Thick ; smooth ;polished ;
a faint ochreous tinge ;
ropey.
Very thick ; smooth ; adhe-
sive.
Thick; smooth ; with a faint
ochreous tinge ; ropey.
Thick ; somewhat rough ;
shining; non-adhesive.
Smooth ; shining; very adhe-
sive.
Thick ; dry and wrinkled
centrally ; non-adhesive.
Very thick ; smooth ; shining ;
with a decided ochreous tinge ;
very adhesive.
Thick ; nearly smooth ; shin-
ing ; very adhesive.
Shining ; smooth ; rather
dry; adhesive.
Shining ; smooth ; very adhe-
sive.
Thick ; perfectly smooth ; shin-
ing ; very adhesive.
Very thick ; finely roughened;
a very distinct ochreous
tinge ; very ropey.
Very thick; finely rough-
ened; a very distinct ochre-
ous tinge ; very ropey.
Very thick ; perfectly smooth;
a very distinct ochreous
tinge ; very ropey.
Very thick; perfectly smooth
and shining; a distinct ochre-
ous tinge ; ropey.
Very thick ; slightly roughen-
ed centrally; a decided
ochreous tinge ; ropey.
Very thick ; perfectly smooth;
shining ; a decided ochreous
tinge ; ropey.
Very thick ; rough and some-
what dry; ropey.
Very thick ; perfectly smooth
and shining; a decided ochre-
ous tinge ; ropey.
G2
46
Scientific Memoirs by
Series. Period after
setting.
Species α.
Species β.
Species γ.
IV
Sep. 12th.
48 hours. Very densely clouded ; a thick
soft, even pellicle.
Densely clouded throughout ; a
dry, wrinkled pellicle.
Densely clouded throughout ; a
relatively thin, almost smooth
pellicle.
72 hours. Densely clouded throughout;
a thick, soft, even pellicle.
On acids, strong purple ; 24
acids,
hours later, limpid, golden
yellow below, reddish-orange
above.
Clouded throughout ; a rela-
tively thin, tough, wrinkled
On acids, strong
purple ; 24 hours later, cloud-
ed, golden yellow below, red-
dish-orange above.
Clouded throughout ; a thin,
dotted, brittle pellicle. On
acids, very strong purple; 24
hours later, densely clouded,
yellow below, reddish-orange
above.
96 hours . 24 hours after addition of acids,
limpid.
24 hours after addition of acids,
hazy.
24 hours after addition of acids,
clouded.
V
Sep. 26th.
48 hours. Clouded throughout ; a firm,
even pellicle.
Lightly clouded ; a thin, dry,
wrinkled pellicle.
Clouded throughout ; a firm,
even pellicle.
72 hours. 24 hours after acids, limpid. 24 hours after acids, hazy. 24 hours after acids, clouded.
VI
Oct. 9th.
24 hours. Lightly clouded ; a thin, dotted
pellicle. On acids, decided
purple ; 24 hours later, limpid,
brownish-topaz.
Clouded throughout ; a thin,
dryish pellicle. On acids, de-
cided purple ; 24 hours later,
limpid, pinkish-topaz.
Clouded throughout, densely at
the top ; a well formed pel-
licle. On acids, decided pur-
ple ; 24 hours later, hazy,
yellow.
48 hours. Densely clouded ; a thick soft,
even pellicle. On acids,
strong purple; 24 hours later,
limpid, brownish-topaz, with a
reddish tinge.
Clouded throughout ; a wrinkled
pellicle. On acids, strong
purple ; 24 hours later, hazy.
Densely clouded ; a thick, soft
pellicle. On acids, strong
purple; 24 hours later, dense-
ly clouded, yellow below, red-
dish-orange above.
72 hours. Lightly clouded; a thick
smooth pellicle. On acids,
deep purple ; 24 hours later,
limpid, brownish-topaz.
Very lightly clouded; a thin,
wrinkled pellicle. On acids,
strong purple ; 24 hours later,
hazy, orange-red.
Clouded throughout ; a thick,
soft pellicle. On acids, deep
purple ; 24 hours later, cloud-
ed, orange.
96 hours . Clouded throughout ; a thick
smooth pellicle. On acids,
intense purple; 24 hours later,
almost limpid.
Almost clear ; a thick pellicle.
On acids, intense purple ; 24
hours later, nearly clear,
brownish-red.
Clouded throughout ; a thick,
smooth pellicle. On acids,
strong purple ; 24 hours later,
densely hazy, orange-yellow.
120 hours. Densely clouded ; a thick, even
pellicle. On acids, intense
purple ; 24 hours later, limpid.
......
......
VII
Oct. 30th.
24 hours. Clouded throughout ; a well
developed, even, soft pellicle.
On acids, a decided trace of
cholera purple ; 24 hours
later, limpid, brownish topaz.
Clouded throughout ; a very
thin, patchy pellicle. On
acids, a decided trace of pur-
ple ; 24 hours later, nearly
clear, yellow below, brownish
topaz above.
Clouded throughout ; a thin,
dry, wrinkled pellicle. On
acids, a trace of purple ; 24
hours later, clouded.
48
Scientific Memoirs by
Series. Period after
setting.
Species α.
Species β.
Species γ.
VII—contd. 48 hours . Densely clouded; a thick, even
pellicle. On acids, well-mark-
ed purple ; 24 hours later,
nearly limpid.
Clouded ; a thin, firm, even pel-
licle. On acids, well-marked
purple ; 24 hours later, slight-
ly hazy.
Clouded ; a firm, somewhat
wrinkled pellicle. On acids,
well-marked purple ; 24 hours
later, thickly hazy.
72 hours . Clouded ; a thick soft, even
pellicle. On acids, strong
purple ; 24 hours later, nearly
limpid.
Thickly clouded; a thin, tough
pellicle. On acids, strong
purple ; 24 hours later densely
hazy.
Very lightly clouded; a soft,
thick, even pellicle. On acids,
strong purple ; 24 hours later,
hazy.
96 hours . Hazy ; a thick, even pellicle.
On acids, intense purple ; 24
hours later, nearly limpid.
Almost clear ; a relatively thin
pellicle. On acids, intense
purple ; 24 hours later, hazy.
Hazy ; a thick, soft pellicle.
On acids, very intense purple;
24 hours later, almost limpid.
VIII
Nov. 11t h.
24 hours . Clouded ; a well developed
pellicle. On acids, decided
purple ; 24 hours later, limpid,
yellow below, brownish-topaz
above.
Clouded throughout ; no pel-
licle. On acids, strong purple ;
24 hours later, limpid, yellow.
Clouded throughout; a well
developed, tough, dryish pel-
licle. On acids, decided
purple ; 24 hours later, cloud-
ed, yellow below, ochreous
peach above.
48 hours . Clouded; a dryish, rather rough
pellicle. On acids, strong
purple ; 24 hours later, almost
limpid.
Lightly clouded; a thin, dry,
wrinkled pellicle. On acids,
strong purple ; 24 hours later,
hazy.
Clouded; a dry, rough, pellicle.
On acids, strong purple; 24
hours later, clouded.
72 hours . Clouded ; a thick, almost even
pellicle. On acids, strong
purple ; 24 hours later, lim-
pid.
Nearly clear ; a thin, very con-
spicuously wrinkled pellicle.
On acids, strong purple; 24
hours later, hazy.
Clouded lightly ; a thick, near-
ly smooth pellicle. On acids,
strong purple ; 24 hours later,
clouded.
96 hours . Clouded ; a thick, soft, even
pellicle. On acids, intense
purple ; 48 hours later, limpid.
Nearly clear ; a thin, dry, con-
spicuously wrinkled pellicle.
On acids, intense purple; 48
hours later, lightly hazy.
Clouded ; athick, nearly smooth
pellicle. On acids, intense
purple ; 48 hours later,
clouded.
IX
Nov. 17t h.
24 hours . Thickly clouded ; a soft, smooth
pellicle. On acids, decided
purple ; 24 hours later, limpid
yellow with a brownish tinge
above.
Thickly clouded; no pellicle.
On acids, deep purple ; 24
hours later, limpid, yellow
below, orange above.
Thickly clouded ; a very thin,
dotted pellicle. On acids,
strong purple ; 24 hours later,
clouded, ochreous peach.
72 hours . Thickly clouded, a thick, finely
wrinkled pellicle.On acids,
strong purple; 24 hours later,
limpid, brownish- topaz.
Nearly clear; a very conspicu-
ously wrinkled pellicle. On
acids, strong purple; 24 hours
later, thickly hazy, reddish-
orange.
Clouded ; a thick, almost smooth
pellicle. On acids, strong,
purple ; 24 hours later, thick-
ly clouded.
PLATE I.
DIFFERENT SPECIES OF CHOLERAIC COMMA-BACILLI OCCURRING IN CALCUTTA.
Pig. 1.
Species α, derived from a case of Cholera in the Medical College Hospital.
Fig. 3.
" β,
" " " " G e n e r a l H o s p i t a l .
Fig. 3.
" γ,
" " " " Sealdah Hospital.
Fig. 4.
"
δ,
" " " " General Hospital.
CULTIVATIONS OF DIFFERENT SPECIES OF CHOLERAIC COMMA BACILLI ON POTATOES.
Photo-etching Survey of India Offices, Calcutta, August 1890.
The Morbid Anatomy of a Form of Biliary Cirrhosis
in children in India.
BY
SURGEON J. B. GIBBONS.
During the last three years a fatal disease of the liver in young children
has been discussed at several meetings of the Calcutta Medical Society ; but no
conclusion as to its nature was arrived at until I showed the liver of a child who
was admitted into the Eden Hospital in a moribund state in January 1888.
Since then I have had the opportunity of examining four additional cases.
The accounts given by the parents and the symptoms observed in Hospital
corresponded with the description of the fatal disease of the liver above men-
tioned, and there can be no longer any doubt that, as the morbid anatomy of
these livers shows, cirrhosis, presenting in the advanced stage the appearances
of the variety termed " Biliary," is a common disease among the children of cer-
tain classes in Calcutta and other parts of Lower Bengal. It will be evident
from the description of the liver of case 5 that in the early stage the appear-
ances present certain marked differences from those of the ordinary form of
biliary cirrhosis, and that the formation of fibrous tissue occurs primarily within
the lobules between the hepatic cells, and therefore " Intercellular Cirrhosis "
would be a more appropriate designation. I have, however, kept to the former
name, because this term was used in communicating the cases to the Calcutta
Medical Society, and because multiplication of the bile ducts is one of the most
striking features of the disease. It is greatly to be regretted that caste pre-
judices have prevented a post-mortem examination being made in any of the
cases which were under medical observation during the whole course of the
disease. In my five cases the children belonged to the poorer cooly class, and
were brought to Hospital in a more or less moribund condition. It is not
among the children of the poor that the disease is common, but among those of
the well-to-do classes of Hindus and Mahomedans. I have never seen a case
in a European or Eurasian child, though large numbers of the latter are treated
at the Medical College Dispensary.
The disease is almost always fatal, and runs its course in three or four months
H 2
The spleen, which was enlarged in all the cases, presented nothing peculiar
under the microscope.
The livers were enlarged uniformly, the shape was normal, the anterior edge
thin, the surface smooth and mapped out into minute areas by delicate lines, so
as to present an appearance like the surface of morocco leather. The capsule
was not thickened and there were no signs of perihepatitis. On section the sub-
stance was very tough and fibrous, and deeply bile-stained. The cut surface
was granular and the lobules were encircled by fibrous tissue, which in places was
so abundant as to obscure the hepatic structure.
In none of the four cases was there more than a drachm of fluid in the
gall-bladder. This fluid was pale, glutinous mucus, altogether different from
normal bile. The orifice of the bile duct in the duodenum was natent.
Microscopical Appearances.
The following description applies to the livers of the four advanced cases,
and is based upon the examination of sections taken from different parts of each
specimen.
The appearances were essentially the same in all, though the amount of
fibrous tissue, the number of bile ducts and the degree of destruction of the
hepatic cells varied in different sections and in parts of a section. Fig. I
was taken from case 2 and shows the alterations produced by the disease
while the hepatic structure is recognisable. In most sections the destruction of
the liver tissue was greater and in some the whole field was made up of fibrous
tissue, bile ducts and a few scattered masses of granular debris. The lobules
were small, irregular in shape, and each was encircled by a band of fibrous tissue,
which varied in width. The hepatic cells were massed together in groups ; the
normal arrangement in columns, radiating from the central vein, was destroyed
by strands of fibrous tissue, which were generally visible with low power (vide
fig. I). Under higher powers the presence of fibres within the lobules, separa-
ting the liver cells into groups, was seen to be universal. The fibrous tissue of
the interlobular tracts was composed of coarse fibres compactly arranged with
many nuclei and considerable round-cell-infiltration ; the blood vessels among
the fibres were large and numerous. The intercellular fibres were also well
formed and distinct, but generally more delicate in structure than those around
the lobules. Among the fibres of the interlobular tracts and also within the peri-
phery of the lobules, numerous bile ducts were visible. The largest, which are
s hown i n f i g. I a s s hor t da r k r ods a mong t he f i br e s be t we e n t he l obul e s ,
possessed a well-marked lumen and were formed of a distinct external coat of
fibrous tissue and lined with cubical epithelium (fig. 4). In the ducts of smaller
size the fibrous coat was indistinct and the lining composed of oval epithelium;
in the smallest only two rows of nuclei could be distinguished. The formation
of these ducts could be traced through every intermediate stage, from the elon-
53
Medical Officers of the Army of India.
55
mal appearance being quite exceptional, and many sections may be examined
without finding a single cell free from marked signs of degeneration.
The macro—and micro—scopical appearances of case 5 presented consi-
derable differences from those of the advanced stage of the degeneration. The
child was one year and three months old; the liver weighed twenty-two ounces
and filled the whole of the upper part of the abdomen. Its dimensions were—
From side to side.
.
.
.
. .
. 7
.25 inches.
Right lobe antero-posterio
.
.
.
.
.
. 4.75
, ,
,,
„ greatest thickness .
.
.
.
.
. 2.
,,
Left lobe antero-posterior
.
.
.
.
.
. 4.75
,,
„
„ greatest thickness .
.
.
.
. 1.25 „
In European children the average weight of the normal liver at one year old
is eleven ounces ; in Native children it is much less. The above measurements
and weight show how great the enlargement of the liver is in the early stage
of this form of cirrhosis. The enlargement was uniform, the organ was not dis-
torted, the capsule was thin, the surface smooth and showed here and there an
appearance of mapping out of the lobules by fine lines. The substance was pale;
the consistence rather tougher than normal, and the cut surface presented a gran-
ular appearance. The gall-bladder was shrunken and overlapped by the anterior
edge, and contained less than a drachm of pale mucous fluid. The common duct
was patent.
Sections presented the following features when examined with low power
(vide fig. 6). The most conspicuous changes were within the lobules, the nor-
mal appearance of which was completely altered by the presence of a large quan-
tity of fibrous tissue forming wide fasciculi between the hepatic cells. Outside
the lobules there were narrow processes of fibrous tissue which proceeded
from the portal sheaths and, as a rule, did not completely separate the lobules
from one another, so that the mapping out of the latter, which formed a prom-
inent feature in the sections of the advanced stage of the disease, was absent,
and most of the lobules merged into each other, as in the normal liver. In most
sections a few lobules were completely invested by narrow interlobular tracts,
but generally these processes Were found only in the immediate neighbourhood
of the portal sheaths, and extended a short distance between the lobules. The
formation of fibrous tissue within the lobules was universal; not a single lobule in
the numerous sections examined had escaped. The lobular structure was com-
pletely altered by the presence of numerous broad fasciculi of fibrous tissue.
The normal radiating arrangement of the liver-cells in columns from the central
vein was destroyed and the cells separated into groups irregularly placed in the
fibrous tissue, which formed a distinct stroma. The intercellular fibres were
equally well developed in every part of the lobules, and no difference could be
detected in the quantity of new growth in the central and in the peripheral
portions.
Scientific Memoirs by Medical Officers of the Army of India.
It remains now to state briefly what is known of the causation of this fatal
affection of the liver. Unfortunately all that can be said at present is that it
is not due to any of the usual causes of cirrhosis of the liver in adults. It is not
necessary to discuss the possibility of alcohol being the cause. The age at which
the disease is found, and the social customs of the Hindus and Mahomedans,
prove that alcohol has no part in its causation. As regards syphilis, the clinical
evidence is altogether against it, and in none of the cases examined by me were
there any signs of infantile syphilis. As to malaria, the general opinion of medical
men in Calcutta is against its being the cause, though it may be a pre-disposing
factor. As I have elsewhere pointed out, there are good grounds for believing
that the disease is brought about by the irritation produced by the products of
faulty digestion, and that the cause lies in unsuitable food, but at present the
evidence is not sufficient to justify a positive opinion.
58
Description of Plate.
To illustrate SURGEON J. B. GIBBONS ' Paper on Biliary Cirrhosis in Children.
F I G . 1 x 3 0 . — S e c t i o n f r o m c a s e 2 , s h o w i n g t h e l o b u l e s e n c i r c l e d b y b r o a d b a n d s o f
fibrous tissue, with numerous bile ducts represented as short, dark
rods among the fibres ; in some parts of the drawing intralobular fibres
are visible.
„ 2 x 160.—Portion of an interlobular tract in the same preparation, with the
bile ducts ramifying among the fibres.
,, 3 x 340.—Structure of one of the smaller bile ducts seen in fig. 2.
„ 4 x 285.—Two large bile ducts lined with cubical epithelium ; the upper one is
branched.
„ 5 x 160.—Portion of a lobule, showing formation of a fibrous network, enclosing
the remains of the liver cells, which are completely destroyed.
,, 6 x 30.—Section from case 5, showing the disorganisation of the structure of
the lobules by the presence of fibres enclosing groups of cells. A few
narrow interlobular tracts are also visible.
„ 7 x 16o.—The same preparation, more highly magnified, showing the groups of
liver cells separated by richly nucleated tissue. In the centre there
is a newly formed interlobular tract. Many of the liver cells possess
two nuclei.
Figures 1, 4, 6, are from drawings by the artist attached to the medical
College ; figures 2, 3. 5, 7 are from drawings by the artist attached
to the Biological Laboratory, Government of India.
BILIARY CIRRHOSIS IN CHILDREN.