vi
It will be noticed that the percentage of cases in which the organism was found
is exactly the same as last year. This percentage May therefore be regarded as
closely approximating to that in which it is possible to demonstrate the organism,
but this does not exclude syphilis as a possible cause of many of the cases in which
the germ could not be found. How unreliable the elicited history of the parents may
be can be gauged from the fact that no syphilitic history was ascertained in thirteen
out of fifteen cases in which the germ was demonstrated. In both cases in which
syphilis was admitted, the father had suffered from the disease and the history as
regards previous pregnancies is very typical. That a negative find does not exclude
syphilis as the probable cause is well shown by case No. 36. Here a syphilitic
history in both parents was elicited., but the organism could not be demonstrated.
This failure may, as stated last year, be due to putrefactive changes having set in
before the examination could be made. In spite of no syphilitic history having been
elicited, cases Nos.16, 19, 23, 38 and 55 in which the organism was found give histories
very typical of syphilis with respect to previous pregnancies. The reverse, however,
is found in Nos. 6, 20, 28, 31, 39, 43, 44 and 47 where the positive finds of the
organism are not associated with histories typical of syphilis at previous pregnancies.
Possibly in these latter we have to do with a more recent infection but such want
of concordance between the microscopical find and the history as elicited, both in
respect of syphilis itself and of what may be called typical of syphilis, would appear
to negative the assumption made last year that syphilis might be the sole cause of
the condition. Without exception when spirochætes have been demonstrated, they
have been seen in the liver, next in order of frequency comes the kidney. They
have never been seen in the brain, epiphyses or placenta. The brain is almost
always in a diffluent condition, so the non-occurrence of the germ there is hardly
surprising. It would probably suffice for the purposes of this investigation if the
liver only were examined.
WORK CARRIED OUT BY CAPTAIN PATTON,I.M.S., DURING
THE YEAR 1911.
The etiology of Oriental Sore .—As a memoir describing the work already carried out is
now in the Press, a résume will here suffice. The parasite was found on four occasions in
the peripheral blood of a suitable case in Cambay, but, in order to find it, it is not only neces-
-sary to examine many blood films but also to select the ease. Unbroken sores with swarms
of parasites are the best for this purpose, for at certain times their margins become swollen
and then show many macrophages packed with parasites and these on bursting liberate large
numbers which are thus taken up by polymorphon ųclear and mononuclear leucocytes ; a case
with multiple sores in this condition is more likely to have parasites in the circulating blood
than a case with a single sore.
A series of experiments were carried out with house flies (Musca nebulo and Mu sca Sp ?)
in order to try and find whether they were transmitting the parasite. Flies were allowed to
crawl over a sore discharging parasites and then to settle on a scratch on my own person;
this experiment was daily carried out for a long period but proved entirely negative. Further,
not a single ulcer or sore other than the true Cambay boil was found which bad become
infected with the parasite and this experiment refutes the loose statements that during the fly
season such skin lesions are very liable to become true boils. The same flies were next bred and
fed on the discharge from a sore and then examined at Frequent intervals. It was found that the
parasite is readily ingested by the fly, but that it never flagellates but dies out after six hours,
and that it is never passed out unchanged by the fly. These experiments carried out in the
endemic area under the most favourable conditions conclusively prove that the house fly plays
no part in the transmission of the parasite of Oriental Sore.
Numbers of experiments were carried out with body and head lice with negative results and
so also with the local Stegomyia. This mosquito was carefully experimented with but the
delve-lopmental stage of the parasite was never found in it.
Phlebotomus Sp ? probably babu, Annandale was only seen during the rains, but it was not
possible to experiment with it as it could not be obtained in sufficient numbers. It was also not
possible to experiment with fleas as they could not be obtained. Dogs which are common in
Cambay were never seen with sores and in any case they were essentially street animals and
owned by none.
A long series of experiments were carried out with the bed bug Cimex rotundatus and at
first no evidence of the development of the parasite was obtained, but on making further enqui-
ries regarding the time when the infection is usually acquired it was found that over 90 per cent.