NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Appendix II.
449
Microscopic Examination.
Many cover-glass preparations were made of the aqueous
humour, and all contained Leprosy Bacilli in fair number.
Two or three masses, evidently shed from the nodule, were
found in each specimen, but loose and independent bacilli
could not be detected. It is thus highly improbable that the
bacteria had grown or multiplied in the aqueous humour.
The eye was carefully washed with sterilized water, and
cover-glass preparations made of the iris. Near the site
of the implanted nodule, where the thickening in the
iris existed, many Leprosy Bacilli were found, but the
same, though much more scantily, were observed in all
parts of the iris examined. The bacilli occurred mostly
in cells, but a number of loose ones were also seen
amongst the tissue elements of the iris. Sections of the
iris were not made through want of apparatus, but little
pieces were squeezed between cover-glasses and then
treated in the ordinary manner.
In view of the absence of all morbid appearances in the iris
and the comparative scarcity of the bacilli in more re-
mote parts of the iris, I am inclined to think that the
organisms have either been deposited on, or taken up
into, the substance of the iris from the aqueous humour
into which they had been cast off from the original nodule
through maceration. The original nodule presented no
differences microscopically from tissue freshly removed
from a tubercular leper, and was full of bacilli.
The retina and vitreous humour were quite free from leprosy,
or other bacilli.
(2) Right eye.—The nodule was floating free in the aqueous
humour. The cornea was clear and the linear incision
made at the time of operation had healed, almost without
leaving a scar. The iris and other parts of the eye-ball,
both on ophthalmoscopic examination and oblique focal
illumination, appeared unaffected. Microscopic examina-
tion was made of the original nodule and the aqueous
humour only, the result being that the nodule was appa-
rently unchanged, but the aqueous humour was quite free
from bacilli. What remained of the two eyes has been re-
served for examination by serial sections at a future time.*
* June 4,892 : Such examination revealed an entire absence of bacilli within the tissues
of the iris, choroid, etc.
2 G
450 APPENDIX TO REPORT OF THE LEPROSY COMMISSION:
(3) A careful autopsy and search did not reveal any dissemination
or secondary growths in any part of the body.
Therefore the result of these two animal experiments must
be considered on the whole as highly unsatisfactory,
as there is an absence of infection or, so far as can
be judged by cover-glass preparations, of even a local
proliferation. The want of inflammatory, or other general
and defined changes in the iris, the clearness of the
aqueous humour and of the cornea are all against a local
contagion, to borrow a term from Virchow. The result
of the experiment on the next animal was equally un-
satisfactory.
(c) Monkey, full grown, operated on January 22nd, 1891—
An iridectomy was performed on the left eye and a piece
of tissue from the same leper who supplied material for
the other animals, was inserted into the anterior chamber.
As it was impossible to prevent the animal from scratch-
ing, or interfering with its eye, some reaction, amount-
ing to slight suppuration and hypopyon, took place, and
the cornea also became slightly inflamed.
August 22nd, 1891.—The monkey was somewhat emaciated
but otherwise no morbid changes were visible on the
surface. After death a close examination of the eye
revealed intense inflammation of the conjunctiva amount-
ing to chemosis, inflammatory changes of the cornea, and
suppuration in the anterior chamber. The wound in the
cornea had not healed and matter from the anterior
chamber was bulging out through the same. Subsequent
dissection showed that the iris was almost completely
destroyed, at least irrecognisable in the mass of thick pus
which had taken the place of the aqueous humour. The
anterior surface of the lens was white and softened. The
rest of the media were perfectly normal to the naked
eye.
Microscopic Examination.
(1) In the conjunctiva no bacilli were found by means of cover-
glass specimens, except at the unhealed wound, whither
most probably they had been discharged from the anterior
chamber.
(2) Matter from the anterior chamber contained bacilli, but only
Appendix II.
451
in small quantity, two out of six cover-glass preparations
showing the typical masses.
(3) The other media of the eye showed no bacilli.
All the other organs of the animal, excepting a few enlarged
mesenteric glands, were apparently normal. The glands
will be left for future examination, but it is highly impro-
bable that they contain any bacilli, as the whole peri-
toneum appeared to be healthy. No reference has been
made to the experiments of Damsch and others, because in
the absence of sections it is quite impossible to speak with
any confidence on such matters as local proliferation and
dissemination. This portion of the work has been re-
served for another time.*
VII.—CULTIVATION EXPERIMENTS WITH THE BACILLUS LEPRÆ.
The results of these experiments—premature and short-
lived—have been published in the British Medical Journal
(June 6th and 20th, 1891). As after a careful review of
all the facts, benefiting by the kind criticism of Professors
C. Fränkel and Baumgarten, I feel convinced that the
artificially grown bacillus was not the Leprosy Bacillus ;
it will suffice simply to mention that attempts were made
by me, in conjunction with the late Surgeon-Major
A. Barclay, to cultivate the bacillus, but with no result.
An explanation of this matter has already appeared in the
above-mentioned journal.
ADDENDUM.
VIII.—EXAMINATION OF MOSQUITOES FOR LEPROSY BACILLI.
The following observations were made in conjunction with
Surgeon-Major S. J. Thomson. The insects were obtained through
the kindness of Surgeon-Major B. O'Brien, Civil Surgeon and
Principal of the Medical College, Agra.
Three sets of mosquitoes were enclosed in muslin bags which
were tied round the legs of three lepers. Of these one suffered from
* Cf. preceding footnote.
452 APPENDIX TO REPORT OF THE LEPROSY COMMISSION
ulcerative tubercular leprosy, another from the tubercular form, and
the third from anaesthetic leprosy. The bags were applied for a couple
of hours in the morning, and again in the evening. At the end of
four or five days many of the enclosed insects had died. These, with
the few surviving ones, were put into separate bottles filled with abso-
lute alcohol and sent up to the laboratory of the Commission at Simla
for microscopic examination.
Ten mosquitoes were selected from each set. Some were gorged,
especially those from the two tubercular cases, but most of the in-
sects were of a natural size and undistended. They were placed in
water to remove the alcohol, and then each set separately ground
up in a small mortar with the least possible quantity of .75 per cent.
salt solution, and ten cover-glass preparations made, using up the
whole material. In this manner thirty specimens were obtained and
stained for sixteen hours in anilin-fuchsin and treated in the usual
manner. On microscopic examination no Leprosy Bacilli were found
in any of the cover-glasses; a few cocci in some of the specimens
were the only organisms seen.
Mosquitoes and Leprosy,
NATURE OF DISEASE.
(1) Tubercular leper without ulcers
(2)
"
"
with ulcers
(3) Anæsthetic leper .
Number of
mosquitoes
examined.
10
10
10
Number of
specimens
prepared.
10
10
10
RESULT.
Negative.
Ditto.
Ditto.
INDEX, AND NAMES OF AUTHORITIES QUOTED.
A
Abraham, Dr. P. S.
. . 23, 346,
Almora Orphanage .
. . 227,
"Anacardium occidentale" (Cashew-
nut oil), treatment by
....
Area, endemic, description of
...
Arjun, Sakharum, Mr
Arning, Dr. . . . 252, 269, 302,
Arsenic, treatment by . . . 341,
Asylums and refuges, description of,
9, effect of, 124, recommended
Atar Chand, Clerk to Commission
Atavism in leprosy
PAGE
335
xiv
XXV
389
333
100
339
III
310
344
388
136
211
B
Bacillus lepræ 99, 101, 392, 420, 441,
Baines, J. A. (Imperial Census Re-
port) 40, 65, 90, 104, 110, 114, 115,
Baker, Oswald, Surgeon-Major . .
Bakewell,
Dr.
333,
Barth (Religions of India)
....
Beauperthuy,
Dr.
333,
Bellew, Dr. H.
W.
72,
Besnier, Dr. M.
E.
268,
"Black" leprosy
....
40,
Blandford, H. E.
.
47, 58, 91,
Blood and serum in leprosy
. 397,
Boinet, Dr. E. (" La Lèpre à Hanoi ")
Bowerbank,
Dr.
British Medical Journal . . 135, 207,
Brothers and sisters of lepers . 234,
451
174
269
334
116
334
73
269
44
110
442
324
341
345
242
C
"Calotropis gigantea" (Madar),
Carter, Vandyke, Dr. xiii, xvi, 205,
210, 333, 337, 338,
Census
36, 66,
Centres of leprosy, diffusion from
269,
Charrin and Roger, Drs. (La Semaine
Médicale)
Children of lepers . . . 212, 225,
Cholera and leprosy . . . 70,
Cleanliness, personal, in leprosy
Climate and leprosy
Collateral relationships in leprosy
Collins, Mr. W. J. (Lancet, 1890) .
Conclusions of Commission
Congenital disease, leprosy not a
.
Contagion in leprosy, 100, 259, 260,
265, 272,
Cornet, Dr. G., on tubercle bacillus .
PAGE
341
340
270
270
305
229
75
303
57
210
385
3S4
210
274
264
D
Dallas, Mr. W. L
Dampness and leprosy
....
Danielssen and Boeck
. xxi, 204,
Death-rate and leprosy
....
Density of population and leprosy
90,
"De novo," explanation of term 99,
217, 223, 262, 279,
Diet and leprosy
"Dipterocarpus turbinatus" (Gurjun
Distribution of leprosy, tables
. .
Dougall, Surgeon-Major J. .
Drunkenness and leprosy
....
59
59
344
7o
103
384
304
335
137
46
335
325
454
Index, and Names of Authorities quoted.
Drysdale, Mr.
T.
Duration of disease in leprosy .
Dust and earth in leprosy 271, 297,
298, 409,
E
Eating and drinking with lepers 267,
Endemic disease, leprosy an
...
Errors of diagnosis in leprosy
xxii,
36,
European and Eurasian lepers
Expectation of life in leprosy . , .
Eye, diseases of, in leprosy
. .
F
Families, spread of leprosy in . 215,
Famines and leprosy
Farms for lepers
Farr, W. (Vital Statistics)
. . .
Fish, as a cause of leprosy 304, 308,
317,
Fitch, Dr. (Report on Leprosy in
Hawaii)
Flies and leprosy
....
302,
Flügge, C.
...
259, 262, 264,
Foster, M. (Text-book of Physiology)
G
Gairdner, Dr. W. T. (British Medical
Journal, 1887)
Gerlach, Dr
Geographical distribution of leprosy
36,
"Gynocardia odorata" (Chaúlmoogra
oil), treatment by
...
338,
H
Habits, injurious, in leprosy
Hankin,
Dr.
Hansen, A.
204, 205, 217, 259, 273,
346,
Hatch, Surgeon-Major . . , .
Heidenstam, Dr. (Report on Leprosy
in Cyprus)
PAGE
57
66
XV
446
294
98
52
113
xxi
346
277
76
389
102
410
254
4'3
265
xiii
320
269
xiii
38
344
325
100
386
276
389
Hill tracts and leprosy 46, 271, 303,
Hillis,
Dr.
Hillairet,
Dr.
Heredity and predisposition in le-
prosy 204,
....
206, 241,
Hunter, Sir W. W. (Imperial Gazet-
teer of India) ....
85, 89,
Husbands and wives of lepers 241,
267,
Hutchinson, Mr. J. . 45, 309, 310,
"Hydrocarpus Wightiana" (Kowti
oil), treatment by
" Hydrocotyle Asiatica" (Asiatic Pen-
nywort), treatment by
....
I
Increase and decrease of population
Increase of leprosy
. . . 48,
Indian Medical Gazette
....
Inoculation and leprosy . 271, 432,
J
Journal of Leprosy Investigation
Committee, 45, 52, 135, 252, 269,
271, 302, 306, 325,
K
Koch, R., on tuberculosis
L
Laboratory Work of Commission 268,
269, 302, 324, 392,
Lancet (M. de Valence's paper)
Larynx, disease of, in leprosy .
Leloir (Traité Pratique de la Lépre)
204, 205, 260, 268,
Leo, Dr.
H.
Leukoderma and leprosy
. .
PAGE
316
337
344
245
214
96
282
312
340
341
64
50
345
262
447
326
320
263
440
218
346
346
305
36
Index, and Names of Authorities quoted.
455
Lewis, T. R , and Cunningham, D. D.
(Report on Leprosy in India, 1877)
27, 39, 40, 45, 117, 126, 205, 227,
245, 251, 284,
Liveing, Dr. R. (Goulstonian Lectures
for 1873) . . 204, 211, 304, 305,
Localities visited by Commission
Lutz, Dr., treatment of ...
342,
M
Macnamara, F. N. (Himalayan India)
"Madura foot"
Marriages among lepers 226, 250, 254,
282,
Mercury in leprosy . . . . . .
Migration of lepers
Monti (Annual Report, Local Govern-
ment Board, 1889)
Mosquitoes and leprosy . . . 302,
Moore, Sir W.
J.
326,
N
Nerve-stretching in leprosy . . 344
"Nga-pi" and leprosy . 308, 310,
Nicholson, Dr. W., on arsenic in le-
Norwegian lepers . 204, 227, 247, 260
O
O'Connor, J. E. (Prices and Wages
in India)
90,
Oils, medicinal, in leprosy
....
P
Pringle, Surgeon-Major R., on vacci-
nation and leprosy
PAGE
311
309
1
343
93
113
14
287
343
126
305
451
329
441
411
341
280
318
332
88
133
Procreative faculty among lepers .
Prostitution and leprosy
....
R
Races, predisposition of, to leprosy
Religion and caste in leprosy . .
Report of Indian Famine Commis-
sion
81,
83,
Report of Sanitary Commissioner
with Government of Idnia . 130,
Report of Local Government Board
131, 264,
Report of Royal College of Physi-
cians on leprosy . . . .113,
Report of Trinidad Leper Asylum,
XXI ....
337, 339, 341,
Rickets
Rivers and sea-coast and leprosy .
S
Salol in leprosy
. . 342, 343,
Salt and leprosy
. . . . 317,
Sandberg, D., on tuberculosis .
Sanitation in relation to leprosy 299,
Secretions and excretions in leprosy
397,
Segregation and isolation in leprosy
265,
Sex in leprosy
Sherring, M. A. (Hindu tribes and
Smoking and living with lepers 271,
Suggestions of Commission for deal-
ing with lepers
Surgical treatment of leprosy .
Syphilis and leprosy
. 325, 329,
T
Tebb, W. (leprosy and vaccination)
126,
Temperature and leprosy
. .
Tetanus, spores of, in dust . 99,
Transmission of leprosy to animals.
Treatment of leprosy . . . 331,
PAGE
251
95
387
no
"3
307
268
305
341
344
217
45
359
321
101
330
303
444
385
xix
312
286
385
344
384
128
60
101
325
347
456
Index, and Names of Authorities quoted.
Tubercles, excision of, in leprosy . .
Tuberculosis compared with leprosy
100, 101, 206, 207, 263, 264, 272, 273
U
Ulcers, treatment of, in leprosy . .
Unna, Dr., treatment of leprosy by
PAGE
345
367
384
345
342
V
Vaccination and leprosy 127, 268, 296,
Vagrants, regulations concerning
387,
Virchow, R. . 45, 204, 208, 214, 261,
272, 309, 325,
W
Water and leprosy . 301, 324, 410,
Watt, Dr. G. (Dictionary of Eco-
nomic Products of India) . 332,
336, 333,
PAGE
413
3SS
214
329
445
341
G. 1. U. P. O. - No. 235 II. D -- 191-93.—2,500.
No. 4.
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SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA .
ON THE ACTION OF THE VENOMS OF THE COBRA (NAJA TRIPUDIANS)
AND OF THE DABOIA (DABOIA RUSSELLII)
ON THE RED BLOOD CORPUSCLES AND ON THE BLOOD PLASMA.
BY
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ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
BY THE SANITARY COMMISSIONER WITH THE GOVERNMENT
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OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
ON THE ACTION OF THE VENOMS OF THE COBRA (NAJA TRIPUDIANS)
AND OF THE DABOIA (DABOIA RUSSELLII)
ON THE RED BLOOD CORPUSCLES AND ON THE BLOOD PLASMA.
BY
GEORGE LAMB, M.D., CAPTAIN, I.M.S.
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
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ON THE ACTION OF THE VENOMS OF THE COBRA (NAJA TRIPUDIANS)
AND OF THE DABOIA (DABOIA RUSSELLII)
ON THE RED BLOOD CORPUSCLES AND ON THE BLOOD PLASMA.
T HE action of the different varieties of snake venom on the constituents of
1
the bood and on the blood coagulability is a subject which has engaged
the attention of various observers in America, Australia, and India. A study of
the literature of the subject' makes it evident that all venoms which have been
worked with have a marked action on the blood, the effect of which is mani-
fested in the production of changes of a destructive nature on the red corpus-
cles, as well as in an alteration of the coagulability of the plasma. From such
a study, however, it is apparent that no investigator has attempted to note care-
fully the differences which exist between the various poisons in these respects.
So much so is this the case, that Calmette of Lille 2 holds the opinion that all
snake venoms have exactly the same physiological actions and only differ from
one another in the degree of toxicity which they possess, one being more toxic
than another. And, again, Martin of Melbourne 3 has put forward the working
hypothesis, founded on his own experiments with the venoms of the Australian
snakes, Hoplocephalus and Pseudechis, and on the researches of others with
various venoms, that all snake venoms contain two or more poisonous proteids,
and that in the varying proportions of these in venoms from different species
of snakes may be found the explanation of the different effects which follow the
inoculation of the several poisons. He thought that the proteids coagulable
by heat acted on the blood and heart, while the incoagulable proteids acted on
the central nervous system.
Along with Dr. Hanna 4 I have shown that Calmette's statement is without
foundation and also that Martin's theory does not, in all probability, apply to
the two venoms with which I propose to deal in this paper. Further, the facts
which I have now to record support my previous observations and show without
a doubt that in their physiological actions, the effects of which are seen in the
changes in the blood constituents and plasma, the venoms of the cobra and of
the daboia differ markedly from one another, and that Calmette's statement
and Martin's hypothesis can no longer pass unchallenged and must be consid-
erably modified to fit the facts now available. In the present communication,
then, I propose to deal (I) with the action which the venom of the cobra (Naja
tripudians) and the venom of the chain viper (Daboia Russellii) exert on the
red blood corpuscles both in vivo and in vitro, the result of which action is
manifested by hæmolysis : and (2) with the action which these two poisons
A2
2
have, also in vivo and in vitro, on the blood plasma, as seen in an altera-
tion of its coagulability.
At the outset it would be well to give a short account of the methods
which were employed to collect and to conserve the poisons used in the experi-
ments recorded below, so as to ensure that the results obtained were uniform
and comparable amongst themselves.
The venom in both instances was collected over a period of some months
from a number of healthy living snakes by 'milking', or rather squeezing, the
poison glands, the secretion being caught in a watch-glass held in a pair of long
forceps. The liquid poison was then thoroughly and rapidly dried over calcium
chloride. The stock of venom, got in this way, was kept in an air-tight tube
away from the light. It has been shown by many investigators that snake
venoms, stored dry in this manner, preserve their toxicity unimpaired for an in-
definite period. Before being weighed the venom was pounded to a very fine
powder and was then kept in a weighing bottle over sulphuric acid or calcium
chloride. This precaution is necessary in a climate in which the atmosphere
is saturated with moisture such as is the case in Bombay. As they were re-
quired, solutions of definite strengths made with saline solution of varying
strength, as indicated in the protocols, were prepared. No solution was kept
longer than an hour or two before being used. As the supply of venom was
always abundant, fresh solutions were prepared every day upon which experi-
ments were made. In this way any diminution of toxicity, which, there is no
doubt, takes place when snake venoms are kept in solution for any length of
time, was avoided. With this introduction we may now pass on to consider—
The action of cobra venom on the red blood corpuscles in vivo
and in vitro.
It has been stated by some observers that cobra venom has no destructive
action on the red blood cells in viva. This opinion is founded on the fact
that a microscopic examination of the circulating blood of animals injected with
large doses of cobra venom shows no structural change of the red cells. The
evidence, however, that this poison has a distinct hæmolytic power in vivo,
both in the case of man and of animals, is very strong. Thus, in the case of
man after a cobra bite there is, in every instance, an exudation of a red-stained
serous fluid from the punctures. A microscopic examination of this fluid shows
the almost total absence of red blood corpuscles. This fact was first pointed
out by Wall 5 ; while, in a case of cobra bite, which, along with Dr. Hanna ,6 I
have put on record, this sanguineous discharge was well marked and lasted for
24 hours. Further, Wall 7 h a s a f f i r m e d t h a t i n e v e r y c a s e o f d e a t h f r o m c o b r a
bite in man there is found on post-mortem examination at the site of the