NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
436
APPENDIX TO REPORT OF THE LEPROSY COMMISSION :
On June 5th, 1891, a minute quantity, about one-fourth of a minim,
of a culture of the first generation on agar of the bacillus which was
vacuolated (see Cultivation Experiments) was introduced with anti-
septic precautions into a pocket in the left ear of a pariah dog, and
at the same time about 1 minim of the original culture of the
bacillus (which morphologically appears like Bacillus Lepræ) in
bouillon, into a pocket of the right ear. Both these cultures at
the time of inoculation were examined and found to be pure. On
June 9th a small subcutaneous lump was felt on the left ear, but
none on the right.
On June 15th both ears at the points of in-
oculation presented distinct local thickening, and about I minim of
the second generation of the vacuolated bacillus on agar was mixed
with twenty times its volume of .65 saline solution, and 1 minim of
this subcutaneously injected into the right ear about one inch from
the thickened nodule. One minim of the culture (fourth generation
on agar) was introduced into the left ear. On July 2nd this dog was
injected at the same place in both ears with 1 minim of the original
culture from tubercle in bouillon. This was fourteen days old, and
the solution injected was 1 : 20 saline. This dog died on July
15th, with symptoms of salivation, wasting, and multiple subcu-
taneous abscesses on limbs and abdomen. On the left ear, but only
at the site of the last inoculation, there was distinct thickening of
the cartilage shown by section ; on the left ear nothing was evident.
The viscera were healthy, but the axillary glands were somewhat
enlarged. The lungs, liver, spleen, mucous coat of stomach, testis,
kidney, pus from the abscesses, and tissue from the local thickening
of the ear were examined microscopically by means of cover-glass
preparations. In no instance were any specimens of the bacilli de-
scribed by us present.
On June 3rd another dog was chloroformed, the peritoneum was
opened, and about one minim of the culture on gelatine from the
culture on agar of the bacillus resembling Bacillus Lepræ was in-
troduced. The culture was examined and was found to contain
plenty of these morphologically similar bacilli.
The dog was killed and examined on August 14th. There were
adhesions of the peritoneum in the neighbourhood of the cæcum.
There were no enlarged glands or growths. The liver, spleen, kid-
neys, stomach, intestines, heart, lungs, parotid and submaxillary
glands were all normal, and microscopic examination showed no
bacilli.
On July 8th, and subsequently at intervals of about a week.
another dog was injected in the right axilla with about five minims
Appendix I.
437
of a solution of a culture on gelatine from the culture in bouillon of
the bacillus obtained from a leprous tubercle by the second method
described above, viz., by introducing a piece of leprous tubercle,
removed with all possible precautions, into bouillon. This dog was
killed and examined on August 15th. All the viscera were normal,
but the mediastinal and mesenteric glands were enormously enlarged-
Microscopic examination showed no bacilli in the viscera or glands.
On June nth, and subsequently at intervals, a rabbit was inocu-
lated beneath the skin of the abdomen with a solution of the fourth
generationeneration on agar from the culture obtained by the first method, viz.,
cultivation in blister fluid. The rabbit was killed and examined on
August nth. The liver contained two white growths which showed
psorospermise under the microscope. The other viscera were healthy,
and examined microscopically no Leprosy Bacilli were found.
On June nth, and subsequently at intervals, another rabbit was
injected on the right side of the abdomen with the same solution as
the last. It was believed that the liquid entered the peritoneal cavity.
The rabbit was killed and examined on August 12th. Nothing was
found at the point of inoculation.
The suprarenal capsules were
slightly enlarged. All the other viscera were healthy. No Leprosy
Bacilli could be found in the suprarenal capsules or in the other
viscera.
On July 2nd the anterior chamber of the left eye of another rabbit
was injected with two minims of a solution of culture obtained by the
second method. On July 8th the anterior chamber of the right eye of
the same rabbit was inoculated in the same way. The iris was
wounded during the inoculation. Both eyes healed perfectly and
no growth was visible in the anterior chambers. The rabbit was
killed and examined on August 13th. The liver showed a semi-
purulent cyst, which was found to contain psorospermise. The other
viscera were normal, and there were no enlarged glands. Four spe-
cimens of the aqueous humour of the right eye were examined micros-
copically. One bacillus comparable with the culture was found. This
was probably a portion of the original injection. No growth of ba-
cilli was found. The lens and cicatrix on the same side were ex-
amined with negative result.
On June 13th, and subsequently at intervals, another rabbit was
inoculated in both ears and in the left axilla with one minim of a
solution of the fourth generation on agar of the culture obtained
by the first method. On June 24th a slight thickening was noticed
at the site of inoculation, and a drop of blood and fluid taken from this
place was stained and examined. It showed four or five deeply stain-
438 APPENDIX TO REPORT OF THE LEPROSY COMMISSION :
ed pink bacilli, and in one part of the field a group of faintly stained
cacilli, matted together, and strongly suggestive of the culture intro-
duced. The rabbit was killed and examined on August 10th. There
was some thickening at the points of inoculation on the ears, but
no bacilli were to be found in them. The liver contained two semi-
purulent cysts showing psorospermise.
The other viscera were
healthy. There were no enlarged glands. No Leprosy Bacilli were
found in any part of the body.
On June 24th, a monkey (Macacus rhesus) was injected on the
inner side of the right thigh with about four minims of solution of
the fourth generation on agar of a culture obtained by the first
method. On July 1st it was injected in the left groin with about two
minims of a solution of the original culture from a leprous tubercle
obtained by the second method. The monkey never showed any
local thickening or evidence of infection, and when last seen, on
August 24th, was, to all appearance, healthy.
From the above series of experiments it will be seen that in the
two dogs operated on at Almora, Leprosy Bacilli were found in the
resected portions of bowel, but that these were in all probability
mechanically washed out of the introduced pieces of tubercle. In
the Simla experiments a few bacilli were found in one ear of a rabbit
at the point of inoculation, and a single bacillus was found in the
anterior chamber of another rabbit, also close to the site of inocula-
tion, In view, however, of the very small number of these bacilli,
and of the absence of any general diffusion through the bodies of the
rabbits, we can only regard the bacilli as portions of the cultures
actually introduced. Indeed, these cultures did not appear to be pa-
thogenic. There was nothing to point to a multiplication even at
the point of inoculation. We therefore consider all our inoculation
experiments absolutely without result.
Interesting negative evidence was also obtained at Ahmedabad,
where we examined twenty-one fowls which had lived for periods of
four or five years in the compound of the Leper Asylum, and had
been in the habit of pecking the ulcerated feet of the lepers to such
an extent as to necessitate their removal. They had been kept
apart for our inspection. All these fowls, when we examined them
on August 2gth, were healthy and in good condition. Surgeon
Quicke informed us that a fowl had recently died in the Leper
Asylum compound which had a large tumour under one wing. Un-
fortunately the specimen was not kept as he had ordered, and the
opportunity of examining it was lost. From Dr. Quicke's descrip-
tion, however, the tumour appeared to be too large for a leprous
Appendix I.
439
nodule. From the numerous recorded experiments of observers in
various parts of the world, and from our own attempts at inoculation,
we consider it extremely doubtful whether a true leprosy, such as we
recognise clinically, can be produced in animals. In the absence of
this step, Koch's postulates remain unfulfilled, and it is impossible to
say whether the cultures we obtained from leprous tissues and fluids
are growths of Leprosy Bacilli or not. Further experiments which
we are determined to prosecute with reference to cultivation and
transmissibility to animals, will, we hope, tend to elucidate the aetio-
logy of a disease which we believe to be due to a specific bacillus.
440 APPENDIX TO REPORT OF THE LEPROSY COMMISSION:
APPENDIX II.
Laboratory Work at Simla,
BY
A. A. KANTHACK.
Most of the work described in this short appendix was
done conjointly with the late Surgeon-Major A. Barclay. As,
however, his untimely and deplorable death occurred before
these lines were even begun, the sole responsibility of all state-
ments contained therein must rest with me. The results of
this portion of the practical work will be stated as briefly as
possible, as they convey nothing new, and are mostly nega-
tive, or old established facts.
Appendix II.
441
I.—EXAMINATION OF TISSUES AND DISCHARGES.
The method of staining for Leprosy Bacilli in each instance was
that generally known by the name of Koch-Ehrlich, or Ziehl's modi-
fication thereof.
(a) Tubercles from the ear of a tubercular leper, an inmate of the
Tarn Taran Asylum.
Typical masses of bacilli were found in the corium of the
skin, the epithelium in all specimens being free. The
bacilli were arranged in irregular clusters, but at times
in small chains of two or three rods. Most of them are
pointed, a few however having blunted ends. The other
physical characters are so well known as not to deserve
special mention. It may, however, be noticed that in some
specimens isolated fuchsin bodies, similar to those found
in Rhinoscleroma and the fungoid disease (Mycetoma)
were found.
(b) Discharge from sores of anaesthetic lepers, inmates of the
Subathu Asylum.
Five patients of a purely anaesthetic type were chosen and
ten cover-glasses prepared from each. Of fifty cover-
glasses ten only showed positive results, and these were
all taken from one patient. Here Leprosy Bacilli, in
masses or scattered about separately, could be found in
almost every field.
(c) Discharge from sores of mixed lepers belonging to the same
Asylum.
Two patients were selected and again ten cover-glasses pre-
pared from either. The result was positive in one in-
stance.
d) Nerve from a purely anaesthetic case.
Surgeon-Major E. Lawrie, while performing the operation of
nerve-stretching, removed small pieces of the greatly en-
larged ulnar nerve.
Cover-glass preparations gave no results. Sections of the
nerve, hardened in alcohol and stained in the usual man-
ner, revealed a few bacilli between the fibrillas, and also
numerous giant cells similar to those observed in a tuber-
culosis, but smaller. Some of the giant cells contained
from one to three Leprosy Bacilli.
442
APPENDIX TO REPORT OF THE LEPROSY COMMISSION
(e) Nerve from a purely anaesthetic case.
This specimen was also obtained through the kindness of
Surgeon Major E. Lawrie. The result of the microscopic
examination was negative, although the piece was excised
from a highly diseased part of the nerve. Round cells
resembling leucocytes were found in large numbers ;
giant cells were absent.
The nerve in each case, as exposed by Dr. Lawrie, was much
thickened, transparent and greyish-yellow, and hard to
the touch. The microscope revealed besides the above-
mentioned cells an atrophy of most of the primitive fibrillae
and also a well marked fatty metamorphosis of the round
cells, especially visible in unstained specimens.
(f) A discoloured anaesthetic patch.
Surgeon-Major Lewtas kindly removed a small piece of skin
from an anaesthetic discoloured patch of a leper. No bacilli
were found in any of the forty-three sections prepared.
(g) Itch pustules of—
(1) two anaesthetic cases and
(2) two mixed cases from the Madras Asylum.
The pustules were situated on apparently healthy portions
of the skin. Six cover-glasses were prepared from each
case, but the result was negative, no leprosy bacilli being
found.
(h) Bulla on the dorsum of the hand of an anaesthetic case (Tan-
jore). Ten cover-glasses were prepared and stained, but
all with negative result.
The patient was afflicted with pure anaesthetic leprosy, and
had paraesthesia of both hands. The ulnar nerves were
both thickened. The bulla was spontaneous in origin,
and not due to any injury or burn. The patient spoke with
confidence on this point, and considering that there was
only a slight loss of sensation, there is no reason to doubt
him, and the bulla must be regarded as a sequela of the
nervous lesion.
II.—EXAMINATION OF BLOOD AND SERUM.
(a) Blood and lymph obtained by pricking a tubercle.
Two patients from the Subathu Asylum were employed, and
after pricking the tubercle pressure was applied, so that
with the blood the juice of the tissues was squeezed out.
Appendix II.
443
Twelve cover glasses were prepared, and all the specimens
showed the characteristic bacilli, mostly in cells and masses.
It was impossible to obtain pure blood from a vessel.
(b) Blood obtained by pricking an apparenthy healthy but anaes-
thetic part of a mixed case.
Two patients from the same Asylum were again chosen, and
after pricking the skin pressure was applied to the part.
Twenty cover-glasses, were prepared, and in two Leprosy
Bacilli enclosed in cells were obtained. As, however, these
men presented extensive cutaneous lesions, it is difficult to
say whether the bacilli had not been shed from other parts
of the body, and thus reached the cover-glass as impurities,
so to speak, especially when it is remembered that only two
out of twenty specimens showed bacilli.
(c) Blood obtained by pricking the dorsum of the foot of purely
anæsthetic cases.
Six patients, three from Subathu and three from Hyderabad,
were employed, and though sixty specimens were prepared
and examined in no case was a positive result obtained
(d) Lymph or juice pressed out of tubercle after previous ligature.
Every specimen (four in number) was swarming with Leprosy
Bacilli.
(e) Blisters raised over tubercles.
Four patients were employed and forty specimens of the ex-
uded fluid examined. The clear serum was free from bacilli
in all instances. In one case the blister subsequently became
sero-purulent, and of six specimens made of this fluid one
contained typical bacilli enclosed in cells. The pustule was
punctured, and the collapsed pellicle removed, and next day
the soft crust examined. Of six specimens four showed
numerous clusters of bacilli. It seems, therefore, an un-
common occurrence to find bacilli in absolutely clear serous
blister fluid. This does not seem surprising, considering that
the greater part of this fluid comes from the vessels, and
excepting epidermal débris only contains leucocytes. Blis-
tering is, however, different from vaccination, where the ir-
ritant is inoculated more deeply into the tissues, and it may
be possible that in this manner cells in the corium containing
Leprosy Bacilli are set free with the exuded fluid.
(f) Blisters raised over apparently healthy parts of skin of tuber-
cular lepers.
The same patients were employed, and the same number of
444
APPENDIX TO REPORT OF THE LEPROSY COMMISSION:
specimens prepared, however with uniformly negative re-
sult.
(g) Blisters raised over apparently healthy skin of anaesthetic
lepers.
Three patients were blistered, and thirty cover-glasses stained,
but bacilli were not found in a single instance.
III.—EXAMINATION OF SECRETIONS.
(a) Saliva—
The saliva of three tubercular cases with extensive facial
lesions was examined at the Subathu Asylum.
Thirty specimens were prepared, and Leprosy Bacilli, mostly
in clusters and embedded in cells, were found in every
specimen.
(b) Nasal secretion-
Two patients suffering from extensive facial tubercular leprosy
were selected. Except that minute tubercles were visible
on the alæ nasi, the nose was quite healthy. Yet all the
twenty specimens stained and examined, contained Leprosy
Bacilli in fair number.
(c) Vaginal secretion of a tubercular leper-
Fifty specimens were examined, but no bacilli found.
(d) Menstrual discharge of an anaesthetic leper.
Thirty specimens were examined, but no bacilli found.
The chief results will now be given in a tabular form :—
TABLE I.
(I)
(2)
(3)
(4)
Source of material.
Nerve of anæsthetic leper
Anaesthetic discoloured patch
Discharge from sore of anaes-
thetic leper
Discharge from sore of mixed
leper
....
Number of
patients
examined.
2
I
5
2
Number of
specimens
prepared.
43 sections
50 (
20 (
RESULT.
Positive in one case.
Negative in all specimens.
Positive in 10.
Negative in 40.
Positive in r.
Negative in 19.
Appendix II.
445
Table I—continued.
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(H)
(15)
(16)
(17)
(18)
(19)
(20)
Source of material.
Itch pustules of anaesthetic
leper .
.
Itch pustule of mixed leper
Bulla over dorsum of hand of an
anaesthetic leper .
Blood and lymph from a tuber-
cle
.....
Blood and lymph from healthy
but anaesthetic part of skin
from a mixed leper
Blood obtained by pricking
dorsum of foot of a purely
anaesthetic leper .
Juice obtained from tissues of a
tubercle
....
Blister over a tubercle
Pustule over a tubercle .
Crust from (13)
Blister over healthy skin of tu-
bercular leper
Blister over healthy skin of
anaesthetic case .
.
Saliva of tubercular leper
Nasal secretion of tubercular
leper
....
Vaginal discharge of tubercular
leper
.
Menstrual discharge of anæs-
thetic leper .
Number of
patients
examined.
2
2
I
2
2
6
1
4
1
1
4
3
3
2
1
1
Number of
specimens
RESULT.
prepared.
12
12
10
12
20
60
4
40
6
6
40
30
30
20
50
30
Negative in all cases.
Ditto.
Ditto.
Positive in all cases.
Positive in 2.
Negative in 18.
Negative in all cases.
Positive in all cases.
Negative in all cases.
Positive in 1.
Negative in 5.
Positive in 4.
Negative in 2.
Negative in all cases.
Ditto.
Positive in all cases.
Positive in 14.
Negative in 6.
Negative in all cases.
Ditto.
IV.—EXAMINATION OF WATER FROM TANKS FREQUENTED BY
LEPERS.
(a) Water from a tank at Bombay, much frequented by lepers.
Only ten specimens were prepared and these were all nega-
tive.
446
APPENDIX TO REPORT OF THE LEPROSY
COMMISSION:
(b) Water from a tank at Tarn Taran, much frequented by lepers.
Hundred specimens were prepared : fifty were stained ac-
cording to Ziehl's modification of Koch-Ehrlich's method
and another fifty according to Baumgarten's method« In
no specimen could any Leprosy Bacilli be found.
V.—DUST AND EARTH FROM LEPER HUTS OF THE TARN TARAN
ASYLUM.
(a) From hut inhabited by a tubercular leper with ulceration on
the right foot.
(b) From hut inhabited by a tubercular leper with ulcers on both
feet.
(c) From hut inhabited by a tubercular leper with ulcers on both
feet.
In each ease one hundred specimens were prepared : fifty
were stained according to Koch-Ehrlich's method, fifty ac-
cording to Baumgarten's method. In all three hundred
specimens the result was negative«
(d) From hut inhabited by an anaesthetic leper with ulcerations on
all extremities.
(e) From hut inhabited by an anæsthetic leper with ulcerations
on both feet.
(f) From hut inhabited by an anaesthetic leper with ulcerations
on both feet.
In each case fifty specimens were prepared: twenty-five were
stained according to Ziehl's method and twenty-five accord-
ing to Baumgarten's method.
In all hundred and fifty specimens the result was negative.
These results will be given in tabular form :—
TABLE II.
(0
(2)
Source of material.
Water from tank at Bombay
Water from tank at Tarn
Taran
....
Number
of
specimens
examined.
10
100
Method.
Ziehl's .
50 by Ziehl's .
50 by Baumgarten's
RESULT.
Negative.
Ditto.
Appendix II.
447
Table II—continued.
(3)
(4)
(5)
(6)
(7)
(8)
Source of material.
Dust from hut of tubercular
leper with ulcers on one
foot.
.
Dust from hut of tubercular
leper with ulcers on both
feet
....
Dust from hut of tubercular
leper with ulcers on both
feet
....
Dust from hut of anaesthetic
leper with ulcers on all ex-
tremities
....
Dust from hut of anaesthetic
leper with ulcers on both
feet
....
Dust from hut of anaesthetic
leper with ulcers on both
feet
Number
of
specimens
examined.
100
100
100
5°5
0
50
Method.
50 by Koch-Ehrlich's
50 by Baumgarten's
Ditto .
Ditto .
25 by Ziehl's
25 by Baumgarten's
Ditto .
Ditto .
RESULT.
Negativa.
Ditto.
Ditto.
Ditto.
Ditto.
Ditto.
VI.—IMPLANTATION OF LEPER TISSUE INTO ANIMALS.
On January 22nd five animals—one monkey, two cats, and two
rabbits—were operated on in Dr. D. D. Cunningham's laboratory at
Calcutta. The tissue was removed from the ear of a tubercular
leper, and minute pieces removed from the centre of the excised
mass, used for implantation. These particles were inserted either
into the anterior chamber of the eye, or dropped into the peritoneal
cavity. The operation in each instance was performed with sterilized
instruments and all antiseptic lotions carefully avoided, sterilized
water alone being used. The eye operations were performed on the
monkey (one eye), one cat (both eyes), one rabbit (one eye), and the
abdominal implantation practised on the other cat and rabbit. Un-
fortunately both the rabbits died before they came into my pos-
session. The animals were left at the Zoological Gardens of
Calcutta, and after the rains had set in sent up to Simla, where
they arrived by the beginning of August in rather emaciated condi-
tion, due, no doubt, to the fatiguing journey.
448
APPENDIX TO REPORT OF THE LEPROSY COMMISSION:
I propose now to state briefly the result of these implantations,
(a) Cat, operated on January 22nd, 1891 —
A particle from a leprous tubercle of the size of a hemp-
seed was deposited into the peritoneal cavity.
August 11th, 1891.—Excepting the emaciated appearance of
the animal nothing abnormal could be detected. On
killing the cat and making an autopsy, the original nodule
was easily found in the omentum. It appeared larger,
but this was evidently due to a new formation of fibrous
tissue around it, and a delicate thread of fibrous tissue
was traced from the nodule to the parietal peritoneum.
No dissemination whatever had occurred, the peritoneum,
intestines, and other viscera being quite free.
On microscopic examination bacilli were found in the nodule,
not different in shape and arrangement from those in any
tissue removed from a tubercular leper. The result is
therefore absolutely negative.
(b) Cat, operated on January 22nd, 1891 —
An iridectomy was performed on both eyes and a particle
from a leprous tubercle of the size of a hemp-seed in-
serted into either anterior chamber. No reaction what-
ever occurred, no iritis or conjunctivitis, and the corneal
wound healed well.
August nth, 1891.—The animal was somewhat emaciated,
but otherwise perfectly healthy, and excepting in the eyes
no changes could be detected anywhere. The media of
both eyes were clear to naked eye examination and to
inspection by focal illumination and the ophthalmoscope.
No iritis could be observed in either eye. The nodule
was plainly seen in the aqueous humour and was appa-
rently undiminished in size.
(1) Left eye.—The nodule was visible on the temporal side,
being fixed by a small thread of fibrous tissue to the scar
in the cornea on the one hand, and to the adjoining part
of the iris on the other, so that it could perform only very
limited movement. The corneal scar was partly vascu-
larised, but otherwise the cornea was perfectly clear.
The iris was normal to all appearance and only slightly
swollen at the insertion of the fibrous thread which con-
nected it with the nodule. The aqueous humour was
clear.
A dissection confirmed the observations of this examination.