NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
8
such non-nucleated masses containing large numbers of parasites
are shown in figure 1.
(2) Forms of multiplication. I have observed three forms of the para-
site which may perhaps be regarded as stages in a process of multi-
plication. They are the following :— ( a) Parasites in which the
large chromatin mass has become kidney-shaped, and the small
mass considerably elongated ; ( b ) Parasites in which the large chro-
matin mass has divided into two and commencing division of the
whole parasite is apparent ; ( c) Forms in which the parasite has
apparently divided into three or more (sometimes as many as eight)
parts. The last forms are rare but are to be seen in films both free
and contained in the characteristic mononuclear cells. They are
usually of about the same size and shape as a red blood corpuscle.
The form as a whole stains brightly pink and for this reason is
easily distinguished from similarly shaped portions of leucocytic
cells containing parasites. Its circumference is very distinct, and
when the form is contained in a leucocytic cell the line of demar-
cation between it and the protoplasm of the cell is very plainly seen.
Arranged in a remarkably regular manner round the inner periphery
of the form are from three to seven or eight chromatin masses
which represent the large chromatin masses of an equal number of
presumably young parasites. Near the centre of the form the small
chromatin masses (which appear only as dots) of the same parasites
form a circle inside the larger ones. One or two unstained vacuolic
areas may be present in the form and occasionally a strand of
faintly blue-stained substance is seen, but the outlines of the in-
dividual parasites are not apparent. One of these forms contained
in a large cell is represented in figure 3.
(3) Parasites consisting of little more than a large nucleus surrounded by
a small amount of body substance, the second chromatin mass not
being present (figure 1, f ).
(4) A small number of polynuclear leucocytes, some of which may contain
one or two parasites.
(5) Débris from the skin tissues, and almost always a few cocci and
bacilli.
Thin films made from the blood which exudes after scraping a sore very
closely resemble films made from blood obtained by spleen puncture in some cases
of tropical splenomegaly. Scattered among the blood corpuscles are a number
of the characteristic large cells crowded with parasites, and a considerable number
of parasites lying free among the cells and corpuscles are also seen.
9
Description of sections. —Portions of tissue from the sores of Cases 1 and
10 were fixed in absolute alcohol and embedded in paraffin. Some of the sections
cut from them were stained with Romanowsky's stain after the method described
by Christophers.* Others were stained in a solution of alcoholic hæmatin pre-
pared according to the following formula:
—
Hæmatin 1/10 gramme.
Alcohol (90%) 2.5 c.c.
Alum 2.5 grammes.
Distilled water 50 c.c.
This stain, if kept for three or four weeks before use, gives excellent resu ts
and shows up the parasites in the tissues quite as well as Romanowsky's stain.
After taking the curl out of the sections by placing them in warm water they
should be floated on to slides and pressed gently with filter paper. If it is found
that the sections do not remain adherent to the slides a little fixative may be used,
but it is not always necessary. After the sections have been dried and the
paraffin melted, they are treated as usual with xylol, absolute alcohol, and water.
The hæmatin stain is kept in a wide-mouthed "staining pot" in which the slide
carrying the sections can be placed. The slides are kept in the stain for from 10
to 20 minutes or more until, by an examination under a low power of the micro-
scope, the nuclei of the leucocytic cells are seen to be deeply stained. They are
then removed from the pot, washed in water, and dried. A drop of thin Canada
balsam is placed on each section and a cover glass pressed gently upon it. The
preparation and cutting of sections is usually considered to be a very laborious
process requiring a large amount of apparatus, but that this is not the case is
shown by the fact that most of my sections were cut during the hot weather in a
hotel at Delhi and in the dâk bungalow at Karnal.
Unless the thinnest possible sections are used the structure of the parasitic
bodies contained in the large cells cannot be made out.
The appearance of a section when viewed under a low power of the micro-
scope is shown in figure 4. The dots in this drawing represent the nuclei
of the mononuclear cells of which the extensive new deposit of granulation
tissue is composed. This deposit of granulation tissue everywhere per-
vades the substance of the true skin, almost entirely replacing the normal
tissues of the part and causing atrophy, and in places disappearance, of the
papillæ, the sweat glands, the hair follicles, and the epidermis. Under a high
power the deposit is seen to be almost entirely composed of large endothelioid
cells, the majority of which contain in their cytoplasm enormous numbers of
* Scientific Memoirs by officers of the Medical and Sanitary Departments of the Government of India,
New Series No. 8.
C
1 0
small, deeply staining bodies, which in thick sections look like large cocci, in
thinner sections like large cocci surrounded by a clear space, and in the thinnest
sections present the characteristic structure of the parasitic bodies already de-
scribed as present in films made from the fresh tissues. Owing to the contraction
undergone by the tissues during fixation the bodies appear more rounded and
smaller than when seen in films, but when very thin parts of the section are
examined the two characteristic nuclei of each body are easily seen, and there
can be no doubt that the bodies are identical with those seen in films. On the
other hand it is easy to understand how Cunningham and Reihl, who had no
opportunity of examining films, were unable to make out any definite structure in
the bodies seen only in sections.
The parasitic bodies are not contained in all the large cells composing the
deposit of fresh granulation tissue. Comparatively large areas of tissue may be
examined in the cells of which no bodies are present, but in these areas the cells
themselves are of the same character as those containing the bodies.
In parts of the section the invasion of hair follicles and sweat glands by the
new tissue can be observed, and in figure 5 is shown a portion of a section in which
nothing remains but a dead hair encased in the characteristic cells containing
parasites.
In addition to the large parasite-containing cells there are seen in sections a
number of cells resembling lymphocytes and rarely one or two polynuclear cells.
In the almost complete absence of polynuclear cells, however, both films and
sections from a true case of Delhi Sore differ markedly from specimens obtained
from other sores.
Summary of results as regards the presence of parasites in Delhi Sores. —
The parasites just described were found in the sores of 11 out of the 18 cases of
which brief notes have been given above. If the sores themselves are counted,
they were found in 13 out of 20 sores. They were not found in the sores of
cases 2, 3, 6, 8, 13, 16, and 18. In cases 2, 6, and 8 the correctness of the diagnosis
was doubtful. Case 3, which was undoubtedly a true case of Delhi Sore, had
lasted eighteen months, and on turning to the description of Case 1, which at the
time of the second examination had also lasted about the same period, it will
be seen that parasites were absent at the time of the second examination, though
they were present in abundance six months before. It is quite possible, therefore,
that in a certain proportion of sores which are undoubtedly true Oriental Sores,
parasites may not be found if the sore has lasted a long time and has commenced
to heal. As regards the Frontier Sores it will be noted that cases 13, 16, and 18 in
which the parasites were not found had been under treatment in hospital consider-
ably longer than the other cases. It would indeed be surprising if the parasites
did not disappear after continuous treatment for 70 days, and I do not doubt that
to the effects of treatment must be ascribed the absence of parasites in these
three cases and their scantiness in cases 14 and 17.
Does the parasite occur as a cause of enlargement of the spleen in places
where it occurs as a cause of Delhi Sore?—In view of the close resemblance between
the parasites of Delhi Sore and those found in certain cases of enlargement of the
spleen, it seemed to me important to ascertain whether these parasites could be
found as a cause of enlargement of the spleen in Delhi or Karnal where they
certainly existed as a cause of Oriental Sores. With this object I examined, by
the operation of spleen puncture, as many cases of enlargement of the spleen as
possible in the neighbourhoods of these towns, selecting only cases in which con-
siderable enlargement of the spleen or liver or both was present, and which, there-
fore, bore a superficial resemblance in these respects to some cases of kala azar.
As it is unnecessary, for our present purpose, to describe these cases in
detail I shall tabulate them as follows :—
N u m b e r .
Place.
Name.
Age.
Condition of spleen.
Condition of liver. Other particulars of the case
Results of examination of
slides obtained by spleen
puncture and by scraping
of ulcers.
1
Delbi .
. Nazaj Khan 40
Beyond umbilicus . No enlargement
detected.
Has had fever and is taking
quinine. There is the scar
of an ulcer on the left leg.
No malarial parasites or
pigment; no Leishman parasites; finger blood also negative.
2 Delhi .
. Zahagir
•
42 Nearly to umbilicus
.
Ditto .
.
. Has had fever and is taking
quinine.
Several
large
scabbed ulcers on legs.
No malarial parasites or pig-
ment ; no Leishman para-
sites ; cocci and bacilli but
no parasites present in
ulcers. Spleen puncture done
on two occasions with same
negative result.
3 Delhi .
. Abdulla
. 3o Beyond umbilicus
.
Ditto .
.
.
Has had no fever for some
time and is working.
No malaria parasites or
pigment ; no Leishman
parasites.
4 Delhi .
. Elai Bux . . 28 To umbilicus
.
Ditto . .
.
Ditto
.
.
.
.
Ditto
ditto.
5 Delhi .
. Amrao .
. 32
Ditto
.
Ditto .
.
.
Ditto .
.
.
.
Ditto
d i t t o .
6 Delhi .
. Tulsa .
. 25 Midway between
umbilicus and pubes
Two inches below
costal margin.
For a few days after admis-
sion an evening rise of
temperature
which was
stopped by quinine. Has
a chronic ulcer on left leg.
No malaria parasites or pig-
ment ; no Leishman para-
sites; puncture performed
on two occasions with same
negative result;
no para-
sites in scraping from ulcer.
7 Soneput near
Delhi.
Ahmed
. 20
Beyond umbilicus . No
enlargement
detected.
Has no fever now ; chronic
ulcers on back of both thighs.
No malaria parasites or pig-
ment; no Leishman para-
sites ; no
parasites in
scrapings from ulcers.
8 Soneput
. Ranji Lal
. 30 1½hands' breadth
below costal mar.
gin.
Ditto .
.
Has no fever now ; chronic
ulcer on fore-arm.
Ditto
ditto.
C2
12
N u m b e r .
Place.
Name.
A g e .
Condition of spleen. Condition of liver.
Other particulars of
t h e c a s e .
Results of examination of
slides obtained by splee
puncture and by scraping
of ulcers.
9
Soneput
. Jai Lal
. 32 One hand's breadth
beyond umbilicus.
Oneinch below costal
m a r g i n .
Admitted for dysentery ; no
fever lately; duration of
splenic enlargement 2 years.
No malarial parasites or pig-
ment ; no Leishman para-
sites.
1 0 Soneput
. Ganashi
. 30 Two inches below
umbilicus.
Two inches below
costal margin.
History of enlarged spleen
for 10 years. Is greatly
emaciated and has ascites,
ten pints of fluid being re-
moved by tapping on 3rd
April 1904. No fever now.
Ditto
ditto.
1 1
Soneput
. Kurarya
• 25 One hand 's breadth i
below costal margin
No enlargement de-
tected.
Admitted for dysentery ; no
fever now.
No malaria parasites or
pigment ; no
Leishman
parasites.
1 2 Soneput
. Rajia .
. 4o Two inches below
umbilicus.
Not examined
History of occasional fever
for two years.
Simple Tertian malaria para-
sites; no Leishman para-
sites; finger blood also
contains S. T. malaria para-
sites.
13 Soneput
. Ram Nath . 30 To umbilicus .. Ditto ..
. History of acute fever ; is
much jaundiced.
Simple Tertian malaria para-
sites and much pigment ;
finger blood not examined.
1 4
Soneput
. Badl oo
. 15
Ditto .
. No enlargement de-
tected.
......
No malaria parasites or
pigment;
no Leishman
parasites.
1 5
Soneput
. Bhola .
. 3o Nearly to umbilicus
Ditto
.
. A strong, healthy-looking
man. Has fever occa-
sionally.
Ditto
d i t t o .
1 6
Soneput
. P h u la n
(female).
23 To pelvic brim
. Two inches below
costal margin.
Is very anæmic and weak.
History of much fever. Is
taking quinine. Has a
chronic ulcer on leg.
No malaria parasites or
pigment;
no Leishman
parasites ; no parasites
in scrapings of ulcer.
1 7
Soneput
Ramkalla .
1 8 To umbilicus .
. No enlargement de-
tected.
History of fever .
.
. Much malarial pigment both
free and in large mononu-
clear leucocytes ; no Leish-
man parasites.
1 8
Soneput
.
. Harnarain . 20 Beyond umbilicus
Ditto
.
. Has several chronic ulcers
on legs.
No malaria parasites or pig-
ment; no Leishman para-
sites ;
no parasites in
scrapings of ulcers.
19 Soneput
. Sundar.
. ... 1½ hands' breadth
below costal margin.
Ditto
. .
. . . . . .
No malaria parasites or
pigment ;
no Leishman
parasites.
20 Soneput
Kabal .
. 45 To umbilicus
Ditto
.
. The splenic enlargement has
been considerably dimi-
nished under quinine treat-
ment.
Ditto
ditto.
21
Soneput
. Gokhal
. 30 Midway
between
umbilicus
and
pube
One inch below
costal margin.
Is very emaciated and
anæmic.
Duration
of
splenic enlargement 12
years.
Ditto
d i t t o .
22
Soneput
. Adami .
26 To umbilicus
. No
enlargement
detected.
Ditto
ditto.
23
Soneput
. Ram Ram . 24 1½ hands below
costal margin.
Ditto
History of frequent fever for
6 months.
Scanty malignant Tertian
rings and crescents; no
Leishman parasites.
importance as regards danger to life, in another they produce a very serious and
14
dangerous general disease ; and on the other hand, the most probable explanation
of the facts is that the parasites of Delhi Sore and those of kala azar, though
indistinguishable in appearance, are in reality quite different in that they produce
entirely different pathological effects.
Attempts to communicate the disease to animals.—On the 17th of April the
skin on the back of a dog was shaved in two places, and it was inoculated on these
areas with scrapings from the granulations of the sore of Case 1 which contained at
the time many parasites. The dog was watched for some months but the wounds
of inoculation quickly healed and no sore resulted. A similar experiment on
another dog was carried out with scrapings from the sores of Case 10, but in this
case also no sore resulted.
Although in none of the cases which I saw was there any evidence that
Delhi Sores ever result in anything more than a local lesion, in view of the pos-
sibility that such sores are the starting point of more serious trouble, I did not
think it advisable to try inoculation experiments on human beings. In Case 10,
however, the nearness of the two sores on the toes to each other and the fact that
one had commenced some time after the other, rendered it very probable that in
this case a successful inoculation had been carried out unwittingly by the patient
himself while scratching the first sore.
Naga Sores.—During my tour in Assam I had an opportunity of examining
films made from scrapings obtained from five sores which had been diagnosed
by Civil Surgeons or Assistant Surgeons as Naga Sores. These sores bear no
resemblance to Delhi Sores, and the chief characteristic of the films was the
presence of a very large number of polynuclear cells some of which contained a
few cocci. No parasite of any kind was found in the films.
Spirilla as a possible cause of sores resembling Delhi Sores occurring in
dogs.—One of the dogs obtained at Delhi developed upon its upper lip a sore
bearing a superficial resemblance to some true examples of Delhi Sore. An
examination in the fresh state of the discharge from this sore revealed the presence
of numerous spirilla in active movement among the blood corpuscles and other
cells. Each spirillum exhibited the same rapid wave-like motion along its own
axis as is seen in the Spirillum obermeyeri, and when stained and examined under
a high power the general resemblance to that organism was very close. Measure-
ments showed, however, that the majority were shorter and perhaps slightly thicker
than the spirochætes of relapsing fever. A few are shown in figure 6, which, drawn
with the aid of a camera lucida, exhibits accurately the general shape of the
organisms and their relative size as compared to that of the blood corpuscles.
The peripheral blood of the dog was examined on several occasions, but
none of the organisms were detected in it.
15
In the absence of any experimental work upon this organism it is perhaps
scarcely justifiable to give even the above scant description of it. I do so only
with the object of throwing out the suggestion that the so-called Delhi Sores
reported to occur commonly among dogs and other domestic animals may
possibly be of a different nature and caused by an organism different from that
of the true Delhi Sores occurring in man.
CONCLUSIONS.
1. The deposit of a tumour-like formation of granulation tissue is the
essential condition in Delhi Sore. The new tissue infiltrates, destroys, and
replaces all the structures of the true skin, and pressing upon the epidermis causes
it to atrophy and disappear, so that an ulcer results. Many of the cells compos-
ing the new tissue contain parasites which, almost certainly, are the primary cause
of the lesion.
2. The parasites cannot be distinguished by examination under the micro-
scope from those obtained from the spleen and other organs in certain cases of
splenomegaly and kala azar.
3. On the other hand the parasites met with in the Punjab are apparently
capable of producing only the comparatively mild local disease known as
Delhi Sore, while those in Assam produce only the dangerous general disease
known as kala azar. This raises many interesting questions, as, for example,
whether the parasites of Delhi Sore and of kala azar, though obviously belonging
to the same class, are different species.
4. A probable mode of infection in Delhi Sore is by the accidental inoculation
of material containing the parasites, and it is reasonable to suppose that such
inoculation may be effected by a biting insect.
5. The evidence adduced points to the fact that even when numerous
parasites are present in a Delhi Sore on the skin for a long period, no general
disease, such as kala azar, results, and (assuming that the parasites of kala azar
and Delhi Sore are identical) for this reason as well as for the reason that no case
of general infection with the parasite was found in the Punjab where local skin
infections with it are not uncommon, it is improbable that the path of infection
in kala azar is by way of the skin. And if any biting insect were proved to be
the infecting agent of Delhi Sores, it would not necessarily follow that this is the
mode by which kala azar is contracted.
6. The parasites were found in Oriental Sores contracted in Delhi, Karnal,
Shahabad, Lahore, Quetta, and Dera Ismail Khan, and for this reason it may be
concluded that "Delhi Sores," "Lahore Sores," "Sind Sores," "Frontier Sores,"
etc., are one and the same disease caused by the same parasite. The ulcers
16
known as "Naga Sores" in Assam, however, are apparently of a different
nature.
7. Attempts to communicate Delhi Sore to two dogs failed. No experi-
ment was made on human beings, but one of the sores of Case 10 was probably
contracted by accidental inoculation from another. The generally accepted
opinion that true Delhi Sores occur on dogs and other domestic animals has
yet to be confirmed.
8. There has been a tendency of late to regard all cases usually diagnosed
in India as "malarial cachexia with enlargement of the spleen" as being due to
the parasite recently discovered in the spleen and other organs of some cases
diagnosed under this designation in Madras and Calcutta. The evidence in this
paper shows that such an opinion is not justifiable in the light of the fact that as
regards most cases of great enlargement of the spleen occurring in the Punjab a
diagnosis of "malarial cachexia" would, in all probability, in the present state of
our knowledge, be correct.
9.
G. I. C. P. O.—No. 2242 S. C.—25-2-05—1145.
Fig. 2.
Fig. 4.
Fig. 3.
Fig. 5.
'
Fig. 6.
Phot ogravure.
Survey of India Offices, Calcutta, November 1904.
No. 13
( NEW SERIES. )
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
ORIENTAL OR DELHI SORE.
BY
CAPTAIN S. P. JAMES, M.B., I.M.S.
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.
1905.
Price Annas 10 or 1s.
ANNUAL ADMINISTRATION REPORT
OF THE
CIVIL VETERINARY DEPARTMENT IN INDIA
FOR THE OFFICIAL YEAR
1892-93.
ANNUAL ADMINISTRATION REPORT
OF THE
CIVIL VETERINARY DEPARTMENT IN INDIA
FOR THE OFFICIAL YEAR.
1892-93.
CONTENTS.
SECTION I.—(MILITARY):
Horse-breeding
...
...
...
Mule-breeding
... ... ...
Remarks
...
...
...
...
SECTION II.—(REVENUE):
Officers of Civil Veterinary Department ...
District horse and mule breeding ... ...
Tours of officers of Civil Veterinary Department
Cost of the Department ... ...
Veterinary Colleges and Schools
... ...
Rules and duties of officers ... ...
Imperial Bacteriological Laboratory ... ...
Babugarh Instruction Farm ... ...
SECTION I.—(MILITARY):
Appendices ... ... ... ...
SECTION II.—(REVENUE):
Appendices ... ... ... ...
PAGES.
1 to 13
17 „ 21
22 & 23
27 & 28
31 to 33
33 „ 35
35 & 36
39 to 44
47
51
55 to 58
61 to 105
109 to 147
GOVERNMENT OF INDIA.
ANNUAL ADMINISTRATION REPORT
OF THE
CIVIL VETERINARY DEPARTMENT IN
INDIA
FOR THE OFFICIAL YEAR.
1892-93.
SECTION I—MILITARY.
HORSE BREEDING.
GOVERNMENT OF INDIA.
ANNUAL ADMINISTRATION REPORT
OF THE
CIVIL VETERINARY DEPARTMENT IN INDIA
FOR THE OFFICIAL YEAR
1892-93.
SECTION I.—MILITARY.
Number of—
HORSE-BREEDING.
The total number of horses kept for stallion purposes by the Government stallions:
in Bengal, Bombay, and Central India on the 1st of April 1892 was as given
in the table below :—
Breed.
Thorough-bred English ... ... ...
Half-bred and Norfolk Trotters ... ...
Australian ...
...
...
...
Three-quarter bred ... ... ...
Arab (horse) ... ... ...
Do. (pony) ... ... ...
Pegu (pony) ... ... ...
Persian ... ... ... ...
Turkoman ... ... ... ...
Country-bred ... ... ...
TOTAL ... ...
Bengal.
59
120
2
1
80
...
...
1
1
4
268
Bombay.
10
8
...
1
26
30
1
...
...
...
76
Central India.
......
......
......
......
6
......
......
......
......
1
7
1