42
end, most so towards the apex, and their medulla does not extend to either extremity,
so that they look very like worms, for which they are apt to be mistaken. I dwell
on this point because when first I saw them I thought I had made a " find," but
soon decided that I was in error. A thin film of blood may now be examined under
the microscope, under one-fifth inch objective, which is best for diagnostic purposes.
It is at once evident that the blood is not normal. The white corpuscles are, as a rule,
quite natural, but the red are much altered. Sometimes débris of red corpuscles may
be observed, and the corpuscles are crenated, irregularly shrivelled, or they look half-
moon shaped, this latter condition resulting from their being markedly concavo-convex.
Large, irregular, filmy-looking masses, which at first look like altered white corpuscles
arranged in a tessellated manner or in lines like strings of coral, turn out to be
altered or decolorised red corpuscles. I have noted this state especially just after the
parasites have left the blood when the fever is declining, but do not consider it
peculiar and special to this disease, for I also find it in the blood of anæmic mules. It
has been noted in the blood of human patients in relapsing fever, but I cannot recall to
mind having seen or recorded it in the blood of the dog or monkey. The first change
noticed in the blood elements of surra cases at Dera Ismail Khan by Dr. Evans * was
leukocytosis, with a remarkable increase in the number of the largest granular lymphoid
corpuscles, which he often saw breaking up under the microscope. Leukocytosis was
not remarkable in my cases at Rangoon. The next change Dr. Evans noticed was in
the red corpuscles ; he speaks of a large number of shapeless particles of pale red jelly
from half the size of a normal corpuscle downwards, whereas I have invariably found
them larger than the normal red corpuscles. He refers to a large number of small
granular particles in the serum which I also have observed; some of these look like
colorless masses of débris, others are small highly refractive nuclei with an evident
independent movement quite distinct from the Brownian notion, by which all such
minute bodies are found to be affected. These are the " point-like bacteria " seen by
Ignatovsky in man, which he found in the perspiration as well as the blood ; but he
observed them also in the blood of typhoid and typhus patients and in perspiration
induced by pilocarpine and even in the sudor of healthy individuals. It is evident
that the point-like bacteria, which I had described in my daily records, are not distin-
guishable from numerous other micrococci, both normal and pathological. I can, by
independent observation, confirm their special prevalence in those phases of the fever
when the spirilloids are absent; further, I may note that I have frequently seen nuclei
like them in the blood of unaffected animals. Particularly when the corpuscles have
aggregated to form rouleaux and so produced an irregular network of solid blood
elements, the diagnostic characters become apparent. These are the presence of
organisms of a special shape, and the fact of a special movement of the corpuscles
being caused by them. The latter condition will be apparent before the former, and
to the practised eye it is detectable under even very low powers, half inch for example
Quite apart from the blood currents which cause numerous red and white corpuscle
to rush onwards in one direction, generally rapidly, but sometimes in an uncertain slow
manner when they are entangled in side currents, also apart from the occasional rush
of a red corpuscle towards the exposed end of a rouleau, there will be noted a
quivering or shaking of some of the red bodies of an irregularly intermittent
character. When parasites are numerous, this may at once be detected in any part of
the field of vision, but sometimes we note it only after very careful attention and
concentration of our vision on certain groups of corpuscles; then the parasites are not
frequent. While examining the specimen it is necessary to alter the focus carefully
with the fine adjustment, so as to ensure all the thickness of the layer of blood being
seen; sometimes the quivering of red corpuscles is detectable only where they are
massed together. I lay great stress on this quivering because it is a special feature of
relapsing fever and surra, and its presence is diagnostic to such a degree that, when a
large number of blood specimens are being examined in a limited time, it is sufficiently
indicative to the practised eye that there are parasites present. After long exami-
nation of a specimen of slightly-quivering blood, we may at length see a minute thread-
like organism with eel-like movements emerge from the mass of corpuscles and move
slowly forward, or we may observe the little being apparently tugging with all its
* Vide paragraph 24 of his report,