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invariable symptom in the progress of the disease is the wasting away of the flesh;
and this is the more remarkable, seeing how much the patient eats, and apparently
with good appetite. This wasting or withering away goes on more rapidly in some
cases than in others. The records of the 4th Punjab Cavalry show an average duration
of forty-three days after the admission on the sick list. Whether they die early or late,
they live until they are reduced in condition to mere living skeletons clothed with little
but skin, most pitiable objects to look at. There is often much anaemic palpitation of the
heart in the last stage, the sound can be heard a little distance off, and the membranes
become blanched. Some cases at last drop down, and die suddenly, perhaps when
they are eating and enjoying food; others become delirious and struggle on the
ground as if in pain; while other cases linger for days after they are down, too weak
to rise or to stand after they are helped up, but go on eating all the grass they get
and much of the corn until at last they die, without pain, passing away gradually like
an English summer's day, no one can tell when the light ends or when the darkness
sets in.
8. Such are the symptoms which any intelligent observer would notice. For
my own more especial observations with regard to the pulse, respirations, temperature,
urine, and blood, I beg to refer you to the appendices lettered A to I. The first
three are records of fairly typical cases of the disease contracted in the normal way ;
the other cases I produced by injecting beneath the skin of healthy animals fresh
blood from the jugular vein of a horse suffering from surra, or else by pouring such
blood into the stomach of healthy animals. These observations I made all myself, and
noted in my memorandum at the moment of observation; so I can vouch for their
correctness so far as they go, but I regret exceedingly the incompleteness of these
records upon some points of special interest to medical men. The vastness of the
field 1 had to work in and the richness of valuable facts to be gathered were more
than I could possibly do justice to alone without trained scientific assistants. I wish
1 could have carried on my examinations of the urine of the cases inoculated as I did
with the normal cases, to see whether it contained albumen, and whether there was in
more than one case any apparent relation between the advent of albumen in the urine
and the decrease of the parasites in the blood. I spent so much time every day in
studying the parasites in the blood, fearing I could not bring any away to show, that
I could not devote myself as much as I wished to the microscopical examination of
the sediment from the urine: my eyes would not stand it. I many times looked for
" casts " in the sediment of the urine, and failed to find any; but I am not prepared
to say none were ever passed, though I believe if they are passed it is rarely, for the
kidneys all appeared quite healthy post mortem, excepting in one case, which I could
not examine by the microscope.* I had to work with the microscope for many hours
a day out-of-doors at the sick lines, or else in a stable, when the thermometer was 82°
within a cool bungalow, and the sun pouring down its rays through a cloudless sky
upon the surrounding bare sandy ground. Very few investigators know what that
means. Moreover, the flies were an additional torment; for when they crowded upon
the stage of my microscope, disturbing the vision, soiling the lenses, and swarming on
my face, &c., it was not possible to fan them off without beating and shaking the
microscope. The blood which 1 was examining or else the tissues of the body at post-
mortem examination attracted them so, and thus much of my energy was expended
in self-control under that provocation.
9. Post-mortem appearances.—The post-mortem examination I made of those
which died from exhaustion revealed no special structural disease, and differed from
those which were destroyed only in post-mortem changes. Owing to the intense
heat I could not make a proper post-mortem examination unless I commenced at dawn
of day, and if the horses did not die at a convenient hour for me, post-mortem changes
would set in before I could examine them. Those destroyed were bled at dawn of
day; the tissues without blood keep better, and as soon as the animal died he was
opened, the internal organs removed, folded in cloths and placed in felted baskets
containing ice, where they remained until I was able to examine them carefully,
making thin sections for the microscope, &c. In the meantime I first examined the
stomach and intestines, opening them from end to end to see the mucous lining and
* It was my last day at Dera Ismail Khan, and I had too much to do.