NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
3
No. 41. Quinine and its Salts : their Solubility and Absorbability, by Captain A. C.
MacGilchrist, M.A., M.D., M.R.C.P., I.M.S. Price As. 9 or 10 d.
No. 42. The Cultivation of the Bacillus of Leprosy and the Treatment of cases by means of
a Vaccine prepared from the Cultivations, Part I, by Major E. R. Rost, I.M.S.
The Cultivation of the Leprosy Bacillus, by Captain T. S. B. Williams, M.B.,
I.M.S. Price As. 8 or 9 d.
No. 43. The Relation of Tetanus to the Hypodermic or Intramuscular Injection of Quinine,
by Lieutenant-Colonel Sir D. Semple, Kt., M.D. Price As. 12 or 1s. 2d.
No. 44. The Preparation of a Safe and Efficient Anti-rabic Vaccine, by Lieutenant-Colonel
Sir D. Semple, Kt., M.D., D.P.H., R.A.M.C. (Retired). Price As. 8 or 9d.
No. 45. Epidemic Dropsy in Calcutta, by Major E. D. W. Greig, M.D., D.Sc., I.M.S.
Price Re. 1 and As. 4 or 2 s.
No. 46. Malaria in the Punjab, by Major S. R.. Christophers, M.B., I.M.S. Price
Rs. 2 or 3 s.
No. 47, Dysentery and Liver Abscess in Bombay, by Major E. D. W. Greig, M.D., D.Sc.,
I.M.S., and Captain R. P. Wells, M.A., M.B., I.M.S. Price Rs. 2 or 3 s.
No. 48. Investigations into the Jail Dietaries of the United Provinces with some observations
on the influence of dietary on the physical development and well-being of the
people of United Provinces, by Major D. McCay, M.B., M.R..C.P., I.M.S. Price
Re. 1-12 or 3 s.
No. 49. Epidemic Dropsy in Calcutta, being the final report of an enquiry carried out by
Major E. D. W. Greig, M.D., I.M.S.
No. 50. Preliminary Report on an Investigation into the Etiology of Oriental Sore in
Cambay, by Captain W. S. Patton, I.M.S. Price As. 6.
No. 51. Dysentery in Hazaribagh Central Jail, January 1910—March 1911, being the report
of an enquiry carried out by Captain R. T. Wells, M.A., M.B., I.M.S. Price
Re. 1 and As. 12, or 2 s. 9d.
Published by and on sale at the Office of the Superintendent of Government Printing, India, Calcutta. Copies are also available from all Agents for the sale of Government publications
A Streptothrix Isolated from the Spleen
of a Leper.
I N the following paper we propose to record the results of our observations on
a pure culture of a streptothrix which we isolated from the spleen of a
leper. The case is of interest for two reasons, firstly, because the streptothrix
closely resembled that described by Deycke Pasha 1 and. Major Rost,2 and
secondly, because of the curious variations of the growth in respect to ( a) mor-
phology, ( b) staining reactions, and ( c) pigment production.
The post-mortem examination or this patient was made 1½ hours after
death. The liver and spleen were much enlarged and showed vast numbers of
acidfast " lepra bacilli " in smears made from them.
The spleen in particular was more carefully examined and removed to the
laboratory for the purpose of making cultures and sections. In all, some thirty-
nine tubes of various media were smeared with the splenic pulp carefully
removed with all aseptic precautions from different parts of the spleen. The
media used comprised tubes of ordinary peptone agar, lemco-agar, " nasgar,"
blood serum, blood agar, Dorset's egg medium and a cheese medium. To some
of the tubes a pure mixed culture of an amœba was added, while bacteria free
amœba cysts were placed on other tubes. The majority of the tubes, however,
were simply smeared with splenic pulp. In each of four of the thirty-nine tubes
a single colony of a golden yellow colour developed in the course of three or four
days, All the tubes remained sterile except those to which a pure culture of a
bacillus had been added together with amœba cysts and the abovementioned
four tubes in each of which a single yellow colony developed. The four yellow
colonies resembled each other closely, and on further study were shown to
belong to one species of streptothrix. One of the colonies, namely, the one
which grew on " lemco-agar," was selected for minute study. The other colonies
were found, two in two tubes of Dorset's egg medium alone, and one in a tube
of Dorset's egg medium to which a pure mixed culture of amœbæ had been
added to the smeared spleen pulp.
1 Deutsche Mediz. Wochenschr. Nos. 13 and 14, 1905.
2 Scientific Memoir by Officers of the Medical and Sanitary Departments of the Government of India,
No. 42.
2
DETAILED STUDY OF THE COLONY ON LEMCO-AGAR.
In all the tubes a considerable quantity (a large loopful) of splenic pulp
was spread over the surface. The tubes were carefully examined from day to
day. On the third day, on the lemco-agar tube, a single minute golden yellow
coloured colony was observed. A smear was made from this colony which was
stained with carbol fuchsin, decolourised by 25 per cent. H 2So4 for one
minute,* and counter stained with Methylene blue. Illustrations III and IV
are drawn from two selected fields of this film. It will be seen that we were
dealing with an acidfast streptothrix, which in some parts was losing its
acidfast properties.
Twenty-four hours later the colony was again examined. It had increased
considerably in size, partly because, in removing some of the culture to make
the specimen described above, the growth had been spread over a large surface
and partly because the colony itself had grown larger. Smears were again
made and stained as above with the result shown in Figure V. It will be
noticed that the acidfast portions of the streptothrix were now scarcer, and
that the filaments were divided into smaller fragments, resembling bacillary
filaments rather than streptothrix filaments. The colony at this time was
further spread over the surface of the agar, and, when examined 48 hours later,
or six days after the tube had first been planted, showed a thick raised opaque
golden yellow mass, as shown in Figure XI. Films made at this stage and
stained by the Zeihl-Neelson method showed that the filaments had still further
broken up and now resembled cocco bacilli, a few of them non-acidfast but the
majority acidfast (Figure VI). At this stage subcultures were made on a
number of other media, viz. , ordinary agar, cheese medium, Dorset's egg
medium, and Rost's medium. The cultures in all these media now grew
rapidly so that in twenty-four hours an extensive growth was obtained. The
colour of the growth differed with the medium used, thus :—
(a) The original growth was golden yellow in colour (Figure XI).
(b) A subculture upon ordinary nutrient agar gave a brick-red growth
(Figure XII).
(c) A subculture from ( b) upon cheese medium was scarlet in colour
(Figure XIV).
(d) A subculture from the scarlet growth on cheese medium upon
Dorset's egg medium became golden yellow (Figure XIII).
(e) A subculture from the original golden yellow colony on lemco-agar
upon Dorset's egg medium gave a golden yellow growth.
* All the slides stained by the Ziehl-Neelson method were treated in this, way.
3
( f ) All subcultures from Rost's medium when put on Dorest's egg
medium gave a golden yellow growth.
A microscopical examination showed that the growth on ordinary agar
medium was non-acidfast (FigureVIII) ; on cheese medium and Dorset's egg me
dium portions were non-acidfast (Figure IX). In old cultures there was a tend-
ency to an increase of the acidfast portions. The individual elements of the
growths varied much in shape, from cocal forms (Figure VI), through bacillary
forms (Figure VIII), to streptothrix filaments (Figures III, IV and VII). In
Rost's medium, however, the growth was for the most part acidfast, and in this
medium the streptothrix nature of the growth was more evident (Figure VII).
The acidfast property was always developed in this medium although the growth
from which the subculture was made was not acidfast. For example, a subcul-
ture from an ordinary agar tube, which was not acidfast (Figure VIII), was put
into Rost's medium, A specimen prepared from this medium after twenty-four
hours was acidfast and the streptothrix nature of the growth was more evident
(Figure VII).
Meanwhile, sections of the spleen which had been hardened and dehydrated
in alcohol and imbedded in paraffin with chloroform were cut and examined by
Captain Taylor, I.M.S. The sections were stained by various methods. It was
found that the imbedding process had made the " lepra bacilli " practically non
acidfast so that Gram's method of staining was found to give the best results. In
one portion of the spleen, which had been treated and stained in this way, in
addition to clumps of ordinary endocellular " lepra bacilli " filaments of strepto-
thrix were found apparently growing in a blood sinus, and extending into the ad-
jacent splenic tissue. Sections made from several other portions of the spleen
failed to show the streptothrix, a portion of this Gram positive streptothrix
growth has been illustrated in Figure I, and is probably the same acidfast
strep- tothrix which was isolated in culture.
The details we have given above showed that we were dealing with a very
pleomorphic organism, i.e ., a streptothrix which under certain circumstances not
only varied greatly, ( a ) in shape, resembling at one time a coccus, at another
time a bacillus, and yet a third time showing typical long streptothrix fila-
ments, but ( b) varied greatly in its acidfast properties, being at one time
completely non-acidfast, and at another time entirely acidfast, the acidfastness
depending on the age of the growth, and on the nature of the culture medium,
and (c) varied slightly in the character of the pigment produced in different
media. These pleomorphic features of our streptothrix are recognised to be
common to other streptotriceæ, a feature of these growths which has been
ably pointed out and illustrated by Foulerton, in his Milroy lectures for 1910.
4
We take this opportunity of drawing attention to the fact, that much
useful work may be rejected if the pleomorphic qualities of the streptotricæ are
not kept in mind. Had we, for example, by chance not examined the minute
colony which developed on the third day in our lemco-agar tube till the colony
had grown larger, as on the fourth day, we would have found such appear-
ances as are illustrated in Figure V, and we would not have been regarded as
very foolish if we had rejected our cultures as possible contaminations, for there
does not appear to be any connection between the acidfast lepra bacilli and
the non-acidfast bacillary bodies shown in the figure. However, we are not yet
prepared to state, till after further study, that there is any connection between
this particular streptothrix which we have isolated and the lepra bacilli found
within certain cells in the tissues. We may, however, put forward the sugges-
tion that the causative organism of leprosy may grow in the form of a strepto-
thrix in various parts of the body—in a blood sinus of the spleen, for example,
as we found in our case :—growing thus the streptothrix may break up into
bacillary filaments and these filaments may be scattered by the blood stream and
be taken up by endothelial cells and other macrophages where they would appear
as the so-called " lepra bacilli " within the " lepra cells." We can conceive
that the majority of these " lepra bacilli " are dead, and that cultures can only
be obtained from a leprosy case when living filaments or spores are encountered,
perhaps only with great difficulty and after much search in some remote part
of the body.
A further point of interest is the following Previous to the colony on
the original lemco tube being spread widely we examined films made from por-
tions of the smeared material which showed no obvious growth. Our object
was to see if the " lepra bacilli " in those portions showed any changes which
might connect them with the acidfast streptothrix growing in another portion
of the same tube. Very interesting changes were observed. See Figure II.
In the first place only acidfast organisms were seen, and these varied in shape
from typical " lepra bacilli," to large fat bacilli, and even comparatively long
acidfast filaments. The illustration is not taken from a single field, but
individual elements showing the various changes described above were selected
from several fields and grouped together as seen in the illustration.
There were present :
—
(a) Typical " dotted " lepra bacilli ;
(b) Lepra bacilli where the " dots " were becoming much larger than
normal ;
(c) Large swollen globular acidfast bodies ;
( d) Parts of acidfast filaments.
•
By a careful examination of the film one could make out intermediate
forms between every stage, from the small thin " lepra bacillus " to the large
swollen acidfast filaments mentioned above. Thus individual bacilli were seen
where only one " dot" had swollen to a large size leaving the other " dots ''
normal ; while other "bacilli " again were noted with a large terminal acidfast
globular swelling. These latter, separated from the remnants of the "
bacilli, "formed the large acidfast bodies mentioned under (c) above. We are not
prepared at present to express any opinion on these changes, but prefer to leave
the observed facts on record.
Finally, this organism, if inoculated into guinea-pigs may produce at the
site of inoculation a nodular swelling. Smears from this show that there are
many acidfast cocco bacilli present, nearly all arranged intracellularly,
Figure X.
I.
III.
Engraved and printed
by the Calcutta phototype Co.
IV.
v.
VI.
VII.
VIII.
Engraved and Printed
by the Calcutta Phototype Co.
XIII.
XII.
XI.
E n g r a v e d a n d P r i n t e d
IX.
X.
XIV.
by the Calcutta Phototype Co.
IP/QB, 10
No. 20.
(NEW SERIES.)
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
SERUM-THERAPY OF PLAGUE IN INDIA ;
REPORTS BY MR. W. M. HAFFKINE, C.I.E., AND VARIOUS OFFICERS
OF THE PLAGUE RESEARCH LABORATORY, BOMBAY.
EDITED WITH AN INTRODUCTION
BY
LIEUT.-COL. W. B. BANNERMAN, M.D., B.SC., F.R.S.E., I.M.S.,
Director, Plague Research Laboratory, Bombay.
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.
INDIA. — Santary Commissioner
No. 20.
(NEW SERIES. )
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
SERUM-THERAPY OF PLAGUE IN INDIA;
REPORTS BY MR. W. M. HAFFKINE, C.I.E., AND VARIOUS OFFICERS
OF THE PLAGUE RESEARCH LABORATORY, BOMBAY.
EDITED WITH AN INTRODUCTION
BY
LIEUT.-COL. W. B. BANNERMAN, M.D., B.SC., F.R.S.E , I.M.S.,
Director, Plague Research Laboratory, Bombay.
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.
Agents for the Sale of Books published by the Superintendent of Government
Printing, India, Calcutta.
IN ENGLAND.
IN INDIA.
H. S. KING & Co., 65, Cornhill, & 9, Pall Mall,
London.
THACKER, SPINK & CO., Calcutta and Simla.
NEWMAN & CO., Calcutta.
E. A. ARNOLD, 41 & 43, Maddox Street, Bond
Street, London, W.
S.K. LAHIRI & CO., Calcutta.
CONSTABLE & CO., 16, James Street, Hay Market,
London, W.
R. CAMBRAY & CO., Calcutta.
HIGGINBOTHAM & Co., Madras.
P. S. KING & SON, 2 & 4, Great Smith Street,
Westminster, London, S.W.
V. KALYANARAMA IYER & CO., Madras.
G. A. NATESAN & CO., Madras.
KEGAN PAUL, TRENCH, TRÜBNER & CO., Charing
Cross Road, London, W.C.
THACKER & CO., LD., Bombay.
BERNARD QUARITCH, 15, Piccadilly, London, W.
A. J. COMBRIDGE & Co., Bombay.
B. H. BLACKWELL, 50 & 51, Broad Street, Oxford. D. B. TARAPOREVALA, SONS & CO., Bombay.
DEIGHTON BELL & CO., Cambridge.
RADHABAI ATMARAM SAGOON, Bombay.
ON THE CONTINENT.
N. B. MATHUR, Superintendent, Nazair Kanun
Hind Press, Allahabad.
R. FRIEDLANDER & SOHN, 11, Carlstrasse, Berlin,
N.W.
RAI SAHIB M. GULAB SINGH & SONS, Mufid-i-Am
Press, Lahore.
OTTO HARRASSOWITZ, Leipzig.
Superintendent, American Baptist Mission Press,
Rangoon.
KARL W. HIERSEMANN, Leipzig.
ERNEST LEROUX, 28, Rue Bonaparte, Paris.
SUNDER PANDURANG, Bombay.
MARTINUS NIJHOFF, The Hague, Holland.
A. M. & J. FERGUSON, Ceylon.
List of Numbers of Scientific Memoirs by Officers of the Medical and Sanitary
Departments of the Government of India (New Series) published previous
to the present issue.
No. 1. Standardisation of Calmette's anti-venomous serum with pure cobra venom : the
deterioration of this serum through keeping in India, by Captain G. Lamb,
I.M.S., and Wm. Hanna, Esq., M.B. Price As. 3 or 4 d.
No. 2. Malaria in India, by Captain S. P. J ames, I.M.S. Price Re. 1-8 or 2 s. 3 d.
No. 3. Some observations on the poison of Russell's Viper (Daboia Russellii), by Captain
G. Lamb, I.M.S., and Wm. Hanna, Esq., M.B. Price As. 5 or 6 d.
No. 4. On the action of the venoms of the Cobra and of the Daboia on the red blood cor-
puscles and on the blood plasma, by Captain G. Lamb, I.M.S.
Price As. 8
or 9d.
No. 5. Specificity of anti-venomous sera, by Captain G. Lamb, I.M.S. Price As. 3 or 4d.
No. 6. First report on the anti-malarial operations in Mian Mir, 1901-03, by Captain
S. P. James, I.M.S. Price As. 12 or 1S. 2 d.
No. 7. Some observations on the poison of the Banded Krait (Bungarus Fasciatus), by
Captain G. Lamb, I.M.S. Price As. 8 or 9 d.
No. 8. A preliminary report on a parasite found in patients suffering from enlargement of
the spleen in India, by Lieutenant S. R. Christophers, I.M.S. Price Re. 1-8
or 2 s. 3 d.
No. 9. Second report of the anti-malarial operations at Mian Mir, 1901-03, by Lieutenant
S. R. Christophers, I.M.S. Price As. 10 or 1s.
No. 10. Specificity of anti-venomous sera (second communication), by Captain G. Lamb,
I.M.S. Price As. 8 or 9 d.
No. 11. On a parasite found in persons suffering from enlargement of the spleen in India—
Second Report, by Lieutenant S. R. Christophers, I.M.S. Price Rs. 2 or 3 s.
No. 12. On the Morphology, Teratology and Diclinism of the flowers of Cannabis, by
Major D. Praia, I.M.S.
Price As. 14 or 1s. 4 d.
No. 13. Oriental or Delhi Sore, by Captain S. P. J ames, I .M.S. Price As. 10 or 1s.
No. 14. On a parasite found in the white corpuscles of the blood of dogs, by Captain S. P.
James, I.M.S. Price As. 10 or 1s.
No. 15. On a parasite found in persons suffering from enlargement of the spleen in India—
Third Report, by Lieutenant S. R. Christophers, I.M.S. Price As. 10 or 1 s.
No. 16. The specificity of anti-venomous sera with special reference to a serum prepared
with the venom of the Daboia Russellii, by Captain G. Lamb, I.M.S.
Price
As. 6 or 7 d.
No. 17. Snake-venoms in relation to Hæmolysis, by Captain G. Lamb, I.M.S. Price As. 6
or 7 d.
No. 18. Hæmogregarina Gerbilli, by Lieutenant S. R. Christophers, M.B., I.M.S.
Price
As. to or 1s.
No. 19. On Kala Azar, Malaria and Malarial Cachexia, by Captain S. P. James,
M.B., I.M.S. Price Re. 1-4 or 1s. 11d.
Published by and on sale at the Office of the Superintendent of Government Printing, India, Calcutta. Copies
are also available from all Agents for the sale of Government publications.
SERUM-THERAPY OF PLAGUE IN INDIA.
INTRODUCTION.
T HE papers published in this number relate to trials in the Bombay Municipal
Plague Hospitals, of the sera prepared according to the me thods of
Professor Lustig of Florence, Professor Terni, formerly of Messina, now of Milan,
Dr. Brazil of San Paulo, Brazil, and Dr. Roux of the Pasteur Institute of Paris.
Originally they were submitted to Government in the form of letters report-
ing results as the experiments progressed, and the work of the editor has simply
been to produce connected reports from the materials submitted to him for this
purpose. Though it has been necessary therefore to recast the reports, the
sense and, as far as possible, the original wording, have been retained.
The first to try anti-plague serum in India was Yersin, who reached Bombay
early in 1897, bringing with him serum prepared in Tongkin and at the Pasteur
Institute at Paris. Its mode of preparation is thus described by Roux. " The
anti-plague serum from horses 21 and 31 was prepared in the following way :—
The horses first received dead cultures of plague bacilli subcutaneously ; after-
wards they received dead cultures by intravenous i njection. Lastly they re-
ceived living cultures by intravenous injection."
Yersin treated a considerable number of private patients in Bombay, the
results being communicated by him to the Plague Committee as follows :—
Died.
Recovered.
Percentage
mortality.
Treated on first day of illness 1 7
.
.
2
15
12
„ s e c o n d
„
„
17
.
.
6
11
35
„
third,,
„
12
.
.
6
6
50
„
fourth„
„
3
.
.
2
1
66
„
fifth„
„
1
.
.
1
0
1 0 0
TOTAL TREATED
5 0
•
•
17
33
34
He further said that " the serum used in these experiments was supplied
by the Pasteur Institute of Nha trang It had to be prepared in great haste,
B
2
so it was weaker than that used last year in China, and the doses to be injected
consequently had to be largely increased."2
The following summarises those cases treated either by himself or under
his directions by other medical men, in the Bombay hospitals.
In the Parel Old Government House Hospital 27 persons were inoculated
with Yersin's serum ; the first three being injected by Yersin himself and the
rest by Captain Thomson, I.M.S.
Three of these must be excluded as the patients were not suffering from
plague, but from (a) meningitis with osseous tumour pressing on the medulla,
(b) hepatitis and remittent fever, (c) some other disease not specified. One
healthy woman was given a prophylactic injection, and must also be excluded.
Of the remaining 23 individuals who undoubtedly had plague, 14 died and 9
recovered, giving a percentage mortality of 6o.86.3 The general mortality in the
Parel Hospital at the time was 64.5, but as the Medical Officer in charge points
out, there were among them a large number of moribund cases, which more than
accounts for the difference.
Captain G. S. Thomson, M.B., I.M.S., who was in charge of the cases,
reports that " the temperature, pulse and respirations were recorded and taken
personally immediately before injection in each case." He notes the following
as results following the injection of the serum :—Fall of temperature in many
cases, fewer complications, lessening of the delirium. " No improvement in the
general condition of the patients could be seen, and the inflamed glands were
certainly not favourably affected." Convalescence did not seem to be quicker
than in cases under the ordinary treatment.
In other hospitals in Bombay nine more patients were treated by Yersin.
Of these one, who recovered, may be omitted as having been already inoculated
with Haffkine's plague prophylactic, which as is well known favourably influences
the course of the disease in those contracting plague subsequent to inoculation.
Of the eight patients, five died and three recovered.
The table below shows at a glance the results in these three classes of
patients :—
Number.
Deaths.
Recoveries.
Percentage
mortality.
Cases treated in private houses
.
5o
17
33
34.0
„ „ „ Parel Hospital.
.
23
14
9
6o.86
„ „ „
Charni
Road
and
Sahib's Servants Hospital
8
5
3
62.5
TOTAL
.
8 1
36
45
44.4