REMARKS ON SOME RECENT RESEARCHES ON MALARIA. To the
Editor,
"
Indian Medical Gazette."
Sir,?la the Indian Med teal Gazette for August, September and November 1892, I published at pages 233, 258 and 323, a series of three papers upon tho subject .of malarial infection with more special refereuco to the [nature and development of the parasitic cause of the^disease, and the relation borne by its successive developmental stages ?to the phenomena observable iu malarial fevers, of which tho paroxysm and the interval are the most important. The views therein put forward by me have been animadverted upon by Surgeon-Major Giles in a paper contributed by him to the Indian Medical Gazette for. November 181)2, pp. 326 to 330. Although Surgeon-Major Giles only refers incidentally
to my papers, his remarks on page [328 shew that his criticism has been hurried, and made without careful referFor this reason I think it doence to the origiual papers. sirable, iu justice to myself, to refer to theso remarks. At pago 328, second column, line 22, Surgeon-Major Gilos says : "
Plehn is
absolutely right
in his dictum, that observations
July
REMARKS ON SOME RECENT RESEARCHES
1893.]
IN MALARIA,
255
large pigmented and non-piginented particles of protoplasm,
conducted otherwise than at the temperature of the blood both within the blood-cells and free, and structures of utterly worthless. It is only that that one can prevent grape-like appear mce," &c So far I take it, the obserthe appearance ' of of Dr. piehn are on all fours with those described of echinoid' forms and other sources vations iallacy." by me. It is to be regretted that Dr. Plehn gives no measurements of these small oval bodies, but I gather that efficiently evident from the use of the term " echi" If for noid spores," " free " and they are what I have described as which I am responsible, that Dr. Giles is here " "contained" " plasmodia," and chained spores." It is a referring to my work, and as he considers the result fallanoticeable fact that nowhere in Dr. Plehn's description cious, and attributes the fallacy to the worthlessness of an " bodies described can I find reference to the " mulberry observation conducted under abnormal temperature condiby me as being phagocyte" cells full of spores, nor does he tions, I would ask him and those who are interested in the notice the '* wheatsheaf bodies which were present in subject to refer to my first paper, pages 233 and 23J, where m the second some cases. We are obliged to conclude that these bodies column of page 234 at line 39 we read : " If now these not present, though it is difficult to imagine that the a plasmodic cells be watched, preferably on were .warm slide, unless the weather is sufficiently hot to disphagocytes so constantly present in malarial cases in India should be absent in malarial infection elsewhere. Dr. Plehn pense with this adjunct the plasmodic bodies will be seen to divide, &c., &c. Here then is a definite statement whichproceeds to say that if we examine the blood two or three Dr. Giles has hours after the fever has remitted, we shall find a large overlooked. As a matter of fact, all the obnumber of very small pale bodies moving about in the servations from which I have attempted to draw any deductions as to the plasma with a somewhat rapid movement communicating of the blood in malarial inmorphology a fection and the changes of the parasite gentle oscillation to the neighbouring corpuscles. He developmental also states that these "parasites" have small dark specks which occur, have been made on a warm slide except during the hottest months of the year in which I found byattached to them by " very fine threads." In the absence experience in May, June and July of 1891 at Lucknow thatof any measurements, it is rather difficult to identify these are
^
?With an air
temperature varying
from 95? to
105?,
bodies,
or even
but I take them
to be
"spores"
and "chained
more, the use of an artificial means of heating my pre-spores," that is, spores either free or connected by filaments parations was a work of supererogation. Further, as ainto chains. This is borne out by his further description of the next stage. His words are, " besides these free forms practical point, I beg to olfer my opinion that in India a constant temperature chamber is by no means a necessity,at this stage of the disease, a considerable proportion of the parasites have penetrated the blood-cells. In with a little living management an ordinary warm slide heated by a current of hot water may be kept at blood heat withblood endoglobular parasites may be recognised as small hardly auy trouble for hours. For example, numbers of mybodies moving gently to and fro within the blood-cells." own observations of blood have been made on such a slideThis corresponds so exactly with what I have described that I cannot doubt that Dr. Plehn is describing the entrance continuously for seven and eight hours at a time with theof precautions detailed in my first paper. In this way I have a single spore into a red cell. observed specimens of blood, which have so far as one can The further description, however, though it bears a judge, retain absolutely normal as regards fluidity of plasmastrong family likeness to what I have observed and describand condition of ed, makes mention of certain refractile grains and rods corpuscular elements. brown-red and glittering which fill the " bodies of Again, on page 330 he finds occasion to say that he wishes dusky the parasites " some hours later. Now this is an appear" " I had {jiven more details of the cultivations I mention, ance I have never seen nor do I quite grasp what is meant as I have already explained to Dr. Giles in a private com- the " bodies of the parasites being filled." It does not munication my reason for referring to the results of culture by seem to me to be competent for an observer to speak of of " malarial " blood in such a very cursory way is simply that I do not wish to put forward these results until I these parasites as though they were coelenterates. If it be bave had the opuortunity of repeating and confirming intended to convey that the intracorpuscular parasite after a time has undergone segmentation in some cases into them. A reference to the concluding paragraphs of my and in other cases into rod-shaped forms, then I in the September number will shew that I am dis- granules, paper understand the description and it is strictly comparable posed to regard the " Plasmodium " not as a specific patho- with my own observations as described at page 234 of the genic organism, but as merely a developmental stage of August number under the heading " Plasmodic" corpuscles, the pathogenic organism, and that this "Plasmodium" though, according to my observations, the cycle of change stage is one which is common to the developmental process- is far more rapid than Dr. Plehn describes it. es of many other organisms which infest the blood. For the rest there is nothing much to notice in the deWhether this view is, or is not, a correct one is not to scription given by Dr. Plehn except that he omits altogether be hastily decided : it is an opinion at which I have arrived to notice the dissolution of the red blood-cell which takes after a long course of carefully conducted observation, and place when the spores break away from it. This is the hitherto I am not aware that the view has been disproved: most important point noticed, with reference to the rapid while if it be ultimately found to be correct it will go anjemia which is of constant occurrence in malarial infecsome distance towards remedying the present somewhat tion. The relationship of the developmental stages of the confusing terminology of malarial infection. parasite to the clinical phenomena is stated by Dr. Plehn ^
^
I pass on now to the very interesting papers in the April to be this that " the commencement of fission determines and June numbers for this year communicated by Surgeon- the exacerbation of the fever." These observations are Major Giles, consisting of an epitome translation of Dr. confirmatory of those of Golgi and of my own. Frederich Plehn's Etiological and Clinical Studies in MaWhile on this point I should like to make a remark as to laria. temperature of 40? or 41? C, which Dr. Plehn recommends Dr. Plehn's observations appear, from page 123 of the as being most favourable to the rapid development of the April number, to have been made upon 18 cases, of which parasites and to cause the liberation of the spores from the 1 1 were in patients, alfording material for a total of 93 red cells.
observations.
Of the 14 cases 11 were typical intermittent. Now the first remark I would make is, that a total of 14 cases?for we must reject the four cases in which the blood perparations were not made by Dr. Plehn himself?is hardly a afford data for sufficient number to very wide generalisation. It is, however, satisfactory to note that in all 18 the "characteristic parasites" were cases, with one exception,
found.
AVhat is the nature of the characteristic parasites observed by Dr. Plehn ? It is as well to consider this point before proceeding further. To this end we must refer to page .205 (June number), and here we find that Dr. Plehn de-
scribes them
as
"
small glittering oval
bodies,
small and
When working at " Surra " in horses which I have elsewhere shewn to be malarial infection of a severe type, I noticed that a temperature of 101?F. to" 105?F. caused the rapid segmentation of the " plasmodia and the escape of
the
resulting
spores into the
plasma, where
the
phagocytes
devoured them. From this I have been led to think whether the high temperature of the malaria patient is not possibly a provision of nature to secure the extrusion of the
from the red cells. On the other hand, it appears more probable, as I have stated elsewhere, that the spores have the power of secreting an acid toxin which leads to the dissolution of the red
parasites
blood-cell.
256
INDIAN MEDICAL GAZETTE.
Dr. Plelin states that he has not been able to follow the ' of these spores into the amoeboid' form. I have been more fortunate, and a full description of the proce=s is given at pages 258-259 by which the spores gain access to the red cells, develop into one or other of the amoeboid forms, and again after a time undergo segmentation into spores. One point to which I have called attention in my papers is worthy of consideration in deciding It is this, that the question of the etiology of malaria. " spores" in all respects similar to those found in the blood of malaria patients may be found iu the air, in the water, " countries. and in the soil in "malarial
development
June, 12;\K 1893.
GEORGE RANKING,
m.d.
[July
1893.
Editor,
"
Indian Medical Gazette."
Sir,?la the Indian Med teal Gazette for August, September and November 1892, I published at pages 233, 258 and 323, a series of three papers upon tho subject .of malarial infection with more special refereuco to the [nature and development of the parasitic cause of the^disease, and the relation borne by its successive developmental stages ?to the phenomena observable iu malarial fevers, of which tho paroxysm and the interval are the most important. The views therein put forward by me have been animadverted upon by Surgeon-Major Giles in a paper contributed by him to the Indian Medical Gazette for. November 181)2, pp. 326 to 330. Although Surgeon-Major Giles only refers incidentally
to my papers, his remarks on page [328 shew that his criticism has been hurried, and made without careful referFor this reason I think it doence to the origiual papers. sirable, iu justice to myself, to refer to theso remarks. At pago 328, second column, line 22, Surgeon-Major Gilos says : "
Plehn is
absolutely right
in his dictum, that observations
July
REMARKS ON SOME RECENT RESEARCHES
1893.]
IN MALARIA,
255
large pigmented and non-piginented particles of protoplasm,
conducted otherwise than at the temperature of the blood both within the blood-cells and free, and structures of utterly worthless. It is only that that one can prevent grape-like appear mce," &c So far I take it, the obserthe appearance ' of of Dr. piehn are on all fours with those described of echinoid' forms and other sources vations iallacy." by me. It is to be regretted that Dr. Plehn gives no measurements of these small oval bodies, but I gather that efficiently evident from the use of the term " echi" If for noid spores," " free " and they are what I have described as which I am responsible, that Dr. Giles is here " "contained" " plasmodia," and chained spores." It is a referring to my work, and as he considers the result fallanoticeable fact that nowhere in Dr. Plehn's description cious, and attributes the fallacy to the worthlessness of an " bodies described can I find reference to the " mulberry observation conducted under abnormal temperature condiby me as being phagocyte" cells full of spores, nor does he tions, I would ask him and those who are interested in the notice the '* wheatsheaf bodies which were present in subject to refer to my first paper, pages 233 and 23J, where m the second some cases. We are obliged to conclude that these bodies column of page 234 at line 39 we read : " If now these not present, though it is difficult to imagine that the a plasmodic cells be watched, preferably on were .warm slide, unless the weather is sufficiently hot to disphagocytes so constantly present in malarial cases in India should be absent in malarial infection elsewhere. Dr. Plehn pense with this adjunct the plasmodic bodies will be seen to divide, &c., &c. Here then is a definite statement whichproceeds to say that if we examine the blood two or three Dr. Giles has hours after the fever has remitted, we shall find a large overlooked. As a matter of fact, all the obnumber of very small pale bodies moving about in the servations from which I have attempted to draw any deductions as to the plasma with a somewhat rapid movement communicating of the blood in malarial inmorphology a fection and the changes of the parasite gentle oscillation to the neighbouring corpuscles. He developmental also states that these "parasites" have small dark specks which occur, have been made on a warm slide except during the hottest months of the year in which I found byattached to them by " very fine threads." In the absence experience in May, June and July of 1891 at Lucknow thatof any measurements, it is rather difficult to identify these are
^
?With an air
temperature varying
from 95? to
105?,
bodies,
or even
but I take them
to be
"spores"
and "chained
more, the use of an artificial means of heating my pre-spores," that is, spores either free or connected by filaments parations was a work of supererogation. Further, as ainto chains. This is borne out by his further description of the next stage. His words are, " besides these free forms practical point, I beg to olfer my opinion that in India a constant temperature chamber is by no means a necessity,at this stage of the disease, a considerable proportion of the parasites have penetrated the blood-cells. In with a little living management an ordinary warm slide heated by a current of hot water may be kept at blood heat withblood endoglobular parasites may be recognised as small hardly auy trouble for hours. For example, numbers of mybodies moving gently to and fro within the blood-cells." own observations of blood have been made on such a slideThis corresponds so exactly with what I have described that I cannot doubt that Dr. Plehn is describing the entrance continuously for seven and eight hours at a time with theof precautions detailed in my first paper. In this way I have a single spore into a red cell. observed specimens of blood, which have so far as one can The further description, however, though it bears a judge, retain absolutely normal as regards fluidity of plasmastrong family likeness to what I have observed and describand condition of ed, makes mention of certain refractile grains and rods corpuscular elements. brown-red and glittering which fill the " bodies of Again, on page 330 he finds occasion to say that he wishes dusky the parasites " some hours later. Now this is an appear" " I had {jiven more details of the cultivations I mention, ance I have never seen nor do I quite grasp what is meant as I have already explained to Dr. Giles in a private com- the " bodies of the parasites being filled." It does not munication my reason for referring to the results of culture by seem to me to be competent for an observer to speak of of " malarial " blood in such a very cursory way is simply that I do not wish to put forward these results until I these parasites as though they were coelenterates. If it be bave had the opuortunity of repeating and confirming intended to convey that the intracorpuscular parasite after a time has undergone segmentation in some cases into them. A reference to the concluding paragraphs of my and in other cases into rod-shaped forms, then I in the September number will shew that I am dis- granules, paper understand the description and it is strictly comparable posed to regard the " Plasmodium " not as a specific patho- with my own observations as described at page 234 of the genic organism, but as merely a developmental stage of August number under the heading " Plasmodic" corpuscles, the pathogenic organism, and that this "Plasmodium" though, according to my observations, the cycle of change stage is one which is common to the developmental process- is far more rapid than Dr. Plehn describes it. es of many other organisms which infest the blood. For the rest there is nothing much to notice in the deWhether this view is, or is not, a correct one is not to scription given by Dr. Plehn except that he omits altogether be hastily decided : it is an opinion at which I have arrived to notice the dissolution of the red blood-cell which takes after a long course of carefully conducted observation, and place when the spores break away from it. This is the hitherto I am not aware that the view has been disproved: most important point noticed, with reference to the rapid while if it be ultimately found to be correct it will go anjemia which is of constant occurrence in malarial infecsome distance towards remedying the present somewhat tion. The relationship of the developmental stages of the confusing terminology of malarial infection. parasite to the clinical phenomena is stated by Dr. Plehn ^
^
I pass on now to the very interesting papers in the April to be this that " the commencement of fission determines and June numbers for this year communicated by Surgeon- the exacerbation of the fever." These observations are Major Giles, consisting of an epitome translation of Dr. confirmatory of those of Golgi and of my own. Frederich Plehn's Etiological and Clinical Studies in MaWhile on this point I should like to make a remark as to laria. temperature of 40? or 41? C, which Dr. Plehn recommends Dr. Plehn's observations appear, from page 123 of the as being most favourable to the rapid development of the April number, to have been made upon 18 cases, of which parasites and to cause the liberation of the spores from the 1 1 were in patients, alfording material for a total of 93 red cells.
observations.
Of the 14 cases 11 were typical intermittent. Now the first remark I would make is, that a total of 14 cases?for we must reject the four cases in which the blood perparations were not made by Dr. Plehn himself?is hardly a afford data for sufficient number to very wide generalisation. It is, however, satisfactory to note that in all 18 the "characteristic parasites" were cases, with one exception,
found.
AVhat is the nature of the characteristic parasites observed by Dr. Plehn ? It is as well to consider this point before proceeding further. To this end we must refer to page .205 (June number), and here we find that Dr. Plehn de-
scribes them
as
"
small glittering oval
bodies,
small and
When working at " Surra " in horses which I have elsewhere shewn to be malarial infection of a severe type, I noticed that a temperature of 101?F. to" 105?F. caused the rapid segmentation of the " plasmodia and the escape of
the
resulting
spores into the
plasma, where
the
phagocytes
devoured them. From this I have been led to think whether the high temperature of the malaria patient is not possibly a provision of nature to secure the extrusion of the
from the red cells. On the other hand, it appears more probable, as I have stated elsewhere, that the spores have the power of secreting an acid toxin which leads to the dissolution of the red
parasites
blood-cell.
256
INDIAN MEDICAL GAZETTE.
Dr. Plelin states that he has not been able to follow the ' of these spores into the amoeboid' form. I have been more fortunate, and a full description of the proce=s is given at pages 258-259 by which the spores gain access to the red cells, develop into one or other of the amoeboid forms, and again after a time undergo segmentation into spores. One point to which I have called attention in my papers is worthy of consideration in deciding It is this, that the question of the etiology of malaria. " spores" in all respects similar to those found in the blood of malaria patients may be found iu the air, in the water, " countries. and in the soil in "malarial
development
June, 12;\K 1893.
GEORGE RANKING,
m.d.
[July
1893.
