by ed
the other occupants, and its spores arrestby their nasal and bronchial mucous mem-
branes. Those who low state of
development to imagine,
from
previous catarrh, offer
health,
from
or
suitable soil for the
a
of these micrococci; may, it is easy become the selected victims of the
disease. The
proposition pneumonia supervene is of
course
My
in
that
all these
on a state
of
way advanced.
no
field of observation has been
to in any way
cases
of low health,
indulge
in
limited
Loo
This,
generalization.
however, is the impression yielded by
a
very
experience, that at any rate a large proportion of cases are below par when attacked. limited
Usually even when first seen, the temperature of the body is high, io3?-io5? F., from which circumstance the REPORT ON SOME OBSERVATIONS IN CONNECTION WITH PNEUMONIA AS OBSERVED ON THE
PUNJAB
FRON-
By G. M. Giles, m.b., f.r.c.s., Surgeon, 1. AT. D.
I can, in the 15
well
noticed
altogether
than
had
some some
or
20
cases
which
of my
recently others
be
found
has been reduced some
I
and
to
that
the
recep-
previous ailment,
more
first admitted
with,
been
suffering from fever, and had bronchial catarrh for
time
previously. by which contagion might be from man to man can easily be under-
The method carried stood.
A sepoy, perhaps in the earliest stage of convalescing from the disease, spits on the earthen floor of his hut. This
drying,
dust which
becomes
covers
the
a
constituent of the
walls
and
floor and
fills the air of such habitations, is breathed in
some
Respiration apparently out
being involved
a
cases were
had
compressible
I have have
drawn the rise
from the normal very rapid. The pulse is frequent, weak and
is
generally
costive.
greatly accelerated, quite proportion to the extent of this period, but is very shallow
of
at
catchy. questioning the man, he usually complains of great pain, and tenderness on one side, and on listening at the point indicated, a pleuritic rub may very commonly be heard. In every case I have as yet watched closely, there have been, at some period, more" or less marked pleuritic signs present, generally in the early period of the case. This pleuritis, however, in one of the cases only, proceeded to effusion, and in that one to only a very limited extent. Commonly at this stage there is no marked dulncss, but only irregularly disposed patches, where resonance is impaired. At this period, there is usually but little expectoration, and on appl^frig the stethoscope, the bre'ithing is heard to be harsh, and 'the exOn
it will
cases
patient's system tive condition by 01*
type-case, combining,
met with.
In many
one
a
the characteristics
as
be
and
relaxed, but in
(Concluded from page 2J9.) I will first describe
may
the artery being relaxed and full. The tongue is foul, bowels irregular,
TIER.
as
conclusion
that the invasion is very sudden
GILES ON THE PNEUMONIA OF THE
October, 1883.J
piratory sound prolonged and abnormally audible. Usually some scattered noisy bronchitic rales
are to
be heard.
If the blood be
now
examined with
a
high
power, it will be found to contain multitudes of minute rounded bodies, similar to
magnifying
already described and blood, pleuritic fluid
those which have
present in
the
rabbit No. In the
been
that
cases
day
a
of
I. came
or
two
at first be seen.
the other
nucleated
or
form makes its appearance. These
are
about three times the diameter of
the first sort, the nucleus in size and appearance being much like one of the smaller form. If the
precaution be taken of warming the slide and rapidly brushing a little oil round the edge of the cover, and the examination be made as quickly as many of the smaller sort will be seen to " " Brunonian two motions, the ordinary
possible, have
vibration and
an
independent
locomotion
of
their own, often sufficiently strong to enable them to move in opposition to the general current of
from
the
the
blood, running by gravitation upper to the lower edge of the
cover.
It is hard to
focussed
FRONTIER.
273
a resting condition. In the larger nucleated form I have never observed any signs of loco-
motive power. or soon after, the apnucleated the of form, congeries of pearance the smaller sort are found united together, by a
Coincidently with,
This
material,
into
to
as
four times the size of
a
whatever be its nature, is of
a
hyaline material, large as three or Icucocyte.
earliest under observa-
tion, the small form alone could After
as
PUNJAB
masses
reaching
firmer consistence than the red blood
corpuscles, by pressing on the cover-glass, are seen, as they pass these masses to have their form altered by contact with the masses (which I take to be a zoogloca stage of the parasite), they remaining quite unaltered for the latter, when moved
in
shape. On
or
about the fifth
day
there is
usually
a
sudden diminution in the number of micrococci
present in the blood, but that is less
complete cycle re-commencing.
a
more or
The stages, however, the first instance ; there each sort
not
of the
permanent, same
are not so
distinct
being,
rule,
as a
a
sort
as
in
few of
in addition to those
which present a second After series has been preponderate. completed, it is almost impossible to make out any signs of a third, the process having ap-
image of bodies, adjustment of the parently become confused. of the objective collar light and of the screw As the patient recovers, they become fewer have been lucky, these locomotive particles as and fewer, but persist in scanty numbers up to they turn are seen not to present a circular complete recovery ; indeed in one case (recorded contour in all positions, but to be pear-shaped, further on) they were still to be found five days and as the cooling of the slide causes the blood after the patient had returned to duty. to coagulate, and the motions become thus To return to the clinical progress of our case,? stopped, I have in some instances glimpsed" the temperature with a moderate morning's faint indications of a lash springing from the remission continues high for from 5 to 10 days, smaller end, so that the whole body would be and then drops almost critically nearly to much like a spermatozoon in shape. normal, which is usually reached in two days. It does not appear, however, that all are The pulse grows more frequent and weaker, furnished in this manner, many shew only the Brunonian vibration, and a day or two after the and in bad cases becomes almost imperceptible. onset of the disease, the smaller form are com- Any improvement in its strength, is a most monly found united in chains of from two to favourable omen. ten individuals, under which circumstances they The physical signs increase in gravity, patch must have abandoned their tails and reached after patch becoming, in one or both lungs, dull,
these
get
a
sharply
but when
the
"
THE INDIAN MEDICAL GAZETTE.
274
but, it appears from what is
to me, in
in
seen
quite
a
different fashion
the acute croupous pneuto meet with in
monia
one
Europe
; the distribution of the dulness
was
accustomed
being,
first, curiously irregular, e. g., in the
at any rate at
flank, and mammary region perhaps, but little impaired resonance, while the lower part of the lung in front, and the scapular region behind, may be Even
absolutely
dull.
the disease is at its climax,
when
of the
a
of the per-
slight shifting stethoscope cussing finger will often bring to notice quite altered physical signs, so that a complete report of the physical signs of any given day would or
occupy several pages were all recorded. Hence one is apt to get the impression that the
in
signs
evanescent,
curiously
any given region and have chanced between are
one
Fine
streaking, or slight tinging with blood, enough, but I have not as yet met with the regular "prune juice" sputa of ordinary croupous pneumonia. Up to the commencement of recovery the is
common
sputa
are
ture to acute croupous
course
pneumonia, yet presents,
being probably lobular and not lobar. peculiarity is the strong tendency complicated by inflammation of the
A further
l'ieura-
ns bns noitadiv copy of the notes of the case, the above described bodies were first
tmbnsqobni
,
is
in which
ary for
observed in the blood, with
a
Then,
as
or
a
two after.
rule, the auscultatory signs take
"
only
which there is almost absolute silence, or a few crepitations on making the patient
take
a
over
deep
breath.
These spots begin first to heard larger and larger moist in recoveries, the chest
crepitate, then are rales, and finally, clears up, usually with
great rapidity.
During the stage of sonance and fremitus but
never
/Oin
i
notes of four other
cases. Qlij
Qj
consolidation, are
often
vocal
re-
exaggerated,
that I have seen, to the marked de-
pneumonia
The sputa at first consist of clear, glairy mucus; after a time they become opaque, of
peculiar greyish red colour, with flocculi of more solid grey material, which sink to the bottom of
DT 11
abstract of the
an
ZSrCXfJU
JIIj
lllOii
These will be sufficient to illustrate, without
iteration, the points advanced above. these, however, I observed the micrococci daily in the blood of several other cases, which came under my care in the 4th P. I., and casually in some other cases in the 1st P. C., and 5th P. L hospitals. They were found, in fact, in every case I have too much
Beside
as
yet examined. As to the exact nature of these bodies
causal connection, otherwise, question, I should be unwilling,
in a
number
decided
their
observations,
on so
limited
hazard
to
any
opinion.
Since I case
of
or
with the disease
or
gree characteristic of the croupous of Europe.
the vessel.
a
3?lj
and the few
moister
character, crepitations mixed with coarser bronchitic previously heard, ;r v. rl sounds, become quite drowned by the latter. When at the worst, there are often large patches, a
Appended
area
day
of the tempera-
physical signs and clinical symptoms, a greater similarity to broncho-pneumonia, the
increases up to the time of the sudden fall of temperature, and remains stationThe dull
ex-
to
as
to be
the pre-
scanty
are
and
acute, and similar in the
the exact spot that vious occasion.
on
a
tenacious, clinging firmly to the vessel in which they are contained. As the patient mends, they become more gopious, yellow, and muco-purulent like the expectoration of acute bronchitis ; finally they become again clear and mucous, and then cease. Here then is a disease which, though equally
tremely glairy
disease
examined
very airless, shewing but the surface, and on
amount of froth
day's observation and the next's ; the true reason being, probably, that one has failed to hit upon one
[October, 1883.
commenced
this report,
a
slight
pneumonia has occurred amongst the of the 4th P. I., detected to this station.
of
guard (Shaik Budin.) By some anilen violet, bodies, which
are
chance
I have obtained
and
find
I
that these
present in the blood of the
man, also do stain with this
dye
in the
manner
GILES ON THE PNEUMONIA OF THE
October, 1883.]
described by Koch.
circumstance, their chains, their forming
This
becoming grouped into zoogloca like masses, and the order in which they make their appearance, seem, to say the least, to point strongly to' 'their being of vegetable nature?micrococci in fact,?the larger nucleated form being perhaps in some way connected with their
reproductive process. very significant fact, that these nucleated cells made their appearance the same day in the blood of dying rabbit (No. 2), and It
seems
in the
a
from the
serum
pleura
that had
been
put aside from the autopsy of the rabbit No. which had died on the previous day.
1
pleuro-pneumonia, septic poisoning, is clearly enough
the records of the post-mortem amination of the animals.
shewn
by
Personally clearly
trace
ex,
I have not as'yet been able to any instance of contagion, but am
strongly inclined to believe, that the disease is capable of being transmitted in this way, probably through the medium of dried sputa diffused through the air. Certainly I should always continue to isolate nevertheless
any case that may
occur.
In favour of this view I received
a
strong
confirmatory evidence from Lieut. F. piece Egerton, late of the 3rd P. C., who tells me that in that regiment, some years ago, there occurred confined to an outbreak of pneumonia, almost whom died of the the Dogra troop, 14 or 15 of other remained the while troops disease, nearly of
seen
in
It is
appcarance identical 'with those/
pneumonia. possible
that
may lead to the
more
be a fact, much might be the done prevent spread of the disease. Greater air-space in the huts, and the adoption Should
contagion
to
of brick, stone,
pucka flooring, capable thorough cleansing would, no doubt, do much to prevent not only this, but mumps and other diseases which
of
or
cause
much
inefficiency
among
sepoys during the year. Before closing these remarks I must, however, mention one other point that has been to me very puzzling. This is, that in the blood of
ordinary
malarious
fever,
men
are to
suffering be found
extended observation of
discovery
some
points
of
difference between them, and, in the absence of any means of accurate
micrometry,
by
to pronounce that
no means
prepared identical, but in general are certainly very similar. It was in seeking for the are
that
I
and
blood, it
though
was some
I
I should be
they they
appearance
bacillus malaria?, fever patients'
bodies in
found these
continually
time before I
At last I found
saw
met with
any
sign
these,
of the
patient newly admitted, actually shivering stage, and on examining his blood, the bacillus could be made out plainly enough in addition to the micrococcus-like0 bodies, a couple of hours after the hot stage having supervened no bacilli could be seen. After this, by treating a few cases of quartan fever without any form of quinine, and by making a point of being at the hospital at the time at which the cold stage might be expected to commence, I again and again made out the bacillus quite plainly. My previous want of success was, no doubt, due to my not examining the blood at the right a
in the
else in
period, or quinine.
under the influence of
cases
The stay of these cases (treated without quinine) in hospital was, however, no longer than the average. So far then all that
free.
from
bodies to all
275
bacillus.
That the rabbits died of a and not of
|
FRONTIER.
PUNJAB
that, in this are are
can
pneumonia
be
definitely said, is frontier, there
of the
present in the blood certain bodies which not present in the blood of healthy subjects,
and that
these
changes in I hope
bodies
run
through
certain
fairly regular during the coming cold season to have opportunities of testing this question further, and under more favourable circumstances
as
manner.
a
to
apparatus, re-agents, &c.
At present I labor under the deficiency of being quite without books of reference, all my
books,
and most of my
crophotographic
microscopical
and
mi-
arrangements, being still
at
THE INDIAN MEDICAL GAZETTE.
27r?
will, I hope, incomplete apology of the present investigation.
Calcutta, as
some
racter
which circumstance
for the very
serve
cha-
[October, 1883.