pure blood be laid lightly on the slide without pressure very few crenated or nodulated forms are seen, and the rouleaux are well formed. If, however, pressure and movement of the cover glass be now applied, so as to break up the rouleaux, thousands of nodulated corpuscles will be produced instautly. A dry smear of blood on a slide without any cover-glass will be seen to have many distorted forms, but very few nodulated ones, and these can be melted into homogenous masses by the addition of moisture. A streak of blood effused into a drop of vaseline placed upon the finger, and then pressed upon by the cover-glass will star out under it into a number of channels through the soft grease. If we watch the corpuscles, many "of which have now become echinoid from pressure, as they rush along with the blood-streams caused by jerking the cpver-glass, we shall observe them to alter in shape and size as they " squeeze " past each other, and shall frequently see an echinoid corpuscle lose all its spores as it is flattened out in a narrow passage and then regain them again in an instant as it rushes into more open water, so to speak. This would be quite impossible were the nodules actually foreign bodies ; and I must highly recommend this vaseline method as an excellent check experiment to those who search the corpuscles for parasites, since it enables us, after a little experience, to manipulate them in a wonderful manner. The same may be said of the appearance of "inbedded" organisms which is common in all blood and which gives forms " very various, circular, oval, pileate Y-shaped," &c., exactly as described by Dr. Ranking, but which is adventitious.as shown by the vaseline treatment,and by the fact that individual corpuscles containing this apparent body may be fused and dissolved on the dry slide by the addition of moisture and leave no vestige of the supposed parasite ! A group of such corpuscles may be melted into a uniform mass without leaving any sign of foreign bodies, although leucocytes and blood-plates remain distinct. I recommend this method With regard to also, but will go into details elsewhere. moving spores and so on. it must be remembered that molecular movement is often very extensive in blood, implicating whole corpuscles sometimes. My own blood is full of moving particles, and I am perfectly well and have never had fever. With respect to free plasmodia, then, it is unnecessary to speak until we know the difference between echinoid and nodulated corpuscles, and between imbedded organisms and the similar appearances I have touched upon ; for these only concern my theory. It is, however, insufficient generally to ?rive mere appearances in the blood ; we must show also that they are not factitious, that is, made in the preparation of the specimen, and that they are not seen in healthy blood. Salt solution also is dangerous ; it may produce crowds of organisms in four hours, as I have seen (at 75-?F.), unless sterile. Much of the vacuolated appearance described is probably due to the cupping and even bagging of the corpuscles frequently observed in sealed specimens. But whatever doubts may be expressed now or hereafter about organisms in the blood, there can be none about them in the contents of the intestine. In meconium and the evacuations of young infants few beside molecular motions can be seen, I think ; but in healthy adults they are common, and in cases of fever, as well as of bowel complaints, the field swarms often with organisms motionless and in active movement, and it is impossible to say that all these are harmless. They are, moreover, just as numerous in purged matter as in rectal fasces. To any one, then, who finds a difficulty in following the simple ideas concerning to some forms of fever which I have endeavouied expiess^ in these pages. I recommend a regular course of examination of fasrsal matter with high powers ; and shall ask him to a canal some remember that each of us has within him absorbent mucous twenty-five feet long, lined with a highly 111s he may persurface and full of such matter. -After fever may be origihaps begin to see how many cases of to limit his former nated in this way and may be inclined diseases to specific tendency to attribute half the tropical wonder how it is that we aerial infection. He may even in t is country, and do not hear more of ordinary enteritis the use of the terms ague, Xebrimay explain this fact by cula and remittent, which it is so easy to write on the bedhead tickets. When Dr. Ranking, however, says that he does not often find intestinal complications in ma arial him to your same issue in fevers, I cannot help referring letters appeared (January) in which there is an -

INDIAN FEVERS. To

the

Editor,

"

Indian Medical Gazette."

Sin,?I must tliauk Surgeon Major Ranking for his prompt reply to my letter to you in which I suggested the possibility of haematozoa malaria) being extravasated from the intestines. Ilis objections, however, are those which I have long considered, and with which I cannot confess myself satisfied. If, indeed, all our fevers were proved to be communicable by transfusion of blood I could have nothing further to say; but I have always been led to believe the Prof. Gerliardt's original experiments in this line have been met vory reservedly by experts on the ground that febrile bloods of all kinds are rarely pure cultivations and produce on injection mere septic reactions. It is necessary that a pure cultu e of the pathogenic organism be injected or, at least, that the induced fever be of exactly the same type as the original one ; and a point like this can be decided only on the most careful and extended experiments. I believe. moreover, that he worked only on pure intermittent forms which I am inclined to admit may, for several reasons be malarial. On the other hand, however, the noncontagibility, iu the ordinary course of these fevers, is a For instance, we often see serious objection to such views the children of nursing women, who are suffering from prolonged fever, remain quite healthy?I have two such cases at present; and how often do we not observe public servants and others returning to their families from Burma or other " ma arious " countries, suffering from severe fever and yet never giving it to their wives and families. That the air we breathe is loaded with spores is absolutely certain ; that they have any connection with our fevers absolutely uncertain unless, (1) the spores have an appearance so distinctive from other spores as to enable us to recognise their identity in the b'ood and the air ; or (2) unless Surgu.. Maj Hanking can cultivate them into mature forms which he can the same as he finds in the prove to be blood. All tftis requires a difficult process of fractional cultivation, particulars of which will be interesting. With respect to tha proliferation in the blood of the organism, we must all th'iuk Surgn.-Maj. Ranking for describing what he himself has seen and for giving us particulars to enable ws to follow him, instead of deluging us with German authorities on the supposition, for which there is no proof, that Indian fevers must be identical with European, Africau aud American ones. There are, however, some disturbing elements in his papers which ought to be noticed. He makes frequent reference to the cell trail of the red corpuscles, as for instance, when he talks of ?' the spiral forms (of included haematozoa ard substitute being probably due to the length of the rod being so great that it has to curl up inside the cell," and of ?' rods perforating the limiting membrane at either pole." I had it was long ago de-

-

thought

monstrated that the red corpuscles have no limiting membraue?soe Buale's " Microscope in Medicine in which conclusive arguments arc adduced, aud study the phenomena 9^ solution aud coalescence of the corpuscles. Agaiu, it is to be wished that he had given some means of distinguishing his ?' echinoid " corpuscles from ordinary nodulated ones. Besides the perfectly smooth forms, we see many with prominent nodules, bright or dark according to the focussing ; sometimes only one on the edge, sometimes many all round (giving the creuated appearance) aud sometimes grouped in the centre as well. They look, I admit, exactly like shining spores in the substance of the corpuscle, but surely Dr. Banking's echinoid corpuscles are not these, for the appcarauco is certainly not due to spores at all, but to pressure or, perhaps, detachment from the

rouleaux, as can easily be proved. In the first place, they are not generally equably dispersed, showing that the appearauce is factitious. If the cover-glass with a drop of

which'our

editorial commenting

on

Peshawar fever and

describing it

INDIAN MEDICAL GAZETTE.

9G

remittent fever with " vomiting1, purging and "bilious and often bloody dejections" and ?' intense

as severe

death,"

'

intestinal symptoms." Surely, this is strong enough. But the fact is that so long ns we continue to consider all intestinal symptoms as merely secondary, we shall not pay them the strict atten-

tion they require and deserve. Personally. I think them to be very common indeed ; but Surgeon-Major Ranking misunderstands me if he thinks me to believe that the fever is in direct proportion to the extent of the local iuflammition. I have repeatedly tried to make it clear that it is the highly septic state of the intestiual contents rather than the amount of local mischief which causes the fever. The lesion may be very slight indeed without affecting my argument; the fever being a mere septic episode just as in traumatic fever. Surely, this is clear enough In many ca?es of prolonged enteritis fever occurs only at intervals owing to accumulations in the bowels, just as it occurs in surgical cases when discharges accumulate in the wound. Worm fevers are important in this connection just because they cannot be caused by mechanical irritation (since were this so the fever would continue so long as the worms were present), but probably by the local catarrh they set up and the subsequent septic absorption from the bowel. With reference to such absorption compare Dr. Hehirs interesting article in the January number with my hasty sketch in August last. Many forms of hepatitis, he thinks, are due to migrations of organisms from the bowel-what more likely ? But when he explains malarial hepatitis by regurgitation of the Plasmodium from the blood into the liver, are we not struck with the opposite view ??that much of the So-called malarial poison may arise in the intestine, pass through the liver, first affecting it, and then pour into the general circulation. And there are simple reasons, more powerful than incomplete microscopical evidence iu support of this view. But the Indian fever question is a difficult one. Personally, I think, we may have two distinct morbific processes : an aerial blood infection as seen in the pure intermittent, the regular course of which suggests a zymotic nature, and a secondary intestinal septic poisoning as seen iu the febricula, remittents, worm fevers, and perhaps enteric, the more irregular course of which, with other It is mischievous. I submit to reasons, suggests that view. rush to the conclusio n that all our fevers, such as the Peshaare war fever for instance, certainly malarial. There the " intense intestinal symptoms" surely render it just po**ible disease may be intestinal. Surely, we are that the whole able to see that such symptoms may account for the constitutional ones without the intervention or invention of malaria at all. If septic fever may arise, if organises may from wounds, why not from the intestines. pour into blood '? There is no reason to look to the intestine," says Dr. " " Our inRanking, the air we breathe is full of spores testines contain more spores, and developed organisms as air much indeed ! With many thanks again well, than very to

Surgn.-maj. Ranking?

Bangalore, 3rd February 1893.

I am, kc., RONALD ROSS, Surgx.-Capt.,

i.m.s.

[March

1898.