The conditions affecting the development of flagellated organisms from Leishman bodies and their bearing on the probable mode of infection / by Leonard Rogers.

  • Leonard Rogers
Date:
1905
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Licence: Public Domain Mark

Credit: The conditions affecting the development of flagellated organisms from Leishman bodies and their bearing on the probable mode of infection / by Leonard Rogers. Source: Wellcome Collection.

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    , —_—— the side-to-side compression produces a_ characteristic ‘* scabbard-shaped” contraction. A totally different class of laryngeal palsies is that which affects the phonatory function—adductor paralysis. This is nearly always bilateral and is not due to organic disease of the nerve path but either to a neurosis—the sae-called ‘*functional aphonia”—or to local disease, such as laryngitis, directly interfering with the action of the muscles. Func- tional aphonia is a common manifestation of hysteria but it should be clearly borne in mind that many cases, probably even the majority, are not purely hysterical. Anything which makes the effort of phonation greater than usual— constitutional debility, thickening of the cords, or laryngeal catarrh—predisposes strongly to this affection, which is characteristic rather of debility than of hysteria. It occurs in men as well as in women, though much less frequently, and I see a large number of such cases among consumptives at the Mount Vernon Hospital. In purely hysterical cases the cough is usually not aphonic; the onset is sudden, as also'is the recovery, for many cases regain the use of the voice, as it were miraculously, on the application of the faradic current or a strong astringent. Paralysis is very seldom complete, usually amounting only to an imperfect apposition of the cords ; unilateral adductor paralysis is extremely rare; it is due to local interference with the muscles and in a few cases to toxic causes. The three sets of adductors may be all affected, or the arytenoideus may escape, or the thyro-arytenoidei may be affected alone. The arytenoideus may, though rarely, be paralysed alone from hysteria or catarrh ; this gives rise to avery peculiar appearance, a triangular chink being left at the posterior part of the glottis. Adductor paralysis may be mistaken for complete bilateral recurrent paralysis, as the cords do not come to the middle line on attempted phona- tion; attention must be directed to the action on deep inspiration, for in recurrent paralysis the cords will not move, but in incomplete adductor paralysis they will now move further outwards; in complete adductor paralysis there is no difficulty, for the cords are. extremely abducted well away from the cadaveric position of recurrent paralysis. These adductor paralyses thus form a marked contrast to the group of abductor palsies; they produce a prominent symptom, aphonia, which attracts early attention, they are y., Adductor paresis; all the adductors affected; phonation. yi., Adductor paresis; arytenoideus unaffected; phonation. yu., Paralysis of the thyro-arytenoidei; phonation. VIIL., Paralysis of the arytenoideus; phonation. not due to serious organic disease and they are not in them- selves dangerous to life. In conclusion, I would again remark that in a knowledge of the appearance and of the causes of laryngeal paralyses we have an important aid to diagnosis in many obscure cases, an aid which the practitioner can by no means afford to neglect. THE CONDITIONS AFFECTING THE DEVELOPMENT OF FLAGELLATED ORGANISMS FROM LEISHMAN BODIES AND THEIR BEAR- ING ON THE PROBABLE & MODE OF INFEC- TION. By LEONARD ROGERS, M.D. Lonp., M.R.C.P. Lonp., CAPTAIN, I.M.S.; ACTING PROFFSS0R OF PATHOLOGY, COLLEGE, CALCUTTA. MEDICAL In THe Lancer of July 23rd, 1904, p. 215, I first described the development of flagellated organisms from Leishman bodies, and in the November number of the Quarterly Journal of Microscopical Science 1 described and illustrated the changes more fully, tracing the development day by day, flagellated forms being only found, as a rule, after three or four days. In one case, however, fully developed forms were found in 24 hours and these appeared to be more like trypanosomes than those which appeared on later dates in the other cultures. This suggested that in the case of the more rapid growth the conditions must in some way have been unusually favourable and led me to carry out a very long series of experiments to determine the optimum conditions for the development in the hope that if found they would throw light on the probable mode of infection of the diseases caused by this parasite. For many months no progress other than that of a negative nature resulted, but recently an important advance has been made which appears to me to indicate strongly the direction in which the solution will be found of the difficult question of the manner in which the infection of the disease is conveyed from one person to another. I propose in the present paper briefly to record the general results of my attempts to cultivate the parasite under different conditions and then to discuss the bearing of these on the probable mode of infection of the disease. My observations on the development of the flagellated forms have been already confirmed by my assistant, Dr. G. C. Chatterjee, Lieutenant 8. R. Christophers, I.M.S., and by Major W. B. Leishman, R,A.M.C., and Captain C. J. B- Statham, R.A.M.C., and I have very little to add to the descriptions I have already published except some minor details. In the first place I should have mentioned the very marked vacuolation which is present from the first enlargement of the organisms up to the flagellated stage in varying degrees, being most marked in large and broad forms, and least in the longest, thin, and most completely developed ones. Another interesting point which I noted early in the inquiry, but the full significance of which was only gradually worked ont, is a well-marked eosin-staining body of a round or oval shape, which usually appears on the second day, and is commonly situated between the macro- and micro-nucleus. When the stage of elongation is reached it travels up to what will become the anterior or flagellated end of the now pyriform double body and carries with it the micronucleus, When the flagella first appear they are seenas short processes projecting from these eosin bodies, and at this stage they cannot as a rule be traced to the position of the micronuclei. In the later stages, especially in the separate completely developed long flagellate forms, this body is absent, while ir nearly complete stages I have frequently seen it either partly or completely extruded from the organism, and then the flagella can be traced close up to the micronucleus. It is possible that this extrusion may bave been due to pressure in preparing the film, but I am inclined to think that it is a part of the developmental process, although I am unable to explain its significance. This eosin-staining body has been independently described by Major Lenehan, whose term ‘‘ flagella body” appears to be a good one. A more marked feature of my long experience 1s the uncertainty of the development of fully flagellated forms being obtained in the cultures in citrated blood, although the earlier stages are nearly always seen. Success depends very largely on the number of parasites found in the spleen blood preparations used, only those in which they are numerous, which form a small proportion of the whole, as a rule giving good results. This is especially the case when the parasites
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