There are quite a number of others who have been over my ground, but the
above must suffice here.
[Illustration: PLATE X.--EXPLANATION OF FIGURES.--1, Spore with thick
laminated covering, constant colorless contents, and dark nucleus.
B, Part of the wall of cell highly magnified, 0.022 millimeter in
thickness. 2, Smaller spore with verruculous covering. 3, Spore with
punctulated covering. 4, The same. 5, Minute spores with blue-greenish
colored contents, 0.0021 millimeter in diameter. 6, Larger form of 5. 7,
Transparent spherical spore, contents distinctly refracting the light,
0.022 millimeter in diameter. 8, Chroococcoid minute cells, with
transparent, colorless covering, 0.0041 millimeter in diameter. 9,
Biciliated zoospore. 10, Plant of the Gemiasma rubra, thallus on both
ends attenuated, composed of seven cells of unequal size. 11, Another
complete plant of rectangular shape composed of regularly attached
cells. 12, Another complete, irregularly shaped and arranged plant. 13,
Another plant, one end with incrassated and regularly arranged cells.
14, Another elliptical shaped plant, the covering on one end attenuated
into a long appendix. 15, Three celled plant. 16, Five celled plant.
10-16 magnified 440/1.]
I wish to conclude this paper by alluding to some published
investigations into the cause of ague, which are interesting, and which
I welcome and am thankful for, because all I ask is investigations--not
words without investigations.
The first the Bartlett following:
Dr. John Bartlett is a gentleman of Chicago, of good standing in the
profession. In January, 1874, he published in the _Chicago Medical
Journal_ a paper on a marsh plant from the Mississippi ague bottoms,
supposed to be kindred to the Gemiasmas. In a consideration of its
genetic relations to malarious disease, he states that at Keokuk, Iowa,
in 1871, near the great ague bottoms of the Mississippi, with Dr. J. P.
Safford, he procured a sod containing plants that were as large as rape
seeds. He sent specimens of the plants to distinguished botanists, among
them M. C. Cook, of London, England. Nothing came of these efforts.
2. In August, 1873, Dr. B. visited Riverside, near Chicago, to hunt up
the ague plants. Found none, and also that the ague had existed there
from 1871.
3. Lamonot, a town on the Illinois and Michigan Canal, was next visited.
A noted ague district. No plants were found, and only two cases of
ague, one of foreign origin. Dr. B. here speaks of these plants of Dr.
Safford's as causing ague and being different from the Gemiasmas. But he
gives no evidence that Safford's plants have been detected in the human
habitat. In justice to myself I would like to see this evidence before
giving him the place of precedence.
4. Dr. B., Sept. 1, 1873, requested Dr. Safford to search for his plants
at East Keokuk. Very few plants and no ague were found where they both
were rife in 1871.
5. Later, Sept. 15, 1873, ague was extremely prevalent at East Keokuk,
Iowa, where two weeks before no plants were found; they existed more
numerously than in 1871.
6. Dr. B. traced five cases of ague, in connection with Dr. Safford's
plants found in a cesspool of water in a cellar 100 feet distant. It is
described as a plant to be studied with a power of 200 diameters, and
consisting of a body and root. The root is a globe with a central cavity
lined with a white layer, and outside of these a layer of green cells.
Diameter of largest plant, one-quarter inch. Cavity of plant filled with
molecular liquid. Root is above six inches in length, Dr. B. found the
white incrustation; he secured the spores by exposing slides at night
over the malarious soil resembling the Gemiasmas. He speaks of finding
ague plants in the blood, one-fifteen-hundredth of an inch in diameter,
of ague patients. He found them also in his own blood associated with
the symptoms of remittent fever, quinine always diminishing or removing
the threatening symptoms. Professors Babcock and Munroe, of Chicago,
call the plants either the Hydrogastrum of Rabenhorst, or the Botrydium
of the Micrographic Dictionary, the crystalline acicular bodies being
deemed parasitic. Dr. B. deserves great credit for his honest and
careful work and for his valuable paper. Such efforts are ever worthy of
respect.
There is no report of the full development found in the urine, sputa,
and sweat. Again, Dr. B. or Dr. Safford did not communicate the disease
to unprotected persons by exposure. While then I feel satisfied that the
Gemiasmas produce ague, it is by no means proved that no other cryptogam
may not produce malaria. I observed the plants Dr. B. described, but
eliminated them from my account. I hope Dr. B. will pursue this subject
farther, as the field is very large and the observers are few.
When my facts are upset, I then surrender.
"NOTES ON MARSH MIASM (LIMNOPHYSALIS HYALINA). BY ABR. FREDRIK EKLUND,
M.D., STOCKHOLM, SWEDEN, PHYSICIAN OF THE FIRST CLASS IN THE SWEDISH
ROYAL NAVY.
[Footnote: Translated from the _Archives de la Medecine Navale_, vol.
xxx., no. 7, July, 1878, by A. Sibley Campbell, M.D., Augusta, Ga.]
Before giving a succinct account of the discovery of paludal miasma and
of its natural history, I ought in the first place to state that I
have not had the opportunity of reading or studying the great original
treatise of Professor Salisbury. I am acquainted with it only through a
resume published in the _American Journal of the Medical Sciences_
for the year 1866, new series, vol. li. p. 51. At the beginning of my
investigations I was engaged in a microscopic examination of the water
and mud of swampy shores and of the marshes, also with a comparison of
their microphytes with those which might exist in the urine of patients
affected with intermittent fevers. Nearly three months passed without
my being able to find the least agreement, the least connection. Having
lost nearly all hope of being able to attain the end which I had
proposed, I took some of the slime from the marshes and from the masses
of kelp and Confervæ from the sea shores, where intermittent fevers are
endemic, and placed them in saucers under the ordinary glass desiccators
exposed on a balcony, open for twenty-four hours, the most of the time
under the action of the burning rays of the sun. With the evaporated
water deposited within the desiccators, I proceeded to an examination,
drop by drop. I at length found that which I had sought so long, but
always in vain.
The parasite of intermittent fever, which I have termed Limnophysalis
hyalina, and which has been observed before me by Drs. J. Lemaire and
Gratiolet (_Comptes Rendus Hebdomadaires de l'Academie des Sciences_,
Paris, 1867, pp. 317 and 318) and B. Cauvet (_Archives de Medecine
Navale_, November, 1876), is a fungus which is developed directly
from the mycelium, each individual of which possesses one or several
filaments, which are simple or dichotomous, with double outlines,
extremely fine, plainly marked, hyaline, and pointed. Under favorable
conditions, that is, with moisture, heat, and the presence of vegetable
matter in decomposition, the filaments of mycelium increase in length.
From these long filaments springs the fungus. The sporangia, or more
exactly the conidia, are composed of unilocular vesicles, perfectly
colorless and transparent, which generally rise from one or both sides
of the filaments of the mycelium, beginning as from little buds or eyes;
very often several (two to three) sporangia occur placed one upon the
other, at least on one side of the mycelium.
With a linear magnitude of 480, the sporangia have a transverse diameter
of one to five millimeters, or a little more in the larger specimens.
The filaments of mycelium, under the same magnitude, appear exceedingly
thin and finer than a hair. The shape of the conidia, though presenting
some varieties, is, notwithstanding, always perfectly characteristic.
Sometimes they resemble in appearance the segments of a semicircle more
or less great, sometimes the wings of butterflies, double or single. It
is only exceptionally that their form is so irregular.
Again, when young, they are perfectly colorless and transparent;
sometimes they are of a beautiful violet or blue color (mykianthinin
mykocyanin). Upon this variety of the Limnophysalis hyalina depends the
vomiting of blue matters observed by Dr. John Sullivan, at Havana, in
patients affected with pernicious intermittent fever (algid and comatose
form). In the perfectly mature sporangia, the sporidia have a dark brown
color (mykophaein). From the sporidia, the Italian physicians, Lanzi and
Perrigi, in the course of their attempts at its cultivation, have seen
produced the Monilia penicinata friesii, which is, consequently, the
second generation of the Limnophysalis hyalina, in which alternate
generation takes place, admitting that their observations may be
verified. The sporangia are never spherical, but always flat. When
they are perfectly developed, they are distinctly separated from their
filament of mycelium by a septum--that is to say, by limiting lines
plainly marked. It is not rare, however, to see the individual sporangia
perfectly isolated and disembarrassed of their filament of mycelium
floating in the water. It seems to me very probable that these isolated
sporangia are identical with the hyaline coagula so accurately described
by Frerichs, who has observed them in the blood of patients dying of
intermittent fevers. But if two sporangia are observed with their bases
coherent without intermediary filaments of mycelium, it seems to me
probable that the reproduction has taken place through the union, which
happens in the following manner: Two filaments of mycelium become
juxtaposed; after which the filaments of mycelium disappear in the
sporangia newly formed, which by this same metamorphosis are deprived of
the faculty of reproducing themselves through the filaments of myclium
of which they are deprived. The smallest portion of a filament
of mycelium evidently possesses the faculty of producing the new
individuals.
It is unquestionable that the Limnophysalis hyalina enter into the blood
either by the bronchial mucous membrane, by the surface of the pulmonary
vesicles, or by the mucous membrane of the intestinal canal, most often,
no doubt, by the last, with the ingested water; this introduction is
aided by the force of suction and pressure, which facilitates their
absorption. It develops in the glands of Lieberkuhn, and multiplies
itself; after which the individuals, as soon as they are formed, are
drawn out and carried away in the blood of the circulation.
The Limnophysalis hyalina is, in short, a solid body, of an extreme
levity, and endowed with a most delicate organization. It is not a
miasm, in the common signification of the term; it does not carry with
it any poison; it is not vegetable matter in decomposition, but it
flourishes by preference amid the last.
In regard to other circumstances relative to the presence of this
fungus, there are, above all, two remarkable facts, namely, its property
of adhering to surfaces as perfectly polished as that of a mirror, and
its power of resistance against the reagents, if we except the caustic
alkalies and the concentrated mineral acids. This power of resisting the
ordinary reagents explains in a plausible manner why the fungus is not
destroyed by the digestive process in the stomach, where, however, the
acid reaction of the gastric juice probably arrests its development--is
that of the schistomycetes in general--and keeps it in a state of
temporary inactivity. This property of adhering to smooth surfaces
explains perhaps the power of the Eucalyptus globulus in arresting the
progress of paludal miasm (?). But it is evident that other trees,
shrubs, and plants of resinous or balsamic foliage, as, for example, the
Populus balsamifera, Cannabis sativa, Pinus silvestris, Pinus abies,
Juniperus communis, have equally, with us, the same faculty; they are
favorable also for the drying of the soil, and the more completely, as
their roots are spreading, more extended, and more ramified.
In order to demonstrate the presence of the limnophysalis in the blood
of patients affected with intermittent fever during the febrile stage,
properly speaking, it appeared necessary for me to dilute the blood of
patients with a solution of nitrate of potassa, having at 37.5°C. the
same specific gravity as the serum of the blood. With capillary tubes of
glass, a little dilated toward the middle, of the same shape and size as
those which are used in collecting vaccine lymph, I took up a little
of the solution of nitrate of potassa above indicated. After this I
introduced the point of an ordinary inoculating needle under the skin,
especially in the splenic region, where I ruptured some of the smallest
blood-vessels of the subcutaneous cellular tissue. I collected some
of the blood which flowed out or was forced out by pressure, in the
capillary tubes just described, containing a solution of potassa;
after which I melted the ends with the flame of a candle. With all the
intermittent fever patients whose blood I have collected and diluted
during the febrile stage, properly speaking, I have constantly succeeded
in finding the Limnophysalis hyalina in the blood by microscopic
examination.
It is only necessary for me to mention here that it is of the highest
importance to be able to demonstrate the presence of fungus in the blood
of the circulation and in the urine of patients in whom the diagnosis
is doubtful. The presence of the Limnophysalis hyalina in the urine
indicates that the patient is liable to a relapse, and that his
intermittent fever is not cured, which is important in a prognostic and
therapeutic point of view.
When the question is to prevent the propagation of intermittent fevers,
it is evident that it should be remembered that the Limnophysalis
hyalina enters into the blood by the mucous membrane of the organs of
respiration, of digestion, and the surface of the pulmonary vesicles. We
have also to consider the soil, and the water that is used for drinking.
In regard to the soil, several circumstances are very worthy of
attention. It is desirable, not only to lower as much as possible the
level of the subterranean water (grunawassen) by pipes of deep drainage,
the cleansing, and if there is reason, the enlargement (J. Ory) of
the capacity of the water collectors, besides covering and keeping in
perfect repair the principal ditches in all the secondary valleys to
render the lands wholesome, but also to completely drain the ground,
diverting the rain water and cultivating the land, in the cultivation of
which those trees, shrubs, and plants should be selected which thrive
the most on marshy grounds and on the shores and paludal coasts of the
sea, and which have their roots most speading and most ramified. Some
of the ordinary grasses are also quite appropriate, but crops of the
cereals, which are obtained after a suitable reformation of marshy
lands, yield a much better return. After the soil in the neighborhood of
the dwellings has been drained and cultivated with care, and in a more
systematic manner than at present, the bottoms of the cellars should be
purified as well as the foundations of the walls and of the houses.
The water intended for drinking, which contains the Limnophysalis
hyalina, should be freed from the fungus by a vigorous filtration. But,
as it is known, the filtering beds of the basins in the water conduits
are soon covered with a thick coating of confervæ, and the Limnophysalis
hyalina then extends from the deepest portions of the filtering beds
into the filtered water subjacent. It is for this reason that it is
absolutely necessary to renew so often the filtering beds of the water
conduits, and, at all events, before they have become coated with a
thick layer of confervæ. The disappearance of intermittent fevers will
testify to the utility of these measures. It is for a similar reason
that wooden barrels are so injurious for equipages. When the wood has
begun to decay by the contact of the impure water, the filaments of
mycelium of the Limnophysalis hyalina penetrate into the decayed wood,
which becomes a fertile soil for the intermittent fever fungi.
The employment for the preparation of mortar of water not filtered, or
of foul, muddy sand which contains the Limnophysalis hyalina, explains
how intermittent fevers may proceed from the walls of houses. This
arises also from the pasting of wall-paper with flour paste prepared
with water which contains an abundance of the fungi of intermittent
fever.
The miasm in the latter case is therefore endoecic, or more exactly
entoichic. With us the propagation of intermittent fever has been
observed in persons occupying rooms scoured with unfiltered water
containing the Limnophysalis hyalina in great quantity.
The following imperial ordinance was published on the 25th of March,
1877, by the chief of admiralty of the German marine. It has for its
object the prevention and eradication of infectious diseases:
"In those places where infectious diseases, according to experience, are
prevalent and unusually severe and frequent, it is necessary to abstain
as much as possible from the employment of water taken from without the
ship for cleansing said vessel, and also for washing out the hold when
the water of the sea or of a river, in the judgment of the commander of
a vessel, confirmed by the statement of the physician, is shown to be
surcharged with organic matter liable to putrefaction. With this end in
view, if you are unable to send elsewhere for suitable water, you must
make use of good and fresh water, but with the greatest economy. In that
event the purification of the hold must be accomplished by mechanical
means or by disinfectants."
"As I have demonstrated by my investigations that in the distillation
of paludal water, and that from the marshy shores of the sea, the
Limnophysalis hyalina, which is impalpable, is carried away and may be
detected again after the distillation, it must be insisted that the
water intended to be used for drinking on shipboard shall be carefully
filtered before and after its distillation."
The Klebs-Tommasi and Dr. Sternberg's report, as summarized in the
Supplement No. 14, National Board of Health Bulletin, Washington, D.C.,
July 18, I would cordially recommend to all students of this subject.
I welcome these observers into the field. Nothing but good can come from
such careful and accurate observations into the cause of disease. For
myself I am ready to say that it may be that the Roman gentlemen have
bit on the cause of the Roman fever, which is of such a pernicious type.
I do not see how I can judge, as I never investigated the Roman fever;
still, while giving them all due credit, and treating them with respect,
in order to put myself right I may say that I have long ago ceased to
regard all the bacilli, micrococci, and bacteria, etc., as ultimate
forms of animal or vegetable life. I look upon them as simply the
embryos of mature forms, which are capable of propagating themselves
in this embryonal state. I have observed these forms in many diseased
conditions; many of them in one disease are nothing but the vinegar
yeast developing, away from the air, in the blood where the full
development of the plant is not apt to be found. In diphtheria I
developed the bacteria to the full form--the Mucor malignans. So in the
study of ague, for the vegetation which seems to me to be connected with
ague, I look to the fully developed sporangias as the true plant.
Again, I think that crucial experiments should be made on man for his
diseases as far as it is possible. Rabbits, on which the experiments
were made, for example, are of a different organization and food than
man, and bear tests differently. While there are so many human beings
subject to ague, it seems to me they should be the subjects on whom the
crucial tests are to be made, as I did in my labors.
As far as I can see, Dr. Sternberg's inquiries tend to disprove the
Roman experiments, and as he does not offer anything positive as a
cause of ague, I can only express the hope that he will continue his
investigations with zeal and earnestness, and that he will produce
something positive and tangible in his labors in so interesting and
important a field.
I would then that all would join hands in settling the cause of this
disease; and while I do not expect that all will agree with me, still, I
shall respect others' opinions, and so long as I keep close to my facts
I shall hope my views, based on my facts, will not be treated with
disrespect.