Page:An Address on the Hæmatozoa of Malaria.pdf/3

 (c) In seven cases there were vacuoles in the red corpuscles containing solid-looking bodies of various sizes and shapes. Certain of these structures resembled micrococci very closely (Fig.5), and stained

deeply in aniline dyes; but others, often in the same corpuscle,were larger, more irregular, and altogether different in appearance (Fig. 6).

The smaller ones were usually highly refractile, and,when two were together, the appearance suggested a diplococcus. In three instances these bodies had a deep brown tint, as if composed of pigment. The larger bodies were homogeneous, very variable in size and shape. No movement was noticed in them, but the outlines of the spaces in which they lay sometimes changed actively. In Case 29, these bodies were very abundant, and for days formed the only noticeable alteration in the corpuscles.

2. The Free Forms.—(a) Pigmented crescents. These bodies, which were found in eighteen cases, present remarkable features in appearance and structure. The form was usually that of a beautiful crescent (Fig.7), with rounded or gently tapering ends; but the degree

of curvature was variable, and many forms were almost straight. The length is about double that of the width of a red corpuscle, sometimes more. They are not attached, and they never show any motion. Joining the ends of the crescents—or, more correctly, at a little distance from the points—a narrow line can often be seen on the concave margin (Fig.7, e). The body of the crescent appears made up of a structureless, homogeneous material, in the centre of which is a prominent collection of pigment granules. This, with the peculiar form, makes these bodies very easily recognisable in the blood, even when closely surrounded by the corpuscles. The pigment is very dark in colour, distinctly granular, and varies somewhat in its arrangement. As a rule, it is central and aggregated, either in a heap, or assumes the form of a band placed transversely to the axis of the crescent. In some instances it is more scattered, but I have never seen it at either end of the body. Although the most careful examination fails to detect any movement in the hyaline substance of the crescent, yet the existence of such may be inferred from the very positive movement which the pigment granules undergo. Fig. 7, a, b, c, represents these alterations; changes in form are exceptionally seen, as shown at Fig.8 (1,2,3). A crescent became, within an hour, an ovoid body.

Sketch 1 was made at 9.40, 2 at 10.10, and 3 at 10.30 The outline of these bodies is very clear and defined. Ovoid, elongated and rounded forms of identical structure are also met with, but the crescents predominate. The number is variable, from one or two in a slide, to six or eight in the field of the 1-12th im. Though almost always free, they occur sometimes in the interior of a corpuscle, indicating, doubtless, the mode of development (Fig. 8, a and b).

(b) The Rosette Form.—In six instances there were rounded bodies,a little larger than red corpuscles, with a dimly granular protoplasm, and in the centre a rosette of pigment (Fig.9). Some of these appeared

to be enclosed in a delicate membrane, others were free. In six cases remarkable changes were seen in these forms, of the nature of segmentation. Thus Fig.10, a, represents one of these as seen at

6, September 4th. At 6.10 (b) there were distinct indications of segmentation in the finely granular protoplasm. At 6.30 (c) this had resulted in the formation of twelve or fifteen rounded bodies clustered about the central pigment, and still enclosed in the sheath. At 7.40 (d) the shell had burst, and given exit to the small corpuscles, which presented a tiny speck at or about the centre. At 10.40 they had not undergone any material change. In Case 60, one of quartan ague, this phenomenon was repeatedly observed. The development of the rosette form can, I think, be traced from the intra-cellular pigmented bodies, which increase in size until the entire corpuscle is filled. In some instances the body was surrounded by the remnant of the red corpuscle, in others there was no trace of it. The pigment granules gradually collect in the centre of the body in a more or less distinct rosette. I thought these changes had been overlooked by the writers on this subject, but I find that Golgi has given a very full description of them, and has beautifully figured the development of the rosette form from the intracellular pigmented bodies. He has followed the process of segmentation with much greater detail than I have been able to do.

(c) Flagellate organisms.—Two or three years ago, when I first read Laveran's papers, nothing excited my incredulity more than his description of the ciliated bodies. It seemed so improbable, and so contrary to all past experience, that flagellate organisms should occur in the blood. The work of the past six months has taught me a lesson on the folly of a scepticism based on theoretical conceptions, and of preconceived notions drawn from a limited experience. Flagellate bodies were seen in seven cases, never in great numbers, usually only one or two in a slide. They are smaller than red blood-corpuscles, of ten not more than half the size. A specimen in one case was equal in one diameter to a red corpuscle lying near it. They are round, ovoid, or pear-shaped; the protoplasm finely granular, and in every instance contained pigment, usually central, which often displayed rapid Brownian movements (Fig. 11). The flagella are variable in

number; one, three, and four were noted in different specimens. The length, as closely as could be estimated, was two or three times that of the body. They are exceedingly delicate, gently tapering, and, except in one instance, I could not determine the existence of a small terminal knob, figured by Laveran. The movement is exceedingly active, and the lashing of the long filaments may be sufficiently