Chapter 7

I also have repeated your experiments in relation to the collection of the mud, turf, sods, etc., and have known them to be carried many hundred miles off and identified. I have also found the little depressions caused by the tread of cattle affording a fine nidus for the plants. You have only to scrape the minutest point off with a needle or tooth pick to find an abundance by examination. I have not been able to explore many other sites, nor do I care, as I found all the materials I sought in the vicinity of New York.

To this I must make one exception; I visited the Palisades last summer and examined the localities about Tarrytown. This is an elevated location, but I found no Gemiasmas. This is not equivalent to saying there were none there. Indeed, I have only given you a mere outline of my work in this direction, as I have made it a practice to examine the soil wherever I went, but as most of my observations have been conducted on non-malarious soils, and I did not find the plants, I have not thought it worth while to record all my observations of a negative character.

I now come to an important part of the corroborative observations, to wit, the blood.

I have found it as you predicted a matter of considerable difficulty to find the mature forms of the Gemiasmas in the blood, but the spore forms of the vegetation I have no difficulty in finding. The spores have appeared to me to be larger than the spores of other vegetations that grow in the blood. They are not capable of complete identification unless they are cultivated to the full form. They are the so-called bacteria of the writers of the day. They can be compared with the spores of the vegetation found outside of the body in the swamps and bogs.

You said that the plants are only found as a general rule in the blood of old cases, or in the acute, well marked cases. The plants are so few, you said, that it was difficult to encounter them sometimes. So also of those who have had the ague badly and got well.

Observation at Naval Hospital, N.Y., Aug., 1877. Examined with great care the blood of Donovan, who had had intermittent fever badly. Negative result.

The same was the result of examining another case of typho-malarial (convalescent); though in this man's blood there were found some oval and sometimes round bodies like empty Gemiasmas, 1/1000 inch in diameter. But they had no well marked double outline. There were no forms found in the urine of this patient. In another case (Donovan,) who six months previous had had Panama fever, and had well nigh recovered, I found no spores or sporangia.

Observations made at Washington, D.C., Sept., 1879. At this time I examined with clinical microscope the blood of eight to ten persons living near the Congressional Cemetery and in the Arsenal grounds. I was successful in finding the plants in the blood of five or more persons who were or had been suffering from the intermittent fever.

In 1877, at the Naval Hospital, Chelsea, I accidentally came across three well marked and well defined Gemiasmas in the blood of a marine whom I was studying for another disease. I learned that he had had intermittent fever not long before.

Another positive case came to my notice in connection with micrographic work the past summer. The artist was a physician residing in one of the suburban cities of New York. I had demonstrated to him Gemiasma verdans, showed how to collect them from the soil in my boxes. And he had made outline drawings also, for the purposes of more perfectly completing his drawings. I gave him some of the Gemiasmas between a slide and cover, and also some of the earth containing the soil. He carried them home. It so happened that a brother physician came to his house while he was at work upon the drawings. My artist showed his friend the plants I had collected, then the plants he collected himself from the earth, and then he called his daughter, a young lady, and took a drop of blood from her finger. The first specimen contained several of the Gemiasmas. The demonstration, coming after the previous demonstrations, carried a conviction that it otherwise would not have had.

AGUE PLANTS IN THE URINE.

I have found them in the urine of persons suffering or having suffered from intermittent fever.

When I was at the Naval Hospital in Brooklyn one of the accomplished assistant surgeons, after I had showed him some plants in the urine, said he had often encountered them in the urine of ague cases, but did not know their significance. I might multiply evidence, but think it unnecessary. I am not certain that my testimony will convince any one save myself, but I know that I had rather have my present definite, positive belief based on this evidence, than to be floundering on doubts and uncertainties. There is no doubt that the profession believe that intermittents have a cause; but this belief has a vagueness which cannot be represented by drawings or photograph. Since I have photographed the Gemiasma, and studied their biology, I feel like holding on to your dicta until upset by something more than words.

In relation to the belief that no Algæ are parasitic, I would state on Feb. 9, 1878, I examined the spleen of a decapitated speckled turtle with Professor Reinsch. We found various sized red corpuscles in the blood in various stages of formation; also filaments of a green Alga traversing the spleen, which my associate, a specialist in Algology, pronounced one of the Oscillatoriaceæ. These were demonstrated in your own observations made years ago. They show that Algæ are parasitic in the living spleen of healthy turtles.

This leads to the remark that all parasitic growths are not nocent. I understand you take the same position. Prof. Reinsch has published a work in Latin, "Contributiones ad Algologiam," Leipsic, 1874, in which he gives a large number of drawings and descriptions of Algæ, many of them entophytic parasites on other animals or Algæ. Many of these he said were innocent guests of their host, but many guest plants were death to their host. This is for the benefit of those who say that the Gemiasmas are innocent plants and do no harm. All plants, phanerogams or cryptogams, can be divided into nocent or innocent, etc., etc. I am willing to change my position on better evidence than yours being submitted, but till then call me an indorser of your work as to the cause and treatment of ague.

Respectfully, yours, ------

There are quite a number of others who have been over my ground, but the above must suffice here.

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: