The fungus-disease of India : a report of observations

Front matter

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Chapter I

the natural history of parasitic fungi generally.

PAGE.

Reasons for undertaking the study of the relation of fungi to disease — Purely botanical questions not discussed— The term * fungus’ adopted as most convenient in describing epi-and endophytic growths — The influence of vitality in limiting the spread of fungi — The nutritive requirements of fungi — Possibility of certain plants producing secretions especially adapted to the growth of certain fungi — Probability of certain diseases producing secretions specially adapted to the growth of fungi — Plies and other iusects attacked by fungi — The inferences which would be natural were isolated growths of fungi in the tissues demonstrated . . • . 1 — 5

CHAPTER II. THE evidence recorded in favour of the fungal origin

OF THE MADURA FOOT-AND-HAND-DISEASE.

The bibliography of the fungus-disease of India — Varieties of the disease distinguished by Dr. Carter — The dark and pale varieties compared — External appearances — Appearances presented by the two varieties on section — Intimate nature of the abnormal products— The pink variety of the disease — The various observations regarding the pink mould — ChionypheCarteri — The pink mould developed in connection with the pale variety — The pink mould developed in connection with the dark variety — The Revd. Mr.

Berkeley’s observations regarding the pink mould . . 6—12

Chapter III

A DESCRIPTION OF SPECIMENS ILLUSTRATIVE OF THE PALE VARIETY OF THE FUNGUS-DISEASE OF INDIA.

Materials examined — Nature of the investigations — Reasons for beginning the report with a description of observations on the pale variety of the disease — Description of Specimen I — Greasy aspect of the preparation — Abundance of oily matter in the tissues — Microscopic examination — Description of Specimen II — Cavities in the tissues : their nature and contents — Condition

IV

CONTENTS.

of the bones — Microscopic examinations — Description of Specimen III — Roe-like bodies and chalky crystalline masses — Condition of the bones — Various stages of degeneration among the fatty tissues — Cavities and channels — Transitions between normal fat and degenerate products — Results of microscopic examination— Description of Specimen IV — Early stage of the disease— Commencing degeneration — Description of Specimen V — Roe-like particles— Description of Specimen VI — Sun-dried material — Description of Specimen VII — Red particles

Chapter IV

PHYSICAL CHARACTERS AND RELATIONS TO SURROUNDING TISSUES OF THE MORBID PRODUCTS OF THE PALE VARIETY OF THE DISEASE.

The degeneration may occur without the local presence of any parasitic organisms — The disease essentially' a degeneration of the fatty tissues — Nature of the degenerative process — The proportion of gelatinoid aud fatty products differ in various specimens— Characters and causes of deformities presert in different instances — Special description of certain morbid products — Myeline — Difficulty of distinguishing vitalised from nonvitalised products .

Chapter V

PHYSICAL CHARACTERS AND INTIMATE NATURE OF THE RED PARTICLES OCCASIONALLY ASSOCIATED WITH THE PALE VARIETY OF THE FUNGUS-DISEASE OF INDIA.

Red particles in a specimen — Their microscopic structure — Behaviour with various re-agents — Effects of heat on them — Their nature — Cause of their color uncertain ....

Chapter VI

A DESCRIPTION OF SPECIMENS ILLUSTRATIVE OF THE DARK VARIETY OF THE FUNGUS-DISEASE OF INDIA.

Specimen I: section of a foot — Character of the cavities — Microscopical characters of the ordinary tissues : muscles : fibrous tissues : bones — The dark material— Specimen II : a heel and ankle — Appearance of the limb before amputation — Appearance of the specimen on section — Isolated grains of blackened material — Specimen III: a hand — Specimen IV: a hand — Specimen V: anterior portion of a foot — The preparation divided in four places : appearance of first section — Appearance of second section— Appearances of third section — Osseous tubercles along the metatarsal bones .....

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13-29

30—35

36-42

43-54

CONTENTS.

V

Chapter VII

PHYSICAL CHARACTERS AND RELATIONS TO SURROUNDING TISSUES OF THE BLACK MATTER FREQUENTLY ASSOCIATED WITH THE FUNGUS-DISEASE OF INDIA.

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The dark material may be found under three conditions — Isolated granules of the dark material — The variations in tint and the specific gravity of the dark material — Effect of the application of heat : chemical characters of the ash — Analysis of the black material by Mr. C. H. Wood — Spectroscopic characters of its solutions — The microscopical characters of the dark material —

The effect of re-agents on the filaments — Amylaceous particles occasionally found in preparations — The black pigment . 55 — 62

Chapter VIII. Cultivations Of The Various Morbid Products Of The

DISEASE.

Account of cultivations of morbid products — A new growing-cell adapted for supplying moist-air to the preparation — ^Cultivations of the black matter — A sun-dried specimen on rice-paste — Corrective cultivation of pure rice-paste : development of a pink mould — General results of cultivation of the black matter in rice-paste — Results of maceration of the black matter in water — Results of a second experiment — Absence of evidence of living elements in the black matter — Occasional occurrence of mould on its surface — Cultivations of morbid products of the pale variety of the disease — Cultivation of material from Specimen No. I — Mould on the surface of the water— Appearance of pink coloring — Pinkness of the material ; of infusoria, rotifers, and fungal elements — Development of cysts on the mycelium — The nature of the cysts ; Eurotia — Questions regarding their development— Coloring matter not the same as that of the red particles — Aspergillus developed on animal substances — Results of other cultivations of the products of the pale variety of the disease — Cultivation in which fungi were purposely introduced— Appearance of a red layer in it — Red Aspergillus — Coloring matter resembling that of the red concretions in its reactions — Both asexual and sexual fructifications of Aspergillus liable to become colored — Results of other similar experiments — Experiments on cultivation of the red concretions . . .63 —79

Chapter IX. Lessons To Be Derived From These Cultivation-experi- Ments

No peculiar species of vegetable organisms developed in cultivations of the various morbid products — Mere color insufficient to determine specificity — Peculiarities of coloring in the present instance ascribable to nature of substratum — Pink coloring not

VI

CONTENTS.

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peculiar to fungi developed in connection with the disease-products— Original observations on the subject agree with later experiments — Effects of alcohol on the vitality of fungal elements— Pink coloring of the fungi no proof of the fungal origin of the disease ..... 80 — 83

Chapter X. Conclusions

Nature of the morbid products — Is the dark variety an earlier stage of the pale? — The various stages in the progress of the dark variety — The cause of both probably identical — Clinical characteristics of the affection — Real nature of the roe-like and pink particles, and of the black masses — No etiological significance can be attributed to the presence of pigment and filaments in the dark variety — Probable uature and source of the pigment —

The fungoid elements in the dark substance not genetically connected with ‘Chionyphe Carteri’ — The filaments and capsules probably vegetations — Whence are the fungoid elements derived? — Experiments showing that fungal forms invariably appear under favourable circumstances in dead tissues . 84 — 90

ILLUSTRATIONS.

Plate I. The pale variety of the fungus-disease of India, &c. . 22

Fig. 1. Outline sketch of a specimen of the pale variety of the

„ 2. Section of a foot affected with the pale variety of the disease 18

„ 3. A roe-like particle with a fungi of feathery crystals . 20

„ 4. Various fungoid forms assumed by myeline . . 34

„ 5. Section of a foot showing dark masses in situ . . 44

„ 6. Peculiar distortion of the hand in a specimen of the dark

variety of the disease • • • . 50

„ 7. Encysted masses of altered adipose and connective tissue . 56

„ 8. A fragment of the affected tissue from a foot . . 57

„ 9. Fungoid filaments and capsules from the dark matter . 60

„ 10. A new form of growing-cell .... 64

„ 11. Organisms found in the tissues of healthy animals a few

hours after death • • . . 90

THE

FUNGUS-DISEASE OF INDIA.

CHAPTER I. THE NATURAL HISTORY Ob’ PARASITIC FUNGI GENERALLY

The importance of undertaking a series of systematic Reasons for under- observations with a view to elucidate rei^nln^of UHin|i k to the nature of the connection between disease- certain disease-processes and growths

of a vegetable character has for a long time been impressed upon us, and we have for several years past kept records of investigations bearing more or less directly on this subject. Hitherto, however, our reports on fungi and allied organisms have referred to the question of the actual presence of any such vegetations, not palpably adventitious, in connection with certain special diseases, and particularly with cholera. Having failed to satisfy ourselves of the existence of sufficient evidence to support the doctrine that any such growths are necessarily associated with these particular classes of disease, we decided on ascertaining, if possible, whether in the diseased conditions in which characteristic fungoid growths are known to exist beyond dispute, the latter are to be regarded as the actual cause of the particular malady. In undertaking this work we were aware that it was taking a step backward — treading the ladder a step lower down than that on which we commenced our work. We saw no alternative, however, but to do this, as personal observation had taught us that certain fundamental data, wrhich we had originally taken for granted as established, were not entitled to such unreserved reliance. Some of these observations we now propose to detail.

THE rUNGUS-DISEA.SE OF INDIA.

We are desirous that it should he understood that Not our intention to it is not our intention to discuss the

discuss purely botani- , . . i • i

cai questions. purely botanical questions which,

though so intimately associated with phyto-path ological studies, belong, nevertheless, more to the province of the professional botanist than to that of the pathologist : such questions, for example, as the relation existing between fungi and algse. The true character of the vegetations which occupy debatable land between fungi and algse — aquatic fungi, Adilya, Saprolegnia, and the like — is of itself a question sufficiently difficult to occupy the undivided attention of botanical experts for years to come, so that we do not consider it necessary to offer any excuse for leaving such questions to those in whose province they lie, and restricting ourselves to their pathological bearings. We are the more inclined to this course, as there are, unfortunately, only too many examples on record of the great hindrance to the advancement of our knowledge of the causation of diseases which has been occasioned by pathologists and botanists having trespassed on each other’s domains. This is an evil which it shall he our endeavour to avoid.

It will be convenient for many reasons to restrict The term ‘ fungus* ourselves to the employment of one

adopted as being the , ., .-*• .. .

most convenient m de- term whilst describing the particular

do-phytic growths. vegetations under discussion ; and as

it is only very rarely that what, in the present state of our knowledge, are regarded as ‘ algae ’ manifest truly parasitic proclivities, we shall refer to them as e fungi ’ simply.

The opinion that fungi are endowed with the power The influence of • vi- of inducing disease is not an un-

tality’ in limiting the . . 0 . , , . . . . ,

spread of fungi. natural one, seeing that they are the

most constant of all the attendants on disease and decay. Their germs are known to be universally distributed, and were it not for the peculiar conditions required for their development, their depredations would he past conception. .Fortunately, nature has fixed a

THE FUNGUS-DISEASE OF INDIA.

very potent barrier between a sporulc and the organised material upon which it may chance to settle, and which, were it not for this barrier, it would speedily appropriate to its own use. This barrier is healthy life. It has yet to be shown that the living matter of the tissues of any animal, so long as it retains its vitality undiminished, is liable to succumb to the attacks of a fungus. Should a spore be brought into contact with bioplasm whose vitality is impaired, however, the changes in the latter which such impairment implies may be of a kind to transform it into most suitable pabulum for the nourishment of the former. The impairment of vitality may he due either to disease, or be a normal process, the result of age : whether the change he normal or abnormal matters little to the fungus — it grows and multiplies wherever it finds material exactly suited to it.

It is the less vitalized portions of animals that are prone to epiphytic attacks — portions which have little or no power of repair. Hence the epidermic tissues, the wing covers and articular plates of flies and other insects, branchial plates of fishes, and the like, are the parts on which fungi are most commonly found. In such cases the vegetable organisms do not attack the living material, but what has ceased to undergo any active nutritive changes and is virtually dead, excreted material. With regard to those instances in which it is known that fungi are associated with the existence of disease during life, it is far from proven in any single case that the disease was not present prior to the fungus. For example, it is most strongly maintained by many observers that it is only the sickly silkworm that is ever attacked by fungi, and that inoculation can only be effected after the worm has sickened.

There is another barrier to the unlimited develop- Tiie nutritive re- ment of fungi, although of less im-

quirements of fungi. port gQ far ag growth of the mere

vegetative portion of the fungus is concerned, and that is the adaptability of the soil for its nourishment. Even with regard to animal parasites this feature is particularly evident, not only with respect to the entozoa,

THE FUNGUS-DISEASE OF INDIA.

but cpizoa also aro limited to certain animals and even to certain defined areas of the body. This law applies as strictly with regard to fungi as to the higher plants ; one spore will sprout and rapidly cover a surface with mould where another will not manifest the slightest indication of growth.

Some leaves become the hosts of certain fungi only— Probability of cer- their entire surface being equally seer etiems1 ^pSbaiiy11!? liable to attack ; whereas it is only of certain fungi. on a very limited area ot other leaves

that other species will develope at all. In Calcutta, for instance, the leaves of Hibiscus rosce sinensis, at particular times of the year, almost invariably present a fungus on their surface, the growth of which is strictly limited to the point on the under surface, where the petiole enters the lamina of the leaf, and which does not spread beyond this spot notwithstanding the production of an abundant development of mycelium and sporular elements. It is evident that at this spot a peculiar secretion is present which furnishes suitable pabulum for the nourishment of the particular fungus.

As already mentioned, even some animals, just as in Probability of certain the case of the leat, while in perfect secretions Pspeciauf health, appear to furnish a secretion of fungi. t0 the growt which throughout life, and without

detriment to their health, supports the growth ot some particular fungus at a particular spot; and it is not improbable that the morbid secretions resulting from disease in others furnish the special pabulum necessary for the development of the particular kinds of fungi constantly forming so prominent a feature in the appearance of such animals both before and after death.

Of animal tissues none are more frequently affected

Flies and insects at- by fungi during life than the bodies tacked by fungi. 0f insects of various kinds ; but whe-

ther the tissues are ever attacked during perfect health is, as already mentioned, a question still warmly disputed. This point, although it may appear, at first

THE FUNGUS-DISEASE OF INDIA.

O sight, to be of very trifling moment, is nevertheless of the utmost importance in estimating the nature and the extent of the influence which fungi exert on the production and maintenance of disease. The fact that the entire bodies of flies, beetles, bees, and such like, when affected with fungi, are found, when examined after death, to have been permeated through and through by mycelial threads, would be most significant were it known beyond doubt that the tissues in question were not diseased before the advent of the fungus — that the fungus did not follow the disease as the roots of a plant creep towards a stream.

Should it, however, be demonstrated that in any

The inferences which disease the gl’OWtll of a fungUS in a would be natural were . . , . “ , a , ■,

isolated growths of living subject can be limited not only

fungi in the tissues de- . . ", . ■, , , , . “

monstrated. to certain tissues, but to certain com-

pletely isolated portions of such tissues, the question would be very much simplified : such evidence would point to the dependence of the fungoid growths on some peculiar condition in those localised spots. It would, further, be evident that, however extensive, in some cases, the modification in the aspect and effects of the disease by tlie development of a fungus might be, the interpretation to be put upon the role of the latter in the malady must be in accordance with the fact that its development depended upon some previous change in the normal tissues.

What our own conclusions are with regard to this matter in connection with the disease in which we have specially studied it, will be gathered from the following account of a series of observations extending over a period of several years. We have endeavoured to curtail the narrative as much as appears to be consonant with the desire that readers may be able to infer the extent and to know exactly the character of these observations, and thus be able to judge whether or not we have worked at the subject in such a way as to entitle us to form an independent opinion.

THE FUNGUS-DISEASE OF INDIA.

Chapter II

THE EVIDENCE RECORDED IN FAVOUR OF THE FUNGAL ORIGIN OF THE MADURA-FOOT- AND HAND-DISEASE, OR FUNGUS-DISEASE OF INDIA.

The disease which we have selected as being the most

suitable for the purpose we had in

The bibliography of the fungus disease of India.

view — the ‘ Eungus-disease of India’

— has been investigated with the greatest diligence and care by Dr. H. Vandyke Carter of Bombay, to whom the profession is indebted for by far the fullest information it possesses with regard to the affection, and who certainly was the first to describe accurately the minute characters of the black particles frequently found in connection with it. His published observations date as far back as March 1860, since which period several communications have appeared from his pen.* These he has summarised and supplemented in a very able monograph on the subject published during the past year.f

Dr. E. W. Eyre also has written a concise description of the disease, as witnessed by himself ( Indian Annals of Medical Science, No. XII, pp. 513 and 813, 1860). He mentions that Garrison-Surgeon Godfrey of Madras was the first to call attention to the affection, under the designation of “ Tubercular disease of the foot,” and that he published an account of some cases observed by him since 1844, in the Lancet, 10th June 1846. The malady has, therefore, been known to the profession for more than thirty years.

No special interest was, however, taken in the matter until Dr. Vandyke Carter, as already mentioned, the

* Transactions of the Medical and Physical Society of Bombay, vol. VI, 1S60. Ditto ditto ‘ vol. VII, 1860.

Ditto ditto vol. VIII, 1S62.

Transactions of the Pathological Society of London, vol. XXIV, 1873.

t “Mycetoma,” or the Fungus-disease of India— London : J7 and A. Churchill, 1874.

JIIE FUNGUS-DISEASE OF INDIA.

Reverend M. J. Berkeley,* and Mr. H. J. Carter, f. r. s.,f published the result of their personal observations. The papers of these distinguished observers were followed by those of many others, so that the bibliography of the disease at present occupies no inconsiderable space in our medical literature. Those of our readers who may desire further details on this point will find a careful resume of the greater part of what has been written concerning the disease in Dr. Carter’s valuable monograph. It will be sufficient for our purpose merely to refer, generally, to what the three writers above mentioned have written, more especially to the writings of Dr. Vandyke Carter and Mr. Berkeley, with whom chiefly rest alike the credit and the responsibility which is attached to the observations and the deductions which have been promulgated with regard to the disease.

According to Dr. Carter, the affection manifests

Varieties of the dis- itself Under two forms, each presentease distinguished by , . . . „ . . A , .

Dr. carter. mg a different stage ot the same dis-

ease : (1), the black or melanoid, and (2), the pale or ochroid, varieties. There is, further, a phase of the disease characterised by the presence in the tissues of pink granules, so that, practically, the malady has been described as presenting three varieties. Although the phase of the disease last mentioned is of rare occurrence, it is, nevertheless, of great significance in connection with the theory of the origin of the disease now commonly accepted — a view typified in the name “ Mycetoma” given to it by Dr. Carter and adopted by the London Royal College of Physicians in its ‘Nomenclature of Diseases.’

As far as external appearances go, the two leading forms have much in common. There paiee vaHetief dcom! is considerable distortion of the foot pea?ances.ternal ap' or hand affected, an increase of size,

Journal of Linnean Society, vol. VIII, p. 135, 1865. f Annals and Mag. Nat. Hist., vol. IX, 1862.

Journal of the Linnrean Society, vol. VIII, 1865.

THE FUNGUS-DISEASE OF INDIA.

more or less marked, in all directions ; there are numerous, somewhat mammillated, apertures, communicating with cavities of various sizes and channels of various lengths in the subjacent tissues. The materials which escape through these apertures differ in the two forms : in the dark variety the fluid which oozes from the foot frequently contains brownish-black granules, in appearance not unlike the rougher description of gunpowder ; whereas in the pale variety little particles, bearing a considerable resemblance to fish-roe, are very commonly seen.

On section also the state of the hard and soft tissues Appearances present- presents much in common : — («) nu-

ed by the two varieties ■*- , . , ... '

on section. merous lined cavities generally com-

municating with each other by means of sinuous channels; (b) softening and excavations, more especially of the tarsal and carpal bones, but frequently also involving the long bones ; and (c) the packing of these cavities with a hard, dark substance in the black variety, and with a more or less soft, yellowish, fatty or gelatinous substance mixed with globular roe-like particles in the other.

It is with reference to the nature of these two sub-

intimate nature of stances, so different in appearance to the abnormal products, naked eye, that Dr. Vandyke Car-

ter’s observations and deductions are of such importance ; not only of importance in relation to the particular malady in which these peculiar substances are found, but to that class of diseases — a class at present very large and still on the increase — whose existence and extension is attributed solely to the pernicious influence of vegetable parasites.

Briefly stated, Dr. Carter describes the dark material in the first variety of the affection as consisting almost entirely of a fungus in its sclerotial form, i. e„ one of the * resting’ states common to fungi and somewhat analogous to the ‘ resting’ states of perennial plants — examples of which are furnished by bulbs and tubers of various kinds. The substance found filling the cavities

THE FUNGUS-DISEASE OF INDIA.

in the pale variety is considered to be indicative of an advanced stage of the disease due to “a change — seemingly a degeneration — ” of the darkened masses.

The fact that a pink mould has been developed in

The Pink variety of connection with specimens of both the disease. varieties has served as a link between

the dark and the pale material ; and this link has, so to speak, been completed by the circumstance that Dr. Carter has observed a case of the disease — practically forming, as before mentioned, a third variety, in which a pink coloration of tho tissues, associated with innumerable pink particles — ‘ fungus-bodies,’ were its characteristic features. Here, therefore, we seem to have the key to the arch which sustains the hypothesis that the Madura-foot and hand-disease is originated and propagated by means of a peculiar fungus.

It is consequently of importance that all who desire to form a correct estimate of the value of so important and popular a doctrine — of importance were it only because of its popularity — and absolutely incumbent

The various observa- on such as by their writings promulin0KnathlCpinkd mould- gate views based, as far as the human ‘chionyphe carter!.’ subject is concerned, almost entirely

on this peculiar malady, to examine this particular point closely. To the best of our knowledge, the following particulars comprise all that have been published with regard to the pink mould and the pink particles. With regard to these two sets of observations, it may be noted that, in the first instance, attention was arrested by the occurrence of pink particles comparable to “ red-pepper grains” in the diseased tissue, accompanied by some pink staining.

Some time subsequently it was observed that a pink

The pink mould de- or crimson coloured mould had developed in connection , , . . „ , .

with the Pale variety, veloped on separate specimens 01 the ochroid variety on two different occasions, and on particles of it placed in boiled rice-paste: — (1) on the exposed portion of a foot which had been macerating in water for eighteen months — the growth extending

TIIE FUNGUS-DISEASE OF INDIA.

“even to the sides of the bottle;” (2) on a preparation which “ had been put into a bottle with some fresh spirit” for preservation about two months previously : the part of the specimen which was above the surface of the fluid, owing to the evaporation of the spirit, acquired “ a red tinge and soon after there appeared a thick layer of crimson mould;” and (3) in connection with some soft particles from a foot which had been placed in some boiled rice-paste a day after amputation : ten days afterwards buff and green moulds were observed, and a few days later a red tint was distinguishable, and stained filaments were traced to the particles.

A similar mould was obtained on four occasions in The pink mould de- connection with fragments of black

veloped in connection ... ° „

with the Black variety, particles obtained from specimens ot the dark or melanoid variety : —

(1) . Some of these particles from a newly amputated foot were mixed with a little cotton soil 1 moistened with animal juices’ and kept for two years and nine months unopened. It was then observed that a thin reddish film had appeared on the still moist surface like that noticed on the salt pans in the marshes near Bombay.

(2) . During the same period similar fresh particles, obtained from the same source as in the foregoing experiment, were placed on rice-paste and set aside in a corked bottle. This preparation also remained unchanged for nearly three years, ‘ when, on opening the bottle and removing its contents into an open glass-cell, a red mould speedily made its appearance and spread luxuriantly : it had not, however, a clear connection with the fungus particles, but seemed to spring up independently of them upon the rice wherever this was exposed to the air.’

(3) . Black particles were taken directly from another foot and placed in some moist ground rice. About six months afterwards a reddish tinge, passing on to crimson, was observed on the rice starch. c The black particles have remained unchanged to all appearance, and the red stains do not surround them, but may spring up unconnectedly.’ (The italics are ours.)

THE FUNGUS-DISEASE OF INDIA.

(4). Aset of three experiments was undertaken: — (a) black particles and rice-paste, (6) rice-paste only, and ( c) black particles which had been kept dry in a box for two or three years (mixed with rice-paste ?).

When examined within a month, the first was unchanged ; the second, i. e., the rice-paste alone, presented a suspicious reddish tinge in one part ; and the third was covered with a pink growth which grew ‘ equally and spread everywhere, but its commencement had no more apparent connection with the unaltered black masses than in the other cases.’

A fifth series was undertaken, but as the specimens were lost, details have not been given.

With regard to these observations, Dr. Carter writes that at first he did not appreciate the significance of this pink tinted growth until he had learnt Mr. Berkeley’s opinion that the peculiar mould was c the perfect condition of the species.’