Asafetida

“ The finest sort, which is generally sold pure, is obtained solely “from the node or leaf-bud in the centre of the root-head.” At Kandahar, the price of this superior drug is equivalent to from 2s. 8d. to 4s. 8d. per lb, while the ordinary sort is worth but from 1s. to 2s.
During a journey from North-western India to Teheran in Persia, through Beluchistan and Afghanistan, performed in the spring of 1872, the same traveller observed the asafœtida plant in great abundance on many of the elevated undulating pasture-covered plains and hills of Afghanistan, and of the Persian province of Khorassan. ”

“ It is well, therefore, when puzzled over some obscure dyspeptic condition in tropical patients, to bear the ascaris in mind. If, for some reason, it is undesirable to give santonin unnecessarily, the stools ought first to be examined with the microscope. If ova (Fig. 168, f, g) are found, a dose or two of santonin may clear up the diagnosis and cure the patient; if no ova are found, the drug may be withheld and the idea of ascarides abandoned.
Treatment.— The ascaris is readily expelled by a few grains of santonin. The dose is from 1⁄2 to 1 gr. for a child, 3 to 5 gr. for an adult. ”

“ If a tear is touched with nitric acid sp. gr. 1·2, it assumes for a short time a fine green colour.
When asafœtida is rubbed in a mortar with oil of vitriol, then diluted with water and neutralized, the slightly coloured solution exhibits a bluish fluorescence. The same will be observed, to some extent, if tears of the drug are immersed in water and a little ammonia is added. The tears of asafœtida when warmed become adhesive, but by cold are rendered so brittle that they may be powdered. With water they easily form a white emulsion. ”

“ Asafœtida of good quality may be obtained in most bazaars. The moister and most strongly smelling kinds should be chosen for medical purposes. It may be given in the form of pill, in doses of from five to ten grains; or in that of mixture, prepared by rubbing down in a mortar five drachms of Asafœtida in a pint of hot water, and straining and setting aside to cool. Of this solution, which is thick and milky, the dose is from one to two table-spoonfuls. Its nauseous taste is a great objection to its use. ”

“ In the same proportion as the population becomes less malarious, so the mosquitoes become less dangerous, and theoretically a millennium is possible in which man and anopheles, mutually purged of the malarial organism, may live happily together. Unfortunately, a malarious man it is believed remains infectious to anopheles for no less than three years, instead of the three days' limit of yellow fever, and this greatly increases the difficulty of exterminating malaria. ”

“ Atabrine tablets provided some relief, besides turning the skin yellow, but they were not effective enough to stop the spread of the mosquito-borne infection. Malaria attacks were so pervasive that nothing short of complete prostration, becoming a litter case, could earn a respite in the hospital. ”

“ I lay no special stress on the three cases in which I did not find the parasites, as the patients were not followed from day to day with the accuracy necessary to give any value to the observations. It must be borne in mind that hæmatozoa are not uncommon in animals, and, as in the rat, do not appear to interfere seriously with the health of their hosts. Under these circumstances, the association of a specific form with a definite disease in an animal makes it all the more probable that the species is pathogenic. ”

“ In 1898 Experiment. it was conclusively shown in Italy that if a mosquito of the Anopheles variety bites a person suffering from malaria, and is kept long enough for the parasite to develop in the salivary gland, and is then allowed to bite a healthy person, the latter will in due time develop malaria. The converse proposition, that persons efficiently protected from mosquito bites escape malaria, has been made the subject of several remarkable experiments. ”

“ Attempts to isolate and grow these hæmatozoa outside the body have failed. Marchiafava and Celli have shown that the inoculation of healthy persons with blood taken from a case of malaria is followed inavariable time by genuine ague paroxysms, in which the blood contains the parasites; but in regions where malaria is prevalent such experiments are not wholly free from objections. A series of negative observations on undoubted cases of malaria would be convincing. ”

“ Below the anus the papillæ are regularly arranged in pairs, seven in number, the two uppermost pairs being double.
Notwithstanding the advantage which the size of this entozoon affords us in the matter of observation and experiment, we are yet ignorant as to the precise mode in which the young gain access to the human body. From what has been said respecting the quick growth of Ascaris mystax in the dog, and from what has been observed respecting the rapid growth of the so-called A. suilla in the hog, we know that the worm requires but a short time to pass from the larval to the sexual state. ”

“ The evidence shows that they belong to a family of mosquitoes, known by the infamous name of Anopheles, and they have used malaria, yellow fever and several other diseases with which to slay man; that the female is the entertainer of a very small creature, a kind of Jonah, whom she swallows, and after a time he gets down from her stomach into her proboscis, and when she bites her human victim he leaps into the wound where he remains and eats red-blood corpuscles, and when grown he breaks up into from six to ten pieces, each piece making a new animal life like the original ”

“ Ascaris lumbricoides, Linneus.—This common parasite was for a long while regarded as identical with the great lumbricoid of the horse, but the question has been finally settled by Schneider, who has shown that the human worm, although identical with Dujardin’s Ascaris suilla of the hog, is nevertheless quite distinct from the Ascaris megalocephala of solipeds. The large lumbricoid occasionally found in the ox belongs to the human worm. Our large human helminth resembles the common earth-worm in general appearance only. ”

“ The heavy rainfalls at the isthmus will probably [Pg 149] prevent the complete sanitation of the country in this respect, for the simple reason that the destruction of the anopheles mosquito or the eradication of the malarial germ can never be complete. There will always be people going about with the malarial organism in their blood, and always anopheles mosquitoes ready to become infected with it and to carry the infection about. But, as we have seen, much can be done by the means described to reduce the ravages of the disease. ”

“ The case of the anopheles and his little contribution to human suffering is very different. Whereas the victim of yellow fever either dies or gets better and quickly ceases to be a source of infection to the mosquito, the victim of malaria seldom dies of the disease, but he remains infectious to the anopheles for three years. The disease does not simply attack new-comers or white people. Natives of the isthmus and the West Indies are subject to it, and, indeed, seem to be in a chronically malarious condition. ”

“ Once the parasite begins to divide, the trophozoites are called schizonts, consisting of many daughter merozoites (blood schizogony) . Eventually, the infected erythrocytes are lysed by the merozoites, which subsequently invade other erythrocytes, starting a new cycle of schizogony. The duration of each cycle in P. falciparum is about 48 hours. In non-immune humans, the infection is amplified about 20-fold each cycle. After several cycles, some of the merozoites develop into gametocytes, the sexual stage of malaria, which cause no symptoms, but are infective for mosquitoes [5] . ”

“ Similarly, species of spiders and other forms which are ordinarily perfectly harmless, may accidentally convey and inoculate pyogenic bacteria.
It is as essential hosts of disease germs that arthropods play their most important rôle. In such cases an essential part of the life cycle of the pathogenic organism is undergone in the insect. In other words, without the arthropod host the disease-producing organism cannot complete its development. As illustrations may be cited the relation of the Anopheles mosquito to the malarial parasite, and the relation of the cattle tick to Texas fever. ”

“ Even if we suppose that the Ascaris suilla and A. lumbricoides are not identical species, still it is evident that any person discharging the eggs of lumbricoids in the vicinity of open waters becomes, by that fact, a source and centre of infection. To ensure an endemic it is probably only further necessary that the human inhabitants should employ the contaminated water for domestic purposes. But time and an increase of temperature must be allowed for the bringing about of those known and unknown larval changes that alike form the necessary antecedents of infection. ”

“ Some observers maintain that Anopheles does not “sing,” like the common mosquito, and its bite is much less irritating. Only the females suck blood; the act is believed to be necessary for fertilization and reproduction. Anopheles rarely bites by day, and then only in dark places. ”

“ These corpuscles and other structures, as well as the worm itself, are figured in my ‘Notes on Entozoa’ quoted below. Next in frequency, perhaps, is the whipworm (Trichocephalus dispar) , which monkeys of all kinds harbor in common with man. Besides these nematodes, Physaloptera dilatata is found in the stomach of American monkeys, and Ascaris distans also (in the large intestine of marmosets more particularly) . This Ascaris has also been found in Cercopithecus fuliginosus and in Simia sabæa. A small spiroptera is said to infest the walls of the stomach of Simia maimon. ”

“ If a yellow fever patient is put into a room in which the mosquitoes have been killed and the doors and windows are screened, he is as harmless, as far as contagion is concerned, as a man with a broken leg. The disease is not spread by fomites.
Malaria is caused by plasmodia, which are protozoa, not bacteria, and it is carried from case to case by mosquitoes of the genus Anopheles. So certain are we that this is the mode of infection that the expression "no anopheles, no malaria" has almost become a medical axiom. ”

“ The problem in Africa is more complex, owing to the fact that the native population is thoroughly permeated with the parasite. Mr. Christophers and Dr. Stephens, in their ‘Further Reports to the Malaria Committee,’ have shown that the children of natives are in the great majority of cases infected with malaria. In one village where the Anopheles was found in ‘considerable numbers,’ 90 per cent. of the babies suffered, 57 per cent. of the children up to eight years, 28 per cent. ”

“ Before all things, we must shut off the sources of the infection. For centuries, men had believed in exhalations and miasmata lying all over the land: and, behold, the agents of malaria are in the puddles round a man's house, and the agents of yellow fever are in the water-butt and the broken bottles and old sardine-tins. Science has given the word, and now there are Anopheles brigades and Culex brigades set going; labourers with brooms and rubbish-carts, sweeping out the stagnant pools, draining the surface soil, and carrying off the odd receptacles that serve to hold mosquito eggs and larvæ. ”

“ Ross had proved that the cause of malaria in man was the presence in his blood of an organism introduced by the attack of the anopheles gnat (or mosquito) , and that the species was only poisonous to man if it had itself become infected with the germ of this organism in biting a man suffering from malaria. Thus man and anopheles act alternately as hosts to the organism, which apparently requires their co-operation for the continuance of its species. ”

“ Anointing the skin with strong-smelling substances is of little use in the open air, but more effective in the house; turpentine appears to be the best. Exposure at night should be avoided. All these prophylactic measures are directed against mosquitoes. There remains the question of protection against the parasite. Chills are recognized as predisposing both to primary infection and to relapses, and malnutrition is also believed to increase susceptibility; both should therefore be avoided. Then a certain amount of immunity may be acquired by the systematic use of quinine. ”

“ Earlier stages of growth should be diligently sought for. Widely dissimilar as the two maw-worms are, it would not greatly surprise me to learn that Sp. megastoma and S. microstoma are dimorphic conditions of one and the same entozoon. At all events, Ercolani’s determination of the relations subsisting between Ascaris inflexa and A. vesicularis suggests a possible analogy of this kind. I may mention that the male Spiroptera megastoma reaches nearly one third and the female one half of an inch in length. A constriction separates the head from the body. ”

“ Amongst them were numbers of anophele, the carriers of the malarial fever microbe. Only the female anophele stings, and she has got to be herself previously infected by the fever germ before she can convey infection to the person bitten. Consequently, anopheles inhabiting densely populated regions are far more dangerous than those found in comparatively deserted ones, such as we were now in. In and around the big villages practically every anophele is a germ carrier, and capable of breeding infection, while those breeding out in the bush are comparatively innocuous. ”