The principles and practice of medicine : designed for the use of practitioners and students of medicine / by William Osler.

  • Osler, William, Sir, 1849-1919.
Date:
1901
Catalogue details

Licence: In copyright

Credit: The principles and practice of medicine : designed for the use of practitioners and students of medicine / by William Osler. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    Two attacks have been described within a year. Of 2,000 cases of enteric fever at the Hamburg General Hospital, only 14 persons were affected twice and only 1 person three times (Dreschfeld). Bacillus typhosus.—The researches of Eberth, Koch, Gaffky, and others have shown that there is a special micro-organism constantly associated with typhoid fever, {a) General Characters.—It is a rather short, thick, flagellated, motile bacillus, with rounded ends; in one of which, sometimes in both (particularly in cultures), there can be seen a glistening round body, at one time believed to be a spore; but these polar structures are probably only areas of degenerated protoplasm. It grows readily on various nutritive media, and can now be differentiated from bacillus coli com- munis, with which, and with certain other bacilli, it is apt to be confounded. This organism fulfils two of the requirements of Koch's law—it is con- stantly present, and it grows outside the body in a specific manner. The third requirement, the production of the disease experimentally by the cultures, has not yet been met. Probably the animals used for experi- mentation are not susceptible to typhoid fever. The bacilli or their toxins inoculated in large quantities into the blood of rabbits are pathogenic, and in some instances ulcerative and necrotic lesions in the intestine may be produced. But similar intestinal lesions may be caused by other bac- teria, including bacillus coli communis. Cultures are killed within ten minutes by a temperature of 60° C. They may live for eighteen weeks at —-5° C, although most die within two weeks, and all within twenty-two weeks (Park). The typhoid bacillus resists ordinary drying for months, unless in very thin layers, when it is killed in five to fifteen days. The direct rays of the sun completely destroy them in from four to ten hours' exposure. Bouillon cultures are destroyed by carbolic acid, 1 to 200, and by corrosive sublimate, 1 to 2,500. (h) Distribution in the Body.—In recent typhoid infections the bacilli are found in the lymphoid tissues of the intestines, in the mesentei-ie glands, in the spleen, in the bone marrow, in the liver, and in the bile. They occur also in irregular clumps in the contents of the intestines and in the stools; and since the introduction of improved methods of cultiva- tion (Eisner, Piorkowski) they have been demonstrated in the latter in about 50 per cent of the cases examined. They may, however, be incapable of demonstration even in fatal cases. The bacilli may be demonstrated in the blood and rose spots in a majority of the cases. They occur in the urine in 25 to 30 per cent of the cases. Their presence in sweat and sputa has been reported in a few instances. From the endocardial vegeta- tions, from meningeal and pleural exudates, and from foci of suppuration in various parts, the bacilli have also been isolated. (c) The Bacilli Outside the Body.—In sterile water the bacilli retain their vitality for weeks, but under ordinary conditions, in competition with saprophytes, disappear within fourteen days. Whether an increase in water can occur is not finally settled, but it probably may take place to some extent at first. Their detection in the water is difficult, and although they undoubtedly have been found, many such discoveries previously re- ported are not certain on account of the inaccurate differentiation of the