Cholera : inquiry by Doctors Klein and Gibbes and Transactions of a committee convened by the Secretary of State for India in Council.

  • Gibbes, Heneage.
Date:
1885
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Licence: Public Domain Mark

Credit: Cholera : inquiry by Doctors Klein and Gibbes and Transactions of a committee convened by the Secretary of State for India in Council. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    three or four remaining joined end to end, and they always move, owing to their peculiar shape, in a spiral; this, of course, is more pronounced in the S-shaped and complex ones than in the single examples. Old cultures, some six or seven Aveeks old, in neutral Agar Agar, show that the commabacilli have a tendency to elongate, coiling and shrivelling up at the same time, so that forms are met with which look like more or less distorted spirilla. Koch states (l. c. p. 20) that the commabacilli never form spores. The cultivations from flakes of the intestinal contents on damp linen, the cultivations of commabacilli in test tubes on alkaline solid material (Agar Agar mixture), proved after 24 to 48 hours the existence of commabacilli Avhicli differ from the typical ones in this respect, that they are about tAvice the thickness, some nearly flat on one side, convex on the other, and that they contained in their interior a spherical or slightly oval bright transparent droplet, which does not take the stain. In the short organisms there is only one about the centre, in the long examples there may be two or even three. And this appearance corresponds in certain respects to what is known of spores of other bacilli; in the Avell known cases of spore formation (bacillus subtilis, anthracis, &c.), the bacilli that form spores are known to swell up and to become thicker, and to form in the interior bright oval or spherical glistening spores which do not take the stain. And for spores these clear droplets could be easily mistaken, but further observations proved that this is altogether a different process, i.e., vacuolation of the bacilli. Noav the objection might be urged ; but are the commabacilli described and cultivated by Koch identical with those described and cultivated in this investigation. It is not likely that such an objection will be raised by any one Avho has carefully read this and the description of Koch’s, and compared the commabacilli as figured here and in Koch’s pamphlet, but seeing that a great many persons, unacquainted or only imperfectly acquainted with: investigations of this kind, have asked innumerable unanswerable questions, and raised all kinds of objections to any criticisms unfavour- able to Koch’s view, it might be as Avell to answer such an objection. Well, first and foremost, the sources from which Koch obtained his commabacilli were identical with the places from Avhicli avc derived our commabacilli, viz., acute typical cases of cholera ; secondly, the locality from which Koch derived his commabacilli Avns identical with that from which Ave derived our commabacilli, viz., the mucous flakes of the lower part of the ileum ; thirdly, the morphological characters of Koch’s commabacilli ave precisely the same as those of the commabacilli described here; an inspection of Koch’s illustrations and ours, and a comparison of Koch’s preparations with ours, leaves no doubt on this point; and lastly, the behaviour of the commabacilli grown on linen, on gelatine, and in other media is the same. The examination of sections of the mesenteric glands, the kidney, liver, spleen, central nervous system, and the blood revealed no commabacilli. One of the most remarkable facts observed is this, the mesenteric glands in connection Avith the loAver part of the ileum of several acute typical cases were examined carefully on fine microscopic sections, Avell stained with methyl blue, or gentian violet, or both, or Spiller’s purple, and not a single commabacillus, not a trace of one, could be detected in them. If, as Koch maintains, the commabacilli in these cases are present in the earliest stages of the disease, and even before, in great numbers in the mucous membrane of the ileum (the mucous membrane and the cavity of the ileum being as it were a pure cultivation), it becomes absolutely unintelligible that no commabacilli should be absorbed and find their Avay into the mesenteric glands (for he assumes the presence of the commabacilli and absorption of the chemical ferment introductory to the outbreak of the symptoms of the illness). It is against all that is knoAvn of pathogenic organisms; for one great character of them is to be able to exist in the living tissues, and the least one ought to expect to find is their immigration, absorption, and presence in the lymphatic tissues of the mesenteric glands. But, as a matter of fact, they are totally absent in these organs. [in the spleen there are certain microscopic lesions to be observed, consisting in death of patches of pulp tissue, these patches are irregular in outline and confluent; t he healthy portions of the pulp become as it were permeated by dead issue ; probably this change is caused by stasis of the blood in the venous radicles of these parts. It . showrs itself in stained sections as unstained patches, the elements of the pulp being indistinct and not taking the stain. Some of the small arteries shoAV hyaline degeneration of the inner coat, in con- sequence of which they become altogether occluded. In the kidney there is always opac swelling and granular degeneration of the epithelium of the convoluted urinary