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this treatment always gives sterile serum; he then coagulates at 65°.

The bacilli infected into such a soil show no change when the culture is maintained at 37° (which is the best temperature) for many days, it is not indeed until from the tenth to the fifteenth day that changes are evident to the naked eye. The first sign is little whitish points, these increase and are wholly made up of colonies of the bacilli; the bacilli are arranged more or less with their long axis corresponding with that of the colony itself, with a space between the individual bacilli. But the most characteristic appearance is that of the arrangement of the colonies-when examined by a low power, they are either in S shapes or in such curious curves as to recall the flourishes of fancy letter writing. In old growths these appearances are lost from the blending and massing of the colonies together.

Baumgarten1 proposed to inoculate, with antiseptic precautions, tubercle containing bacilli into the anterior chamber of the eye of a rabbit; after from six to eight days the affected part of this anterior chamber is to be inoculated into a second rabbit. By a repetition of this process several times, an absolutely pure cultivation free from all admixture of foreign germs can be obtained.

Nocard and Roux 2 recommend the addition of 6 to 8 per cent. of glycerin to blood serum or agar-agar as very suitable for the growth of the tubercle bacillus. Tubercle bacilli are also said to grow well in broth containing equal parts of glycerin and peptone.

Hueppe3 gives a process by means of which the tubercle bacilli may be cultivated in blood serum, and isolated by the method of plate cultivation. Fluid blood serum, either sterilised or collected germ free, is warmed to 37° C. in the ordinary way, and then equal parts of agar-agar solution is added (2 per cent. agar broth with 5 to 10 per cent. grape sugar), the whole is mixed by shaking, poured on to a plate, and incubated.

Pawlowsky has succeeded in cultivating the tubercle bacillus on potatoes. Koch had declared that the bacillus only developed on animal substances and had failed to raise it on potatoes.

1 Centrl. f. d. med. Wissen, 1884.

2 Annales de l'Institut Pasteur, 1887.

3 Central. f. Bak. u. Parasit. Bd. I., No. 20.

4 Annales de l'Institut Pasteur, No. 6, 1888; and Public Health, vol. i.

(347) The Universal Presence of the Bacilli in True Tubercle.

Baumgarten,1 almost contemporaneously with Koch, succeeded by treating sections of tubercle with very dilute soda solution or potash, in demonstrating bacilli. The identity of these with Koch's bacilli was at a later date established. Baumgarten drew the conclusion from his researches that bovine tuberculosis, human tuberculosis, phthisis, and scrofula belonged to a single species of disease.

Weichelsbaum (Archiv f. exper. Pathol. Bd. XVII.) also tested the views of Koch as to the presence of the tubercle bacilli in human tubercle and as to their pure cultivation, as well as the opposite views of Spina; he obtained the same results as Koch. At the same time he recognised the difference between the small nodules excited by indifferent bodies and those caused by infection from tuberculous products or pure cultivations.

Koch pursued his researches with such ardour and so thoroughly that there has been little left for others to discover save in matters of detail. He found the bacilli most numerous in miliary tubercle; in cheesy bronchitis and cheesy pneumonia; they were extraordinarily numerous in the contents of cavities, shreds from which were almost wholly composed of them. He also found them several times in scrofulous glands, in the fungus granulations of joints; he also recognised them in bovine tuberculosis as well as in the spontaneous tubercle of pigs, fowls, monkeys, rabbits, and guinea-pigs; they were likewise constant in a number of cases in the inoculated tubercle of rabbits, guinea-pigs, and cats. He also found the bacillus in lupus and was able to cultivate it from thence artificially. The constant presence of the tubercle bacilli in tuberculous organs having been ascertained, he turned his attention to their culture and to the production of tuberculosis through the inoculation of the cultures. This requirement was also fully attained; out of these products new cultures were made which had the same action on animals. Since the tubercle bacillus only grows between 30° and 40°, Koch declared it a true parasite which obtained entrance into the animal organism mostly through breathed air adhering to particles of dust. In phthisical sputa

1 Central. f. d. Med. Wissenschaft, No. 15, 1882. Deutsche Med. Wochenschrift, No. 22, 1882.

Koch found great numbers of tubercle bacilli, and since, after several weeks' drying, the sputa still retained its infectious character, it was the most common source of the infection, but the flesh and milk of tuberculous animals also played a part.

(348) Experimental and Clinical Proofs of the Contagious Nature of Tuberculosis.

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A number of physicians have collected evidence from their clinical experience to prove the contagiousness of tuberculosis, e.g., Meyerhoff, T. Demuth,2 Faisan,3 Lindmann (tubercular infection from the operation of circumcision), Herterich, Dehove, Ogston,7 Alison, Potain, L. Langer,1o Krasker,11 Bonyer, 12 Webb,18 Martin,14 Ganett,15 Wahl,16 Leser,17 Schmidt 18 (tuberculosis infection from a kiss), and others. To these also belong cases of the so-called infectious tuberculosis of men, in Finger's19 comprehensive description of lupus and tuberculosis.

De Lamalleree 20 cites a case in which a person became infected through eating a half-cooked fowl which had itself become tuberculous through consuming with its food phthisical sputum.

Among pathologists, Koch's doctrine found more ready acceptance, most of them repeated his experiments either in single points or generally, and were convinced of their accuracy. Many of these researches do not appear in literature because, being simply confirmatory of Koch's results, their communication was considered unnecessary. Of the published works confirming Koch's results the following may be mentioned :

Watson Cheyne,21 who had worked partly under Koch's instruc

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11 Centralblatt f. Chirurgie. 1885, No. 47.

12 L'Union méd. 1885, No. 71.

13 Philadelphia Med. and Surgical Reporter. 1885.

14 Revue d'Hygiène. Bd. VIII. 15 Boston Med. and Surgical Journal. 1886.

16 Archiv. f. klin. Chirurg. Bd. XXXIV.

17 Fortschritte der Medicin. 1887, No. 16.

18 Ein Fall v. localer Impftuberculose. Dissert. Leipzig, 1887.

19 Central. f. Bakteriologie u. Parasiten.

Bd. II., Nos. 13 and 14.

20 Gazette méd de Paris. 1886, No. 32.

21 Practitioner, 1883.

tuberculosis by rubbing in cultivations of the tubercle bacillus into cutaneous wounds. Cases of true cutaneous infection have been recorded in the human subject, for instance, Lesser1 relates the case of a washerwoman who frequently washed the linen of her husband, who died of a tubercular affection of the lungs as proved by post-mortem examination. The woman presented herself at the same hospital in which her husband had died with a small tumour the size of a cherry growing on the wrist, this was extirpated and found to contain tubercle bacilli. Eight days after the operation the patient showed herself with a perionychia tuberculosa of the terminal phalanx of the left ring-finger. The skin appeared at different places as if it were worm-eaten and undermined by cheesy masses. After removal there was good recovery, but some slight rales could be detected at the apex of the right lung.

A similar case is described by Steinthal (Deutsch. med. Wochen. No. 10, 1888), and also one is described by Merklen (Gaz. hebdom. de Med. et Chir. 1885, 27). In the latter case a woman, 26 yearr of age, had nursed her phthisical husband for six months. She used to wash his linen and clean the spittoon. Two months after his death there formed on the back of her second finger a tubercular nodule. This, in four weeks, affected the lymphatics of the arm, and an abscess formed in which tubercular bacilli were discovered. The apices of the lungs also became affected. M. B. Schmidt (Arbeiten aus der Chirurg. Poliklinik, Leip. 1888) relates the case of a woman aged 44, who nursed her husband dying of phthisis. Before his death he bit her, as she was about to kiss him, on the upper lip. On the bitten part a tuberculous swelling developed. She also had, on the ulnar side of the little finger and the wrist, three characteristic tuberculous nodules in which, after excision, were found giant cells and tubercle bacilli. There are also cases in which medical men seem to have been infected in making post-mortem examinations of tuberculous subjects.

The tuberculous nodules which are sometimes to be met with in the face, more especially of children, are considered by Lesser as the seat of tubercle inoculation. He relates two cases. The first was a child three years of age which was brought to him with a red livid tubercle of a doughy consistence, situated on the point of

155.

1 Deutsche med. Wochenschrift. No. 29, July 19, 1888; Public Health, vol. i.

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