Изображения страниц
PDF
EPUB

to do so in a wagon, or with an ox-team, the degree of improvement was greater among the consumptive invalids than it is at the present time, because then all phthisical patients, even though they left home upon a mattress, must live in the dry open air, sleep under the stars, and often do their own cooking.

"The charm of this unique country lies in its variety, its capability of developing new and interesting features, and the novel experiences it offers wherever one may turn. The mountains, with their beautiful parks and canons, are accessible from most of the first stopping points upon the railroad, by less than a day's ride.

Armed, equipped, and outfitted, a party may follow one of the creeks up a rugged canon, camping at nightfall upon the banks of the stream beneath the crags; finally they reach a park above, where they pitch their tent in a wooded vale near a tumbling mountain stream, or,

'By shallow rivers, to whose falls
Melodious birds sing madrigals,'

and spend weeks delightfully, sketching, botanising, geologising, fishing or hunting, but always and ever recuperating. As one has wisely said, 'No one need be afraid of the sunlight of Colorado. It has all the beneficial effects of sunlight in other countries, with none of its enervating effects common elsewhere. Bask in it, enjoy it all you can, for few have as yet fully appreciated the beneficial effect of the chemical action of sunlight on the blood.'

"As for the sunsets of Colorado, they are, as we have said, truly unsurpassed. No artist, without incurring the imputation of exaggeration, could do full justice to the vivid tints and gorgeous colours which bathe our western skies after the sun has sunk below the mountain horizon.

"To see one of these camping parties coming in from the mountains after 'roughing it' for a month or two, is sufficient to convince the most incredulous of the utility of the régime. They left the plains thin, languid, and pallid; they return bronzed and rugged, with elastic tread and full chests, gladly owning that to the experiences of camping out they owe a new lease of life. It is an opinion which I have previously expressed, that to the fact of sleeping upon the ground in the pure dry air, amid the balsamic exhalations of this primitive resting place, may be attributed much of the happy result of camping out. The system, roused by the tonic influences of earth and air, wakes into new life and vitality, and morbid feelings and conditions wear away."

"Quito, in Ecuador-on the line-with a population of 70,000, is about 9,000 feet above the level of the sea, and backed both east and west by mountains, the highest of which has an elevation of nearly 20,000 feet. It is thus well sheltered, and the atmosphere is both dry and warm, and equable. Dr. Domec, who spent about four years there recently, states "that in a large room, with the door and window open day and night, he found the temperature to oscillate all the year round between 57 and 65° Fahr. and that during four years he watched daily the thermometer, placed in a large drawingroom of the house in which he lived, without a fire, and open to every wind day and night. He never saw it, between 6 P.M. and 10 o'clock at night, above 63° or below 57° Fahr. Sometimes in the night, with the wind from the mountains, the thermometer was lower, but the falling of the temperature was always of short duration, and its fall never reduced that of the room below 57°. He only saw two or three cases of spontaneous phthisis among natives during that time, and in all cases of inherited phthisis from the seacoast that he met with, the progress of the disease soon appeared to be arrested."*

As regards the latter (sea voyages) it must be noted that a voyage has a very different effect from a residence on the coast, and sailors have frequently informed us that they always suffered from colds when on shore, which never disappeared till they were fairly out at sea again. One of the most suitable voyages, and from which most excellent results have often been observed, is round the Cape to Australia in a first class ocean steamer, the voyage being so timed that the patient leaving this country in October arrives in Australia about the close of the year. But a mistake which is very commonly made by patients who have recovered their health on the voyage out, is to disregard instructions, and, instead of returning after a short stay, to remain in Australia, and especially in towns such as Melbourne, where consumption is very rife, and where all the improvement they have experienced is apt soon to be lost, too often never to be regained. Much benefit is also frequently obtained from a trip to the Mediterranean during the winter and spring months.

We are well aware that many points in connection with the treatment of phthisis have not even been touched upon, and that others have been treated in a most cursory way, but all that we could attempt to do was to give a slight sketch of the Consumption as a Contagious Disease. By Daniel Henry Cullimore. London: Baillière, Tindall & Co.

[ocr errors]

views which our present experience has led us to adopt, and we shall consider that the time of the members of the Society has not been entirely misspent if we have succeeded at any point in interesting any of you with regard to a subject of the deepest importance, and in connection with which a wide divergence of opinion may reasonably be entertained.

KOCH'S RESEARCHES ON TUBERCULOSIS.

BY GEORGE A. HERON, M.D., London.

ON the 24th of March, 1882, in a paper read before the Physiological Society of Berlin, Dr. Robert Koch claimed to have established, by experiment and by observation, the existence of a micro-organism which is associated with tubercle, and not only associated with tubercle, but, according to Koch, the cause of all tubercle. This organism is a bacterium of the kind known as a bacillus, and it is, consequently, rod-shaped. In length it varies from about 300 to 12000 in., and its breadth is about th of its length. In looking at a specimen of these bacilli, it will be seen that certain of them contain spores, two to four, ranged along the length of the organism.

In attempting to give an outline of some of the points on which Koch lays especial emphasis in the lecture referred to above, it is obvious that attention must be given solely to what is there stated. Since that date no observations have been published tending to disprove Dr. Koch's work. On the other hand, the bacillus described by him has been found by several observers in the tissues and in the sputa of persons whose conditions of disease would have suggested to any clinician, of ordinary experience, the probability of the presence of tubercle in the patient. It must, then, be admitted, that we have now to deal with a new fact which characterises, by the presence of these organisms, certain cases of disease of well known type, about the exact clinical significance of which there is, even now, no inconsiderable difference of opinion. For those who find themselves justified in accepting Koch's results as true, all difficulties about the nature of these cases must cease, as soon as it is found that the patients concerned harbour in their tissues, or in their secretions or excretions, this bacillus of tubercle.

The bacillus is demonstrated in tissues by employing the process first described by Professor Ehrlich. Koch has adopted this process in preference to the one devised by himself, and with the aid of which he worked out all his early experiments. Ehrlich's process will be found fully described in the British Medical Journal of 14th October last, and Professor Vignal makes some useful remarks upon the process in the same Journal on 28th October. It is, for these reasons, unnecessary here to touch upon the method of investigation required for the detection of the bacillus. There is, however, one error in my remarks as they appear in the Journal of 14th October. I ought to have said, that the bacillus of leprosy gives precisely similar results with those shown by the bacillus of tubercle when these two organisms are submitted to the process of staining devised by Ehrlich. There are, however, some differences in form, as Dr. Koch points out, between the two bacilli. The bacillus of leprosy is "more slender and more pointed at the ends" than that of tubercle. They are also distinguished from one another by the colour test of Weigert, to which the bacilli of leprosy respond; those of tubercle, on the contrary, are unaffected by it.

Dr. Koch thus describes the appearance of the bacillus in tuberculous tissues:-"In all cases where the tuberculous process is in its early stage and progressing rapidly, the bacilli are to be seen in great numbers. They then lie thickly, and often in groups or small bundles inside the cells, and in some places give the same appearances as the bacilli of leprosy when they are found in cells. Near these (groups or bundles) are found numerous free bacilli. Especially on the borders of large cheesy deposits crowds of bacilli appear, which are not shut up in cells.'

"As soon as the highest point of the tubercle eruption is overstepped the bacilli become rarer, or are only to be found in little groups or singly at the edges of the tuberculous deposits, and lying near them are bacilli so faintly coloured as scarcely to be recognisable; these are presumably already dead or in the act of dying. Finally, they can quite disappear, although they are rarely altogether absent, and then only in such places as those in which the tuberculous process has come to a standstill."

In his lecture, Dr. Koch lays emphasis upon the connection which appears to exist between the presence of the bacillus and of the giant cell. "If," he says, "in the tuberculous texture giant cells appear, then the bacilli lie by preference in these structures. In cases of very slowly progressing tuber

culous processes, the inside of those giant cells is generally the only place where the bacilli are to be found."

Dr. Koch has a theory about the connection between the giant cell and the bacillus, and it is this:-"It is to be concluded from the size and position of the giant cells containing bacilli, that these cells are the youngest, while, on the other hand, those cells which are free from bacilli are the oldest, and it is to be assumed that these last originally contained bacilli, and that the organisms have either died or have gone over to that condition which will presently be described. From the observations of Weiss, Friedländer, and Laulamié, according to whom giant cells were formed around foreign bodies, such as vegetable fibres and the eggs of strongylus, we may be able by analogy to realise the relation of the giant cells to the bacilli. We may infer that here also the bacilli, as foreign bodies, are enclosed by the giant cells, and on this account, if the giant cells are found empty, all further relations of the tuberculous process go to shew that the presumption is correct, that the giant cells had formerly harboured one or more bacilli, the organisms having occasioned the origin of the cells." So much for the appearances described by Koch as illustrating the presence of the bacillus of tubercle in tissue, and its peculiarities there. It makes no difference whether the bacillus is seen in a human being or in a monkey, a guinea pig, a mouse, or a hen, the organism is always the same in every detail.

And now as to the facts upon which Koch, on 24th March last, founded his claim for the recognition of this organism as associated with tubercle. He found the bacillus present in the following cases:—

1st. In the human subject

11 cases of miliary tubercle.

12 cases of cheesy bronchitis and pneumonia. (In six of these cavities had formed.)

1 case of tumour of brain of the size of a hazel nut.

2 cases of freshly extirpated scrofulous glands.

2 cases of synovial degeneration of joints.
Twenty-eight cases in all.

2nd. Amongst the lower animals

10 cases of perlsucht of the ordinary type.
1 case of caseous cervical gland in a pig.
1 case of a hen which died of tubercle.
3 cases of spontaneous tubercle in apes.
9 cases of spontaneous tubercle in guinea pigs
7 cases of spontaneous tubercle in rabbits.
Thirty-one cases in all.

« ПредыдущаяПродолжить »