The pathological effects of dead tubercle bacilli / by Stewart Stockman.

Date:
[1891?]
Catalogue details

Licence: Public Domain Mark

Credit: The pathological effects of dead tubercle bacilli / by Stewart Stockman. Source: Wellcome Collection.

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

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    Ill* .. ,i«h'm;,< Vl n'n:( ,s or heap '* n HKlU'l.i: haui.u. hi WilUll KvUtiliiivgti.1 i,t tnl». In I' I'l'lovo. Ko ''l an uhtuu'im ' Tviii> ium.ic mulovtnko '»vh> luiolllt prodmi „ , \\ In i' llVJlVl.'d fUVlH'UtmiOOHMh i.I.-.i • 11-1' >MV' I >'M'i imentovlinovi' fully oniiulnoti- ,1.1 lal'I'U-. In Uwn >xpoi'tmoht m they muni dond I,, man I’WlUnvs on ulyivvtno, si»\iii\ mul broth .**•» thou oxpovimotils l hoy u ,-,l haoilli that, hud boon i\*ni lb oil' avihiblo piwdinn.., but they found that tbo wi'iv the *“me bothov tboy need hnollli from u«uv ov :»h>I whether theao bail boon washed two from iboiv ' imnUiols or not. Tboy oonohiiloil Unit. tbo loaiona ed wove due to some siibstanoo baoto ovio-proto Hoti d ion o( tliomiowbosin the tissues, or oxlrtuitod in ; omo otboi wav Tboy inolino mow to tbo tovmov view. ti> miboutanoous biooulation tboy pi'otluml an nhseoss in iiv»o tu., io weeks. Tiibovvto baoilh utmiuililo by tbo oivlmavv methods were Couiul m tbo pus. by intviiporitonoul ami plourat moonlation with a milky emulsion of baoilli tboy jnwiluoovl nOublos of various si/.os on tbo serous moiniuanoa. tbo,,- wow made up of a oontval emimy-looking part sur- 'u!'.v' l'>, ‘Unvns tissue. Tbo oontval part eonsistod of epi- thelioid eells mul giant eells. Tubovolo baoilli wow abundant in tbo oontval part; well-marked oasoation was not found. tntvav onous inooulations wow mado into tbo auviouiav vi'ins of rabbits. Tbo animals wow killed and examined at intervals of fwm ono to sixty days. A tow diod after tbo tbird wool;. In animals killed aftor ono day tbo baoilli wow found in tbo hums, livov, and spleen most abundantly in tbo Urst-montionod organ. Tbo older tbo tubowlo tbo towor soomod tobotbobaoitti. After live days wbito nodules wow found in tbo lung, somo being mievo- soopio, otliovsquito visible totbooyo. They wove present upto tbo sixtieth day, tbo longest poriodof observation. Theirstvue- tmv consisted of epithelioid colls, giant colls, and leucocytes, baoilli wow found between the oolls and inside giant cells. Y.utor the nodule was denser and made up of epithelioid, cells and loose connective tissue. Aftor three weeks microscopic nodules, apparently having their origin inside the capillaries, were found in the liver. After live or six weeks visible nodules were found in the latter organ. Prudden and llodenpvl conclude that the nodules originate in a prolifera- tion of the vascular endothelium under the stimulus of dead and disintegrating tubercle bacilli. They say that “the dead bacilli seem to act as foreign bodies simply, curiously stimulating, it is true, but only foreign bodies after all. I think too much is made hero of the foreign body question. Every foreign body does not produce, this tissue reaction, although the power to do so may not belong exclu- sively to the tubercle bacillus. The action of the dead tubercle bacillus is in large part, at least, special to it, and it is the foreign body of this order that we are most likely to meet with in the tissues. At the conclusion of their paper these authors oiler some suggestions as to the influence of the products of the living germ on the degenerative changes in a true tubercle. They suggest, too, the possibility of the more fibrous tubercles being due to dead bacilli. Curiously enough it was tliatrlast idea and a wish to further test an opinion which I had formed as to the origin of tuber- culous giant cells, that led me to undertake some experiments with dead baciili. I had conceived the idea and started ex- perimenting with dead bacilli before I knew of their paper. x have since read it very carefully, and wish here to acknow- ledge my indebtedness to the authors. I have performed most of my experiments on different animals, but many of the results confirm those of Prudden and Hodenpyl. I must also mention that Straus and Gamaleia3 have to some extent confirmed the results of the American authors by experimenting on guinea-pigs, rabbits, and dogs. They say little about lesions in the liver. They did not find giant cells in the nodules. That may he because in their experiments loo few bacilli were- ajrested in one part, or because the centres of the nodules were not examined. Many of their animals wasted and died. When the clumps of bacilli were broken up and well distributed in the fluid the animals wasted and died all the same, but no lesions were found. Evidently several dead bacilli are necessary in one part to produce a lesion. If the number of bacilli was very small the animals wasted, then recovered, and appeared quite healthy, but if a second small dose were administered they wasted and died. Bv using very small and ever-increasing doses of the dead bacillus they immunised the animal against it. With the products of the bacillus in artificial culture they could produce no lesion. Tuberculosis of the Udder. If one examines a number of tuberculous udders from the cow, one generally finds distinct caseous nodules, hut that is not the only form that the tuberculous lesion may assume. At the Edinburgh abattoir during the last five years I have found a considerable number of very cirrhotic udders without any appearance of a caseous nodule in their substance. On ex- amining these microscopically I have found tubercle bacilli and tuberculous giant cells, although the former were .net veiw numerous. For that reason I think that the percentage of Uibereulous udders has been slightly underestimated. These udders, however, will not very much increase the amount of tubercle-infected milk, because the affected quarters give little or no milk, and the cow is soon to be sent the abattoir. The bacilli enter the udder by way of the blood vessels, and it is highly probable that at an earlier date there were dis- tinct caseous tubercles in these udders now cirrhotic. Two possible explanations of the difference in these two lesions suggest themselves: . , 1. The bacilli might have been overcome by the tissues to such an extent that they could no longer produce distinct caseation, but were still able t© excite a proliferation of the tissues and cause the formation of giant cells. 2. The bacilli might have arrived in the gland in an attenu- ated condition, and were thus no longer able to produce the distinct caseous lesion. - . Tliere is nothing wildly imaginative in these suggestions if we think on what we know of the tubercle bacillus. It is well known that the bacillus first acts by exciting a proliferation of the tissues. The new eells, instead of completing then- development, however, tend to become caseous. Still, we know that the cells do sometimes complete their development and form fibrous tissue. This is especially the case in the old tubercles found in the ox and pig. They are often surrounded by a rim of fibrous tissue, which is invading the caseous centre. Moreover, the tuberculous lesions of the muscles— muscle is considered a bad medium for the growth of the tubercle bacillus—which I have described in the pig were distinctly fibrous.1 . I may say, too, that I have once found tubercle bacilli m fibrous nodules under the mucous membrane of the fourth stomach of the ox, and have several times found them in fibrous thickenings on the subcarpal regions of the ox. These are mainly the observations which have led me to undertake these experiments. , ^, Kxitcnmcnl I. -Irish terrier bitch. I began to experiment on this animal lor tbo purpose of trying to render her immune against tuberculosis by using the toxin and dead bacilli. I first injected her with tubereium in doses varying from io c.em. to 30 c.cm. There was no temperature reaction, rthon continued with injections of the products of tho^tubcrclc bacillus m glycerine broth, from which the microbes had been separated by filtration through porcelain without previous heating. Tlio cultures were aUbivdd to go for from 2 to 2J mouths and longer. Beginning with 6 c.cm., 1 went to 10, 20, 40, 50, 95 c.cm. without disturbing the animal at all. With 95 c.cm. the temperature rose o.S° F., but was not abb ye the physiological limits (102.6). I next gave her 190 c.cm. into the vessels and under the skin. This toxin came from a 2} months’ culture. It pro- duced a rise in temperature of i° F. in 6j hours. This shows the fcpblo svstemic cll'cct of the tubercle toxin. Thinking tliat'.tlic tosn prepared iii the ordinary wav was too weak to produce much effect, for there followed no local lesion whatever—it thus differs from the powerful diph- theria toxin-1 thoutrht of trying the effects of dead bacilli. Under the skin oi the chest region I injected a thick emulsion of tubercle baCiU* killed bv three hours’ steaming. The bacilli came from a glycerine broth culture that had bccu kept for for five months. An abscess lormecl and burst throe days afterwards. A month later a second injection ot bacilli in thick emulsion was given under the skin. The latter came from a glycerine broth culture that had been in the incubator tor lour months, and afterwards killed by three hours’ steaming. On the third day a swelling about the size of a hen's egg formed at the seat of inocula- tion The skin over this abscess was ascpticiscd, and somo pus was a-spiirated into a sterilised syri 11 go by passing its needle into the cavity. Coyer-glass preparations made'with the pus simply swarmed with tubercle bacilli; no other microbes were present. Glycerine agar tubes sown with the pus remained storilc. The abscess then was caused by the tubercle bacilli, which wore beyond doubt dead. The abscess burst 011 the filth day, and the wounds took a considerable time to heal up. The tempera- ture rose to 105° F. on the morning after the second injection. It loll to 101.S0 on the sixth day. On the afternoon oi the sixth day 30 c cm. of a ftltored tubercle culture were injected. The temperature next morning had risen to 104.5°, and had fallen to 102° the day alter. Three weeks alter the second injection of bacilli I injected subcutaneously about 4 c.cm. of the drogs left in the preparation of tuberculin. This material was very rich in bacilli, which had been killed at about 110° C. Five days after- wards there was slight swelling and tenderness, hut 110 distinct abscess lormed. The temperature rose 1° on the day alter, and fell to the normal on the fourth day. , . ... One might draw the following conclusions from this experi- ment: (1) That the soluble products of the tubercle bacillus produce-little effect on the healthy organism, although they have a very decided action on animals whose bodies contain the tubercle bacillus, living or dead. (2) That the dead bacilli are far more active than the soluble products, although this may be on account of their retaining a strong toxin in thoir bodies. This bitch van about and enjoyed perfect health for ten months afterwards. I was anxious to see if she would still