agents, but from repeated trials of its virtues, I can most heartily recommend it as a splendid remedy in catarrhs, not only of the uterus, but of mucous surfaces generally. After these stronger remedies have been used for a time, say until the catarrhal symptoms have been materially modified, their use should be discontinued and something of a more soothing nature substituted. And here again I must make favorable mention of an unofficinal drug, for in my hands nothing has given such complete satisfaction as Merrill's fluid hydrastis. This should be applied once or twice a week by means of the swab, and the erosions about the os uteri, which Dr. Similibus so innocently mistook for ulcers, will rapidly disappear if a small pledget of cotton be saturated with this remedy and left in contact with the raw surface over night.

(To be Continued.)

THE BACILLUS TUBERCULOSIS.

BY CHARLES DENISON, A. M., M.D.

It is not my intention, at this time, to write more than a short supplement to my report of last year on "The Infectiousness of Phthisis.' I intend now to give only a resume of the results achieved by a few of the faithful searchers after microcytes since our last meeting, so as to bring our knowledge of the bacillus tuberculosis from Koch's wonderful discovery up to the present period.

There has been a great deal of microscopic investigation of, and experimenting with, this bacillus since Dr. Robert Koch, in March, 1882, read his memorable essay before the Physiological Society of Berlin. These investigators have not all agreed to be sure, but the majority, and the most painstaking ones have, and that too, in a very uniform verdict in favor of the existence of the bacillus as a causative element in all true tubercular lesions. On the other hand there is no uniformity to the negative evidence, and it is more untrustworthy and less conclusive. The results are corroborative of the appearances as described by Koch himself. "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 smail bundles inside the cells, and in some places give the same appearances as the bacillus 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 laying near them are bacilli, so faintly

colored as scarcely to be recognizable; these are presumably already dead or 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 stand-still." We learn that Koch's later experiments have confirmed his previous statements, and from his researches and the labors of others, many interesting conclusions have been drawn as to the mode of spreading and the life history of these microcytes. While the methods are very taxing and intricate, and much remains to be found out, yet these facts are calculated to give confidence in the completeness of the clinical history of this bacillus as connected alone with the etiology of so called tubercle.

Let us consider some of them:

1. It makes no difference whether in man, animals, or birds, the bacillus tuberculosis is found, it is always the same in every essential detail. The experiments have been made upon, and tubercular forms of disease have been examined from dogs, cats, rabbits, apes, guinnea pigs, bats, hares, etc., and the bacillus has been seen to be identical with the tubercular germ as found in the human subject.

2. The confounding of the bacillus of tubercle with any other microcyte has been made nearly impossible by close study of the habits and conditions of growth of this germ, according to Koch's "cultivation experiments," which, by some have been carried on for a long time and through many series or crops of bacilli, with a constant change of the cultivating soil, so that all foreign influence or admixture might be excluded. It might be mentioned here that it is claimed by some that these later cultivations, when used in inoculation, are not as seriously and actively infective as the original virus. Much might depend upon the susceptibility of the tissue inoculated. However should the claim mentioned be still further verified, who can tell but it might furnish the key to the arrest or prevention of tuberculosis, through a form of inoculation?

Anyway these cultivation experiments are a sufficient answer to the objection of Dr. H. D. Schmidt, of New Orleans, who has been extensively quoted as showing (Chicago Medical Journal and Examiner, Dec. 1883,) that Koch's bacilli are nothing more than crystals of margaric acid, for how could they be fat crystals if they were cultivated, as has been done, in a soil devoid of fat.

Dr. Councilman, pathologist on the staff of the Maryland Medical Journal, is rather caustic in his criticism of Schmidt's essay. He claims. that there is as much difference between margaric acid crystals and the bacilli as there is "between a tree and an iron lamp post, "' and closes his attack with these words: "We would earnestly recommend the author of this valuable contribution to medical science to read a few of

the articles in bacteria literature that have lately appeared; that of Koch in the Miltheilungen or some of Weigert's articles in Virchows' Archieves, then to commence his studies with the micrococci and other simple forms, studying the characteristics of each as he goes along, then to try and get some of the tissue from authrax and study the bacilli there, and gradually approach the higher and more difficult field of microscopic art. If he will do this, we feel quite sure that in a short time he will gladly retire from circulation such copies of the December number of the Chicago Medical Fournal as he can get his hands on."

3. According to Dr. Samuel West, in the London Lancet, and his extended examinations very generally confirm the results of others or the investigations of others, the bacilli are found in largest numbers and grouped in considerable masses, not so much in lung tissue as in the caseous material surrounding or lining the walls of cavities. On the other hand it is generally conceded that it may be impossible to find the bacilli in sputum when the physical and other signs may indicate the first stage of tubercular disease. This is forcibly illustrated by a case cited by Dr. Prudden in the Medical Record of April 14th. It was one of the exceptions where bacilli could not be detected by careful examination of the sputum of a phthisical patient. When the patient died both lungs were found to be "extensively involved, and large numbers of bacilli were found imbedded in cheesy nodules; but there was little breaking down of tubercle and no cavities." As a means then, of early diagnosis, which is what would be especially desirable, the fact of Koch's discovery has not yet shown itself of much use.

4. Again it is found that in prolonged third stage cases, it is often impossible to find bacilli in the sputum, or being found they are more apt to be separated, not in masses and fewer in number. Of course the inference is clearly justified by such clinical facts, that this bacillus is very closely connected with the progress of phthisis, since if we go where they are, they are abundant according to the activity of the destructive agencies. The microscopic examination of the sputum may then be a valuable means of knowledge in making up an opinion as to a given case, since a uniform abundance of the bacilli would be proof, presumptive, at least, of rapidly breaking down lung tissue.

*NOTE-Dr. Prudden in an article "On the occurrence of tubercles in which the bacillus tuberculosis is not demonstratable by the ordinary method of staining." in the New York Medical Record of June 16th, concludes as follows: "The more extended researches of the past year have shown that the examination of sputum is of much more practical importance than the original announcement gave reason to expect; that the techinque of sputum examination for the bacillus tuberculosis must become a part of the professional furnishing of every expert diagnostician, whether the bacilli stand in a causative relation to tuberculosis or not, and that to be reliable, considerable skill and much patience must be exercised; that the color test must be subjected to some limitations not anticipated in the original announcement, because some other bacilli and many other objects are found to present the coloration originally supposed to belong to the tubercle bacilli alone; and finally that the decoloration by nitric acid in Ehrlich's method of staining may result in the complete removal of color from some of the structures which it is desired to demonstrate, unless the greatest care be exercised and possibly even then, since the conditions which modify their power of resisting the action of the acid are not yet definitely known."

5. The fact of failures to find bacilli in exceptional cases, presumably tuberculous, should be noted as showing that much has yet to be learned about the life and various manifestations of this germ. Koch notes some difference in the bacilli as they disappear from recognition, both as to shape and the facility with which they take the coloring fluid. Whether the best staining method has yet been devised, or that there are conditions in tissue which prevent proper staining of the bacilli, or that there is something like duality in the tubercular virus, has yet to be determined, in view of such failures as that of Dr. Prudden's to detect bacilli in one out of nine cases of miliary tuberculosis examined. Neither in the kidney, liver, spleen, pia mater, or lungs of this case was the bacillus found, while in all others the bacilli were found in varying proportions. In no case were they not found in the lungs when present in other portions of the body.

6. W. Watson Cheyne, M. B., F.R.C.S., has lately made a very interesting report to the association for the advancement of medicine by research on the relation of micro-organism to tuberculosis. He has gone over many of the experiments and investigation of Dr. Koch, Prof. Toussaint, of Toulouse, and Dr. Scheiller, of Berlin, by visiting each gentleman's laboratory and personally studying their methods and re-examining specimens from animals which had been variously inoculated with bacilli artificially cultivated.

Prof. Toussaint has done considerable in the way of cultivation of bacilli. He starts with the tuberculous material from cows, (perlsucht) to infect animals with which he experiments. He has made about fifty culivations from tuberculous animals and always found the same micro-organisms. From his results it is concluded that the cultivations take two or three months to produce tuberculosis by inoculation, as long or longer than tuberculosis material. "He has caused tuberculosis in animals by injection of the saliva, urine and blood of tuberculous animals.

Dr. Schuller of Berlin thought the bacilli of tuberculosis were transmitted by the micrococci described by him. His cultivations did not so uniformly produce tuberculosis as the others, and when successful did not kill as rapidly as tuberculous material.

7. According to Dr. Cheyne's description of the tubercle bacilli, they vary in length, the longest being about one-seven thousanth of an inch, and their width is about one-fifth or one sixth of their length. They are more or lest rounded at the ends and when highly magnified they generally present a beaded appearance, clear spots being seen between the stained parts, and the rods outside the clear spots being stained. The number of beads in a single rod varies from four to eight. These rods are usually straight, sometimes curved, and in tissues are found lying in

pairs stuck together at their ends, or more often singly; sometimes they are found in dense masses, and sometimes considerably scattered, two or three now and then lying across each other. In cultivations they are as a rule shorter and stuck together in masses.

8. Dr. Koch has lately been cultivating the bacilli on blood-serum, and Dr. Cheyne says "These have been carefully examined microscopically, and nothing but tubercle bacilli have been found ; no other microorganisms.

The inoculations with this cultivated material was very uniformly successful in producing, in animals experimented on, tuberculous disease. On the other hand Dr. Cheyne carried out Prof. Tousaint's experiments, trying to induce tuberculosis by inoculation of non-tuberculous material and uniformly obtained negative results. He concludes that “the certainty of the production of tuberculosis by inoculation of tuberculous material, and the rapidity of its occurrence are in direct ratio to the number of bacilli present in the original material.”

9. It has been thought that because the vessels in the center of tubercle had been obliterated that it was non-vascular tissue. Dr. Cheyne thinks there never were any vessels in the center, but as bacilli are found in these centers, chiefly in the giant cells, he believes these cells have grown rapidly because of the presence of the bacilli in them and that these giant cells are simply epithelioid cells, perhaps produced as Lanlaine had demonstrated to him from the endothelium of blood-vessels, but growing more rapidly because of the presence of the bacilli. If the process should be slow and the accumulation of these epithelioid cells are not very great, the granulation tissue surrounding them may become organized into fibrous tissue more or less perfect. In this connection Koch has pointed out that in many cases, where there is only fibrous tissue and giant cells, it is only in the cells that one finds the bacilli. It is from such proofs as these that Dr. Cheyne concludes that the epithelioid cells are to be taken as the typical histological element of tubercle because they are always found in tubercle, unless early caseation has destroyed them, and the bacilli are always found in them in the first instance. His definition of tubercle then would be: "A nodule composed of a central mass consisting in the main of epithelioid cells, or in its place a cheesy mass, surrounded by more or less inflammatory tissue, with or without the presence of giant cells, the main diagnostic mark being the presence of the tubercle bacillus."

There are many other papers, or results of investigation into this bacillus question, which, did time permit, it would be interesting to refer to; but I prefer to close this resume, since it must be imperfect, with the above conclusive reference to Dr. Cheyne's valuable contribution to