Diseases of the liver, gall-bladder and bile-ducts.

  • Humphry Rolleston
Date:
1905
Catalogue details

Licence: In copyright

Credit: Diseases of the liver, gall-bladder and bile-ducts. 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.

    26/852 (page 6)
    have been obtained by Pratt and Fulton,* and by Pakes and Bryant ;t while from a case of infective endocarditis GwynJ repeatedly isolated the micro-organism from the blood during hfe. The micro-organism may be present and yet not give rise to any formation of gas; this was shown in the cases recorded by Gwyn and by Pratt and Fulton. Though this infection may occur in the body during life, there is no evidence that it ever produces gas until death has occurred. The micro-organism may give rise to necrosis of the cells of the liver and to purulent inflammation, as was shown in Pratt's and Fulton's case of cholangitis with multiple abscesses in the hver. The Bacillus aerogenes capsulatus is anaerobic, and must be distin- guished from the bacillus of malignant oedema. It stains with Gram's method. It is very frequently present in the aUmentary canal, and has been found to be widely distributed in nature. Besides the Bacillus aerogenes capsulatus, other gas-producing bac- teria must be taken into account; thus, the colon bacillus (Kanthack, Pakes and Bryant) and other members of the aerogenes group, such as the Bacillus mucosus capsulatus (W. T. Howard, Jr.§), have been described as giving rise to gaseous cysts. Welch, however, is rather sceptical about their claim to be regarded in this light. The liver is the organ most frequently affected. In 23 cases tabulated by Pakes and Bryant, this organ was affected in 15. Etiology.—As the formation of gaseous cysts is a death agony or postmortem phenomenon, the Bacillus aerogenes capsulatus is often found in association with other micro-organisms. Other micro-organisms probably favour the development of the Bacillus aerogenes capsulatus by diminishing the bactericidal power of the blood, and also by reducing the resistance of parts of the hver. My friend, Dr. J. H. Drj^sdale, has communicated to me his unpublished results, which show that hot weather is a factor in the production of foaming liver, but that this con- dition may occur in the absence of any of the ordinary signs of decom- position. It is found much more frequently when there has been recent loss of blood, which seems to favour the entrance of the micro-organisms into the blood or their development in it. Ulceration and injmy of the intestines also favour the entrance of the micro-organisms, which are commonly present in the alimentary canal, into the tissues of the body. Incubation of livers, taken at random from the postmortem room, did not give rise to the formation of gaseous cysts, but incubation of livers from cases of htemorrhage gave positive results showing that the micro- organisms had got into the organs. It is generally recognized that the infection of the liver may take place either by the blood-stream or by the bile-ducts. Infection most commonly arrives by the portal vein, and is due to some lesion, such as ulceration, in the intestinal tract. The inlet of infection may be in * Pratt and Fulton: Boston Med. and Surgical Journ., June 7, 1900, p. 599. t Pakes and Bryant: Guy's Hosp. Reports, vol. liv. t Gwyn: Bull. Johns Hopkins Hosp., 1899, vol. x, p. 134. § W. T. Howard, Jr.: Journ. of Experiment Med., Oct. 25, 1900, p. 139.