Cholera : inquiry by Doctors Klein and Gibbes and Transactions of a committee convened by the Secretary of State for India in Council.

  • Heneage Gibbes
Date:
1885
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Licence: Public Domain Mark

Credit: Cholera : inquiry by Doctors Klein and Gibbes and Transactions of a committee convened by the Secretary of State for India in Council. 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.

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    hours ancl a half ; she was taken ill at 10 a.m. on 19th November, and she was dead at 7.30 p.m. the same day. Post mortem was made an hour later. Body was extremely well nourished, the whole of the small intestine was slightly injected and filled with clear watery fluid, in Avhicli Avere suspended a large number of the typical mucus flakes. In those of the lower part of the ileum on microscopic examination were found Arery large numbers of exceedingly minute commabacilli, smaller than the typical ones of other cases, but there were present also many commabacilli, somewhat larger and of the size of the typical ones, and further a great many comma- bacilli conspicuous by their thickness and length, as much as six times as big as the first variety ; there were present in large and small masses everywhere the small straight bacilli; finally, there were numerous micrococci in chains and dumb-bells, and thick straight bacilli singly and in chains. In fact, the mucus flakes seemed to be one mass of bacteria. Sections through the hardened mucous membrane shoAved that the epithelium of the surface vvas gone as a whole, but noAvhere in the tissue (including the Peyer’s glands) could there be detected a trace of comma- bacilli. If what Koch describes on page 6 of his pamphlet,—viz., the presence of large numbers of commabacilli between the epithelium of the Lieberkiihn’s follicles and the membrana propria, and extending into the cavity of the follicles, and into the surrounding lymphatic tissue of a Peyer’s gland,—Avere atypical representation of what is the case in an acute and typical case of cholera, then we might reasonably expect to occur again in typical cases. But this is absolutely not the case. Our prepara- tions were made after the same method as Koch’s, they were well prepared and well stained, and if commabacilli had been present we should not have failed to bring them out, for in preparations of some cases other micro-organisms, such as micrococcus, bacillus subtilis present on the surface and in the superficial epithelium layer, are brought out very conspicuously. In tAvo cases only were there present in sections through the Peyer’s glands near the ileo-coecal valve commabacilli in some places around Lieberkiihn’s crypts, and also scattered here and there amongst the superficial parts of the lymph follicles. But besides the commabacilli, and in great majority, Avere straight bacilli, which with the commabacilli could be traced from the broken surface into the depth of the mucosa. As one of these is a good case in Avliich commabacilli Avere found in the mucosa, but with a majority of straight bacilli; Ave will give for better estimation the history of this case. The patient, get. 30, Avas attacked Avith vomiting and purging at 4.30 p.m. on the 6tli October, he was admitted into the J. J. Hospital, Bombay, at 7.30 p.m. on 7th October. When admitted he was deeply collapsed, pulse imperceptible, features sunken, extremities cold, no urine. He died at 6 a.m. on 8th October. Post mortem at 8.30 a.m. The patient Avas evidently moribund from 7.30 p.m. of 7th October till 6 a.m. of 8th October, i.e., for nearly 12 hours ; in addition to this the post mortem was made two hours and a half after death; the tem- perature of the air Avas above 75 F. No wonder that under all these circumstances the tissue of the bowels should have become invaded by micro-organisms. In another case of acute typical cholera, where the post mortem had been made 14 minutes after death, but where the patient had been moribund from 9 a.m. till 3 p.m., sections through the hardened Peyer’s glands and mucosa of the ileum showed the epithelium of the surface as well as that lining Lieberkiihn’s follicles bodily loosened and raised from the mucosa, but fixed in position during hardening. While there was total absence of commabacilli here or anywhere else in the mucous membrane and lymph follicles, there were nevertheless in some places on the surface minute groups of putrefactive bacillus subtilis, and from here they entered into the spaces resulting from the de- tachment of the epithelium of the Lieberkiihn’s follicles from the membrana propria. And even capillary blood ATessels of the lymph follicles near the denuded surface, were found crowded with putrefactive bacilli and micrococci. In a third typical case, death after 10 hours, post mortem after half an hour, there were present numbers of straight putrefactive bacilli in the tissue of the villi and around the bottom of the Lieberkiihn’s follicles, but only here and there could a commabacillus be found close to the epithelium of the surface. The preparation then, described by Koch on page 6 and figured on page 7 of his paper, is an exceptional one, and is not typical of cholera. As many typical cases as were examined by us, as often did we miss such a condition. It follows from this that the statement of Koch that in acute cases the mucous membrane of the ileum contains so great a number of commabacilli as to represent almost a pure cultivation of commabacilli is in direct opposition to the facts observed. And if this statement of Koch is not in conformity with the facts, his inference, that the large number of these commabacilli produce a large quantity of the chemical
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