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
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.
17/58 page 15
![tubes ; in the capillaries of the Malpighian tufts there is sometimes haemorrhage, always albuminous transudation into the cavity of the capsules of the Malpighian corpuscle. In the liver opac swelling of the liver cells and deposit of pigment in them. In some of the lymph spaces granular matter may be met with taking the dye, and on superficial examination may be mistaken for organisms, but their irregular shape and unequal sizes prove them to be different. The mucous, and particularly the sub-mucous, tissue of the intestine contain as a rule vast numbers of plasma ceils, marked very conspicuously by their granules being stained conspicuously by the aniline dye, and generally of a different tint from the other tissues ; thus, in specimens stained with methyl blue and Spiller’s purple, the o-ranules in the plasma cells are stained pink; in specimens stained with gentian violet they are deep blue. The same plasma corpuscles occur also in small numbers in the connective tissue of the kidney, particularly in that part forming the transition of the cortex into the medulla. In the small intestine, besides the total loosening and detachment of the epithelium of the surface and of the Lieberkiihn crypts, there is always enormous congestion of the blood vessels, and in some villi stasis.] In a memorandum on the “ Comma-shaped Bacillus,” alleged to be the cause of cholera, Dr. T. R. Lewis, Assistant Professor of Pathology, Army Medical School at Netley, states that he examined sections of the small intestine of patients dead of cholera, in which no commabacilli were present, and that also in the cholera evacuations the commabacilli are sometimes extremely rare. From this he concludes Koch’s statements as to the importance of the commabacilli entirely upset. Dr. T. R. Lewis had not at that time before him Dr. Koch’s detailed account, and for this reason his negative observation proves nothing against the theory of the commabacilli. As has been quoted on a former page, Koch distinctly states that while comma- bacilli are present in varying numbers in the evacuation of cholera patients, they can be found always in very great numbers in the mucous flakes of the lower part of the ileum, and that in acute typical cases of cholera the part of the mucosa of the ileum surrounding the lymph follicles is characteristically and generally infiltrated with them, so much so that the mucosa appears like a pure cultivation of comma- bacilli, and that the further away from this part of the ileum the less numerous they are to be met with. Now, large portions of the ileum can under this statement be examined without finding any commabacilli, or only a few of them ; and, nevertheless, the mucous membrane of the lower part of the ileum might be full of them. Besides, as Koch states, only typical acute cases show the uncontammated appearances. Such being the case, it is clear that Dr. T. R. Lewis’s negative observation proves not much against Koch’s theory, for Dr. Lewis does not state to have examined the lower part of the ileum in acute typical cases. He might have examined hundreds of sections of the upper part of the ileum or of the whole jejunum, without finding any commabacilli. It happens that Koch is wrong with the lower part of the ileum (as has been minutely described on a former page), but that Koch’s view might be right has not been disproved by those observations of Dr. T. R. Lewis. It is different with Dr. Lewis’s statement of their occurrence in the mouth of healthy persons. There is no doubt many not comma-shaped bacilli may, in dried and stained specimens, appear of a shape not unlike Koch’s commabacilli, e.g., in every specimen of tubercle bacilli, and glanders bacilli, and many others, one meets with individuals which are more or less curved, but that these are Koch’s commabacilli no experienced observer would dream of thinking. Koch justly insists on cultivating the comma- bacilli of cholera patients, for only by artificial cultivations, i.e., when large numbers of them become available, is it possible to be quite certain that one has to deal with a real and permanent form. Such being the case, the statement of Dr. T. R. Lewis that there occur in the saliva on dried and stained specimens bacilli which look like Koch’s commabacilli does not yet prove that they are Koch’s commabacilli. What he ought to have done is to cultivate them, and hereby to ascertain whether this is a real and permanent form, and if he could have been able to show that they behave in cultivations exactly in the same manner as Koch’s commabacilli, then he would have been justified in drawing conclusions ; but unfortunately he omitted to do so, and therefore his observations of bacilli which are curved, although quite correct, nevertheless do not possess full critical value. The same applies to the observations of Drs. Finkler and Prior (note in No. 36 of the Deutsche M., Woch, 1884), who have convinced themselves that in cholera nostras the evacuations contain commabacilli morphologically identical with those found in Asiatic cholera. This of course does also](https://iiif.wellcomecollection.org/image/b24976714_0019.jp2/full/800%2C/0/default.jpg)
