diaphragm, notwithstanding the absence of certain objective symptoms, such as expansion and immobility of the lower half of the chest, projection of the epigastrium, and closure of the oesophagus, that he had found emphasized in the books.

The discussion of the case was participated in by a number of members, some of whom were unwilling to accept Dr. Rockwell's view of it, although no positive conclusion could be reached in regard to it.

DR. BIRDSALL thought that it might perhaps be due either to hysteria or to hepatic colic.

Medical and Surgical Journal. isolated being only common bacteria. The same may

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be said of the micrococcus and the corpuscles called zoöglow which were found in the giant cells of tubercle by Rindfleisch, Aufrecht, Malassez, and others. The 24th of April, 1882, Dr. Robert Koch, of Berlin, demonstrated to the Medical Society of that city a new micro-organism of rod-like form, belonging to the genus bacillus, characteristic in its chemical and morSubscriptions received, and single copies always for sale, by the under-phological properties and effects, which he claimed to signed, to whom remittances by mail should be sent by money-order, draft, be the true pathogenic and virulent agent of tuberor registered letter. HOUGHTON, MIFFLIN AND COMPANY, No. 4 PARK STREET, BOSTON, MASS. culosis. Koch arrived at the discovery of this microbe by a peculiar process of staining which, as somewhat modified and improved by later workers, consists in coloring the morbid substance by aniline, then subjecting the preparation to the action of dilute nitric acid, which decolorizes all the figured elements except the bacillus. The section is finally colored anew in vesuvine, which stains all the other microbes blue, the tubercle bacilli alone retaining the brown color acquired from the aniline. Thus obtained the bacilli appear as very thin rods, whose length is about one fourth that of a blood corpuscle.

THE TUBERCLE BACILLUS.

IT is natural that pathologists, impressed by the specific character of tuberculous disease and its ready inoculability, with, moreover, facts before them proving the infectious properties of dried tuberculous sputum when inhaled by animals, should early have come to the conclusion that tuberculosis is a communicable disease, having generic and pathogenetic affinities with the zymotic contagious diseases, being dependent like them for its origin and manifestations on a self-multiplying element foreign to the organism in which it exercises its irritant and lethal influence. But what might this causal element be? a chemical poison impregnating and oppressing the system, or a microbe, akin to the moulds, intruding itself into the higher life, and finding there a receptivity — pullulating, developing, and luxuriating at the expense of the organism which becomes its habitat? All the evidence of analogy is against the former supposition, and there is every analogy in favor of the latter, but experimental research has given demonstration of a more satisfactory kind.

It is probable that no announcement ever made a profounder sensation in the medical world, or was received with more enthusiasm. Here was a field of investigation for the mycologists and the pathological histologists of which they were not slow to take possession. The first demonstration of the aetiological relation of the bacillus to tubercle is concomitance; if invariably and always the microbe is found to accom pany the disease, the presumption is warranted that it is the cause, though it may be the effect. The first step, then, to prove a causal relation is to prove the constant presence of the specific parasite in tuberculous tissue, or in the products of tubercle. This, the easiest part of the demonstration, within the reach of even the amateur microscopist, has been quite thor

Leaving one side the history of investigations undertaken to establish the bacterial origin of acute febrile diseases universally recognized as communica-oughly worked out. ble, a history almost dating from Pasteur's Studies on Fermentation, and the brilliant discoveries of Devaine and Ferdinand Cohn, it is to Villemin that is due the credit of having first clearly indicated the contagious nature of tuberculosis, and its inclusion among parasitic diseases. Villemin's views were based on the results of inoculations of guinea-pigs and rabbits with minute quantities of tuberculous matter, and the communication and diffusion of tuberculosis thereby. The memoir of Villemin was published in 1865. Facts were even then accumulating to show the parasitic origin of all contagium, but the specific bacterium of no single infectious disease had been positively determined. Villemin boldly asserted the parasitic origin of tubercle, and showed how strikingly in harmony is this conception of the disease with the doctrine, formulated by Laennec, and then becoming popular, of the unity of phthisis.

Dating from the year 1877, several experimenters, notably Klebs, Schuller, Reinstadler, Toussaint, believed that they had discovered the parasite of tuberculosis, and practiced inoculations with the microbe to which they attributed the disease. Their inoculations were without effect, the bacteria which they had

In a prize essay recently read before the French Academy of Medicine the author, M. Herard, sums up as follows an answer to the question “Is the bacillus constant?" "The researches, to-day very numerous, of competent histologists in every land agree in this: The bacilli are found, with very few exceptions, in all the products of the excretions of a tuberculous organ, and notably in the sputa of phthisical patients. Coustantly, or almost constantly, they are observed in the divers tuberculous lesions; yet while in certain cases the quantity of bacilli is considerable, and they are found in all the lesions, whatever the stage of evolution of the disease, in other cases the number is small, and they are seen in greatest abundance in the young granulations, and especially in the centre of the granulations in the giant cells. When the bacilli are wanting in the parts that have undergone caseous degeneration they are generally met with in abundance in the surrounding zone which contains the granulations recently developed. Sometimes the bacilli are only found in the walls of cavities or of ulcerated bronchi, and there they are very numerous." The bacilli then, according to M. Herard, exist in variable number according to the degree of evolution of the

lesions; abundant in the earlier stages when the tu-
berculous development is active, they are less and less
numerous as destruction and elimination take place,
and the soil becomes, presumably, less fitted for their
nurture and support.
In later periods of the disease
other microbes those of putrefaction seem to ac-
quire predominance.

With regard to the few exceptional cases where the bacilli have not been found it is safe to say, according to M. Herard, that either the disease was past the stage of active development of the specific microbe or that the manipulations undertaken to show them were not sufficiently exact.

Granting constant concomitance, is it not possible that Koch's bacillus may accompany other lesions than those of tuberculosis? The voice of the experts thus far negatives this question. The bacillus is not found in any pulmonary affections except such as constitute phthisis, and its presence becomes a very valuable diagnostic sign. Some authorities, among whom we may mention Germain Sée, Dreschfeld, Celli, and Guarnerini, would hesitate to pronounce a diagnosis of phthisis in the absence of the specific bacillus from the expectoration. Sée claims to have diagnosticated phthisis by the bacillus in the sputum before the stethoscopic signs were sufficiently pronounced to warrant affirmation of the existence of the

disease.1 But concomitance alone proves nothing;

Finally, in this whole matter of tuberculous ætiology, predisposition plays an important part. Not every man or animal can become tuberculous, and the soil must be adapted to the parasite or it cannot find a habitat and thrive. There must be a peculiar receptivity either inherited or acquired. This susceptibility of constitution and of tissue, then, constitutes the initial step in the genesis of tuberculosis, and it is against this predisposition that prophylactic medicine is mainly directed. The condition of organism most favorable to the inroads of the parasite is one of lowered vitality, with the pulmonary alveoli unprotected by epithelium, a condition likely to follow a severe catarrh. Here the bacilli find ready access to the lungs in the air of respiration, and, unless the vital resistance of the economy can be aroused to overcome them, do their work of destruction.

We do not attempt at present even to refer to the light which the parasitic theory of tubercle sheds on the unity of scrofulosis and tuberculosis and of the varied forms of phthisis.

REPORT OF CASES TREATED IN WARD XIX.
ROYAL INFIRMARY, EDINBURGH.
NOWADAYS the records of abdominal surgery are

the elements of romance, and one rises from perusing them with a thrill of excitement quite as great as that which one experiences from reading an exciting tale of adventure. There is the deadly peril hanging imminent over the unfortunate victim, who is a prey to suffering and despair, the desperate venture, the hairbreadth escape, the alternation of hope and fear, the final victory over the dread disease, and the restoration

the bacillus must be shown to be the cause and not the effect, nor even an unimportant accompaniment. Here two lines of evidence are open: production of the disease by inoculation with the microbe, and in general very cheerful reading. They have many of suppression of the disease by removal of the microbe. The former line of proof is alone available at present to experimental pathologists. It must be confessed that in this department of inquiry but little has as yet been done. Were it not for Koch's brilliant success in the culture of the bacillus, after Pasteur's method, a method, however, differing from that of Pasteur in that Koch, after many trials and failures, found that a solid medium (gelatinized blood) was every way more favorable for the perfect isolation and development of the microbe than the ordinary liquid media; were it not, moreover, for the positive results which he obtained from inoculations with the bacterial product of a long series of cultures, thus demonstrating the genesis of tubercle from a figured element alone, it could not yet be affirmed that the parasitic theory of

tuberculosis stands on

to health of one doomed to die.

There seems

This makes a very bright page in the history of medicine, and the sense of exhilaration is surprisingly vivid when fresh from reading such a series as that contained in the Report of Cases Treated in Ward XIX. of the Royal Infirmary, Edinburgh, by Thomas Keith. The number is not large, only seventy-nine, but it represents the work of about three years in that institution, in this one direction. a substantial scientific basis. Those, moreover, who are not willing to accept Koch's experiments as conclusive, or who still believe that these experiments were in some yet unexplained way vitiated by error, will look for more proof before they are convinced. It is true that such conscientious experimenters as Baumgarten 2 have demonstrated that tubercle owes its virulence and its contagium to the presence of bacilli by showing that granular and caseous matter, phthisical sputa, etc., when inoculated in animals, does not engender tubercle if previously deprived of its bacteria. This is excellent confirmatory evidence, but we still await the more important cor1 Diagnostic des Phthisies Doutenses, etc., Paris, 1884. 2 Centralblatt, 1883, No. 42.

to have been in this number an unusually large proportion of what would be considered desperate cases. There were ten cases of hysterectomy for fibrous tumors, and sixty-nine of ovariotomy. Only thirteen of the cases of ovariotomy were without adhesions, and but two of the cases of hysterectomy could be called simple. Yet the mortality was slight, five deaths in all; two from undoubted septicemia, two from carbolic-acid poisoning, and one probably from exhaus

tion.

It is interesting to notice Keith's attitude towards pure Listerism, so-called. Of eighty-two cases of abdominal section (two cases of Battey's operation, and one for interstitial pregnancy being included), twenty

"Jacob the Zouave," formerly a private in a yet in the infancy of abdominal surgery, and have French regiment of zouaves in Algeria has been maknot yet proven all things, to know what we may holding himself a prominent figure in Paris of late. He fast.