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The question of tubercle bacilli in the blood in advanced pulmonary tuberculosis
October, 1934]
TUBERCULOUS
I t may be regarded on the one hand as a protection of the system by immobilisation of the pathogenic organisms or on the other hand as a means of preserving the virus which at any moment may become diffused throughout the body. It is impossible at present to speak of immunity to tuberculosis in man. The most successful method of defence is 9immobilization of the pathogenic agent by the reticule.endothelial system.
T U B E R C U L O U S BACILL/_'EMIA. CORPER, tt. J., and DAMEIIOW, A. P. Tlao Question of Tubercle Bacilli in the Blood in Advanced Pulmonary" Tuberculosis. Amer. ltev. Tub., 1933, 28, 118. For the purposes of this study, the blood of 120 patients with advanced puhnonary and general tuberculosis was examined for tubercle bacilli by guinea-pig inoculation and by three different culture methods. The results in each case were negative. Two specimens, however, yielded saprophytic acid-fast tubercle bacilli, which could be readily differentiated from pathogenic tubercle bacilli both culturally and by animal inoculation. I n 200 further specimens of blood from patients in a tuberculosis sanatorium examined by two reliable culture methods, not a single positive culture 9 was obtained. The writers conclude that there is no
CLINICAL
AND
BAOILIJ~MIA
evidence of a true baeillmmia " i n the sense that tubercle bacilli circulate in the blood for a fairly long time, or that the bacilli multiply in the blood," although there obviously may not only be occasional embolic showers of tubercle bacilli from disintegrating tuberculous feel, but also terminal periods in the course of the disease when showers of caseous products containing viable bacilli may be found in the blood of man and experimental animals. This condition is, however, probably most unusual, and in any case when embolic showers do occur in man they appear to be rapidly removed from the circulation. ]{ALLOS, P. Ueber die Ziichtung der Tuberkulosebazillen aus dem Blute nach LSwenstcin. Gior. d i Batteriol. e I m m u n o l . , 1933, 10, 1171. As the result of his own investigations and a study of the literature the writer comes to the conclusion that the tubercle bacillus can be grown from the blood in only about 4 per cent. of all eases in contrast with the high proportion (50-80 per cent.) claimed by LSwenstein. The author attempts to explain the discrepancy by the fact that the mere microscopical demonstration of acid-fast bacilli on the surface of the cultures is no evidence of their being tubercle bacilli. The growth must first be submitted to a thorough cultural and pathological examination.
LABORATORY
I. T I I E R A P E U T I C P N E U M O PERITONIUM.
A subphrenie method of inducing therapeutic pneumoperitoneum for the relief of intestinal tuberculosis eompli'eat{~ig advanced pulmonary tuberculosis is described by Dr. Andrew L. Banyai [1], of the Muirdale Sanatorium, Wauwatosa, Wisconsin. The teclmiquo is as follows : The patient; is placed in the same position as for artifici.'d pneumothorax with a sandbag under the lateral aspect of the chest. Local anmstbesia is induced with 1 per 9
4l
METHODS.
novocain. The skin is elevated between the index finger and the thumb and nicked with a fine scalpel. A 2"5 in.~t long needle, 19 gauge, without an obdurator, is used for injection, the needle being connected with the manometer of the pneumothorax apparatus. The p o i n t of entrance of the needle must be selected below 9the site of the eostopbrenic angle,, near the lower margin of the thorax. The needle must; be introduced slowly. The manometer indicates negative pressure as soon as the needle passes through the parietal
TUBERCULOUS
I t may be regarded on the one hand as a protection of the system by immobilisation of the pathogenic organisms or on the other hand as a means of preserving the virus which at any moment may become diffused throughout the body. It is impossible at present to speak of immunity to tuberculosis in man. The most successful method of defence is 9immobilization of the pathogenic agent by the reticule.endothelial system.
T U B E R C U L O U S BACILL/_'EMIA. CORPER, tt. J., and DAMEIIOW, A. P. Tlao Question of Tubercle Bacilli in the Blood in Advanced Pulmonary" Tuberculosis. Amer. ltev. Tub., 1933, 28, 118. For the purposes of this study, the blood of 120 patients with advanced puhnonary and general tuberculosis was examined for tubercle bacilli by guinea-pig inoculation and by three different culture methods. The results in each case were negative. Two specimens, however, yielded saprophytic acid-fast tubercle bacilli, which could be readily differentiated from pathogenic tubercle bacilli both culturally and by animal inoculation. I n 200 further specimens of blood from patients in a tuberculosis sanatorium examined by two reliable culture methods, not a single positive culture 9 was obtained. The writers conclude that there is no
CLINICAL
AND
BAOILIJ~MIA
evidence of a true baeillmmia " i n the sense that tubercle bacilli circulate in the blood for a fairly long time, or that the bacilli multiply in the blood," although there obviously may not only be occasional embolic showers of tubercle bacilli from disintegrating tuberculous feel, but also terminal periods in the course of the disease when showers of caseous products containing viable bacilli may be found in the blood of man and experimental animals. This condition is, however, probably most unusual, and in any case when embolic showers do occur in man they appear to be rapidly removed from the circulation. ]{ALLOS, P. Ueber die Ziichtung der Tuberkulosebazillen aus dem Blute nach LSwenstcin. Gior. d i Batteriol. e I m m u n o l . , 1933, 10, 1171. As the result of his own investigations and a study of the literature the writer comes to the conclusion that the tubercle bacillus can be grown from the blood in only about 4 per cent. of all eases in contrast with the high proportion (50-80 per cent.) claimed by LSwenstein. The author attempts to explain the discrepancy by the fact that the mere microscopical demonstration of acid-fast bacilli on the surface of the cultures is no evidence of their being tubercle bacilli. The growth must first be submitted to a thorough cultural and pathological examination.
LABORATORY
I. T I I E R A P E U T I C P N E U M O PERITONIUM.
A subphrenie method of inducing therapeutic pneumoperitoneum for the relief of intestinal tuberculosis eompli'eat{~ig advanced pulmonary tuberculosis is described by Dr. Andrew L. Banyai [1], of the Muirdale Sanatorium, Wauwatosa, Wisconsin. The teclmiquo is as follows : The patient; is placed in the same position as for artifici.'d pneumothorax with a sandbag under the lateral aspect of the chest. Local anmstbesia is induced with 1 per 9
4l
METHODS.
novocain. The skin is elevated between the index finger and the thumb and nicked with a fine scalpel. A 2"5 in.~t long needle, 19 gauge, without an obdurator, is used for injection, the needle being connected with the manometer of the pneumothorax apparatus. The p o i n t of entrance of the needle must be selected below 9the site of the eostopbrenic angle,, near the lower margin of the thorax. The needle must; be introduced slowly. The manometer indicates negative pressure as soon as the needle passes through the parietal