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The Types of Tubercle Bacilli Found in the Bones, Joints, and Genito-Urinary Tract in Human Tuberculosis
ABSTRACTS.
175
Australia, but a summary is given of the characters of the worm that is found in cattle in India, and in tabulated statements many details of measurement are given. The male parasite varies from 3'38 to 9'3 cm. in length and from '175 to '220 mm. in thickness. The posterior extremity of the body is often coiled, and the tail is curved in the ventral direction immediately posterior to the cloacal swelling. The central portion of the body shows well-marked transverse ridges, which are '005 to '006 mm. in width. Towards the extremities these ridges disappear. Th,ere are three lips to the mouth, and just behind to the level of the opening there are three papillce. The cesophagus, which measures about I mm. in length, has at its point of junction with the straight intestine a well·marked bulb. The nerve ring is situated about 2 mm. froITh the anterior extremity, and the excretory pore is close behind it. The anal papillce, of which there are eight or nine pairs, are sometimes asymmetrical. The short spicule is about 10 of a millimetre in length, and the long spicule is about two and a half times this size. The proximal ends of the spicules are funnel-shaped. The distal end of the long spicule is pointed or slightly bifid, while that of the short spicule is shoe-shaped, and acts as a guide for the long spicule. The female parasite may measure a metre in length, and it appears to be devoid of any transverse ridges. For the greater part of the length, however, the body shows prominent wavy ridges, which may form an almost continuous single or double spiral round it. The bulb of the cesophagus is less distinct than in the male, and no excretory pore could be made out. The vulva, which is placed on a slight prominence about '5 mm. behind the anterior end, leads to the vagina, which has thick walls and is sometimes twisted. Imperfect preservation prevented exact details being observed in the eggs contained in the genital tubes, but all stages of development up to the free embryo could be found. In a tabulated statement the author gives the names of the countries visited or from which information was obtained, the species of bovine animals examined, the previous records of the occurrence of worms belOnging to this genus, and the species encountered in the present investigation. It would appear that onchocerca gutturosa is the type found in Northern Africa, onchocerca indica in India, and onchocerca gibsoni in bos indicus in the Malay Archipelago. The types of animals taken into consideration in connection with the parasite were: bos taurus, including the tame oxen of Europe and Northern Asia; bos indicus, including the humped domesticated cattle of India; and bos bubalis, the water buffalo. (Sweet, Investigations into the Occurrence 0/ Onchoceriiasis in Cattle and Associated Animals in Countries otl,er than A ustralia, Government Printer, Melbourne, pp. 1-54·)
THE TYPES OF TUBERCLE BACILLI FOUND IN THE BONES, JOINTS, AND GENITO-URINARY TRACT IN HUMAN TUBERCULOSIS. THE material used in the investigations recorded in this paper was collected during the period 1st August 1913 to 31st May 1914, and an attempt was made to include in the enquiry as wide a range of cases as possible without restriction as to age, locality, or other circumstances. A tabular statement shows the age and sex of each patient, the situation of the lesions, the source of the material used for cultivation purposes, including III
176
ABSTRACTS.
information as to whether the cultures were obtained direct or after inoculation of guinea-pigs, and, finally, the type of bacillus isolated. The statement contains the particulars mentioned of 261 cases. In fortyseven instances not included in the table negative results were obtained. In twenty-three of these tubes of egg medium were inoculated from the spleens of forty guinea-pigs killed six weeks after inoculation. This precaution was taken because strains of tubercle bacilli of low virulence may survive in experimentally infected animals without producing macroscopic lesions. A summary of the investigation shows that in 196 cases the bacilli isolated were of the human type, in fifty-five of the bovine, and in ten they were atypical. Material was obtained from ISS patients under ten years of age, and the bacilli cultivated in forty-five instances (29 per cent.) were of the bovine type. The remaining 106 cases yielded only 9'4 per cent. of bovine strains, and of these only three were over sixteen years old, their ages being seventeen, seventeen, and twenty-two. Bacilli were classed as of the human type when they showed the following characteristics: They produced luxuriant growths upon media containing 5 per cent. glycerin. On glycerin-agar there developed within two or three weeks a thick confluent wrinkled layer; and on glycerinised potato the growth was abundant and pigmented. All the strains ultimately attained to uniformity in type of growth. The original material was used in every instance for the inoculation of guinea-pigs and rabbits. In practically every case the guinea-pigs died of generalised tuberculosis. In the few cases in which the disease was found to be localised further guinea-pigs were inoculated with culture, and the invariable result was generalised tuberculosis. The rabbits inoculated were killed 100 days after inoculation, and the usual result was that they were only slightly affected. In a comparatively small number of cases the rabbits showed disease of a more severe type. The lungs were enlarged and largely replaced by caseous tissue. In ten instances the disease terminated fatally in less than 100 days. In these severe infections the marked lesions were confined to the lungs, the spleen was not affected, and there was only slight tuberculosis of the kidneys. As a rule the rabbits were inoculated subcutaneously between the shoulders with serum cultures, and in a few cases the inoculations were made with broth cultures subcutaneously on the abdomen. With the object of ascertaining whether the relatively high degree of virulence shown by some of the strains of human bacilli was maintained or possibly increased, cultures were made from the severely affected lungs and tested upon further rabbits. The disease produced was rarely as severe as in the original rabbits, and never of greater severity. The severe ca'ies may be explained either on the ground that some of the rabbits showed a special susceptibility or that in the act of inoculating some small vessels were ruptured and the bacilli gained access to the blood stream. In support of the latter view it is pointed out that the lesions produced correspond with those ordinarily produced by intravenous inoculation with human virus. Passage through rabbits showed that the apparently exalted virulence was not maintained. , The results do not invalidate the use of the rabbit for establishing the human type of a strain, but they indicate the necessity of repeating inoculations when working with a eugonic strain which produces severe pulmonary tuberculosis by subcutaneous inoculation. The results of the experiments carried out with rabbits, which form the evidence upon which the conclusions regarding the nature of the strains isolated are based, are given in the form of a table. In forty-one cases cultures were recovered from rabbits which had been
ABSTRACTS.
used for virulence tests. The characters of these cultures, with three excep tions, were identical with those of the original cultures. Eighteen of the cultures obtained were also tested with rabbits, and with the same three exceptions were found to correspond with the human type as regards pathogenicity. A number of rabbits were inoculated with one of these strains, the material used for the inoculations being derived from cultures grown from one of the rabbits originally inoculated, and from one of the guinea-pigs inoculated at the same time. The results in some of the animals suggested that the strain was a bovine one, but in the majority of the animals the lesions produced were such as to indicate that the strain was a human one. Similar results were obtained with the second exceptional strain. In the third exceptional strain cultures from one of the originally inoculated rabbits were fairly luxuriant, but not as luxuriant as the human type usually yields. Rabbits inoculated intravenously with this culture showed generalised lesions like those produced by the bovine type. No final conclusion has been arrived at with regard to these cultures, but three possible explanations of the facts are indicat( d; (I) modification of the bacilli in the rabbits, (2) admixture of human and bovine bacilli, (3) accidental infection of the rabbits with bovine bacilli. The bacilli classed as of the bovine type all produced cultures identical with those of bacilli of bovine origin on glycerinated media, and the majority of them were markedly dysgonic. While a few yielded better growths, none grew so profusely as the human type. All the viruses were highly virulent for the guinea-pig, and with the exception of twelve all produced in rabbits generalised tuberculosis which proved fatal in less than 100 days. Experiments carried out with the twelve exceptional viruses indicated that they were only a little below the ordinary bovine strains in virulence. During the course of the investigation the authors encountered ten strains which they experienced difficulty in classifying. To the records of these they have added three others encountered in previously reported experiments. Of these thirteen strains, six were indistinguishable culturally from bovine bacilli, but their pathogenicity for the rabbit was that of the human bacillus. The remaining seven strains were also of low virulence for the rabbit, but on serum they grew well and developed bright yellow pigment. On glycerin agar growth was extremely slow and took the form of numerous minute colonies with the subsequent development of a few large convoluted pigmented colonies. On glycerin-potato growth was slow and resulted in the formation of large, peculiarly shaped, pigmented colonies. On glycerin-broth only a few islands of growth developed. The authors also deal with the bacteriological ch2.racters of tubercle bacilli isolated from seventeen cases of tuberculosis of the urino-genital system. A tabular statement gives the age of the patients, the seat of the lesions, the source of the cultures isolated, ar d the type of bacilli recovered in each -case. In fourteen of the cases the bacilli were of the human type. These were all eugonic and of Iow virulence for the rabbit. The results of the inoculations of rabbits are also given in tabular form. Fuller details are given of the three cases from which bacilli of the bovine type were isolated Five samples of urine from a patient twenty-four years old, who suffered from frequency of micturition but was otherwise in good health, were received between 1st May 1912 and 13th October 1913. Cultures were obtained direct from sediment treated with antiformin from the first and second samples, and through guinea-pigs from the first, third,
17 8
ABSTRACTS.
fourth, and fifth. All were typically bovine, both culturally and with regard to their pathogenicity for the rabbit. In the second case cultures from the urine were highly dysgonic and typically bovine on glycerinised media. The lesions produced in rabbits were those of a bovine type, except that in two of them they were rather less severe than those generally produced. The patient in this case was nineteen years of age. After the sample of urine had been taken the left kidney was removed and found to be extensively tuberculous. The third case had a history of the removal of cervical glands in early childhood, the patient at the time of investigation being twenty years of age. Tuberculosis of the right kidney had been diagnosed in August 1913, and the sample of urine was obtained on 22nd May 1914. Bacteriologically the bacilli were identical with those isolated from the first of these cases. Of the seventeen cases examined, the lesions were present in the urinary tract in eight, and in the genital organs in nine (seven in the testes, one of the salpinx, and one of the prostate). (Eastwood and Griffith,Jl. of Hygiene, Vol. XV., No.2, January 1916, pp. 157-314')
THE CLINICAL IMPORTANCE OF THE PSAMMOMATA IN HORSES. THE tumour·like growth to which the author refers in this paper under the term cholesteatoma is that to which the name psammoma is applied in English veterinary literature. The greater part of the paper consists in a review of the literature regarding the etiology of, and the effects produced by, growths of tltis kind. According to Jeest, they occur more frequently in draught horses than in riding animals. Roll and Bruckmiiller distinguish two types, which, although of the same nature, present different appearances to the naked eye, and in this they agree with the French observers Le Dor and Ball, who recognise the "pearl cholesteatoma" and large cholesteatomata. The former consists of small nodules or aggregations of nodules about the size of a pea in the lateral plexus of the cerebellum or in the plexus of the lateral ventricles. The latter are greyish-yellow growths with a smooth or granular surface, and situated in one or both lateral ventricles. These sometimes attain the size of a hen's egg. Various explanations of their etiology have been given. Formerly they were looked upon as true neoplasms, and they were classed by Roll and Bruckmiiller as fibromata or fibroid neoplasms. Le Dor, Olt, and Rievel consider them to be endotheliomata (angiosarcomata). On the ground that pus produced by streptococci is rich in cholesterin, Kitt believes that the growths represent a result of streptococcus infection. According to Schmey and J eest the tumours are th e result of chronic irritation. The latter author states that the cholesterin is the irritant. This is brought from the brain tissue by macrophages to the lymph spaces in the plexus and deposited there, the cause of this being some condition of irritation of the plexus. A simple disturbance of the circulation may be a sufficient cause. Krummacher and Jeest agree that the cholesterin is derived from the brain tissue, but Biinz was unable to detect cholesterin in it. Wehrbein states that, while cholesteatomata are of inflammatory origin, the primary seat of the inflammation is in the middle coats of the arteries of the plexus.
175
Australia, but a summary is given of the characters of the worm that is found in cattle in India, and in tabulated statements many details of measurement are given. The male parasite varies from 3'38 to 9'3 cm. in length and from '175 to '220 mm. in thickness. The posterior extremity of the body is often coiled, and the tail is curved in the ventral direction immediately posterior to the cloacal swelling. The central portion of the body shows well-marked transverse ridges, which are '005 to '006 mm. in width. Towards the extremities these ridges disappear. Th,ere are three lips to the mouth, and just behind to the level of the opening there are three papillce. The cesophagus, which measures about I mm. in length, has at its point of junction with the straight intestine a well·marked bulb. The nerve ring is situated about 2 mm. froITh the anterior extremity, and the excretory pore is close behind it. The anal papillce, of which there are eight or nine pairs, are sometimes asymmetrical. The short spicule is about 10 of a millimetre in length, and the long spicule is about two and a half times this size. The proximal ends of the spicules are funnel-shaped. The distal end of the long spicule is pointed or slightly bifid, while that of the short spicule is shoe-shaped, and acts as a guide for the long spicule. The female parasite may measure a metre in length, and it appears to be devoid of any transverse ridges. For the greater part of the length, however, the body shows prominent wavy ridges, which may form an almost continuous single or double spiral round it. The bulb of the cesophagus is less distinct than in the male, and no excretory pore could be made out. The vulva, which is placed on a slight prominence about '5 mm. behind the anterior end, leads to the vagina, which has thick walls and is sometimes twisted. Imperfect preservation prevented exact details being observed in the eggs contained in the genital tubes, but all stages of development up to the free embryo could be found. In a tabulated statement the author gives the names of the countries visited or from which information was obtained, the species of bovine animals examined, the previous records of the occurrence of worms belOnging to this genus, and the species encountered in the present investigation. It would appear that onchocerca gutturosa is the type found in Northern Africa, onchocerca indica in India, and onchocerca gibsoni in bos indicus in the Malay Archipelago. The types of animals taken into consideration in connection with the parasite were: bos taurus, including the tame oxen of Europe and Northern Asia; bos indicus, including the humped domesticated cattle of India; and bos bubalis, the water buffalo. (Sweet, Investigations into the Occurrence 0/ Onchoceriiasis in Cattle and Associated Animals in Countries otl,er than A ustralia, Government Printer, Melbourne, pp. 1-54·)
THE TYPES OF TUBERCLE BACILLI FOUND IN THE BONES, JOINTS, AND GENITO-URINARY TRACT IN HUMAN TUBERCULOSIS. THE material used in the investigations recorded in this paper was collected during the period 1st August 1913 to 31st May 1914, and an attempt was made to include in the enquiry as wide a range of cases as possible without restriction as to age, locality, or other circumstances. A tabular statement shows the age and sex of each patient, the situation of the lesions, the source of the material used for cultivation purposes, including III
176
ABSTRACTS.
information as to whether the cultures were obtained direct or after inoculation of guinea-pigs, and, finally, the type of bacillus isolated. The statement contains the particulars mentioned of 261 cases. In fortyseven instances not included in the table negative results were obtained. In twenty-three of these tubes of egg medium were inoculated from the spleens of forty guinea-pigs killed six weeks after inoculation. This precaution was taken because strains of tubercle bacilli of low virulence may survive in experimentally infected animals without producing macroscopic lesions. A summary of the investigation shows that in 196 cases the bacilli isolated were of the human type, in fifty-five of the bovine, and in ten they were atypical. Material was obtained from ISS patients under ten years of age, and the bacilli cultivated in forty-five instances (29 per cent.) were of the bovine type. The remaining 106 cases yielded only 9'4 per cent. of bovine strains, and of these only three were over sixteen years old, their ages being seventeen, seventeen, and twenty-two. Bacilli were classed as of the human type when they showed the following characteristics: They produced luxuriant growths upon media containing 5 per cent. glycerin. On glycerin-agar there developed within two or three weeks a thick confluent wrinkled layer; and on glycerinised potato the growth was abundant and pigmented. All the strains ultimately attained to uniformity in type of growth. The original material was used in every instance for the inoculation of guinea-pigs and rabbits. In practically every case the guinea-pigs died of generalised tuberculosis. In the few cases in which the disease was found to be localised further guinea-pigs were inoculated with culture, and the invariable result was generalised tuberculosis. The rabbits inoculated were killed 100 days after inoculation, and the usual result was that they were only slightly affected. In a comparatively small number of cases the rabbits showed disease of a more severe type. The lungs were enlarged and largely replaced by caseous tissue. In ten instances the disease terminated fatally in less than 100 days. In these severe infections the marked lesions were confined to the lungs, the spleen was not affected, and there was only slight tuberculosis of the kidneys. As a rule the rabbits were inoculated subcutaneously between the shoulders with serum cultures, and in a few cases the inoculations were made with broth cultures subcutaneously on the abdomen. With the object of ascertaining whether the relatively high degree of virulence shown by some of the strains of human bacilli was maintained or possibly increased, cultures were made from the severely affected lungs and tested upon further rabbits. The disease produced was rarely as severe as in the original rabbits, and never of greater severity. The severe ca'ies may be explained either on the ground that some of the rabbits showed a special susceptibility or that in the act of inoculating some small vessels were ruptured and the bacilli gained access to the blood stream. In support of the latter view it is pointed out that the lesions produced correspond with those ordinarily produced by intravenous inoculation with human virus. Passage through rabbits showed that the apparently exalted virulence was not maintained. , The results do not invalidate the use of the rabbit for establishing the human type of a strain, but they indicate the necessity of repeating inoculations when working with a eugonic strain which produces severe pulmonary tuberculosis by subcutaneous inoculation. The results of the experiments carried out with rabbits, which form the evidence upon which the conclusions regarding the nature of the strains isolated are based, are given in the form of a table. In forty-one cases cultures were recovered from rabbits which had been
ABSTRACTS.
used for virulence tests. The characters of these cultures, with three excep tions, were identical with those of the original cultures. Eighteen of the cultures obtained were also tested with rabbits, and with the same three exceptions were found to correspond with the human type as regards pathogenicity. A number of rabbits were inoculated with one of these strains, the material used for the inoculations being derived from cultures grown from one of the rabbits originally inoculated, and from one of the guinea-pigs inoculated at the same time. The results in some of the animals suggested that the strain was a bovine one, but in the majority of the animals the lesions produced were such as to indicate that the strain was a human one. Similar results were obtained with the second exceptional strain. In the third exceptional strain cultures from one of the originally inoculated rabbits were fairly luxuriant, but not as luxuriant as the human type usually yields. Rabbits inoculated intravenously with this culture showed generalised lesions like those produced by the bovine type. No final conclusion has been arrived at with regard to these cultures, but three possible explanations of the facts are indicat( d; (I) modification of the bacilli in the rabbits, (2) admixture of human and bovine bacilli, (3) accidental infection of the rabbits with bovine bacilli. The bacilli classed as of the bovine type all produced cultures identical with those of bacilli of bovine origin on glycerinated media, and the majority of them were markedly dysgonic. While a few yielded better growths, none grew so profusely as the human type. All the viruses were highly virulent for the guinea-pig, and with the exception of twelve all produced in rabbits generalised tuberculosis which proved fatal in less than 100 days. Experiments carried out with the twelve exceptional viruses indicated that they were only a little below the ordinary bovine strains in virulence. During the course of the investigation the authors encountered ten strains which they experienced difficulty in classifying. To the records of these they have added three others encountered in previously reported experiments. Of these thirteen strains, six were indistinguishable culturally from bovine bacilli, but their pathogenicity for the rabbit was that of the human bacillus. The remaining seven strains were also of low virulence for the rabbit, but on serum they grew well and developed bright yellow pigment. On glycerin agar growth was extremely slow and took the form of numerous minute colonies with the subsequent development of a few large convoluted pigmented colonies. On glycerin-potato growth was slow and resulted in the formation of large, peculiarly shaped, pigmented colonies. On glycerin-broth only a few islands of growth developed. The authors also deal with the bacteriological ch2.racters of tubercle bacilli isolated from seventeen cases of tuberculosis of the urino-genital system. A tabular statement gives the age of the patients, the seat of the lesions, the source of the cultures isolated, ar d the type of bacilli recovered in each -case. In fourteen of the cases the bacilli were of the human type. These were all eugonic and of Iow virulence for the rabbit. The results of the inoculations of rabbits are also given in tabular form. Fuller details are given of the three cases from which bacilli of the bovine type were isolated Five samples of urine from a patient twenty-four years old, who suffered from frequency of micturition but was otherwise in good health, were received between 1st May 1912 and 13th October 1913. Cultures were obtained direct from sediment treated with antiformin from the first and second samples, and through guinea-pigs from the first, third,
17 8
ABSTRACTS.
fourth, and fifth. All were typically bovine, both culturally and with regard to their pathogenicity for the rabbit. In the second case cultures from the urine were highly dysgonic and typically bovine on glycerinised media. The lesions produced in rabbits were those of a bovine type, except that in two of them they were rather less severe than those generally produced. The patient in this case was nineteen years of age. After the sample of urine had been taken the left kidney was removed and found to be extensively tuberculous. The third case had a history of the removal of cervical glands in early childhood, the patient at the time of investigation being twenty years of age. Tuberculosis of the right kidney had been diagnosed in August 1913, and the sample of urine was obtained on 22nd May 1914. Bacteriologically the bacilli were identical with those isolated from the first of these cases. Of the seventeen cases examined, the lesions were present in the urinary tract in eight, and in the genital organs in nine (seven in the testes, one of the salpinx, and one of the prostate). (Eastwood and Griffith,Jl. of Hygiene, Vol. XV., No.2, January 1916, pp. 157-314')
THE CLINICAL IMPORTANCE OF THE PSAMMOMATA IN HORSES. THE tumour·like growth to which the author refers in this paper under the term cholesteatoma is that to which the name psammoma is applied in English veterinary literature. The greater part of the paper consists in a review of the literature regarding the etiology of, and the effects produced by, growths of tltis kind. According to Jeest, they occur more frequently in draught horses than in riding animals. Roll and Bruckmiiller distinguish two types, which, although of the same nature, present different appearances to the naked eye, and in this they agree with the French observers Le Dor and Ball, who recognise the "pearl cholesteatoma" and large cholesteatomata. The former consists of small nodules or aggregations of nodules about the size of a pea in the lateral plexus of the cerebellum or in the plexus of the lateral ventricles. The latter are greyish-yellow growths with a smooth or granular surface, and situated in one or both lateral ventricles. These sometimes attain the size of a hen's egg. Various explanations of their etiology have been given. Formerly they were looked upon as true neoplasms, and they were classed by Roll and Bruckmiiller as fibromata or fibroid neoplasms. Le Dor, Olt, and Rievel consider them to be endotheliomata (angiosarcomata). On the ground that pus produced by streptococci is rich in cholesterin, Kitt believes that the growths represent a result of streptococcus infection. According to Schmey and J eest the tumours are th e result of chronic irritation. The latter author states that the cholesterin is the irritant. This is brought from the brain tissue by macrophages to the lymph spaces in the plexus and deposited there, the cause of this being some condition of irritation of the plexus. A simple disturbance of the circulation may be a sufficient cause. Krummacher and Jeest agree that the cholesterin is derived from the brain tissue, but Biinz was unable to detect cholesterin in it. Wehrbein states that, while cholesteatomata are of inflammatory origin, the primary seat of the inflammation is in the middle coats of the arteries of the plexus.