SCIENTIFIC. TUBERCULOSIS.

Otago Witness, Issue 1958, 30 May 1889, Page 35

SCIENTIFIC. TUBERCULOSIS.

gpedaUy Written!,, for the OtagdWUneti.*

* , By Edwin Wooton, F.R.G-.S.

flow and again in everyday life 'the name 0 { gome one disease is thrust on the public attention, and becomes, like ja campaign, a . oiotore, or a book, the hours-to pic 'So, as fffrite, iii-townflnips.aild.fon stations,-rang-ing over a fair and feiiile po"*rtiW-of this tond, n* en gather.': and. Mlkiif 'ih'reatened' Augers and accomplished; Jill, ; of a disease enterißgarid spreading thr.pa.gh; their herdji of d»ttte ; sb insidiously ■that'the's'ource^ of its . coming is unknown, though the path of its destiny ca'tf'ba traced "past its dfead tictims. fe the doori.of that temple^wherfe Justice, in niercj dispenses :d: df ops of iioty whitewash to ippsQunious supplicants.-.that , being marked tber«with 'they may, h^ye protection from # 8 ' cry'— " Pay me that • thou 0 . . Taljerftulosls. ; , i 'Oar' latest celebrity in the World of'dis-'j uses ifl charaoterisedvessentially'by.the fdr'-' gation of certain nodules called tubercles. Of these there are two kinds— the grey and the yellow. All. are at first grey, and are then Bemi-trarisliicent rounded, bodies, vary- . liig'in sine generally from that of a pin's point to its T h'ead.: * Sometimes they are fajger. In structure' 1 they -• cbrisist always of jells, with very frequently, an. intercellular nettrork" of- fibres, called a stroma. The central cells are very large, and surrounding these are zones $f smaller cells. „Those of ; outermost v;jßdne.-are;.'inv ;jßdne.-are;.'in form, identical ffltii'lyiriphcorpuaol'es,-.";-^ • The yellow 'tubercfes are merely degene-, rated form?. of the grey variety; • They are much, softer than the grey and larger, ;being apt unffequontly. the size "of a small walnut. Jflbercleß do • not contain 1 any bloodvessels. These bodies do not grow in the proper sense of the tena, but. several ina^bfrfdrmed. close together. .-! When .fchja. occurs and softening {juts set' In the softened, masses merge into each other by the gradual bbliteratidn of bloodvessels ] lying b§i|w'een them, and consequent.' idestruction .i>f intervening tissue depending, on these vessels for its nutrition. HeDce a tjibfctoulous Iting or other part may exhibit.' a oonsiderafole extent of - such softened tubercle. The,. chief factor in the change from the grey w the yellow form has been frequently stylefr ,-.- -•' ,- '. '•• FATTY DEGHSBBATION; but it i^usfr 1 be understated that yellow tubercle nev^r shows |iri any part the structure of true fat. The .process is one of dis-integration;-the cell-wall^ bbcdme' ; broken down, and* there results an accumulation of fottygranulai.rfe&rii.. . . '• In aorne caees this change does not occur, j bnt the' stroma mentioned develops; the softer parts d,f,th« grey, tubqrcle are absorbed, the result:being a hard fibroid mass. • When men fibroid development occurs the tubercle affected'; is .harbaless ; Jt ceases to be " a focus of infection,", or, more.. correctly, a- source- of infection. -So far aj3 itself is concerned a recovery has. been ieffected, and if this- fibroid indurationob'tain in all the tubercles existing, the being— man or brute— is in no danger of death. , In certain cases also -salts, especially those of lime; arG' deposited in- the- grey tubercle, leading to its transformation into a hard calcified mass. Here, too, a condition of safety is reached. Theae grey nodules may be found, in any; part of the body, but they «c most .common in.the mucous and serous membranes, the lymphatic glands and vessels, the lungs^liyer; spleen, 'Jkidneys, and festes. Before we, proceed -further there are OBBTAIN^ POINTS OF PHYSIOLOGY we must bring clearly to rMnd. Beside fee vascular system, consisting of -arteries WBng the blood from, .and veins returning it to the heart, there is another system, of Twsels, styled lymphatics,' ramifying throughout the b.P.dy. ;• They .commence for the nwjor part in unwalled spaces lying between the cells, becoming" walled" as" they converge to form larger channels, and by uniting show 1 progressively increasing- magnitude, and a corresponding diminution in number until »t length they end' in two tr'urtk canals, called respectively the _right lymphatic and the thoracic duct. Th« office of these lymphatics -in their Intercellular distribution as seen is to remove from the body tissues the -worn out] cellular material inevitably resnlting' £rom ; j tital activity. The arterial "blood we know ' lo.be the source of nutrition ; and that the wnotis blood returns laden with the poison carbonic acid. These facts I assume to bemfficiently familiar to the majority of my fteders to need no demonstration. We see therefore that the lymphatics play a part lot even second io that of the vascular system, for unless the worn out cells are reeved new and vitally active ones cannot be formed. i There are certain membranes in the body taring to wrap or enfold important organs, !*> the lungs, liver, heart, and intesines. [They are very thin and carry innumerable ; minute bloodvessels. The membrane cells ■Secrete from the blood a fluid which serves 'o keep th« membranous surfaoe smooth, *Mm, and soft. These membranes are called serous, and the fluid, their cells secrete, ter wn. They are all abundantly supplied lymphatics which absorb and remove foe constantly seoreted fluid. On-account of 'M« function of absorption fulfilled by the tftaphatics they" are 1 styled absorbents. They JJNe, however,, an office other than that of ■% scavengers. ; In, the walls of the and intestines they are more plainly |iable than elsewhere^ and here their duty is |° absorb certain portions of the digested jod. In the intestinal canal fat is one article % take up very readily ; but that they may to do this the fat must be in a state '' saponification — in other words, a soap ; N.from fat it is transformed into soap by "to action chiefly of the alkaline juice of the or sweetbread. We are now pret**ed to face the question— HOW IS TUBERCLE FOBMED? fording it differently, What is the source Mt Ac cells'in tubercle ? This was for many ,**te the centre of controversy among the fce&ist pathological scientists. In 1885-6 I pributed to the Dublin Journal of Medical pence certain articles on tuberculosis and FofcOa, embodying the details jjand re- 1

siilts of previous practical .experimental work in. which I had been engaged. The .evidence- bearing on the source of tubercle is too extensive to be given here in other than a summarised form. Very briefly, then, I found there occurred, under certain conditions, an exudation from lymphatic vessels of fluid and cells ; in fact that there obtained a hitherto unrecognised lymphatic inflammation, distinct from, but perfectly ' analogous with, co.mmon ,or vascular inflammation. This discovery is now very generally . "accepted as accurate. Tubercle el 'found to Jbe formed u.ndeß ceitain circumstances by : the exuaa^ion'of^, lymphatic* cells and fluid, followed byocclusion of the lymphatio yes- j .aelfl ; and tinder other conditions by the non- ! iremoval of effete cells, and a subsequent exu- : \ dation. The latter process is that obtaining ' ;n tuberculosis outside the laboratory, and to this I must in the limited space at my disposal confine jmy'^ejf. ..,. There now arises a second question— What causes-this 'lymphatic inflammation ? I answer briefly, .. Occlusion pf.'the lymph phanjpels. ,If ]any reader who - may pare for ■Investigating .thesubject practically will take | a piece of serous membrane, 1 , as for 'example-, ■ £he peritoneum, studied with . tubercles,- and j 'Will inject with 'fluid 'pigment* the'"maiii : lymphatic vessels; he will at dnCe see that the stain maps out perfectly the^essels in ! their ramifications, save in the immediate j neighbourhood of , the tubercular <- nodules. ] 'if jhe will now examine a .small pbr- j tion of .this membrane, .haying, such a nbdulej under a low, microscopic powersay liri, he will see -the "coloured lines terminate some little distance from the tubercle. Here" and there a faint streak may show a ■ still open channel, but-f »r the majpr part the lymphatic vessels abotit the tiiberclt are, obliterated:"'*" A minute portion' of the membrane taken from the immediate border of . ths tubercle shows tjhe spaces converted into ' what may be conveniently termed corda-jr; that i.3, the material' witß which they are filled is solid. :.. -V ' ; '. So we may ask a .third, question— What is the cause of thirf' occlusion 1 The reply to this given by the greater number of to-day ( 'B patholbgists would be— the bacillus tuberr culosis. This- — i ' ; BAcoiLLAB theory and the chief arguments concerning if may now be briefly stated. All beings affected ,with tuberculosis show in the tuberculous parts certain rod-ljke bacteria, called bacilli. 'These 4o not differ in. form' from bacilli, found outside the body.ip. common decaying : matter,' but they,. stain differently [-when treated w,ith. certain. chemicals. 7lf7 If these bacilli be idjected into the--' tissues of 'other ; animals, iubprculosis results ; and if they be .'cultivated. iii",'tHe laboratory,' tri"af "ii, . be, , allowed 'to multiply in' certain materials, theip descendants algo produce tuberculosis. In very aciite cases of the disease the" blood .of tuberculous is. infective, by .inoculation. Tuberculous animals give the .disorder to the non- tuberculous when pastured or stalled or otherwise confined with and the tutiercfik of v the victims contain the bacilli. To this it may be replied that many tubercles in brutes and mando.npt show , a. .trace of the bacilli. \ This is nqw'l admitted by" the leading' observers, including Slein, himself an. ultra-bacillariani-; that. »uoh nonbacterial "tubercles are -productive ' of the .disease by inoculation ; jtha^ whenever bacilli are found, save after u iho'c"ula'tion from cultures, there also will' be: seen, according to many, observers, micrococci and other hacteria; thatcultivations.o'f suchmicrococciproduce'tuberculosis as readily a's the bacillus; that prolonged careful irritative inoculation of lymphatics, with common septic material produces deposits undis'tinguishable from tubercle, although tubercular matter "is fair more speedy and virulent in its r &c'ti6n than such septics. To,whjch"may be added, that I myself haye i found, tubercular matter, free from' bacilli, placed in test tubes inoculated with- cultivated "bacilli" frdrn a purely septic source (hay in' water), rendered .such bacilli'On beirfg J removed 1 Q9,^able"of .pijoduc-, ing the' "dise^e Jbj inoc'rilatioji; "OultjUres'of such bacilU removed ftdrn their Source became less" virulent in adtiori,',tKpugh ,,»W specifically infective. *' "■ , » ■],>■>'-, ■ i r.i\-Si Results differing but very slightly from the foregoing were obtained with miwqcocci^ '• In summing up the. 'arguments aifepting ■ this question, '-we" must 'bear- ffi Mhd*that, bacilli. -are ;theJ simplest'-' i ofm 'iff bacteria." They grow in animal matter more readily than any other Jb&cterium,- -and can- maintain a flourishing -existence where other bacteria 1 would live with 4iflaculty ? if, at pll.. Bacilli, like all' bacteria, derive_their character from the soil in which they grow, which character they import 'toioeVsplli' B"yl)areful cultivation 4n any animal-'mediumlsay-fIUGh an-, organ as the eye, they are rendered peculiarly capable of establishing. themselves- in that organ, and there producing a disease. Unquestionably bacilli do" multiply, .more readily than any other bacterium in tuberculosis. Unquestionably, also, inoculation of an animal either with micrococcrderived from tubercle, or- hay 'bacilli' developed in non-bacterial tubercle, 'and their 'cultures, will produce the^disease. In,, the" former of these two' cases micrococci \alone "will be found in the tubercles., ' - •" , w%l :' So we arrive at the' conclusion that tuberculosis is a disease of the lymphatio system, characterised* by' lymphatic exudation "»nd occlusion ; it may be produced in th§ labora--j tofy by various artificial, methods; iiis cojn-, municable there and oiitside' by any tuberculous material ; it spreads withputrinopulation from animal to animal.-. in. confined; spaces— i.e., when a common tit stallingobtains. The young of- tuberculousanimals are .peculiarly, liable, to .the^disease. The lymphatic'.'weaknessas hereditary.; There ( is truth in the bacillur f& epry, but its advocates have gone to extremes. If the bacillus j were'the one specific germ' of the 'disease it alone would show virulence;; This is not the case; but it maybe in course of development, so that .in :the future, . unless we discover a more convenient bacillicide than we at present possess, the disease may spread with increased rapidity. The poison : of tubercle > is^hen tubercular matter, whether a living oi dead animal, cell, or a bacterium. We have seen howrthis'matter can render innocent septic bacteria infective; and I ask, therefore, does net "this point to the possibility of tubercle containing some peculiar chemical compound which imparts the irritating properties to any- ceU living ,

therein f The issue of queetions suoh. as thid may not seem to bear practically on the extirpation of ,the/,disßase, but tbeyTieyer-, theless do so)bear, 3 and that very strongly! -In science eyery.fact.discovered 'plaices itself^pt amid an inchoate jumble of dissopi^ted other facts,- but far due and: proper order, and it. may be that if such 'compound be : ' ever proved to exist, we shall have simplified ourproblem as to treatment. -" THE TUBBBOiiH POISON- ' -' ' \ is ta'fien ihtq 1 the 'stomaoh'^atid' lungs. Iran animal. be 'thoroughly healthy, it has more chances, of esoape than if sickly.. Bnt the slightest soreness or catarrh of the mucous ■purfa^es; ; will rnpjfe;feadi^y,allo>the absorpctioniof tubercularmfttena^b •">.*•;•? Boiling, or other thorough, cooking,, kjlls all bacteria. In'uhderdonVmeat thebacteria if present would" stm be.infectiye. We MVo seen that nowbaejberlaj' tubercle is able to impart the disease, but thdrougb< boiling retfders it "harmleßß. Th 6 (reaipn- of jbfeja Ji npt.yet.deeided. ,.-, • ... v , '*' ••- -> "In this brief notice I b*v».Wd9*vour«d to bring'the reader -face. to,f ace^th^^ . ? - : - ,. , TKH FAOTS. AND'POSSIBILmfS Off' A ,-

- t ■-. . ••>' PfiESBINO>I>ANOEB.< ' ■ •If It is,trfie, l as rhold^t>6 bp/qr even pwfllble, ,as any. candid- .opponent* .will admit, I that septic baoteria, swarming .-by millions in t every dtm'ospnei'e,''cAn, 7 .ttifoiigtieritrance to \•, diseased body, - take- on themielves the power of infection ; it it be^trae or .possible, jas Thold it : to be.'that such, a bacterium j called a bacillus is ejye'n now in process of I development" into a apeoifio infeotive agent ; then if Naturebe allowed to pursue herlittla duties unchecked, we may look forward to the e'volutio'n'of our bacterial friend into a virulently agent more deadly than any now-known, because- mote destructive to-the tissues; The questions," then, before the country are these : < 1. The possibility of conversion on thepftrt at bacteria 1 from septic to pathogenic, or diieaaeproducing, agetits. N 2. The discovery of an ef active b*qillicid»,«r, more.broAdly^becteriande. ,- . . ' * £ ' : I 3. The discovery of any chemical mataries morbi tifiatr may exist in tubercle. - 4. If such material be found, the diicovery of such compound or element as will nsgative it» virulenoo. . ' / „ / . ; .. . ( We have no right to look abroad for. solutions to these problems. .Tuberculosis is here, and under> certain conditions. It is our duty -to battle with it to the best of our ability, •and,' our knowledge being here, to be able, to imake. ourselves aqquajnted witty, these con-, ditions.c -• :• » •• > - - 1 It is not a matter of locality or localresponsibility." Ifris not one affecting'atook- . 'owners^ only\ ' Every tnhabited'"(ri'ch of New. Zealand has in the issue, of questions a truly vital interest. It is" above "all not. £ case for the investigation and commonplace report of an equally common■place medical or veterinary practitioner ;but one demanding the services -of skilled (scientists.^ Suoh services, although jnciije^w; are not costly. • ■/: ' ; ' > '.J-'-^\;. J -'-^\; - That the Gorernment, ' unless ~ singly ipressedl, will mpye" in, this matter there '» very little bop^. Xew Zealand 'stockowners,-and' khj. portion the. public possessing a distaste -for cooked -tubercle, wish for Governmental action, th«y hinst employ their real or assumed influence with their "representative members. Possibly the most expeditious plan 1 would'beth^ forma-; tion of a committee to raise a subscription fund for prosecuting the necessary- researches. . • ■ ■ • ' ' .