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KOCH has discovered that the remedy for tuberculosis consists of a glycerine extract of a pure cultivation of tubercle bacilli, the local effect of which, when injected into a healthy guinea-pig, produces a nodule found at the point of inoculation, which, when a second puncture is perpetrated, causes what may be called the bacillary fluid to be brought into the current of its circulation, so that the infected tissue may react upon the agent which it had previously been able to resist.
Forcible breaking down of adhesions under anæsthesia is not recommended, as it is followed by great suffering and the adhesions re-form. Operation for ankylosis arthroplasty should not be undertaken, as the ankylosis recurs. Tuberculous disease of joints results from bacillary infection through the arteries.
According as the cellulitic, the œdematous, or the gaseous characteristics predominate, the clinical varieties of bacillary gangrene may be separately described, but it must be clearly understood that they frequently overlap and cannot always be distinguished from one another.
The acute bacillary forms of gangrene all assume the moist type from the first, and, spreading rapidly, result in extensive necrosis of tissue, and often end fatally. The infection is usually a mixed one in which anaërobic bacteria predominate.
Several observations made recently in Rome tend to demonstrate that the schizomycete of malaria does not always assume the complete bacillary form described by Klebs and myself; but this morphological question possesses no further interest for the hygienist.
Dysentery was also increasing, and wards were reserved for these cases. It was mainly what is called bacillary dysentery, for which Epsom salts is one of the best remedies. All typhoid cases, as soon as convalescent, were sent to India. That was because they often carry the germs in the intestinal tract a long time after recovery and therefore may become a source of infection.
#Clinical Varieties of Bacillary Gangrene.# #Acute infective gangrene# is the form most commonly met with in civil practice. It may follow such trivial injuries as a pin-prick or a scratch, the signs of acute cellulitis rapidly giving place to those of a spreading gangrene.
And a similar appearance is produced when gelatine is inoculated with a pure culture of this bacillus, the gelatine liquefying at the seat of inoculation, and the small colony continually enlarging; but above it there occurs the excavated spot, like a bubble of air floating over the bacillary colony.
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