food
or drink, or whether they may not primabe taken up with the air and from it enter tiie saliva and only by this circuitous route finally reach the gastric cavity. The biology of the choleraic bacteria does not allow a decision to be arrived at exclusively in favour of either of these possibilities. Choleraic bacteria are capable of living in liquids, and can thus reach the mouth directly ; but they may also be eventually diffused by evaporation, and thus come to be inhaled. Moreover, even in a dry condition, they are, under certain circumstances, capable of retaining their vitality for prolonged periods, as I have maintained for some years, and as Berkholtz has at length recently determined. Dry but capable of development they may be inhaled, and then either reach the lungs directly or reach the stomach through the intervention of the saliva. In the latter case, in spite of their access by means of respiration, they will reach the intestinal tract directly and multiply there primarily; in the former case, when taken up by the pulmouary surface, their localisation within the intestiual tract can only occur second-* arily. Without putting the possibility of this entirely aside in regard to infection of the human subject, the experiments which have recently been carried out in regard to the results following inhalation of bacteria have not tended to induce belief in its occurrence, as up to the present time 110 success has attended attempts at causing infection through the lungs by such as are capable of living iu the blood parasitesThe choleraic bacteria are, moreover, itself. judging fromin their behaviour in the human guineaTpigs, not blood parasites, subject and and this, iu the meautime, venders it most pro? bable that, whether inhaled from moist or dry substrata, they constantly reach the stomach primarily and pass thence into the intestines, where they are able to germinate and multiply. Iu consequence of the above facts and pro-? babilities, which offer no insuperable contradictions to epidemiological facts and indication, it is essential to examine all the relations of choleraic bacteria to the stomach and intestines
rily
ON THE ETIOLOGY OF ASIATIC CHOLERA. A
REPORT FURNISHED TO THE GERMAN MEDICAL SOCIETY OP PRAGUE. By PROF. FERDINAND HUEPPE.
In the following pages I propose to give a brief accouiit of certain investigations which I have carried out during the past few years in regard to the parasite of cholera, and which, specially through the work of Dr. G. E. C. Wood, have so far attained completion as to render it possible to regard certain of the old controversies between contagio-bacteriological and the older miasmatico-epidemiological doctrines as at length in a moribund condition. The result of my own investigations along with those first of Dr. Lustig (now Professor of Pathology in Cayliari) and later of Dr. Wood of Edinburgh, both in association with him aud subsequently in further independent investigations carried out in accordance with suggestions of mine, is to confirm Enoch's statement that the choleraic process takes place solely within the intestinal tract, and that cholera must be regarded as a specific intestinal putrefaction with the formation of specific toxic material. The loss of water aud denudation of the intestinal mucous membraue, important though they be in
symptomatology,
are
mere
secondary
matters
from an etiological point of view. The localisation of the cholera process in the intestinal tract, according to our observations, in accordance with similar results of H. Buchner and D. D. Cuuuingham, follows not merely on reception of the parasite via the mouth, but also as a secondary localisation in it as the poiut of least resistance, when the introduction of the virus and the infection of the organism have been effected by means of other channels. Natural infection of the human subject,?and here for a moment I leave the region of facts which have as yet been dealt with experimentally,?must in greater part,if not solely, occur as the result of the parasite traversing the stomach and so reaching the intestinal tract directly. At the same time it must be regarded j*s qn entirely open question whether the choleraic bacteria invariably aud solely arrive in the gtocfl^ch directly fyom the mouth, aud only with
and their secretions. In connection with this it has been demonstrated as a fundamental fact that, in spite of the earlier statements, choleraic bacteria are, iu a suitably selected substratum, capable of living when excluded from air, or, iu other words, in the absence of free oxygen, and that iu fact they then' generate their poison with greater energy and rapidity than when cultiva~ ted in the ordinary methods., permitting of the But >vith this the fact that the access of air. choleraic process in the human subject and guinea-pigs is carried out auaerobically in the iutestines acquires a conclusive chemio-biolor
gical explanation. these
The reducing properties of have gradually conae tQ
bacteria, which
Aug.
1890.]
HUEPPE ON CHOLERA.
be recognised, furnish an additional support to this. Any one who desires to form any conclusions of an etiological or therapeutic nature in regard to the behaviour of choleraic bacteria in the human subject from experiments on cultivations or ou the lower animals, must, at the outset, furnish evidence that he has taken into account the outstanding phenomenon of the anaerobiosis of the choleraic parasites iu the human subject, and has considered the secretions and the enzyme in the form in which they are present in the living subject. As, however, unsolved problems were percropping up in the existent state ol
petually general physiological questions, "Wood specially investigated the relations between enzymes
and protoplasmic action in bacteria, which live both where air gains access and where it is excluded, and which can be influenced at will, in certain well-known species such as bacillus anthracis and its vaccini varieties, choleraic bacilli, micrococcus iudicus, micrococcus prodigiosus, bacillus pyocyanogenus. Compare " Enzyme action in lower organisms" in pr?ceedings of the Roy. Soc., Vol. XVI, and " Reports from the Laboratory of the Royal College of Physicians, Edinburgh," Vol. II-> 1890, pp. 253, 275. I had previously often observed, iu testing the reactiou of the intestines of cholerised guinea-pigs, that the acidity in the ascum was frequently so slight that choleraic bacteria could readily withstand a greater degree than that actually present. With regard to the observation that choleraic bacteria are incapable of survival beyond the cajcum, of which I have only encountered a siugle exceptional case, Koch's explanation?that it is the acidity of the is caecum that determines their destruction therefore insufficient for all cases; and there must be other factors at work of more general importance than acids. Wood has now ascertained it to be a general fact that bacteria capable of anaerobic existence are much more susceptible to the action of external influences when in the anaerobic than when in the aerobic condition ; and he was able to trace this unequivocally to the influence of membraue-formatiou connected with the alteration in the nutritional processes of the bacteria when living apart from atmospheric oxygen. The novel fact which has just been referred to, that choleraic bacteria in the intestine during and due to their anaerobic existence develope toxine both more rapidly and in larger amount than when external to it, and are therefore so dangerous to those attacked, is now ?
supplemented by a second fundamental physiological fact, that, when in the anaerobic condition within the intestine, they are, in spite of their
increased
physiological activity,
more
233
susceptible to the action of external influences. Pancreatin has no influence on any of these relations connected with anaetobiosis ; it neither increases the toxic or the toxogenic power of the bacteria, nor prevents their development. As a result of their anaerobic existence, whilst in the intestinal tract choleraic bacteria are thus in a condition of depressed resistance to the action of external influences, but they are neither rendered incapable nor less capable of multiplication, or incapable of action, they become specially susceptible to the action of acids, so that mere traces of the latter suffice to destroy them. In this state, which is that in which they leave the iutestine and occur in the recent evacuations of the sick, they are easier destroyed than in auy other condition. In order to satisfy a practical indicatio causalis, I fouuded a method of individual etiological treatment on these two fundamental facts, and on the existence of two distinct First, those which traverse groups of bodies. the stomach unaltered and first come into action in the alkaline intestinal fluids; and second, those which pass through the stomach unaltered, but which are resolved into their active constituents by the intestinal secretions; and in order to carry out the method, I recommended salol among other bodies as worthy of experimental trial iu the first rank, and this quite independent of Sulili's general recommendation, and of Lowenthal, who was aware of both our previous recommendations of it, and who recommended it 011 wholly incorrectly interpreted and insufficient investigations., I must here point out that, in so far as I am concerned, the etiological method is the great thing, and salol merely the most suitable body as yet attainable for effecting an internal, possibly specific, disinfection against cholera. The Indian results with which I am as yet acquainted, and regarding which I shall subsequently report when the number of experiments is greater, are as yet so universally and uncommonly favourable that my etiological method, including perhaps salol as a medium, ought to form the future basis for the treatment of cases of cholera. The great susceptibility of the choleraic bacteria in the condition in which they are present in the fresh evacuations, is also very important in relation to the disinfection of the dejecta of choleraic patients, and renders it doubly incumbent that it should, where possible, be carried out generally and vigorously, when once this period is past, the bacteria outside the body normally pass into a condition of greater resisting power to the influence of external ao-ents. Due to auaerobiosis, a may frequently arise in effecting the diagnosis of cholera by means of demonstration of the nresence of comma-bacilli. Wood was, at will,
because,
difficulty
31
234
THE INDIAN MEDICAL GAZETTE.
f Aug. 1890.
In the outer world the soil is of most interest able to influence the characteristic nature of the to us in this respect, because bacteriology has in Koch far described so growth gelatine by that he had cultivations which liquified gelatine to recognise and explain the epidemiological as quickly and as little characteristically as the phenomenon of the association of epidemics of Prior-Finkler comma-bacillus, and others which cholera with locality and season, without at the same time hushing up or prejudicially rewere no longer capable of liquifying gelatine at all. Anaerobiosis as well in artificial cultivations presenting certain exceptions as impossibilities. "We are here dealing with the weightiest of as in the intestine tends to depress the capacity for liquifying gelatine, so that many choleraic epidemiological experiences, and I believe that bacteria may be overlooked in diagnostic cul- on the basis of my own and my scholar's observations, we can, on the whole, now form a better tivations due to the absence of Koch's funnel. more satisfactory conception of them. and into facts account, we have Taking these new That soil-conditions in relation to temperature further an immediate scientific explanation of the the requisites for the existence of bacteria previously enigmatic phenomenon, that cholera furnish been has so seldom is only directly demonstrated by C. Fraenkel propagated contagiously the for from the sick to strata, and that, under certain the The upper directly Pettenkoferian explanation that the bacteria of circumstauces, choleraic bacteria can withstand the body are in a condition in which they are association with other saprophytes has been incapable of infecting is, as it stands, incorrect. shown by Schottelius and Gruber, a fact which They are, on the contrary, very infective, and in I have myself observed in respect to 11011the condition in which they are most toxoo-enic. sterilised water and soil. The fact ascertained by myself, by Wood, By transferring them from animal to animal and by Holscheunikoff, that choleraic bacteria with evasion or paralysis of the gastric juice, J have ascertained that a much smaller quantity and many other microbes capable of anaerobic of the anaerobic, iutestiually developed bacteria existence are, when anaerobic, extraordinarily is necessary to cause infection than when the capricious in respect to the quality of their aerobic ones of artificial cultivations are employ- nutritive media, which they can then only break up by means of direct decomposition in order ed. But the choleraic bacteria, as the result to obtain their requisite energy, is connected within the intesof their anaerobic condition this subject. In the aerobic condition the with so a condition in the tiues, leave body susceptible same species are much less susceptible, because to the action of external influences, that they they are then able to develop the same energy must almost inevitably be destroyed by the from transferred wheu one by means of direct oxidation of less valuable directly gastric juice The possibility of oxidation?the animal to another. Direct communication of the materials. condition?renders the utilisation of aerobic disease must, therefore, be purely exceptional. which would not otherwise be These choleraic bacteria, which are for the materials possible, to provide for the multiplication and time being so susceptible, very rapidly become adapted of the species. But the aorobiosis maintenance more resistant when enabled to multiply outincreases the directly also sufficient capacity to resist in suitable and nutritive the side body external influences according to Wood's obsermaterial. Even the conditions under which, to its action in the formation of according to Koch's observations, they are able vations owingOn both these membrane. sick grounds choleraic in the the linen of to multiply aerobically bacteria are more resistant when in the outer at the expense of the serious fluids excreted than when in the body, or in our artificial along with them must be taken into account in world with their narrowly limited condicultivations and that so the most efficient this respect, rapid I tions. have, moreover, further demonstrated treatment of the linen is au absolute desideraunder these conditions and a sufficient similar that, A aerobic tum in choleraic therapeutics. the peculiar resistance connected of bacteria occur temperature, choleraic may multiplication with sporogenesis is developed, having directly even in the evacuations themselves when disinobserved the formation of arthrosporic zooglasa fection is omitted, as the other saprophytes to take place. to do Schottelius' in them not, according present I shall not here discuss the question of the and Gruber's observations, invariably and certainly secure their destruction. Aerobic multi- arthrospores, but content m)-self with remarking in plication will most efficiently make for the that one of our most competent botanists such at who one is the present only transport of the germs and the diffusion of matters, Klein, epidemics, if the proper and easy destruction of correctly interprets the standpoint which Colin de Bary and I the bacteria is not attempted or attained in the originally took up, and which sick-bed and chamber and an uncontrollable subsequently developed. My opponents move in diffusion into the outer world be the result?a a noteworthy circle in dealing with this subject. diffusion which can never be absolutely provided At first it was maintained that arthrospores against, and which has already occurred in were possibly veryforinteresting to botanists, but of 110 importance hygienists and patholoBengal, the native laud of cholera in India.
healthy?
Aug.
HUEPPE ON CHOLERA.
1890.]
gists,
with
importance for them lying in spores I capacity for duration. M. Gruber has
all a
ascertained that the previously undetected power of duration may be present in them, or, in other words, that they may play the part of true resting spores ; and indeed, in my opinion, from the analogy of other observations on putrefaction, it is probably present very frequently and strongly pronounced under natural conditions in the outer world, and that it is precisely in this that arthrospores play a ?reat and conspicuous part. My long-contested assertions of their high resistance to drying have at length been confirmed bv Berckholtz, who under Gaffky's instance and direction specially tested the point, and have been extended considerably, which is the more noteworthy, as Gaffky formerly along with Koch directly contested my statements. Now, however, when the increased capacity for resistance can no longer be denied, the unpleasant fact is softened off by the interpretation that it is due to zooglcea formation, and not to the presence of any resting spores. As, however, this has certainly not been demonstrated by Berckholtz, not a single one of his facts conflicts with my observations, whilst I have directly observed and demonstrated the arthrosporic zooglrea, and therefore hold that my statements are absolutely correct. Were it not that there are in reality all degrees in the power of resisting external ageucies, such as chemicals, drying, and putrefaction, one might distinguish' three; the minimum occurring in au aerobic existence, the mean in the vegetative form of aerobic life increasing with the age or the cultivation and the intensity of zoogltea formation, and the maximum being present in the case of arthrosporic zooglaia formation. It is probable, as I have from the outset indicated, on the analogy of the behaviour of bacteria during the drying-up of swamps, that in nature, on the drying up of accumulations of water and the diminution of the soil-moisture, there is much greater opportunity for the formation of arthrosporic zoogtaa than in artificial cultivations. As the requisite proof of the existence of the resting conditions has now been satisfactorily supplied, I am now able to go further and to maintain that, if exposed to suitable external conditions permitting of aerobic growth, the vegetative anaerobic form highly susceptible in the feces of choleraic patients devepresent forms. The external conditions lopes resistant do not determine any special ripening of the now
parasites as^ Pettenkofer conjectured ground of epidemiological experiences ; they do?not act by converting inactive into the
choleraic on
the
active
parasites.
On
contrary,
a
very probacteria under such longed existence of the conditions is specially adapted to diminish their toxogenic aud infective power. But if such aerobic forms, which ave more resistant to the
235
action of external influences, including acids, attain access to the stomach, the chances of their surviving gastric influences and reaching the intestinal tract rises in proportion to their increased resistance, so that now the vicious circle is strikingly simple and biologically clear. The epidemiological experience, on which Pettenkofer has justly insisted on layiug so much stress, that, as a rule, the infective power of the choleraic virus is influenced by external agencies?-that, as a rule, choleraic infection is indirect and determined by external influences?has in fact found a corroboration in bacteriology, although the explanation is not that proposed by Pettenkofer and is in part directly opposed to it. Among these external conditions, the epidemiological phenomenon of dependence on the soil is of the greatest importance, and for the estimation of this Pettenkofer has ascertained that in many places the fluctuations in the soilwater furnish a useful and suitable index. The soil-water in itself is of no import save as an index to the water-content?to the decrease or increase of moisture?of the overlying strata of soil in which the processes of decomposition and the multiplication of choleraic bacteria go on. The epidemiological observation, that with depression of the soil-water, that is with diminution in the moisture of the upper strata of the soil, the danger of cholera rises, and that with increase in the moisture of the upper strata of the soil it diminishes, is so well established, as a rule, that it must be susceptible to an exact bacteriological explanation. This observation is also in keeping with the doctrine that periods of drought are more favourable to the diffusion of soil diseases than periods of moisture, and both together justify and attempt at an explanation such as I have founded on certain experimental data. Given certain conditions of temperature, which are present at certain periods of every year, along with sufficient and suitable nutritive material, and choleraic bacteria can certainly multiply in the soil in spite of being associated with other saprophytes. Owing to the great susceptibility of the choleraic bacteria in an aerobic growth, this would seem to be possible, or at all events probable, in the soil only as the result of aerobic growth, and these only in association with excess of nutritive material. On the other hand, aerobically developed and otherwise resistant choleraic germs will be most certainly preserved by the exclusion of air precisely in association with and
qualitatively
quantitatively insufficient nutritive material permitting of: their anaerobic growth.
not
the must be the of the importance of fluctuations in the soil-water as established by ation. Let it be assumed that choleraic
or drink, or whether they may not primabe taken up with the air and from it enter tiie saliva and only by this circuitous route finally reach the gastric cavity. The biology of the choleraic bacteria does not allow a decision to be arrived at exclusively in favour of either of these possibilities. Choleraic bacteria are capable of living in liquids, and can thus reach the mouth directly ; but they may also be eventually diffused by evaporation, and thus come to be inhaled. Moreover, even in a dry condition, they are, under certain circumstances, capable of retaining their vitality for prolonged periods, as I have maintained for some years, and as Berkholtz has at length recently determined. Dry but capable of development they may be inhaled, and then either reach the lungs directly or reach the stomach through the intervention of the saliva. In the latter case, in spite of their access by means of respiration, they will reach the intestinal tract directly and multiply there primarily; in the former case, when taken up by the pulmouary surface, their localisation within the intestiual tract can only occur second-* arily. Without putting the possibility of this entirely aside in regard to infection of the human subject, the experiments which have recently been carried out in regard to the results following inhalation of bacteria have not tended to induce belief in its occurrence, as up to the present time 110 success has attended attempts at causing infection through the lungs by such as are capable of living iu the blood parasitesThe choleraic bacteria are, moreover, itself. judging fromin their behaviour in the human guineaTpigs, not blood parasites, subject and and this, iu the meautime, venders it most pro? bable that, whether inhaled from moist or dry substrata, they constantly reach the stomach primarily and pass thence into the intestines, where they are able to germinate and multiply. Iu consequence of the above facts and pro-? babilities, which offer no insuperable contradictions to epidemiological facts and indication, it is essential to examine all the relations of choleraic bacteria to the stomach and intestines
rily
ON THE ETIOLOGY OF ASIATIC CHOLERA. A
REPORT FURNISHED TO THE GERMAN MEDICAL SOCIETY OP PRAGUE. By PROF. FERDINAND HUEPPE.
In the following pages I propose to give a brief accouiit of certain investigations which I have carried out during the past few years in regard to the parasite of cholera, and which, specially through the work of Dr. G. E. C. Wood, have so far attained completion as to render it possible to regard certain of the old controversies between contagio-bacteriological and the older miasmatico-epidemiological doctrines as at length in a moribund condition. The result of my own investigations along with those first of Dr. Lustig (now Professor of Pathology in Cayliari) and later of Dr. Wood of Edinburgh, both in association with him aud subsequently in further independent investigations carried out in accordance with suggestions of mine, is to confirm Enoch's statement that the choleraic process takes place solely within the intestinal tract, and that cholera must be regarded as a specific intestinal putrefaction with the formation of specific toxic material. The loss of water aud denudation of the intestinal mucous membraue, important though they be in
symptomatology,
are
mere
secondary
matters
from an etiological point of view. The localisation of the cholera process in the intestinal tract, according to our observations, in accordance with similar results of H. Buchner and D. D. Cuuuingham, follows not merely on reception of the parasite via the mouth, but also as a secondary localisation in it as the poiut of least resistance, when the introduction of the virus and the infection of the organism have been effected by means of other channels. Natural infection of the human subject,?and here for a moment I leave the region of facts which have as yet been dealt with experimentally,?must in greater part,if not solely, occur as the result of the parasite traversing the stomach and so reaching the intestinal tract directly. At the same time it must be regarded j*s qn entirely open question whether the choleraic bacteria invariably aud solely arrive in the gtocfl^ch directly fyom the mouth, aud only with
and their secretions. In connection with this it has been demonstrated as a fundamental fact that, in spite of the earlier statements, choleraic bacteria are, iu a suitably selected substratum, capable of living when excluded from air, or, iu other words, in the absence of free oxygen, and that iu fact they then' generate their poison with greater energy and rapidity than when cultiva~ ted in the ordinary methods., permitting of the But >vith this the fact that the access of air. choleraic process in the human subject and guinea-pigs is carried out auaerobically in the iutestines acquires a conclusive chemio-biolor
gical explanation. these
The reducing properties of have gradually conae tQ
bacteria, which
Aug.
1890.]
HUEPPE ON CHOLERA.
be recognised, furnish an additional support to this. Any one who desires to form any conclusions of an etiological or therapeutic nature in regard to the behaviour of choleraic bacteria in the human subject from experiments on cultivations or ou the lower animals, must, at the outset, furnish evidence that he has taken into account the outstanding phenomenon of the anaerobiosis of the choleraic parasites iu the human subject, and has considered the secretions and the enzyme in the form in which they are present in the living subject. As, however, unsolved problems were percropping up in the existent state ol
petually general physiological questions, "Wood specially investigated the relations between enzymes
and protoplasmic action in bacteria, which live both where air gains access and where it is excluded, and which can be influenced at will, in certain well-known species such as bacillus anthracis and its vaccini varieties, choleraic bacilli, micrococcus iudicus, micrococcus prodigiosus, bacillus pyocyanogenus. Compare " Enzyme action in lower organisms" in pr?ceedings of the Roy. Soc., Vol. XVI, and " Reports from the Laboratory of the Royal College of Physicians, Edinburgh," Vol. II-> 1890, pp. 253, 275. I had previously often observed, iu testing the reactiou of the intestines of cholerised guinea-pigs, that the acidity in the ascum was frequently so slight that choleraic bacteria could readily withstand a greater degree than that actually present. With regard to the observation that choleraic bacteria are incapable of survival beyond the cajcum, of which I have only encountered a siugle exceptional case, Koch's explanation?that it is the acidity of the is caecum that determines their destruction therefore insufficient for all cases; and there must be other factors at work of more general importance than acids. Wood has now ascertained it to be a general fact that bacteria capable of anaerobic existence are much more susceptible to the action of external influences when in the anaerobic than when in the aerobic condition ; and he was able to trace this unequivocally to the influence of membraue-formatiou connected with the alteration in the nutritional processes of the bacteria when living apart from atmospheric oxygen. The novel fact which has just been referred to, that choleraic bacteria in the intestine during and due to their anaerobic existence develope toxine both more rapidly and in larger amount than when external to it, and are therefore so dangerous to those attacked, is now ?
supplemented by a second fundamental physiological fact, that, when in the anaerobic condition within the intestine, they are, in spite of their
increased
physiological activity,
more
233
susceptible to the action of external influences. Pancreatin has no influence on any of these relations connected with anaetobiosis ; it neither increases the toxic or the toxogenic power of the bacteria, nor prevents their development. As a result of their anaerobic existence, whilst in the intestinal tract choleraic bacteria are thus in a condition of depressed resistance to the action of external influences, but they are neither rendered incapable nor less capable of multiplication, or incapable of action, they become specially susceptible to the action of acids, so that mere traces of the latter suffice to destroy them. In this state, which is that in which they leave the iutestine and occur in the recent evacuations of the sick, they are easier destroyed than in auy other condition. In order to satisfy a practical indicatio causalis, I fouuded a method of individual etiological treatment on these two fundamental facts, and on the existence of two distinct First, those which traverse groups of bodies. the stomach unaltered and first come into action in the alkaline intestinal fluids; and second, those which pass through the stomach unaltered, but which are resolved into their active constituents by the intestinal secretions; and in order to carry out the method, I recommended salol among other bodies as worthy of experimental trial iu the first rank, and this quite independent of Sulili's general recommendation, and of Lowenthal, who was aware of both our previous recommendations of it, and who recommended it 011 wholly incorrectly interpreted and insufficient investigations., I must here point out that, in so far as I am concerned, the etiological method is the great thing, and salol merely the most suitable body as yet attainable for effecting an internal, possibly specific, disinfection against cholera. The Indian results with which I am as yet acquainted, and regarding which I shall subsequently report when the number of experiments is greater, are as yet so universally and uncommonly favourable that my etiological method, including perhaps salol as a medium, ought to form the future basis for the treatment of cases of cholera. The great susceptibility of the choleraic bacteria in the condition in which they are present in the fresh evacuations, is also very important in relation to the disinfection of the dejecta of choleraic patients, and renders it doubly incumbent that it should, where possible, be carried out generally and vigorously, when once this period is past, the bacteria outside the body normally pass into a condition of greater resisting power to the influence of external ao-ents. Due to auaerobiosis, a may frequently arise in effecting the diagnosis of cholera by means of demonstration of the nresence of comma-bacilli. Wood was, at will,
because,
difficulty
31
234
THE INDIAN MEDICAL GAZETTE.
f Aug. 1890.
In the outer world the soil is of most interest able to influence the characteristic nature of the to us in this respect, because bacteriology has in Koch far described so growth gelatine by that he had cultivations which liquified gelatine to recognise and explain the epidemiological as quickly and as little characteristically as the phenomenon of the association of epidemics of Prior-Finkler comma-bacillus, and others which cholera with locality and season, without at the same time hushing up or prejudicially rewere no longer capable of liquifying gelatine at all. Anaerobiosis as well in artificial cultivations presenting certain exceptions as impossibilities. "We are here dealing with the weightiest of as in the intestine tends to depress the capacity for liquifying gelatine, so that many choleraic epidemiological experiences, and I believe that bacteria may be overlooked in diagnostic cul- on the basis of my own and my scholar's observations, we can, on the whole, now form a better tivations due to the absence of Koch's funnel. more satisfactory conception of them. and into facts account, we have Taking these new That soil-conditions in relation to temperature further an immediate scientific explanation of the the requisites for the existence of bacteria previously enigmatic phenomenon, that cholera furnish been has so seldom is only directly demonstrated by C. Fraenkel propagated contagiously the for from the sick to strata, and that, under certain the The upper directly Pettenkoferian explanation that the bacteria of circumstauces, choleraic bacteria can withstand the body are in a condition in which they are association with other saprophytes has been incapable of infecting is, as it stands, incorrect. shown by Schottelius and Gruber, a fact which They are, on the contrary, very infective, and in I have myself observed in respect to 11011the condition in which they are most toxoo-enic. sterilised water and soil. The fact ascertained by myself, by Wood, By transferring them from animal to animal and by Holscheunikoff, that choleraic bacteria with evasion or paralysis of the gastric juice, J have ascertained that a much smaller quantity and many other microbes capable of anaerobic of the anaerobic, iutestiually developed bacteria existence are, when anaerobic, extraordinarily is necessary to cause infection than when the capricious in respect to the quality of their aerobic ones of artificial cultivations are employ- nutritive media, which they can then only break up by means of direct decomposition in order ed. But the choleraic bacteria, as the result to obtain their requisite energy, is connected within the intesof their anaerobic condition this subject. In the aerobic condition the with so a condition in the tiues, leave body susceptible same species are much less susceptible, because to the action of external influences, that they they are then able to develop the same energy must almost inevitably be destroyed by the from transferred wheu one by means of direct oxidation of less valuable directly gastric juice The possibility of oxidation?the animal to another. Direct communication of the materials. condition?renders the utilisation of aerobic disease must, therefore, be purely exceptional. which would not otherwise be These choleraic bacteria, which are for the materials possible, to provide for the multiplication and time being so susceptible, very rapidly become adapted of the species. But the aorobiosis maintenance more resistant when enabled to multiply outincreases the directly also sufficient capacity to resist in suitable and nutritive the side body external influences according to Wood's obsermaterial. Even the conditions under which, to its action in the formation of according to Koch's observations, they are able vations owingOn both these membrane. sick grounds choleraic in the the linen of to multiply aerobically bacteria are more resistant when in the outer at the expense of the serious fluids excreted than when in the body, or in our artificial along with them must be taken into account in world with their narrowly limited condicultivations and that so the most efficient this respect, rapid I tions. have, moreover, further demonstrated treatment of the linen is au absolute desideraunder these conditions and a sufficient similar that, A aerobic tum in choleraic therapeutics. the peculiar resistance connected of bacteria occur temperature, choleraic may multiplication with sporogenesis is developed, having directly even in the evacuations themselves when disinobserved the formation of arthrosporic zooglasa fection is omitted, as the other saprophytes to take place. to do Schottelius' in them not, according present I shall not here discuss the question of the and Gruber's observations, invariably and certainly secure their destruction. Aerobic multi- arthrospores, but content m)-self with remarking in plication will most efficiently make for the that one of our most competent botanists such at who one is the present only transport of the germs and the diffusion of matters, Klein, epidemics, if the proper and easy destruction of correctly interprets the standpoint which Colin de Bary and I the bacteria is not attempted or attained in the originally took up, and which sick-bed and chamber and an uncontrollable subsequently developed. My opponents move in diffusion into the outer world be the result?a a noteworthy circle in dealing with this subject. diffusion which can never be absolutely provided At first it was maintained that arthrospores against, and which has already occurred in were possibly veryforinteresting to botanists, but of 110 importance hygienists and patholoBengal, the native laud of cholera in India.
healthy?
Aug.
HUEPPE ON CHOLERA.
1890.]
gists,
with
importance for them lying in spores I capacity for duration. M. Gruber has
all a
ascertained that the previously undetected power of duration may be present in them, or, in other words, that they may play the part of true resting spores ; and indeed, in my opinion, from the analogy of other observations on putrefaction, it is probably present very frequently and strongly pronounced under natural conditions in the outer world, and that it is precisely in this that arthrospores play a ?reat and conspicuous part. My long-contested assertions of their high resistance to drying have at length been confirmed bv Berckholtz, who under Gaffky's instance and direction specially tested the point, and have been extended considerably, which is the more noteworthy, as Gaffky formerly along with Koch directly contested my statements. Now, however, when the increased capacity for resistance can no longer be denied, the unpleasant fact is softened off by the interpretation that it is due to zooglcea formation, and not to the presence of any resting spores. As, however, this has certainly not been demonstrated by Berckholtz, not a single one of his facts conflicts with my observations, whilst I have directly observed and demonstrated the arthrosporic zooglrea, and therefore hold that my statements are absolutely correct. Were it not that there are in reality all degrees in the power of resisting external ageucies, such as chemicals, drying, and putrefaction, one might distinguish' three; the minimum occurring in au aerobic existence, the mean in the vegetative form of aerobic life increasing with the age or the cultivation and the intensity of zoogltea formation, and the maximum being present in the case of arthrosporic zooglaia formation. It is probable, as I have from the outset indicated, on the analogy of the behaviour of bacteria during the drying-up of swamps, that in nature, on the drying up of accumulations of water and the diminution of the soil-moisture, there is much greater opportunity for the formation of arthrosporic zoogtaa than in artificial cultivations. As the requisite proof of the existence of the resting conditions has now been satisfactorily supplied, I am now able to go further and to maintain that, if exposed to suitable external conditions permitting of aerobic growth, the vegetative anaerobic form highly susceptible in the feces of choleraic patients devepresent forms. The external conditions lopes resistant do not determine any special ripening of the now
parasites as^ Pettenkofer conjectured ground of epidemiological experiences ; they do?not act by converting inactive into the
choleraic on
the
active
parasites.
On
contrary,
a
very probacteria under such longed existence of the conditions is specially adapted to diminish their toxogenic aud infective power. But if such aerobic forms, which ave more resistant to the
235
action of external influences, including acids, attain access to the stomach, the chances of their surviving gastric influences and reaching the intestinal tract rises in proportion to their increased resistance, so that now the vicious circle is strikingly simple and biologically clear. The epidemiological experience, on which Pettenkofer has justly insisted on layiug so much stress, that, as a rule, the infective power of the choleraic virus is influenced by external agencies?-that, as a rule, choleraic infection is indirect and determined by external influences?has in fact found a corroboration in bacteriology, although the explanation is not that proposed by Pettenkofer and is in part directly opposed to it. Among these external conditions, the epidemiological phenomenon of dependence on the soil is of the greatest importance, and for the estimation of this Pettenkofer has ascertained that in many places the fluctuations in the soilwater furnish a useful and suitable index. The soil-water in itself is of no import save as an index to the water-content?to the decrease or increase of moisture?of the overlying strata of soil in which the processes of decomposition and the multiplication of choleraic bacteria go on. The epidemiological observation, that with depression of the soil-water, that is with diminution in the moisture of the upper strata of the soil, the danger of cholera rises, and that with increase in the moisture of the upper strata of the soil it diminishes, is so well established, as a rule, that it must be susceptible to an exact bacteriological explanation. This observation is also in keeping with the doctrine that periods of drought are more favourable to the diffusion of soil diseases than periods of moisture, and both together justify and attempt at an explanation such as I have founded on certain experimental data. Given certain conditions of temperature, which are present at certain periods of every year, along with sufficient and suitable nutritive material, and choleraic bacteria can certainly multiply in the soil in spite of being associated with other saprophytes. Owing to the great susceptibility of the choleraic bacteria in an aerobic growth, this would seem to be possible, or at all events probable, in the soil only as the result of aerobic growth, and these only in association with excess of nutritive material. On the other hand, aerobically developed and otherwise resistant choleraic germs will be most certainly preserved by the exclusion of air precisely in association with and
qualitatively
quantitatively insufficient nutritive material permitting of: their anaerobic growth.
not
the must be the of the importance of fluctuations in the soil-water as established by ation. Let it be assumed that choleraic
