Bacteria / Especially as they are related to the economy of nature, to industrial processes, and to the public health

by Sir George Newman

5. The Respiratory Tract: Air. The air may become infected with germs of disease from dusty trades, dried sputum, etc. If such infected air be inhaled, pathogenic results will follow, especially if the bacteria are present in sufficient numbers, or meet with devitalised, and therefore non-resisting, tissues.

These, then, are the five possible ways in which germs gain access to the body tissues. The question now arises, How do bacteria, having obtained entrance, set up the process of disease? For a long time pathologists looked upon the action of these microscopic parasites in the body as similar to, if not identical with, the larger parasites sometimes infesting the human body. Their work was viewed as a devouring of the tissues of the body. Now, it is well known that, however much or little of this may be done, the specific action of pathogenic bacteria is of a different nature. It is twofold. We have the action of the bacteria themselves, and also of their products or toxins. In particular diseases, now one and now the other property comes to the front. In bacterial diseases affecting or being transmitted mostly by the blood, it is the toxins which act chiefly. The convenient term infection is applied to those conditions in which there has been a multiplication of living organisms after they have entered the body, the word intoxication indicating a condition of poisoning brought about by their products. It will be apparent at once that we may have both these conditions present, the former before the latter, and the latter following as a direct effect of the former. Until intoxication occurs there may be few or no symptoms, but directly enough bacteria are present to produce in the body certain poisons in sufficient amount to result in more or less marked tissue change, then the symptoms of that tissue change appear. This period of latency between infection and the appearance of the disease is known as the incubation period. Take typhoid, for example. A man drinks a typhoid-polluted water. For about fourteen days the bacilli are making headway in his body without his being aware of it. But at the end of that incubation period the signs of the disease assert themselves. Professor Watson Cheyne and others have maintained that there is some exact proportion between the number of bacteria gaining entrance and the length of the incubation period.

Speaking generally, we may note that pathogenic bacteria divide themselves into two groups: those which, on entering the body, pass at once, by the lymph or blood stream, to all parts of the body, and become more and more diffused throughout the blood and tissues, although in some cases they settle down in some spot remote from the point of entrance, and produce their chief lesions there. Tubercle and anthrax would be types of this group. On the other hand, there is a second group, which remain almost absolutely local, producing only little reaction around them, never passing through the body generally, and yet influencing the whole body eventually by means of their ferments or toxins. Of such the best representatives are tetanus and diphtheria. The local site of the bacteria is, in this case, the local manufactory of the disease.

Whilst the mere bodily presence of bacteria may have mechanical influence injurious to the tissues (as in the small peripheral capillaries in anthrax), or may in some way act as a foreign body and be a focus of inflammation (as in tubercle), the real disease-producing action of pathogenic bacteria depends upon the chemical poisons (toxins) formed directly or indirectly by them. Though within recent years a great deal of knowledge has been acquired about the formation of these bodies, their exact nature is not known. They are allied to albuminous bodies and proteoses, and are frequently described as tox-albumens. It may be found, after all, that they are not of a proteid nature. Sidney Martin has pointed out that there is much that is analogous between the production of toxins and the production of the bodies of digestion. Just as ferments are necessary in the intestine to bring about a change in the food by which the non-soluble albumens shall be made into soluble peptones and thus become absorbed through the intestinal wall, so also a ferment may be necessary to the production of toxins. Such ferments have not as yet been isolated, but their existence in diphtheria and tetanus is, as we have seen, extremely likely. However that may be, it is now more or less established that there are two kinds of toxic bodies, differing from each other in their resistance to heat. It may be that the one most easily destroyed by heat is a ferment and possibly an originator of the other. A second division which has been suggested for toxic bodies, and to which reference has been made, is intracellular and extracellular, according to whether or not the poison exists within or without the body of the bacillus.

Lastly, we may turn to consider the action of the toxins on the individual in whose body-fluids they are formed. It is hardly necessary to say that any action which bacteria or toxins may have will depend upon their virulence, in some measure upon their number, and not a little upon the channel of infection by which they have gained entrance. It could not be otherwise. If the virulence is attenuated, or if the invasion is very limited in numbers, it stands to reason that the pathogenic effects will be correspondingly small or absent. The influence of the toxins is twofold. In the first place (i.) they act locally upon the tissues at the site of their formation, or at distant points by absorption. There is inflammation with marked cell-proliferation, and this is, more or less rapidly, followed by a specific cell-poisoning. The former change may be accompanied by exudation, and simulate the early stages of abscess formation; the latter is the specific effect, and results, as in leprosy and tubercle, in infective nodules. The site in some diseases, like typhoid (intestinal ulceration, splenic and mesenteric change) or diphtheria (membrane in the throat), may be definite and always the same. But, on the other hand, the site may depend upon the point of entrance, as in tetanus. The distant effects of the toxin are due to absorption, but what controls its action it is impossible to say. We only know that we do find pathological conditions in certain organs at a distance and without the presence of bacteria. We have a parallel in the action of drugs; for example, a drug may be given by the mouth and yet produce a rash in some distant part of the body. In the second place (ii.) toxins produce toxic symptoms. Fever and many of the nervous conditions resulting from bacterial action must thus be classified. We have, it is true, the chemical symptoms of the pathological tissue change, for example, the large spleen of anthrax or the obstruction from diphtheritic membrane. But, in addition to these, we have general symptoms, as fever, in which after death no tissue change can be formed.

We may now consider briefly some of the more important types of disease produced by bacteria:

1. Tuberculosis.[90] As far back as 1794 Baillie drew attention to the grey miliary nodules occurring in tuberculous tissue which gave rise to the term "tubercles." This preliminary matter was confirmed by Bayle in 1810.

In 1834 Laennec described all caseous deposits as "tubercles," insisting upon four varieties:

(1) Miliary, which were about the size of millet seeds, and in groups;

(2) Crude, miliary tubercles in yellow masses;