4. A solution of per-chloride of mercury does not kill the tubercle bacilli, as it does sporeless bacilli (Lingard and Klein).
Koch and many bacteriologists have declared the bacillus to be a "true parasite." Koch based this view upon the belief which he entertained that the bacillus can grow only between 30° C. and 41° C., and therefore in temperate zones is limited to the animal body and can originate only in an animal organism. "They are," he said, "true parasites, which cannot live without their hosts. They pass through the whole cycle of their existence in the body." But at length Koch and others overcame the difficulties and grew the bacillus as a saprophyte.
Schottelius[92] has observed that tubercle bacilli taken from the lung of phthisical persons buried for years still retains its virulence and capability of producing tuberculosis upon inoculation. He further shows that tubercular lung kept in soil (enclosed in a box) shows a marked rise in temperature. Klein quotes these experiments as indications that "tubercle bacilli are not true parasites, but belong to the ectogenic microbes which can live and thrive independent of a living host."
It has now been abundantly proved that the bacillus of tuberculosis is capable of accommodating itself to circumstances much less favourable than had been supposed, especially as regards temperature.
Temperature of Growth of Bacillus. 30–41° C. have been laid down by Koch as the limits of temperature at which the bacillus will grow in culture medium outside the body. The generally accepted temperatures as most favourable to the growth of the bacillus are between 36° C. and 38° C.
Sir Hugh Beevor, however, was able to grow the bacillus upon glycerine agar at 28° C. (82° F.), obtaining an ample culture which developed somewhat more slowly than on blood serum, and to a less extent than at 37° C. In both Beevor succeeded in growing the bacillus at a lower temperature even than on agar, viz., at a temperature rarely above 60° F. Sheridan Delépine and others have also been successful in obtaining growths at room temperature both in summer and winter.
Although, speaking generally, there is an actual cessation of growth at low temperature, the bacillus may be exposed to very low temperatures for a considerable time without losing its power of again becoming active when returned to a favourable environment (Woodhead).
The Relation of the Bacillus to the Disease. All four of Koch's postulates have been fulfilled in the case of Bacillus tuberculosis. Hence we are dealing with the specific cause of the disease. Yet, whilst this is so, we may usefully ask ourselves: How does the bacillus set up the changes in normal tissues which result in tubercular nodules? In arriving at a solution of this problem we are materially aided if we bear in mind the fact that such an organism in healthy tissues has a double effect. First, there is an ordinary inflammatory irritation, and secondly, there is a specific change set up by the toxins of the bacillus. Directly the invading bacilli find themselves in a favourable nidus they commence multiplication. In three or four days this acts as an irritant upon the surrounding connective-tissue cells, which proliferate, and become changed into large cells known as epithelioid cells. At the periphery of this collection of epithelioid cells we have a congested area. This change has been accomplished by the presence of the bacilli themselves. The production of their specific poisons changes the epithelioid cells in the centre of the nodule, some of which become fused together, whilst others expand and undergo division of nucleus. By this means we obtain a series of large multi-nucleated cells named giant cells. If the disease is very active, these soon caseate and break down in the centre. In a limb we get a discharge; in a lung we get an expectoration. Both discharge and expectoration arise from a breaking down of the new cell formation. Previously to breaking down we have in a fully developed nodule healthy tissue, inflammatory zone, epithelioid cells, giant cells, containing nuclei and bacilli. The sputum or the discharge will, during the acute stage of the disease at all events, contain countless numbers of the bacilli, which may thus be readily detected, and their presence used as evidence of the disease. It is obvious that if the centre of the nodule degenerates and comes away as discharge a cavity will be left behind. By degrees this small cavity may become a very large one, as is frequently the case in the lung, which particularly lends itself to such a condition. Hence, though at the outset a tubercular lung is solid, at the end it is hollow.
| Bacillus Tuberculosis (In sputum from a case of phthisis, "consumption" of the lungs) × 1000 By permission of the Scientific Press, Limited | Bacillus Tuberculosis (The bacilli are arranged within the giant cell) × 1000 |
| Streptococcus Pyogenes (From broth culture) × 1000 By permission of the Scientific Press, Limited | Bacillus Anthracis (From splenic blood of cow) × 1000 By permission of the Scientific Press, Limited |