UPON THE BACTERIOLOGY 
OF 
Progressive Cirrhosis of the Liver 
J. G. ADAMI, M.A., M.D., F.R.S.E., 
PROFESSOR OF PATHOLOGY, McGILL UNIVERSITY, MONTREAL, AND PATHOLOGIST TO THE 
ROYAL VICTORIA HOSPITAL. 
REPRINTED FROM THE MONTREAL MEDICAL JOURNAL AUGUST, 1898. UPON THE BACTERIOLOGY 
OF 
PROGRESSIVE CIRRHOSIS OF THE LIVER 
BY 
J. Gr. ADAMI, M.A., M.D., F.R.S.E., 
Professor of Pathology, McGill University, and Pathologist to the Royal Victoria 
Hospital, Montreal. UPON THE BACTERIOLOGY 
OF 
PROGRESSIVE CIRRHOSIS OF THE LIVER. 
BY 
J. G. Abami, M.A., M.D., F.R.S.E., 
Professor of Pathology, McGill University, and Pathologist to the Royal Victoria 
Hospital, Montreal 
It is needless for me here to enter into a discussion of the various 
theories which have been adduced to explain the development of 
cirrhosis of the liver. I need only say that the experience of a large 
number of observers, who for weeks and months have inoculated 
and treated animals with various alcohols has shown that alcohol 
itself induces at most the fatty liver with, it may be, a very slight 
amount of fibroid change in the portal areas, and that not a single 
observer has by this means been able to produce anything at all 
resembling the extreme deposit of fibrous tissue which we meet with 
in the hobnailed liver. 
Alcohol in the main leads to the fatty liver, while on the other 
hand the evidence has steadily accumulated, notably in India, that 
extreme cirrhosis may attack children and adults who have not taken 
a particle of alcohol either medicinally or otherwise. 
Within the last few years, the French school of pathologists headed 
by Hanot, has regarded the enlarged cirrhotic liver with jaundice 
as being of infectious origin, and it is common in France, now-a-days, 
to speak of “ le foie infectieux,” but to the best of my knowledge 
no one has as yet described any one micro-organism as being found 
frequently associated with these cases of so-called infectious liver. At 
1 A paper read for the author by Professor Osle», in the Section of Medicine, at 
the meeting of the British Medical Association at Edinburgh, July, 1898. 4 
most, Levi1 from a case of cirrhosis in a 17 year old male, with marked 
periportal hbrosis and enlarged spleen, obtained a diplococcus patho- 
genic for guinea pigs. The age of the patient, the proliferation of 
the bile ducts and the absence of ascites, would indicate that his case 
was one of what is termed “ Hanot’s Cirrhosis” but the bacteriology 
is rendered somewhat doubtful in that there were also present bac- 
terial endocarditis of the pulmonary valve and suppurative meningitis. 
Unfortunately I have not been able to obtain the original paper, 
nevertheless, this brief statement of the main features of the case, 
makes it at least possible, as Paltauf has urged, that the endocarditis 
and meningitis and the presence of diplococci in all the organs, may 
have been due to a complication. 
On the other hand there is a somewhat suggestive relationship 
between these cases of Hanot’s cirrhosis and epidemic jaundice, in 
some cases of which observers have noticed the presence of a diplo- 
coccus or bacillus with polar staining. 
To the best of my knowledge, no one has as yet recognised the fre- 
quent presence of any one form of micro-organism in the commonest 
form of hepatic cirrhosis—the so-called portal cirrhosis, tending to 
the production of the hobnailed liver, with or without marked atrophy 
of the liver. 
On behalf of the Government of the Dominion, I spent the sum- 
mers of 1894 and 1895 in Nova Scotia investigating a very remarkable 
disease affecting the cattle in a limited area of the country—the so- 
called “ Pictou cattle disease”—of which the main lesion is a singularly 
extensive cirrhosis of the liver. The disease is only found in a dis- 
trict spreading along the northern coast of the peninsula, in a tract 
of country about 40 miles long by from sto 12 miles broad. There 
apparently it has been noticed for some 40 years, now at one end of 
this area now at another. The disease would seem to be very chronic 
and not to affect all the cattle on a farm simultaneously, but unless 
due precautions are taken, in the course of three or four years most 
of the animals upon a farm will, one after the other, be affected. It 
would seem further that the disease does not spread directly from 
animal to animal, for there appears to be no special incidence of cases 
following upon the long winter sojourn of the animals in the byres, 
which, with rare exceptions, are miserably dark and ill-ventilated, the 
attempt being to keep these as warm as possible in consequence of 
the severity of the winter. 
One or two cases are on record in which the disease has broken out 
in a neighbourhood after the body of a cow affected with the disease 
1 Arch. Gen. de Med., March and April, 1894 5 
has been washed down by one of the streams and stranded upon the 
farm lands. The gradual extension from farm to farm, through any 
given district, seems to be largely brought about by the fact that 
each farm has at the back of it a belt of woodland into which the 
cattle roam during the summer. The belts are badly fenced off from 
each other, and here, if an animal is affected, it attempts to wander 
off* into the woodland and there die in some remote corner. Thus, 
unless precautions are taken, the carcasses of these animals remain 
uninterred and appear to act as centres of infection. Under the 
present Government regulations, notification is given of every sus- 
picious animal, and the Government Inspector, if satisfied that it is 
a case of the disease, immediately destroys the beast and burns the 
carcass, or has it buried in quicklime. By this means the number 
of animals affected is rapidly being reduced, so that within the last 
few years the number of cases occurring annually has sunk from 150 
to under 30. 
As for the symptoms of the disease, the first symptom which is 
noticed is that the milk has a somewhat acrid odour upon boiling and 
acquires a pecular bitter taste ; within a few days the animal becomes 
dry, it is weak and restless, the coat stares and the limbs are dragged, 
the bowels loose, the abdomen a little swollen, the eyes are staring, 
the conjunctivse subicteroid. The animal becoming weaker and 
weaker dies apparently in a condition of complete exhaustion. In 
some few cases death is preceded by a period of intense excitement 
almost maniacal in character, the animal rushing about charging at 
obstacles and then falling into a condition of paresis followed rapidly 
by death. 
I killed and made post-mortem examinations upon some 30 animals 
during two years a*nd found, as Dr. Osier and Dr. Wyatt Johnston 
previously determined, that the main lesions are an extreme condition 
of generalised cirrhosis, not only periportal and pericellular, the 
organ being somewhat enlarged and having a smooth and rarely a 
finely granular surface. There is evidently an abundant production 
of thin bile, for with scarce an exception the gall-bladder was found 
very full and the faeces well stained. The periportal and abdominal 
lymph glands in general are large and succulent, there is a moderate 
amount of ascites, the fluid being perfectly clear and limpid, and 
together with this there is a rather remarkable condition of a gela- 
tinous oedema of the mesenteries and intestinal walls. A further 
constant lesion is the presence of numerous follicular ulcers in the 
4th or true stomach. These, save in the very acute cases, are found in 
a cicatrised condition, giving strongly the impression that the earliest 6 
lesion in the case has been gastric and has been followed by infection 
of the abdominal lymphatic system and the portal area. 
From all the animals which I killed, I was more fortunate than 
my predecessors in gaining a characteristic micro-organism. This 
may have been due to the fact that I employed a somewhat different 
method of gaining my cultures. Instead of taking the media and 
inoculating on the spot, all I employed was a series of sterilised glass 
pipettes in which I collected relatively large amounts of the juices of 
the various organs ; ascitic fluid, blood, etc., and then when back in 
my temporary laboratory, either upon that or the following day, I 
inoculated my media. By this means, constantly from the lymph 
juice of the abdominal glands and from the liver juice or bile and more 
rarely from other organs and fluids, I obtained in each case growths 
of a characteristic micro-organism ; small, polymorphous, at times 
appearing as a diplococcus and at others as a diplobacillus which by 
its polymorphous character gave me a considerable amount of trouble, 
until I found that employing the same broth tube, at the end of 24 
hours I obtained the one form, at the end of 48, the other. Further 
study showed me that this micro-organism was in reality a short 
bacillus with polar staining, in this resembling to Some extent the 
micro-organisms of haemorrhagic septicaemia in the lower animals, but 
unlike them, possessing a slight capsule. I was able to grow this 
upon all the ordinary media of the laboratory. Into the character of 
this micro organism I will not here further enter, beyond stating that 
I found it pathogenic for rabbits, guinea pigs and mice, rabbits dying 
in from 15 to 35 days, guinea pigs in from 30 to 35 on the average. 
The characteristic features of this disease—the ascites without 
jaundice, the gastric and intestinal disturbance and the condition of 
the liver—led me seriously to consider the points of similarity 
between the course and symptoms of these cases and those present in 
portal cirrhosis in man, and though it may seem a small matter, I 
was especially struck by the fact that the first post-mortem which I 
performed upon a case of atrophic cirrhosis upon my return from 
Nova Scotia in 1895, presented the same gelatinous oedema of the 
mesenteries and intestinal walls which was so prominent a feature in 
the Pictou cattle disease. 
Thus on and off for the last three years my attention has been 
directed towards this possibility of discovering bacteria in ordinary 
progressive portal cirrhosis. Upon three occasions I have thought 
that I have gained specific micro-organisms. In two, unfortunately, 
the growth became contaminated with the colon bacillus, and as this 
occurred on the eve of my vacation I was unable to continue the 7 
search further. In the third, which occurred a little over a month 
ago, the growth was very slight, and although pure, ic had apparently 
died out on the fifth day and I was unable to gain any further cul- 
tures, if indeed what I saw was anything beyond the frequent 
presence of diplococci already existing in this liver juice at the time 
of extraction. 
The difficulty that lias pursued me in this search has been that 
which has prevented me from publishing so far any extensive report 
of my studies upon the Pictou cattle disease, namely, the extra- 
ordinary difficulty in staining the micro-organism in the tissues. I 
have tried a very great number of methods, and while with many I 
have been able to recognise the bacteria, the results obtained have 
been so inconstant that I have felt that others following me might 
o o 
very possibly have negative results ; thus I have been unwilling to 
make any full statement until I should be able to state clearly how 
to be able to recognise the micro-organism. While this micro- 
organism stains deeply it appears to lose its stain even more 
rapidly than does the tissue. Sometimes Gram’s or Weigert’s method 
shows them perfectly, but while the iodine appears to have a deter- 
rent effect upon the decolorisation of the microbes, the stain is not 
properly fixed by its means. And while again I have obtained good 
results by staining with methylene blue dissolved in anilin oil, a 
momentary passage of sections so stained, through a mixture of anilin 
oil and xylol and so through xylol into Canada balsam, yet even here 
the colour appears to fade out rapidly so that in a few days the micro- 
organisms are unrecognizable. Eventually the thought struck me 
that bleaching in the sunlight might be a possible means. By this 
process there would be no diffusion currents set up, and if, as ray 
previous work had shown, the bacilli took up the stain with rapidity 
then the deeply stained sections would have so much of the dye in the 
bacilli that, upon bleaching out, the bacilli would be left stained when 
the tissue itself had become colourless. 
My laboratory assistant, Mr. E. W. Hammond, prepared a large 
series of sections in this way and obtained some excellent results. He 
found that, as I had suggested, strong staining with carbolised fuchsin 
followed by bleaching for a short time each day for a period of a fort- 
night or more, demonstrated the bacteria admirably. While the 
process is a slow one it has the undeniable advantage that each day 
the mounted section can be examined to see how far the process of 
bleaching has progressed. By this means I was able to find out that 
in the Pictou cattle disease the micro-organisms, while present scat- 
tered through the new fibrous tissue, are present also in large numbers 8 
within the fliver cells, and in the liver of a rabbit which had been 
inoculated with the micro-organism isolated by me, although the animal 
died before any marked cirrhosis had developed, the liver cells were 
seen to contain these microbes in very great numbers. As to how the 
micro-organisms enter these cells, that is a point on which at present I 
can throw no light, but the appearances given, as will be seen in a 
specimen under the microscope in the Pathological Exhibit, is that 
these cells contain large numbers of extremely minute diplococci. 
Recently, within the last month, a remarkable case of cirrhosis with 
pigmentation unaccompanied by diabetes has again drawn my atten- 
tion to the bacteriology of atrophic cirrhosis. Dr. Maude Abbott, 
who is working in my laboratory at the Royal Victoria Hospital, 
showed me some sections of the abdominal lymphatic glands, stained 
by Weigert’s fibrin stain in which, under high power, I noticed a 
peculiar fine granulation, and upon examining under the 18th inch 
immersion, these fine granules resolved themselves into minute diplo- 
cocci. 
Examining the liver stained the same way, I there noted large 
numbers of the same micro-organism, and since then I have gone 
through all my five cases of cirrhosis which I have had during the 
last three years ; through specimens of four well marked cases of hob- 
nailed liver received from Professor Hektoen, of the Rush Medical 
College, Chicago, and through a series of sixteen livers, some of well 
marked atrophic cirrhosis, others of milder stages of cirrhosis sent to 
me by Dr. Flexner from the Johns Hopkins Hospital. So far in 
every case of well marked portal cirrhosis whether of the small 
shrunken type or of the large hobnailed type, whether associated 
with jaundice without ascites or with ascites without jaundice, I came 
across constantly one characteristic form of micro-organism, obtain- 
ing the best and most permanent results by the method already 
mentioned, of staining in carbolised fuchsin and bleaching or partially 
bleaching in the sunlight. 
This micro-organism is extraordinarily minute; by the trained eye, 
in well stained specimens, it can be recognised under the 12th inch 
immersion, but for satisfactory work it is absolutely necessary to em- 
ploy the 18th or 20th inch immersion lens. According!: to the depth 
of the stain, so does it appear either as an ovoid bacillus, which might 
easily be mistaken for some stained deposit in the liver cells, or as a 
minute diplococcus surrounded by a halo, the explanation being that 
with strong staining the the bacillus and capsule are stained through- 
out, with weak, the body of the micro-organism and the capsule are 
decolorised, leaving simply the polar staining. Even in the tissues 9 
this micro-organism is somewhat polymorphous, that is to say, that 
at times one sees the two stained portions so close together as to re- 
semble a minute edition of the gonococcus, at other times they are 
further apart and appear rounded like the coccus form of pneumo- 
coccus, while in the same specimen a rare form may be seen in which 
the two stained portions are even slightly elongated. These are 
present in greatest numbers within the cells. A remarkable feature 
about them, and one which years ago I noted in connection with the 
Pictou cattle disease, is whether they be seen in the lymphatic glands 
or in the liver, in the unstained condition many have distinctly a 
brownish tinge, so that in the liver especially these bodies may at 
first sight be mistaken for minute granules of precipitated bile pig- 
ment. They vary in number; in two cases in which the disease 
appeared to be of very slow progress but few were present; in those 
cases in which the bands of portal connective tissue showed an abund- 
ance of small round cells and in which the disease according to all 
indications was active and progressing, the number was remarkable, 
in fact so numerous were they that it was impossible for me to arrive 
at any other conclusion than that there is a distinct association be- 
tween the presence of this micro-organism and the development of 
the disease. 
So minute are these micro-organisms that it is difficult to focus 
them, and I would strongly urge those attempting to confirm these 
observations to take, if 'necessary, from twenty minutes to an hour 
studying an individual field of the microscope before arriving at any 
definite conclusion. 
Here, perhaps, I should correct myself. In the fully stained condi- 
tion the micro-organisms while small are not so very much smaller 
than the ordinary run of pathogenic bacteria. But in this fully stained 
condition, as already stated, they are very difficult to distinguish from 
granules scattered through the cell protoplasm ; it is in the partly 
decolorised condition in which the polar staining alone is recognisable 
and is peculiarly characteristic, that they appear so very minute. 
Indeed, I know of no form so minute, save that recently described by 
Nocard and Roux as being the causative agent in the contagious 
pleuro-pneumonia of cattle, and the strain upon the eyes in studying 
these microbes is most severe. This adds greatly to the difficulty of 
photographing the micro-organisms. 
I am indebted to Dr. Patrick, the photographer of our hospital, for 
the accompanying lantern slides, in which despite great difficulties he 
has managed, I think successfully, to demonstrate the organisms in 
the tissues; but with regard to this I may that where he shows 10 
one micro-organism the slightest change of focus would bring others 
into view, so that his slides show but about l-20th of the number 
recognisable in any given field. 
As to whether the micro-organisms in the human and in the bovine 
liver are identical it is impossible for me to affirm. At Johns Hopkins, 
as in our own hospital and in a large number of foreign hospitals, 
not to mention the leading hospitals in the old country, it is now the 
custom to obtain cultures from half a dozen or more regions, including 
the liver, in every autopsy performed within fifteen hours after death. 
And, while the methods employed for obtaining cultures are in many 
cases faulty, to the extent that an insufficient amount of tissue juice is 
taken, it seems to me unlikely that had this form been cultivable 
upon the ordinary media, it would not before now have been isolated. 
Nevertheless, there is this to be said, that very frequently the colon 
bacillus grows upon cultures made from the liver; isolated colonies 
of the micro-organisms from the Pictou cattle disease, while growing 
more slowly, are not unlike those of the colon bacillus, and thus pos- 
sibly the micro-organism if growing in a manner similar to that of 
the Pictou cattle disease, might be neglected on account of this simi- 
larity in appearance. 
It so happens that here in Montreal cases of the disease are few and 
far between ; five cases only have come under me in tour years, and 
in a series of 934 autopsies made during twelve years at the Montreal 
General Hospital and indexed by Professor Wyatt Johnston, I find 
that altogether 31 cases of cirrhosis of the liver are recorded and 14 
of the cirrhotic and fatty liver, with one recorded as “ hypertrophic 
cirrhosis.” I have thus thought it wise to publish these observations, 
even though I can at the present moment make no absolute statement 
with regard to the isolated micro-organism and its character, beyond 
the statement that, as already mentioned, in one agar tube made from 
the live juice, I was able to recognise the form, although in not very 
great numbers and with the absence of any visible growth. 
Lastly, as to the cases in association with which I have found this 
micro-organism. If future observers confirm the observations given 
above, then we must conclude that many of the divisions and distinc- 
tions attempted to be drawn between the forms of advanced cirrhosis 
of the liver, must be broken down for, in the first place, I have found 
the same appearance in the large liver with moderate granulation or 
slight hobnailed condition, which some would speak of as “ hyper- 
trophic cirrhosis,” as again in the small contracted typical hobnailed 
liver ; in cases frankly multilobular with sharply defined bands of 
connective tissue cutting off relatively large areas of liver substance 11 
and showing relatively few bile ducts ; as again in cases of the more 
unilobular type with ill-detined edges to the lobules and abundant 
bile ducts ; in cases which have shown jaundice without ascites, ascites 
without jaundice, and again both jaundice and ascites ; lastly, incases 
with a pronounced alcoholic history and others in which no history of 
alcoholism could be obtained. 
I am far from wishing it to be understood that I am here laying 
down that all cases of fibroid change in the liver present these minute 
micro-organisms ; to make any such suggestion would be absurd. 
Nor again am I prepared to say that Hanot’s cirrhosis affecting the 
young adult and presenting the enlarged liver with smooth surface 
and accompanying this, crises of icterus, is identical with the more 
ordinary form of progressive cirrhosis affecting the adult. It may be 
so or it may not. All that I at present am prepared to lay down 
is this, that the progressive and extensive cirrhosis affecting the 
adult at or after forty years of age is, according to my investigations, 
accompanied by the presence in the liver cells, as again in the newly 
formed connective tissue, of an extraordinarily minute bacillus, having 
a polar staining and resembling greatly in its appearance under the 
microscope a form which I have isolated from cases of infective cirrhosis 
among cattle. 
I cannot conclude without again expressing the debt under which 
I labour to several helpers. To Dr. Maude Abbott and Dr. Patrick ; 
to my Laboratory Assistant at the University, Mr. E. W. Hammond, 
who aided me very materially in Nova Scotia ; Mr. Howell, my assis- 
tant at the Royal Victoria Hospital, but for whose energy I should 
have been unable to prepare and examine all my material ; to Mr- 
Nicholson, who has most gladly crossed the Atlantic to demonstrate 
my specimens during the course of the meeting ; and above all, on 
this occasion am I indebted to a member of McGill University, my 
predecessor not only in the teaching of Pathology, but also in the inves- 
tigations in the Pictou cattle disease, than none, not even myself could 
more willingly or more appropriately, or better, have brought this 
subject before you. 
Appendix, (July 12th, 1898.) 
By a remarkable coincidence, upon the afternoon of the day upon 
which I completed the dictation of the foregoing in order that I might 
have it complete for Dr. Osier to take with him to Edinburgh, I was 
called to perform a post-mortem upon a case apparently of heart 
failure which turned out to be one of atrophic cirrhosis of the liver. 
I should here add that a diagnosis of cirrhosis of the liver had been 12 
considered and had been left in doubt ; while clearly, from the con- 
dition of the heart, death had resulted from failure of that organ. 
Not to enter too fully into the details of the case, for the clinical 
notes of which 1 am indebted to Dr. James Stewart, I may say that 
the body was that of a female of 56, who had always lived in Canada, 
and who, after the diseases of childhood had, until two years previously, 
enjoyed good health. She had 10 children with no miscarriages, and 
there was no history of inherited disease. She gave a moderate his- 
tory of alcoholism, stating that she chiefly drank beer, but if one may 
base any argument upon the frequent presence of minute whitish 
plaques which were found scattered along the oesophagus, she was a 
pronounced alcoholic. 
For the last two years she had not been well, dating her impaired 
health from a fall while out walking, when she injured her back 
somewhat. For the last year her heart had been very weak and upon 
exercise her feet and legs became swollen. Since last April, the 
weakness, swelling of the legs and abdomen, shortness of breath and 
palpitation have been much worse, and for three days before admis- 
sion, dyspnoea, sleeplessness and weakness had been extreme, while 
for months she had steadily been losing flesh. 
Upon examination she was found sallow, with moderate anmmia of 
mucous membranes, the sclerotics were icteroid with distension of the 
superficial vessels; the face was emaciated and there was orthopncea ; 
the temperature was normal, the pulse rapid and the respirations were 
36. The skin, more especially the face, neck and arms, was of a peculiar 
ashy colour ; this, she stated had been noticeable for some years ; 
there was slight general oedema, marked oedema of the lower ex- 
tremities, and definite ascites. The pulse was 100. very irregular in 
volume and rhythm ; the apex beat was unrecognisable; there were 
no murmurs. There was evidence of right-sided pleurisy and numerous 
coarse and fine rales with expectoration of frothy mucus. There was 
frequent vomiting and retching, though this had begun only a few days 
before admission to hospital. The urine was dark, amber coloured, 
with flocculent sediment, a fine ring of albumin and contained some 
bile. For a week or more her condition improved ; the heart became 
more powerful, the ascites diminished. Suddenly upon the 6th, the 
patient died. 
The autopsy was held six hours after death, and showed the fol- 
lowing conditions . 
Heart.—Large, full, with dilatation of the cavities, the muscle being 
somewhat atrophied and fibroid. The coronary vessels were athero- 
matous. All the valves were normal and in both auricles were puri- 13 
form and breaking down ball thrombi indicating a very feeble circu- 
lation. 
Lungs.—Both showed adhesions to the diaphragm and elsewhere, 
and on section presented little beyond oedema, save that the lower 
lobe of the right lung was almost completely compressed and airless 
as a result of the right-sided pleursy. The right pleural cavity con- 
tained about 700 ccm. of red stained fluid without flocculi. 
Abdomen.—The abdomen contained between 900 and 1,000 ccm. 
of turbid and greenish ascitic fluid. Neither liver nor spleen were 
visible. 
Stomach.—This was long and narrow with mucosa thickened, the 
cardiac portion having a curious straw berry-like appearance with line 
white dots standing out, but not projecting from the generally red- 
dened surface. This faded off in the pyloric portion of the stomach 
where there was a fair amount of mucus. 
Duodenum.—The first three inches presented an identical straw- 
berry-like appearance to that seen in the cardia. 
Intestines.—The small intestines in general were congested and the 
last three inches before the ileo-csecal valve showed large prominent 
solitary follicles. The walls of the small intestine had a distinctly 
brownish tinge as of von Recklinghausen’s Hsemochromatosis. The 
mesentery of the small intestine was distinctly fatty and swollen, 
and upon section abundant milky lymph poured out wherever it was 
cut. 
The abdominal lymph glands were in general reddened and succu- 
lent. The retroperitoneal glands, especially those in the neighbour- 
hood of the portal fissure and of the pancreas, were markedly enlarged. 
Liver.—The liver was distinctly small, weighing 1045 grams or a 
little over two pounds ; the two lobes were correspondingly diminished 
in size, the organ was pale and had a finely granular surface ; there 
were abundant old fine veil-like adhesions over the upper surface to 
the diaphragm. On section the organ cut fairly firmly more especially 
along the lower half of the right lobe and the under surface. On the 
whole the appearance on section was more fatty than fibroid. Micro- 
scopically, the organ presented along with fibroid thickening of the 
portal sheaths, a somewhat diffuse cirrhosis, the bands of fibrous 
tissue not being sharply cut and being infiltrated with a considerable 
number of small round cells. The cirrhosis was very obvious but not 
of the more usual type and the diffuse nature of the change may 
explain why the surface was finely granular rather than distinctly 
hobnailed. 
Gall Bladder.—This had oedematous thickened walls. 14 
Spleen.—Of normal size and rather soft, although on section the 
trabeculae were seen larger and more prominent than usual. 
Pancreas.—Voluminous and moderately firm 
Suprarenale.—Of fair size. 
Kidneys.—These were the hog-backed type of mixed interstitial 
and parenchymatous nephritis. This so-called ‘ hog-backed ’ appear- 
ance, is that which, as I believe, Formad of Philadelphia, was the first 
to point out, is the more common form of alcoholic kidney in North 
America. The organs were large with a finely granular surface and 
full and firm cortex. There were white infarcts both in the kidney 
and the spleen. 
The body was still warm at the time of autopsy and I obtained 
numerous sterilised pipettes of tissue juice from the liver, spleen, 
kidneys, abdominal lymph glands, ascitic fluid, pleural fluid, pericar- 
dial fluid, blood, and lymph from the mesentery, and with these made 
a series of inoculations on the surface of sloping glycerinated agar 
tubes, as also some into broth. 
Portions of the collected ascitic and pleural fluid were centrifugal- 
ised, the cellular debris dissolved by caustic potash and after further 
centrifugalisation the deposit examined under the microscope after 
staining with carbolised fuchsin. This deposit showed rather rare 
minute diplococcus forms with a slight halo round them, similar in all 
respects to those recognised in the tissues. 
A series of slide preparations were made from the various pipettes 
direct, fixed in the usual method and stained with carbol fuchsin, 
which was warmed until definite vapour was given off, then washed 
with water just cool enough to bear the hand in it, and mounted. As 
a result the characteristic diplococcus form was found in the prepar- 
ations made from the liver, lymph from the mesentery, the ascitic 
fluid, the heart blood, the left kidney and the mesenteric glands ; they 
were not found in the pleural cavity, the bile or the pericardial fluid. 
Next, using a fair amount of the fluid out of each pipette, fallowed 
this to flow over the surface of slanting glycerinated agar tubes, my 
experience with the Pictou cattle disease having shown me, that 
while the fluid in the pipettes could show numerous diplococci, appar- 
ently the majority of those are dead, and only a few remain alive. 
By this means, in 24 hours I obtained fairly frequent growths in 
tubes from the spleen and left kidney, and rare growths in the mesen- 
teric glands and heart blood. Four colonies only appeared upon the 
tube prepared from the liver, and two from the ascitic fluid and these 
latter did not show clearly till the expiration of 48 hours. 
Subcultures made again directly upon the glycerinated agar surface, 15 
showed a fine rather thin growth at first of minute discrete colonies; 
later these ran together into thin waxy lines which upon the expira- 
tion of four or five days assumed a faint yellowish tinge. Other 
tubes were made directly from the pipettes of the kidney and spleen 
into beef broth. This upon the following day showed a faint turbidity, 
which, just as in the case of the Fictou cattle disease, if anything, 
lessened with further growth, while a whitish deposit formed at the 
bottom. Since then, using the remaining pipettes, I have obtained a 
great number of broth cultures, the growth being much more free 
upon this medium than upon the agar, and further, yielding forms 
which are more characteristic and less liable to cause confusion; for 
the micro-organism is most remarkable in its characters. 
Grown upon broth, in 24 hours it is present in the form of minute 
diplococci surrounded with a faint halo or capsule. Often these tend 
to be arranged in irregular chains in which the separate appearance 
of the dots are not quite regularly arranged, the long axis joining the 
two dots not of necessity coinciding with the long axis of the chain. 
Grown upon glycerinated agar, the appearance is most puzzling, 
and although I had similar experience when working out the charac- 
ter of the micro-organism of the Fictou cattle disease, these agar 
cultures have given me a week of profound anxiety, until within the 
last 24 hours I have solved the problem. A 24 hour culture at 37° 
upon glycerinated agar, reveals minute forms which upon careful 
staining with fuchsin, not too deep, are clearly forms of diplococci. 
One gets every transition from the frank diplococcus form through one 
in which only very careful focussing shows that the somewhat oval 
bacterium has at either pole a deeper stained mass, to forms in which 
the polar staining cannot be made out so that one appears to deal 
with true short bacilli. Add to this, a certain number of oval forms 
can be seen still smaller than the diplococcus, in which the distinction 
between the two ends cannot be made out. 
In 48 hours, and still more in 72 hours, the same culture which had 
given this appearance at the end of 24 hours appears to*be contamin- 
ated by the presence of long distinct bacilli ; that is, if sections be 
well stained with fuchsin, while this is still more the case after stain- 
ing with Loeffler’s methylene blue. At hrst sight, a culture from 
this variety showing these bacilli of irregular length with rounded 
ends, often lying side by side, appears to be undoubtedly of the colon 
bacillus or some allied form. And here I gain an explanation of the 
contrary results obtained by a bacteriological confrere and myself in 
London two years ago. I took to him cultures isolated from two 
cases of cirrhosis which, on examination in Montreal, seemed to be 16 
diplococci, and his statement that he found only colon bacilli made 
me cease my investigations for the time. I can now well understand 
his most pardonable mistake. 
Yesterday upon examining the agar plate culture from the spleen 
which had been made upon the 7th inst, and had been left for 24 hours 
in the incubator and there apparently yielded no growths and which 
thus had remained for four days at the ordinary temperature in the 
shade, I recognised one form of growth alone present, extremely minute* 
the colonies well separated from each other. 
Upon removing one colony and making a coverslip preparation 
stained with fuchsin, I found that I had to deal with long chain-like 
bacilli interspersed with some shorter forms of the same breadth. 
The appearance was so wholly unlike anything that I had previously 
made out in the broth cultures, that I neglected this colony and made 
a culture from another identical in appearance and equally isolated, 
and in this case after staining with fuchsin, and as I thought over- 
staining, I washed in absolute alcohol. The result obtained was most 
remarkable. The long bacillary forms could still be recognized in 
this as in the other specimen and if anything they were longer, but 
each long filament showed a discoloured sheath in which, scattered at 
perfectly regular intervals, were pairs of dots deeply stained. In 
some places individual dots could be clearly recognised elongated 
and replacing the pairs. These pairs of dots in size resembled 
the diplococcus-like forms seen in the broth cultures and in the 
tissues to which I have already so frequently drawn attention. 
I regret that time has forbidden that I should obtain photographs of 
this very curious appearance so that they could be demonstrated with 
the lantern. In the series of preparations which will be found in the 
Pathological Museum, this form will be placed under the microscope 
and there will also be a series of sketches made by me under Zeiss’s 
Camera Lucida showing this appearance. 
I touched the same colony with a platinum needle and inoculated a 
broth tube from it and eight hours later, the broth, which had in the 
meantime been kept at 37°, showed a faint turbidity, and now some 
specimens treated with carbolised fuchsin in the same way, showed 
in place of the singularly long filaments, numerous diplococcus forms, 
fairly large, in which the connecting more colourless portion could be 
well seen, while here and there a rarer form showed three instead 
of two dots along the course of the bacillus. These observations 
satisfactorily explain the curious condition of affairs. 
The microbe which is seen in the tissues as a diplococcus surrounded 
by a faint halo, is in broth after 24 hours present also as a diplococcus 17 
but rather larger, showing or not showing the halo according to 
the extent of the stain. 
Upon agar agar, while first present as a diplococcus form, it grad- 
ually extends and each day is seen as a longer bacillary form, but if 
stained and decolourised with carbolised fuchsin and decolourised to 
the right extent, each long filament is seen to be made up of diplo- 
coccus-like members lying in the common sheath. I made out a 
similar condition of affairs in connection with the Pictou cattle 
disease, but do not remember to have come across such long fillamen- 
tous forms. 
We seem thus to be dealing with a form totally unlike any which 
to the best of my knowledge, has been described ; the polymorphism 
is remarkable. It is most difficult, however, to determine how to 
describe the appearances seen, and I am at a loss whether to state 
that we are dealing with an encapsuled diplococcus or with a bacillus 
having inclusions taking a peculiar deep staining, just as in the 
ordinary cell, the nucleus stains deeper than the surrounding proto- 
plasm. The general appearance in the tissue is certainly that of an 
encapsuled diplococcus, but on the other hand, grown outside the body 
and upon agar and then treated with Loeffler’s methylene blue, the 
whole of that portion which plays the part of a capsule to the diplo- 
cocci takes on a stain with as great intensity as do ordinary bacteria. 
On the whole at present, I am inclined to the latter view, because 
examining tubes in which proliferation is most rapidly proceeding, I 
find upon staining with carbol fuchsin and decolourising with alcohol, 
that one has in the youngest ovoid forms what is most suggestive 
of the polar staining such as one sees in the bacteria of haemorrhagic 
septicaemia, that is to say, there is at either pole not a complete coccus 
form, but a deep staining concavo-convex segment, the two 
parts being separated by a clear space and the membrane joining the 
ends of the opposite crescents being clearly visible. 
If this form coincides in other respects with the micro-organism of 
Pictou cattle disease, it will grow rather more easily upon slightly 
acid media, it will grow upon serum and very slowly in gelatine with- 
out marked liquifaction, and will be fatal for animals of the labora- 
tory at a relatively long period after inoculation. 
It so closely resembles the micro-organism of the Pictou cattle 
disease that I feel that I may safely prophesy this, for the time 
taken in unravelling the mutability of growth upon agar agar has pre- 
vented me from working out these points till the last few days. 
The great similarity in appearance presented by growths upon agar 
agar under ordinary staining to the colon bacillus may perhaps make 18 
it necessary to say a few words about the relationship of the micro- 
organism isolated by me, to the bacillus in question. 
I have made growths side by side, and find that in broth the colon 
causes a greater turbidity and appears to grow more freely upon agar 
agar and also to be endued with greater motility. While upon stain- 
ing an 18 hour broth culture of the micro-organism by the Nicolle 
Morax method, in order to demonstrate flagella, I found that the 
micro-organism, which are even stumpier than the colon bacillus, 
under similar circumstances to be possessed of terminal flagella, either 
one or two, and not of lateral. This, if it were necessary, would seem 
distinctly to prove that the micro-organism is wholly distinct from 
the colon group. However, I make this statement provisionally, and 
will give fuller details as to the characters of the micro-organism 
within the next few months, probably in the Journal of Experi- 
mental Medicine} 
I trust, however, that I have said sufficient to prove; Ist, That in 
at least a very large number of well-marked cases of progressive 
cirrhosis in man, there is to be found largely within the liver cells, 
also in the lymph spaces in the newly formed connective tissue, a 
peculiar and very minute form of micro-organism, present on stain- 
ing to the proper extent, as a diplococcus surrounded by a faint 
halo, or when stained deeply, being a rather obscure bacterium, which 
may easily be mistaken for stained deposits within the cells. 
2nd. That in the infective cirrhosis of cattle, a very similar micro- 
organism is recognisable, present in like positions within the tissues 
and showing similar appearances when stained. 
3rd. That from at least 30 cattle affected with this disease I have 
been able the isolate the micro-organism—from the liver, bile, abdom- 
inal lymph glands, and in some cases from the various organs of the 
body. 
4th That the micro-organism isolated is a polymorphous micro- 
organism, appearing as a small diplococcus when grown in broth, 
tending to assume a distinctly bacillary form when grown for a few 
hours on other media, or in broth for a longer period. 
sth. That this micro-organism is pathogenic for the animals of the 
laboratory, and that in them it is to be recognised within the hepatic 
cells as in other regions. 
1 August 20th.—Fuller studies have shown me that these statements need 
amending. While the bacilli at first caused no fermentation of glucose and lactose 
broths, later growths gave definite gas production, though not so extensive as the 
atypical colon bacillus. The broth growths also remain atypical, but undoubtedly 
the bacilli when growing freely have, like the colon bacillus, latex-al flagella. The 
germ belongs to the colon group. Fuller details of its characters will be given in a 
later communication. 19 
6th. That from a case of distinct atrophic cirrhosis in the human 
being, I have been able to isolate from various organs of the body a 
similar micro-organism, which grown in broth has a diplococcus form, 
grown upon agar, is present as a short or longer bacillus according to 
the age of growth. 
D o 
This is not the occasion for me to discuss at length the bearing of 
these observations upon the nature of progressive cirrhosis in man. 
It is only necessary for me to say that if they are confirmed, as per- 
sonally I feel they must be confirmed by everyone who proceeds with 
sufficient caution to follow the methods employed by me, then cirr- 
hosis of the liver assumes an entirely new aspect. We gain a satis- 
factory explanation at once of such phenomena as the enlargement of 
the spleen, which, as has already been noted by more than one 
observer, may be made out before there is any sign of portal obstruc- 
tion ; we see why so frequently there should be right-sided pleurisy, 
and may even find that the question as to whether a case is compli- 
cated with ascites or jaundice, depends upon this micro-organism ; 
depends upon whether it sets up a low inflammation of the peri- 
toneum, or whether it more especially affects the liver cells and bile 
ducts ; while disturbances which may occur not immediately in con- 
nection with the liver, in the pancreas and in the kidney, would seem 
to gain a possible explanation from the fact brought out by me, that 
this micro-organism, common in the liver cells, is in an advanced 
case to be gained from the heart blood and from the kidney. 
That the micro-organism only causes cirrhosis, I do not believe; 
indeed, we may find that it is the cause of more than one disturbance 
in the liver, and indeed in other organs. This I base upon the fact that 
in the case in which I have isolated this allied form from man, the 
micro-organism shows itself capable of existing in several regions of 
the body; in fact of setting up what bacteriologically we regard as a 
septicsernic condition. 
The illustrations referred to together with a further note on the 
o 
subject, will appear in the next number of the Journal,