A CONTRIBUTION 
TO THE STUDY OF 
THE TUBERCLE-BACILLUS. 
By HAROLD C. M.D. 
OF JAMAICA PLAIN. 
Read at the Annual Meeting of the Massachusetts Medical Society, 
June 12, 1883. 
BOSTON: 
PRESS OF DAVID CLAPP & SON, 
35 Bedford Street. 
1 883. A CONTRIBUTION 
TO THE STUDY OF 
THE TUBERCLE-BACILLUS. 
By HAROLD C. ERNST, M.D. 
OF JAMAICA PLAIN. 
Read at the Annual Meeting of the Massachusetts Medical Society, June 
12, 1883, and printed in the “ Communications ” of 
the Society for that year. A CONTRIBUTION TO THE STUDY OF 
THE TUBERCLE-BACILLUS. 
Koch’s (l)1 announcement in the Spring of last year of 
his discovery of the specific organism lying at the bottom of 
and being the cause of tuberculosis, marks an epoch in the 
history of this much-discussed pathological problem such as 
it had never known before. 
Beginning with Villemin’s (2) experiments tending to 
show the inoculability of tubercle, this subject has attracted 
attention from the best observers of the time ever since, and 
their results have tended more and more to show the com- 
municability of the disease. The strides of microscopic 
pathology and the facts observed in regard to micro-organ- 
isms in other forms of disease, have assisted in preparing 
scientific minds for the discovery that is under consideration 
to-day. 
The importance of Koch’s facts has led to an immense 
amount of work in the same direction, for purposes of con- 
firmation or refutation. It is now more than a year since 
his results were first given to the public, and a review of 
what has been done since then will be of interest and im- 
portance. No discussion of the individual papers will be 
attempted, and only those will be mentioned which have for 
their object the determination of the existence of the tuber- 
cle-bacillus and its significance. 
Koch’s results—after a long series of experiments, in 
1 See references at the close of this paper. 4 
A CONTRIBUTION .TO THE STUDY 
which he not only discovered the organism which lie claimed 
to be the actual cause of tuberculosis, but proved the asser- 
tion by the most careful cultivations and inoculations—arc 
now so well known as to require little comment here. 
Since the publication of his experiments, investigations 
have been carried on with a view to the discovery of the 
tubercle-bacillus in all the morbid processes known as tuber- 
culous. In all of these experiments, the proportion of 
success to failure has seemed to grow larger as observers have 
become more familiar with the manipulation necessary for 
the demonstration of the bacillus. The few who have di- 
rectly denied its existence in the tissues, or its pathological 
significance if there, have either seen reason to change their 
views or are still at work upon the problem. Before Koch, 
there were other observers claiming the discovery of the 
specific cause of tuberculosis—thus : as the result of his 
work, lvlebs (3) had announced his monas tuberculosum— 
an actively-moving organism ; Schuller (4) and Toussaint 
(5), a spherical micrococcus ; and Aufrecht (6) speaks of 
a rod-shaped organism, which he found in the centre of 
tuberculous masses and which he now claims to be identical 
with Koch’s bacillus. 
From all of these, Koch’s discovery differs, in that it has 
no movement, is rod-shaped, and more than twice as long 
as it is broad—being from one-quarter to wholly as long as 
the diameter of a red blood-corpuscle—and in that he has 
isolated his discovery by cultivation and has produced the 
specific disease with the result—which none of the others 
have ever done. 
Entering now upon the discussion of the papers that have 
been brought out by Koch’s work, we come first upon that 
of Machiafara and Celli (7), who published results showing 
that they had found the bacilli in fifteen cases of phthisis— 
one with haemoptysis and no physical signs—and in the OF THE TUBERCLE-BACILLUS. 
5 
stools of phthisical patients in great numbers. They ex- 
amined also, and with negative results in every examination, 
thirteen cases of other lung-disease. 
Formad (8), after what he considers exhaustive research, 
grants that bacilli are present, but not invariably : he thinks 
that they may be the causa mortis by producing a fatal 
result in a process which would otherwise not be so, but he 
does not ascribe to this organism any quality which would 
make it a veritable causa or materies morbi. 
Balmer and Frantzel(9) find the bacilli in enormous num- 
bers in rapid cases of phthisis, and less numerous in the more 
chronic ones. " Infection fever ” was always present in the 
cases in which bacilli were present in large numbers. They 
found bacilli very numerous in the tissue of tuberculous 
lung, in the walls of tuberculous ulcerations of the intes- 
tines, and in the pus of tuberculous joint affections. Their 
observations lead them to the following conclusions :—They 
found the tubercle-bacillus in the sputum of one hundred and 
twenty cases of phthisis without exception. In the cases of 
lung disease not tuberculous, tubercle-bacilli were never 
found. Therefore when they are found in the sputum we 
have a case of tuberculosis. On the other hand, when they 
are absent after repeated and careful examinations of the 
sputum, tuberculosis of the lung may be excluded. They 
consider that a perfect prognosis of a case may be given as 
the result of repeated examinations of the sputum extend- 
ing over a period of weeks or even months. They also 
conclude that the most favorable soil for the growth of this 
bacillus is in the cheesy contents of a cavity rather than in 
its walls. 
Hiller (10) thinks it possible to formulate the dogma that 
"Initial haemoptysis is a symptom of the infection of the 
lungs, standing in the relation of effect to cause.” 
Schmidt (11) thought he had proved that the so-called 
tubercle-bacilli were fat crystals—because they disappeared 6 
A CONTRIBUTION TO THE STUDY 
if treated with ether. Hirschfelder (12) has however shown 
that even after boiling the cover-glass in ether, and washing 
in fresh ether, the bacilli may be readily demonstrated by 
Ehrlich’s method. Schmidt probably dissolved out the 
coloring matter, and has himself since come to a belief in 
the bacillus. 
Ransome (13) demonstrated the bacilli in the expired air 
of cases of undoubted phthisis. 
An opponent of Koch’s views on the specific nature of the 
tubercle-bacillus is Balogh(14), who says he has found bacilli 
in the marshes around Pesth, which are indistinguishable 
from the tubercle-bacillus. Inhalation experiments with 
these bacilli caused nodular growths in the lung in which 
the tubercle-bacillus was found ; and inoculation with scar- 
latinal urine and with bronchial sputum gave the same nod- 
ular growths. He took no measures—so far as reported— 
for the absolute exclusion of the tubercle-bacillus. 
Prof. Koryani (15) found Koch’s bacilli in the sputum of a 
case which had been regarded as one of pulmonary syphilis ; 
by this means a correct diagnosis was reached. 
Guttman (16) has been unsuccessful in his researches, 
only finding the bacilli four times out of one hundred prepa- 
rations of phthisical sputum—all prepared after Ehrlich’s 
method. 
D’Espine (17) finds no correspondence between the num- 
ber of the bacilli and the stage of the disease. 
Lichtheim (18) has found bacilli in the sputum of patients 
with cough, before the lungs present any sign whatever. 
He considers, however, that the point of origin of inflamma- 
tion must have some communication with the air passages 
before the bacilli can be discovered in the sputum, even in 
well advanced tuberculosis. He found bacilli in the stools 
of intestinal tuberculosis, and especially in the ulcerations 
of the intestinal wall—he also found them in cases of tuber- 
culous peritonitis. OF THE TUBERCLE-BACILLUS. 
7 
Chiari (19) thinks that the number of the bacilli is in di- 
rect proportion to the severity of the disease. He has never 
found any other bacilli staining as does Koch’s. 
Heron (20) believes that the tubercle-bacillus furnishes 
a good prognostic guide, and that the more numerous it is, 
the more rapidly fatal is the disease. 
Smith (21) demonstrated the tubercle-bacillus in the ex- 
pired air of consumptives. 
Pfeiffer (22), after a great number of observations, comes 
to the conclusion that the bacilli can always be found in 
the sputum of advanced tubercular disease of the lung, but 
that the examination must be repeated a great number of 
times before the definite exclusion of bacilli can be reached. 
Babes (23) of Pesth demonstrated the bacilli in the urine 
of three patients, in two of whom tuberculous nephritis with 
ulceration of the pelvis of the kidney was demonstrated 
afterwards in post-mortem examination ; in one there was 
also tuberculous ulceration of the bladder. 
Cramer and Menche (24, 24a) both consider the tubercle- 
bacillus as a diagnostic landmark. Cramer, however, found 
an organism staining like the tubercle-bacillus in every case 
in twenty examinations of healthy stools. Menche claims 
that the examinations are liable to error because of imperfect 
staining—and further, that possibly tuberculosis of the 
intestinal wall may be only manifest in the stools. 
Frankel (25) found numerous tubercle-bacilli in the pus 
of a scrofulous- or tuberculous-joint, and Dreschfeld (26) 
confirms this by the same observation in a case of the same 
nature in the ankle. Frankel has also found the bacilli in 
the secretions covering laryngeal ulcers in fifteen out of six- 
teen cases. Lewin confirms this, but Guttman was unable 
to do so in two cases. 
Ziehl (27) has obtained positive results in seventy-three 
cases of undoubted phthisis ; he found no bacilli in thirty-four 
cases of other lung disease. He thinks it more likely that 8 
A CONTRIBUTION TO THE STUDY 
there is no other " fungous-form ” in nature to he stained 
thus, than that the tuberele-baeillus is the only one which is 
stained slowly in Fuchsine and Methylene-blue. lie considers 
the observation of the bacillus a certain means of diagnosis 
of the tuberculous process and a method of differentiation 
from other forms of disease ; but their absence must not be 
considered as excluding tuberculosis. lie speaks with 
especial certainty upon the prognostic value of the numbers 
of the bacilli in the excretions. 
Ilosenstein (28) found the bacillus in the urine of a 
patient with symptoms of tuberculous disease of the epididy- 
mis—the lungs being perfectly free. Lichtheim detected 
the bacillus, post mortem, in the contents of the pelvis of 
the kidney in a case of renal tuberculosis. 
West’s (29) conclusions, after the examination of fifty 
cases of phthisis, are : I. That bacilli are found in all cases of 
phthisis with excavations, varying in number with the 
rapidity of the destructive process ; II. That their arrange- 
ment in groups and masses indicates a greater amount of 
destruction of the lung tissue, unless the isolated bacilli are 
in great numbers ; III. That there is no variation in the size 
of the bacilli; IV. That the bacillus being evidence of the 
destruction of lung tissue may be confirmatory diagnostic 
evidence, although he has only found them after the physical 
signs were clear. 
Williams (30) found bacilli in one hundred and six out 
of one hundred and nine cases of phthisis. Of the remaining 
three—in one, but one examination was made; in another, 
the excretion seemed to be purely bronchial; and in the 
third, the slides were spoiled and he could get no more, 
lie considers it hardly justifiable to draw any conclusions 
from the activity of the disease and the number of the bacilli 
—although as a rule they are few in the cases in which the 
disease is quiescent. 
Hreschfeld (20) found bacilli in varying numbers in forty- OF THE TUBERCLE-BACILLUS. 
9 
six cases of positive lung-tuberculosis ; in two or three 
doubtful cases; and none in eight non-tuberculous lung 
affections. He considers them of diagnostic but not of 
prognostic value. 
Dettweiler and Meissen (31), after the examination of 
eighty-seven cases of phthisis, conclude that the number of 
the bacilli in the sputum has no bearing upon the prognosis. 
An observation which they have confirmed by a series of 
parallel records—clinical and of the number of the bacilli in 
the sputum. 
Spina (32) asserts that there are other bacilli with the 
same staining reaction as the tubercle-bacillus, and that he 
can find no other means of differentiation ; that he could 
not find Koch’s bacillus in tuberculous organs that had not 
been for a certain time exposed to the air ; and that Koch’s 
results are inconclusive, on the ground of too few experi- 
ments. 
Immediately after Spina’s work was published, Koch’s(33) 
reply to his critics appeared. His article is characterized by 
vigor and by an evident security in the position he took at 
the start upon the merits of his discovery. 
He first turns his attention to America, and merely men- 
tions Cutter(34), who considers the bacillus to be "embryo- 
nal forms of mycoderma aceti.” Of Rollin Gregg (35), who 
suggests that the bacillus may be only fibrine filaments, 
Koch says he seems to have considered that microscopical 
investigations would be superfluous for the establishment of 
his views. Schmidt (11) is advised to get good colors and 
learn how to use them before announcing fat crystals as ba- 
cilli. Formad (8) is told to become sufficiently expert not 
to let his animals die of tuberculosis when inoculated with 
wood, glass, metal, &c. Sternberg’s (36) failure to find 
the bacillus puts him out of court. 
Then turning to Germany, he remarks that "if one thinks 
that Germany cannot bring forth such blossoms of tubercle 10 
A CONTRIBUTION TO THE STUDY 
literature as these, he is much mistaken.” lie says that 
Beneke (37) must have found fat crystals and not bacilli in 
the blood of healthy men ; that Cramer’s twenty cases of 
bacilli in the stools of healthy men have been contradicted 
by Menche (24a) and Gaffky’s (38) experiments, and that 
they were not identified with the tubercle-bacillus, although 
they were stained after Ehrlich’s method. Balogh (14) found 
bacilli in Berlin mud, which Koch did not succeed in doing. 
Koch moreover denies any value to Balogh’s inoculation 
experiments, because no sufficient precautions for the exclu- 
sion of the tubercle-bacillus were taken. Schottelius (39) 
produced anatomical tuberculosis in dogs by causing them 
to inhale masses of finely-pulverized non-tuberculous mat- 
ter. Koch says that the anatomical appearances are not the 
criterion of what is tuberculous, and that Bertheau and 
Weigart have completely contradicted him. I)ettweiler(31) 
discriminating between phthisis and general tuberculosis, 
attempts to show that the tubercle-bacillus is the accompa- 
niment and not the cause of tuberculosis. Koch thinks he 
would change his mind if he knew more about the pathology 
of tuberculosis. Koch (32) then turns his attention to 
Spina, and in summing up a criticism of his work—after 
leaving exposed the fallacy of his reasoning—concludes by 
saying: "All his work shows that Spina does not know 
enough to observe bacteria microscopically, nor to cultivate 
nor to inoculate them. Ilis work will have no influence 
upon the discovery of the tubercle-bacillus.” 
Since Koch’s article in March, observations have been 
published by 
Demme (40), who thinks he can confirm Lichtheim’s ob- 
servations as to the bacilli in acute miliary tuberculosis. 
He considers it probable that ulceration is necessary before 
the bacilli can be seen in the excretions. As an instance 
of probable infection, he relates the case of a child which 
was put out to nurse in a family, and whose foster-father OF THE TUBERCLE-BACILLUS. 
11 
died of acute phthisis. The child had not the slightest he- 
reditary taint of phthisis or of syphilis, and was infected 
through the nasal mucous membrane. After suffering from 
ulcerative ozcena, it developed tubercular meningitis, and 
died. Tubercle-bacilli were found in the ulcerated and non- 
idcerated pituitary membrane. 
Purser (41) quotes a case in which the bacilli were dis- 
covered in the sputum five weeks before the clinical signs 
showed any disease of the lungs. 
Prudden (42) found bacilli in forty-six out of fifty-eight 
cases, in simple sputum preparations ; and in thirty-nine 
out of forty-two, of sections. He thinks it is evident that, 
in nearly every case of tuberculosis, there are many miliary 
tubercles of all forms, and in many cases, much tubercu- 
lous tissue from which the bacilli seem to be entirely absent 
—which may perhaps be explained by their not staining 
well after life is gone or going, and perhaps by their having 
disappeared from tubercle which has come to a standstill. 
The longest and clearest work upon the subject of the 
tubercle-bacillus yet published is that by Mr. W. Watson 
Cheyne (43). As a preliminary to his work, this gentle- 
man visited the laboratories of Toussaint at Toulouse, and 
of Koch at Berlin, and observed the methods of work at 
both places—carrying away material for subsequent experi- 
ment and examination. 
In his experiments as to the inoculability of tuberculosis 
he has exercised the greatest possible care to prevent con- 
tamination of instruments and hands, and has kept the 
animals experimented upon under the very best hygienic 
conditions—this latter a precaution that has not always been 
taken. 
In his inoculation experiments with non-tuberculous ma- 
terial, he obtained negative results in every case. He ex- 
plains the contradictory results of former observers by :— 
first, the mistaking of cheesy masses, not tubercular, for tu- 12 
A CONTRIBUTION TO THE STUDY 
bercle, where a microscopic examination was not made ; and, 
second, by the fact that even where a microscopic examina- 
tion was made, the accuracy of the diagnosis would depend 
very greatly upon the methods of staining employed and 
the views which the observer held as to what constituted a 
tubercle. It must be remembered also, with regard to the 
early experiments in this direction, that the danger of me- 
diate inoculation was not recognized, and that therefore the 
channels for the possible introduction of specific micro- 
organisms were left unguarded—as the precautions necessary 
for the thorough disinfection of instruments, etc., had not 
yet been made out. He failed to obtain tubercle with the 
material obtained from Toussaint, and explains the latter’s 
results by the growth of tubercle-bacilli in his culture-fluids 
and their introduction during inoculation. The latter oc- 
currence is rendered more probable because Toussaint trusts 
so much to disinfection by carbolic acid, which, although 
effectual against ordinary micro-organisms, has been shown 
to have no effect upon the spores of other bacilli, unless it 
acts for a long time. The tubercle-bacillus apparently pro- 
duces spores, and there is no reason to suppose that these 
are less resistant than those of bacillus anthracis and other 
bacilli. 
In the researches of Klebs and Schuller, a pure cultiva- 
tion was not obtained, nor were the cultivations carried 
beyond the third generation; nor was Schuller always 
successful in producing tuberculosis by the injection of his 
cultivations. Not even the best microscopists and those 
who have done most with micro-organisms (Koch, Weigert, 
etc.) have been able to find the micrococci which Schuller 
declares he has seen in artificial tuberculosis. Cheyne has 
found micrococci only twice, and neither time in tubercle. 
The difference between the results of previous researches 
and Koch’s is that his are much the more definite. lie, 
like others, cultivates micro-organisms from tubercle, but OF THE TUBERCLE-BACILLUS. 
13 
now it is no longer the fact that he only sometimes succeeds 
in causing tuberculosis, and that the tubercle thus produced 
occurs as slowly or more slowly than after the inoculation 
of tuberculous material. The result of the inoculation of 
his cultivations is certain, and more rapid in its commence- 
ment than after the inoculation of tuberculous matter. 
As a result of all his work, Cheyne comes decidedly to 
the conclusion that the tubercle-bacillus is the cause of tu- 
berculosis, and that scrofulous glands, degenerated (stru- 
mous) synovial membranes of joints, phthisical lungs—in 
short, all those materials obtained from man, which, inocu- 
lated into animals, produce acute tuberculosis—contain in 
them bodies (bacilli) which, if they entered the circulation 
in sufficient numbers, would give rise to acute tuberculosis. 
It has been demonstrated by several observers that proba- 
bly in all cases of acute tuberculosis a place can be found 
where these bacilli get into the circulation. 
Cheyne considers the bacilli to be developed in the first 
instance in epithelioid cells, and that, in the lung, these 
cells are derived from the alveoli. He thinks that giant 
cells are. epithelioid cells which have grown rapidly—ap- 
parently as the result of the presence of bacilli in them. 
He thinks that the structural definition of a tubercle must 
run as follows :— 
"A nodule, composed of a central mass, consisting in the 
main of epithelioid cells, or in its place a cheesy mass, sur- 
rounded by more or less inflammatory tissue, with or with- 
out the presence of giant cells. The absolute diagnostic 
mark is the presence of the tubercle-bacillus. It is not, 
however, always necessary for a tubercle to be a nodule. 
If there are plenty of epithelial cells, or if it occurs when 
there are no pouches—as there are in the lung—it may be 
diffuse.” 
Cheyne then discusses the facts of the varying numbers 
of the bacilli in phthisis, and draws the conclusions that 14 
A CONTRIBUTION TO THE STUDY 
according to the number and rapidity of growth of the ba- 
cilli we have fibroid phthisis or caseous pneumonia. On 
this basis can also be explained the difference in the effects 
produced by these organisms in man and rodents. Rodents 
which are inoculated subcutaneously always develope gene- 
ral acute tuberculosis, which is extremely.rare in man when 
compared with the frequency of pulmonary tubercle ; be- 
cause in man the bacilli are not inoculated, but are received 
into the bronchial tubes by inhalation ; their entrance into 
the circulation is prevented in the first place by the inflam- 
matory changes which occur around the alveoli in which the 
bacilli grow. If man were inoculated as rodents are, 
analogy makes it probable that acute tuberculosis would be 
developed. 
The papers which have appeared since this publication 
are few but of great importance. 
Ransome (44) has shown bacilli exhaled by a patient 
suffering from phthisis. He obtained them by condensing 
the vapor of the breath in a large glass globe surrounded 
by ice and salt, and stained them by Gibbes’ (44H) method. 
Cornil (45) studied the bacillus in tuberculous granula- 
tions as being the most simple lesions. He found generally 
in the centre of a tuberculous mass a vessel obliterated by 
fibrin, and bacilli in the centre of this ; they were usually 
present also in the walls of this vessel and near by, in 
varying numbers. He found that the number and dissemi- 
nation of the bacilli varies very greatly, and could not find 
them at all in one case of tubercular meningitis. He found 
them in the spaces between the epithelial cells (lymph- 
spaces of Ranvier), and in the connective tissue, and in the 
protoplasm about the nuclei of the embryonal cells which 
form tubercle. 
Ballagi (46) concludes from his investigations that:— 
1.—Koch’s bacillus can be separated from other forms of 
bacilli. 2.—A differential diagnosis from all other organisms 
o o OF THE TUBERCLE-BACILLUS. 
15 
can be reached by their staining reaction (Ehrlich’s), and 
they can be thus separated in the tissues from putrefactive 
and disease germs (as the bacillus of leprosy). 3.—Putre- 
factive and other bacteria cannot be isolated by any known 
special staining method. 4.—The tubercle-bacilli do not 
occur with regularity in the sputum of persons in the first 
stages of phthisis (apex catarrh, haemoptysis). 5.—In the 
sputum from patients in the advanced or fibroid stages 
the bacilli can always be found, especially in the form 
known as galloping consumption, although in no case do 
their numbers correspond invariably with the height of the 
fever or the stage of the destructive process. 6.—The tu- 
bercle-bacilli can be found in tuberculous organs when the 
process is not very old (chronisch). 7.—There are no 
bacilli in the sputum of non-phthisical patients. 8.—Their 
repeated occurrence is conclusive of the diagnosis. Their 
absence, however, does not prove the absence of a tubercu- 
lous process. 9.—Their number and distribution is of no 
prognostic value. 
Frantzel (47) has now observed three hundred and 
eighty cases of phthisis, and followed them up for months. 
He has examined also eighty cases of other lung disease, 
and always with negative results. In every one of the 
cases of phthisis he found bacilli in the sputum, and was 
often able to make a diagnosis by their presence, when the 
physical signs were negative—a diagnosis which was inva- 
riably confirmed by the further progress of the disease. In 
five cases which progressed with the picture of phthisis, no 
tubercle-bacilli were found, and further observation showed 
that none of them were cases of "cheesy infectious phthisis” 
(which was confirmed in three by post-mortem examina- 
tion). These further observations lead him to adhere to 
the first of the three laws which he enunciated in his former 
article—that the presence of the bacillus in the sputum deter- 
mines the presence of tuberculosis. He also considers the 16 
A CONTRIBUTION TO THE STUDY 
quantity of bacilli—as determined after repeated examina- 
tions extending over a long time—as of great prognostic 
value. (He thinks that the examination should be extend- 
ed over weeks or months, and should be repeated every 
day—or at least every second day—with notes and com- 
parisons, and the conclusions to be drawn from the general 
average.) He thinks that such a long series of observa- 
tions will give us a more certain prognosis than even the 
physical signs. As a result of his further study of the sub- 
ject, he wishes to modify, slightly, his second law, i. e., 
"that wherever, after repeated and careful examinations, no 
bacilli are found in the sputum, there is no tuberculosis 
the lung.” This law would now read as follows :—"When, 
after repeated and careful examinations, no bacilli are found 
—provided that sputum is present and comes from the lungs 
—there is either no lung tuberculosis, or else there are 
no cheesy softened foci emptying their contents into the 
bronchi.” 
At a medical meeting in Vienna, on May 13th, Spina (48) 
read a paper on the subject of Koch’s bacillus. It was 
especially devoted to the discussion of its behavior towards 
staining fluids, and he still denies any specific property to 
it. He gives no further inoculation or cultivation experi- 
ments, and bases his rejection of Koch’s theory especially 
upon the fact that the bacilli are found to act differently to- 
ward staining fluids than it was at first announced they did. 
In proof of the presence of other organisms having the 
same staining reaction, he gives the results of Dr. Matray’s 
work, which is as follows :— 
1. Micro-organisms of many kinds, especially staff- 
shaped bacteria, cocci singly and in colonies, leptothrix and 
torula forms, were stained blue on a brown ground : a, in 
bronchiectic sputum ; b, in sputum of bronchial asthma ; c, 
in sputum of diffuse bronchitis (every time in 94 prepara- 
tions) ; d, in the "furred tongue” of non-phthisieal patients OF THE TUBERCLE-BACILLUS. 
17 
(eleven cases with 28 preparations) ; e, in the lochia of 
non-phthisical lying-in women (twelve cases with 43 pre- 
parations) ; f, in the sputum of fourteen cases of pneumonia 
(46 preparations) ; g, in the stools of a typhus fever pa- 
tient ; h, in the expressed fluid of a case dead of malignant 
oedema. 
2. Bacilli in form, size, grouping and reaction like the 
tubercle-bacilli were seen : a, in the sputum of a case of 
bronchiectasis (in 54 preparations) ; b, in the furred-tongue 
secretion of sick and well persons (eleven cases, 28 prepa- 
rations) ; c, in the stools of a typhus-fever patient (every 
time in 16 preparations) ; d, in the sputum of a case of 
bronchial asthma (every time in 34 preparations) ; e, in 
the sputum of a case of diffuse bronchitis (6 preparations) ; 
f, in the lochia of a healthy lying-in woman (2 prepara- 
tions) ; g, in a case of croupous pneumonia (4 prepara- 
tions) . 
He quotes Kaberhel and Matray (assistants assigned to 
him by Strieker) as concluding that, "on the one hand, 
micro-organisms which do not differ from the tubercle-bacil- 
lus react to staining fluids as do these bacilli; and on the 
other hand, that Koch’s bacilli react to staining fluids exact- 
ly as do other micro-organisms.” 
He also quotes, as a point against the specific nature of 
the tubercle-bacillus, the recent observation of a bacillus 
similar to these in several cases of lupus. 
Strieker himself addressed this meeting in support of 
Spina and his methods. 
Klebs (49) as the result of his more recent work, gives 
the following summary :— 
1. The tuberculous process is caused by organisms, as 
was first shown by me, and rendered certain by Ii. Koch. 
2. I have not come to the same results as Koch in re- 
gard to the morphological relations of the tuberculous or- 
ganism. On the one hand, I must hold fast to the fact that 18 
A CONTRIBUTION TO TIIE STUDY 
finely granular micrococci are present in the albumen cul- 
tures, as well as in the youngest form of inoculated tubercle. 
On the other hand, I am in no way meaning to assert that 
Koch’s bacilli are unessential impurities. They appear to 
represent an essential stage of development of the tubercle 
organism for the further development of tuberculosis, if 
they are not always present. 
3. In regard to the history of the development of tuber- 
culosis, I think that I have presented the proof that: 
(a) The development of the tuberculous pi’oeess begins 
very soon after the inoculation, and not after from 10 to 14 
days, as Cohnheim and others believe. The difference de- 
pends, not upon an error of these last investigators, but 
upon the nature of the changes, which are to be regarded as 
the first stage of the tuberculous process. Completely 
formed tubercles, which can be distinguished with the un- 
aided eye, appear in fact only after the longer period. But 
before the appearance of these, there are already extensive 
cellular deposits present in places which are at a great dis- 
tance from the place of inoculation (mesentery). These 
represent perivascular infiltrations which are either devel- 
oped further to the known form of tubercles, or can retro- 
grade in the different stages of their development (cheesy 
nodules, either with or without contracting cicatrization, 
adhesive and deforming forms of peritonitis). 
(b) The same primary method of distribution is also 
found in human tuberculosis, in which also the traces of these 
retrogressive formations in the mesentery and' omentum are 
found in cases of pulmonary tuberculosis. In other cases, 
on the contrary, a further development of this form of tu- 
berculous invasion comes on, which leads to the formation 
of cheesy foci in the organs, which are only related by 
means of the blood-vessels with the point of entrance of the 
tubercular virus into the organism (cheesy foci of the bones, 
the central nerve-apparatus, etc.). OF THE TUBERCLE-BACILLUS. 
19 
The work which I have done upon this subject has been 
for the purpose of identifying the bacillus, and determining 
the frequency of its occurrence in tuberculous lesions. The 
organs examined have been lungs, liver, spleen, kidney, 
peritoneum, bronchial, mesenteric and inguinal glands, pia 
mater and the eye. In all of these bacilli have been 
found in varying numbers. They are less numerous in old, 
or slow, processes ; very abundant in rapid ones, and espe- 
cially so in the cavities filled with cheesy material. They 
are found in the swollen epithelioid cells of tubercle, or lying 
between them—singly, or in groups of from two to a dozen 
or more. They very frequently seem to be divided into a 
series of dots, from four to six in number, which occupy the 
body of the staff, and are taken to be spores. The result 
of my observation is confirmatory proof of the existence of 
the bacilli, and of Cheyne’s proposition that their presence 
is diagnostic of tubercle. The difficulty with which they 
have been demonstrated in some cases, and the care required 
to obtain the desired result, seem to explain some of the 
failures in this direction. Nothing less than a fb Zeiss 
objective, together with an Abbe’s illuminator, is sufficient 
for the perfect examination of a section. All my observa- 
tions have been made with this apparatus, and a No. 3 eye- 
piece. All the sections have been made with a Jung 
microtome. Upon several occasions the bacilli have been 
observed in the blood-vessels, which would seem to show one 
method of auto-infection—the lymph-channels undoubtedly 
furnish another. I have seen a bacillus lying half in, half 
out of a swollen cell, its presence seeming to have acted as 
an irritant upon this special cell element. I have never seen 
anything but the bacillus staining red on a blue ground— 
although there have been plenty of other organisms which 
were stained blue. 
The method of staining employed has been practically 
that of Ehrlich, which has seemed to give the most satisfac- 
tory results. It is as follows : 20 
A CONTIUHUTION TO THE STUDY 
For sputum :—The cover-glasses are spread with a thin 
layer, taken from the more solid portion of the specimen, 
using fired platinum needles for its distribution. They are 
then dried carefully over the flame of an alcohol lamp, and 
after drying are passed two or three times through the flame 
itself. They are then placed in a solution of Fuchsine 13. 
and aniline oil—one gramme of the first to fifty grammes of 
the second. The latter is made by shaking a few drops of 
aniline oil with distilled water and filtering. The specimens 
are allowed to stand in this solution for twenty-four hours. 
They are then washed and placed in a solution of one part 
of nitric acid (C. P.) and two parts of distilled water, and 
allowed to remain until they are completely decolorized, or 
until at the most a pinkish hue is all that is left visible to 
the eye. All the acid is then removed by repeated washing 
in distilled water, and the specimens are placed in a satu- 
rated watery solution of inethyline-blue and allowed to 
remain for from five to eight minutes. The superfluous 
staining-fiuid is then removed by repeated washing, the 
specimens are carefully dried as before, and are finally 
mounted in Canada balsam and examined. 
For the tissues a similar method was pursued, except with 
the differences made necessary by their nature. Before 
placing in the Fuchsine solution, the alcohol. should be 
removed by thorough washing, and the reagents should be 
allowed to act for a longer time, more especially when the 
sections are thick or the specimens are old. After staining 
in methyline-blue, they should be washed, dehydrated in 
alcohol, cleared up in oil of cloves, and mounted in Canada 
balsam. 
The following is a complete record of the examinations 
I have made of different organs for the detection of the 
bacilli: 
No. I.—A guinea-pig inoculated in the groin with a few* 
drops of tuberculous sputum, in December, 1882 ; died in 
the middle of January, 1883. OF THE TUBERCLE-BACILLUS. 
21 
Sections were prepared from the liver, spleen and perito- 
neum,—the lungs were healthy. 
No bacilli were found in the sections of the liver. 
The spleen showed bacilli singly in the tissues and in the 
swollen epithelial cells. 
The peritoneum containd bacilli in the miliary nodules, 
about the edges, and in the centre of the tuberculous mass. 
No. II.—A guinea-pig inoculated in the same manner as 
the preceding; died January 13, 1883. 
No changes in any organ but in the liver. 
Slides from this showed the bacilli in numerous places in 
and near the tuberculous portion, which was in the form of 
infiltration, rather than of nodules. The general position 
of the bacilli was in the lymphoid cells, and rather in the 
region of the portal vein. 
No. III.—A guinea-pig inoculated as the preceding, in 
December, 1882 ; died in March, 1883. 
The lungs presented no abnormal appearances. 
The spleen showed plenty of evidence of degeneration, 
and bacilli were found in numbers in the cells and lying free 
in the tissues. 
The liver and an enlarged inguinal gland were examined, 
with negative results. 
No. IV.—A. guinea-pig inoculated on March 13, with a 
few drops of tuberculous sputum (from Case IV.) ; the 
syringe was inserted in the left inguinal region just under 
the skin. Died in ten days. 
All the organs gave negative results, except in the spleen, 
where, with no changes visible to the naked eye, a number 
of bacilli were found in and near the finer blood-vessels. 
The cellular tissue at the point of inoculation was found 
to be stuffed with bacilli, lying in and between the much 
swollen cells, and in immense numbers. 
No. V.—A guinea-pig inoculated in the same manner as 
the first three, in December, 1882 ; died, after progressive 
emaciation, on April 2, 1883. 22 
A CONTRIBUTION TO THE STUDY 
All the organs showed tubercular infiltration, and sections 
under the microscope showed bacilli in the lungs, liver, 
spleen, kidney, inguinal glands, and skin under the point 
of inoculation. 
No. VI.—A guinea-pig inoculated in the eye, in Decem- 
ber, 1882 ; died April 15, 1883. 
The lungs, liver and glands showed signs of disease. 
The bacilli were found in plenty in the giant cells and 
the alveolar walls of the infected portion of the lungs, and 
in smaller numbers in the cells and lying free at the edges 
of the tuberculous deposit in the liver. They were also 
found in the gland examined. 
No. VII.—A child of 3£ years, died of acute miliary 
tuberculosis. 
Sections from the lung, liver and mesenteric gland showed 
bacilli very distinctly. Slides from the liver and peritoneum 
were unsuccessfully mounted and gave negative results. 
No. VIII.—A cheesy bronchial gland, removed three 
months before examination, and preserved in absolute 
alcohol. 
Bacilli were found in plenty in the cheesy portions near 
their edges ; fewer in the degenerated parts, and scattered 
through the comparatively healthy tissue beyond. 
No. IX.—A case of acute miliary tuberculosis in a child. 
Sections from a peritoneal gland and the liver gave nega- 
tive results ; there was no tuberculous infiltration on the 
slides prepared. 
The sections from the kidney contained very little tuber- 
culous infiltration. Bacilli were noticed in small numbers 
in the region of the straight tubules, and a few in the 
interior of swollen Malpighian bodies. 
The omentum contained occasional masses of bacilli, with 
numbers of isolated staffs in the infiltrated tissue. 
No. X.—A specimen marked 'r Gland from Autopsy.” 
But two slides were prepared from it, and gave no evi- 
dence of the presence of bacilli. OF THE TUBERCLE-BACILLUS. 
23 
The specimen was very old, and had no attainable history ; 
it may therefore be fairly rejected as evidence. 
No. XI.—Tuberculosis of lung. 
A specimen of very old fibroid phthisis. The tissue under 
examination was almost all cicatricial, and nothing was seen 
that could be distinctly made out as the bacillus. 
No. XII.—Tuberculosis of peritoneum. 
The nodules were extremely fine and widely separated, 
and a section of one was not obtained. Bacilli were seen, 
however, in small numbers, lying singly in the tissues where 
the presence of swollen cells indicated the neighborhood of 
the tuberculous process. 
No. XIII.—This was a specimen sent in as a " Cheesy 
Mesenteric Gland,” from a case in which death was caused 
by the perforation of an ulcer of the intestine into the peri- 
toneal cavity and the subsequent peritonitis. 
There was no tuberculous disease of the gland at all, and 
bacilli were not found. 
No. XIV.—Contents of a cheesy cavity from the lung 
of a rapidly fatal case of tuberculosis. 
Bacilli were found in immense numbers ; in some cases 
the cells seemed to be stuffed with them, and most of them 
showed a well marked division into spores. 
No. XV.—Scrapings from the wall of a lung cavity in 
an ordinary case of phthisis. 
Bacilli in immense numbers. In some places the whole 
field filled with them. 
No. XVI.—Contents of a lung cavity in a case of slow 
tuberculosis. 
Bacilli in immense numbers, in masses and singly, and 
presenting well-marked divisions into spores. 
No. XVII.—Cheesy cervical gland. 
Largely made up of fibrous material, with a few small 
cheesy foci. Bacilli were found in the edges of these 
portions in clumps and singly, and in the few giant cells that 
were seen. 24 
A CONTRIBUTION TO THE STUDY 
No. XVIII.—Case of tubercular meningitis ; dead after 
a month’s illness. 
A much enlarged bronchial gland was found, and the pia 
mater was full of minute granulations. 
Bacilli were found scattered about near the edges of the 
tubercular portion of the gland, with many spores. 
Sections of the pia mater showed very fine bacilli, with 
many spores—their situation being, in general, in the 
neighborhood of the finer blood-vessels and the lymph 
spaces. The origin of infection in this case was very evi- 
dently the enlarged gland. 
No. XIX.—Tuberculous lung. 
This specimen was a mass of tubercle, with cheesy foci 
and cavities. 
The bacilli were found in the edges of the cheesy mass 
—in some instances in its centre. There were many spores, 
and occasionally bacilli were seen in what was apparently 
healthy tissue. 
No. XX.—Tuberculous lung. 
This, like the preceding, was a mass of tubercle, with 
many cheesy foci and much cicatricial tissue. 
Bacilli were found, in not very large numbers, near the 
edges of the more recent degenerations ; in much less abund- 
ance in the old fibrous portions. 
No. XXI.—Tuberculosis of kidney. 
Bacilli were found in plenty in the contents of a small 
cavity in the cortex of the kidney, and in the tissue from a 
nodule near by. 
This case had been diagnosticated during life as a perine- 
phritic abscess, and a drainage tube had been inserted for 
almost a year. 
No. XXII.—Tuberculosis of eye. 
This specimen was removed last fall, and had been pre- 
served in chromic acid. 
It was only after two attempts, and staining prolonged for OF THE TUBERCLE-BACILLUS. 
25 
forty-eight hours, that a few bacilli were discovered in the 
nodule. 
No. XXIII.—Acute miliary tuberculosis in a child. 
Bacilli were found in large numbers in the cells in the 
tuberculous portions of the spleen, of an enlarged cheesy 
mesenteric gland, and in a tuberculous ulceration of the 
intestine. 
As a result it will be seen that in every case of inoculation 
tuberculosis was devoloped, and the microscope revealed the 
bacillus in some portion of the organs of the animals expe- 
rimented upon. There are a number of guinea-pigs still 
under observation. 1 was able to trace the bacilli with in- 
creasing certainty as practice trained my eye for their defi- 
nition in the tissues. I have found a marked difference in 
the apparent size of these organisms in the sections examined. 
In some specimens they appear very fine and delicate—al- 
most indistinguishable—sometimes only a line of dots being 
visible : in most cases they are exceedingly distinct and well- 
marked. However, as they are always of the same size and 
appearance in the preparations of fluid matter, and as those 
which appear to be finerand more delicate seem to fade quicker, 
I am led to believe that the apparent variations in size are 
due to optical effects from imperfect staining. Some obser- 
vers obtained their results in the examination of tuberculous 
tissue by grinding a tubercle in a mortar with water, and dry- 
ing the resultant mass upon cover-glasses in the manner of 
sputum preparations. The ease of this method is more to 
be commended than its accuracy—for in an examination of this 
kind every source of error should be eliminated that it is 
possible to get rid of. 
In February last I began a series of observations of the spu- 
tum of a set of phthisical patients—all known to be so by the 
physical signs. These observations have been continued up to 26 
a contribution to the study 
very recently, and the results obtained in five represented 
in a diagrammatic manner upon the charts. The upper curve 
represents the temperature of the day of the examination— 
the lower, the number of bacilli. The examinations have 
been made at average intervals of a week. The results of the 
examinations of the sputum are here given in detail. 
Case I.—Sick for three years—haemoptysis the first 
symptom. 
Thirteen examinations of the sputum were made, with posi- 
tive results in eleven. The number of bacilli varied from none 
at all to very numerous. The results are condensed on 
Chart I. 
Case II. — Sick for one year — haemoptysis the first 
symptom. 
From February 17 to June 3, fourteen examinations were 
made, with positive results in thirteen. When bacilli were 
found at all, they always occurred in large numbers. (Vide 
Chart II.) 
Case III.—Cough for six months. Gained weight while 
under observation, and was finally discharged relieved. 
From February 17 to April 20, eleven examinations 
were made, with positive results in six. For five successive 
examinations no bacilli were seen, and they never occurred 
in large numbers. 
Case IV.—Cough for eight months. 
From February 17 to April 20, ten examinations were 
made, with positive results in nine. The number of bacilli 
varied very greatly, and the results are tabulated on Chart 
IV. 
Case V.—Sick for seven years. 
From February 17 to June 3, fifteen examinations of the 
sputum were made, with positive results in nine; the bacilli 
always occurred in very small numbers. (Chart V.) 
Case VI.—Sick for three years—haemoptysis the first sign. 
From February 17 to June 6, there were fifteen exami- OF THE TUBERCLE-BACILLUS. 
27 
nations of the sputum, with positive results in twelve. The 
bacilli were always very few until the last examination, 
when the number observed increased very greatly, but with 
no corresponding increase in the temperature. For three 
months this patient’s temperature has been sub-normal much 
of the time. (Chart VI.) 
Case VII.—Sick one year—hemoptysis the first sign. 
From April 20 to June 3, four examinations were made, 
and very many bacilli were found in every case. This pa- 
tient’s temperature curve was pretty constantly high. 
Case VIII.—Cough for one year. 
From May 19 to June 3, three examinations were made, 
with bacilli in diminishing numbers ; the temperature upon 
the days of the examinations being less each time also. 
Case IX.—Cough for two years. 
From May 19 to June 3, three examinations were made, 
with very many bacilli in every case. The temperature, 
however, showed no exact correspondence. 
Case X.—Cough and hannoptysis for ten years. 
From February 17 to June 3, fifteen examinations were 
made, with positive results in six only—and in these the 
bacilli were always seen in but very small numbers. The 
temperature of this patient has been for weeks at a time 
within half a degree of normal. 
Case XI.—This was a case of pleurisy which was exam- 
ined for comparison. 
From March 14 to May 19, seven examinations were 
made, with negative results in every case. 
A comparison of the charts tends to show that there is 
only a very general correspondence between the numbers of 
the bacilli and the height or variations of the fever line. 
A large number of bacilli does not necessarily mean a high 
temperature. The fever curve of each patient varies some- 
what, and has a general average of its own, sometimes 
a very high one and sometimes entirely the opposite. It is 28 
A CONTUIBUTION TO THE STUDY 
with this average range of temperature in the special case, 
that the number of the bacilli must be compared ; and it is 
only by this observation of special cases that the information 
obtained is of value. It is also shown that a continued ex- 
amination of the sputum for weeks at a time may be neces- 
sary before the absence of the bacilli can be definitely 
assumed—as is shown in Case V., where six successive exa- 
minations were made before they were detected. In rapid 
cases, with free expectoration, there are enormous numbers 
of the bacilli to be found. The characteristics of the spu- 
tum also seem to be something of a guide to the number of 
bacilli that one may expect to find. If it is largely mucous, 
with but a few yellowish nodules in it, bacilli will only be 
found in these nodules ; and then, possibly, only in small 
numbers. If, however, the sputum be of a more purulent 
fluid character, the bacilli will probably be present in great 
numbers, whatever portion is examined. 
The result of all the work that has been done upon this 
subject may be summed up as follows : 
I. — A staff-shaped micro-organism exists, in all forms of 
the tuberculous process, and its presence has been demon- 
strated in them. 
II. —It is more abundant in the rapid than in the slow 
forms of the process. 
III. —Its specific nature as the cause of tuberculosis is 
claimed by Koch on the ground of his observations. 
IV. —Its specific character has not been successfully 
refuted by trustworthy observations. 
V. —Its value as diagnostic evidence of tuberculosis is 
very great; although its absence cannot be considered as 
excluding that process. 
The only observer who has thus far attempted the repeti- 
tion of Koch’s cultivation experiments, is Prof. Feltz (50), 
of Nancy, who has announced the complete failure of his OF TIIE TUBERCLE-BACILLUS. 
29 
work. The manipulation is such, however, that more than 
one failure must occur to upset the testimony of complete 
and repeated successes. 
1. R. Koch.—Berlin. Klin. Woch., April 10, 1882. Baumgarten.—Cen- 
tralblatt for die Med. Weis.. No. 25, 1882. 
2. Villemin.—Etudes sur Tuberculose. Paris, 1868. 
3. Klebs.—Prager Med. Woch., Nos. 42, 43, 1877. 
4. SchOller.—Die Scrophulose und Tuberculose Gelenkslerden, 1880. 
5. Toussaint.—Comptes Rendus, 1881. 
6. Aufrecht.—Pathologische Mitheilungen, Magdeburg, 1881. 
7. Machiafara and Celli.—Gazzette degli Ospit., Oct. 29, 1882. 
8. Formad.—Phil. Med. Times, Nov. 18, 1882. 
9. Balmer und FrUntzel.—Berliner Klin. Woch., No. 45, 1882. 
10. Hiller.—Zeitschrift fUr die Klin. Med., v. s. 638. 
11. Schmidt.—Chicago Med. Journal and Examiner. Dec. 1882. 
12. Hirschfelder.—N. Y. Med. Record, Jan. 6, 1883. 
13. Ransome.—British Med. Journal, Dec. 16, 1882. 
14. Balogh.—Wiener Med. Woch., No. 51, 1882. 
15. Koryani.—Wiener Med. Woch., No. 51. 1882. 
16. Guttman.—Berliner Klin. Woch., No. 52, 1882. 
17. D’Espine.—Revue Med. de la Science Romaine, Dec. 1882. 
18. Lichtheim.—Fortschritte der Med., No. 1, 1883. 
19. Chiari.—Wiener Med. Presse, Jan. 7, 1883. 
20. Heron.—British Med. Journal, Jan. 17, 1883 ; Lancet, Feb. 3, 1883. 
21. Smith.—British Med. Journal, Jan. 20, 1883. 
22. Pfeiffer.—Berliner Klin. Woch., No. 3. 1883. 
23. Babes.—Societe d’Anat., Paris, Jan. 26, 1883. 
24. Cramer.—Erlanger Phvs. Med. Sitzb., Dec. 11, 1882. 
24a. Menche.—Verein for Natur—und Heilkunde am Jan. 22, 1883. 
25. FrUnkel.—Berliner Klin. Woch., No. 4, 1883. 
26. Dreschfeld.—British Med.'Journ.. Feb. 17, 1883. 
27. Ziehl.—Deutsche Med. Wochenschrift, No. 5, 1883. 
28. Rosenstein.—Centralblatt fur die Med. Weisensch., Feb. 3, 1883. 
29. West.— London Path. Soc., Feb. 6, 1883. 
30. Williams.—Med. Soc. of London, Feb. 12, 1883. 
31. Dettweiler und Meissen.— Berlin. Klin. Woch., Nos. 7 and 8, 1883. 
32. Spina.—Studien Uber Tuberkulose, Wien., 1883. 
33. Koch.—Deutsche Med. Wochenschrift, No. 10, 1883. 
34. Cutter.—Am. Med. Weekly, 1882. 
35. Gregg.—In letter to Koch. 
36. Sternberg.—Med. News, No. 1, 1882. 
37. Beneke.—Die erste Ueberwinterung auf Nordenay, Norden, 1882. 
38. Gaffky. 
39. Schottelius. Virchow’s Archiv., bd. xci. heft i. 
40. Demme.—Berlin. Klin. Woch., No. 15, 1883. 
41. Purser.—Dublin Med. Journ., March, 1883. 
42. Prudden.—N. Y. Med. Record, April 14, 1883. 
43. Cheyne.—Practitioner, April, 1883. 
TABLE OF REFERENCES IN THE PAPER. 30 
THE STUDY OF THE TUBERCLE BACILLUS. 
44. Ransome.—British Med. Journ., April 14, 1883. 
44a. Gibbes’ Method.—British Med. Journal, Oct. 14, 1882. 
45. Cornil.—Gazette Ilebdomadaire, April 27, 1883. 
4fi. Ballagi.—Wiener Med. Presse, No. 17, 1883. 
47. Frantzel.—Deutscher Med. VVoch., No. 17, 1883. 
48. Spina.—Wien. Med. Presse, May 13 and 20, 1883. 
40. Klebs.—Virchow’s Arch. f. Exper. Path, und Pharm., bd. 17, 8. 51. 
50. Feltz.—Gazette Ilebdomadaire, March 2, 1873. CHARTS. 
The upper curve represents the temperature on the day 
of the examination. 
The lower curve is a diagrammatic representation of 
the number of the bacilli found at each examination. BACILLI. 
TEMPERATURE. 
CHART I. BACILLI. 
TEMPERATURE. 
CHART II. BACILLI. 
TEMPERATURE. 
CHART IV. BACILLI. 
TEMPERATURE. 
CHART V. BACILLI. 
TEMPERATURE. 
CHART VI.