ACUTE ANTERIOR POLIOMYELITIS

You say: "Ttiberculosis presents problems that have puzzled pathologists and clinicians since the days of Koch." I would say that the difficulty of understanding the bacteriology of the inflammatory conditions, which give rise to the clinical signs and symptoms of tuberculosis, has been increased by the discovery of Koch, of the relationship of his bacillus to this disease. There are several indisputable facts which cannot correlate the present accepted bacteriological knowledge of this disease. Although Koch's bacillus is definitely associated with the bacteriology of this disease, tuberculous inflammation is the result of bacterial toxins, and Koch's bacillus does not produce toxins. Koch's bacillus cannot, therefore, be the direct causative agent in the production of tuberculous pathology. I would like to bring before the notice of your readers two simple experiments which can be carried out in any well equipped laboratory. (1) If healthy guinea-pigs are injected with pure cultures of Koch's bacillus, and in the course of four to six weeks, when the animals are prostrated with the disease, their spleens are removed in such a way as to avoid extraneous bacterial infection and are pulverized in a mortar with a little sterile broth, and some of this brothspleen mixture is sown in broth, after a few days to a week's incubation at body temperature, there will appear greyish colonies in the culture medium, On microscopic examination these colonies will be found to be made up of cocci. These cocci produce toxins in the broth-culture medium. (2) If other healthy guinea-pigs are injected with these cocci, they develop all the symptoms of acute tuberculosis. If they survive the intial toxremia and their organs are examined after several weeks, typical tuberculous foci will be found and the bacillus of Koch will be found in these foci. The inference drawn from these experiments, together with the knowledge that Koch's bacillus does not produce toxins, is that Koch's bacillus is only a part of the bacteriological picture of tuberculosis. The presence of the bacterium of tuberculosis in the form of Koch's bacillus does not give rise to the disease. It is only when it takes the form of the toxin-producing coccus that the classical symptoms appear. The capacity of Koch's bacillus to lie dormant in the tissues, unaffected by the tissues' lytic agents, explains the "persistence of tuberculous infection", the subject of your article in the Australian journal. This conversion of Koch's bacillus into a toxin-producing coccus also explains the hitherto unknown source of the toxins which bring about tuberculous pathology. From this revised conception of the bacteriology of tuberculosis there arises a rational scientific means of combating the pathological results of tuberculous toxremia with a sure means of overcoming tubercular infection. The bacillus of Koch, by reason of its fatty capsule, is capable of resisting the bacteriolytic agents of the body, and therefore cannot be destroyed by the body resources. The coccal form of the causative bacterium, to whose toxins the pathology of the disease is actually due, is devoid of this protection, and is vulnerable to the bacteriolytic powers of the tissues and phagocytic leucocytes. The toxin produced by the coccus can be overcome by an antitoxin serum produced in the laboratory in the same way as diphtheritic antitoxin. Injections of tuberculin appear to bring about the conversion of Koch's bacillus in the infected body into the coccal form, as it is well known that tuberculin is only toxic when injected into bodies infected with tuberculosis, and in the first of the above animal experiments if, when the tuberculous guinea-pig is prostrated with the disease, it receives a large injection of tuberculin, the coccal infection in its spleen is greatly increased. I hope that these few words will serve to throw light on hitherto unknown facts concerning the bacteriology of tuberculosis. I hope that many of your readers will carry out the simple experiments outlined, and they can in this way assure themselves that Koch's bacillus is only a partial explanation, and the least important from clinical and therapeutic points of view, of the bacteriology of tuberculosis.