REVIEW — TROPICAL MEDICINE, ETC. 211 



of blood from the median basilic vein and injecting it into tlie peritoneal cavity of guinea Tuberculosis 

 pigs. In three out of fourteen cases tubercle bacilli were thus found to be present in the —eo/Uiiuud 

 circulating blood. 



Eeference may be made to rather an important observation from a prophylactic point of 

 view, viz., the method of sedimenting and disinfecting sputum at the same time by means 

 of hydroxyl. Sachs-Miicke' found that on the addition of hydroxyl to sputum, a stormy 

 evolution of oxygen gas is produced and the gas bubbles tear and break up the tough solid 

 sputum masses. He recommends the addition of equal parts of hydroxyl and 1 per cent, 

 solution of perchloride of mercury to the sputum receptacles. 



Thus, with a minimum amount of trouble and danger, the daily amount of sputum may 

 be both disinfected and sedimented. 



As regards the diagnosis of tuberculosis, the metliod of examining the sputum for 

 tubercle bacilli has been frequently attended with tlie difBculty of obtaining a uniformly 

 even smear, thick enough to present a fair sample of the particular specimen under 

 examination, yet not so thick as to obscure the light. 



Eickards- in a paper describes an apparatus by means of which all masses of sputum 

 previously coagulated by 5 per cent, carbolic acid solution and all caseous particles are broken 

 up rapidly and the sputum is rendered homogeneous throughout. This method of shaking up 

 the sputum gave a gain of 2-8 per cent, of positive results in detecting the tubercle bacillus. 

 Rickards found that, by the addition of a small amount of 10 per cent, aqueous solution of 

 caustic soda previous to the shaking, digestion of the mucus took place more readily, 

 rendering the smearing easier. He recommends a Babcock machine for sedimenting 

 the sputum. 



In connection with the diagnosis of the tubercle bacillus by the Ziehl-Neilsen 

 method of staining, a very important recent paper by Dr. Hans Much^ shows that 

 this observer found, on making post mortem examinations of cattle infected with tubercle 

 bacilli of known origin and ordinary character, and presenting typical nodules in the lung, 

 that the most careful examination in certain cases may fail to reveal acid-fast forms, 

 and this also in spite of the fact that inoculation experiments may demonstrate the 

 tuberculous nature of the lesions and that from some of the cases tubercle bacilli may even 

 be obtained by culture. 



Similar results were observed in the case of the so-called "cold abscesses " occurring 

 in the human subject. Much found by using the methods of Gram and Ziehl-Neilsen, 

 that there were two forms of non-acid-fast tubercle bacilli ; one a rod-shaped form, partly 

 granular, and the other a granular form consisting of granules lying singly or clustered 

 together into irregular groups. In using Gram's method the preparations were left in the 

 gentian violet solution for 48 hours before decolorisation. 



Further, he showed that by taking small pieces of lung tissue from a case where 

 no ordinary tubercle bacilli were found, and incubating for varying periods in serum tubes 

 placed in an incubator at 37° C., when stained by Gram only granules and rods were 

 obtained; but after incubating for six days, bacilli staining by Ziehl-Neilsen's method 

 were recognisable. In a paper on the same subject in the Beitrage znr Klinik der Tuhercnlose, 

 Band VIII, Heft 1, page 85, Much suggests that the Ziehl-Neilsen's staining depends 

 upon some other constituent of the bacillus than that upon which the Gram method rests. 



Michaelides, in a paper in the same number of that journal, arrives at similar 

 conclusions. He also states that there is a form of the tubercle bacillus which does not 

 stain with Ziehl-Neilsen or with Gram, but which can be demonstrated by the Loeffler- 

 Giemsa method of staining. These recent observations are evidently of considerable 

 practical importance in diagnosis. 



A valuable and recent aid to the diagnosis of tubercle was furnished by Calmette' in 

 June, 1907, and is now known as the " Calmette Ophthalmo-reaction." 



Calmette announced that if tuberculin be placed in the eye of a tuberculous subject a 

 conjunctivitis is produced, whereas in a healthy subject there is no change. 



* Sachs-Miicke (October, 1906), "A method of Sedimenting Sputum by Hydrogen Peroxide." Jonnin! of 

 rreventive Medicine. 



* Rickards (May, 1907), "Sputum shaking and Sedimenting Apparatus." Journal of Infectious Disennes. 

 ' Much, H. (.Tune 6th, 1908). Berlin Klin. JVoch. 



* Calmette, A. (August 30th, 1907), " Sur un nouveau precede de diagnostic de la tuberculose chez I'homrae 

 par I'ophthalmo-reaction a la tuberculine." Bull, ile riiixlilut Paslc^i-r. 



