K B. GALLI-VALERIO
Texposé de mes recherches personnelles, voyons $*il est possible de grouper ces affections dans un tableau.
Et d'abord, essayons de rattacher les pseudo-tuberculoses décrites après mon travail de 1897 à quelques-unes des formes qu'on con naissait déjà alors.
Dans le groupe des pseudo-tuberculoses déterminées par B. pseudo-tuberculosis rodentiumy entrent sans aucun doute celle décrite par Bettencourt, celle décrite par Cipollina, celle que je viens de décrire, celle déterminée par Klein. Pour moi y entre aussi celle provoquée par Courmont avec du matériel d'une arthrite de l'Homme et celle de Courmont et Nicolas. S'en rapprochent beaucoup celle de Vallée et celle de Lucel.
Les pseudo-tuberculoses de Sivori, de Cherry, Thomas et Bull, entrent dans le groupe des pseudo-tuberculoses déterminées par le B. pseudo-tuberculosis ovis,
La description incomplète que je possède de la pseudo-tuberculose décrite par Sabrazès, me laisse douter de son classement.
Voici, pour le moment, Le tableau des pseudo-tuberculoses bactériennes en relation avec les agents qui les déterminent :
i''^ Groupe : Sàurefestbacillen. —Origine : beurre, fumier, Graminées, tourbe, eaux.
2« Groupe : B, pseudo-tuberculosis rodentium, — Origine : Homme (Malassez et Vignal, Castro, Chantemesse, Brigidi, Hayem, Grancher et Ledoux-Lebard, Mazza et Mensi, Bettencourt, Courmont). — Cofcaj/c (Eberth, Charriu et Boger, Zagari, Galli-Valerio, Cipollina, Vincenzi?). — Lapin (Eberth, Dor, Lucet, Nocard). — Lièt^re (Mégnin et Mosny ?). — Rat blanc (Galli-Valerio ?). — Bovidés (Nocard et Masselin, Courmont, Liénaux ?, Parietti, Vallée ?, Courmont et Nicolas). — Cheval (Pfeiffer). — Porc (Galli-Valerio?). — • Poule (Nocard). — Pigeon (Bivolta?, Mazzanti?, Sabrazès?).
Dans ce groupe, les origines ne sont pas du tout sûres. Nous savons aujourd'hui que B. pseudo-tuberculosis rodentium est un microbe très répandu dans la nature, que souvent on trouve la pseudo-tuberculose spontanée des Cobayes et dans bien des cas susdits, nous devons nous demander si le Bacille se trouvait bien dans l'organisme d'où le matériel d'inoculation provenait ou y était
ETUDE SUR I.ES NEOFORBfATIONS NODULAIRES ^ 299
surajouté ou même, si dans quelques cas, les Cobayes inoculés n'étaient pas des Cobayes qui présentaient la pseudo-tuberculose spontanée avant l'inoculation. J'ai marqué d'un point d'interrogation les cas sur lesquels on peut être douteux par rapport à leur classification dans ce premier groupe. La très grande variabilité de ce Bacille, les descriptions incomplètes que plusieurs observateurs en ont données, empêchent souvent un jugement sûr.
3® Groupe : B, pseudo-tuberculosis oms. — Origine : Mouton (Preisz et Guinard, Sivori, Cherry, Thomas et Bull, Baumgarten ?).
4« Groupe : B. pseudo-tuberculosis murium. — Origine : Souris (Kutscher).
5« Groupe : B. pseudo-tuberculosis liquefaciens. — Origine : Homme (Du Cazal et Vaillard, Legrain).
6» Groupe : Doppelpunktba4:iUus. — Origine : Homme ( Disse et Taguchi).
7« Groupe : B. pseudomorceux. — Origine : ChevcU (Kutscher).
8® Groupe : Microcoques. — Origine : Homme (Manlredi). — Porc (Toussaint).
^ Un coup d'œil jeté sur ce tableau nous montre que, par rapport
h leur origine, les pseudo-tuberculoses bactériennes, abstraction faite de celles déterminées par les Sàurefestbacillen, peuvent se grouper comme suit :
Origine de l'Homme : 13 cas ; origine du Cobaye : 6 cas ; origine du Lapin : 4 cas ; origine du Li^tyre : 1 cas ; origine de la Sauris : 1 cas ; origine du Bat blanc : 1 cas ; origine de Bovidés : 6 cas ; origine du Mouton : 4 cas ; origine du Cheval : 2 cas ; origine du Porc : 2 c^s ; origine de la Poule : 1 cas ; origine du Pigeon : 3 cas.
Pour ce qui se rapporte à l'Homme, on peut affirmer que, sinon I dans tous les cas cités, certainement dans plusieurs, on y a trouvé
I B. pseudo-tuberculosis rodentium, chose appuyée aussi par le résultat
^ positif de l'inoculation de ce Bacille au Singe faite par Klein.
La présence du B. pseudo-tuberculosis liquefaciens chez l'Homme semble aussi certaine, comme celle du Microcoque du granulume progressif de Manfredi. Douteuse reste celle du Doppelpunktbacillus de Disse et Taguchi.
La très grande diffusion du B. pseudo-tuberculosis^ non seulement
:W0 GALM-VALERIO. — ÉTUDE SUR LES NÉOPOHMATIONS NODULAIliKS
dans des lésions des animaux, mais même dans le milieu extérieur, le rend le plus importaRCà connaître au point de vue des infections pseudo-iuberculeusés bactériennes de THomme et des animaux domestiques. Il faudra, en outre, bien se souvenir de ce Bacille dans les recherches expérimentales sur les Cobayes, car dans certains cas on pourrait croire avoir provoqué des lésions nodulaires avec le matériel inoculé, tandis qu'on se trouve en présence d'un cas spontané de pseudo-tuberculose dû au Bacille en question.
OBSERVATIONS ON FILAKIA VOLVULUS'*'
IIY
W. T. PROUT, M. B , Oh. M. Edin.
Colonial Surgeon, Sierra Leone.
I am indebted for the opportunity of describing the foUowing spécimen to D' Hood, District Surgeon, Sierra Leone. He observed a rounded tumour about the size of a pigeon's egg, on the buttock of a Prontier Policeman, who had reported sick, complaining of vague rheumatic pains. In appearance and consistency it resembled a fatty tumour, but on excising it, it was found to be a cyst, containing v^rhat seemed to be a raass of Filaria bathed in a .semipurulent looking fluid. Unfortunately the incision which had been raade to ooen the tumour had eut across the Worm, but 1 was able to dissect out with difTiculty a complète adult maie, and numerous fragment of an adult female packed with embryos.
Some time afterwards D' Hood was fortunate enough lo come across another spécimen of the same kind, again in a fronfier policeman. The cl^nical history of the case showed nothing remarkable. The Man complained of weakness. vague pains, an and inability to do his duty, which consisted of going on patrol in the district. A gleet was discovered, with swollen inguinal glands, and tlie case was supposed to be of a syphilitic nature. On further examination a tumour was discovered in the gluteal région. This was excised, and the Man was sent down to Freetown, where he was admitted to Hospilal and kept under observation for a considérable time. During this period the clinical features were not marked. He slill complained of vague aches and pains which gradually dîsappeared, and there were occasionally slight irregular rises of température. He was put on gênerai tonic treatment, and at the end of a couple of months expressed himself as fît to résume duty, and was discharged. I examined the blood on one or two
(1) This note was alreiidy published in tlie Brilish médical Journal, I. p. â09, january 26, 1901. We g[\e hère some new flgures, cstablished after author's original pencil slcetcbes.
occasions, but was unable to detecg any tilarial embryos. I aiso punctured the inguinal glands with a hypodermic syringe, but here again examination of the fluid gave a négative resuit. I may State, however, that at that time, owing to pressure of other work, I was unable to dévote as mucb time to the examination of the blood as I should like to hâve done, and it is possible that a more fréquent examination, moreespeciallyatnight, would haverevealed the présence of embryos. So far then, apart from the présence of the Filaria which I am about to describe, there do not appear to hâve been any distinctive features in the case.
TuBfouR. — It was about one inch in length by threenjuarters in breadth. On making an incision, a greenish, semi-purulent locking fluid about the consistence of cream escaped from the cyst. This, on microscopic examination, was found to contain numerous fiiarial embryos. The capsule of the cyst consisted of dense librous tissue, lined internally by a layer of soft caseous looking material, which could be easily scraped ofi and was eomposed of granular matter, fat cells, flat nucleated epithelial cells. It contained free embryos. The interior of the cyst was fîlled with the adult Filariae, lying in loops, twisted up in the most confusing fashion; entering the cyst walls, runningalong shallow channels, and then reentering the cyst. Owing to this and to the softness and brittleness of the Wôrm, it was a matter of the greatest diflicuUy dissecting it out, and I found it impossible to do so without breaking it. Eventualiy, however, I succeeded in isolating a complète unbroken adult maie, and the head, tail, and intermediate fragments of a female. Thèse two formed the whole contents of the cysl.
Mâle worm. — He is of much smaller and narrower dimensions than the female. Length of one spécimen 3^^025, of the other 3^"^035. It is white in colour, and somewhat flattened in shape, which is possibly artificial, and due to immersion in the preserative. The chitinous cuticle, which is about 18 \l in thickness, is very distinctly striated throughout, the striations becoming finer as they approach the head and tail. The greatest diameter of the body is 144 [jl, which is maintained throughout the greater part of its course. There is a gentle and uniform taper to head and tail. Diameter at head 44 p..
The head (fig. 1) is rounded and not club-shaped. The mouth is
OBSERVATIONS ON FILARIA VOLVULUS
simple. The alimentary canal is simple, straight and opens ternii-
nally. Other canals can be seen in the body cavity, probably waler
vascular and reproductive Systems.
The tail (fig. 2) is very markedly incurvaled. At a distance of 49 a
from the extremily, the anal orifice can be seen. Posterior to Ihis, the tail is narrow, 28 fx.; immediately anterior, it measures 44 ji, while just where the incurvature ends the diameter bas increased to 64 ji. The extrême end of the tail, on the concave side, is tlattened, and at this point, four papillae arran-
Fig. 1. — Head of the maie. — A, after a pencil drawing; B, after a photograph.
Fig. i, — Tail of Ihe maie.
ged one behind the other can be seen. Thèse appear to me to be in pairs, as on focussing carefuliy past them, the dim outlines of others can be seen.
The anal orifice itself , is seen to bave one post-, one pre-anal, and two latéral papillas. Probably a similar number is to be found on the other side giving a total of eight anal papillae.
From the orifice a spicule projects for a distance of 48 a. The extremity of this is slightly clybbed, from which it expands gra-
dually to a trumpel-shaped inner end. It has a well delined double outline and a central canal, which has a minute opening at the free end. The latter is 6 a in diameter, and the trumpet-shaped end 14 [JL. Length 82 [jl. Beginning just within the orifice is another spicule, which is much longer, 177 p, and has much the same shape, though narrower al the point 4;jl. Both spicules are incurva ted following the curvature of the taii , and show signs of striation, the larger more markedly so.
Female worm. — The female is longer and thicker. The total length of the head, tail, and intermediate fragments is 40,4^"\ or about 16 inches.
The head is rounded and blunt (lig. 3, A). The lail is blunl and slightly curved (fig. 3, B), but is not incurvated like the maie lail.
The diameter close to the end is
^^^ ttÉH^I ^H*^) rapidly inçreasing to 36(iL at
^^^^ cl^^H which it remains throughout the
^^^H 'ir^^H greater part of the Worm, tapering
iVll \ ^^B "^^'*^ gradually to the head where
^•41, . ,-^ ^ ^^p it measures 4|x.. The body is slria
* y ted from end to end, but not so
markedly as in the maie Worm,
A B and has a well delined while chiti-
FiK. 3.- A. head of Uie female ; ««"« ^^^ti^^^- 'The alimentary canal B, taii of the same. is straight. but I was unable to
make out the opening of the anus.
At a distance of 43o<'"^ from the tait, the double utérus, which has throughout a well delined external lining membrane, can be observed commencingiaa sacculaled exlremity. It is hère seen lo be filled with a number of small finely granular cells, somewhat elongated and arranged like columnar epithelium, the base against the walls, the narrow end towards the lumen of the utérus. A little furlher on, they increase in size, are pear-shaped, and measure 8[a2 by 12jjL. At a distance of 14^™ from the lail signs of difïerentationare first to be seen. They now measure from 24{jl by 12 a to 32 a by 22 a. A distinct cet! wall can now be made out.
Slill further up, the proloplasm has shrunk from the cell wall and dilTerentiation is more marked. Size 36 a by 28 (a. The cells by this time bave lost their pear shape and are more or less rounded.
OBSERVATIONS ON FILARIA VOLVL'LIS
.TOH
Soon the embryos take on a more definite shape, lying curled up in the cell with clear amnionic fluid separaling them from a verv distinct lining mambrane. On slaining with logwood the curled up embryos show minute nuclei. The cells vary in size and average 32 a by 34 fA.
Followingthe utérus up, someof the curled embryos are seen ro hâve ruptured the cell membrane and to be lying free in thecavity. They gradually uncurl, and finally are to be seen packed in rows and interlaced with one anolher. Development does not proceed at Ihe sa me rate in both branches oi Ihe utérus, as in one branch curled embryos can be seen, with the other branch full of straight embryos Iving alongside. The embryos hère measure 480 to 200 [l in length by 4 [A in breadlh. Eventually bf)th branches o( the utérus are seen to be fi lied with straight embryos.
The branches o( Ihe utérus conta ining embryos can be traced distincly to within Irams of the hcad. After this owing to the clearness of the spécimen they were more difficult to follow, and 1 was unable to détermine the vagina or ils opening.
The alimentaiy opens terminally and at the siiles two indislincl canals can be made out.
Embryos. — The free embryos found lying in Ihe cyst measurc 2oOa in length by oa to 6îjl in breadlh. The head is rounded. The tail is very sharp with a taper of aboul 1/5 of the length of Ihe body. A collection of Une granules is seen running along the body.
Flg.4. — Fragment of the l)ody of ttie femalc, showiDg ttie narrow intestine and two large utérine tut>es, wltli embryos at différent stages of ttieir developiiient.
giving the appearance of a fine canal. About tbe junction of the anterior fiflh wilh the posterior four fifths, there is a rlear spot free from granules, evidently the V shaped spot of Manson. 1 could not however satisfy inyself as to this particular shape.
The embryo is not sheathed.
The tollowing stalement gives in a tabular forni, the charaderislics of the embryo of this, in coniparison with those of tbe blood Worms alrealdy known :
riLAHIA DIURNA
FILARIA NOCrURNA
PILARIA PERSTANS
HRESBIVT FILARIA
Ungth.
Breadtb.
7ji5
Sbeath.
présent
présent
absent
absent.
Head.
Tall.
Sharp
Cephalic armature slx-lipped.
Sbarp 1/5 taper
PapUlated.
Truncated.
Rounded.
Sharp taper 1/5.
B<Kly.
Vspot.
Central granular aggregation.
présent
III defined aggregation.
présent
No central aggregation.
none.
Central grannlar aggregation.
clear spot.
It would appear tlien to resemble F. noctuma and F. diuma in several points with the exception that it is smaller and possesses no sbeath.
The above description is that of a Filaria vvhich, so far as I ani aware, bas not hitherto been described in détail, if at ail. Making allowance for shrinkage conséquent on the raelhodex of préparation^ and taking into âccount the geographical facts, the clinieal characters of Ihe tumours, and the anatomical features of the embryos, a diagnosis of the Worm nanied' by Leuckart Pilaria volvulus is highly probable. Whether, judging from ils superficial position, Ihis Filaria complètes its cycle -by ulcération of the tumour, and sheds its embryos into the outerworld in the same way as the Guinea-Worm does; or whether the embryos gain entrance lo the blood, and follow the usual cycle in the Mosquito, are points vvhich require further observation.
OBSERVATIONS ON FILARIA VOLVULUS 307
The former is, in my opinion, unllkely, and when we reniember the hundreds of thousands of embryos which the adult Worm is seen to contain, we can understand how even a single Worm can give rise to a very marked degree of infection of tlie blood. Tbe removal of the tumour in this case may bave been the cause of the absence of embryos from the biood, and if such is the case, a very P important indication for treatment is given for those cases where
the adult is situated superficially in glands or otherwise.
Lastly, I may be permitted to take this opportunity of expressing my thanks to Professor Hamilton, for very kindly allowing me the use of the pathological Laboratory, Aberdeen, and to D^ Manson for his kind and valuable suggestions.
. SUR UN CAS DE FRAMBŒSIA OBSERVÉ EN ALGÉRIE ET QUI PARAIT DÉTERMINÉ PAR UN STAPHYLOCOQUE
