An Address on Cholera and its Bacillus
An Address on Cholera and its Bacillus
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关于霍乱及其芽孢杆菌的演讲
DOI：
10.1136/bmj.2.1235.403
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发表时间：
1884
影响因子：
--
通讯作者：
R. Koch
中科院分区：
文献类型：
--
作者：
R. Koch
[在会议开始前，科赫博士展示了一些显微制剂，稍后将参考。科赫博士还解释了霍乱杆菌的制备和培养方法。准备工作照常进行。从粪便或肠道内容物中滴出一滴粘液，涂在物镜上，然后烘干。然后，通过气体白酒灯的火焰将物镜抽三次，洒上品红或甲基蓝的水溶液，几秒钟后冲洗干净，以便立即在显微镜下借助十二分之一英寸的油系统和阿贝冷凝器进行观察。肠道切片必须在纯酒精中硬化，最好在亚甲基蓝的浓水溶液中染色24小时，或加热一小段时间，然后在通常的马尼拉锅中处理。仅在极少数情况下，仅用显微镜检查就足以诊断，一般情况下，必须采用后续培养方法才能证明有芽孢杆菌的存在。将一小滴粘液放入10立方厘米的食品明胶(肉-水-胡椒-明胶，含10%)中。明胶，具有弱碱性反应)，并通过使液体运动来分布在其中。然后将液体明胶倒入水平放置的玻璃板上，通过放在下面的冰来冷却玻璃板。用消毒的玻璃棒铺开的明胶很快就凝结在一起了。然后把盘子放在玻璃容器下，保持潮湿直到细菌菌落生长，然后用Zeis A.A.目镜或相应的电源进行检查。]先生们，-对于卫生措施，我们需要尽可能坚实的基础。这不仅是一个非常昂贵的机构的问题，而且是许多人的幸福和痛苦的问题。这在预防瘟疫方面尤其如此，可以毫不夸张地说，在这方面，最重要的卫生努力正在进行中。因此，我们应该假设，在抗击瘟疫的斗争中，人们将从完全建立和科学阐述的基础开始；但不幸的是，情况并不是所有地方都是这样，特别是在霍乱方面，缺乏这样坚实的基础。诚然，关于霍乱的性质及其传播方式和感染方式，已经发表了许多观点，并提出了各种理论；但这些观点仍然非常不同，它们是如此截然相反，以至于我们不能在未经审查的情况下，将它们视为我们想要采取的抗击这一瘟疫的措施的支持或起点。一方面，有人断言霍乱是一种起源于印度的特定疾病；另一方面，这一点存在争议，并认为霍乱也可以在其他国家自发发生，并不依赖于特定的原因。一些人认为霍乱只由霍乱患者及其影响传播；另一些人则认为霍乱可以通过商品、健康的人和气流传播。关于饮用水作为传播传染病的媒介的重要性，关于土壤条件的影响，关于病人的粪便中是否含有传染病的问题，以及关于潜伏期的问题，同样存在着相互矛盾的意见。但所有这些恰恰是预防霍乱的最重要的几点，只有在霍乱病原学的这些基本问题上达成某种统一的意见，才可能成功抗击霍乱。我们在了解其他传染病的病原学方面所取得的进展，对霍乱的病原学几乎没有什么好处。这一进展主要是在过去十年中发展起来的；在此期间，没有机会调查霍乱--至少在欧洲或邻近国家没有机会；在印度，霍乱可以持续提供调查材料，没有人通过应用新的调查方法来从事这项工作。
[BEFORE the opening of the sitting, some microscopic preparations were exhibited by Dr. Koch, which will be referred to afterwards. Dr. Koch also explained the method for preparing and carrying out the cultivation of the cholera-bacillus. The preparation takes place in the usual manner. A drop of mucus from the dejecta, or from the contents of the intestines, is spread on an object-glass, and dried. The object-glass is then drawn three times through the flame of a gasor spirit-lamp, sprinkled with a watery solution of fuchsine or mnethyl-blue, and rinsed after a few seconds, in order to be immediately investigated under the microscope with the help of an oil-system, one-twelfth inch, and Abbe's condenser. Sections from the intestine, which must be hardened in pure alcohol, are best coloured in a strong watery solution of methylene-blue for twenty-four hours, or by being warmed for a short time, and then treated in the usual maniier. The microscopic test alone is sufficient in only a comparatively few cases for the diagnosis, and generally the followinig method of cultivation is necessary for proving the certain presence of the commabacillus. A very small drop of mucus is placed in 10 cubic centimetres of foodgelatine (meat-water-pepton-gelatine, containing 10 per cent. of gelatine, and having a weak alkaline reaction), and distributed in it by putting the fluid in motion. Then the liquid gelatine is poured on to a glass plate lying horizontally, which is cooled by means of ice lying under it. The gelatine, spread out by a sterilised glass-rod, very speedily congeals. The plate is then put under a glass-receiver, which is kept damp till the colonies of bacteria develop, and is then examined with a Zeis A. A. eye-piece 4, or a corresponding power.] Gentlemen,-For sanitary measures, we require bases of as firm a foundation as possible. It is not only a question of very costly institutions, but of the happiness and misery of many people. This is most especially true for protection from pestilences, in which, it can be said without exaggeration, the most important sanitary efforts are being engaged. We should therefore suppose that, in the struggle against pestilences, people would start from thoroughly established and scientifically elaborated bases ; but unhappily this is not everywhere the case, and especially with regard to cholera such a firm basis is wanting. It is true that a host of views on the nature of cholera, and its mode of speeadino and infection, have been expressed, and various theories have been propounded concerning it; but the opinions are still so very divergent, they are so diametrically opposed, that we cannot take them, without examination, as supports or starting points for the measures we want to take in combating this plague. It is asserted, on the one hand, that the cholera is a specific disease originating in India; on the other hand, this is disputed, and it is held that cholera can also arise spontaneously in other countries, and is not dependent on a specific cause. Some hold that cholera is only introduced by the cholera-patient and his effects ; others say that it can be spread by merchandise, by people in good health, and by currents of air. Equally contradictory opinions exist concerning the importance of drinking-water as a vehicle for conveying the infectious matter, and concerning the influence of the conditions of the soil, and concerning the question whether or not the infectious matter is contained in the dejecta of the patient, and on the duration of incubation. But all these are precisely points of the greatest importance for the protection against cholera, and a successful resistance to the disease will not be possible till some unity of opinion has been arrived at on these fundamental questions of the etiology of cholera. The etiology of cholera has profited little from the progress which we have made in the knowledge of the etiology of other infectious diseases. This progress has developed chiefly in the last ten years ; and during this period there has been no opportunity of investigating cholera-at least, not in Europe or in adjacent countries; and in India, where the cholera could have continuously afforded material for investiaation, nobody has been found to occupy himself with this task by appYying the new methods of investigation.