No.
Boston
Medical Library
Association,
19 BOYLSTON PLACE.
(/,/ ^ I- '^
ALPHABETICAL CONTENTS
Bacteriolo
RLD
AND
Modern Medicine
1892.
ORIGINAL.
A New Hydropathic Treatment for Dyspepsia 50
Apparatus for Cultivating Anaerobic Bacteria, either in
plates or tubes (^illustrated) 323
A Renal Calculus of Unusual Size — Nephrectomy — Re-
covery 356
A Thermogenous Substance in Urine 87
Bismuth by Enema in Dysentery 20
Contribution to the Study of Progressive Muscular
Atrophy {ilhistrated') 402, 435
Diet in Gastric Neurasthenia, or Nervous Dyspepsia 121
Digestion of Milk in the Young 87
Double Chancre a Distance — An Inquiry into Syphilitic
Auto-inoculation 259, 295
Electricity in a Blacksmith Shop 53
Experiments in the Treatment of Tuberculous Guinea-
pigs with Tuberculine 331
For Cracked Nipples 50
*' Grippe " and Phthisis 45
Immunity against Pneumonia 160
Influence of the Continuous Current on Microbes, Par-
ticularly on Charbon Bacteridia {illustrated) 1, 41, 77, 119
La Grippe , 195
La Grippe and Dengue 160
Lessons in Bacteriology {illustrated) 17, 54, 86, 123
London Medical News 159, igS
Massage and Scanty Urination ; 265
Micro-organisms of the Mouth 191, 226
Modern Treatment of Furuncles 231
Observations on Staining the Flagella on Motile Bac-
teria 115
Origin of the Infection of the Urinary Organs 199
Physiological Hygiene 264
Physiological Medicine 229
Protoplasmic Foci-Theory of Metabolism 243, 262, 297
Pruritus Ani 239
Putrefactive Bacteria in Healthy Dead Animals 293
Radical Treatment for Consumption 86
Results of Pure Cultures of Tubercle Bacilli and other
Pathogenic Bacteria from Sputum 329
Resistance of Sputum Pneumococcus 160
Statistics of Anaesthesia 265
The Application of the Microscope in Medical, Medico-
legal, and Legal Difficulties ., 80, 121
To Prevent Diphtheria 124
The Attenuation of Virulent Micro-organisms 155,196
The Influence of Dress in Producing the Physical Deca-
dence of American Women (illustrated) ... 4, 46, 83, 157
Trephining for Cerebral Hemorrhage 160
Trephining for Epilepsy 160
The Study of Immunity 257, 291, 323, 355, 393, 429
Treatment of Tuberculosis by Aristol 265
The New Chemistry of the Stomach 324, 358, 396, 430
THEORY AND PRACTICE.
A New Communication from Prof. Koch 32
A New Remedy for Tuberculosis 33
Antidote for Viper Wounds 34
Y\ntrum of Highmore 35
Berlin Methods of Antiseptic Dressing 33
Bouchard's Bath in Typhoid Fever .... 28
Cause of Diabetes 35
Cold as a Caustic 34
Cold Water in Dysentery 34
Experimental Researches Relating to Sugar 32
Globulicide Power of the Blood Serum 29
How to Give a Fomentation 33
Implanting Artificial Teeth ". 34
Influence of Bromide of Potash on the Liver 34
Origin of Suppuration in the Antrum of Highmore 35
Phagocytes : the Warrior Cells 25
Radical Cure of Inguinal Hernia in Infants 35
The Cause of Rheumatic Diathesis 27
Tuberculosis by Heredity. 31
Unfermented Breads for Dyspeptics 30
TRANSIiATIONS AND ABSTRACTS.
A New Remedy for Psoriasis — Gallacetophenone 58
Ascites with Abdominal Tumors 128
Acetic Acid in Chronic Laryngitis 129
Analogy of Migraine to Epilepsy 168
Antisepsis at Bergmann s Clinic 169
Antiseptic Treatment of Burns 169
Administration of Creosote by Enema 205
A New Method of Treatment of Spina bifida 237
An Improved Transfusion Apparatus 267
A New Boric Preparation, — Boroborax 269
Alcoholism and Insanity 304
A New Method of Anaesthesia 442
Atropine for Hypersecretion of Gastric Juice 305
Analysis of Milk by Electricity 337
A New Symptom of Bright's D'sease 443
2
ALPHABETICAL CONTENTS.
A New Dietetic Regimen 444
Arrowhead Poison 337
Auto-intoxication of Intestinal Origin 409
Brown-Sequard's Elixir •• 59
Celluloid Substitute for Bone 59
Creosote in Pulmonary Tuberculosis 128
Calcareous Food 303
Chimiotoxic Value of Tuberculine 337
Diphtheria and Glanders Bacilli 126
Detection of Alkaloids in the Urine 372
Effect of Vinegar upon Digestion 59
Effects of Electrical Currents of High Potential 269
Electrical Anesthesia 443
Fever by the Action of Soluble Pyocyanic Substances 129
For Cracked Nipples 443
Gout and the Use of Sugar 59
Haemostatic Gauze 270
Haematotherapy in Tuberculosis .^ 305
Hygiene and Regimen of Rheumatism 443
Immunity and Treatment of Swine Erysipelas and other
Infectious Diseases 128
Influenza in Russia • 442
Iodoform Injections for Goiter 204
Intra-cellular Parasitism of Cancerous Neoplasms {illus-
trated) 235, 266
Laveran's Parasites in Intermittent Fever 270
Lysol 205
Methyl-blue as Antiperiodic 59
Methyl-blue in Acute Nephritis 128
Modifications of Muscular Fibers in Trichiniasis (illus-
trated) 334
New Treatment for Chronic Laryngitis 169
New Method of Establishing an Artificial Anus 442
Nitrite of Amyl for Chloroform Poisoning , 205
New Methods in Skin-Grafting 237
Neutralizing Snake Venom 270
New Views Respecting Alkalofdal Antagonism 375
Organic Oxidations in Tissues 303
Psorospermose Foliculaire Vegetante 56
Pyoktannin for Ozaena 128
Pain and Inflammation of Dental Origin 167
Pure Creosote 268
Phagocytes and Immunity 335
Race Deterioration 271
Speaking without a Larynx 58
Study of the Germs of Malaria 203
Sputum as a Diagnostic Sign in Certain Diseases 127
The Glycogenic Function of the Liver 438
The Pathology of Stomach Digestion 57
The Value of Lotions in Diphtheria 57
Treatment of Stricture by Electricity 59
The Morphology and Biology of the Yeast Fungus {illus-
trated) 88, 125
The Micro-organisms of Under-Garments 129
The Rational Treatment of Hepatic Affections 161
The Action of Bacterial Products on Vaso-motor Centers. 166
The Liver as an Organ of Asepsis — Clinical and Thera-
peutical Considerations 200, 232
The Work of the Heart 202
Toxicity of the Urine in Diseases of the Liver 205
Transfusion of Tissue Juices 268
The Goat as a Source of Vaccine , 270
The Liver as a Bile-making Organ 300, 332, 370, 407
The Cure of Consumption 304
The Cure of Rabies by the Blood Serum of Immune
Animals 304
The Toxic Nature of Normal Urine £36
The Toxic Properties of Bases Extracted from Muscular
Tissue 373
Thoracic Deformities in Young Men 374
The Formation of Sugar from Peptones 375
Ventilation as a Means of Disinfection 58
Variola and Vaccine 91
Vesication for Incontinence of Urine 237
BACTElRIOIiOGICAIi NOTES.
A New Use for Tuberculine 60
Action of the Gastric Juice of Man on Pathogenous
Germs 9(2
A New Toxine in Urine 130
A N ew Bacillus of Malignant Oedema 206
Alcoholism and Tuberculosis 207
A New Diplo-bacteria Found in the Blood and Urine of
La Grippe Patients 238
Action of Dog Serum on Rabies Virus 272
A Remarkable New Skin Disease 273
A New Antiseptic Combination 273
A Mode of Infection of Milk Little Known 376
A New Leucomaine 134
Bacterial Products 60
Bacteria in Peritoneal Serum of Strangulated Hernia. . . , 238
Blennorrhagia 306
Behavior of the Typhic Bacillus in the Soil 306
Bacterial Complications in Cholera 412
Bacteriological Diagnosis of Cholera 413
Certain Actions of Tuberculine 131
Destruction of Microbes by Amoeboid Cells in Inflamma-
tion 93
Diminished Bactericide Property of the Blood Serum of
Rabbits Vaccinated against Pneumonia 171
Different Modes of Contagion in Tuberculosis 376
Enzootic Cerebritis in Horses 61
Eberth's Bacillus and the Bacillus Coli 170
Germs of Oleomargarine 338
How the Bacillus Coli Communis Invades the Organism. 273
Induced Immunity against Pneumococcus 6t
Influence of Temperature on the Bactericide Action of
Light 92, 130
A New Chemical Function of the Cholera Bacillus 445
Laparotomy in Tuberculous Peritonitis of Children 445
The Treatment of Actinomycosis 445
Infectious Maladies Modified by Antagonistic Microbes. . 272
Immunity and Cure of Experiment Animals in Diphtheria
and Tetanus 412
Luminous Bacteria 61
Mechanism of the Action of Pathogenous Microbes 272
Microbic Action in the Digestion of Cellulose 273
Milk and Microbes : . 60
Nutritive Processes of Microbes 272
On the Structure of Bacteria 92
Prevention of the Multiplication of Disease Germs 60
Phagocytosis and Immunity 170
Ptomaines of Measles and Whooping-cough 206
Preventive Vaccination of Animals against the Cholera
Microbe 412
Preventive Inoculation of Hog Cholera in Man 413
Recurrent Erysipelas 207
Role of Oxygen in the Production of Ptomaines 273
Some Modes of the Transmission of the Bacillus of Tu-
berculosis 238
Staphylococcsemia 338
The Pneumococcus and Cerebro-spinal Meningitis 61
The Action of Common Salt on Bacteria 92
Tubercular Germs and Hospital Dust 93
The Bacillus of La Grippe 93
The Influence of Wood Smoke on the Life of Bacteria. . . 130
The Leprosy Bacillus 131
The Microbe of La Grippe 131
The Bactericide Property of Urine 131
Traumatic Tetanus Cured by Anti-toxine of Tetanus 171
The Flora of Butter 207
The Bactericide Substance of the Blood 206
The Bacteria of Melons 238
The Resistance of Virus of Pneumonia in Sputum 239
The Action of Muscular Tissue in Certain Infections 239
The Action of Essential Oil Vapors on the Bacillus of Ty-
phus, of Tuberculosis, and of Charbon 239
Tubercle Bacilli in Semen 272
ALPHABETICAL CONTENTS.
'The Pure Cultivation of Actinomycosis and its Trans-
missibility to Man 306
'The Bacilhis of Typhoid Fever and the Bacillus Coli
Communis 33°
The Action of Mineral Filters on Microbic Fluids 338
The Cause of Immunity, and the Cure of Infectious Mala-
dies 339
The Etiology of Suppuration in Tuberculosis 339
The Treatment of Tuberculosis by Antiseptic Vapor-
izers 370
The Bacillus of Cholera 377
The Penetration of Walls by Germs 377
The Action of Tobacco Smoke on Pathogenic Micro-or-
ganisms 412
Treatment of Osteitis and Tuberculous Arthritis by a
Solution of Iodoform in Oil 444
EDITORIAIi.
An Epidemic of Typho-Diarrhceal Disease 447
Arsenic in Skin Disease 67
Actinomycosis ^33
An Excellent Opening for a Medical Missionary 174
Alcohol as a Food 208
Astonishing Medical Advice 212
A Fact Useful for a Laparotomist > 512
An Interesting and Instructive Experiment 213
A Magazine's Plea for Clairvoyants 276
An Inquiry into Syphilitic Auto-Intoxication 280
A New Form of Electrical Current {illustrated) 308
A Higher Standard of Medical Education 344
Bacteriomania 208
Bacteriology in Medical Colleges 210
Biology in the Study of Character 279
Brown-Sequard's Extract of the Sexual Glands 312
Brown-Sequard's Elixir 448
Bacillus Coli and Eberth's Bacillus 416
Calomel and the Liver 66
Cold Baths in Typhoid Fever 96
Curetting before Laparotomy 379
" Dangerous Science " 132
Earthworms and Tuberculosis 343
Etiology of Specific Diseases 340
How to Prepare Koch's Tuberculine 22
How Cholera Attacks the Human Body, and How to
Prevent It 451
Hydrogen Peroxide in Pelvic Abscess 24
Headache Cured by Massage 67
How the Bacillus Coli Communis Invades the Organism. 311
Heredity 415
Infection of Surgical Wounds by Catgut 24
Immunity ' 62
Indigestibility of Cheese 175
Intestinal Gymnastics 211
Is Aseptic Surgery Possible ? 450
La Grippe and Consumption 25, 62
Micro-organisms and Alcohol in Digestion 98
Misdirected Surgery 134
Micro-photography 243
Mixed Drugs in Therapeutics 311
Meeting of the American Public Health Association in
the City of Mexico 446
Metchnikoff on Vaccination 344
Microbes in Breast Milk 414
Notice to Subscribers 62
Natural Resistance to Infectious Diseases 245
Our Purpose 21
Our Collaborators and Contributors 94
•Oysters and Typhoid Fever 64
Papoid in Dyspepsia 450
Phagocytosis 22
Putrefactive Germs in Healthy Meat. 310
Prize Essay on Quackery 313
Removal of the Appendages for Epilepsy 176
Reaction in Cold Bathing 244
Rest-hour 414
School Reform 211
Scientific Exposure of Magnetism Frauds 417
The Bacteriological World and Modern Medicine. 20
The Relation of the Diagnosis to the Cure of Tuber-
culosis {illustrated) 23
The Two Ways in Therapeutics 25
The Cause of Nervous Headache 63
Tobacco Using and Physical Development 66
To Our Subscribers 94
The Germicidal Properties of Milk 94
The Hygiene of Valvular Disease of the Heart 95
The Relation of the Will to the Passions 98
To Render Tobacco Harmless 135
Tobacco Insanity and Nervousness 135
The Germicide Properties of Cinnamon 136
Two Newly Observed Peculiarities of Feminine Physique. 136
The Abuse of Tonics 172
The Causeof Chronic Degenerative Disease of the Spinal
Cord 176
The Opium Habit in India 312
The Decline of Antipyrine 313
The Surgical Treatment of Retroversion of the Uterus. . . 341
The Increasing Prevalence of Tapeworm 343
Tuberculosis Contracted at Health Resorts 378
The Abuse of Mercury 380
The Influence of Tobacco upon Digestion 380
The Infection of Milk 381
Toxicity of the Urine in Epilepsy 382
The Comparative Vital Resistance of Carnivorous and
Vegetable Eating Animals 382
The American Medical Temperance Association 240, 274
The Effect of Warm Baths upon Assimilation 244
The Relation of Putrefaction of Disease Phenomena in
Live Tissues 275
The Sinusoidal Current 416
The Tea and Coffee Habit 418
Various Microbes in Tuberculosis 241
liABORATOR/lT OF HYOIEINE.
A Peculiar Case of Malignant Disease of the Uterus
{illustrated) ? 179
Action of Essential Oils and Creosote on Certain Bac-
teria 215
Analysis of Stomach Fluids 354, 390
Bacteriological Studies of Dr. Kellogg's Aseptic Drain-
age tube 102
Catgut and Silk Ligatures 101
Clinical and Experimental Tuberculosis 389
Convenient Methods for Determining CO2 {illustrated). 425
Disinfection of Buildings, etc 181
Elimination of Microbes by Urine 141
Further Experiments with Vaccine 103
How to Sterilize Milk 70
Importance of Good Stains in all Microscopical Work. . . . 217
Infectious Abortion 180
Investigation of Contaminated Drinking Water 458
Laboratory of Hygiene and its Object 37
Latency of Diphtheria Germs 141
Liver Flukes in Cattle {illustrated) 320, 351
Lotion in Diphtheria 39
Microbe of Abscess in La Grippe 139
Mouth Antisepsis 140
One Cause of Antagonism to the Germ Theory in Tuber-
culosis 216
Poisonous Products of Decomposition 285
Pseudo vs. True Gonorrhoea 139
Query about the Yeast Plant. 286
Relative Influence of Germs and Their Products in the
Production of Disease 351
4
ALPHABETICAL CONTENTS.
Researches Respecting the Purity oiYacc'me(zllusirated) 69
Staining the Bacillus Tuberculosis 38
The Bacillus of Tuberculosis 71
The Durability of Apochromatic Lens 72
The Morphology of the Bacillus of Tuberculosis 139
The Bacterium Coli 140
The Vitality of the Pneumococcus 319
The Acid of the Gastric J nice • 424, 457
The Coloring Matter of the Micrococcus Prodigiosus. . . . 427
The Role of Micro-organisms in the Production of Gas in
the Alimentary Canal 247
TECHNIQUE.
A New Mode of Staining Spores 459
Anise Oil as an Imbedding Material for the Freezing
Microtome . , 459
A Test for Carcinoma 142
A New Bacillus in Green Sputum 321
A New Method of Coloring Spores 322
Blood Fermentation 182
Clear Agar-agar Culture Medium 182
Glycerine . . 287
How to Obtain Pure Cultures of the Bacillus of Tubercu-
losis 287
How to Extract Griffith's Leucomaine from the Urine of
Epileptics 354
Lustgarten 's Method of Coloration 288
Method of Staining the Parasites in Cancer-cells 287
Method of Rapid Staining for Tubercle Bacilli in Speci-
mens Preserved in Muller's Fluid 354
Przewaski's Method of Imbedding in Paraffine 218
Practical Points in Handling Objectives to Obtain Best
Definition 287
Staining Glanders Bacilli 142
Staining Tubercle Bacilli in Sections 249:
Smith's Method of Drawing 288-
To Extract Ptomaines from Urine 72
To Mount Cover-glass Preparations in Canada Balsam. . . 104-
The Absence of Hydrochloric Acid 459
The Preparation of a Thermogenous Substance from
Urine 142-
To Extract Bactericide Substances from the Blood and
Confer Immunity against Charbon 218
To Clean Slides and Cover-glasses 218
The Test for the Comma Bacillus 3gr
SANITARIUM BUIiliETIN.
Antiseptic Drainage in Abdominal Surgery {illustrated) 105
A New Method of Operating upon Hemorrhoids (illus-
trated) 148
A New Method of Palpation of the Kidney {illustrated) 219
Biennial Report of the Superintendent of the Battle
Creek Sanitarium 73, 110, 143, 183.
Baths in Typhoid Fever 187
Clinical Report 150
How to Increase the Haemoglobin 154
How Oxygen is Used in the Body 154
Interesting Case of Rudimentary Uterus, Ovaries, and
Atresia Vaginae {illustrated) 186
Michigan Climatology 220
Orificial Surgery 251
Record of Surgical Work in the Sanitarium Hospital. 152, 188
The Value and Use of Inhalations in the Treatment
of Diseases of the Respiratory Organs {illustrated) 108
Reviews
...36,68, 99, 137, 177, 214, 245, 280, 314, 345, 383, 419, 45^
PLATE I.
BACTERld
World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH, U. S. A, NOVEMBER, 1891. NO. 1.
Original Articles.
INFLUENCE OF THE CONTINUOUS CURRENT ON
MICROBES, PARTICULARLY ON CHARBON
BACTERIDIA.
BY M. N. APOSTOLI AND LAGUERRIEEE, OP PARIS.
April 28, 1890, we presented to the
Academy of Sciences in Paris, a note
giving a very brief account of the work
that we had undertaken together, since
1888, to ascertain the influence of the
continuous current on microbes.
The Society of Electrotherapy being
now organized, we would submit, with
additional details, this same work to its
appreciation.
Others before us have made experi-
ments to determine the influence of elec-
tricity on microbes.
The first of these was Schiel, who, in
1875, endeavored to ascertain the efl^ect of
the continuous current, and of the in-
duced current on bacteria of infusions of
hay and meat. His conclusion was that
feeble currents sufficed to modify micro-
bian vegetation.
In 1879, Cohn and Mendelssohn exam-
ined this question. Their experiments
were made principally on the culture of
the micrococcus prodlgiosus on potatoes;
that is to say, on a solid substance. The
general conclusion reached was that the
fields of culture, and the microbes that
they contained, were modified by the
electrolitical eff'ects produced by the cur-
rent. As for ourselves, we have desired
to enlarge the circle of preceding experi-
ments, and to determine, as far as possi-
ble, their significance ; and the following
are the results of our new and personal
researches.
We have employed difl'erent media of
solid and liquid culture; but, generally
speaking, we have used peptonized broth.
Our study has been on many microbes,
some of which were pathogenic, others
non-pathogenic. First of all, we have
used the bacteridia of charbon, that or-
ganism being the one best adapted to the
experiments of the laboratory.
In our researches, we have first utilized a
strong experimenting tube, traversed hor-
izontally by two platinum wires, placed
about three centimeters from each other,
and soldered to a metallic armature des-
tined to establish a connection. See Fig. 1.
In the next place, we have utilized
cylindrical tubes of the same caliber,
whose two extremities were closed by
India-rubber stopples; the lower stopple
was traversed by a platinum wire, twisted
in a spiral in the interior of the tube ; the
upper stopple was traversed by a small
glass tube closed by a cotton-batting plug
ORIGINAL ARTICLES.
permitting sterilization, and being itself
traversed by a platinum wire extending
more or less on the media experimented
upon. See Fig. 2.
This plan was more convenient than
the first, but it did not, however, permit
us to study separately the differential
action of the poles, and we were obliged
to resort to a veritable apparatus com-
posed of four communicating tabes, and
whose cultures have often been intercalary
stoppers of gelosine. See Fig. 3.
At the present time we also utilize tubes
in V (see Fig. 4), whose disposition is very
convenient for cultures on old media (gel-
atine, gelose, potatoes).
In all our experiments, the tubes or
apparatus were sterilized, first, through
the boiling process ; then they received
the media of culture next sown ; or, more
generally, the contents of several tubes
of liquid cultures (peptonized broth) were
thoroughly mixed in a sterilized bottle,
then distributed in experimenting tubes.
Tubes of cultures were preserved as
witnesses and as means of control.
The removals of cultures were always
made purely by means of tubes, before
and after the passage of the current, and
these removals themselves served to make
new cultures or test inoculations.
Our experiments of control have been
made on numerous animals, and have
killed 140 guinea-pigs, forty-two rabbits,
and two dogs. In these experiments,
some animals under test were inoculated
before the passage of the current ; others,
in their turn, underwent the same opera-
tion after the passage of the current, and
with removals made on the positive and
negative tubes, and on each of the inter-
polary tubes.
Our inoculations ^yere made with the
syringe of Prof Strauss, first at the Prac-
tical School, then at the laboratory of
Prof. Pouchet, in the Museum.
While acknowledging the labors of
Schiel and those of Cohn and Beno Men-
delssohn, we think we have taken a large
contributive part in the study of the im-
portant question of the influence of the
current on the vitality of microbes.
1. We have experimented with the
principal fields of culture utilized in
laboratories.
2. We have used pathogenic microbes
and non-pathogenic microbes. W^ith the
latter, we have made numerous inocula-
tions in animals, which have enabled us to
determine to what extent microbes were
attenuated in their virulence, or even de-
stroyed.
3. With our apparatus with commu-
nicating tubes whose contents were sep-
arated by partitions of a conductor
(gelosine), we have clearly determined
and differentiated the action of the cur-
rent on each pole and on the interpolary
circuit, and we have shown : —
(1.) That this action was en rapport with
the intensity of the current ; and, —
(2.) That it was manifested only at the
positive polcj not being at all apparent at the
negative pole and in the interpolary circuit.
4. In determining the influence of the
intensity, we have shown that the inten-
sity is the principal factor of the attenua-
tion or of the destruction of the virulence,
and that the duration of the application
of the current is but a secondary factor.
5. W^e have employed the highest med-
ical doses utilized in electrotherapy.
6. We have eliminated the thermal in-
fluence due to electrolysation, to better
appreciate the pure and simple electric
action.
7. Finally we have equally demon-
strated that, outside of the thermal ac-
tion, the electrolytic products accumu-
lated at the positive pole, are the only
ORIGINAL ARTICLES.
agents of the attenuation or destruction of
microbes.
As to the researches of Prochownich
(of Hamburg), they were instituted after
ours, and we have been glad to see that
he confirmed our personal conclusions
with great authority.
With these general considerations thus
expressed, we will present, chronologic-
ally, the very brief and synthetical sum-
mary of the different series of our '^^.peri-
ments, which will serve as a basis of
future complemental researches.
First Series {October 23, 1888), Bacteridi% of
Gharbon. — Tubes No. 1.
A current of 150 milliamperes, applied
3 minutes, one hour after supplying the
tubes with peptonized gelatine, hindered
all vegetation in those tubes, at the same
time that it was being developed in the
witness-tubes.
Guinea-pig with witness-tube, died.
Guinea-pig inoculated with experiment-
ing tube, survived.
Second Series {November 9, 1888), Charbon}
Tubes No. 1
1. Current of 150 milliamperes, on an
average, applied 3 minutes on tubes of
peptonized gelatine in full bacteridian
vegetation since seven days, hindered
the march of vegetation, without destroy-
ing it.
2. A current of 200 milliamperes, ap-
plied on tubes of gelatine in full bac-
teridian vegetation during 3 minutes,
destroyed all vegetation and all virulence.
Cultures and inoculation made with
witness-tubes have proved a success ; the
cultures and inoculations made with ex-
perimenting tubes remained negative.
The third, fourth, and fifth series of ex-
periments have not furnished results that
were appreciable or sufficiently interest-
ing to be chronicled.
Sixth Series {March 7, 1889), Bacilus Anthracis ^
and Others. — Tubes No. 1.
1. A current of 80 milliamperes, 3 min-
1 In all our experiments with pathogenic forms, we
have operated exclusively with bacteria of charbon.
2Bacteridia, or bacillus, of anthrax and charbon are
identical.— Ed.
utes, 2 minutes, or 1 minute only, on tubes
of gelatine, did not modify the virulence.
2. Three guinea-pigs inoculated with
the product of each of the tubes, died
the third day after the inoculation.
Seventh Series {March 20, 1889), Micrococcus Pro-
digiosus, deeper blue Sarcina, Anthrax. — Tubes
No. 1.
1. A current of 100 ipailliamperes, ap-
plied 3 minutes, did not modify the
tubes of the micrococcus iwodigiosus. The
sowing done with experimenting tubes
succeeded like those that were accom-
plished with witness-tubes.
2. A current of 140 milliamperes, ap-
plied 3 minutes, did not produce an ap-
preciable action on the bluest tube sown
on gelatine. The tubes sown with an
experimenting tube gave the same result
that those did which were sown before
the operation.
3. A current of 160 milliamperes, ap-
plied 3 minutes, appears to have modi-
fied vegetation of yellow sarcina.
4. A current of 168 milliamperes, 3
minutes, did not modify the virulence of
the charbon culture broth. Two guinea-
pigs inoculated after the passage of the
current, died in forty-eight hours, as did
the witness guinea-pig inoculated before
the operation.
EigJith Series {April 6, 1889), Micrococcus Pro-
digiosus, Bacillus Subtilis. — Tubes No. 1.
1. A current of from 80 to 100 milliam-
peres, applied 3 minutes, did not modify
the vegetation of the micrococcus prodi-
giosus.
2. The same intensity of current, ap-
plied 5 minutes, did not modify the vege-
tation of bacillus subtilis. In these two
cases, the sowing done before and after
the experiment, gave the same positive
results with peptonized broth.
Ninth Series (April 21^. 1889), Charbon,
Tubes No. 2.
1. Tubes with gelatine containing an-
thrax cultures whose vegetation had been
destroyed the 31st of March, by the cur-
rent, are successfully sown with microbes
of putrefaction.
ORIGINAL ARTICLES.
2. Tubes of peptonized gelatine, no^
sown, having, two months before, been
subjected to the influence of a current of
200 milhamperes, were successfully sown
with microbes of putrefaction.
Tenth Series {April 26, 1889), Charl)on.
Tubes No. 2.
A current of 40 milliamperes, 3 min-
utes, did not modify the virulence. Some
result with a current of 60 milliamperes.
Guinea-pigs inoculated, succumbed.
Eleventh Series (May 31, 1889), Gharbon.
Tubes No. 2.
1. A current of 100 milliamperes, 3
minutes, on tubes of charbon whose viru-
lence was naturally attenuated by age,
did not produce appreciable results; of
two guinea-pigs inoculated before the
experiment, one died in the night of
June 3 to 4.
2. A current of 250 milliamperes, ap-
plied 3 minutes on peptonized gelatine,
from the 20th of May, modified the
virulence ; a guinea-pig inoculated before
the experiment, died ; another inoculated
after the passage of the current, survived.
Twelfth Series {June 4, 1889), Gharbon.
Tubes No. 2.
A current of 160 milliamperes, applied
3 minutes, appeared to have attenuated
the virulence. A guinea-pig inoculated
after the experiment, succumbed in forty-
eight hours ; of two guinea-pigs inocu-
lated after the experiment, one died in
the night of June 8 to 9.
Thirteenth Series {June 9, 1889), Gharbon,
Tubes No. 2.
A current of 170 milliamperes, applied
9 minutes on broth of fresh culture, pro-
duced no appreciable effect ; two guinea-
pigs inoculated before the operation, died
in the night of June 10 to 11. Of three
guinea-pigs inoculated after the experi-
ment, two died also in the night of June
10 to 11, and the third in the night of
June 11 to 12.1
1 The different answer obtained in the experiments of
the 12th and 13th series, which appears to be contradic-
tory, is, without doubt, owing to a difference in the de-
gree of the virulence of the anthrax employed.
fTo be continued )
THE INFLUENCE OF DRESS IN PRODUCING THE
PHYSICAL DECADENCE OF AMERICAN
WOMEN.
J. H. KELLOGG, M. D. , BATTLE CREEK.
[ "Annual Address upon Obstetrics and Gynecology,"
delivered before the Michigan State Medical Society at
the Annual Meeting held at Saginaw, June 11 and 12, 1891.
Illustrated by a stereoptican.]
As my subject suggests, I am to under-
take to show that certain features of the
mode of dress common among civilized
American women have been, and are, a
prominent factor in producing a wide-
spread and marked physical deterioration
among the women of this country. Pos-
sibly the question may be asked whether
such a deterioration exists. It is not
probable, however, that it will be worth
while to spend any considerable time in
attempting to demonstrate the proposition
that American women are degenerating
physically, before an audience made up
chiefly of medical men and women ; for
has there been a medical convention din-
ner within the last quarter of a century at
which there was not heard the familiar
toast, " Woman — God's best gift to man,
and the chief support of the doctors"?
A few months ago, I addressed an
audience of six or seven hundred young
women at an educational center in a neigh-
boring State, upon the subject of physical
culture. As my audience seemed to be an
amiable one, I ventured to ask a few ques-
tions, and among other inquiries, asked
how many women present (all of whom
had reached adult age) believed them-
selves to be physically superior to their
mothers. A bare half dozen raised their
hands, and two or three of them timidly
looked about, apparently to see if any one
present was prepared to contest their
claim.
One of the most convincing evidences
of the physical failure of American women
is to be found in the fact developed by
the last census of the United States, that
there has been, in the last ten years, an
enormous falling off in the birth-rate, as
the result of which several million babies
ORIGINAL AHTICLES. , 5
are lacking. A lowered birth-rate is a stamina in American women. A host of
much more serious matter than an in- other facts confirming and supporting
creased death-rate, although the imme- those given, might be brought forward;
diate result as regards the population but I will not thus unnecessarily consume
might be the same. An increased death- your time, since the proposition is not
rate may mean nothing more than a tem- likely to be disputed by any intelligent
porary increase in the activity of one or physician who has had wide opportunities
more of the causes of disease and death, for observation.
while a lowered birth-rate means a radi- But I must not devote more of the half-
cal and constitutional fault of some sort, hour allotted me, to introductory remarks,
threatening the very existence of the race. Fully realizing that I am likely to incur
Any one who has had an oppoftunity to the displeasure of some of my fair auditors
become acquainted with the physical con- before I have done with my subject, I may
dition of the average young woman of the as well declare myself at once as prepared
present generation, will be easily con- to defend the proposition that the*average
vinced that the next census will show a civilized American woman is deformed,
still greater falling off in the birth-rate This very uncomplimentary proposition
than the last. A corset-choked woman doubtless impresses my hearers as some-
knows very well that she is quite unfit, what startling. Nevertheless, I believe
physically, for the rearing of children ; the evidence which I shall present will
and besides the physical unfitness, she convince the majority of you that, how-
finds herself so lacking in fortitude, and ever repulsive and distressing the fact
so oppressed with nerves and neuralgias may be, it is true.
and an abnormal susceptibility to pain, A penchant for modifying the natural
that she very naturally shrinks from the form of the body so as to produce deform-
physical ordeal, as well as the mental and ity in some part, seems to prevail quite
moral responsibility, which motherhood extensively in the human race, although
involves. it must be admitted that in many savage.
Another most significant fact, for which and some civilized tribes, this strange pro-
mothers must be held largely responsible, pensity takes a less dangerous direction
is the enormous business carried on at the than among the civilized races. The
present time in the manufacture and sale , Indian woman of Alaska ornaments her
of infant foods. According to a paper upper lip with a pin stuck through it.
read by Dr. Hofi'man, before the Ameri- Among the women of some other savage
can Association for the Advancement of tribes, fashion demands that a fish-bone
Science, at its last meeting, there is con- or a piece of wood be inserted in the
sumed in the United States every year, under lip in a similar fashion, by means
not less than eight or ten million dollars' of which the flesh is dragged down, and a
worth of infant foods. That these foods strange deformity produced. The civilized
are rarely, if ever, perfect substitutes for woman finds the lobe of her ear a more
the child's natural aliment, is well known, convenient place from which to hang her
What has created such an enormous de- jewelry, and so she bores a hole through
mand for these substitutes ? Certainly it this part of her body, and inserts a wire
is not the unnatural increase of the num- weighted with a stone, and thus emulates
ber of infants which has exhausted the the example of her savage sisters. There
natural food supply; for I have already are mothers roaming in the forest, shoe-
mentioned that there has been, in the last less, hatless, and without other garments
ten years, a falling off in the birth-rate than a bark apron and the picturesque
amounting to several millions. designs of the tattooer's pencil, whose so-
These evidences point with tremendous licitude for their children leads them to
emphasis to the fact of the decline of compress their heads into cones, or to
ORIOINAL ARTICLES.
shape them to a fascinating flatness by
the steady pressure of a hoard against the
infant skull. Other mothers, less barbar-
ous, but none the less anxious for the
welfare of their little ones, squeeze the feet
of their daughters into shapeless masses
of bones and gristle, in the firm belief that
no young lady can make an eligible bride
if her foot exceeds in measure the conven-
tional three inches. Still other mothers,
more civilized, and none the less fondly
thoughtful of their daughters' interests,
base their expectations of a successful
career for them as much upon the meager
dimensions of their waists as upon the
comeliness of their countenances or the
brilliancy of their accomplishments.
Some years ago, while engaged in some
anthropometric studies among Chinese
women and the women of the primitive
Indian tribes of Arizona and New Mexico,
I was forcibly struck with the marked
difference in physical proportion between
the savage and the civilized woman. I
have made personally, and secured through
others, a large number of measurements,
which place upon a mathematical basis
certain points of difference that are ex-
ceedingly pronounced, particularly the
larger waist of the savage or semi-civil-
ized woman when compared with the
highly civilized woman. I have since
extended my studies of the subject to
the peasant women of various nationali-
ties, particularly French, German, and
Italian women, and a single race of East
Indian women. Early in the course of
my studies, the thought occurred to me
that there might be a positive and con-
stant relation between the external con-
figuration of the body and the mal-
position of various internal organs. I
accordingly devised a simple apparatus
for the purpose of making outline traces
of the figure at any desired angle. With
this instrument I have made a large
number of tracings (several hundred in
all), and have made a careful study of
the position of the abdominal and pelvic
viscera in each case.
The following is a tabulated statement
of some facts which I have collected, and
which bear especially upon the matter of
waist proportion : —
Av. Av. Per cent
height waist of waist
(ins.) (ins.) to height.
American women 61.64 24.44 89.6
Telugu women of India 60.49 24.65 40.6
English women tbrick-makers who
wear heavy skirts) 60.04 25.00 41.3
Frenchwomen 61.06 28.00 45.4
Chinese women 57.85 26.27 45.4
Yuma women 66.56 36.84 55.2
Civilized men — American 67.96 29.46 43.3
Mrs. Langtry 67.00 26.00 38.8
Venus de Milo 47.6
Percent.
Height Waist, of waist
. to height.
Average of 43 women, from 18 to 25
years old.... 60.7 27.1 44.64
Average of 25 Women, from 18 to 30
years old wearing corsets or tight
bands 62.5 23.3 37.3
Average of the same 25 women a few
months after reforming their mode
of dress 62.5 27.15 43.4
Average of 10 girls, from 9 to 12 years
old 23.5
Average of 2,000 men, from 18 to 27
years, measured by Dr. Seaver, of
Yale 68.6 29.3 42.7
A few remarks upon the above figures
will render them more significant. Of
the 100 American women whose average
proportions are given in the table, the
majority were upwards of 30 years of age.
Dr. M. Anna Wood, of Wellesley Col-
lege, has measured 1,100 women between
the ages of 19 and 21 years. Her meas-
urements make the height of the aver-
age American woman to be 63 inches,
waist 24.6 inches ; percentage of waist to
height 39.
The Telugu women of India, as I am
informed by Miss Cummings, who kindly
made a large number of measurements
for me, sustain the skirt, which forms
almost their only clothing, by means of
a cord tied around the waist and drawn
as tightly as possible. This is doubtless
the reason for the small waists of these
women as compared with those of the
women of other savage or semi-civilized
tribes.
English working women doubtless often
do themselves great harm by wearing
many heavy skirts attached to waist-
bands. I once found a young English
woman engaged in the very laborious oc-
cupation of making brick, kneading the
clay with her fist as a baker kneads dough,
and beating it into the moulds with her
fist, who was at the same time carrying
Expiration. Inspiration.
■ Fig. I. Pneographic tracing of a healthy woman.
Expiration. Insp.
Fig. 2. Pneographic tracing — woman in corset.
Costal. I¥ai8t. Costal. \¥alst.
Fig. 3. Man.
Costal .
Fig. 4. Woman in corset.
Waist.
Costal.
Fig. 5. Chippewa Indian woman.
Waist. Costal.
IVaist.
Fig. 6. Woman who never wore a corset.
Costal.
Fig. 7. Man in corset.
Waist.
Fig. 8. Dog.
Costal.
\raist.
Fig. 9. Dog with corset on.
PLATE I. — Breathing Movements in Man and Dog.
8 ORIGINAL ARTICLES.
upon her waist the weight of six heavy the ancient statues of women which have
quilted skirts, with no other support than been discovered, the famous Venus de
bands. The average waist measure of a Milo, is 47.6 per cent of the height. Mrs.
dozen English women brick-makers was Langtry's waist measure, to be in the
25 inches, and the proportion to height same proportion as that of the Greek
43.7 per cent. beauty, should be 32 inches. I have
The German peasant woman, unless she taken the pains to make measurements
has the misfortune to live sufficiently of a considerable number of male statues,
near some large city to be somewhat in- the work of eminent ancient artists, pre-
fluenced by the example of her fashion- served in various European galleries, and
able sisters, discards waistbands altogether find the average proportion of the waist
and wears her garments suspended from to height of seven famous models to be
the shoulders by means of a waist, which 46.4, or a little less than that of the Venus
gives her a more vigorous figure than the de Milo.
English peasant woman. I have recently made measurements of
French women are in the last-named 43 working women between the ages of
respect also more fortunate than their 18 and 25 years. These young women
English sisters, by reason of which they were all wearing loose garments, having
enjoy the advantage of a waist proportion been induced to do so by a representation
of 45.4 per cent of the height. of the evils resulting from waist constric-
Chinese women, of whom I have made tion. Some had but recently adopted a
a large number of measurements, and re- healthful style of clothing, while others
ceived much more data through the kind- had enjoyed the advantage of ample waist
ness of Miss Culbertson, of the Home for room for several months or years. In a
Chinese Women, San Francisco, and also few instances, corsets and tight waistbands
from a lady medical missionary in China, had never been worn. I found the aver-
although considerably below the average age waist measure of 43 young women,
height of American women, have two who were selected only with reference to
inches greater waist circumference, which age, to be 27.15 inches, or 44.64 per cent
is doubtless attributable to the fact that of the height, nearly 3 inches in excess
their mode of dress is such as to allow of the average feminine American waist,
the most perfect freedom of movement The waist of a young woman with this
and room for development at the middle proportion, and of the same height as
portion of the trunk. Mrs. Langtry, would measure 30 inches
But the primitive Yuma Indian women instead of 26.
of Arizona and New Mexico excel all others Comparative measures made in the
whose waist measures I have taken, the cases of 25 of these young women showed
average waist proportion being 55.2 of the that before the adoption of loose garments
height. their average waist measure was 23.3
The famous English beauty, Mrs. Lang- inches. Since that time there had been
try, has recently had published a detailed an increase in waist proportion to such
account of her physical proportions, by an extent that the average waist measure
which it appears that her height is 67 at the time the measurements were taken
inches, and her waist measure only 26. was 27.15 inches. The proportion of
inches. Mrs. Langtry takes evident pride waist to height in these 25 young women
in the fact that many of her measure- had increased by the change of dress from
ments correspond very closely with those 37.3 per cent to 43.4 per cent, and the
of some ancient Grecian models, but she waist measure had gained 3.85 inches, or
omitted to call attention to the fact that 6.16 per cent.
her waist measure is only 38.8 per cent of I recently secured the measurements of
her height, while that of the queen of all 10 girls between the ages of 9 and 12
10 ORIGINAL ARTICLES,
years, and found the average waist meas- also show the average modern feminine
ure to be 23.5 inches. waist, when it is allowed a chance for nat-
From these facts is it not evident that ural development, to be nearly two per
the small waist of the civilized American cent larger in proportion to the height
woman is a deformity ? Can any one as- than the modern male waist,
sign a physiological reason why the civ- 2. A second question to which I invite
ilized woman should have a smaller waist attention is, Why does the waist of the
than the savage woman ; or why Mrs. civilized woman cease to grow at the age
Langtry's waist measure should be 26 of 10 or 12 years, while the rest of the
inches instead of 32 ? Certainly no other body continues to develop ? Lungs, liver,
reason can be given for the abnormal stomach, spleen, bowels, pancreas — all
waist of the civilized wopaan than the fact the organs which occupy the region of
that this portion of the body has been the waist line, continue to grow, but the
subjected to abnormal pressure in such a waist of the civilized woman absolutely
way as to prevent natural development and refuses to increase in size, notwithstand-
to compel the acquirement of a deformity, ing the developing force beneath it, after
If, in answer to the question why the the age of 12 or 14 years. I find the av-
civilized woman of to-day has a smaller erage waist measure of girls from 9 to 12
waist than the beautiful women of ancient years of age to be 23.5 inches. I have in
Greece, whose figures furnished models for some instances found the waist measure
the sculptors whose masterpieces modern in girls of 12 to be 26 inches. The ra-
artists have sought in vain to equal, it is tional answer to this question is the fact
said that the change observable is a prod- that about this age the constricting in-
uct of evolution, or a result of civiliza- fluence of tight bands, corset waists, or
tion, may we not pertinently inquire why corsets begins. The fashionable dress-
a similar change is not to be found in the maker insists that the young lady's figure
modern man? must be ''/ormed," and so, as she develops,
Two other pertinent questions may be she grows into a mold like a cucumber in
asked in this relation : — a bottle. And thus it happens that we
1. Why does the civilized woman re- find the civilized woman with a waist dis-
quire a smaller waist than the civilized proportionately small, as we find, among
man ? Certainly no physiological reason the aristocratic class of Chinese women,
can be given, and well-known anatomical dwarfed and misshapen feet. The small-
facts suggest that if there is any natural footed woman of China, in consequence
diff'erence in proportion, woman requires of her deformity, is compelled to hobble
a larger waist than man. She has a larger about in a most ungraceful fashion, re-
liver in proportion to her size and weight quiring usually one or more persons to
than man, and the exigencies of mother- sustain her in keeping her balance. She
hood require provision for an increase in cannot run, skip, or dance as can her
waist capacity to which man is not sub- large-footed sisters. She is willing, how-
ject. It is interesting to note, also, in this ever, to endure the inconveniences of be-
connection, that the waist proportion of ing a cripple and the loss of the use of
the Venus de Milo, who may be con- her feet and legs rather than forego the
sidered as the typical woman of the an- pleasure of being in fashion. If the sac-
cient Greeks, is 47.7 per cent, while that rifices which the civilized woman makes
of the average Grecian man, already to fashion were no greater, there would
shown, is 46.4. be comparatively small ground for com-
We can draw but one conclusion from plaint, but the constant girding of the
these considerations, namely, that the waist results in mischiefs of vastly greater
small waists of the women of modern magnitude than those which the Chinese
times are an abnormality. My tables woman inflicts upon herself.
0
c1
>d
I-i-i
O
-1
(D
m
^
ro
p
r+
c
12 - ORIGINAL ARTICLES.
As the flat-headed woman watches with is exchanged for a more healthful one, or
interest and growing pride the progress- ordinary clothing laid aside for a few
ive depression of her infant's skull, while weeks, as during confinement to bed from
from day to day she binds more tightly illness. Probably few women will ques-
upon it the flattened disc of wood ; and as tion the fact that the waist is made
the Chinese woman glories in the shriv- smaller by constriction of the corset and
eled and misshaped stump of what was tight bands. A lady said to one of my
once her child's foot, as a developing nurses, when she learned of her healthful
marl^ of aristocratic gentility, in like man- mode of dress : " But how do you manage
ner does the civilized mother pride her- to keep your stomach down ? " The cor-
self on the smallness and roundness of her set is worn with a deliberate purpose of
daughter's corset-deformed waist, disre- modifying the form of the waist, which it
garding alike the suggestions of art, the does, to the great damage of health and
warnings of science, and the admonitions vigor. I have shown by careful measure-
which nature gives in the discomfort and ments in some hundreds of cases, that the
distress occasioned by the effort to secure waist of an adult woman increases within
a change in the natural contour of the hu- a few months, under the influence of
man form which is more monstrous in its proper clothing and proper exercise, from
violation of the laws of beauty, more one or two to six or seven inches,
widely at variance with the dictates of Let me call your attention more directly
reason, and more disastrous in its con- to some of the important particulars in
sequences to bodily health and vigor, than which the ordinary mode of dress among
any similar barbarity practiced upon civilized women, especially constriction of
themselves or their children by the mem- the waist, results in physical injury. The
hers of any savage or semi-savage tribe, chief of these are : —
How such a disfigurement of the physique 1. Downward displacement of all the
could ever have come to be considered abdominal and pelvic organs, and nu-
desirable or beautiful, is a problem hard merous functional and organic diseases
to solve, since it involves not only an growing out of this disturbance of the
enormous loss of strength and vigor, but a static relation of these organs,
violation of all the relevant i^i^ecepts and 2. Lack of development of the muscles
principles of art which have been handed of the trunk, which by long compression
down to us by the great masters, as well and disuse, to a very large degree lose
as rules of hygiene in which all medical their functional activity, resulting in re-
men of every age agree. Taxation of the abdominal walls, weakness
I may ask further, How does it happen of the muscles of the back, general physi-
that the waist of the average girl of 9 or cal feebleness, and destruction of the
12 years measures 23.5 inches, while the natural curves of the body, which are not
waist of the young woman of from 18 to only necessary for health, but also essen-
30 years who has worn corsets or tight tial to physical grace and beauty, and the
bands for a number of years, is only 23.3 development of many bodily deformities,
inches? Why should the waist decrease such as drooping shoulders, flat or hollow
in size with age while every other bodily chest, sunken epigastrium, straight spine,
dimension increases ? 3. An ungraceful and unnatural carriage
Still another question of interest arises of the body in sitting, standing, and walk-
from the fact to which almost every ing.
woman can testify, that the waist of the 4. An abnormal mode of respiration,
average woman accustomed to constriction The idea that a displaced stomach can
from clothing, increases in measure when- be a possible cause of disease or incon-
ever it has an opportunity for develop- venience may be new to some. Neverthe-
mentj as when the common mode of dress less, the researches of Glenard, Bouchard,
14 ORIGINAL ARTICLES.
Dujardin-Beaumetz, and other eminent waist is occupied by the small intestines,
French physicians, have shown beyond the bladder, and the rectum, with the
room for doubt that displacement of uterus and its appendages in the female,
the stomach, bowels, kidneys, liver, and and the prostate gland and other special
other abdom^inal viscera, may be produc- structures in the male. It is noticeable
tive of the most pronounced disturbance that the organs of the greatest weight and
of health and a source of great inconven- functional importance are located at or
ience. Indeed, from my own studies on above the waist.
this subject I have become convinced that How are all these important organs
a displaced and dilated stomach is more held in position ? Although fitted to-
likely to be productive of immediate and gether with the nicety of an articulation,
harmful consequences of a grave charac- the viscera are certainly not held together
ter, than displacement of the pelvic vis- by anything corresponding to the firm
cera. But before one can fully understand ligamentous bands which unite the os-
the relation of waist constriction to dis- seous elements of a joint. Every abdom-
placement of the abdominal viscera, it inal surgeon will testify to the extreme
will be necessary to call to mind a few propensity for escaping from the abdomi-
important anatomical facts. nal cavity when the slightest opportunity
The trunk is practically divided into offers, manifested by some of the viscera,
two cavities. The division of the lower The so-called ligaments which hold in
cavity into pelvis and abdomen is an ar- place the liver, stomach, spleen, and
tificial and not an anatomical subdivision, bowels, cannot properly be called liga-
useful for the purpose of discription, but ments, as very little ligamentous struct-
misleading and confusing, unless ignored ure enters into their composition. The
in studies concerning causation and patho- same must be said of the ligaments which
logical relations. Anatomically, the trunk are supposed to support in place the uterus
is divided by the diaphragm into two cavi- and ovaries, although it must be added
, ties only, the upper containing the chief that some of the uterine ligaments con-
organs of respiration and circulation, and tain muscular tissues which play a very
the lower containing the principal organs important part in maintaining the uterus
of digestion and the genito-urinary appa- in its proper relation to the trunk and the
ratus. The chief anatomical facts which contiguous organs. I think the idea is
I desire to be kept in mind are, the nor- gaining ground among those who have
mal position of each of the viscera which made a special study of this subject, that
occupy the lower cavity of the trunk, and the chief factors in the support of the
the mode in which these various organs pelvic viscera, as well as other of the or-
are held in place. It will be remembered gans of the lower trunk cavity, are the
that the liver, spleen, pancreas, and stom- tone of the muscular walls of the abdo-
ach are all located above or at the waist, men and the juxtaposition of the organs
as shown in the accompanying diagram themselves.
after Ziemssen. Plate II. The transverse Compression of the waist necessarily in-
colon lies at the waist line, the point of volves displacement of the organs occu-
junction of the ascending and transverse pying this portion of the trunk. The un-
colon on the right side dropping a little yielding character of the chest walls, and
below the line, while the point of conjunc- the resistance of the diaphragm prevent
tion of the transverse with the ascending any considerable displacement in an up-
colon at the left side rises considerably ward direction. Consequently, the neces-
above the waist line, being held in place sary result of waist-compression, either by
by the pleuro-colic fold of the meso-colon. the corset or by tight bands, is, that the
The kidneys lie just at the waist. The liver, stomach, bowels, and other organs
greater portion of the space below the occupying this zone of the body, are car-
ORIOINAL ARTICLES. 15
ried downward. The same force which In 6 cases, both kidneys freely movable,
diminishes the circumference of the body In 2 cases, downward displacement of
at the waist, interferes with the normal the spleen.
activity and development of the muscles In one of these cases, the spleen lay at
which form the anterior wall of the lower the bottom of the abdominal cavity. I
trunk, so that they offer little resistance to have found a large number of otitline
the displacing force applied at the waist, tracings in cases of women suffering from
In nearly twenty years of medical prac- pelvic diseases, and supplemented these
tice, I have had to deal almost exclusively by careful examination of the position and
with chronic disorders of various sorts, conditions of the abdominal and pelvic
and especially with two classes of chronic viscera, with the following results, as re-
disease, — digestive disorders, and mala- gards the relation of the static changes in
dies peculiar to women. Having under the abdominal organs, to similar changes
observation from 1,000 to 1,500 cases an- in the organs of the pelvis,
nually, under conditions favorable for In 150 cases of pelvic disease, the stom-
careful study and comparison, I long ago ach and bowels were displaced in 138
noticed the remarkable frequency of the cases.
association of certain forms of pelvic dis- In 66 cases the stomach and bowels
order, especially in women with a narrow were displaced without displacement of
waist and a protruding abdomen. I did the uterus. In 26 of these cases, there
not, however, attach so great importance was also a displacement of one kidney,
to the matter as I should have done, I and in five, a displacement of the liver,
frankly confess, had I not had an errone- In only seven cases was there displace-
ous notion respecting the normal contour ment of the uterus without displacement
of the female figure. It was only after of the abdominal viscera, and three of
careful study of this matter among savage these were cases of large uterine fibroids
women, and women whose figure had in which the visceral displacement was
never been modified by the deforming in- probably present, but masked by the
fluence of the ordinary civilized dress, that morbid growth.
I acquired a basis from which to view this I shall have thrown upon the screen,
subject in a rational way. I then began presently, outline tracings of the figures of
careful inquiry into the matter, and for some of these cases, which will show very
several years back have made, in all cases clearly the amount of visceral displace-
of pelvic diseases of women coming under ment occasioned by an improper dress,
my observation, a careful study of the My statistics seem to show very clearly
condition and relative position of the that visceral displacement is not a disease
various abdominal viscera, as well as of which is especially confined to the pelvis,
the pelvic organs. Indeed, a careful study of the means by
In 250 cases of women suffering from which the pelvic organs are held in place,
pelvic diseases, taken consecutively and suggests that they are better provided for
without selection, in each of which a in this respect than any other of the vis-
careful examination was made with ref- cera below the diaphragm. The data
erence to the condition and position of which I have collected respecting the rel-
each of the abdominal viscera as well as ative frequency in the displacement of the
of the pelvic organs, I observed the fol- pelvic organs, and other organs of the ab-
lo wing disturbances of the static relations dominal cavity, clearly support this idea,
of the viscera : — In 150 cases of pelvic disease, there
In 232 cases, downward displacement were only four cases in which displace-
of stomach and bowels. ment of the pelvic organs was present
In 71 cases, right kidney distinctly without displacement of one or more of
movable and sensitive to pressure. the abdominal viscera, while there were
16
OBIOINAL ARTICLES.
66 cases in which the stomach and bowels
were displaced without any displacement
of the pelvic organs. In 26 of these cases
there was also a displacement of the kid-
ney, and in five a displace«ient of the
liver. It is evident, then, that visceral
displacement of the organs of the lower
trunk must be regarded (of course leav-
ing room for exceptions) as a general dis-
order, affecting more or less the entire con-
tents of the abdomen and pelvis, rather
than as a disease confined to one or two
of the organs in which the subjective
symptoms happen to be most prominently
manifested.
How a displacement of the stomach, a
kidney, the bowels, the uterus, or an
ovary, may occasion disease, is a patho-
logical question which it is not necessary
to spend time in discussing, since the dis-
turbance in blood-circulation, and hence
in nutritive changes (possibly, also, in the
supply of nervous energy), and the de-
velopment of abnormal and pernicious
nerve-reflexes, are etiological factors, the
influence of which is too well known and
understood to be disputed, and which are
likely to come into active operation under
the morbid conditions established in an
organ crowded by abnormal pressure out
of its proper place. Nature has placed
each internal organ in the position in
which it can do its work most easily and
efficiently ; and the studies of the results
of visceral displacement which have been
made by eminent scientific physicians,
have shown that to morbid conditions of
this sort may be fairly attributable the
most serious, and not infrequently the
most obstinate, disturbances of some of
the most important vital functions, and
through them, of all the other functions
of the body.
(To be continued.)
EXPLANATION OF PLATES.
PLATE I.
Figure 1. Pneographic tracing showing the
respiratory movements of a healthy woman.
That portion of the curve above the base line
represents expiration ; the curve below the line
represents inspiration. This tracing was ob-
tained by means of a new form of pneumo-
graph, or pneograph, which represents the
whole respiratory movement, and which I have
elsewhere described.
Fig. 2. Pneographic tracing furnished by a
woman wearing a corset. The subject was the
same person who furnished the preceding-
tracing, and the tracing was made with the
same instrument, adjusted in the same manner.
The evident increase in the length of the ex-
piratory movement, or rather decrease in the
length of the inspiratory movement, as well as
the change in form of the expiratory movement,
are strongly suggestive of the interference with
respiration occasioned by constriction of the
waist
Fig. 3. Pneumographic tracing of the upper
and lower costal movements in breathing, fur-
nished by a healthy man. The pneumograph
employed in taking this tracing was a modified
form of the instrument designed by Paul Bert.
In obtaining the upper costal movement, the
instrument was adjusted at the middle of the
sternum and the spine opposite. In obtaining
the lower costal tracing, the instrument was
adjusted to the sides of the chest.
Fig. 4. Pneumographic tracing furnished by
a civilized woman wearing a corset. It will be
noticed that this tracing is almost exactly the
reverse of the preceding.
Fig. 5. Tracing obtained from a Chippewa
Indian woman who had never worn a corset.
Fig. 6. Tracing furnished by a civilized
woman who had never worn a corset. It
will be noticed that the last two tracings have
the same character as the tracing furnished by
a healthy man, shown in Fig. 3.
Fig. 7. Tracing furnished by a man wearing
a corset. This tracing is practically identical
with the one shown in Fig. 4, furnished by a
woman wearing a corset.
Fig. 8. Tracing obtained from a healthy dog.
Fig. 9. Tracing obtained from a dog with a
corset on. By examination of the last two
tracings it will be seen that a healthy dog
breathes just as does a healthy man or healthy
woman whose respiratory movements are un-
obstructed, and that a dog wearing a corset
breathes as does a woman under the same cir-
cumstances, chiefly with the upper instead of
the lower portion of the chest.
PLATE II.
Figure 1. Diagram of the trunk, showing
position of the viscera, after Ziemssen. It will
be noticed that the lower border of the stomach
ORIGINAL ARTICLES.
17
falls at a point about midway between the lower
end of the sternum and the umbilicus.
Fig. 2. Diagram showing the action of the
diaphragm, front view.
Fig. 3. Diagram showing the action of the
diaphragm, side view.
PLATE III.
This plate is a representation of natural
figures.
Figure 1. Outline of a healthy, well-devel-
oped man, thirty years of age.
Fig. 2. Outline of a well-developed woman,
of twenty-six years.
Fig. 3. A Greek statue.
Fig. 4. Outline of an Italian model girl.
PLATE IV.
Outlines showing the effect of the corset in
destroying the natural symmetry of the figure.
Figure 1. Side profile of a young woman who
had once been addicted to tight lacing, but had
greatly improved her figure by reforming her
dress.
Fig. 2. Side profile of the same person with
corset on. This tracing shows clearly the in-
fluence of the corset in destroying the natural
dorsal curve, and producing protrusion of the
lower abdomen.
Fig. 8. Front profile of a young woman of
seventeen years who had never worn anything
tight in her life. The two side sets of lines il-
lustrate the form of the waist with a corset on
and with it off. This young woman's waist
measure was three inches less outside all her
clothing with the corset on, than next the skin
with the clothing removed.
Fig. 4. Side profile of the same person who
furnished the preceding outline, showing the
distortion of the figure and displacement of
the internal viscera occasioned by tight lacing.
LESSONS IN BACTERIOLOGY.
BY PAUL PAQUIN, M. D., D. V. S.
Lesson VII. — Cultivation of Bacteria.
( Continued.)
Part III. — Brood- Ovens and Heat-Regulators.
The most of bacteria grow well at the
usual temperature of a room. For such
it is only necessary to expose the cul-
tures in a convenient place inaccessible
to children. But there are microbes
which develop only, or better, at certain
temperatures ; and again, it is often neces-
sary to vary the temperature or regulate
it, and keep it steadily for definite periods
at special points, for particular purposes,
as for the production of morphological
changes in a given organism, or for the
modification of certain characteristic ac-
tivities.
The maintenance of constant tempera-
ture is difficult, and needs very close
watching. It is in such cases that a
special apparatus becomes necessary,
though not exactly indispensable, to con-
trol the temperature. This device con-
sists of a check on the flow of gas by the
expansion of mercury in specially con-
structed tubes attached to the brood-oven,
A simple, cheap, and satisfactory thermo-
regulator is that of Reicherts, which can
be purchased from any instrument house,
selling chemical apparatus.
But the practicing physician may wish
to cultivate bacteria without the outlay
of anything near the cost of any of the
brood-ovens and regulators for sale in the
market. He may do so by constructing
a quadrangular box of zinc (see Plate III.,
Fig. 7,) with three side walls and bottom
double, to admit water between. This
box may be covered with a non-conduct-
ing substance, such as heavy felt or asbes-
tos cloth or cotton-batting, and thus be
made easy of control, as compared with a
metallic box without such a cover. For
this, gas may be used as fuel, but if unable
or unwilling to command this article, lard
(oil) may be used, as shown in the cut
referred to above. Take a large basin,
fill it with water to within an inch or twp'
from the top, pour a layer of oil, say one
quarter to a half inch, on top of the water,
and place upon it one or several small
floats with wicks, and ignite them. Of
course the flame cannot be varied by any
means, so it is necessary to seek and find
the right distance at which it should be
placed under the bottom of the box.
These floaters give a very constant heat..
The brood-oven (or thermostat) should
be put in a room where the temperature-
is constant, so as to be affected the least
possible by variation. A cellar is a good
place.
18 ORIGINAL ARTICLES.
Lesson VIII. — Bacteriological Analysis op to before, or over the cut surface of steril-
Fluids, Solids, and Gaseous Substances. ized potatoes ; if earth, it may be desic-
Part I. cated, pulverized finely, and dusted over
The microscope alone is inadequate to the same material ; if air dust, as the
reveal all that is necessary to know con- ^^st gathered on a plate in a room, the
cerning microbes in any given substance. ^^^^^ means may be used. Then put
It does not show fully what organisms are ^^e plates at the ordinary temperature of
present, which are dead, and which aUve, ^ living room, and watch for developments,
to what class or species they belong. When specks of growth appear here and
whether harmless or pathogenic. So there, pick them up one by one very care-
something more than a microscopical ex- f^% with the point of a sterilized plati-
amination is needed to complete a trust- ^^"^ needle, and inoculate into separate
worthy bacteriological analysis of any- tubes of cultures, taking all the precau-
thing, except in a few special cases, as in tion that the mind will suggest to pre-
Ihe diagnosis of tuberculosis, where tech- vent contamination with air germs in the
nique has so far advanced that micro- manipulations that must be resorted to.
scopic revelations, are positively reliable Another method is to make streaks
in almost every case. across the plate cultures, as already men-
It is not my purpose here to go at tioned in a former lesson. (See Plate III.,
length into details of laboratory technique, Fig- 4.) For this, the material to study
but merely to draw attention to the main must be in such a state as to adhere to
points.^ the platinum wire. The fluid or semi-
The chief instruments necessary in these fluid is in proper state, but for earth or
analyses have already been noted in for- solids of other character it may be dif-
mer lessons, and so have the methods of ficult. Still it may be resorted to with
inoculation and the culture media. decided benefit, even in studying dry,
One may become familiar with bacte- powdered material. For instance, in an-
riological analysis, by studying, first, alyzing fine, pulverized earth, one may
water, earth, air. In the first place, if sterilize a platinum, inoculating needle,
it is only desired to abstract pathogenic plunge it in sterilized (distilled) water,
forms, water may be inoculated sub- dip it in the powder, and then make streaks
cutaneously in a small susceptible organ- with it across the gelatine, or the agar-
ism; earth may be inserted in a little agar plate. The powder that adhered
pocket cut in the skin; the dust of the to the needle will stick to the nutrient
air and a little sand from the sand filter, substance, and the microbes will de-
(which after sterilization allowed the air to velop in the little furrows and isolated
penetrate through, thus retaining its float- colonies.
ing particles) may likewise be inserted into Solid tissues may be mashed as indi-
Si, cut aperture in the skin, and perhaps cated in our previous lesson, and the
by this means germs will develop locally pulp inoculated. So from this plate cult-
-or generalize throughout the organization, ure one must make in test tube (Plate III.,
enabling the investigator to find them by Fig. 2), individual cultures with each
microscopical research. Bu+ if it is desired speck of growth of different appearance
to show all the forms, as is usually the (and even similar appearance),
case, then it is necessary to have recourse It will be remembered that the object
to cultivation. of these analyses is the isolation of the
To cultivate the bacteria of water, a different forms of bacteria, each being
simple means consists of spreading a little isolated in a special test tube of culture,
of the fluid over plate cultures referred It remains to be seen what are their
.see Lesson VII., Page 714, of bxcterioi.ogicai. individual properties. Separate cultures
World, October number, for methods of culture, etc. mUSt then be Continued for a loug time,
ORIGINAL ARTICLES.
19
Fig. 7.
m
\m
^
I-
Fig. 1.
Fig. 6.
Fig. 5.
Fig. 4
Fig. 3.
Fig. 2.
PLATE III.
20
EDITORIAL,
and the attributes and products of each
form carefully marked.
Finally, the pathogenic qualities can
be determined only by inoculation of
each separately in animals.
Now all the different testing means
mentioned so far, may fail to reveal all
the germs. The anaerobic forms, which
prosper better without contact with free
air, may not appear. We will see later
how these may be isolated and identified.
iPart II. in December Number.)
The Bacteriological World-
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price
&2.00 per. Annum.
Single Copies, 25 Cents,
PLATE III.
BACTERIOLOGICAL APPARATUS.
Figure 1. Pipettes to gather specimens or for
use in laboratory. They are plugged with
cotton.
Fig. 2. Inoculating solid medium in test tube.
Fig. 3. Test tube of culture medium in wire
basket ready for sterilizer.
Fig. 4. Growth of micro-organisms by colonies,
in streaks inoculated across a gelatinous plate.
Fig. 5. Plates of culture as No. 4, standing on
superposed glass benches inside glass dish.
Fig. 6. Potato cultures inside glass dish.
Fig. 7. Thermostat (or cheap brood-oven) ex-
plained in text, (a.) opening to cavity be-
tween walls to admit water ; (b.) thermome-
ter ; (c.) ridges to hold shelves; (d.) dish
containing water ; (e.) oil on top of water ;
(f.) floating wick ablaze.
Bismuth by Enema in Dysentery.
— Probably no remedy is any more uni-
versally used as a means of relieving
gastric or intestinal irritation than the
sub-nitrate or sub-carbonate of bismuth.
The prompt efficiency of this remedy is
in many cases most gratifying to the
physician as well as to the patient. The
remedy is less valuable, however, when
the irritation or inflammation is located
in the lower part of the alimentary canal,
as in dysentery. Dr. H. C. Wood, of the
University Medical Magazine^ recommends
employing the remedy locally in these
cases, by enema, injecting into the bowels
a large enemata containing two or three
drams of bismuth. The remedy is cer-
tainly worth a trial.
Battle Creek, Mich., November, i89i.
In January last, when we issued our
first number, the outlook was gloomy;
few friends dared to risk their fortune-
and reputation as our collaborators, and
fewer still did we encourage in the enter-
prise, preferring to try to rise by sheer
force, labor, and merit than to sail chiefly
on the reputation of others. True, we
endeavored to secure articles from men of
learning, and did succeed in several in-
stances. It was just that we should thus-
seek to present to our readers the best
thoughts on bacteriology, from the best
authors and investigators; but, after all,,
the work was exceedingly difficult, and
progress very slow.
Despite all obstacles, however, we have-
succeeded. The Bacteriological World
is to-day established ; it has outgrown
the creeping period, and begins to walk
erect. With this number it appears in a
new dress, with the addition of a useful
ornament upon its face and great addition
to its brain — Modern Medicine. This-
is the first issue of a new volume of the-
Bacteriological World and its fused
associate, and it marks the beginning of a
new era, and the entrance upon a broader
field of scientific literature.
We thank our subscribers, who havr
made this progress possible, and our scien-
tific friends, who, in granting us the as-
sistance of their influential names and
meritorious writings, have elevated tlie
tone of our nature, and added power to
our feeble voice. We respectfully trust
that in the future they will cheerfully
continue their interest in our enterprise,,
EDITORIAL. 21
and put some of their best thoughts be- journal specially devoted to a large class
fore the medical world through our col- of remedies which in recent years have
limns. been coming into prominence, and which
The Bacteriological World and Mod- might be grouped together under the term
ERN Medicine will reach 10,000 people " physiological therapeutics." It is the
monthly. The following by Dr. Kellogg purpose of the Bacteriological World
■explains our purpose in our old and new and Modern Medicine, to undertake to
£elds of labor. p. p. occupy this gap in periodical medical lit-
^ , erature. In its monthly columns the sub-
mw DiTDDnQi? ^^^^ ^^ physiological therapeutics will be
UUK FUKFUbb. discussed from both theoretical and prac-
tical standpoints. Besides its regular dis-
Probably nothing has contributed more cussions of bacteriological subjects, it will
to the advancement of medical science in treat of such remedial means as electricity
the last quarter of a century than the in its various forms, hydropathy, dietetics,
growing tendency toward specialism and massage, Swedish movements, medical
the development of various specialties in gymnastics, various applications of heat,
medical practice. The rapid accumula- sunshine, mental influence, and all other
tion of important and often revolutionary non-surgical and non-medicinal therapeu-
facts in the various departments of med- tic remedial agencies. Climatology, me-
ical knowledge, especially within the last terology, mental, physical, and moral hy-
twenty-five years, has made it impossible giene, and allied subjects, will be discussed
for any one mind to grasp the whole of so far as they sustain relations of impor-
medical science, and has rendered it nee- tance to health and disease,
•essary that one who would become in the It will be the aim of the editors of this
Mghest degree proficient as a surgeon or journal to make its pages an epitome of
medical practitioner, should devote him- the ablest and most advanced thought,
;self to some one particular line of study and the ripest experience upon all sub-
iind research as the only means of attain- jects which come within its scope. The
ing the desired end. While it may be Bacteriological World and Modern
conceded that the tendency to specialism Medicine is not designed for a special
has been carried somewhat too far, the class. The subjects to which it is devoted
great advantages which have resulted must be of interest to every practitioner
from the labors of specialists, must be who wishes to keep himself abreast with
regarded as one of the most important the most advanced lines of medical prog-
elements of progress in modern medi- ress, no matter whether he be a general
cine. practitioner or a specialist in some partic-
The same necessity for special studies ular line of medical work.
and special work which has resulted in A number of excellent authorities in
the development of so great a number of bacteriology and special lines of physio-
•specialists in medical practice, has given logical therapeutics have been engaged to
rise to similar classification and division contribute to the columns of the journal,
of labor among medical journals, of which and it is believed that the reputation of
we have two distinct classes : Journals the Bacteriological World, the new
•devoted to general medical subjects, and scope of the name, and the auspices under
those devoted to subjects of particular which we begin this volume, are such as
interest to the specialist. We have jour- will guarantee success. Certainly, no pains
nals devoted to surgery, gynecology, ped- or expense will be spared to make the jour-
iatrics, ophthalmology, otology, clima- nal fulfill its mission to the satisfaction of
tology, physiology, balneology, bacteri- those who may become its patrons,
ology, and dietetics ; but we have no j. h. k.
22
EDITORIAL,
PHAGOCYTOSIS.
Among the factors in producing immu-
nity against disease, is the very interest-
ing phenomenon known as phagocytosis,
i. e., the destruction of micro-parasites hy
microphages of the body, — certain cells
of various organs and of the liquids of the
economy, such as the spleen, blood, etc.
In this war against bacteria, the animal
cells englobe the former, swallow them,
fill themselves full of them sometimes,
until they are enormously bloated, and
even split open. The death of the bacte-
ria, and often of the microphages, results,
probably from the action of both the
products of animal cells and bacterial
organisms, for vacuoles of liquid soon
form in a microphage containing microbes
in its body. The foremost expounder of
this factor in immunity is the eminent
Russian bacteriologist, Metchnikoff, of
Pasteur's Laboratory. We present, in this
issue, some striking illustrations of his on
the subject. They will prove of interest
to all who may study them.
All the figures of Plate I. were made
from nature, from charbon in white rats,
and appeared in Les Annates de VInstitut
Pasteur ^ in blue color. They are very
greatly magnified, as will be seen by the
Zeiss lens used.
1. Represents a microphage filled with
bacteridia. It is from a sub-cutaneous
exudate of four days. Magnified with
eye piece 4, objective -^-^ Zeiss.
2. Another microphage of same origin :
Eye piece 4, objective -j--^.
3. A microphage of same exudate with
bacteridia in degeneration. Eye piece 4,
objective y\.
4. A microphage of same exudate with
two bacteridia artificially liberated. Eye
piece 4, objective -^^.
5. A split microphage of same ex-
udate ; a. conical bacteridia, n. remainder
of the nucleus. Eye piece 4, objective y^
6. A microphage filled with bacte-
ridia. Exudate of the eye 72 hours after
inoculation. Eye piece 4, objective ■^^.
1 Tome IV., April, 1890.
7. Microphage of same source. Eye
piece 4, objective y^g.
8. Microphage of same exudate; en-
globed bacteridia very pale. Eye piece
4, objective y^g-.
9. Microphage of same origin allowing
the escape of bacteridia. Eye piece 4^
objective -^-
1 8*
10. a. Macrophage containing bacteridia
and leucocytes ; n. nucleus of the macro-
phage. Exudate of the eye 46 hours after
inoculation. Eye piece 3, objective y^g-.
11. The remainder of a microphage from
exudate of the eye 72 hours after inocu-
lation; n. debris of nucleus. Eye piece
4, objective y^g-.
12. Bacteridia of first vaccine englobed
by microphages. Exudate of the an-
terior chamber of the eye. Eye piece 3,
objective y^g.
13. Dead microphage with growing bac-
teridia, in broth. Eye piece 2, objective
F. Zeiss.
14. Another micro^Dhage of the same
preparation ; a. dead bacillus. Eye piece
4, objective F. p. p.
HOW TO PREPARE KOCH'S TUBERCULINE.
In his fourth communication on the
treatment of tuberculosis {Deutsche Med.
Wochemchrift, Oct. 22, 1891), Prof. Koch
explains the method of preparing tuber-
culine (paratoloid). The process now
followed is the following : Culture flasks
(Elenmeyer preferred) are filled half full
with sterilized veal broth, slightly alka-
line, containing one per cent peptone and
four to five per cent glycerine, or with a
one per cent solution of meat extract.
Inoculation of this fluid medium is made
with a particle of pure culture. The flasks
are exposed to a temperature of 101° F. for
from six to eight weeks, i. e., until the
culture is completely ripe.
At the beginning, the culture is slow,
but gradually some whitish, flat frag-
ments of culture bcGfin to form on the
surface, finally grow intensely, and float
until about the sixth, seventh, or eighth
1
^ ,'*>--^
/
Ir
i
f I *w
e-
I 1
^-k'
1.— BACILLUS TUBERCULOSIS IN SPUTUM A FEW DAYS OLD\
The sijecinien had not been treated by an3- means to destro3- the pus cells and mucus. The
microbes are stained with fuchsin and the field (including pus cells
and mucus) with aniline green.
a, Rod-Shape Bacillus; l>. Pus Corpuscle; r, probably" a Spore; d, a Bacillus, showing- dots
which are probably Spores; r. Strings and Film of Mucus.
2.— LONGER BACILLI OF TUBERCULOSIS IN SPUTUM ^
(7, Isolated Bacillus; />, Bacilli in Epithelial Cell; r, Bacilli in a Pigmented Cell,
PLATE II.
' Cut from " Microscopical Diagnosis of Tuberculosis,'''' by Dr. Paul Paquin, made from an ordinary
mount stained by a process adopted \iy the author. ^
- Cut from " Les Bacteries^'''' \>y Cornil & Babes, Paris, France.
EDITORIAL.
23
week; then they fall to the bottom.
At this period, the growth is a layer of
considerable thickness ; its top surface is
dry, whitish, and often pleated. It falls
to the bottom because the growth stops
and imbibition takes place.
Microscopical examination of the cult-
ure is then made, and if it is pure, the
tuberculine may be prepared. To this
end, the cultures are reduced to ten per
cent of their primitive volume in a water
bath, kept in the neighborhood of 212° F.
As this requires hours of heating at about
boiling point, the bacilli are all killed.
But for greater safety still, the substance
should be filtered through porcelain. The
tuberculine thus obtained contains forty
to fifty per cent of glycerine, which pro-
tects it against the invasion of microbes.
One has only to protect it, then, from
fungi. It may keep its strength and
purity for years, doubtless. The germs
must be grown in masses in order to
obtain reliable tuberculine.
p. P.
THE RELATION OF THE DIAGNOSIS TO THE
CURE OF TUBERCULOSIS.
Why should one tenth of the people
die of tuberculosis? Is it because this
malady is always incurable? — No. Is
there no remedy at any stage? — There
is. Why, then, do so many die? — It is
chiefly because in fifty per cent of the
cases proving fatal, physicians fail to rec-
ognize the disease early enough, and in
twenty per cent of the rest they believe it
is inevitably fatal under all circumstances.
These facts are the result, on the one hand,
of ignorance on the subject of the quickest
and most reliable means of diagnosis —
the bacteriological methods ; and on the
other, of the determination of a number
of physicians, who, despite mountains of
logic and evidence, still refuse to accept
truth, and even seek, through the medical
press and by popular remarks, to dis-
suade others from believing in the estab-
lished facts concerning the causation and
means of propagation of the disease. At
this date, one who has followed and in-
vestigated the question of tuberculosis,
experimented with it, weighed all the
evidence pro and con, gathered and di-
gested the enormous mass of observations
and the results of researches in all parts
of the civilized world, reads with amaze-
ment the absurd and bold attacks made
from time to time, through the medical
press, on the revealed truths concerning
the nature of tuberculosis. Were it not
that ignorance, doubtless, lies at the bot-
tom of most of such antagonism, con-
science would feel like classifying the
rebellious as guilty of great harm, for
they favor a course that hasten the death
of their fellow-men.
Tuberculosis, in its incipiency, if not
radically curable, may surely be nullified
or modified by favorable climatic influ-
ences. We owe to our patients all that
science can give them to prolong or save
their lives. It is exceedingly wrong to
guess in making a diagnosis of such im-
portance and responsibility, or wait until
the lesions are such as to enable one to
make a diagnosis by physical means or
any of the old methods, for then it is too
late for the subjects to go to a more fa-
vorable climate.
The physicians must eventually get into
the habit of making their own microscop-
ical diagnoses, as they make their more
common examinations. It is not so diffi-
cult as is believed, nor is it so costly.
Any one can, by the numerous improved
bacteriological methods found in works on
bacteriology (and some were published
in the Bacteriological World the past
year), diagnose tuberculosis much earlier
than by any other method, with a cheap
microscope and a one-sixth objective. One
need not be a microscopist for an accurate
diagnosis of this character. We beg to
draw attention to Plate 11. in this issue^
giving the common appearance of sputum
and the bacilli as revealed by a method
of staining used in the Laboratory of
Hygiene under the writer's direction.
p. p.
24 EDITORIAL.
INFECTION OF SURGICAL WOUNDS BY gut, even if thoroughly sterilized, must
CATGUT. ^^ excluded from surgical practice ; for in
wounds which are not absolutely pro-
Klemm reports {Bidletbi General de tected from germs, it may decompose un-
Theriapeutlque) some interesting experi- der the influence of microbes, and cause
ments to determine the influence of catgut the formation of an abccess, when silk un-
in producing suppuration. The complete der the same conditions would produce
sterilization of catgut is very difficult, and no disturbance. j. h. k.
many surgeons have banished catgut from ► •
their practice. Notwithstanding we have HYDROGEN PEROXIDE IN PELVIC ABSCESS.
to-day succeeded in producing catgut ab-
solutely aseptic, by the method ofRever- We have for a number of years made
din, or that of Brunner, suppuration still the use of peroxide of hydrogen (Mar-
occurs from time to time, in defiance of chand's) in the treatment of suppurating
the surgeons. ^ At the clinic of Dorpat, surfaces, abscesses, etc., with excellent re-
since the substitution of catgut for silk, suits, but have never observed a more
suppuration is frequently observed in the gratifying result than that recently ob-
bottom of wounds toward the tenth day, tained in a case of pelvic abscess of long
when everything had gone well and a per- standing. The abscess discharged by a
feet result had been expected. As the small opening just behind the cervix
work had been done with the greatest uteri, and was very profuse, and extra-
care as to asepsis, and as the aseptic ordinarily fetid. Our stock of peroxide
character of the catgut had been especially of hydrogen happened to be exhausted
verified, not only with reference to its sur- at the time, the new supply ordered being
face, but also as regards its interior, by somewhat delayed in reaching us, and we
culture experiments, Klemm supposed at first employed listerine, using it in th(.
that the catgut, even though sterile, proportion of one part to three of distilled
formed in the wounds a favorable culture water. There was no apparent eff'ect upon
medium for the development of germs the discharge, as regards either quantity
which accidentally entered during the or character. The odor continued as bad
operation. He then made some compara- as ever. When the new supply of peroxide
tive experiments with silk upon rabbits of hydrogen arrived, we immediately be-
and cats, by introducing into a wound gan using it in the proportion of one part
of the thigh on one side, a thread of cat- to ten of distilled water, with the result
gut, and into a wound of the other side that after the first washing the intensely
a thread of silk. The strictest antiseptic fetid odor disappeared entirely, the Jis-
precautions were taken, and the wound charge became healthy in appearance,
closed by sutures. On opening the wound and diminished in quantity so rapidly
several days later, he found oedematous that within ten days there was no dis-
infiltration around the catgut, which was charge whatever, except at the washing,
swollen, reddened, and odorous. On the and then the quantity evacuated was not
side in which the silk was placed, noth- more than a dram, when it had previously
ing similar was observed. Placed upon been several ounces, besides continuous
a gelatin culture medium, this catgut de- discharge in the intervals between the
veloped 2,500 colonies ; the silk gave only washings.
seventy to eighty colonies. Before the After the first washing with peroxide
operation, these substances were sterile, of hydrogen, the patient's temperature,
Infection, then, occurred during the oper- which had for several months previously
ation. Many diff'erent experiments gave been above normal, fell to normal and has
the same results. The author believes remained at that point since. There is
himself justified in concluding that cat- certainly at present no agent known which
EDITORIAL,
25
•€Ould properly replace hydrogen peroxide
as a disinfectant of unhealthy surfaces.
It would seem to be especially valua-
ble in the treatment of abscesses, the dis-
charges of which, through the relation of
the cavity and the lower part of the ali-
mentary canal, usually possess so repul-
sive an odor as to render the existence of
the patient almost unendurable.
' J. H. K.
Theory and Practice.
PHAGOCYTES: THE WARRIOR CELLS.
The Two Ways in Therapeutics. —
In general, there are two methods of treat-
ing any disease : —
1. Attempting to meet the various
symptoms presented in the case by ap-
propriate remedies.
2. Seeking to aid nature in curing the
patient by removing the cause of the
•disease.
The first method is empirical, the second
rational. He who follows the first method
is continually at sea, tossed about by every
wind and wave of opinion, and continu-
ally going on bootless errands after some
ignis fatuus in the shape of the latest new
panacea. The physician who looks un-
derneath the superficial expression of the
disease, seeking after the causes which
underlie its manifestations, seeks for an
explanation of the phenomena of disease
in the careful study of physiology and
pathology, and bases his therapeutics
upon the results of laboratory research,
controlled by careful clinical observation,
rather than upon the confusing and often
contradictory conclusions reached by em-
pirical experimentation. j. h. k.
-» — • — ^-
La Grippe and Consumption. — We
trust the article by Prof. Stickler will not
be overlooked on account of its brevity.
'The subject of which it treats is an im-
portant one. Four similar cases, in which
pulmonary tuberculosis followed quickly
upon the heels of la grippe^ have come
under our personal observation. Here is
a problem for the bacteriologist to solve :
In what does the apparent affinity be-
tween la grippe and tuberculosis consist?
Is it in the preparation of the field for
"the reception of the 'tubercle bacilli ? or
is it that undiagnosed tuberculosis bacilli
already in the system are given full
sway by the weakening of the tissues by
da grippe f j. h. k.
BY C. VON FALKENHORST.
( Vom Fels znni Meer, Stuttgart, February.)
Our body is a well-organized State.
The cells with which life is so intimately
bound up, are its citizens, and the num-
ber of these citizens is legion. In com-
parison with the cells in our body, the
human population of the earth is insig-
nificant. The red blood corpuscles alone,
whose function is to carry and distribute
oxygen, are estimated at approximately
twenty-five billion in the body of an
adult man.
These industrial communities, although
shut in from the outer world by a pano-
ply of skin, are by no means secure in
the enjoyment of a tranquil existence.
Devious highways connect their most shel-
tered recesses with channels communicat-
ing with the outer world, and through
these they are assailed by legions of no
less insignificant foes, who invade the
several provinces of the kingdom to lay
waste and destroy. These invaders are
the bacteria, which are now recognized as
the agents of so many diseases.
Nature has endowed our organisms with
forces to resist disease germs, and cases
occur daily in which people are restored
to health by the agency of these unknown
defenders. The cells proper to the sys-
tem are under investigation, and among
them some investigators profess to have
discovered warrior cells, which in a cer-
tain sense may be regarded as a standing
army of defense, and their function being
to fall on and devour the invaders, they
have been styled phagocytes.
These defenders of the human system
have long been known, but their function^
until recently, was not suspected. Every
one of our readers has heard or read of
the white corpuscles in the blood ; these
are our anti-bacteria military, the most
simply uniformed and most simply armed
26 THEORY AND PRACTICE.
troops in the world, for they belong to the sea-urchins and star-fish, whose skins are-
simplest forms of life. These white blood frequently transparent. The Russian
corpuscles, or leucocytes, are simple naked zoologist, Metchnikoff, has established that
cells, consisting merely of a speck of pro- the leucocytes, in a manner, purify the
toplasm and a nucleus, but in spite of blood. On the introduction of a speck of
their simple organization, in spite of the carmine or dust, they immediately close
absence of differentiated organs, they themselves upon it. In all evolutionary
nevertheless act as other creatures act. i^rocesses and transformations of the lower
yThey have neither fins nor feet, but are, animals, there are portions of the tissue
nevertheless, capable of progress. This which cannot be utilized in the new struc-
is provided for by a property of proto- ture. They are thrown off as debris, and
plasm which admits of their putting out the leucocytes enclose and assimilate them,
tentacles in one direction, which tentacles The same course is pursued in the meta-
draAV the body after them. They seize morphosis of the tadpole ; the leucocytes
their food with these tentacles, draw it to congregate in the tail, and consume it.
them, enfold and assimilate it. The ten- So, too, in the metamorphosis of insects,,
tacle which serves first to propel toward they perform the function of removing all
its prey, and then to grasp it, is finally unutilizabletissue, and practically, of con-
used as a stomach in which *to digest it. verting it into utilizable material ; for
The nucleated speck of protoplasm, in these roving cells, at length, weary of
spite of this structural simplicity, is fur- their active independent existence, build
ther endowed with sensation, and the themselves into the tissues of the organism
power of reproduction. to provide for growth, or for repair of the
Such are the white corpuscles of the waste of decay,
blood. At periods of inaction they pre- On account of their habits Metchnikoff
sent the appearance of colorless, round called these cells phagocytes, that is de-
balls ; they are not found in the principal vourers^ and as we have seen, they con-
veins, being unable to stem the current, stitute an organized sanitary police.
The seat of their activity is in the smaller The phagocytes prey also upon all for"
veins and capillaries, where they wander eign substances in the system, and con-
at will, prey and eat like the beasts of the sequently upon all invading bacteria and
forest, or the monsters of the great deep, disease germs.
The number of these white blood cor- But the phagocytes are by no means in-
puscles, in a grown person, is estimated at vincible. They, too, are liable to defeat,
approximately a hundred million. Re- and it is observed that the phagocytes of
lated forms of the white blood corpuscles, different animals vary in their attitude
are found in the lymph, chyle, and other toward bacteria. Indeed, some investiga-
fluids of the system, even in the crystal- tors are of the opinion that the invading
line lens ofthe eye, where they traverse the armies in warm-blooded animals, prey
interstices of the membrane, like adven- on the white blood corpuscles; but even
turous explorers cut off from the main those who reject the phagocyte theory,
body of their race. admit that there are cells proper to the
Similar wandering cells with amoeba- system which oppose the invaders,
like movements are also diffused through Bacteriology is the youngest branch of
the lower orders of the animal kingdom, the tree of knowledge. It has already
and in insects, and their study in these achieved many triumphs, and will doubt-
forms has led to some very interesting less soon solve the riddle of the precise
conclusions as to the part they play in relation of the micro-organism to the cell,
metamorphosis and evolution. An op- If at first glance it seems shocking to re-
portunity for studying their activity in fleet that our bodies are the seat of vast
living forms, is afforded by the larvae of communities who rove over it as over their
THEORY AND PRACTICE.
27
own domain, it should console'us to reflect
that in the pursuit of their own well-being,
they are undesignedly efficient agents in
achieving ours also. In fact, they are an
army of sanitary police evidencing indi-
vidually intelligent purpose in the over-
throw of numerous foes, against which
man himself has hitherto been powerless,
and whose tactics he does not even un-
derstand. — The Literary Digest.
THE CAUSE OF RHEUMATIC DIATHESIS.
(.Abstract of a Memoir by F. P. LeRoux, Academy of
ScieDce, Paris.)
In the present memoir I present the
series of observations which have brought
me to conclude that the cause of the
rheumatic diathesis resides in the inva-
sion of the intestines, by masses of zo-
5gloea, better known under the name of
intestinal mucus. The prevailing opin-
ion has hitherto been that these produc-
tions are the exudate from the intestinal
mucous membrane, a mucus more or less
dense, of which the greater or less abun-
dance is an effect, and not the cause, of
the disease. In addition to the mucus,
properly so-called, the presence had also
long been observed of products, membra-
nous or lamellar in structure, which had
been considered an epithelial desquama-
tion from the intestine. In addition,
there had been mentioned some tubular
products rarely observed, the form of
which was thought to be due to a simul-
taneous desquamation of the whole sur-
face of the portion of the intestine. In
his work entitled, " Traite des Humeurs,"
Robin mentions some curious examples
of the last-named product.
Since my childhood I have had to battle
against rheumatism under its generally
recognized manifestations, and believe that
I have discovered something new in the
symptoms of this disorder. The present
work, then, may be regarded as a con-
clusion of a series of observations cover-
ing a period of fifteen years. It was on
the occasion of an attack which was
pretty likely to prove fatal, that I was
able, about three years ago, to discover
the connection of certain morbid mani-
festations with the presence in the intes-
tine of the mucous products referred to.
I have set myself to dislodge these mu-
cous products, to collect them, and to
observe their forms.
The mucous bundles present themselves
in various sizes, preserving constantly
analogous forms, which preclude the idea
of casts. The arrangement is that of
membranous ridges arranged around a
very narrow trunk of tubulous appear-
ance. When by appropriate medicines
one secures their expulsion, so that the
mucous membrane of the intestine is
cleansed, they may be gathered in the
form of small masses of an amber color.
In the water, these masses unfold them-
selves, and the bodies in question in-
crease in size by the absorption of water.
Everything indicates that these cylindrical
masses come from tubulous pouches more
or less elongated, which I have called
generating tubes.
These matters, including the generating
tubes, become considerably swollen un-
der the action of a solution of tannic
acid. S*alicylic acid contracts them, etc.
By means of tannic acid, salicylic acid,,
or with a solution of a copper salt, I have
been able to remove from the intestine,,
generative tubes which had resisted dur-
ing many years the purgative agents or-
dinarily employed. It was only after the
elimination of a great quantity of these
generative tubes that I was able to secure
any considerable improvement in health.
Microscopic examination shows the
mucous masses produced to be principally
formed of a zoogloeic mass of micrococci
(which I propose to call micrococcus gla-
rese), surrounded with mucilage and
mixed with certain bacteria appearing to
form colonies.
The poisonous properties of the mucous-
masses appeared at first to result from the
fact that their passage into the intestine,
which in certain cases may be accurately
observed, produced morbid symptoms al-
28 THEORY AND PRACTICE.
most simultaneously, some of which were migraine, a certain variety of obesity
general, others local. The connection caused by thickening and induration of
of all the morbid manifestations called the skin and subjacent muscles, inflam-
rheumatic, with the presence in the intes- mation of the salivary glands ; then result-
tine of these products, is shown by the ing from the muscular ulcerations, gas-
observations reported in my memoir. tralgia, dilatation of the stomach, lessen-
Are these mucous products toxic, in ing of the expulsive force of the bladder ;
themselves ? or not being in themselves but the symptom especially general and
toxic, do they serve to support the growth characteristic is the generalized chronic
of other species of bacteria which are inflammation of the blood-vessels bring-
toxic in character ? or, again, do both the ing, as a final result, hemorrhages, and in
•conditions supposed, exist at the same particular cerebral hemorrhages,
time ? The last hypothesis appears to I have known a simple expulsive treat-
me the best, but I advance no definite ment to produce an amelioration of the
theory upon this point. general state, on condition of being em-
How is the system attacked by these ployed daily; but some years perhaps will
morbid products ? Have we to deal with be required to bring about a radical cure,
one or many toxic secretions, and is it Experience has shown me that to ob-
not possible to suppose that there may be tain the most rapid and permanent results
a dissemination of spores throughout the it is necessary to employ an alterative
system ? This is a question which is re- plan of treatment which will attack the
served for the future. generative tubes. I ^have been able to
However this may be, I have estab- dislodge some of them contained in the sig-
lished by daily observations upon myself, moid flexure, by means of irrigation made
and upon other patients, that a great with solutions of tannic acid or a copper
number of symptoms, more or less recog- salt; but in myself there existed other colo-
nized as belonging to the rheumatic dia- nies situated much higher in the intestine,
'thesis, have a certain concomitant relation In the attempts which I have made to
with the greater or less quantity of mu- attack them simultaneously by the stom-
cous products with which the intestine ach and the intestine, tannin from nut
was burdened. The ca^pricious behavior galls has seemed to me to be the most
of rheumatic attacks, and of affections active of similar substances.
which depend upon them, are easily .^♦^.
explained if one observes that the genera-
tive tubes may act as storage chambers of BOUCHARD'S BATH IN TYPHOID FEYER.
greater or less capacity. These magazines
empty their products into the intestines, The efficacy of the cold bath as a
in some cases nearly uniformly, so that the means of shortening the duration and
manifestations of the disease are moder- lessening the mortality of typhoid fever,
ate. In other cases the discharge of the has been clearly shown by Brand, Lieber-
contents of the generative tubes occurs meister, Winternitz, Ziemssen, and others,
irregularly. In these cases the excretory Brand administered a bath at a low tem-
organs are not able to eliminate the perature eight times a day, whenever the
poisons which accompany the mucous temperature of the patient rose above
masses with sufficient rapidity, in conse- 1012° F., continuing the bath ten or
quence of which their eff'ects upon the fifteen minutes. Liebermeister employed
system are much more grave. a bath during the whole course of the
The most prominent morbid symptoms disease, administering it twelve times a
that can be connected with these causes day, from ten to fifteen minutes each
are, after the pain and ulcerations of all time. He made the temperature of the
the muscles, aponeuroses, tendons, etc., bath from 59° F. to 68° F. The patient
THEORY AND PRACTICE.
29"
was left in the cold bath until the condi-
tion of rigor was well marked. Some-
times the condition of the patient became
very alarming, and his suffering was al-
ways very great; nevertheless, the mor-
tality was lessened.
Ziemssen rendered the bath less disa-
greeable to the patient by gradually cool-
ing it. He began with a temperature of
95° F. and lowered the temperature rap-
idly to 77° F., then allowed the patient to
remain in the bath from ten to fifteen
minutes, until his teeth chattered and he
was thoroughly chilled. When used in
this manner, the cold bath produces a
violent nervous shock and spasmodic con-
traction of the blood-vessels of the skin,
which lessens in a marked degree the
peripheral circulation. As the result, al-
though the patient's temperature lowered,
it was found to be increased shortly after
the bath, not infrequently reaching a
point even higher than that before the
bath. Riess suggested and employed a
continuous bath at 88° F. This form of
bath lowers the temperature of the pa-
tient and lessens the mortality of the dis-
ease, but is exceedingly tedious for the
patient.
Bouchard has proposed a form of bath
which produces no nervous shock, or
spasm of the cutaneous vessels, and
which thus encourages the elimination
of heat from cooling of the blood while
circulated in the vessels of the skin. We
quote the following description of this
bath from his work, " Legons sur les Auto-
Intoxication dans les Maladies : " —
*' The initial temperature of the bath
should be 3^° F., below that of the body,
— 100° F., for example, if the patient's tem-
perature is 103 ?° F. At this temperature
the patient is comfortable, and experiences
no shock. The water should be cooled
very gradually, at the rate of one fifth of
a degree per minute, that is, 2° F. every
ten minutes, until the temperature reaches
86° F., never lower.
" No sensation or nervous shock, no vas-
cular agitation, occurs during this long
time. The pulse does not become con-
tracted ; . . . there is none of the stupor
peculiar to typhoid fever. The lowering
of the temperature secured is much greater
than that of the cold bath.
"I give the bath eight times a day.
Some patients thus pass half the day in
water. The lowering of the temperature
is much more durable than the cold bath.
The elevations of temperature are much
less considerable."
Bouchard thinks that by this means he
is able to secure a lowering of temperature
of at least 1° F., and sometimes more
than 5° F. The elevation of the tem-
perature after the bath is very slow, and
never occurs quickly. The higher the
temperature the greater the effect of the
bath, with the exception of cases of ex-
cessively high temperature, as 103 J ° F.
to 105° F. There is also but little effect
in cases in which the temperature is
100° F. or below, and upon a person
whose temperature is normal, there is
practically no effect.
GLOBULICIDE POWER OF THE BLOOD SERUM..
M. Daremberg recently reported to the
Academy of Sciences, Paris, the results of
some interesting physiological studies re-
specting the influence of the blood serum
upon blood corpuscles. La Semaine Medi-
cals summarizes his work as follows : —
" The physiological study of the blood
serum has taken recently a new direction.
It has been shown that the serum of
many animals exercises a destructive
action upon a certain number of mi-
crobes. The serum of animals vaccinated
against diphtheria and tetanus, is even
capable of destroying the tetanic poison
and the poison o/ diphtheria. It has
also been observed that these remarkable
properties of the serum disappear under
the influence of different physio-chemical
actions, — heat, light, etc.
'' There is another property of the
blood serum observed long ago by Creite,
Landois, Panum, and Hayem. This is
the power possessed by the blood serum
30 THEORY AND PRACTICE.
of one species of animals to destroy the and the vapor of mercury. It is also
red globules of the blood of an animal of modified by traces of ether, or alcohol,
another species. We have made a com- either amylic or ethylic, and other sub-
parison of this power of the serum to stances. The white of an egg has no lobg-
destroy foreign red globules, which we ulcide properties.
will call briefly the globulicide power of " M. Gilbert has called attention to the
the blood, with the destructive action of fact that the normal blood serum of man
the serum upon microbes, or microbicide is eminently conservative of normal blood
power. corpuscles, and also of the degenerated red
" If we place upon a slide two or three corpuscles of anaemia. On the contrary,
drops of blood serum from a dog, deprived as shown by Maragliano, the serum of
of its red globules by coagulation, or invalids suffering from various infec-
more certainly by the action of centrifu- tions maladies, as well as the serum of
gal force, and then mix a trace of the anaemic patients, has a very marked de-
blood of a guinea-pig or a rabbit, the red structive action upon both normal and
globules of these animals will be seen to pathological red corpuscles,
disappear in two or three minutes as if " These observations suggest that the
they were dissolved. The globules may lessened number of red corpuscles and the
be preserved indefinitely in the serum of various modifications of the corpuscles
an animal of the same species. observed in anaemia, and especially in
'' If one mixes with the serum of a dog, chlorosis, are due to a previous altera-
a trace of blood from a pigeon or a frog, tion of the serum."
of which the red globules are nucleated, , , ,
the globules are seen to loose their coloring
matter, and become, in from twenty-five Unfermented Breads for Dyspep-
to thirty minutes, reduced to their tics. — The inability of dyspeptics to
nuclei. digest bread, so frequently observed, is
" The serum of the ox, the pigeon, and often wrongly attributed to an incompati-
the tortoise, possesses the same destructive bility of farinaceous substances with this
power for the red globules of an animal disease. As a rule, farinaceous substances
of another species. The serum of a rab- are particularly wholesome for the ma-
bit has generally very little globulicide jority of the subjects of dyspepsia. The
power for globules of the Mammifera, of dilated stomach is unable to deal success-
birds, or batrachians. The globulicide fully with food substances which require
power of the serum is invariably de- much disintegration, and which require
stroyed by heating from 122° F. to 140° long digestion in the stomach. Farina-
F., as is also its bacteriacide power. Even ceous foods are readily disintegrated in the
after five minutes exposure to this temp- stomach, and quickly reduced to a state
erature, the globulicide power begins to proper for admission to the small intestine,
lessen sensibly. After from twenty-five where their digestion is chiefly performed,
to thirty minutes' heat, it completely dis- The reason for the disagreement of
appears. Temperatures below 122° F. breads with dyspeptics has been clearly
do not afi'ect the globulicide power of pointed out by Bouchard, Dujardin-Beau-
the serum. Serum exposed to a diffused metz, and others. It is not that the bread
light for from eight to ten hours, loses its contains starch, but that it contains mi-
globulicide power. Serum placed in the crobes capable of converting starch into a
presence of a trace of essence of garlic variety of irritating acids and other poi-
for some hours also completely loses its sonous products. Speaking of the use of
globulicide power. This globulicide power fermented bread by dyspeptics, especially
of the serum is slightly retarded by traces those with dilated stomachs, Bouchard
of corrosive sublimate, of paraldehyde, remarks: —
THEORY AND PRACTICE.
31
" In the use of bread, the crust alone
;should be permitted, or the toasted
crumbs. The reason for this is that the
baking of the bread has interrupted the
fermentation of the dough, but has not
permanently arrested it ; so that fermen-
tation begins again as soon as warmth
and moisture present the favorable con-
ditions. In torrified bread (zwieback)
fermentation is, on the contrary, jDcrma-
nently arrested.
" What is panary fermentation ? The
general idea respecting this subject is that
formulated by Graham. In the presence
of cerealine (diastase), starch divides into
maltose and dextrine. The maltose under
the influence of saccharomyces minor is
converted into dextrose and levulose.
These two sugars under the influence of
saccharomyces, ferment to produce alco-
hol, and the carbonic acid gas which
raises the bread.
"M. Duclaux, who has accepted this
theory in principle, denies, however, the
existence of alcohol in this form of fer-
mentation.
"The question has been taken up by
M. Chicandart. According to the result
of his researches, neither soluble starch
nor dextrine are to be found in dough
undergoing fermentation. Neither sugar
nor alcohol are found, but acetic, butyric,
and lactic acids. The butyric and lactic
acids are found even when pure gluten is
fermented. There are also found leucin,
tyrosin, and phenol, that is, the products
of the fermentation of an albuminoid
substance. It is, then, the gluten of the
dough which gives rise to the products of
acetic fermentation, in the presence of
the bacillus glutinous. This microbe re-
sists the temperature to which the center
of the loaf is exposed during the baking,
and may continue in the stomach the
process of acetic fermentation. A knowl-
edge of these facts shows the utility of
unfermented bread, and of grilled, or
twice-baked, bread in the dietary of dys-
peptics."
It will be seen that this is amost inter-
'Csting topic for investigation.
Tuberculosis by Heredity. — Since
the bacterial origin of tuberculosis has
been established, the old views respecting
the hereditary character of the disease
have been losing their hold upon the
professional mind, and the heredity of
tubercular consumption, formerly con-
sidered an established fact, has come to
be regarded as nothing more than the in-
heritance of a constitutional susceptibility,
or morbid tendency. According to the
facts recently submitted by M. Landouzy,
in the Revue cle Medecine, the old view may
be correct after all, and we may have
been too hasty in our conclusions respect-
ing the possibility of the direct transmis-
sion of the disease from mother to child.
Here are some of the facts deduced by the
author to prove the direct hereditary
transmission of tuberculosis : —
1. The author and M. Martin showed
by experiments made in 1883, that tuber-
cles could be produced in guinea-pigs by
inoculation from a foetus, the mother of
which was tuberculous, although the
foetus showed no signs of tubercular dis-
ease.
2. Birch-Hirschfield and Schmorl re-
cently reported a case in which tubercle
bacilli were found in the foetal liver and
in the placenta.
3. Johne and Malvoz have also made a
similar observation in the foetal calf
4. It has been shown, experimentally,
that anthrax bacillus may be transmitted
to the calf through the cow.
5. A case is shown which indicates that
the foetus may also be infected from the
paternal germ, although the mother re-
mained healthy.
The author concludes, from the facts re-
ferred to, that the offspring of tuberculous
parents may be aff'ected in two ways : —
1. By actual infection with the bacillus,
the development of which may be hast-
ened or retarded by various circum-
stances.
2. By receiving a peculiar susceptibility
from the parent, which renders the system
a favorable soil for the development of the
bacillus. Such children, if they survive
32
THEORY AND PRACTICE.
parturition, die eaily of congenital de-
bility. In the opinion of the author,
tuberculosis in relation to marriage, is as
much a question of hygiene as syphilis
and marriage.
-•■ — • — ^-
A Ne"w Communication from Prof.
Koch. — Under date of October 22, Prof.
Koch gave to the medical profession a
fourth communication upon the treatment
of tuberculosis by tuberculine. In this pa-
per, he not only gives the minute details
necessary to enable any competent bacte-
riologist to produce the lymph as well as
himself, but details some very interesting
experiments which he has made for the
purpose of separating from the lymph
the active principles to which it owes its
peculiar properties. After many unsuc-
cessful attempts, he finally succeeded in
extracting a large part of the active prin-
ciple of the lymph by the addition of one
and one half volumes of absolute alcohol,
washing the deposit thus obtained with
an equal quantity of 60 per cent alcohol.
By this means he obtains a substance
which, has, when administered to guinea-
pigs, fifty times the potency of tubercu-
line, and when administered to man,
forty times the efficiency of tubercu-
line.
The chemical constitution and proper-
ties of the extract of tuberculine thus ob-
tained are found to correspond in charac-
ter neither to ptomaines nor toxalbumins,
and is placed by Prof. Koch in the group
of albuminoid matters. He considers it
possible that among the products of other
microbes, similar substances maybe found.
For some months, Prof. Koch has ex-
perimented at the Moabite Hospital, in
Berlin, with the pure product obtained
by the method described, but finds it in
no respects diff'erent from tuberculine.
The fact is somewhat disappointing, as
the hope had been entertained that the
unpleasant symptoms which often fol-
low the use of tuberculine, and which
render the results of its employment so
uncertain that most conservative physi-
cians have declined to resort to its use,
might be eliminated by the removal of
foreign substances or poisonous prinqiples
not essential for the production of the
specific eff'ect sought in the use of this
remedy.
Prof Koch's article appears in the
Deutsche (Med.) Wochenschrift for October
22, 1891.
» — • — 4
Experimental Researches Relating
to Sugar. — Albertoni, of Bologna, has
recently reported, according to the British
Medical Journal, the results of some very
interesting researches, undertaken for the
purpose of ascertaining the effect of sugar
upon the system, when taken in various-
quantities and under various conditions.
The animals experimented with were dogs,,
which were killed one hour after being-
fed. The following is a concise summary
of the facts observed : —
1. A very considerable quantity of un-
changed sugar was always found in the
stomach. Of glucose, 60 per cent of the
sugar taken was absorbed within an hour,,
the total quantity taken in each experi-
ment being about three ounces ; of maltose,
from 70 to 80 per cent was absorbed ; of
lactose, the proportion absorbed was from
20 to 40 per cent.
2. The amount of water contained in,
the stomach in the case of lactose was-
greater than that introduced, especially
when the concentrated solution was em-
ployed. This evidently explains the laxa-
tive character of lactose.
3. The intravenous injection of grape-
sugar (cane-sugar and maltose) increased
the pulse from 15 to 20 beats.
4. In man, three ounces of cane-sugar,
taken by the mouth, increased the pulse
from 4 to 8 beats per minute.
5. Glucose, maltose, and cane-sugar in-
creased the blood pressure in dogs from
15 to 20 millimeters of mercury.
6. Sugar introduced directly into the-
blood, caused dilatation of the vessels of
the kidney.
7. Lactose and levulose acted differently^
from a mixture of glucose, lactose, and
saccharose, increasing the blood pressure
TEEORY AND PRACTICE. 33
but diminishing the number of pulse out of hot water, and applied directly to
beats. the skin ; nevertheless, it is much better,
8. All sugars, with the exception of after wringing out the flannel as dry as
levulose, produced polyuria. desired, to fold it in a dry flannel cloth
The last-named facts lead to the sug- of one or two thicknesses before applying
gestion that levulose might be properly it to the patient. A little time is required
employed as a sweet in cases of diabetes, for the heat of the fomentation to pene-
and Kults has thus used it, although with trate the dry flannel, and thus the skin
what results is not reported. The result is allowed an opportunity to acquire tol-
of experiments now in progress in the erance for the heat, and a greater degree
Laboratory of Hygiene will be reported of temperature can be borne than if the
at an early day. moist cloth is brought directly in contact
•— ♦— . -^ith the surface. The outer fold of dry
Berlin Methods of Antiseptic Dress- flannel will also serve to keep the cloth
ing. — According to Dr. Keiffer, dry dress- warm, by preventing evaporation,
ings are employed in Berlin for nearly all A fomentation is sometimes needed
wounds. The dressing used is either plain when no hot water is at hand. It is
sterilized gauze, iodoform, or carbolic or not necessary to wait for water to be
sublimate gauze. Solutions of corrosive heated in the usual way. Soak the flan-
sublimate, varying in strength from 1-1,- nel in cold water, wring as dry as
000 to 1-10,000, and from 3 to 5 per cent desired, fold in a newspaper, and lay
solutions of carbolic acid, are used for upon the stove or wrap it about the
opening contaminated wounds. Strong stove pipe. In a few minutes it will be
solutions are used for cleaning the skin as warm as the patient can bear. The
about the field of operation. paper keeps the pipe from becoming
Lysol, a new antiseptic, in from i to 1 moistened by the wet flannel, and at the
per cent solution, is used for disinfection same time prevents the flannel from be-
of the hands, instruments, and for daily ing soiled by contact with the pipe,
vaginal douches. The advantages pos- Fomentations thoroughly applied will
sessed by this antiseptic are that it sapon- relieve most of the local pains for which
ifies fats, has a less disagreeable odor than liniments, lotions, and poultices are gen-
carbolic acid, and is a good and efficient erally applied, and are greatly to be pre-
disinfectant in the weak solution named, ferred to these remedies, since they are
Many surgeons have abandoned the cleaner, and aid nature more eff'ectually
use of sponges, and use instead crumpled in restoring the injured parts to a oound
gauze. condition.
Catgut, after having been abandoned, " *""^ '
has again come into use. Many plans are A New Remedy for Tuberculosis. —
employed for the disinfection of catgut. Remedies for tuberculosis in its various
one of the best of which is that used by forms are quite numerous now-a-days.
Martin, who places the catgut for twenty- The latest suggestion is that of M. No-
four hours in a solution of sublimate daud, who employs aristol hypodermi-
1-1,000, then preserves it until required cally, and claims for it remarkable results,
for use in a mixture of two parts of alco- He uses a 10 per cent solution of aristol
hoi and one part oil of juniper. in sterilized oil of almonds. He reports
.^•— • a case of tuberculous disease of the hip
How to Give a Fomentation. — joint cured in twenty-five days ; and of
Doubtless every physician knows how to twenty-three patients suffering from pul-
apply a fomentation, yet the following monary tuberculosis treated, claims to
suggestions may be of value to some one : have obtained in seven cases a practical
A flannel cloth may be folded, wrung cure, the patients having remained well
34 THEORY AND PRACTICE.
for three or four months. In five cases The learned naturalist states that chromic
there was great improvement; in three acid is a sovereign remedy in cases of
cases no effects. In these cases there were poisoning by the viper. According to his
large cavities in the lungs. Six patients experiments, the acid must be introduced
were slightly improved. The treatment into the wound. It should be employed
in the cases cured was continued from in a one-per-cent solution. When used
twenty-five to thirty days. The author in this proportion, no caustic effect upon
summarizes his experience with aristol as the tissues is observed. The remedy has
follows : — been tried with success.
1. Aristol is a toxic when administered
hypodermically. Cold as a Caustic. — The London
2. Its elimination is chiefly through the Lancet reports the invention, in Germany,
lungs. of an instrument for the utilization of cold
3. It acts as an antiseptic and an alter- as a means of producing caustic effects
ative. similar to those of intense heat. The ad-
4. Its effects are very prompt, and after vantages of this method of cauterizing in
the fifteenth or sixteenth day there is a certain classes of cases will be at once ap-
diminution of the froth and suppression of parent. It cannot, however, completely
the night sweats. replace the Paquelin thermo-cautery, or
5. After twenty or twenty-five days' electric cautery, since the latter not only
treatment, the patient usually begins to devitalizes but destroys the tissues, and
increase in weight. at the same time renders them absolutely
6. This remedy is useful in the first and sterile, a fact of no small value in certain
second stages of pulmonary tuberculosis, surgical cases.
but is of little or no value when large »• * "
cavities exist, and there is very little ex- Implanting Artificial Teeth. — Dr.
pectoration. Znamensky, of Moscow, Russia, has been
7. Injections do not produce infiamma- experimenting upon the implantation of
tion or abscess at the point of puncture, artificial teeth in dogs, with excellent re-
The treatment is not painful. suits. A tooth which had thus been im-
We shall look with interest for further planted could not be shaken or removed
results from the use of this new remedy. - by any force which could be applied with
* — •-— • the fingers. He has performed the same
Influence of Bromide of Potash on operation in one case upon a human be-
the Liver. — M. Fere recently reported ing, with good results. Dr. Rainey, of
to the Society of Biology, the results of Illinois, has been experimenting in a
researches conducted by himself and M. similar line, using roots made of block
Herber, which show that when bromide tin, and obtained good results.
of potash is administered for some time, " • •
the drug accumulates in the liver. The Cold Water in Dysentery. — Dr.
results obtained by the authors named H. C. Wood calls attention to the value
differ from those published by other ex- of a large enema of cold water in the
perimenters, which indicated an accumu- treatment of dysentery. We have made
lation of the drug in the brain. use of this valuable remedy for the last
* • ■* fifteen or sixteen years, and with excellent
Antidote for Viper ^Vounds. — Ac- success in many cases. In some instances
-ording to the Journal Z)' Hygiene, Dr. we find the use of hot water preferable.
Kauffman, Professor in the veterinary Our practice is to employ hot water first,
school of Alfort, near Paris, recently ob- as the best means of cleansing the diseased
tained a prize from the Academy of Medi- surface. If this does not give prompt re-
cine for a memoir upon viper poisons, lief, cold water, or even ice water, is em-
THEORY AND PRACTICE. 35
ployed in as large a quantity as the patient CAUSE OF DIABETES.
can readily retain. This remedy is es- •
pecially valuable when the disease is Recent studies of this subject have
located in the lower part of the colon, shown a probable important relation be-
Dr. Wood sometimes employs ice sup- tween disease of the nancreas, and diabe-
positories, which he introduces in rapid tes. A discussion on pancreatic diabetes
succession, usually one every three to five recently occurred in the French Academy
minutes until eight or ten have been of Medicine. M. Lancra {V Union Med-
introduced. icale) showed a dog in which diabetes
, , had been produced by the complete re-
moval of the pancreas. It was main-
Origin of Suppuration in the An- ^^^^^^^ ^j^^^ ^^^^i destruction of the pan-
trum of Highmore.— Dr. Luc, of Paris, ^.^.g^g^ without removal, does not produce
maintains that suppuration of the an- ^^le same result as removal of the organ,
trum of Highmore is due to infection ^ g/^ expressed the opinion that there
from carious teeth, and recently reported jg g^ pancreatic diabetes, but that all cases
to the French Society of Laryngology, ^^ diabetes in which there is a marked
twenty cases demonstrated to be from tendency to emaciation, are not of pancre-
this origin. One case proved to be an atic origin. According to the experiments
exception. There was no caries of the ^f Hedon, the absence of pancreatic juice
teeth, but the patient had had, several does not produce this form of diabetes,
months before, erysipelas of the face. According to the experience of M. See,
After the evacuation of the contents of ^he best anti-diabetic remedy is anti-
the sinus by operation, the patient had a py^ne in doses of sixty grains daily,
new attack of erysipelas of the face, during ei^ht or ten days.
Examination of the pus showed the pres- ^ OUivier recognizes a hereditary form
ence of the streptococcus of erysipelas. ^^ diabetes.
^ ^ M. Sammola considers diabetes and
glycosuria as not the same thing; the
Radical Cure of Inguinal Hernia presence of sugar in the urine being only
in Infants. — Karewski (Centralblatt fur one of the symptoms of diabetes, a symp-
Chirurgie) recommends radical operation tom sometimes found when diabetes does
for the cure of hernia in young infants, not exist.
a complete cure by bandage being so M. Boccardi has shown that certain
rarely obtained, and the condition so changes in the nerve centers follow the
liable to relapse even when an apparent complete destruction of the pancreas.
cure has been obtained. He thinks the M. See considered the presence of sugar
bad results heretofore obtained in opera- in the urine an infallible sign of diabetes,
tions upon young children have been due • M. Loncreaux defines three kinds of
to the suture of the wound in layers, diabetes : The constitutional form in
which, while useful in adults, is not which the patient is adipose, the pancre-
appropriate to the tissues of infants. He atic diabetes, and nervous or chromatic
recommends, after laying the parts open, diabetes. He does not consider hereditary
to reduce the contents of the hernia, to diabetes as a special type, but considers
free the sack from the surrounding tissues that glycosuria and diabetes may be re-
up to the internal ring, then to twist the garded as distinct conditions ; for persons
sack and ligate it. He uses a tampon in whom the appearance of sugar is only
of iodoform gauze. The suture is then occasional, after a time become diabetic,
closed, and the drain left for a few days, It is possible that the so-called pancre-
to avoid the possibility of sepsis. He re- atic diabetes is really, after all, only a
ports good results in nine cases. nervous diabetes.
36
REVIEWS.
Reviews.
Practical Pathology and Morbid
Histology. — By Heneage Gibbes, of Ann
Arbor. Published by Lea Bros., Philadel-
phia. This work is very practical, and is
-a capital exposition of the essentials of
pathology and morbid histology. One
could scarcely find elsewhere as much
practical information condensed in 300
pages, on the subjects of which this vol-
ume treats. It comprises three parts;
viz., Practical Pathology ; Practical Bacte-
riology; Morbid Histology ; Photography
with the microscope. In these days,
when every physician should have some
practical information on all these ques-
tions, and when much study and a vast
amount of literature is necessary to obtain
it, this work will simplify and shorten the
labors very much. For many reasons, it
will be found of much utility also, in every
laboratory; its illustrations are all from
photographs, and though not all perfect,
will improve our knowledge on many
things which are usually shown by draw-
ings, often more or less inaccurate.
English language, in the expiring year, so
replete with information on all the de-
partments of medicine, which every phy-
sician seeks daily, and needs continually,
in his ministration to the sick. It is a
sort of cyclopedia of advanced thought
and progress in the medical world. No
physician should be without it.
The Annual of the Universal Med-
ical Sciences. — By Chas. E. Sajous, etc.
Five volumes. Published by F. A. Davis,
Philadelphia. This is a masterpiece in
every respect. An attempt to do it justice
in a review would necessitate several
months of close study, for it is a complete,
lengthy though concrete, exposition of the
status of the progress of medicine in the
world, since the annual of 1890. It is, be-
sides, very practical and adapted to the
physicians' needs. Dr. Sajous and his
seventy associate editors, deserve more con-
gratulations and praise for this work than
the whole medical press could bestow ;
and the publishers deserve the thanks of
all interested, for their admirable illustra-
tions, typography, binding, etc. There
has not appeared a medical work in the
The Supreme Passions of Man. — By
Paul Paquin, M. D. Published by the
Little Blue Book Co., Battle Creek, Mich,
price 65 cents. It is an original essay of
nearly two hundred pages, which places
the primary influence producing passions,
including drunkenness, in the inherited
tendencies of the cells and their daily re-
plenishing by foods and stimulants. It
holds that rich foods and exaggerated
diet furnish the essential grounds for
passion, and that all of these, including
drunkenness and the various crimes of
the flesh and their well known train of
fearful diseases, could be absolutely con-
trolled by science under medical guid-
ance. It brings forth the peculiar and
perhaps untold idea, that alcoholism often
begins with impressions given to the cells
by alcohol formed in the stomach and in-
testines by microbic fermentation of undi-
gested food. It contains some radical
views worthy of every physician's con-
sideration in most of its chapters, particu-
larly in those entitled, " Appetites and
Passions," " The Chemistry of Passions,"
" The Evolution of Sin," " Beneath the
Cloak of Marriage," and " The Solution
of the Liquor Problem." It is a work
that, in our dilemma on the diseases due
to passions, abortions, etc., is unique and
needed.
It is illustrated by a map of cells in-
tended to impress the popular mind with
the truth of cellular aggregation forming
the body, and forming the base ot its
activities. It is radically different from
any medical work we have ever seen on
the questions treated.
The Laboratory of Hygiene
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
IvIONTMIvY BULI^KTIN.
Battle Creek, Mich., November, 1891.
LABORATORY OF HYGIENE AND ITS OBJECT.
For several years the managers of the
Sanitarium have had in contemplation,
the establishment of a Laboratory of Hy-
giene for the purpose of carrying on, on
an extensive scale, investigations in mat-
ters relating to health and disease, study-
ing especially such questions as have an
important relation to diet and regimen.
A small laboratory was equipped some
two years ago, and some work has been
done in this direction ; but the great ob-
stacle hitherto in the way has been the
lack of a competent director to devote his
whole time to this line of research. The
right man has at last been found, in Dr.
Paul Paquin, the well-known Professor
of Bacteriology and instructor in the
:State University of Missouri, located at
Columbia.
Prof. Paquin made a visit to the Sani-
tarium during his summer vacation, and
became so much interested in the work
of the Institution, and the lines of inves-
tigation which it is desired to carry on
here, that he consented, at the solicitation
of the managers of the Sanitarium, to
offer his resignation to the curators of the
University, and undertake the important
work of organizing upon a broad and
scientific basis, the Sanitarium Labora-
tory of Hygiene. The laboratory is sub-
divided into a number of departments,
as follows: —
A Physiological Department, in which will
be studied the various vital functions of
the body, which are capable of experi-
mental study. The subject of digestion
will receive special attention.
A Bacteriological Department, in which
will be cultivated and studied all known
forms of bacteria, or germs. The relations
of bacteria to food, water, air, and conta-
gious diseases, will be studied with minute
care, and by the aid of all the resources
afforded by the most recent and reliable
researches upon this question.
A Pathological Department, in which
special study will be made of diseased
conditions, and the causes of such diseases
as consumption, cancer, and other grave
maladies.
A Chemical Department^ a necessary sup-
plement to the work of the other depart-
ments of the laboratory.
A Vaccine Department, in which will be
produced, to begin with, the means of pro-
tection from smallpox, and later, charbon,
black leg, and that most terrible of all
known diseases, hydrophobia. The pur-
pose of undertaking the preparation of
bovine vaccine in this laboratory is a scien-
tific one rather than one related to com-
mercial interests. It has been discovered,
and clearly demonstrated by Prof. Paquin,
before the American Health Association,
that the severe inflammation, and other
symptoms of poisoning which not infre-
quently follow vaccination, and which
sometimes, though rarely it is true, result
fatally, are the result of the introduction
into the system of poisonous microbes
which are not found at all, or in very small
quantities, in safe vaccine matter, and
which are not essential to its activity and
(37)
38
LABORATORY OF HYGIENE.
efficiency. Means have been perfected
by which vaccine may be produced as
free from dangerous germs as possible,^ so
that the great objections which have been
urged against vaccination may be wholly
removed, and this efficient means of pro-
tection against smallpox may be em-
ployed with perfect safety.^
Prof. Paquin is eminently qualified for
these lines of research by long residence
in Paris, and study in foreign laboratories
whose names are world famous for their re-
searches and discoveries in this direction.
The French language being his native
tongue, Prof. Paquin was able to avail
himself of the advantages offered him to
an unusual degree, and his six years' ex-
perience as an original investigator and
instructor in these subjects, has eminently
qualified him for the important work
which he has undertaken.
The five departments of the laboratory
necessarily involve much work, and im-
ply that special talent must be engaged
in it, and furthermore, that many inves-
tigations must be slow and costly. The
Institution has looked into all that, and
realizes the great responsibility involved
without any direct restitution of its ex-
penditure ; but this should not deter, as
the task is undertaken for no other
purpose than the good of the human
race, and no matter how slow and costly,
we shall publish no report in haste,
for the vainglory of the investigators or
the promoters ; we shall give each ques-
tion studied due consideration, and an-
nounce progress or definite results from
time to time, in these columns, as may
be deemed wise. Therefore, we do not
expect at once to enter the arena of
science with results of great magnitude
in all the departments of our laboratory ;
but we do hope to present continually
some valuable scientific and practical
facts in various lines of research.
The questions now being studied in the
departments are as follows : —
1 This is not the case in most commercial institutions.
2 An illustrated report of close investigations on vaccine
and vaccination, will appear in December number.
Purity and impurities in vaccinia of
commerce (bovine vaccine).
Tests of a new kind of drainage tube
(improvised by the superintendent).
The kind, and action of fruit micro-
organisms in digestion.
The cause of pus production in using^
catgut ligature.
Typhoid fever, and its modes of dis-
semination.
The relative toxicity of microbic prod-
ucts on different culture media.
The relative toxicity of urines under
different dietetics.
In the Vaccine Department^ a limited
quantity of very pure, active, and safe
vaccinia is produced during our investi-
gations, and supplied to the physicians
who may wish to try a thoroughly re-
liable article. We have not opened a
commercial establishment, with agents in
various parts of the country ; but we will
on request, mail, pure, fresh vaccine points
at $1 per package of ten. Already we
have orders for such specimens from even
remote parts of the United States, and
from Mexico. We feel confident that the
aseptic methods employed to produce the
vaccine in a perfectly new and purposely
modeled building, will lead to a great im-
provement over the ordinary ways of most
commercial establishments, and remove
the objections often advanced against this
mode of protection against smallpox.
J. H. K.
STAINING THE BACILLUS TUBERCULOSIS.
The following is the method of Pittion
and Roux for differential staining of ba-
cillus tuberculosis.
Make three solutions as follows : —
Solution A: Ten parts of fuchsin dis-
solved in 100 parts of absolute alcohol.
Solution B : Three parts of liquid am-
monia in 100 parts of distilled water.
Solution C : Alcohol 50 parts, water 30'
parts, nitric acid (con.) 15 parts, aniline-
green to saturation. In making this solu-
tion, dissolve the green in the alcohol, and
TECHNIQUE.
39
add the water, and lastly the acid. This
solution will not keep long, and must be
made fresh each time.
To use : To ten parts of solution B add
one part of solution A, and heat until
vapor begins to make its appearance.
Now float the cover glass prepared in the
ordinary way, film down, for two or three
minutes (while you mix solution C). Re-
move the cover glass with platinum for-
ceps, and wash thoroughly with distilled
water, then let fall a few drops of solution
C on the film side, and wash again, con-
tinuing the operation of washing and de-
colorizing until the red color is replaced
by a tinge of green; then give a final
washing, dry, and mount in balsam.
The mount under the microscope should
show the bacilli stained a beautiful rose
red, on a delicate green background.
It is well for the beginner to make solu-
tion C weaker in acid, so that the decol-
orizing will be slower and can be better
watched.
If solution B is too strong in ammonia,
it will precipitate the fuchsin.
It will be noticed that recommenda-
tion is made to prepare solution C, each
time, fresh, because it does not keep long.
This is a drawback in using this staining
method. I have found that this precau-
tion is unnecessary, however, as the solu-
tion acts just as well when it is yellow
with age and in a state of decomposition,
as it were, as it does fresh. If one uses
solution C in this condition, it will be
found that in washing, the water in-
stantly brings back the green color, and
the background of the preparation is
always stained a beautiful green. If any-
thing, the old solution is better. So the
whole process may be much simplified
by making the three solutions at once, to
be used when necessary. p. p.
Technique.
How to Prepare Hydrogen Perox-
ide.— A French chemical journal gives
the following as a simple method of pre-
paring a solution of pure hydrogen per-
oxide. Mix barium peroxide with water
to the consistency of thin milk. Decom-
pose the peroxide by the addition of HCL,
specific gravity 1.100. Add to the mix-
ture one fourth its volume of ether, and
shake well. The ether dissolves one part
of the hydrogen peroxide. Turn ofi"
the ether, and shake with twice the
volume of pure water. The water will
take up a great part of the peroxide.
Separate the ether, and add to a fresh
barium peroxide solution. After shaking,
decant the ether, and mix with the same
proportion of water several times. By re-
peating the operation the water may be
made to take up more of the hydrogen
peroxide, till it contains from 5 to 9 per
cent of this valuable disinfecting agent.
A small amount of ether in the solution
will aid in its preservation. When it can
be obtained, it is far cheaper to purchase
the peroxide of hydrogen from some re-
liable manufacturer, as The D revet Mfg.
Co., of New York, but in an emergency
the method suggested might prove val-
uable.
-^ — • — ^
Lotion in Diphtheria. — P. Kastenko
and F. Grabovoski found that corrosive
sublimate 1-5,000, alcohol 85 per cent,
phenic acid 2 per cent, destroyed the
diphtheria bacillus on agar culture in
one minute.
Creosote in Consumption. — Dujar-
din-Beaumetz, and numerous other French
physicians, give pure Beechwood creosote
pre-eminence as a remedy for pulmonary
tuberculosis. Three methods of adminis-
tration are employed : By the mouth, in
pills or capsules; hypodermically, dis-
solved in fluid vaseline or oil of sweet
almonds carefally sterilized ; and by the
rectum, either in the form of suppositories
or an emulsion. The last method gives
the patient the least inconvenience, and
has the advantage of producing no dis-
turbance of digestion. We have made
use of this remedy for sonie months, and
have seen in a number of instances verv
40
NOTICES.
appreciable improvement. We have also
found it useful in cases of chronic diar-
rhea. The following formula is a conven-
ient one : —
Pure Beechwood creosote, from 20 to 60
minims.
Oil sweet almonds, 3 oz.
Yolk of one egg.
Water, 60 oz.
Dissolve the creosote in the oil, add the
yolk of the egg, and shake until well mixed,
then add the water. Administer just be-
fore going to bed, after emptying the
bowels by an enema of warm water.
We have been surprised to note the toler-
ance of both the rectal membrane and the
general system to this remedy. We have
administered it in doses varying from 15
to 60 minims, by this method, and have
never seen the slightest unpleasant result
in consequence. Care must, of course, be
taken to avoid the use of this remedy in
cases of renal insufficiency.
Notices.
Test for Creosote in the Urine. —
The following method is employed by M.
Kugler : Shake the urine with ether, sep-
arate the ether, evaporate, add water to
the residue, and decant the water from
the insoluble deposit. This solution of
creosote throws down a reddish-brown
resinous precipitate with bromine, and
gives a greenish-blue color, with a trace
of perchloride of iron.
-• — • — *-
Micro-Spectroscopic Examination
of the Blood. — M. Hennocque, who
has, perhaps, made more extended spec-
troscopic studies of the blood than any
other pathologist, has recently perfected
a new form of hsematoscope, by means
of which he is able to measure with great
exactness the amount of oxyhsemoglobin
in the blood, when the quantity contained
is greater than .000,000,81.
-* — • — «-
Nummular matters in sputum should
be treated with a 2 per cent solution of
caustic potash before staining for bacilli.
[LlTEKARY ]
The Arena for December contains a
frontispiece of J. G. Whittier, and arti-
cles as follows : " New Discoveries in
the Heavens," by Camille Flammarion;
"Protection or Free Trade — Which?"
by Hon David A. Wills ; " Whittier, the
N. E. Poet," by Geo. Stewart; "Faith in
God as a Personal Equation," by Rev.
C. A. Bartol; "Association in Clubs with
its Bearings on Working-Women," and
" In the Meshes of a Terrible Spell," by
Helen Campbell ; " Citizenship and Suf-
frage," by Francis Minor ; " The Logic
of Port Royal and Modern Science," by
Prof. T. Funck Brentano; "Qualification
of the Elective Franchise," by R. H. Will-
iams ; " Uncle Ripley's Speculation," by
Hamlin Garland ; editorials, book notices,
etc. Arena Pub. Co., Boston, Ma3s. $5
per year.
[Commercial.]
Queen and Co., Opticians, etc.,
moved to 1010 Chestnut street, Phila-
delphia. This great house, with its nu-
merous and varied branches of business
as manufacturers and dealers in optical,
chemical, engineering, photographic, me-
teorological apparatus, had been looking
for more convenient quarters for some
time, and have at last found a location
more suitable to their diverse departments.
Department No. 3, of special inter-
est to our readers, is for microscopes
and all instruments which are allied to
the microscope. They include micro-
scopic objectives and accessories, mount-
ing materials, microscopic objects (in-
cluding histological and pathological
specimens), works upon microscopy, po-
larizing apparatus, reading glasses, hand
magnifiers for botanists and others, graph-
oscopes, stereoscopes and views, etc., etc.
From this department comes the Micro-
scopical Bulletin^ a journal ably conducted
by the manager, who is an enthusiast
upon the subject. No other publication
upon microscopy has so large a circle of
readers.
^^
Various microbes from a mixture of two different cultures, 36 hours old, from commercial vac-
cine points of a same crop. A drop of each of the liquid cultures were mixed and
diluted with distilled sterile water, and spread very evenl3' on
cover g"lass before mounting".
(See article on Vaccine in this number.
PLATE III.
xhe:
• •
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH., U. S. A., DECEMBER, 1891. NO. 2.
Original Articles.
INFLUENCE OF THE CONTINUOUS CURRENT
ON MICROBES, PARTICULARLY ON
CHARBON BACTERIDIA.
BY M. N. APOSTOLI AND LAGUERRIERE, OP TARTS.
(Continued.)
Fourteenth Series {June 16, 1889), Gharhon.
Tubes No. 2.
A current of 250 milliamperes, 9 min-
utes on broth of charbon culture, only
attenuated the virulence ; two rabbits in-
oculated before the experiment, died in
the night of June 17 to 18; four rabbits
inoculated after the operation, died also,
but about seventy-two hours after the
first.
Fifteenth Series {June 25, 1889), Charbon.
Four guinea-pigs, having been inocu-
lated with culture attenuated by the cur-
rent, and having survived, were inoculated
with virulent anthrax, and died in three or
four days. They had retained all, or
nearly all, their receptivity for charbon.
Sixtt,enth Series {June 25, 1889), Charbon.
Tubes No. 2.
1. A current of 500 milliamperes, 3 min-
utes, then of 400 during the 4th minute,
and of 350 during the 5th minute, de-
stroyed all virulence; two guinea-pigs
inoculated before the experiment, suc-
cumbed ; four guinea-pigs inoculated after
the experiment, remained indifferent.
2. A current varying from 500 to 250
milliamperes, applied 10 minutes on an-
other tube of the same culture, modi-
fied that culture, and the inoculation of
four guinea-pigs therewith remained neg-
ative.
Seventeenth Series {June 29, 1889), Charbon.
Tubes No. 2.
A current of 250 milliamperes, 10 min-
utes, modified the cultures of charbon
broth ; two guinea-pigs inoculated before
the oj^eration, died in about thirty-six
hours, while six guinea-pigs inoculated
after the experiment, remained unaf-
fected.
Eighteenth Series {July 3, 1889), Charbon.
Tubes No. 2.
A current varying from 150 to 220 mil-
liamperes applied for 15 minutes, caused
the temperature of the tube to rise to
90° ; two guinea-pigs inoculated before the
operation died in about forty-eight hours ;
five guinea-pigs inoculated after the op-
eration, survived.
Nineteenth Series {July 9, 1889), Charbon.
Tubes No. 2.
1. A current of from 210 to 260 mil-
liamperes, 5 minutes, raised the tem-
perature of the culture to 48° ; two
guinea-pigs inoculated before the opera-
tion, succumbed in seventy-two hours;
three guinea-pigs inoculated after the
operation, survived.
2. A current of 500 milliamperes, re-
duced progressively to 170 milliamperes at
the 5th minute, applied 5 minutes, raised
the temperature to 95° centigrade ; two
guinea-pigs inoculated before, died ; three
guinea-pigs inoculated afterward, sur-
vived.
In these experiments, the sowing done
with cultures tested by the passage of the
current, remained sterile.
42
ORIOWAL ARTICLES.
Twentieth Series {July 11, 1889), Charbon.
Tubes No. 2.
1. A current of from 130 to 180 mil-
liamperes attenuated a charbon culture.
Temperature ranged from 32° to 48° centi-
grade in 5 minutes. Two guinea-pigs
inoculated before the experiment, died in
forty-eight hours; the three guinea-pigs
inoculated after the experiment, survived.
2. A current decreasing from 130 to 30
milliamperes, applied during 30 consecu-
tive minutes, and having produced a max-
imum temperature of 60°, attenuated the
virulence ; three guinea-pigs inoculated,
died twenty hours after the witness
guinea-pigs.
Twenty-first Series {July IJ^, 1889), Charbon.
Tubes No. 2.
A current of from 220 to 500 milliam-
peres, applied 5 minutes, caused the cult-
ure to raise to 99° centigrade, and killed
the microbes : two guinea-pigs inoculated
before, died in forty-eight hours ; three
guinea-pigs inoculated afterward, lived.
Twenty-second Series {July 14, 1889), Charbon.
Tubes No. 2.
1. A constant current of 200 milliam-
peres, applied 5 minutes, raised the tem-
perature of the tube from 26° to 54° C.
The same culture as that of July 14.
Of five guinea-pigs inoculated, two died
the fourth day ; the others lived.
2. A current of the same intensity is
applied 10 minutes to another culture of
the same age. During the experiment
the temperature rose from 26° to 83° C.
Five guinea-pigs were then inoculated,
three of which died respectively the
21st, 22nd, and 23rd of July.
N. B. — These two experiments are in-
complete, no guinea-pigs having been pre-
viously inoculated.
Twenty-third Series {July 21, 1889), Charbon.
Tubes No. 2.
1. Two guinea-pigs were inoculated
with the same culture as the preceding
experiments, that is to say, with a culture
ten days old. One of the guinea-pigs died
in the night of the 24th to the 25th ; the
other lived.
2. The virulent liquid was then attenu-
ated by 150 milliamperes in 5 minutes;
temperature raised to from 30° to 59° C. ;
three inoculated guinea-pigs survived.
3. The same virus, attenuated at 100
milliamperes in 5 minutes, 31° to 41° cen-
tigrade, gave a negative result from the
inoculation of guinea-pigs.
N. B. — These experiments have their
value ; but the destruction of the viru-
lence with a feeble intensity, is owing to
the fact that that virulence had already
been naturally attenuated by age.
Twenty fourth Series {July 2^i, 1889), Charbon.
A guinea-pig inoculated July 4, with
charbon broth attenuated at 160 milliam-
peres, 3 minutes, re-inoculated without
success June 25 ; then July 14, with viru-
lent broth, was inoculated for the fourth
time July 23, with a c.c of virulent
broth, and died of charbon, July 27.
This is the only guinea-pig which, in
the course of our experiments, appeared
to have acquired a certain immunity. Of
all the other guinea-pigs which were in-
oculated with charbon broth, more or less
attenuated, some succumbed rapidly to
the effects of a virulent inoculation, others
succumbed only in four or five days, that
is to say, more slowly than the witnesses
inoculated with the same virus.
Twenty -fifth Series {July 26, 1889), Charbon.
Tubes No. 2.
1. Eight guinea-pigs, virgins as to
inoculation, were inoculated without
success, with tubes of charbon broth
previously sterilized.
Twenty-sixth Series {July 30, 1889), Charbon.
Tubes No. 2.
Experiments made in the presence of
M. Bouchard and M. Charrin.
1. Three guinea-pigs inoculated with
virus of twenty-four hours, of the Pasteur
Institute, received five divisions of the
Strauss syringe, and succumbed in less
than forty-eight hours.
2. Nine guinea-pigs were inoculated
with attenuated tubes, and five divisions
of the syringe.
ORIGINAL ARTICLES.
43
(a.) Three guinea-pigs were inoculated
with a tube placed in ice^ and sub-
jected to a current of from 100 to 110
milliamperes, 15 minutes. One of the
guinea-pigs, twice inoculated (the syringe
performed badly), died August 4; the
other two lived. In this experiment,
the initial temperature was 6°; at the
15th minute, it was 37 1°.
(J).) Three guinea-pigs inoculated with
virus attenuated during 15 minutes, 80 to
150 milliamperes, temperature from 26°
to 33°, lived.
(c.) Three guinea-pigs inoculated with
virus attenuated during 6 minutes, by
current from 85 to 115 milliamperes,
lived. The temperature of the liquid
had been raised from 25l^° to 45°. In
the exj^eriments h and c, the tubes used
were not placed in ice.
These eight guinea-pigs were inoculated
August 17 by Charrin, with virulent char-
bon, and succumbed.
N. B. — In this experiment, we are not
absolutely sure of the intensity ; two gal-
vanometers, one of which was Shunte^ had
been intercalated in the circuit. These
galvanometers have given scattering re-
sults, and we have thought it proper to
give the average of the two different men-
surations.
Twenty-seventh Series (July 31, 1889), Gharbon.
Experiment with virus the second day
of sowing: Ten guinea-pigs were inocu-
lated and died of charbon. These ani-
mals had been previously inoculated with
liquid, the virulence of which had been
attenuated or destroyed by currents, the
intensity of which had varied, in the dif-
ferent tubes, from 180 to 500 milliamperes.
In guinea-pigs inoculated with tubes
that had had the maximum intensity,
death occurred in less than 48 hours.
With the other, death occurred near the
fourth day.
Twenty-eighth Series {Oct. 15, 1889), Charbon.
1. Two guinea-pigs that had already
been twice inoculated with attenuated
* It was the second time in the course of our experi-
ments that the tubes had been placed in ice to eliminate
the thermal influence.
virus, received two drops of virulent
virus (fifth day of sowing) ; one died only
the fifth day, the other survived, but
was killed by a new virulent inocula-
tion, October 29.
2. Five guinea-pigs inoculated with two
drops of the same virus, subjected to an
average current of 200 milliamperes, 5
minutes, survived.
Twenty -ninth Series {Oct. 19, 1889), Charbon.
1. Two guinea-pigs, virgin as to inocu-
lation, were inoculated with two drops of
virulent virus, the same as used in the
previous experiment. One died the fourth
day, the other, the fifth.
2. With the same virus attenuated at
the previous meeting, two guinea-pigs,
virgin as to inoculation, were inoculated
with two drops, and lived.
3. Eight other guinea-pigs that had pre-
viously been inoculated with attenuated
virus, were inoculated without success
with two drops of virus attenuated at
the preceding experiment.
Thirtieth Series {Oct. 22, 1889), Gharbon.
Five drops of culture of October 9 were
used without results in inoculating two
guinea-pigs, virgin as to inoculation. This
culture having been left in the labora-
tory room, had naturally lost its virulent
quality.
Thirty- first Series {Oct. 26, 1889), Charbon.
1. With culture of twenty-four hours
placed in the drying room at 25°, two
guinea-pigs were inoculated. One re-
ceived two drops and died in less than
forty-eight hours ; the other received only
one drop and died only the fourth day.
2. The culture was attenuated by a
constant current of 130 milliamperes, 5
minutes. Fourteen guinea-pigs were in-
oculated with eight drops of this attenu-
ated virus. Three of them died in about
seventy-two hours. The others lived.
Thirty-second Series {Nov. 16, 1889), Charbon.
Nine guinea-pigs, eight of which having
already been inoculated with virus more
or less attenuated by the galvanic current,
were inoculated with two drops of viru-
44
ORIGINAL ARTICLES.
lent culture received from the Pasteur
Institute, November 3. Seven of the old
guinea-pigs died. The guinea-pig that
had not been inoculated, and the old
guinea-pig lived.*
Thirty-third Series {Nov. 2J^, 1889), Charbon.
Tubes No. S.
This was the first time we used appa-
ratus No. 3, which clearly separates the
poles, and in which the liquids that gather
around each of them, take and keep in a
distinct manner the opposite reactions.
1. Four drops of a virus slightly viru-
lent were inoculated into two guinea-pigs
without result.
2. A current of from 80 to 70 milliam-
peres is tlien applied on the culture for
30 minutes.
(Communicating tubes placed in ice.)
Four drops from the positive tube killed
two guinea-pigs ; one died the third day,
the other, the fourth.
Four drops from the negative tube
killed one guinea-pig out of two, the
fourth day.
Four drops from the central positive
tube or from the central negative tube,
produced nothing on four guinea-pigs.
N. B. — There was then revivification
of the virus, especially at the positive
pole.
Thirty-fourth Series {Dec. Jf., 1889), Charbon.
Tubes No. 3.
1. Two witness-rabbits were inoculated
with five divisions of virulent culture
received from the Pasteur Institute. The
rabbits died the morning of December 8.
2. Two guinea-pigs previously inocu-
lated with attenuated virus, received five
divisions of the same culture. One died
December 9, the other survived.
The apparatus — tube No. 3 — is placed
in pounded ice. Before the passage of
the current, thermometers placed in the
different tubes registered the following
temperatures : —
Positive tube, 3° C. ; negative tube, 2° ;
iTo give a striking and convincing result, it is neces
sary to use virulent culture of from twenty-four to thirty-
six hours old. Outside of this, the virus is modified, and
the results become uncertain.
central tube, 2°. At the end of ten
minutes of a constant current of 200 mil-
liamperes, the elevation of the tempera-
ture was the same for the different tubes ;
2 degrees for the negative tube and for
the intermediary tubes, 2} for the positive
tube.
Of six rabbits which were inoculated,
two for each pole and two for the inter-
polary circuit, the two rabbits of the pos-
itive tube were the only ones that resisted ;
the four others died in the night of De-
cember 7 to 8 ; that is to say, in the same
time that the witness-rabbits died.
3. As in most experiments with ap-
paratus No. 3, tubes of peptonized broth
were supplied, or sown with removals
made, after the passage of the current on
the positive tube, on the negative, and in
the tubes of the interpolary circuit. Only
the sowing done with the positive tube
remained sterile. On the other hand,
sowing done with the cultures of the in-
terpolary circuit or with that of the nega-
tive tube, gave a positive result. Howbeit,
the degree of virulence of those cultures
has not yet been studied.
N. B. — In this experiment, as well as
in all others made with apparatus No. 3
the gases produced by electrolysis es-
caped at the upper extremity of the posi-
tive and negative tubes : the two central
tubes of the interpolary circuit were shel-
tered against all gaseous mixtures.
Thirty-fifth Series {Jan. 31, 1890), Charbon.
One of the two rabbits inoculated De-
cember 4, with attenuated culture of
the positive tube, was inoculated with
four drops of virulent charbon. The rab-
bit died in the night ot February 2 to 3.
Thirty- sixth Series {Feb. 4, 1890), Charbon.
Tubes No, 3.
With tubes of broth and of peptonized
gelatine sown since forty-eight hours in
full bacteridian vegetation, two rabbits
were inoculated and remained refractory.
On apparatus No. 3, placed in ice, a
feeble current of from 90 to 95 milliam-
peres is applied for 10 minutes. Inocu-
ORIGINAL ARTICLES.
45
lated rabbits with different tubes remained
refractory, as the witness- rabbits had been.
The sowing done with the negative and
interpolary tubes vegetated absolutely like
the sowing done before the experiment.
The sowing done with the positive
tube commenced to produce its effect
the fourth day.
N. B. — In these experiments, the virus
sown and used for inoculation was not
sufficiently virulent to kill rabbits.
However, the sowing by means of the
positive tube demonstrated that the viru-
lence of the positive tube, or at least its
vegetation, modified itself relatively to
that of the other tubes.
Thirty -seventh Series {Feb. G, 1890), Gharbon.
Three guinea-pigs inoculated with cult-
ures of the positive, central, and negative
tubes of the preceding experiments, re-
mained refractory.
The virus must therefore have been of
a greatly weakened virulence. It still
vegetated in media of culture, but it did
not kill even the guinea-pig.
(To be continued.)
"GRIPPE" AND PHTHISIS.
BY JOSEPH WILLIAM STICKLER, M. D.,
Pathologist to Memorial Hospital, Orange, N. J.
Dr. V. M. Gayle, of Kansas City, Mo,.
says : " Epidemic influenza, if not prop-
erly treated, is more liable to serious,
complications than almost any other dis-
ease we know of" I think he is correct.
Even when ^ well treated, it is apt to be
accompanied with distressing lesions of
one sort or another, and not infrequently
it is followed by pulmonary phthisis.
This is the point to which I call your
attention.
Not long ago I was called to see a pa-
tient sixty-five years old, a Scotchman,
with a good family history — no phthisis
on either father's or mother's side. He
had never had a pulmonary lesion till
attacked by "La Grippe " one year ago
last Christmas. The attack lasted about
three weeks, and left him with a cough.
The cough continued, and expectoration
was moderate. The patient's general con-
dition suffered very manifestly. He lost
in both weight and strength. In July,
1890, he had quite a profuse hemorrhage,
which prostrated him perceptibly. He
then began to expectorate more profusely,
and coughed almost constantly. Boils de-
veloped about the trunk, and a perineal
abscess made its appearance. His appetite
became seriously impaired, and emaciation
progressed rapidly. He soon became con-
fined to his home, and a little later to his
bed. When I first saw him, a few days
ago, he could scarcely walk, was very thin,
coughed hard and often, and expectorated
freely. Physical examination revealed a
cavity at the apex of each lung, consoli-
dation of the entire left lung, except the
lower portion of the lower lobe, and con-
solidation of the upper lobe of the right
lung, except that portion of it in which
the cavity existed.
This man will die. He will be killed
by pulmonary phthisis. All his trouble
dates back to the " Grippe." Had he not
had " La Grippe," phthisis would not
have developed. Possibly he might have
escaped the pulmonary lesion had he gone
at once to a more healthful climate, say,
Denver, Col., or Ashville, N. C; but the
fact stands that he will soon leave his
family and friends, because the " Grippe"
started in his lungs a fatal phthisical
process.
A few months since, I was asked to go
to Bethel, Conn., to see a young man ill
with phthisis. When I questioned him, I
learned that he had had an attack of
" Grippe " about a year ago. He thought
he had made a good recovery, but it was
not long before he began to cough and
expectorate, and after a little time had
elapsed, he presented all the symptoms of
pulmonary phthisis. When I saw him,
he had cavities, large and small, in both
lungs, was coughing almost constantly,
expectorated profusely, had night-sweats,
was emaciated to the point of looking
like a skeleton, had laryngeal tubercular
ulcers, and scarcely strength enough left
46 ORIQINAL ARTICLES.
to make it possible for him to stand up and four had never worn corsets or tight
without support. About two months later waistbands, having always worn clothing
he died. suspended from the shoulders. It is no-
I might mention other cases, but will ticeable that in a number of cases in
not do so, as the point to which I would which corsets had never been worn, tight
call your attention is apparent. waistbands had produced very extensive
To prevent the occurrence of such phys- displacement of the stomach, bowels, and
ical disaster, watch every " Grippe " pa- kidney. In one of these the liver was
tient very carefully. Frequently examine displaced downward,
the langSj and as soon as you discover In the 50 men, I found only six in
evidence of the existence of phthisis, ac- whom the stomach and bowels could be
quaint the family (sometimes the patient) said to be prolapsed. In one the right
with the fact, and adopt such a course of kidney was prolapsed. In only three was
treatment as will be calculated to save the degree of prolapse anything at all
the patient's life. comparable with that observed in the
My own opinion is to the effect that women, and in these three (and in one
the climatic treatment (with such supple- other of these six cases, making four in
mentary help as may be wise) is the best, all) it was found on inquiry that a belt or
and should be recommended at an early something equivalent had been worn in
date. three cases, as a means of sustaining the
' ' ■ pantaloons. In one case the patient at-
THE INFLUENCE OF DRESS IN PRODUCING THE tributed his condition to the wearing of a
PHYSICAL DECADENCE OF AMERICAN ^^^"^ furnished with a belt drawn tightly
WOMEN.
about the waist. This belt had been
worn a sufficiently long time to be an
J. H. KELLOGG, M. D., BATTLE CREEK. ample causc for the vlsccral displacement
observed. In the two cases of slight vis-
(Continued.) ccral prolapsc in which belts had been
The question may arise, whether we worn, there was considerable deformity
are treating the subject fairly, in charg- of the figure due to general weakness,
ing upon errors in dress, so great and so and a habitual standing with the weight
serious modifications of the human form upon one foot. By comparison, we see
as we have pointed out, and whether it the relative frequency of visceral prolapse
is not possible that visceral displacements in the men and women examined, was
in some of those cases to which I have 12 per cent of the men and 80 per cent
called attention, are to be found in men of the women. In other words, visceral
as well as in women. In order to place prolapse was found to be 61 times as fre-
this subject upon a rational basis, I re- quent in women as in men. It is also
cently made a careful examination re- noticeable that, with the exception of two
specting the position of the stomach, cases of visceral prolapse in the men, the
liver, and bowels in 50 working men visceral prolapse in the men was due to
and 71 Avorking women, all of whom the same cause which caused visceral pto-
were in ordinary health. lapse in women : viz., constriction of the
Of the 71 women examined, 23rolapsus waist. It makes no difference, of course,
of the stomach and bowels was found in whether the constriction is applied by
56 cases. In 19 of these cases, the right means of a corset or a waistband or a belt,
kidney was found prolapsed, and in one I have met a number of cases of visceral
case, both kidneys. The 15 cases in which prolapse in men in which the disease was
the stomach and bowels were not pro- directly traceable to the wearing of a belt,
lapsed were all persons under 24 years of One case was that of a military officer,
age. None of these had ever laced tightly, who wore a tight sword-belt, in which he
ORIGINAL ARTICLES. 47
carried almost constantly a heavy sword, abdominal contents in their normal posi-
I have also made some observations of the tion. As I have already shown, an addi-
same character among blacksmiths, who tional injury results from the failure of
have a habit of sustaining their panta- these weakened muscles to perform their
loons by means of the strings of their duty as guys, which balance the upper
leather aprons tied tightly about the half of the pelvis upon the trunk, and by
waist, the suspenders being loosened so their efficient action in health, maintain
as to give greater freedom to the move- a graceful and healthful poise of the body,
ments of the arms. Farmers, also, some- The strong and beautiful curves which
times seek to liberate their shoulders by are observed in a spirited horse are not
wearing the suspenders tied about the only attractive from an sesthetic point of
waist. Leaving out of consideration the view, but are also of the highest signifl-
four cases of men in whom the visceral cance from a physiological standpoint,
displacement was due to the same causes In the healthy, vigorous animal, one ob-
which produce this morbid condition in serves that the head is held high, the
women, we find but two cases in which neck and back strongly curved, the limbs
the viscera had become displaced from firmly set, and the whole expression in-
other causes, or one in twenty-five, — a dicates vigor and strength. The same is
frequency just one twentieth of that in equally true of the human body. An
which this diseased condition is found erect head, well curved back, prominent
in women who consider themselves en- chest, retracted abdomen, and firmly set
joying ordinary health. limbs, are indicative of an energized car-
These facts, it seems to me, are amply riage of the body which is characteristic
sufficient to establish my proposition, — of health. The flat chest, posterior dorsal
that constriction of the waist is the cause curve, projecting chin, protruding abdo-
of downward displacement of the pelvic men, are equally indicative of a relaxed
viscera, and of the diseases which naturally and weak carriage of the body, charac-
grow out of such disturbances of the static teristic of feebleness and disease. The
relations of the organs occupying this por- spiritless and tired horse does not hold
tion of the trunk. his head down ; he lacks the vigor and
The injury inflicted upon the body at disposition to hold it up. So the woman
its central portion by constriction of the who has been accustomed to the support
waist, attacks the very citadel of its of stays of steel or bone, finds herself,
strength and vigor, the stomach and its when without these means of support,
associate organs constituting the head- feeling, as she says, " as though she would
quarters for the supply of force and en- fall to pieces." The muscles of the waist
ergy for the whole system. It is doubtless lack the ability to balance the chest and
for this reason that the great abdominal shoulders upon the hips,
brain, the largest collection of nerve mat- As I shall show you presently, in the
ter in the sympathetic system, is found outlines which will be thrown upon the
in such close relation to the stomach, screen, that the direct eff'ect of the corset.
Lying, as it does, exactly in the plane of and of any constriction of the waist, is
the waist, any abnormal pressure at this to break down the natural curves of the
point must act directly upon this great back, straightening the spine, thus de-
center of reflex nervous activity. pressing the chest, and causing the shoul-
By the inactivity of the muscles of the ders to fall forward, and producing general
trunk, and the failure of development due collapse of the front wall of the trunk,
to continued pressure, the muscles of the In consequence of the weakening of the
central and anterior portions of the trunk muscles which support the trunk, and es-
become abnormally weak, so that their pecially weakness of the waist muscles,
natural tone is insufficient to support the an ungraceful and unnatural carriage of
48 ORIGINAL ARTICLES.
the body appears, not only in walking sexes, and in both men and women of
and standing, but in sitting. The weak savage tribes, in whom the dress of the
waisted woman is comfortable only when two sexes is practically alike, the chief
sitting in a rocking or easy chair. She movements noticeable to the eye in in-
cannot be comfortable unless the back is spiration are widening of the chest at its
supported ; consequently, in sitting, the lower part and bulging of the abdominal
muscles of the trunk are completely re- wall. There is at the same time a
laxed, thus causing collapse of the waist rhythmical action of the muscles of the
and protrusion of the lower abdomen by pelvic floor, induced by the increase-
the depression at the waist occasioned by of abdominal pressure resulting from
the depression of the ribs. the flattening of the diaphragm acting^
Such persons^ in standing, assume a against the resistance of the tense ab-
great variety of awkward and unhealth- dominal muscles.
ful positions, some of the most common That the respiratory movements are-
of which will be shown presently upon practically alike in adult persons of the-
the screen. The most common faults are two sexes, I think has been fully estab-
dropping the shoulders, projecting the lished by the observations of Mays, Dick-
chin, hips too far forward, weight resting inson, and others, as well as by my own
upon the heels or upon one foot, and a studies upon Indian women of various
general lack of even and graceful balance tribes, Chinese women, Italian peasant
of the body. In walking, the forward women, and American women whose
position of the hips makes it impossible breathing has never been interfered with
to plant the whole sole of the foot down by tight-fitting clothing,
at once and firmly, so the weight is thrust The relation of corsets and tight bands
continually upon the heels. This diffi- to respiration has usually been studied
culty is increased by wearing high-heeled with reference to their influence upon the
shoes. A swinging, swaying, wriggling, lungs or the respiratory process. The im^
or otherwise awkward gait, is the most portant relation of the respiratory process
common mode of walking one sees in wo- to the abdominal and pelvic viscera has
men, very few of whom are good walkers, too often been overlooked, although the
in consequence of the inability to balance disturbance of the normal relation exist-
the body, through the weakness of the ing between respiration, and the circula-
muscles of the waist. tion of the blood in the abdominal and
The fourth charge which I have made pelvic viscera, is undoubtedly a matter of
against the common mode of dress, in far greater importance than any interfer-
which the waist is constricted, is that it ence with the respiratory process occa-
induces and necessitates an abnormal sioned by constriction of the waist,
mode of respiration. When the waist is constricted, both ele-
In normal breathing, the shape of the ments of the respiratory process through
chest-cavity is changed in the act of in- which the abdominal pelvic circulation is
spiration in such a manner that its diam- assisted, are seriously weakened. The in-
eter is increased in all directions. The crease of the abdominal tension, resulting
greatest increase, however, is in its longi- from the pressure of the diaphragm, is
tudinal diameter, due to flattening of the prevented by the fact that the transverse
diaphragm ; and in the lateral transverse diameter of the lower portion of the chest
diameter of the lower part of the chest, is not only diminished, but fixed. The
due to the action of the inspiratory lateral attachments of the diaphragm are
muscles, and, according to Briiger, also in thus approached in such a manner that
part due to the depression of the abdomi- this muscle is rendered incapable of effi-
. nal viscera by the contracting diaphragm, cient contraction. At the same time, the
In normal respiration in children of both intra-thoracic negative pressure is dimin-
Fig. 1. Effects of tight lacing, and
neglect of physical exercise.
Fig. 2. The same person after a
few months' training.
PrloFiLE Tracings Showing Correct and Incorrect
Standing Positions.
60
ORIGINAL ARTICLES.
ished through the crippling of the inspira-
tory act. The lower portion of the chest
being held firmly, any increase in the
transverse diameter of this part is im-
possible. The normal descent of the dia-
phragm being prevented, the longitudinal
diameter of the chest cannot be increased
to the proper extent. The chest is left
free to act only in its upper part, the
elasticity of which is much less than that
of the lower portion, in consequence of
the rigid character of the ribs, and the
shortness of the cartilages which connect
the ribs to the sternum, as well as the
comparative weakness of the muscles
which act upon this portion of the
chest.
The crippled condition of respiration in
a woman whose waist is constricted by a
corset or tight bands, is clearly shown by
the readiness with which such a woman
gets out of breath when called upon to
make unusual exertion, or when there is
a special demand for lung activity from
any other cause. The first thing done for
a fainting woman is to cut her waistbands
and corset strings ; but no one would ever
think of tearing oj)en a man's ^yest or
slitting up his shirt front under the same
circumstances.
A NEW HYDROPATHIC TREATMENT FOR
DYSPEPSIA.
BY PROF, WM. WINTERNITZ, M. D., OF VIENNA.
EXPLANATION OF PLATE.
Figure 1. Side-view outline of a woman of
twenty-four years, who was suffering from
nervous dyspepsia and prolapsus of uterus and
ovaries.
Fig. 2. This outline represents the same
young woman after a few months' physical
training. She was restored to excellent health,
and has since been able to engage regularly in
the profession of nursing.
For Cracked Nipples. — Dr. F. Van
Allen recommends bathing the parts with
ordinary white of egg, after carefully
cleansing. The application should be
made after each nursing. Before the
child nurses, the parts should be moist-
ened with a little water. The white of
egg, after being applied, should be al-
lowed to dry before the parts are covered.
[This article was prepared by Prof. Winternitz ex-
pressly for the Bacteriological World and Modern
Medicine several months ago, but a press of other mat-
ter has delayed its publication until the present time.
This explanation is given on account of the fact that a
translation from the German of a description of the same
treatment, has recently appeared in an American medical
journal. — Eds.]
Those suffering from disorders of the
stomach furnish a proportionately not
very large contingent of the various ma-
terials of disease which annually come
under my notice. According to statistics
which have for twenty-five years been
accurately kept, only 11.6 ]3er cent of all
the patients that come to my water-cure
at Keltenlentgeben for treatment, suffer
from troubles of the stomach or the in-
testines ; and if we consider that accord-
ing to the same statistics 56 per cent of
these have been healed, and some what
over 40 per cent were helped, — some
more, some less, either permanently, or
lasting some little while, — while only
4 per cent were treated without any
marked results for the better whatever,
it must surely be conceded that hydro-
pathic and dietetic treatments must be
counted among the most efficient helps in
healing these forms of disease.
There are among my patients numer-
ous cases who have already undergone
the mose diversified cures, partly with
some passing relief, partly without any
at all, quite a goodly proportion of whom
have finally been healed here.
Aside from the general remedies which
affect the entire surface of the body,
hydropathic stomach-cures, particularly
sitz-baths, under various degrees of tem-
perature, and cooling, or heating and
stimulating compresses, or packs around
the body, are decidedly to be i)referred.
To-day I shall not enter into the gen-
eral working-effects of hydropathic stimu-
lation on the entire surface of tbe body,
or how water-treatment accidentally af-
fects the digestive processes ; nor shall I
ORIGINAL ARTICLES. 51
stop to consider the known modes of dyspeptic disturbances of the most vehe-
heightening the appetency for more rapid ment kind put in their appearance. A
and complete digestive action, which fact sensation of burning, a visible swelling,
has led me, by means of direct investiga- and a measurable rise of temperature
tion in that direction, to discover a surer in one or another part of the body, with
foundation for it, as I will soon develop ; simultaneous spastic contractions of the
neither shall I stop to deplore the fact vessels and a marble-like coldness in
that in general the effects of thermic influ- other parts, alternated with sudden pa-
ences, as brought to bear upon the surface ralysis of single fingers, toes, or of entire
of the body, are undervalued, and that extremities. For months at a time, me-
only rarely anything farther than warm- nostases, profuse leucorrhoea, metrorrha-
ing, cooling, or cleansing effects are wont gies, ovarial pains, a narrowing of the
to be expected, recognized, or traced. range of vision, aphony, and occasional
In mo st instances it is an utters urprise cutaneous analgia occurred. The thread
if, for ex ample, the statement is made which ran through all these varying
that a cold bath could change the reaction, symptomic manifestations consisted of
•or the degree of acidity of the urine, grave dyspeptic disorders of all sorts, —
This fact is met with such naive incre- voracious appetite, and anorexia, cardial-
dulity as that of the little child who, gia, tympanites, belching ; and finally
when told not to put its little naked feet there occurred, after every partaking of
on the cold floor lest it should catch a food, vomiting of the same, thus com-
cold in the head, asked in turn how that pleting a series of symptoms which had
could well be, since the head was so far objectively no kind of organic lesion to
removed from the soles of the feet. account for it, except a rapidly increasing
I shall on this occasion, also, refrain from loss of flesh, tachycardia, and occasionally
dwelling on the effects of cold and heat, painful palpitation of the heart, scanty
and stimulating applications (to the body, urinary secretion, and anuresis.
and to the regions of the stomach in par- Every imaginable internal and external
ticular) to induce more or less accelera- treatment had been consistently tried
tion of the processes of digestion in the during a period of three years, but with
stomach, and to change its functions of hardly a passing improvement of con-
secretion and motion ; for I desire, first dition. A cure tried in Italy had like-
of all, to introduce to j^ou my New Hy- wise only a very short-lived success,
dropathic Stomach-cure, considered from a The patient came under my care in a
purely clinic point of view. most lamentable condition, physically
Madame R. is a delicately framed lady, and morally. My first task consisted in
of about 30 years of age, and mother of trying to stop the vomiting after each
two boys, aged 9 and 10, respectively, meal, and to remove the tormenting
Four years ago she lost her beloved hus- cardialgia, or at least to reduce the same ;
band through sudden death, and had to for the prospects of improving the condi-
sufler other heavy shocks about the same tion of nutrition and the nervous state
time. She is descended from a nervously would otherwise be very slender. An
affected family. Shortly after these men- examination of the vomit led to no de-
tal sufferings commenced, she began to be sired results, since it consisted almost
sickly; she became anaemic, out of humor, always of the unaltered foods that had
and irritable. Little by little the entire been eaten, whicl? were thrown up by
complex of hysteria symptoms developed means of antiperistaltic motions. In a
in her case. After an intercurrent pleu- few instances, however, the throwing up
ritis, which had brought her down still of the food was followed by vomiting
lower, these symptoms increased in a very acrid, slimy, watery fluid, con-
severity. Vasomotoric, neuralgic, and taining muriatic acid in considerable pro-
62 ORIGINAL ARTICLES.
portions, as the tests proved. Artificial the wet bandage, and tHe tube with hot
attempts to aid digestion were neglected water flowing through, which appliance,
by such seemingly normal secretions of as experience taught, had to be in po-
the stomach. Every possible attempt sition about half an hour before food
was now made to stop the intolerance of could be safely passed to the patient ;
the stomach. But dietetic medication, and the entire apparatus remained also
hydropathic applications, — everything, in fully half an hour up to an hour after
short, seemed in vain. Not even a rigid each meal, in active use.
milk-cure, by trying all possible forms of Not one single time did the patient
milk, norkephir (a kind of fermented vomit again, under this mode of treat-
milk, like the Russian koumiss), seemed ment. But every time when any of these
to prove efl'ective ; milk by the spoonful, details were neglected, vomiting returned,
either cold or warm, could not stay the At first I allowed only the use of milk, in
vomiting, either. Raw, scraped meat, gradually increasing quantities ; but soon
ham, soup, beef-tea, champagne, ice pills, solid foods could be and were partaken
morphine, cocaine, and every available of and retained.
nervine, cold and stimulating packs, warm The appearance of the patient, as well
cataplasms over the abdomen and the as her real state of health, improved visi-
region of the stomach, — all were used, bly. Soon she increased in bodily weight,
without any satisfactory results. Articles and the nervous disturbances became es-
of food which had been given the patient sentially less. About four weeks after
while in a horizontal posture, could be commencing this treatment, small meals
retained a few minutes longer, and a were passed to the patient while in a
Weir-Mitchell treatment was continued sitting posture, without bandages or tube,
for many weeks ; likewise local and gen- and were retained by her ; only the prin-
eral electrization, — but everything was in cipal meal was yet taken in a prostrate
vain. The anaemia of the skin prevented posture, and with the appliances in active
the stimulating compresses on the body, use, as before.
to which I had recourse again and again, After eight weeks she was in a flourish-
from getting warm, and so they caused ing condition ; her weight of body had
only an unpleasant sense of chilliness and been increased by 14 kilos (24 lbs.), the
discomfort. haemoglobin of the blood which had been
Thereupon cold, moist, stimulating as low as 50, stood now at 70, and we
compresses on the body, well wrung out could send our patient away cured, al-
before application, were suggested to my though still a little nervous,
mind, combined with the application of You will not wonder that I felt very
a gutta percha tube through which hot skeptical toward these so utterly sur-
water at 140° F. was kept running, di- prizing eff'ects of this mode of treatment,
rectly over the pit of the stomach. But oftentimes the most unheard-of things
This direct local supply of heat more prove effective in hysteria, and the auto-
than counteracted the disagreeable sense suggestive way in which this new treat-
of coldness, caused by the cold cloths ment was introduced, ought certainly to
which enveloped the body, since a higher be taken into account. But what sur-
excitant of the nerves counteracts a less prised me most was the fact that the sim-
intense one. Under this influence, while pie hot applications to the region of the
in bed and in a hori^ntal position, the stomach alone, were not followed by favor-
patient was supplied with food, which able results ; they could neither stop the
thereupon was retained immediately, and vomiting, nor remove the disagreeable
without the least difficulty. From this feeling, but had, on the contrary, produced
time on, the patient took everything that pyrosis and troublesome pulsations in
was passed to her, while in bed, under the stomach. I therefore looked about.
ORIGINAL ARTICLES.
53
for other ailing bodies, to still further
test the method described.
A second case of very obdurate nervous
dyspepsia, with vehement cardialgia was
healed just as promptly as the first was.
A large number of sufferers from gastral-
gia — such as often accompanies anaemia
— and chlorosis were relieved of their
pain; their digestion and the formation
of blood improved, in a surprisingly short
time.
You will understand that in most of
these cases, I tried hot applications alone,
at first ; but almost without an excep-
tion, the patients became worse instead
of better.
A few cases of simple ulcus ven-
triculi derived considerable advantage
from this treatment, such as cessation
of the cardialgia, removal of the subjec-
tive difficulties, improvement of digestion
and nutrition, and that in many cases of
chronic catarrh of the stomach with slow
digestion ; and in a few instances of dila-
tation of the stomach the treatment has
also seemed beneficial. But how should
I interpret the effectiveness of these modes
of treatment ? I started by asking my-
self: Why did the direct hot applica-
tions to the pit of the stomach, without
the cold compresses around the body, not
work favorably or give satisfaction in the
cases under examination? From a theo-
retical standpoint I could only conclud e
that a rather long, intense action of heat
would i)roduce a relaxing, and a loss of
tonus of the vessels and tissues affected, —
conditiqns which are favorable to passive
hyperaemia and hypostases ; especially
by pre-existing weak circulation, and by
anaemia, chlorosis, and chronic catarrhs
of the pituitary membrane, such danger
is certainly not likely to be disregarded.
But such a hot tube, though covering
only a limited part of the stimulating
compress, must work differently. This
stimulating compress consists of several
layers of linen cloths, soaked in the
coldest possible water, well rung out and
well dried ; this kind of pack adapts itself
to the temperature of the surface of the
body, and if it really enlivens the circula-
tion of the skin, it warms up to but little
less than the temperature of the blood
itself.
In another case, I have found that it is
probable, that the difference between the
effects of a direct application of heat —
cataplasms — and that of the stimulating
compresses, that is to say, the warming of
cold compresses by transmission of heat
from the surface of the body, must be
sought in the fact that with the first case
was combined angeoparesis, and with the
other an active enlargement of the ves-
sels, perhaps under the influence of
"checking" nerves. Out of these grow,
in both instances as I have shown,^ to-
tally opposite effects upon the circula-
tion ; in the former case, passive hyper-
semia; in the latter, an active fluxion.
The hot tube, in connection with the cold
compress under it, or the bandage around
the body, seems to aid the stimulating
effect of the latter ; even by a heightened
anaemia of the skin, its application is
made possible, and causes an active flux-
ion in the mucous membrane of the
stomach, too, to remove thereby manifold
digestive disorders.
Gentlemen, whether my theory is cor-
rect or not, is a matter of secondary im-
portance. Its clinic and therapeutic
value you will be able to confirm your-
selves, I have not the least doubt, when
you give the matter your considerate
thought, and test for yourselves the ap-
plication of the hot tube upon the cold,
stimulating compress of the body.
» • ^
Electricity in a Blacksmith Shop. —
A California gentleman suggests the fol-
lowing as the best method of determining
whether a horse's foot is being injured by
nails not properly directed : Attach the
poles of a battery, such as is ordinarily
used for medical purposes, one to the
horse's bit and the other to the shoe. If
the foot is being injured by the shoe or
nails, the horse will squirm under the
test ; otherwise, he will not regard it.
1 '-About Little Observed Effects of Hydropathic An-
ti!)yresi8."
54 ORIGINAL ARTICLES.
LESSONS IN BACTERIOLOGY. in a very gradual slant to a point a couple
• of inches in length, and holding the point
BY PAUL PAQuiN, M. D. dowuward. The reason of this appear-
ance is that the germs are aerobic ; they
Lesson VIII. - Bacteriological Analysis of ^^^^ ^^^^ ^^ ^y^^ ^^p -^ contact with the
Fluids, Solids, and Gaseous Substances. f^^^ ^^i^., and form a large deposit there,
(Continued.) whilc the growth is lighter and lighter in
Part IL— Anaerobic Bacteria. the puncture as it penetrates into the
Pasteur in 1861 discovered that many depth of the medium where free oxygen
micro-organisms live without free oxygen, has access, with greater difficulty, and
This was a surprise, wiiich, notably in may be almost wanting. 2. Just the re-
Germany, created much doubt. The verse appearance of that explained above
doctrine of anaerobiosis, founded on this may present itself; that is, the conical
discovery, was by no means accepted streak of growth may come to a point at
without controversy. However, ex])eri- the top of the mass of culture medium
mentalists were soon in the field witli and spread out as it penetrates to the
facts supporting Pasteur's views. This bottom. This is because the majority of
discovery w^as not only of great immediate the germs are anaerobic ; they live better
value in the study of bacteria, but also of not in contact with free oxygen, and hence
much importance in the study of the physi- develop more luxuriously at the bottom,
ology of respiration, elucidating many for- in the depth of the mass, where free oxy-
merly obscure or misunderstood points gen is very rare, than at the surface where
in the phenomena of fermentation. Close it is abundant. 3. The growth may take
investigations of the affinity of microbes place in all parts of the puncture equally
for oxygen, including yeasts and molds, well, forming a cylindrical aperture or
showed a very wdde difference, some hole, as wide at the top as at the bottom
requiring little or no free oxygen and and at all intermediate points. This is
others a great abundance of it. Be- because the air has '' neither helped nor
tween those two extremes, /. e., the aerobic hindered " these germs in any part of the
to which free oxygen is a necessity, and growth.
the anaerobic to which it is not necessary Many apparatus have been invented to
and is even sometimes poisonous, there cultivate anaerobic microbes, all of which
are many intermediate stages or degrees tend to remove free oxygen from the field
of transition in w^hich oxygen can be dis- of culture. None of them, however, re-
pensed with more or less completely, while move the last trace of it, though they
several forms are found which live equally remove enough to enable the cultivation
well with or without oxygen, of these organisms in a satisfactory man-
Suppose that one has a tube of gelati- ner. The simplest way to cultivate ana-
nized beef broth in a good, solid condition, erobic microbes is to inoculate them in a
and that a little matter from some source or tube and cover them with agar-agar, or oil,
other is inoculated straight down through etc. Some methods consist in the use of
the mass with a platinum or glass needle gas, carbonic acid, and hydrogen, and
so as to leave a puncture easily visible in necessitate the generation of these, a thing
the medium, any of the following con- not always easy except in laboratories,
ditions may be noticed within a few days : Any one, however, may cultivate anaero-
1. The growth may be larger on top and bic bacteria, in a measure, at least, with-
graduallj/ decline to a point toward the out special apparatus, by various means
bottom, in the form of a cone, with the which exclude most of the oxygen. As
large extremity upward. The shape of the purpose of these lessons is to benefit
this growth's appearance in a tube might chiefly those deprived of laboratory ap-
be represented by whittling a lead pencil paratus, the students and physicians, I
ORIGINAL ARTICLES. 55
will give only a method accessible to all. by one, as many as can be thus reached,
Suppose it is desired to find and isolate and pick them with an inoculating needle,
anaerobic bacteria, the first thing is to and inoculate in separate tubes for isola-
render the specimen, or part of it, to a tion. Thus may one cultivate and isolate
liquid or semi-liquid, or to powder by anaerobic bacteria without special appara-
proper means, — crushing it and mixing tus, such as vacuum pumps, apparatus to
it with steriUzed water if necessary, using manufacture gas, etc. And, of course,
all the })recautions needed to prevent con- from these colonies one may also make
tamination with air germs, etc., as nmch microscopical studies,
as possible. For typical cultures of anaerobic ])ac-
A small (juantity of the material to be teria and for their preservation, special
analyzed is sown in a test-tube, filled methods alluded to in the foregoing
about two inches with nutrient gelatine must be resorted to.
or agar, melted and cooled to the lowest 1. Culture in gelatine. Put in a test-
point at which it will remain fluid. The tube two or more inches of gelatine
mass is mixed as uniformly as possible l)y medium, to which a substance greedy for
gentle rotary and vertical motions of the oxygen is added, say a small quantity of
tube, causing the gelatine to move about formiate of soda, and sterilize ; let cool
thoroughly. If successful, a number of down until solidified, inoculate down to
colonies will appear scattered throughout the bottom with a long needle (better a
the mass, being much more prolific at long, thin glass point), in such a way as to
the bottom and in the depths than at the make only a very fine puncture and not
surface, if the n:iajority of the forms arc to introduce air bubbles into it. The
anaerobic. In such a case, the points of anaerobic germs will grow at the bottom,
growth will decrease in (juantity and size The writer, in trying this method rec-
as the colonies approach the surface where ommended by Salmonsen and others, has
free oxygen is more and more abundant, obtained better results by sealing the
But if the mixture contains germs of both puncture made by inoculation, by melt-
classes, aerobic and anaerobic, then there ing a little gelatine in the opening of it
may be colonies of the former at and near with a slim glass rod, heated enough to
the surface, and colonies of the latter in sterilize it, and allowed to cool a little
the depth. Accordingly, in taking mi- before introducing it into the tube,
crobes from the colonies growing in such 2. It is recommended, l)y Salmonsen
a medium, one should recollect these facts, again, to cover the culture made by a
and note which are from the bottom and puncture in a solid medium with an oily
which from the top. substance, as was mentioned in a pre-
In such a culture, specks, spots, and ceding page. This method is very suc-
drops perhaps will appear here and there cessful. The process consists in inoculat-
in the mass. If the gelatine is liquefied, ing as in the preceding method and
one can introduce a sterile fine-point glass covering the medium immediately after
pipette (capillary tube) sealed at the top, with olive oil, vaseline, or even agar, at
until the open point reaches the liquid 2 per cent, sterilized in water bath, or in
growth, then break the top, and a drop a steam sterilizer, and allowed to cool
will enter the tube. The pipette is with- down to but little more than a semi-liquid
drawn, and this drop may be inoculated condition. The layer of substance thus
in the depth of another gelatine or agar poured on the top of the inoculated solid
tube, and thus be isolated and propagated medium in a test-tube should be about
in a state of purity. But if the colony an inch or two thick. Necessarily a little
has caused no liquefaction, then it may oxygen will be imprisoned by this pro-
be necessary to break the tube and cut cess, but not sufficient to interfere with
the culture medium to the colonies, one the growth of the anaerobiotic microbes.
.56
TRANSLATIONS AND ABSTRACTS.
Translations and xA^bstracts
The articles in this department are prepared expressly
for (his journal.
PSOROSPERMOSE FOLICULAIRE YEGELANTE.
From the Canadian Practitioner^ of Jan.
1, 1891, we quote: " Accorclinu^ to Darier,
there exists in man a group of cutaneous
diseases which merit the name of psoros-
permosis, being due to the presence in
the epidermis of parasites of the order
sporozaires, of the group psorosperms, or
coccidia. In one of these diseases the
coccidia of a particular species invade the
foUicular orifices of a greater portion of
the cutaneous surface, where they appear
in the form of round bodies, generally en-
cysted and contained in the epithelial
cells, or as refracting granules, the accu-
mulation of which forms a plug which
projects from the orifice of the follicle.
" The presence of these bodies enables
one to make the diagnosis of the disease,
as they are not met with in any analo-
gous clinical affection. The neck of the
follicles invaded becomes secondarily the
seat of papillomatous vegetations, which
can develop to a great degree and form
real tumors.
" This affection, from an etiological
point of view, should be placed wdth
Paget's disease of the nipple, and prob-
ably with moUuscum contagiosum."
Darier's case, reported to the Inter-
national Congress of Dermatology and
Syphilis, held in Paris in 1889, had the
following characteristics : " The isolated
lesions had the appearance of papules
surmounted by a crust ; but if the latter
be removed, it is seen not to be a crust,
but a small, obtuse horn plunged into a
dilated follicle orifice, and having a softer
extremity with a sebaceous aspect. The
margins of the orifice are somewhat ele-
vated and papular in character. In the
axillary, and especially the inguinal re-
gions, the lesions are larger, conglom-
erated, and forming by their union true
tumors, which become excoriated on their
surface. Where the eruption was con-
fluent, as on the sternum, scalp, axilla?,
and back, there were brownish crusts."
'' The lesions are almost always spread
over the greater part of the cutaneous sur-
face, but have points of election where
they attain a maximum of development, or
at least of confluence ; they are, the scalp.
face, presternal region, flanks, and espe-
cially the inguinal regions. In the first
stage the elementary lesion is a small
papule surmounted by a dark brownish
or grayish crust, which is dry and hard
to the touch, adheres firmly to the integu-
ment, and is a true horn, imbedded in an
infundibuliform depression by a conical
or cylindrical extremity, dirty white in
color, of semi-solid consistence, and some-
Avhat fatty to the touch. The depression
of the skin which receives this horn is
sliglitly entorme at the margins, a little
elevated, and manifestly corresponds to a
dilated orifice of a hair-sebaceous follicle.
AVhere the lesions are confluent, there is
a brownish or earthy-like layer in the
skin, more or less fatty to the touch ; there
is a series of irregular compact elevations,
giving a rasp-like feeling to the hand.
Removal of this layer shows the skin
irregular and rough, riddled with small
funnel-shaped orifices; the epidermis is
not destroyed, and there is no oozing of
blood. In a more advanced stage, the
lesions are larger; in certain parts the
elevated margin is deprived of epidermis
and appears ulcerated, while sebaceous
matter, either pure or mixed with pus,
can be pressed out of the follicle orifice.
"The disease commences as small
papules the size of a pin-head and al-
most the color of normal skin ; as they
increase in size, they become somewhat
hyperaemic, and in an advanced stage they
are hemispherical or flatfish in form.
The summit of some is excoriated by
scratching, and carries hemorrhagic crust.
When the lesions become confluent, they
form elevated patches covered with flat-
tened, yellowish or brownish corneous or
fatty concretions ; or the corneous mass
may form marked elevated collections, or
even papillomatus growths."
Microscopical examination of the le-
sions in the cases observed by Darier,
showed the accumulation of special mat-
ter in the neck of the follicle, changes in
the epidermis, especially in the rete, and
some circulatory disturbance in the co-
rium. The secreting portion of the gland
was unaffected. Sections showed that
the neck of the hair and sebaceous gland
follicle was the principal seat of the le-
sions, but not exclusively.
The neck of the follicle is dilated, cone-
shaped, and filled with a coherent mass
of corneous-like material, which extends
from the base of the cone to above the
general surface, and corresponds to the
adherent crust already described.
TRANSLATIONS AND ABSTRACTS.
57
The rete is hypertrophied, as shown by
the presence of abnormal projections of
this layer into the corium, both on the
general surface and along the hair follicle.
There is also a papillomatous growth of
the corium toward the epidermis.
These changes Darier believes are due
to an organism appearing under the form
of round bodies, nucleated and sur-
rounded by a thick membrane and situ-
ated in the interior of the epithelial cells,
displacing or pushing aside its nucleus.
They are present in great numbers in the
base of the cup, while the horny plug is
composed in great part of the same bodies,
which here have become transformed into
refracting granules. They are also pres-
ent in all portions of the rete layer.
In old lesions the projection of the rete
into the corium and the papilloma-like
new formation of connective tissue was
very marked, and resembled closely the
condition present in epithelioma.
-• — • — ^-
The Pathology of Stomach Diges-
tion.— The Semaine Medicate thus summa-
rizes an important communication upon
this subject recently made by M. Hay em '
to the Medical Society of the Hospitals
of Paris: The speaker stated first that
the transformation of albuminoid mat-
ters in the stomach is effected in two
stages. Before being peptonized, albumi-
noid substances combine with hydrochlo-
ric acid, forming acid albumens. In the
first stage of digestion, the production of
these acid albumens is very active. It
takes place at the expense of the fixed
chlorides. During the second stage, on
the contrary, of the peptonization, prop-
erly so-called, of the albuminoid mat-
ters, these same products decrease while
the fixed chlorides reappear. By regis-
tering the quantity of fixed chlorides and
acid albumen contained in the stomach at
different periods of the digestive process,
M. Hayem has determined the state of
the digestive process at each of these
periods. The process may be accelerated
or retarded. There are, hence, two classes
of morbid conditions relating to stomach
digestion, — those which result from ac-
celeration of the digestive process, and
those resulting from delayed digestion.
From the facts peculiar to these different
types of morbid conditions relating to the
digestive process, M. Hayem formulates a
general law, as follows : —
In the absence of mechanical obstacles
to the passage of the contents of the stom-
ach into the intestine, the evacuation of
the stomach appears to depend upon the
evolution of the digestive process, as to
whether it is intense or feeble.
When the stomach has accomplished
the work which it is capable of doing, it
relieves itself of its contents. On the con-
trary, when under the influence of a, par-
ticular kind of irritation, the work of the
stomach is delayed, or even when it con-
tinues, the evacuation of the stomach is
retarded. As the development of the
digestive process itself depends upon the
quantity and quality of the gastric secre-
tions, one may say, as a conclusion, that
the motor troubles of the stomach appear
to be governed by secretory changes.
In various recent publications there has
appeared, notably in foreign countries, a
tendency to explain most of the forms of
dyspepsia by the aid of supposed nerve
vaso-motor disorders. According to these
theoretical views, gastric atony, ending
ultimately in dilatation, is most often pri-
mary, and capable of explaining the
modifications of the chemical process.
A careful examination of the facts does
not support these fantastic conceptions.
M. Hayem, in reply to a question raised
by M. Mathieu, remarked that according
to his observation, in the majority of cases
in which the nervous phenomena con-
nected with disorder of the stomach ap-
peared first, they have been, in reality,
preceded by some changes in the chem-
ical actions of the stomach.
^ • -m-
The Value of Lotions in Diphtheria.
— P. Kastenko and F. Grabovski recently
made a careful study of the therapeutic
value of some of the substances more com-
monly employed as lotions in the treat-
ment of diphtheria. Solutions of the fol-
lowing substances, according to the Bulletin
General de Therapeutique, ordinarily em-
ployed in the treatment of diphtheria as
gargles and in compresses, have been ex-
amined by the same investigators, from
the point of view of their effect upon the
bacilli of diphtheria : —
Alum 3 per cent, phenic acid from 1 to
2 per cent, corrosive sublimate 1-5,000,
hydrochloric acid 1-1,000, boracic acid 4
per cent, citric acid 5 per cent, salicylate
of soda 5 per cent, chlorate of potash 3
per cent, solution of chloride of iron and
glycerine, equal parts ; one part of iodine,
two parts of iodide of potash in 300 parts
of distilled water ; essence of turpentine,
essence of peppermint.
The following substances destroyed in
one minute the cultures of the diphtheria
58
TRANSLATIONS AND ABSTRACTS.
bacillus upon agar: Corrosive sublimate
1-5,000, alcohol at 85 per cent, solution
of equal parts of perchloride of iron and
glycerine, iodine one part, iodide of potash
two parts, distilled water 300 parts; a 2
per cent solution of phenic acid.
A 5 per cent solution of salicylate of
soda, or citric acid, destroyed the cultures
in five minutes.
The following solutions destroyed the
cultures in 30 minutes : Alum 3 per cent,
phenic acid 1 per cent, hydrochloric acid
1-1,000, alcohol 42 per cent.
No effect was produced by essence of
turpentine or peppermint in five minutes.
A 3 per cent solution of chlorate of pot-
ash, and a 4 per cent of boracic acid,
produced no effect in 30 minutes.
A New Remedy for Psoriasis — Gal-
lacetophenone. — Pyrogallic acid is so
valuable a remedy for psoriasis that its
use is still continued by many dermatolo-
gists, notwithstanding its relinquishment
by others on account of the frequent oc-
currence of systemic poisoning, sometimes
even fatal, following its use. According
to the Semaine Medicate^ however, it may
now be dispensed with, as Nencki has
succeeded in producing a derivative sub-
stance which he terms gallacetophenone,
which possesses all the therapeutic proper-
ties of gallic acid, and is non-poisonous.
The remedy produces excellent results in
the. form of an ointment, one part to nine
of the medicine, good effects appearing
within a few hours from the first applica-
tion. The new remedy also has the ad-
vantage that it does not soil the clothing
of the patient. Gallacetophenone is a
yellow powder. It is soluble in hot
water, alcohol, ether, and glycerine. Its
solubility in cold water is slight, but is
increased by acetate of soda. The follow-
ing formula is a suitable solution : —
Gallacetophenone 4 parts
Acetate of soda 30 "
Hot water 100
exposure to an impure atmosphere are
not due to the foul odors inhaled, but to
the microbes by which the foul odors are
produced. Any system of disinfection,
to be effective, must be capable of de-
stroying or removing these organisms.
Dr. Richard Stern has recently made
an exhaustive study of this subject, mix-
ing pure cultures of various microbes with
dust collected from factories and school-
rooms. He diffused the dust thus pre-
pared throughout the atmosphere of a
room specially arranged for the investiga-
tion, and then made a careful study of
the air under difierent conditions, employ-
ing Petri's method for estimating the
number of micro-organisms in a given
quantity of air. The conclusions ar-
rived at are, according to the Boston
Medical and Surgical Journal^ as follows : —
"1. The micro-organisms rapidly sink
to the floor in quiet air. The finer the
dust upon which the micro-organisms
rest, the slower the gravitation. 2. The
usual ventilation, effecting a renewal of
air from one to three times an hour, has
no effect upon the removal of micro-
organisms with summer ventilation, and
only to a very limited extent with winter
ventilation. 3. Ventilation, effecting a
more rapid renewal of air (six or seven
times to the hour), effects the removal of
micro-organisms but slightly, without a
sensible draught. 4. A rapid and com-
plete removal of the micro-organisms from
the air is only attainable with a strong
draught. 5. Micro-organisms are not
blown off from the floor, walls, furniture,
clothing, etc., even with the stronger
draughts. 6. The evolution of steam in
a room is not capable of rapidly and com-
pletely precipitating the micro-organisms,
although it hastens this process to an
appreciable extent.
Ventilation as a Means of Disinfec-
tion.— The value of ventilation as a
means of securing air purity cannot be
questioned ; nevertheless, there seems to
be good ground for the belief that the
popular faith in ventilation is considerably
exaggerated. Recent researches concern-
ing the character and properties of pto-
maines and other poisonous products of
bacterial origin, have clearly shown the
fact that the injurious results following
Speaking without a Larynx. — At a
meeting of the Royal Society of Physi-
cians, at Vienna, an interesting discussion
recently occurred respecting the existence
of the function of voice without a larynx.
A man was present from whom the entire
larynx and part of the oesophagus had
been removed for carcinoma. He was
able to speak very well by the aid of an
artificial larynx. Schroetter related a case
in which, after removal of the larynx,
there was a sort of reproduction of the
vocal cords, or, rather, a production of
folds of mucous membrane which served
the iDurpose of vocal cords sufficiently to
enable the patient to speak. Schroetter
TRANSLATIONS AND ABSTRACTS.
59
and Stoerk also reported each a still more
remarkable case, in which not only the
larjaix but a considerable part of the
pharynx was removed, so that there was
no communication whatever between the
mouth and the trachea, the patient
breathing by means of a tube placed in
the trachea. These patients were able to
talk, notwithstanding. Schroetter thinks
that in these cases a sufficient amount of
air may be forced out from the stomach
and oesophagus to enable the organs of
voice and the mouth to form words.
the fact has appeared that acetic aoid con-
nected with tartaric and oxalic acids, very
materially hinders this portion of the di-
gestive process. It is worthy of note, as
being in the line of scientific progress, that
many of the most skillful chefs are sub-
stituting, in their culinary processes,
lemon juice for vinegar, thus avoiding at
once both the wriggling eels and the mis-
chief-making acid.
Celluloid Substitute for Bone. —
Billroth, and other German surgeons, re-
port success in the use of celluloid to
replace portions of the skull which had
been loosened by injury necessitating their
removal. When the operation is done
aseptically, suppuration does not occur.
Gout and the Use of Sugar. — Dr.
Jonathan Hutchinson, the great London
physician, forbids his patients who are suf-
fering from gout the use of cooked fruits
if eaten with sugar. The employment of
cane sugar he finds particularly injurious.
Ripe fruit eaten raw, without the addi-
tion of sugar, is harmless, while cooked
fruit to which sugars have been added,
are almost certain to produce an attack of
the disease in persons subject to gout.
Treatment of Stricture by Elec-
tricity. — M. Long, of the Medical Col-
lege of Vienna, considers electrolysis the
proper method of treating strictures of
the urethra when the contracted portion
involves the cavernous portion of the
urethra, but prefers surgical treatment
when the spongy part is aff'ected.
Bro'wn-Sequard's Elixir. — M. Brown-
Sequard still continues the use of his ex-
tract of the genital glands of rabbits and
guinea-pigs, and recently reports a num-
ber of cases of ataxia, diabetes, and pul-
monary tuberculosis, which have been
greatly benefited or cured by his in-
jections.
-• — • — *-
Effect of Vinegar upon Digestion.
— Modern laboratory investigations are
bringing into question the propriety of
using as food numerous articles which
have almost universally been accepted as
harmless or useful articles of food. Dr.
Roberts showed, long ago, that tea and
coff'ee hindered digestion. Condiments
have been interdicted in consequence of
the irritating effect upon the stomach and
kidneys The microscopists have dis-
covered that the eels of vinegar sometimes
take up their abode in the alimentary
canal as parasites, and become a source of
irritation and disturbance to the digestive
organs ; and now, according to Virchow's
archives, John has been investigating the
influence of acids upon salivary digestion
or the conversion of starch into sugar, and
Methyl-Blue as Antiperiodic. — Drs.
Goodman and Ehrlich, physicians to the
Moabite Hospital at Berlin, have been ex-
perimenting with this new therapeutic
agent in the treatment of malarial fever.
Recognizing the facility with which the
white blood corpuscles absorb this stain-
ing agent, and especially the facility with
which the Laveran parasites are stained
by it, it occurred to them that this agent
might be useful as an antiperiodic rem-
edy. They accordingly employed it in
two cases of malarial fever, one of the ter-
tian and the other of the quotidian vari-
ety. Under the influence of the remedy
the paroxysms ceased in a few days, and
the parasites disappeared from the blood
within eight days. The remedy was ad-
ministered in capsules, in doses of ten
centigrams (one and one half grains), re-
peated five times in twenty-four hours, at
intervals of three hours in the tertian
case, and at intervals of one hour in the
case of quotidian fever. The remedy was
given from ten to twelve hours before the
expected appearance of the chill. The
patients continued to take methyl-blue
for eight or ten days after the fever disap-
peared, taking each day fifty centigrams
(8 grains).. During the treatment, the
urine retains an intense blue color and is
somewhat increased in quantity, but con-
tains no albumen. The stools are not
blue when passed, but become blue after
exposure to the air, as the result of the
oxidation of the reduced methyl-blue
which they contain. The patients have
continued well since their recovery.
60
BACTERIOLOGICAL NOTES.
Bacteriological Notes.
[The notes appearing in this department are abstracts
or translations prepared expressly for the Bactebio-
LOGicAii World akd Modern Medicine from original
sources.]
Prevention of the Multiplication
of Disease Germs. — " In regard to the
disease-producing or pathogenic germs,"
says the Sanitary News, "it is important
to understand what forces or agencies will
retard their multiplication or wholly de-
stroy them. In emergencies, chemistry
is resorted to, and antiseptics and disin-
fectants are employed ; but in the proper
prevention of disease, such emergencies
should not be allowed to arise. Sunlight,
pure air, and thorough cleanliness are
natural enemies to disease germs. They
cannot flourish where they have not their
proper food, and that is found in damp-
ness, darkness, mold, and filth. Keep the
habitation flooded with sunshine and
pure air, keep away all filth and damp-
ness, and the germs of disease will find
no foothold, no nidus in which to breed
or food on which to grow. Nature is
struggling all the time to keep her domain
healthful, and a fit habitation for man ;
but man shuts out the air and light, con-
taminates all things about him, and dis-
ease is the reward of his recklessness and
neglect. There is more health in a sun-
beam than in drugs, and more life in pure
air than in the physician's skill. The
sunlight may fade your parlor carpet, but
better that than have disease fade your
cheeks. The wind may tan and freckle
the face, but it is better tanned and
freckled than thin and sallow. Help
nature to keep your habitation healthful
by allowing her forces an opportunity to
operate. There is more health about you
than disease. Health is man's natural
condition. He has to violate some law
before the penalty of disease is inflicted.
He can place about him such conditions
that disease germs will invade his system,
or he can live amid surroundings so pure
that health will bless him both in his
freedom from physical ills and in the
sweet consciousness of right living."
as toxines, ptomaines, toxalbumins, be-
long to the nerve poisons, and all of them,
with the exception of cadaverine and pu-
trescine, are devoid of pyogenic proper-
ties, and have but a slight action on the
leucocytes, which are in great part the
subjects for suppurative fluids.
" This fact would point to other sub-
stances in the products of suppuration, to
explain the phenomena of pyogenic in-
fectious processes. Such agents were found
to exist. Buckner, Nencki, Lange, and
Roemer have demonstrated them in the
plasma of pyogenic bacteria. These sub-
stances are proteids (or proteins) possess-
ing positive pathogenic properties on
leucocytes."
m • m
A New Use for Tuberculin. — The
Board of Health of Philadelphia has found
a new and very practical use for tubercu-
lin. This enterprising Board is paying
great attention to the milk supply of
Philadelphia, and had great difficulty in
determining in some cases whether or not
certain cows found in dairies supplying the
city were or were not tuberculous. Exper-
iments made by the Veterinary Depart-
ment of the University of Pennsylvania
show that Koch's tuberculin is capable of
detecting tuberculosis in the early stage
of the disease in cows as well as in human
beings.
-» — • — ^-
Bacterial Products. — Mr. Buckner,^
who has studied the effects of bacterial
products in inflammation and suppura-
tion, concludes as follows : —
" The products secreted by bacilli, such
1 Centralhlattftir Chirurgic, No. 50, 1890.
Milk and Microbes. — Just after the
medical profession, and to some extent the
laity, have become thoroughly impressed
with the idea that milk should be boiled
before being eaten, to insure the destruc-
tion of the microbes which it contains,
Dr. Freudenreich comes forward with a
series of experiments by which he claims
to prove that fresh raw milk possesses re-
markable germicidal properties. Accord-
ing to his experiments, the bacillus of chol-
era, when put into fresh cow's milk, dies in
an hour, the bacillus of tyjDhoid fever suc-
cumbs at the end of twenty-four hours,
while other germs die at the end of vary-
ing periods. Milk which has been ex-
posed to a temperature of 131° F. loses its
germicidal properties. Milk which is four
or five days old is also devoid of microbe-
killing power.
How are these results to be reconciled
with previous observations? This is a
question which the bacteriologists must
settle by practical experiments. We hope
to be able to report soon some results of
work done in the Laboratory of Hygiene,
bearing upon this question.
BACTERIOLOGICAL NOTES.
61
INDUCED IMMUNITY AGAINST PNEUMOCOCCUS.
Dr. Klemperer has shown that im-
munity against the pneumococcus sep-
ticaemia may be induced by the employ-
ment of the serum of immune animals, or
by means of a bouillon-culture of the pneu-
mococcus. The serum of rabbits which
have been rendered immune will also pro-
duce immunity against the pneumococcus
infection. Serum seems to have the power
to destroy, not the pneumococcus itself,
but the poison which it generates.
The introduction of the serum of im-
mune animals into the systems of persons
suffering from pneumonia has been tried
by way of experiment, with encouraging
results. The temperature and pulse were
reduced, and in two cases the tempera-
ture remained normal ; in the other cases,
it rose again at the end of six hours.
There is doubtless a very great future in
this line of experimentation. The time
may come, and it is possible that the day
may not be far distant, when we shall be
able successfully to fight germs with
germs ; or, if the germs themselves are
not brought face to face in the battle,
the weapons with which they make their
attack — certain characteristic poisons
which they produce — may be so used that
the deadly poison developed by one germ
may be successfully neutralized by the
poison produced by some other germ, or
by the same germ under different condi-
tions.
*» — • — *
The Pneumococcus and Cerebro-
spinal Meningitis. — Dr.Netter, Director
of the Laboratory of Hygiene of the Fac-
ulty of Medicine, of Paris, has according to
Dr. J. Burdon Sanderson in the British
Medical Journal., made some very remark-
able experiments which indicate that the
pneumococcus which has been- shown to
be closely associated with croupous pneu-
monia, is also associated with other spe-
cific and acute inflammations, particularly
epidemic cerebro-spinal meningitis. Zau-
fal has shown that otitis of the middle ear
is also associated with the pneumococcus.
This microbe is the same which was dis-
covered a number of years ago by Stern-
berg, who observed that rabbits injected
with saliva from ms own mouth died of
septicaemia.
It is not probable that the pneumococ-
cus is alone sufficient to produce pneu-
monia, or perhaps any other disease, but
it is, as Dr. Sanderson suggests, a sort
of sword of Damocles, which is in readi-
ness to fall at any moment when the
conditions become favorable, as the result
of exposure to cold, or other influences
which reduce the resisting power of the
body.
The pneumococcus is found to be con-
stantly present in the mouths of persons
who have recently had pneumonia, and
is often found in the mouths of persons
who are in perfect health, and have been
for an indefinite period. Its constant
presence for some time after an attack of
pneumonia doubtless explains the readi-
ness with which relapses occur after this
disease.
Enzootic Cerebritis in Horses. — Dr.
N. S. Mayo, of the agricultural College of
Kansas, has investigated the enzootic dis-
ease of horses that prevail in that State
and many other States during certain sea-
sons, and has come to the conclusion that
it is due to the germination of the spores
of the aspergillus glaucum in some important
organs of the body, notably the kidneys
and liver ; and the formation of abscesses
in the cerebrum as a result of the distri-
bution of mycelia and spores by means of
the circulation. The investigations will
prove very useful, as they bear the evi-
dence of having been carefully made, and
many thousands of dollars are lost annu-
ally to stock owners, by this, so-called
" mad staggers". The disease originates
from the ingestion of moldy corn — the
mold, in this case, being the penicillium
glaucum.
^ — » ^
Luminous Bacteria. — Various phe-
nomena of illumination in the darkness
of night, in the woods, marshes, and the
sea, have been noticed from time imme-
morial, and not very long ago they were at-
tributed to supernatural powers — spirits,
for instance — by the superstitious. It is
now established that they are the result
of some form of microbic vegetation. The
phosphorescence of a rotting stump in a
marsh, of a fish in the sea, is due to such
low life. Mr. Giard, a French naturalist,
has recently observed a bright phosphores-
cence in a crustacean, the Talitrus, a speci-
men of which he found slowly walking
on the beach. He found that the lumin-
ous condition emanated from the diseased
muscles which contained phosphorescent
bacteria. By inoculation he reproduced
the microbes in the muscles of other Crus-
tacea and the same luminous appearance.
62
EDITORIAL.
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
.00 per Annum. Single Copies, 25 Cents.
Battle Creek, Mich., December, i89i.
NOTICE TO SUBSCRIBERS.
The Bacteriological World has
widened its field to include Modern Medi-
cine, enlarged its form, secured the old
collaborators, engaged hew ones among
the foremost scientific men of Europe and
America, and reduced its subscription
price to two dollars per year. This cer^
tainly ought to be an inducement to new
subscribers to at least try our periodical
for a few months.
The year of subscription of every one
whose first number dates back to January,
1890, ends with this copy. We respectfully
solicit renewal at an early date, that we
may enter the names promptly at the be-
ginning of the year 1892. We go to press
on the 15th of every month.
-• — • — «-
LA GRIPPE AND CONSUMPTION.
Dr. Stickler's timely article, which ap-
pears in this number, was mentioned
editorially in our last because it was to
appear in that number. It was a little
too late, however, and we are pleased to
give it space in this issue. It expresses
facts which will doubtless be of much
value both to practitioners and patients.
IMMUNITY.
Three theories are now chiefly discussed
;to explain immunity against disease :
Phagocytosis, the germicide action of
'body fluids, and the interference of pro-
tective proteids of the cells. Each of
them have their foremost advocates in
men learned in medical sciences, — trained
thinkers, respected the world over, and
in whom the medical world has much
confidence. The first finds its strongest
expounder in Metchnikolf, of Pasteur's
Laboratory, whose investigations have at-
tracted universal attention.^ The second
in Mitchell Prudden, Buchner, and other
equally brilliant and energetic investiga-
tors; the third in Hankin and his dis-
ciples.
Some of these theories, supported by
very plausible and even convincing argu-
ments and experiments, are claimed to be
the exclusive cause respectively of what
is known as immunity or antagonism of
the body to the action of virulent matter.
Others are more liberal, broader in their
acceptation.
However, these theories, though they
are great achievements, are not fully satis-
factory. Each one separately, and all
collectively, fail to reach the fundamental
principles. Each is limited, and rests on
an accepted obscure conception of what,
in our ignorance, we term vital force.
Not one proves the laws underlying im-
munity. Though they have advanced
our knowledge wonderfully on the sub^
ject, they do no more than point to par-
ticular methods by which nature resists
the invasion of virus, destroys it, or
allows its existence in the body without
damage to the tissues, etc. Metchnikofl',
in his admirable work, has shown us the
battle between the cells of the body and
the cells of the enemy, and spread before
our astonished eyes one of nature's most
potent methods of warfare, the digestion
of micro-parasites by phagocytes.
Buchner, Prudden, etc., have shown by
admirable essays and experiments how
nature poisons, as it were, the parasitic
intruders by some elements of the fluids
of the body.
Hankin has demAstrated how each
cell may be armed with a fearful poison-
ous protein, which deals death blows to
microbes. Thanks to those brainy, pa-
1 See plates explaining his views in November number.
EDITORIAL. 63
tient men for this progress. All these facts Mc Laughlin's article advanced one of
tending to advance the settlement of the those forcible, revolutionizing thoughts
questions of immunity, are so many great which, in 1887, was too far ahead of his
obstacles removed by science from the time to be considered calmly by searchers,
way of preventive medicine, but none or at all by most of men. Now it de-
explain immunity fully. mands a hearing, and is deserving of it.
It remained for one less famous in the How would it have been if a foreign
medical world to advance, we believe, the celebrity had advanced it from a lofty
first expression tending to explain the chair of science, instead of Mc Laughlin
actual laws underlying immunity. We from the sanctum sanctorum of a practicing
are indebted for the most logical con- physician in Texas ? We suspect that a
elusion on the matter, to a thinker who crowd of enthusiasts would have flocked
worked undisturbed by the clash and abroad to have a personal explanation of
rivalries of science, in a remote corner of the wave motions of the microbic and
the earth, if we judge from a scientific animal substances, and to have a peep,
point of view. We refer to Dr. J. W. if possible, at the sublime sight of atomic
McLaughlin, of Austin, Texas, whose first union, liberation, disruption of albu mi-
article on the problem appeared as far noids, and their union in various ways to
back as 1887, in Daniel's Medical Journal form ptomaines, etc., etc.
(Austin), and who, in 1890, published a But of course a discovery in America
remarkable essay on the same question.^ can never be, for Americans^ as grand and
And yet, strange to say, little heed was true as a discovery in a foreign land,
paid to this truly meritorious publication. Mc Laughlin's explanation of immunity
Was it because it emanated from one does not exclude the theories of Metchni-
whose modesty seems to keep him in the kofF, Prudden, and others ; it is an exposi-
background, in a country remote from the tion of the laws underlying them all. In
leading scientific centers ? Or was it be- fact, it explains the laws of any theory of
cause it was too scientific, too far above the immunity yet to be conceived so long as
average mind, to be grasped, and even the wave-motion law holds. p. p.
beyond the reach of some who write on the — •— .
much discussed problem? We suspect it THE CAUSE OF NERVOUS HEADACHE,
was due in a measure to both causes.
The explanation of McLaughlin rests on There are few practitioners who have
accepted laws of physics and chemistry : not frequently found themselves baffled
the law of wave motion, the laws of atomic in their eff'orts to relieve a chronic suff'erer
attraction, vibration, disruption. Assum- from nervous headache. The inefficiency
ing that the molecular and atomic theories of all the remedies which have been pro-
accepted universally by the foremost phys- posed for this malady, is evidenced by
icists, chemists, and most scientists, are their number, and the eagerness with
true, and that Huxley and others of his which every new remedy proposed is
school are right in their conclusions that grasped and submitted to trial. Antifeb-
the forces at work in organic and inorganic rin and antipyrin, and the various other
matter are identical, we cannot dismiss analogous drugs which have recently been
Mc Laughlin's explanation without study, recommended for this distressing affection,
if we are sincere in our zeal to find the although at first vaunted as panaceas, soon
truth and willing to accept it, irrespective prove to be as inefficacious to effect a
of its place of birth, and unmindful of the permanent cure as older remedies. The
eclat of glorious and renowned reputations real cause of failure is not due to the stub-
to back it. bornness of disease, but to a failure to
irrK^i„** ,,. V. ^. . ,, recognize its cause. In a great maiority
1 The latter was published m full in our leeuee of August ® /. i • . J J
and September. of cascs a careful investigation will show
64 EDITORIAL.
that the patient is suffering from the re- an enter-clyster. We prefer the term
tention of decomposing fecal matter in colodyster. Two quarts of warm water are
the large intestine. Most patients suffer- generally found to be amply sufficient
ing from nervous headache, suffer habitu- for the purpose. Sometimes two or three
ally from constipation, or, if questioned, repetitions of the treatment are necessary
will state that the single daily stool is thoroughly to remove from the colon old
ragged and very foul smelling. accumulations. After injection, the
The administration of a large enema, or water should be retained a little time
better still, a colo-clyster, in these cases, and the bowels should be manipulated
will almost invariably bring away a large with the hand, either by the patient or
amount of fecal matter which has been re- by an attendant, so as to cause the water
tained, notwithstanding the daily evacua- to pass as far up in the colon as possible-
tion. Doubtless there are a large number If the patient is very feeble, the colo-clys-
of persons suffering from fecal accumula- ter may be administered with the patient
tions, who have regular daily stools, and lying in a half-prone position. The pa-
suppose their bowels to be in a perfectly tient should lie the same as in the Sims
healthy condition. These retained fecal position, only turned toward the right in-
matters contain a great number of mi- stead of toward the left side,
crobes, which, under favorable conditions The benefit derived from this treatment
for growth, develop poisonous ptomaines, is not only through the removal of fecal
which, as has been clearly shown by the matter, but, through the absorption of a
recent researches of Trastour, Bouchard, portion of the water introduced, the kid-
Brouardel, and other pathologists of the neys are aided in the elimination of the
French school, play a most important role poison from the system. If the water em-
in the production of a great variety of ployed is quite warm, it will also produce
symptoms hitherto little understood. profuse perspiration, by which the elim-
Leven has shown that attacks of nerv- ination of the poison is likewise assisted,
ous headache are usually accompanied The colo-clyster, even when thoroughly
with tenderness of the solar plexus, or the employed, will not always give immediate
abdominal sympathetic — especially the relief to a person suffering from an attack
lumbar ganglia of the sympathetic. It of nervous headache, but will almost in-
will be found that the two conditions, variably shorten it, and if employed once
hypersesthesia of the lumbar sympathetic, or twice a week, or whenever there is
and poisoning by the absorption of pto- evidence of fecal accumulation, will go
maines developed in retained fecal matter farther toward the prevention of subse-
in the large intestine, usually co-exist, quent attacks than any other remedy,
and we have seen extreme tenderness of The use of a small quantity of water in
the lumlmr sympathetic ganglia disap- these cases is worse than none at all, as it
pear within an hour after the admin- encourages the development of microbes,
istration of a colo-clyster and the thorough and facilitates the absorption of ptomaines
evacuation of the contents of the large in- by bringing them into solution,
testine. It is my experience that noth- ^ ^' ^- ^•
ing is so valuable as a means of cutting CYSTERS AND TYPHOID FEYER
short an attack of nervous headache, and
preventing an occurrence of the disease, The scavenger habits of the oyster ren-
as a complete clearing out of the large in- der it peculiarly liable to become a vehicle
testine, which may be readily accom- of the infectious material of typhoid fever
plished by the administration of a large and other allied diseases. The British
enema, the patient being placed in the Medical Journal, in an editorial, thus dis-
knee-chest position. An enema taken in cusses the relation of oysters to typhoid
this way is called by Dujardin-Beaumetz fever : —
EDITOUIAL. 65
" The question of the causation of ty- pertroph}^ followed by atrophy of the
phoid fever by the ingestion of oysters liver, and hemorrhages from the various
growing in polluted estuaries has come mucous surfaces. The last-named symp-
into public prominence in connection torn is speedily followed by death.
with the illness of His Royal Highness The disease prevails among the Fuegi-
Prince George. It is not for the first time, ans to such an extent as to threaten the
At the meeting of the British Medical extinction of the race. Mussels are very
Association in Cambridge, Sir Charles abundant on the Fuegian coast, and the
Cameron, the present medical officer of natives depend on them largely for sus-
health for Dublin, read a paper entitled tenance. Their nutritive value is so
" Sewage in Oysters," in which he pointed small that a large quantity is required
out that oy.sters growing in estuaries and to support life, — the Fuegian sometimes
other places to which sewage has access eats from ten to twenty pounds of
must often contain sewage matter. In- mussels in a day. It seems that the con-
deed, he found this to be the case in oys- dition of the mussels varies with the state
ters collected in Dublin. So lately as Sep- of the moon, the creature becoming poison-
tember 20, 1890, he recorded in the 5rfe/i ous during the wane of the moon, at
Medical Journal a series of cases of enteric which time a great number of the mus-
illness ( fortunately not fatal ) from appar- sels die. It is believed by Segers that
ent poisoning by oysters, referring also to the poisonous ptomaines produced by
four fatal cases of poisoning by mussels, the decomposition of the dead mussels
in the case of Mrs. O'Donner, and herfam- are absorbed by the survivors, and that
ily, which created a great and painful this is the cause of the disease produced
impression earlier in the year, and were in those who eat them. By feeding the
reported in our columns of July 3 9 ; in this mussels to fowls, Segers was able to
case also, the mussels were in contact with produce symptoms similar to those ob-
sewage water; and he notes that in nearly served in human beings. Injections of
all the cases of mussel poisoning on record, extract of the livers of diseased mussels,
they were in contact with sewage or stag- prepared at a temperature sufficiently
nant water, although there is a tendency high to destroy microbes, caused in fowls,
to refer mussel poisoning to other causes, in mild doses, a sort of intoxication, a
It may be remembered, also, that Dr. staggering gait and a rise of tempera-
De Fabeck reported in our pages cases ture. Large doses were followed by di-
of typhoid fever attributed to poisoning lation of the pupils, coldness of the ex-
by sewage-polluted oysters in Naples, and tremities, tremor, weakness of the heart
called attention to the danger of eating and death.
oysters — a danger to which, from per- From the toxic effect of the injections
sonal experience, we can testify. There with liver extract prepared at a tempera-
were, it may be added, a great many per- ture sufficiently high to destroy microbes,
sons in Dublin last winter who attributed Dr. Segers concludes that the mussel poi-
attacks of typhoid 'fever and diarrhea, soning is chemical in character, and not
etc., to the use of oysters." microbic. The disease in human beings
Dr. Segers, of Buenos Ayres, a surgeon may be successfully treated in the first
in the navy of the Argentine Rei3ublic, stage, but in the second stage, when
recently described, according to the British atrophy of the liver has begun, the
Medical Journcd, a newly observed disease disease proves rapidly fatal in spite of
which he denominates " chronic mussel all treatment.
poisoning." In a recent visit to Terra The accumulation of evidence against
del Fuego, he made a careful study of the oyster as an article of diet seems to be
this disease. The following are the prin- rapidly increasing, and it appears safe to
cipal symptoms : Marked jaundice, hy- predict that the time is not far distant
66
EDITORIAL.
when this clehcacy will be discarded as
too risky a morsel for human consump-
tion. J. H. K.
» — • — « ■ —
TOBACCO USING AND PHYSICAL DEVELOPMENT.
Dr. Jay W. Seaver, medical director
of the Yale gymnasium, and professor of
physical culture in Yale University, has
been making a careful study during the
last eight years, of the influence of tobacco
upon development. His statistics show
that non-smokers were 20 per cent taller
than smokers, 25 per cent heavier, and
have a lung capacity 66 per cent greater.
These figures are wonderfully significant,
especially the last. A man wlio has a
lung capacity two thirds greater than that
of another man has an immense physical
advantage. His prospects for long life are
greater, and his physical efficiency will be
certainly as much greater as his breath-
ing capacity. A man with small lung
capacity is like a furnace with a small
draft. All his vital activities must be in-
ferior to those of a man of greater lung
capacity. ^
Similar observations have l)een made at
Amherst college, with like results. In a
recent graduating class, the non-smokers
were found to have gained in weight over
the smokers nearly one fourth. The non-
smokers surpassed the smokers by a gain
in height of 37 per cent, in chest circum-
ference 42 per cent, and lung capacity
8.36 cubic inches.
Science recently published the results of
an experimental inquiry into the con-
dition of thirty-eight boys of all classes of
society, of average health, who had used
tobacco for different periods ranging from
two months to two years. Of the thirty-
eight, twentj^-seven showed severe con-
stitutional injury and stunted growth.
In thirty-two there were irregularities of
the heart action, stomach disorders,
cough, and a craving for alcoholic liq-
uors. Thirteen had intermittent pulse,
and one had consumption. All were in-
duced to discontinue the use of tobacco,
and as a result, in six months one half
were free from their former symptoms,
and by the end of the year the entire
number had recovered, thanks to nature's
recuperative forces. Supj^ose these young
men had continued the use of tobacco for
a series of years longer ; the disorders
which were so clearly defined would have
become mor.e or less permanent, and the
return to health after a discontinuance of
the drug would not have been so speedy
and complete. Hundreds of thousands of
persons are living in a state of chronic poi-
soning from the use of tobacco. Their
vital powers are depressed to such an
extent that their physical, mental, and
perha2)S moral efficiency are vastly in-
' ferior to what they might be without the
depressing influence of this toxic incubus.
The evidence of these statistics is over-
whelmingly convincing, and ought to set
every intelligent young man who is be-
ginning to patronize the pipe or cigar to
thinking earnestly whether he can afford
to subject himself during the best part of
his life to chronic nicotine poisoning.
Physicians might do more than any other
class of men to eradicate the enormous
evil of tobacco using, if they would dis-
countenance its use by precept and ex-
ample. J. H. K.
-»■ — • — ■m-
Calomel and the Liver. — Since Dr.
Bennett's experiment on dogs, made many
years ago, by which he showed that
the administration of calomel diminished
rather than increased the production of
bile, there has been much discussion
respecting the value of this drug as a
cholagogue.
The clinical results obtained by its use
have seemed to confirm the traditional
notion of its liver-stimulating qualities to
such a degree that practitioners have con-
tinued to employ it, as Dr. Palmer, of the
Michigan University, once said with much
warmth, when confronted by the results
of physiological experiment, "in spite
of Dr. Bennett and all the dogs of Edin-
burg." Numerous repetitions of Dr.
Bennett's experiments have, however,
uniformly arrived at the same results.
EDITORIAL. 67
Rutherford and Provost assert most posi- the skull, sometimes midway between the
tively that calomel administered in the skull and the vertehrie prominens. Careful
usual way diminishes the secretion of the manipulation of the affected parts, giving
bile. The change in the appearance of particular attention to the nodosities
the stools observed after the use of calo- should any exist, is one of the best means
mel, and which has usually been at- of relieving occipital and various forms of
tributed to an increased discharge of bile, persistent headache.
has been shown to be really due to a In applying massage to the head, the
coloration produced by the calomel. That fingers should not be allowed to slip over
calomel is beneficial in certain cases in the'surface of the scalp, but they should
which the liver is supposed to be at fault, be pressed firmly upon the surface, so
there is too much clinical evidence to al- that the whole scalp will be moved, down
low room for doubt ; nevertheless, the to the bone. By this means the rigidity
results of modern pathological studies of the subcutaneous tissues, which is fre-
seeni to show that in the conditions in quently found in these cases, will be over-
which calomel is ordinarily prescribed, come, and as the tissues become more
the fault is not with the liver, but rather pliable, the headache will disappear. We
with the digestive tract. The liver is have often secured relief from a persistent
overwhelmed with an enormous quantity headache by this means, within fifteen or
of poisons, ptomaines which are produced twenty minutes. J. ii. k.
by the action of microbes in the aliment-
./ » — 0 — 4
ary canal. Calomel is a good antiseptic.
By the destruction of these microbes, or Arsenic in Skin Disease. — The rou-
the inhibition of their development, the tine employment of arsenic in skin dis-
production of ptomaines is checked and eases has been a source of much evil,
thus the liver is relieved. We arrived at The writer has met a number of instances
this explanation of the apparent chola- in which acute inflammation of the kid-
gogic effects of calomel some years ago, and neys has been induced by this routine
are glad to see that so good an authority practice, and great mischief has been done,
as Dujardin-Beaumetz has recently ad- A young lady, the daughter of a physician,
vanced the same idea. It should be consulted us some years ago, being sent
added that many practitioners still use ^7 her father, for chronic eczema. On
the drug in quantities unnecessarily large; inquiry whether arsenic had been tried,
for all the advantages of the drug, in the patient replied in the negative, say-
cases in Avhich its use is capable of ben- ing her father, an eminent and experienced
efit as a germicide, may be obtained by physician, had told her that she had better
repetition of small doses as well as by suffer from the skin disease than chronic
by the use of large ones. J. h. k. arsenical disease. We are not condemn-
^ ing the use of arsenic altogether, but only
oppose its indiscriminate use. We are
Headache Cured by Massage. — Mas- glad to note that so eminent a medical au-
sage of the head is one of the very best thority as Jonathan Hutchinson, of Lon-
remedies for certain forms of headache, don, has recently called attention to this
Headache affecting the back part of the evil, particularly in the treatment of
head, is particularly amenable to this elderly persons. There are few cases of ec-
mode of treatment. In some cases of zema or other chronic skin disease, which
chronic headache which are persistent, cannot be cured by careful regulation of
and resist all other methods of treatment, the regimen of the patient, and local appli-
there will be found to be certain points at ^ cations, and without resorting to the
which the tissues are thickened and in- prolonged use of arsenic, or any other
durated, chiefly located about the base of constitutional remedy. J. h. k.
68
REVIEWS.
Reviews.
Etiology and Prevention of Yel-
low Fever. — By Major George M. Stern-
berg, M. D. This report from the U. S.
Marine Hospital Service, published by or-
der of the Secretary of the Treasury, is a
fine specimen of art, and an excellent. ex-
position of the deep researches of the au-
thor, and several others, on the cause and
prevention of yellow fever. It contains no
less than 21 full-page plates, illustrating
the various micro-organisms that have
been found from time to time by various
investigators in connection with this dis-
ease.
Dr. Sternberg completely demolishes
Dominigo Friere's beautiful ideas, and
shatters as well the theories advanced by
Finlay, Carmona, Gibier, Billings (Frank
S.), and Tacerda, all of whom had a par-
ticular germ to which they attached some
importance from an etiological stand-
point. Much credit is due to Dr. Stern-
berg's admirable work. We only regret
that, notwithstanding his studious and
conscientious labors, the author must ac-
knowledge that ^' the specific infectious
agent in yellow fever has not been dem-
onstrated."
» • *
Practical Points in the Manage-
ment of Diseases of Children. — Prof.
I. N. Love, M. D., St. Louis, Mo.; Geo. S.
Davis, publisher, Detroit. As might have
been expected by those who know Dr.
Love and his medical equipment and
experience, this little volume is essentially
practical. It is not to follow a conven-
tional method of reviewing that we say
*' it fills a want " in medical literature.
There are few gaps now among medical
publications, except in the advance line of
thinkers and modern practice, but Dr.
Love's book pushes its way among the
practical and reliable works, and at once
shows us that there was a gap. No man
can speak with more authority than Dr.
Love on the diseases of children. His
great love and sympathy for the little
ones; his years of study and practice
among them ; his teachings on the subject
of their maladies; his peculiar and rare
magnetism with the young, have fitted
him to write just such a book, which
should be in the hands of not only doc-
tors, but mothers, and parents of both
sexes.
The Physician's Visiting List. — By
Lindsay and Blakiston. P. Blakiston,
Son & Co., publishers, Philadelphia. This
little pocket book is a most complete and
yet exceedingly simple account and refer-
ence book combined. It presents in a
compact form the metric system ; con-
verting tables of apothecaries, and the
gram system ; posological tables in En-
glish and metric systems ; new remedies ;
incompatibilities, poisons and antidotes;
disinfectants ; examination of urine ; etc.,
etc., etc. It contains blank leaves for
visiting list, monthly memoranda ; ad-
dresses of patients, nurses, and their ref-
erences ; accounts asked for ; memoranda
of wants ; obstetric engagements ; vaccina-
tion engagements ; record of births and
deaths ; cash accounts, etc. It is one of
the indispensable books for doctors.
[books beceived.]
Laboratory Practice, bv Prof. Josiah
P. Cooke, LL. D. Published by D. Ap-
pleton & Co., New York.
Microscopical Diagnosis, by Chas.
H, Stowel, M. D., and Lewis Reed Stowel,
M. D. Geo. S. Davis, publisher, Detroit.
Taking Cold, by F. H. Bosworth,
M. D. Published by Geo. S. Davis, Detroit.
Diarrhea and Dysentery, by Alonzo
B. Palmer, M. D., LL. D. Published by
Geo. S. Davis, Detroit.
Precis d* Analyse Microbiologique
des Eaux, by Dr. Gabriel Roux, Lyon,
France. Published by J. B. Boilliere et
Fils.
Bacteria and their Products. — By
German Sims Woodhead, M. D., London,
Walter Scott.
Euzootic Cerebritis, or "Staggers " of
Horses, by Prof. N. S. Mays, Manhattan,
Kansas.
The Work of Medicine for the
Weal of the World, by Prof. C. H.
Hughes, St. Louis, Mo.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
NIONTHLY bulletin:.
Battle Creek, Mich., December, 1891.
RESEARCHES RESPECTING THE PURITY OF
VACCINE.^
The director of this laboratory began
investigations and experiments in 1887,
on the relative purity and activity of the
vaccine of commerce. Owing to multi-
plied duties, he was unable to pursue his
work steadily to completion. He carried
on various series of investigations at
long intervals, in 1887, 1888, 1889, and
1890, at the University of Missouri, and in
1891 at the institution now under his di-
rection. To this date, one hundred and
ten specimens of commercial vaccines
from twenty different sources have been
studied bacteriologically. During these
studies, which are still in progress and
will be prosecuted more closely than
heretofore, there were isolated by culture
eight forms of bacteria, which produced,
after inoculation, lesions or symptoms of
disease more or less pronounced in rab-
bits, guinea-pigs, rats, mice, cattle, and
man, or in several of the species, and
seven which produced no lesion or
symptom. Among the pathogenic forms
were —
Staphylococcus pyogenes.
Staphylococcus pyogenes aureus,
Staphylococcus pyogenes citreus,
Bacillus pyogenes foetidus.
Bacillus septicus, —
a bacillus which was connected with, and
probably the cause of, gangrene ; a micro-
coccus in connection with another case of
gangrene; and a saprogenous bacillus in
connection with septic lesions.
The last three not identified with known
forms, were isolated in 1889, from two dif-
ferent crusts purchased on the market.
All of these forms were pathogenic to
rabbits, and some of them to certain of
the other animals mentioned.
The quantity inoculated varied from
1 to 3 drops of a liquid culture diluted
iThis report of progress gives more details and more
experiments than that madeitoJthe American Health As-
sociation at its last meeting in Kansas City.
in from two to six or seven drops of dis-
tilled sterilized water. Forty rabbits in-
oculated with these bacteria (7 animals
with each kind of the pathogenic germs
enumerated above) resulted in 28 local
lesions, of which five were nodules more
or less pronounced; thirteen were ab-
scesses which he^-led ; ten were abscesses
or infectious wounds followed by general
infection and death. Nine cases died from
septicseemia without local lesions. Only
three remained apparently free from
symptoms of disease. Among the seven
kinds of bacteria which were found in
these vaccines, and which proved to be
harmless by inoculation, one was the bac-
terium termo, which may, under certain
circumstances complicate a wound, though
it is not generally considered a parasitic
microbe.
A mulatto, vaccinated with a commer-
cial product supposed to be safe, had local
septicaemia of a very severe and painful
type. Constant local cold-packing re-
duced it after two days' close attention.
A coccus and bacillus existed in the
sanius secretion of the angry, deep ulcer
that took place at the seat of the pustule.
Both these microbes were accidentally
lost before any inoculation.
Twenty-six specimens of virus on ivory
points, from twelve different sources,
purchased in the market, were tested by
inoculation to rabbits. Three points of each
specimen were wiped with a sterile cloth,
soaked from one to three hours in two
drams of distilled sterilized water, and ten
drops were inoculated hypodermically.
The result was, nineteen local swellings,
diffused or circumscribed, and four ab-
scesses, one of which caused general in-
fection and death. Three samples proved
harmless.
Microscopic analysis of the material
inoculated, revealed a degree of purity or
impurity in ratio with the symptoms ob-
served. The points offering the smallest
number of septic germs produced the
slightest lesions, and vice versa. Those
(69)
70
LABORATORY OF HYGIENE.
that produced no lesions at all appeared
about free from any foreign microbes.
Four rabbits were tested with twelve
half quills. Of these, two produced local
swellings, and one an abscess which healed.
Fourteen inoculations made with vac-
cine from cones or crusts, produced results
as follows : Every rabbit had marked
swellings, and ten of them had abscesses ;
of the whole lot, one died within 48
hours, from general infection, and two
died after long suppuration.
On the other hand, thirty rabbits were
inoculated with vaccine virus, diluted in
sterilized water, in which (vaccine) the
microscope and cultures indicated the
greatest relative degree of jDurity. The re-
sult was a slight enlargement at the
point of inoculation in fifty per cent, but
there was not a single diffuse swelling,
not one abscess, not a death. Possibly
the vaccine virus itself produced the
slight symptoms observed.
At this stage of our experiments, taking
into account extensive observations in
several hundred cases of vaccination in
man and beast, none of which are re-
corded here, and from which the writer
gathered statistics, we believe that : —
a. Most of commercial vaccines are
more or less impure, bacteriologically
speaking.
h. Much of it is dangerously contami-
nated with pathogenic germs.
c. Crusts, scabs, and cones are very im-
pure and wholly unfit for vaccination of
human beings.
d. That the extensive inflammatory
symptoms, such as diffused reddish or vio-
let swellings, painful or painless oedema ;
angry or sanious ulcers ; lesions with
tough, purple, adhering scabs, surrounded
by painful enlargement; swellings ex-
tending several inches, or even a foot or
more away from the point of inoculation,
and involving the lymphatics at consider-
able distance; little abscesses here and
there, remote from the spot vaccinated,
are so many lesions or symptoms of com-
plication of vaccinia.
e. That such complications are secon-
dary, — the vaccinia cocci preparing the
field for the septic forms to grow.
/. That frequently the foreign germs de-
stroy the vaccinia growth in the inoculated
spot before the latter has produced its ef-
fects, and the patient is left unprotected,^
and may be vaccinated again success-
fully or take smallpox.
>The writer has seen several cases in which second vac-
cination took well, after such complications, which doctors
had thought typical vaccinia.
g. That the foreign germs found asso-
ciated with vaccinia cocci are not neces-
sary to produce the true, simple vaccinia
pustule.
h. That many doctors mistake marked
complications for good vaccinia pustule.
i. That it is possible to produce abso-
lutely safe^ vaccine by antiseptic and
aseptic methods, though extremely diffi-
cult to produce vaccine absolutely free
from certain air germs.
j. That vaccine from a second dipping in
the same pustule a day or two after the
first one, as is done in many commercial
institutions, is a Ixad and dangerous prac-
tice, as such vaccine is almost always very
impure. (See frontispiece plate.)
^ — •— *
HOW TO STERILIZE MILK.
Since the subject of the sterilization of
milk has been agitated, the question is
often asked. What is the best method of
sterilizing milk? that is, destroying the
germs of disease or fermentation which it
may contain. We have made many ex-
periments, and from our experience can
confirm the results of many observers who
have given attention to this subject, that
the complete sterilization of milk is a
matter of no small difficulty. Milk which
has been boiled for half an hour once or
twice each day for several days in suc-
cession, will keep for a number of days,
but ultimately sours. This is due to the
fact that some of the germs contained in
milk are particularly hard to kill, and re-
quire a temperature above that of boiling
milk.
We have recently been conducting some
experiments upon this subject, with re-
sults so satisfactory that we are glad to
be able to communicate them to the
readers of the Bacteriological World
AND Modern Medicine. The first experi-
ments were made with a tin receptacle
cajDable of resisting a pressure of twenty-
five pounds. This was partly filled with
water and placed in boiling water, to the
action of which it was exposed for half
an hour. The pressure indicator showed
no very considerable increase in pressure
within the closed receptacle. We then
tried boiling the tin vessel in a saturated
solution of salt in water, when the press-
ure, as indicated by the pressure gauge,
rose to four pounds. This was the re-
sult which we expected. We accordingly
proceeded to a further experiment, which
consisted in boiling milk tightly sealed in
I This is done at this Laboratory by scientific methods.
LABORATORY OF HYGIENE.
strong bottles, in a saturated solution of
salt. Milk sterilized in this way, by boil-
ing in the salt solution for half an hour,
will keep perfectly for an indefinite length
of time. We opened, a few days ago, a
bottle of milk which had thus been ster-
ilized last June (1891), and found it to be
as fresh as when placed in the bottle.
It is only necessary to take the precaution
to allow the solution of salt, in which the
bottles are boiled, to cool before removing
the bottles. If the bottles are removed
from the solution while hot, tliey will
almost instantly burst. The vessel con-
taining the bottles of boiling milk should
be set aside and allowed to cool gradu-
ally, when the bottles should be removed
and placed in an ice chest or an ordinary
refrigerator. Ordinary soda-water or beer
bottles are excellent for the purpose ; or
beer 1)ottles may be used. Ordinary corks
may be used for the purpose, but they
should be previously boiled for half an
hour. They should be pressed in tightly,
and fastened with wire or with a jDatent
fastener. After the bottles have been
cooled and removed from the boiling
kettle, the tops should be carefully dried,
and if corks are used, covered with seal-
ing wax, such as is ordinarily used for
canning purposes.
The efficiency of the salt solution is due
to the fact that its boiling point is 227°F.,
■»vliile that of boiling milk is less than
200° F. By using different salts, a still
higher temperature may be attained. For
example, a saturated solution of carbon-
ate of potash, or saleratus, boils at a tem-
perature of 275° F., while a saturated
solution of chloride of calcium boils at
355° F. These high temperatures are,
however, unnecessary.
THE BACILLI OF TUBERCULOSIS.
These little rod-shaped parasites vary
between 2 and 6 /^^ in length according to
special conditions of their life, and o /« 3 to
o /" 5 in width. Their average length is
about 3 /", and the average width about o /"
4. They may be straight, or slightly
curved, or irregular in their aspect. They
appear either as homogeneous little rods,
or as finely dotted bacilli ; these dots are
' The fi (mikron), a unit in certain microscopic meas.
urements, means micromillimeter, and is equal to one
thousandth of a millimeter. A millimeter is, as the word
implies, the one thousandth of a meter, and a meter
is equal to 39.37 inches. A millimeter, then, is nearly
1-25 part of an inch, and a ^ (mikron) is the 1-1,000 part
of 1-25 of an inch.
due to the presence of fine ovoid or spher-
ical bodies placed end to end like a very
minute string of beads. These germs can
scarcely be seen without coloring reagents
except with high-^jower lens, and then
the dots or spherical bodies, which are
looked upon as spores, do not a^^pear.
The organisms unstained, particularly if
treated with potassa, have the appearance
of hyaline, or motionless rods.
The stained bacilli of tuberculosis can
be appreciated when magnified 350 to
400 diameters, but it is better to exam-
ine them under greater increase, say 480,
and it is still better to see them at 700 or
even 800 if possible. This high increase
is not necessary for diagnosis.
The bacilli may appear shorter or longer
in the same specimen, according to their
age. For instance, fresh sputum may at
first show very fine, short rods. Let it
stand a day or two, and if it does not
desiccate, the forms will be found more
clearly dotted and longer. After standing
for days or weeks, many fine, loose dots
— spores doubtless — may be observed,
and long bacilli formed by them, disposed
end to end. In patients having large
lung cavities, the bacilli are sometimes
longer, and the loose spores more numer-
ous, than in milder cases.
The quantity of bacilli in sputum, and
in all fluids, varies greatly ; it depends on
the extent and age of the lesions. They
are usually much more numerous in ex-
tensive cavities than in secretions from
small lesions resulting from slight tuber-
cles. A given mount may contain only
a few — half a dozen or less — and the
next, hundreds.
Sometimes we find bacilli in a large
cell, a giant cell, indicating an attempt,
perhaps, on the part of nature to destroy
the germs by cellular digestion — phag-
ocytosis.
Usually specimens to be analyzed, par-
ticularly sputum, contain numerous other
germs which have no direct relation to the
disease so far as the cause is concerned,
but are doubtless very harmful complica-
tions; for they must be, as in wounds,
dangerous and most potent factors in the
destruction of tissue, in producing pus
cavities, and in creating very damaging
ptomaines.
The good influence of high altitudes on
consumptives is due not a little to the
fact, I imagine, that pus or decomposition
germs are comparatively rare in high al-
titudes, and complications such as almost
always exist in other atmospheric condi-
72
LABORATORY OF HYGIENE.
tions in tubercular lesions opened to the
air, find there no destructive agent of the
class of ptomaine makers and the like.
These foreign germs, in making analysis,
can be made to appear unstained at the
side of stained tubercle bacilli, or may be
stained as the background, and may
therefore be readily distinguished.
Tubercle bacilli may be found in
sputum, milk, urine, tubercular abscess
of the skin, joints, etc., and also in in-
testinal discharges. In cases of these dis-
charges, one may discover the bacilli in
analyzing the coating of the feces, the
liquid of an evacuation obtained by a
clyster, given a few minutes after a thor-
ough washing of the intestines by careful
but extensive enema. At other times it
is necessary to analyze much of th^ fecal
matters, and frequently to repeat the oper-
ation. Hundreds of other germs may be
found in these matters.
Technique.
The Durability of Apochromatic
Lens. — As is well known by microsco-
pists, whatever advantage an apochromatic
lens has over the ordinary kind, its dura-
bility seemed inferior to the latter. At
least it has been the experience of several
workers to find themselves with a depre-
ciated, costly lens, which previously did
splendid work. The director of this lab-
oratory had this experience with one of
Zeiss's apochromatic lenses. Prof Burrill,
of Illinois, in a paper read before the
American Society of Microscopists, gives
the following experience on the sub-
ject : —
" I have now to add a word in regard
to the durability of the apochromatic, the
want of which has been frequently ques-
tioned. After about two years' use it be-
came evident that this lens was in some
way impaired, and by looking through
it from the back with a magnifier, a
hazy-granular appearance was noticeable,
not due to dust on the back lens. Last
March the objective was sent to the
makers for examination and repair. It
reached me again in July, as good as new,
with the statement that the front lens
had been slightly decentered, and that the
repair had been easily made, and was
without charge. I have no other infor-
mation upon this point, neither do I
know what interpretation to place upon
the granular appearance noted. There is
certainly nothing of the kind visible
now."
To Extract Ptomaines from Urine.
— The necessity of more frequent analy-
sis of urine from a diagnostic standpoint,
is made more and more apparent every
day. The following is an additional ar-
gument in that line : —
In a note to the Academy of Science,
Paris, Mr. A. B. Griffiths presents the
following method of extracting ptomaines
from urine in certain infectious maladies :
" A considerable quantity of urine is alka-
linized by the addition of a little carbon-
ate of soda, and mixed afterward with
half its volume of ether. After deposit
and filtration, the ether is shaken with a
solution of tartaric acid, which fixes on
the ptomaines to form soluble tartrates.
After evaporation of the dissolved ether,
the acid tartaric solution is again alkalin-
ized by carbonate of soda and shaken
with half its volume of ether. This ether
solution is allowed to evaporate spontane-
ously. The ptomaines remain as residue.
" a. Scarlet Fever : The ptomaine thus
extracted from urine in case of scarlet
fever is a white crystalline substance
soluble in water, slightly alkaline. It
forms a crystallized chlorhydrate and a
chloraurate. Phosphomolybdique acid
produces a white yellowish precipitate ;
phosphotungstic acid gives a white pre-
cipitate; picric acid, a yellow precipitate.
It is also precipitated by Nessler's solu-
tion. The chemical formula of this pto-
maine is as follows : C^H^^AzO^
" Pure cultures of micrococcus scarla-
tina, gave the same ptomaine by Gau-
thier's method.
"6. Diphtheria: The urine of diphtheritic
cases is also a white crystalline substance.
It gives a chlorhydrate and a chloraurate.
Tannic acid precipitates it yellow ; phos-
phomolybdic, white ; picric acid, yellow ;
and Nessler's solution, brown. Formula :
C'*H'"Az'Ol The bacillus diphtheria No.
2, JKlebs and Loeffler, gives the same
ptomaine in pure cultures.
" c. In a case of congestion of the kid-
neys, the parotid glands and the sub-max-
illary glands, a ptomaine, crystallizing in
prismatic white needles, was formed.
Formula: C^H^^Az^Ol It is very poi-
sonous.
"These ptomaines do not exist in nor-
mal urine, and are truly formed in the
economy under the influence of the mala-
dies mentioned."
BULLETIN OF the
Medical and Surgical Sanitarium,
Battle Creek, Michigan.
ANNUAL REPORT OF THE SUPERINTENDENT OF
THE BATTLE CREEK SANITARIUM.
To the Stockholders of tJie Medical and Surgical
Sanitarium : —
As doubtless most of you are aware, the Sani-
tarium, although opened in 1866 and incorporated in
1867, began its real work at its re-organization in
1876. At this time, the institution was placed un-
der a new management; new plans and methods
were adopted, a broader and more liberal policy was
Introduced, and the medical management was placed
upon a thoroughly rational and scientific basis.
At the time of its re-organization, the assets of
the institution were about $45,000, most of which
had been contributed by the friends of the institu-
tion and subsequent to its incorporation, as non-
dividend paying stock. The stock was issued in
twenty-five dollar shares, and was purchased in
amounts ranging from one to forty shares, by the
friends of the enterprise. The total number of stock-
holders at the present date is 642.
The purpose of the promoters of this enterprise,
as defined in the By-laws, was the treatment of the
sick by rational methods and the promotion of sani-
tary reforms.
At its fii'st organization, it was expected that small
dividends would be rendered, but within a year after
the incorporation of the institution, the stockholders
voted to devote their dividends to charitable and
benevolent purposes, the increase of the facilities of
the institution, the treatment of the sick poor, the
diffusion of sanitary knowledge, etc.
All stock issued since the time referred to has
contained a clause equivalent to the above, and all
dividends have been used as indicated. It will thus
appear that the institution is simply a self-support-
ing charitable enterprise. All officers, managers, and
other persons connected with the institution, are em-
ployed upon moderate salaries. Not a single dollar
of the earnings of the institution has ever been dis-
tributed to stockholders, or to any other persons,
except to objects of charity. Each year a portion
of the earnings of the institution has been devoted
to improvements, repairs, etc., and as large a sum
as possible has been appropriated annually to the
charitable treatment of the sick poor. This feature
of the institution has steadily increased from year to
year within the last fifteen years, until, in the last year,
from Oct. 1, 1890, to Oct. 1, 1891, a total of more
than $32,000 was reached. This sum includes not
only those cases treated in the Sanitarium proper,
but also expenses incurred in the support of free
(
beds in the Sanitarium hospital. The amount ex-
pended during the last year in this way was some-
what injudiciously large, as it left nothing from the
net earnings for repairs and improvements; never-
theless, it is hoped that by the exercise of greater
economy in some departments, the same or nearly
as large an amount may be expended during the
coming year. In fact, the plans which the mana-
gers have made with reference to charity treatment
for the year to come are considerably more liberal
than for the year past. The conditions upon which
charity patients are received, are chiefly as follows : —
1. Only worthy, indigent, and friendless persons
will be received as free patients.
2. No one will be admitted without proper creden-
tials and recommendations.
3. No one will be admitted for more than three
months at a time, and each month the Medical Super-
intendent in charge shall examine the patients with
reference to the propriety or necessity of their pro-
longed stay, and shall sign a statement of the pa-
tients' condition, with a recommendation.
4. Each patient must deposit, on entering the hos-
pital, a sum suflRcient to defray his expenses home,
and also sign an agreement to leave the institution
when requested to do so by the Board of Managers.
5. Incurable persons will not be received, or if re-
ceived, will not be retained.
6. Insane persons, epileptics, and patients -with
offensive, loathsome, or contagious diseases, will not
be received.
7. Persons wishing to enter the hospital must
make arrangement by correspondence beforehand.
The total number of patients who have been made
the recipients of charitable treatment during the last
two years, has been 837. This is, of course, a much
smaller number than is treated gratuitously at many
hospitals, but it should be remembered that the in-
stitution has no source of income whatever except
from its own earnings, and consequently its charitable
work must be, to a degree, limited. It should also
be taken into consideration that the expense of car-
ing for patients in a Sanitarium is very much greater
than for hospital cases. A few items of expense will
make this point clear : The number of employees
in the institution, during the last two years, has
varied from 325 to 365. As stated above, the
salaries are small, and yet the total sum is by no
means inconsiderable, amounting, for the last two
years, to $115, 657. 62. During the greater part of the
year, the milk supply of the institution amounts to
from ten to twelve hundred quarts daily. The ex-
pense for fuel during the cold season, is from forty
73)
74
SANITARIUM BULLETIN.
to fifty dollars daily. The expense of maintaining a
large and extensive electric lighting plant is not
small ; and even the water bill, although the water
rates are moderately low, amounts to a considerable
sum, with a consumption of from 30,000 to 60,000
gallons of water daily.
At the time of its re-organization, the outfit of the
whole establishment consisted of one small two-story
wooden building called the Main building, which
was capable of accommodating about twenty patients,
and a half dozen cottages. At the present time, the
buildings of the institution consist of a large Main
building, a Hospital, an Annex, and twenty cot-
tages and other buildings. The main building is
312 feet in length, with a rear extension of 100 feet,
and is five and six stories in height, above the base-
ment. The hospital building is 100 x 60 feet, five
stories high.
The construction of the new brick veneer main
building was begun in 1877, and completed in 1878.
This building was capable of accommodating about
150 patients. In 1884 a five-story addition w^as
erected at the south end of the main building. In
1888 a hospital accommodating 150 beds was erected
a few rods north of the main building; and in 1890,
the main building was raised one story In height,
and a six-story addition erected at its north end.
The present buildings of the institution are capa-
ble of accommodating from four hundred to five
hundred patients. During the greater part of the
year, not only the entire buildings of the institu-
tion are occupied, but several hired cottages as well.
There are few vacant rooms at any time.
In the erection of the buildings of the institution,
care has been taken to secure the very best possible
sanitary conditions. All sewers ai*e connected with
large smoke-stacks, so that any sewer-gas which may
be generated is consumed. Openings into the sewers
are so placed as to furnish to them a constant supply
of fresh air, so that with the strong draft secured by
the connection of the sewers with the smoke-stackg,
the most thorough ventilation is constantly main-
tained, making contamination of the bouse air by
sewer-gas impossible. There is, however, no plumb-
ing in connection with private rooms or wards.
Water-closets of the most approved pattern are
placed with reference to isolation and the prevention
of contamination.
The system of ventilation is somewhat unique
for a building of this size. By means of large open-
ings in the basement, which, in the main building
aggregate 50 square feet in sectional area, pure air
is admitted directly from out-of-doors, and passed
through immense heaters by which it is warmed to a
proper temperature, which is maintained at 70° F. for
the day time, and 60° F. during the night. This air
is carried by large ducts to the several halls, being
introduced at different points, eo as to secure perfect
distribution. The halls are thus kept constantly
filled with a volume of pure air. Each room is sup-
plied with an independent ventilating duct, the open-
ing of whi<-;h is placed beneath a window, the coldest
place in a room, and the point to which the foul air
naturally gravitates. The duct is carried up in the
inside walls, so as to secure constancy of action and
independent discharge, above the roof of the build-
ing. The duct for each room has sufficient capacity
to supply 3,000 cubic feet of air per hour for each of
five persons, the air traveling at the rate of five feet
per second. As rooms with one duct are rarely
occupied by more than one person, it is apparent
that an amply sufficient supply of fresh air is secured
for each individual.
As the result of many examinations with the
anemometer, the supply of air is found to be from
10,000 to 15,000 cubic feet per hour for each patient.
This secures such a degree of purity that odors are
never discoverable in the establishment. Even in
the hospital, the odors of iodoform, carbolic acid,
and other antiseptics are never met in the halls, —
nor anywhere, in fact, except in connection with
their immediate use. The air of individual rooms
never intermingles, in consequence of the arrange-
ment of the ventilating apparatus. There is a con-
tinued forward march of the air current from the
supplying-ducts into the halls, from the halls through
open transoms into the individual rooms, and thence
through the ventilating ducts directly out-of-doors.
The placing of the ducts in the inside walls secures a
sufficient degree of warmth, so that back currents do
not occur.
The automatic distribution of pure warm air
operates with certainty and efficiency during the
whole year, when doors and windows are necessa-
rily kept closed in consequence of low external tem-
perature.
Large openings are arranged at the ends of each
hall, so that in case of excessive warmth at any time,
the temperature of the halls can be brought down to
a desired point within a few minutes ; but any con
siderable variation of temperature does not occur, as
a competent person has assigned to him, as his duty,
the inspection every Ixour, and recording of the tem-
perature of each hall and all public rooms of the
establishment, as well as the external temperature
and the temperature in the hot-air chambers.
The excessive dryness of the air, usually so notice-
able in extremely cold weather, is corrected by means
of numerous steam jets, so placed in the hot-air cham-
ber as to render it possible to secure any degree of
saturation with moisture required. The condition of
the air as regards moisture is observed each hour by
means of hygrometers, and recorded.
The heating of certain rooms is so arranged that
a higher or lower degree of water saturation may be
secured, if desired, for adaptation to the wants of
pulmonary or renal disease.
The fresh-air inlets are provided with means for
cooling the air, so that in case of excessive heat in
summer-time, a thing which rarely occurs in Michi-
gan, the air brought into the building may be lowered
from eight to ten degrees below the external tempera-
ture. In the last thirteen years it has been necessary
to bring this apparatus into operation only on two or
SANITARIUM BULLETIN.
75
three days, during the excessively hot summer of
1886, when such an extreme degree of heat prevailed
everywhere.
Both safety and air purity are promoted by the
exclusive employment of the Edison incandescent
system of electric lighting for illuminating purposes;
the same current siL^o furnishes an ample source of
electricity for surgical and medical uses.
The institution is organized into departments, each
being under competent management, the principal
ones among which are the following, aside from those
exclusively concerned with the domestic work of
the institution : —
The Department of Hydrotherapy. — An extensive
suite of apartments complete for both ladies and
gentlemen, furnishes facilities for every useful form
of hydrotherapeutic appliance. These means are
employed by the aid of attendants who have been
thoroughly traiued for their work. In addition to
ordinary hydrotherapeutic measures, facilities are
furnished for Turkish, Russian, and electrical and
electric-light baths.
The Department of Massotherajiy . — This depart-
ment, which employs a score of well- trained ma-
nipulators, employs every form of massage, Swedish
movements, both passive and active-passive, and
mechanical massage. Closely connected with this
department is —
The Gymnasium, a room capable of accommodat-
ing several hundred, in which is to be found every
appliance suitable for the use of invalids, as aids to
exercise. In addition, patients are trained daily in
Swedish gymnastics both medical and pedagogic,
Delsarte, calisthenics, and various other forms of
exercise. Preparatory to work in the gymnasium,
each patient is subjected to a careful test of all the
priocipal groups of muscles in the body, the re-
sults being recorded upon a chart, after the graphic
method, so that each individual's weak points are
at once apparent. By this chart, a careful exercise
prescription is prepared, in which the patient is in-
structed and supervised in daily carrying out. Im-
provement of physical strength under this training
is often marvelous, patients not Infrequently doub-
ling their total muscular capacity within a month.
Careful measurements of the ' body are also taken
for the purpose of detecting deformities or lack of
symmetry. The results of these tests and measure-
ments often give most important therapeutic in-
dications in addition to the information which they
convey respecting the needs of the individual as
regards muscular exercise.
T?ie Department of Electrotherapy. — This depart-
ment is provided with the most etRcient appliances
known for the use of electricity in all its useful
forms: Galvanic, Faradic, dynamic, and static cur-
rents are ready to be drawn upon for appropriate
cases, in any quantity desired, from a current adapted
to a diseased eye or to the destruction of a hair, to
the heavy current required for the treatment of
tumors. The same careful, pains-taking accuracy is
used in the employment of the electric current, as is
used by a skilled pharmacist in the preparation of his
medicinal prescriptions,
Dopartment for Mental Diseases. — Persons suffering
from mental disorders of a pronounced character,
are cared for in a pleasant home specially fitted up
for the purpose, located on the Sanitarium farm
within sight of the Sanitarium and about half a mile
distant. The home is connected with the Sanitarium
by telephone, and is furnished with every necessary
appliance for the proper treatment of this class of
patients. Patients here have the advantages of quiet,
seclusion, and homelike conditions, and are not allowed
other associations than those of persons who are well,
and whose influence over them will be wholesome.
Kind nurses, special attendants, pleasant surround-
ings, and the same careful regimen, hygienic and
other treatment which any nervous invalid would re-
ceive, accomplish for this class of persons results
which are not ordinarily attained in public asylums,
or even in private institutions where a large number
of insane persons are more or less indiscriminately
associated together, and where the important ad-
vantages of the scientific application of massage,
electricity, physical training, and allied measures of
physiological treatment are not ordinarily secured.
Dietetics. — This department, while not entirely
distinct, still sustains so important a relation to the
work of the institution that it should be mentioned.
It consists essentially of an experimental kitchen,
a cooking-school, an extensive diet-kitchen, and a
series of diet-tables at which patients can obtain any
article of food which his physician may consider in-
dicated in his case. The diet prescription of each
patient is prepared with the same care as is required
in medicinal, exercise, or other prescriptions. Pre-
paratory to giving diet prescriptions, a careful chem-
ical examination in each case is made of the secretions,
and a rational foundation is found on which to base
directions for thedietary. This department is so sys-
tematized that the patient is supplied with a variety
of foods suitable to his case, without ever being at a
loss to know what to select, so that he is relieved
from the necessity of engaging in that dyspepsia-
producing occupation in which so many patients
suffering from stomach disorders often spend a con-
siderable part of their time; viz., introspection of
the stomach, and conjecturing as to the compatibility
or incompatibility of the various articles of food
swallowed, with one another or with the stomach.
Surgical Department. — While this is not the most
prominent feature of the institution, it still deserves
notice. The Sanitarium hospital accommodates from
100 to 150 beds, and is unquestionably one of the
finest structures of its size in the country, and is
well adapted to the purposes for which it was con-
structed, there being but three or four wards in the
hospital capable of containing more than three or
four beds each. By this means that quiet is secured
to the patient which is so invaluable in the majority
of surgical cases until convalescence is established.
As soon as patients are -able to do so, they meet
socially in the sitting-rooms and parlors of the
76
SAmTAUIUM BULLETIN.
hospital by the aid of the wheel-chairs, though still
at all times under the supervision of their nurses,
the matron, or the house physician.
The hospital has a fine operating-room and a
complete outfit of sterilizing apparatus for dress-
ings, clothing, etc., and every useful surgical ap-
pliance. No public clinics are held, but physicians
sending patients are of course always welcome to
be present at operations, and visiting physicians are
always courteously treated.
The most radical aseptic measures are employed in
connection with all surgical operations, and as the
result, a very low rate of mortality is maintained.
Within the last two years, a record has been made
of 52 ovariotomies without a death, and 100 con-
secutive cases with only three deaths.
The physicians of the institution appeal to surg-
ical measures as seldom as possible ; and it is found
that the varied appliances of the institution
render it possible to cure many cases which have
been pronounced Incurable, without surgical means.
No case is subjected to a surgical operation before a
thorough trial of non-surgical measures has been
made, unless the history of the case shows that such
measures have been previously employed for so great
length of time that further trial is useless. This re-
mark is made to correct the popular notion that
surgery is the favorite and almost exclusive method
of any institution of the nature of a hospital. The
Sanitarium hospital is, comparatively, a recent ad-
dition to the department of the institution, and was
only added to render it possible to deal exclusively
with a class of cases which have been refractory to
all forms of non -surgical measures of treatment.
The expectations of the managers that in the estab-
lishment of a hospital, abetter than ordinary surgical
record would be made by the combination of Sani-
tarium treatment and regimen, in the preparation
and after-care of patients, with the most advanced
methods of modern surgery, have been more than
realized, as already indicated, by the low rate of
mortality secured in a long succession of critical
cases.
Nurses' Training -school. — For the last seven years,
it has been found necessary to maintain a nurses'
training-school, for the purpose of supplying the in-
stitution with trained nurses. Several hundred
nurses have been trained in this school, many of
whom are now practicing their profession in various
parts of the United States. The number of students
In the school varies from 70 to 100, at different
seasons of the year. The aids afforded by this school
for the acquirement of a knowledge of medical and
surgical nursing have rendered the school so popu-
lar that the number of applicants has for a long
time been greater than could be received. At the
present time, there are several hundred names of ap-
plicants on file, awaiting their opportunity to get into
the school. There has recently arisen a demand for
nurses trained after the methods of the Sanitarium
training-school for foreign mission work, and the im-
portance of this line of philanthropic work seemed to
be so much in harmony with the character of the
work of the institution, that the managers have
thought it best to give this class preference over
others, so that at the present time, almost the entire
class, numbering some 60 members, are pledged to
medical missionary work in some needy field. In this
school each nurse is not only instructed in the bed-
side care of the sick, in surgical nursing, monthly
nursing (for young women), but also in the work
carried on in all the different departments of the in-
stitution. Each also receives thorough instruction
in the science of cookery, and especially cookery for
the sick, in medical dietetics, and in dietetics in gen-
eral. The course requires two years of study, and a
post-graduate course is provided for nurses who wish
to continue their studies further.
Tfie Laboratory of Hygiene. — This, one of the
latest additions to the institution, has been estab-.
lished within the last two years, and put upon a
thoroughly satisfactory and permanent basis within
the last six months. The director of the laboratory,
Dr. Paul Paquin, recently Professor of Bacteriology
in the State University of Missouri, aud State Vet-
ei'inarian for that State, is considered a rarely com-
petent man for the place. The laboratory has a
number of departments which are devoted, respect-
ively, to bacteriology, physiology, chemistry, path-
ology, and lastly, a vaccine laboratory in which
is undertaken the preparation of vaccine absolutely
free from the pathogenic microbes which are found
very abundantly in the different brands of vaccine
which are in common use at the present time.
Preparatory Medical School. — In addition to the
other departments, there has been established with-
in the last two years, in connection with the institu-
tion, a preparatory medical school in which young
men and women are received who are preparing
themselves for medical missionary work in foreign
lands. Several such persons (the present number is
nearly 20) who have pursued a medical course in
the preparatory school at the Sanitarium, are now
continuing their studies by the aid of pecuniary
assistance furnished by the institution, at leading
medical schools. All these persons are pledged to
enter upon work as medical missionaries for a period
of not less than five years after their graduation.
From the interest shown by the individual members
of the class, we have reason to hope that each one
will make this line of philanthropic effort his life
work.
The l^hysicianH. — The present number of phy-
sicians employed in the institution is nine, most of
whom have had from five to twenty years' experience
in connection with the establishment, in addition to
a thorough education in the best under-graduate
and post-graduate medical schools, and so are well
prepared for work in their several lines.
{To be continued next month.)
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V .
MORPHOI.OGY OF THE YEAST- PLANT.
• •
THE
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH., U. S. A., JANUARY, 1892. NO. 3.
Original Articles.
INFLUENCE OF THE CONTINUOUS CURRENT
ON MICROBES, PARTICULARLY ON
CHARBON BACTERIDIA.
HV M. M. APOSTOI.I AND LAGUERRIERE, OF PARIS.
( Continued. )
Thirty-eighth Series (Febrtuiry /-,-, iSgoJ, Blue
Fits. lube No. S-^
A CURRENT of 200 milliamperes, applied
5 minutes on cultures of blue i)us, did not
give appreciable results.
llnrty-ninth Series (February 20, iSgoJ, Char ban.
Tubes No. 2 and No. j;.
1. A current of 200 milliamperes (tube
No. 2), applied 5 minutes, attenuated the
bacteridian virus ; six drops of culture
inoculated before the application killed
the guinea-pig, but did not kill the rabbit ;
six drops injected after the application did
not kill the guinea-pig.
2. Two rabbits were inoculated with
charbon virus, furnished us by Mr. Roux,
of the Pasteur Institute, and succumbed
in about thirty-six hours.
3. The cultures were submitted 5 min-
utes to a current of 200 milliamperes in
apparatus No. 3.
Two rabbits inoculated with the posi-
tive tube (six drops) remained refractory ;
the cultures sown with the same tube re-
mained sterile. Two rabbits inoculated
with six drops of the negative tube died
the 23rd of February ; the sowing done
with the same tube succeeded. '
Two rabbits inoculated with six drops of
the interpolary tubes died in the night of
the 22nd to the 23rd ; that is to say, later
than the witness-rabbits, and a little sooner
than the rabbits inoculated with the nega-
tive tube ; the sowing done with inter-
polary tubes succeeded.
' See plates of the tubes and apparatus in Nov. number.
The reactions obtained with litmus pa-
per in this experiment and in consecutive
experiments were as follows : —
1. At the positive pole the blue paper
turned red.
2. At the negative pole the red paper
turned blue.
3. At the central positive tube the blue
paper became red.
4. At the central negatixe tube red pa-
per turned blue.
After forty-eight hours, the apparatus
having remained in place, the reactions
with the litmus paper were sensibly the
same : which shows hoW slowly is effected
the diffusion in liquids during a state of
rest.
FortietJi Series (February 2j, i8go). Charbon.
1. The two rabbits inoculated with posi-
ti\'e tubes in the preceding experiment,
received two drops of virulent charbon.
One died the morning of the 28th, and the
other the first of March.
2. A guinea-pig having resisted the in-
oculation with attenuated virus the 20th of
February, was inoculated with one drop
of virulent charbon, and died in the night
of the 27th.
Forty-first Series (March 6, iSgo), Charbon.
Apparatus No. j.
The four tubes of apparatus No. 3 were
isolated by intercalary stoppers of ster-
ilized gelosine, as was also the entire ap-
paratus.
N. B. — Through forgetfulness, which we
regret, the tubes of cultures were not mixed
before their distribution in the apparatus.
Of two rabbits inoculated with ten drops
of the culture of charbon, one died of
charbon ; as to the second, the result was
doubtful.
Application of 5 minutes of a current of
100 milliamperes on the cultures.
Ten drops previously separated in the
positive tube did not kill the rabbits. Ten
drops of the negative tube, and even of
the central negative tube, killed rabbits
and guinea-pigs. The sowing done with
78
ORIGINAL ARTICLES.
abstractions from each of the tubes suc-
ceeded, but much later in the central
positive tube than in the other tubes.
Forty-second Series (March g, iSgoJ, CJiarbon.
Inoculations and abstractions made
with cultures resulting from the product
of tubes which had felt the effect of the
passage of the current in the previous ex-
periments, demonstrated once more that
attenuated charbon may be the origin of
more attenuated charbon.
Forty -tliird Series (March 12^ iSgo), Charbon.
With the contents of small pipettes, com-
prising the extractions made the 6th of
March in the different tubes of apparatus
No. 3, inoculations were made on rabbits.
Inoculations made with the virus which
had not been subjected to the current,
produced death ; inoculations made with
the different tubes of the apparatus sub-
jected to the current, gave a negative re-
sult. This is logical for the positive tube,
and is explained in relation ^o the other
tubes by a purely spontaneous attenua-
tion, the apparatus being left exposed to
the action of the light.
Forty-fourth .Series (March 16^ i8go), Charbon.
Apparatus No. j.
T. The different tubes of culture were
mixed in a sterilized Chamberland pipette ;
the mixture was then distributed in appa-
ratus No. 3, whose inferior central part
was filled with sterilized gelosine.
Apparatus placed in ice ; 12° C. at the
positive pole and at the negative pole.
Application of a current of 60 milliam-
peres 5 minutes.
Before the distribution of the cultures,
two rabbits received ten drops of the mix-
ture, and remained indifferent.
After the passage of the current : Ten
drops of the positive tube killed two rab-
bits in four days. Ten drops of the nega-
tive tube killed one rabbit in three days,
out of two that had been inoculated. Ten
drops of the central positive tube killed
one inoculated rabbit in five days. Ten
drops of the central positive tube did not
kill one inoculated rabbit.
2. Apparatus No. 3 received a new dis-
tribution of charbon, and was then sub-
jected to a current of 60 milliamperes 30
minutes.
After the passage of the current : Ten
drops of the positive tube used in inoculat-
ing two rabbits caused the death of one
the fourth day ; that of the other, the
fifth day. Ten drops of the negative tube
used to inoculate two rabbits, left them
indifferent. - -
N. B. — From which we conclude that a
current of feeble intensity would revivify
the virulence of the positive pole in the
liquid of culture naturally attenuated.
Forty-fifth Series (March 26^ iSgo)., Charbon.
Apparatus No. j.
1. Mixture of cultures ; previous inocu-
lation of ten drops of this mixture on two
rabbits had caused death March 28 and 29.
Apparatus No. 3 with gelosine in the
central part, was placed in pounded ice.
(^urrent of 50 milliamperes five minutes.
After the passage of the current : Ten
drops of the positive tube killed two
guinea-pigs in forty-eight and seventy-
two hours.
N. B. — From which it is apparent that
the influence of the current with feeble
dose had been vivified instead of at-
tenuated.
2. AV^ith new distribution of the same
culture in apparatus No. 3 ; action of a
constant current of 200 milliamperes five
minutes.
After the passage of the current : Ten
drops of the positive tube did not affect
three guinea-pigs inoculated.
Ten drops of the negative tube killed
three guinea-j^igs ; two in forty-eight
hours ; the third in seventy-two hours.
N. B. — The influence of the current with
a strong dose had manifestly been attenu-
ated at the positive pole.
Forty-sixth Series (May 20, iSgo,) Charbon.
.Apparatus No. j.
With dog-charbon furnished by M. Malm,,
of the Pasteur Institute, broth sown seventy-
two hours before and inoculated in a dose
of ten drops, left two rabbits indifferent,
which was owing to an insufficient viru-
lence.
A thread of magnesium, rolled upon
itself several times, is substituted for the
electrode of platinum at the end of the
positive pole.
Application of a current of 160 milliam-
peres 10 minutes.
After the passage of the current : The
blue litmus paper assumed a bluer tinge at
the positive pole than at the negative pole.
Ten drops of virus drawn from the bot-
tom or toward the top of the positive tube
killed two rabbits, and six drops killed
four guinea-pigs.
Six drops of the negative tube killed
two guinea-pigs.
A benign virus was therefore trans-
formed into a deadlv virus under the influ-
ence of the small quantity of oxygen that
remained unemployed, the greater part of
ORIGINAL ARTICLES.
79
it having united with the aluminum during
the gradual process of its formation.
In this experiment, hydrogen itself, like
oxygen, used in small doses, would seem
to increase the virulence of pathogenic
organisms.
Forty-seventh Series (May 3(^, jSgoJ, Staphy-
lococcus Pyogenes Atireus.
Five divisions of Strauss syringe con-
taining a fresh culture of the staphylo-
coccus pyogenes aureus were inoculated in
two rabbits.
Vast abscesses, a large mortification of
the skin in the region inoculated, and the
emaciation of the animals, were the results
of the operation. Six weeks later, the
animals were not yet restored.
Forty-eighth Series (JnneS., iSgo)^ Staphylococcus
Pyogenes Aureus. Apparatus No. j.
Distribution of a mixture of cultures in
apparatus No. 3, whose central part is
partitioned with gelosine, and whose elec-
trodes are recovered with an intermediary
layer of gelosine.
1. The tubes of broth were sown with
success.
2. Fifteen drops of mixture were in-
oculated in two rabbits. Positive result :
Tumefaction, abscess, gangrenous opha-
celus at the point inoculated.
3. Current of 250 milliamperes, 10
minutes.
The sowings consecutive to this appli-
cation were positive.
Fifteen drops of the positive tube and
as many of the negative succeeded more
or less, according to the subjects inocu-
lated.
N. B. — In this experiment, the stoppers
of gelosine which surrounded the elec-
trodes and separated them from the broth
of culture, prevented the action on this
broth from the products of electrolysis,
and, consequently, prevented all attenua-
tion.
4. A current of 500 milliamperes ap-
plied 6 minutes on a new distribution of
the same culture, caused an elevation of
the temperature from 11 to 3i°C. at the
positive tube, and from 11 to 24°C., only,
at the negative tube.
The inoculations ( fifteen drops), on
rabbits remained negative with the posi-
tive tube, and positive at the negative
pole.
N. B. — In this last experiment, we had
not kept the stoppers of gelosine in con-
tact with the poles ; and this accounts for
our obtaining a positive answer.
Forty-ninth Series (June lo.^ iSgo), Rabbit Pus.
Apparatus No. j.
Pus of an abscess formed by an experi-
ment on a rabbit was sown on peptonized
broth.
1. Fifteen drops of this culture inocu-
lated in two rabbits produced tumefaction,
abscess, gangrene at the seat of the opera-
tion, emaciation, and finally the death of
one of the animals.
2. Current of 250 milliamperes, 10 min-
utes, with ice and without stoppers of
gelosine on the electrodes.
Fifteen drops of the positive tube gave
an absolute negative result on two rabbits.
Fifteen drops of the negative tube pro-
duced the same local effects as on rabbits
inoculated before the passage of the cur-
rent.
3. Current of 500 milliamperes, 5 min-
utes, on the same media of culture, intro-
duced in the same apparatus. The positive
thermometer rose to 42 °C., the negative
to 40° C.
Fifteen drops of the positive tube pro-
duced no result.
Fifteen drops of the negative tube pro-
duced precisely the same effects on the
rabbit as those obtained with virus not
subjected to the current.
The broth sown with the positive tube
remained sterile.
The broth sown with the negative tube
vegetated very rapidly.
Fiftieth Series (yune 20., iSgo), Dog Charbon.
Apparatus No. j.
1. Fifteen drops of culture caused the
death of two rabbits. One died the 26th
of June, the other, the 28th.
2. Application of a current of 300 mil-
liamperes, 3 minutes, with electrodes of
platinum. After the application : Fifteen
drops of the positive tube were inoculated
in two rabbits ; one died the 23rd, the
other the 25th, in the morning.
Fifteen drops of the negative tube were
inoculated in two rabbits ; one died the
25th of June, the other, the 28th.
N. B. — The dose of 300 milliamperes ap-
plied 3 minutes, is therefore insufficient,
so far as the duration is concerned.
Moreover, the rabbits inoculated with
the positive tube died first, which goes to
show that oxygen exalts the virulence of a
media of eulture instead of lessening it, if
the current is not applied at least five
minutes.
Dr. SiMOL'JON, of California, in a re-
cent paper, calls attention to the fact that
the nose is not in the middle of the face.
80
ORIGINAL ARTICLES.
THE APPLICATION OF THE MICROSCOPE IN
MEDICAL, MEDICO-LEGAL, AND
LEGAL DIFFICULTIES.^
BY FREDERICK GAERTNER, A. M., M. D. ,
PITTSBURG, PA.
Member of Society of Physicians and Surgeons, Uerlin.
Since the introduction of microscopy
as a study and a method of examination
and research, and es])ecially since its ap-
plication in medical, medico-legal, and le-
gal difficulties, science ma}' be considered
nearly complete.
A microscopist, who has not mastered
microscopy in all its details is certainly
incompetent and unreliable in his exami-
nations. The competenc}- and reliabilit}'
of such a scientist are of especial impor-
tance when expert testimony is required
at court, where the life of a fellow-citizen
may be invohed in cases of indictment
for murder, rape, infanticide, and criminal
abortion. This reliability is of scarcely
less importance in cases of malpractice
suits, suits for damages, cases of forgery,
the adulteration of food and drink, the
mutilation of legal documents, etc. This
testimony mav establish the genuineness
of legal documents and discover counter-
feit currency. All similar secret crimi-
nalities can be revealed and indubitabl}'
established by the agency of that wonder-
ful instrument, the microscope. Until
from about ten to fifteen years ago, the
commonwealth in prosecution of crimi-
nals, especiall}' in cases of murder, would
select and siibpania the best medical ex-
perts, who would give their experience and
observation under similar circumstances.
Now the commonwealth ignores such
testimony and seeks the most learned
specialists, /. c, an expert microscopist,
and bids him make a thorough, scientific
investigation, including microscopical,
micro-chemical, and chemical examina-
tions of the subject before him. His
testimony is then given before an intelli-
gent jury, and thus the indicted person
may be justly cleared, or justly convicted
by facts which would otherwise never have
been revealed.
If a physician has love for his profession,
he cannot fail, if he needs its use, to have
the greatest possible interest in the study
and application of the microscope. The
man who has made microscopy a part of
his profession will soon find his scientific
and microscopical services in demand
1 Kead . before the l'iltsl.)ur£c Academy of Science and Art.
both for investigation and research in the
ad\'ancement of science and art, and for
the enlightenment of medical, medico-
legal, and legal difficulties.
More than a mere knowledge of medico-
legal principles, more than talent or even
genius, is requisite for the scientific prac-
tice of microscopy. The young man who
is eager to begin at the very top of the
ladder to study medico-legal microscopy
(and all young men are eager), soon dis-
covers that it is the part of wisdom to go
slowly, that creeping comes before walk-
ing, and that after all there is something
not to be found in medical, legal, and
microscopic books, nor to be learned from
the lips of a preceptor or mentor, and that
this something is nothing else than experi-
ence. Experience is the essential factor
in the solution of the complex and intri-
cate problems which present themselves
to the practiced scientist and expert mi-
croscopist.
Indeed, it seems that every one should
know to some degree the use and aj^plica-
tion of the microscope, and the grocer,
butcher, and farmer in particular should
make themselves acquainted with its work-
ings and manipulations. The physician
simply must be a microscopist or be com-
paratively incompetent and unable to ar-
rive at a positive or correct conclusion in
diagnosing and prognosing many cases.
No man should make microscopy a pro-
fession unless he has a genuine love for it.
It is generally true that men are success-
ful only in those callings or pursuits to
which they are inclined, and in which they
continue from choice: and I think this is
especially true in regard to the study of
microscopy. Success therein means hard
work, even under the most favorable cir-
cumstances, and oftentimes, indeed al-
most always, a long probation.
In my opinion, microscopy should be
made a compulsory study in all universi-
ties and colleges, particularly medical
colleges ; and even in high schools its
fundamental branches should be taught.
Microscop) is certainly of paramount im-
portance to the pharmaceutist (druggist),
chemist, botanist, and geologist, as well as
to the physician.
In European universities every student
must have completed three semesters in
microscopy before he can become a candi-
date for his final examination. I think the
proper authorities should make microscopy
a compulsory study in all higher grade
schools, and especially medical colleges,
and should encourage microscopical re-
ORIGINAL ARTICLES.
81
searches and investigations just as Eng-
land, (xermany, Austria, and France have
done during the past decade. Microsco-
pists abroad have been encouraged by the
offer of capital prizes, honorary medals,
etc., etc.
If it is a wise provision of our Govern-
ment to enact laws for the benefit and
protection of commerce, it would be still
wiser and nobler to provide laws for the
advancement of science and art, and for
the protection of humanity against diseases
which in our country are due largely to
the adulteration of food and drink, and the
accumulation of micro-organisms in them.
MEDICAL MICROSCOPY.
The microscope, applied in the study
of medicine, can no longer be considered
an accessory but has become a necessary
and highly important factor.
Microscopy is to the science of medicine
what the alphabet is to reading. It has
not only elevated medicine to a science,
but has also thoroughly investigated and
developed anatomy, histology, physiology,
embryology, pathology, bacteriology, bot-
any, etc., which constitute the science of
medicine and surgery.
Wjthout the microscope the medical
profession or the scientific physician,
would be at a loss in the discrimination of
diseases. The physician would be unable
to distinguish between diseases related in
various ways or apparently alike, with any-
thing like certainty, and would thus be
compelled to follow the example of old-
time physicians, and treat the symptoms
instead of the disease proper, as the
scientific physician now understands how
to do. For example, in the case of a
man suffering from icterus generalis (Gelb-
sucht), commonly called jaundice, the old-
timer would immediately, upon arriving
at the bedside, diagnose jaundice and
treat the symptoms instead of the disease
pr(3per, the pathological condition. Now
a physician would invariably endeavor to
treat the causes of jaundice which would
be one of the four distinct and different
pathological conditions, either that of —
1. Gastro-duodinitis acuta.
2. Occlusion of the ductus communis
choledochus.
3. Hepatitis interstitialis racens, includ-
ing degenerations and atrophies.
4. Carcinoma hepatis and carcinoma
duct, biliferorum.
The scientific physician would no more
think of treating jaundice (the symjjtom)
than he would treat the headache of a per-
son suffering from typhoid or scarlet fever,
or the polluted breath (fetor) of one suffer-
ing from diphtheria, or the urine of one suf-
fering from Bright' s disease, technically
called nephritis. He would instantly re-
sort to the microscope to find the cause,
/. e., the pathological condition, the abnor-
mal physiological functions, before basing
his etiological conclusion. If the patient
were vomiting, he would examine the vomits
microscopically and chemically, and thus
find a more rational indication, determin-
ing at an early date, possibly, whether or
not the patient w^as suffering from cancer
of the stomach.
By a microscopical examination of the
sputum, especially by the staining methods
of Koch, Erlich, Weigert, Friedlander, and
others, he would at once be able to state
whether or not the disease was tuberculosis.
Consider the importance of the micro-
scope in the analysis of tumors. By its^
use the physician may readily distinguish
between the heterologous types of tu-
mors, epithelial growths, commonly called
cancerous, and other analogous sorts,,
not epithelial but fibro-plastic growths,,
which we denominate sarcomatous. Both
are of a most malignant character, and
stand in contradistinction to non-malig-
nant types of tumors or growths. The
greatest success of a surgeon depends
upon his distinguishing malignant from
non-malignant tumors at an early date,
and being able to make the excision in due
time, and thus save the patient's life.
The invention of the microscope was
certainly a boon to mankind, since it is
one of the chief aids of physicians. A
physician without a microscope is almost
like a man without eyes ; he is unpro-
tected and uncertain, and must be con-
sidered incompetent, simply because he
cannot see as far as the scientific physi-
cian who sees by the aid of the micro-
scope.
Without the improved microscope the
great French chemist and bacteriologist,
Pasteur, woidd never have discovered the
process of fermentation, and his bacterio-
logical researches would scarcely have
been begun ; but by its aid he has proved
without a doubt that all infectious dis-
eases are due to microbes, commonly
called germs.
Prof. Koch, the world's most renowned
bacteriologist, by means of that wonderful
instrument, the microscope, has revealed
to us scientific means by which it is
anticipated that tuberculosis may be diag-
nosed and cured in the near future.
S'2
ORIGINAL ARTICLES.
Medico-Legal Microscopy.
This is certainly a broad field, and much
remains for future investigation, research,
and observation.
The physician must be, and the attorney
should be, a microscopist. Everything
that concerns a medical examination in a
legal sense or a legal examination in a med-
ical sense, may be enlightened and accu-
rately determined by the use of the micro
scope. Here are to be understood the
previously mentioned cases of homicide,
infanticide, rape, criminal abortions, mal-
practice suits, suits involving the adul-
teration and imitation of food and drink,
etc.
Within the last decade, scientists have
shown the possibility of determining old
and dried human blood spots from those
made by the blood of the lower animals.
It is comparatively easy for a microsco-
pist to distinguish with certainty the blood
of amphibious animals and fishes, but it is
a decidedly different matter to distinguish
human blood from that of the higher order
of animals.
Scientists, namely Bizzozzero, Cantani,
Friedlander, and others have demonstrated
the possibility of often distinguishing dried
and old human blood spots from those of
animals, whether found upon wood, iron,
cloth, or other substance.
Histologists and pathologists have dem-
onstrated the great value of the microscoi)e
in distinguishing the skin, hair, brain mat-
ter, and even the excretions and secretions
of the human being from those of the lower
animals. Moreover, expert microscopists
have pointed out that the blood which cir-
culates through our arteries and veins
might be so contaminated with constitu-
tional diseases, such as septicaemia, leukae-
mia, and certain fevers, that it would be
possible to determine accurately and e\'en
beforehand, the severity of the disease, to
give a correct diagnosis and prognosis,
and to make a clear differentiation of dis-
eases.
How else than by the microscope could
such marvelous feats be accomplished ?
What a safeguard is such power in the
above-mentioned cases !
Were it not for the microscope, it would
sometimes be an impossibility for a physi-
cian to state with certainty that upon a
certain female, rape had been committed ;
this decision is a very difficult one, and
can occasionally be determined accurately
and positively only upon the finding of
certain microscopic characteristics, such
as the finding of spermatozoa, spermatic
crystals (Charcots), etc., upon or about
the vagina or its surroundings, such as
dresses, night-shirts, or drawers.
In cases of infanticide it is frequently
necessary to prove by scientific methods
whether or not the infant child has
breathed. Cast a piece of lung tissue
into a vessel containing water, and by its
floating or sinking alone decide whether
the child had breathed or not. This is the
old and unreliable method. The micro-
scope affords a much more reliable proof.
Under the microscope, a section of the
lung tissue of a child that has breathed
presents the following genuine character-
istics : —
1. The lung tissue presents the a])pear-
ance of being expanded, that is, the al-
veoli are expanded and contain air, mucus,
and loose epithelial cells.
2. The epithelial cells lining the alveolar
walls are flattened.
3. The blood in the arteries is positively
oxygenized, aerated-arterial blood.
In contradistinction to this, the lung
tissue of a child that has not yet breathed
reveals under the microscope the ap]3ear-
ance of real and as yet embryonic lung
tissue.
T. The lung tissue is shown to be as yet
in a collapsed condition, and to contain
neither air, mucus, nor flattened epithelial
cells.
2. The alveolar walls are lined with a
well-developed and as yet distinct round
cell epithelium.
3. The blood in the arteries is shown to
be venous blood.
The microscope again solves medico-
legal difficulties in cases of malpractice
suits, etc., by analyzing food, drink, drugs,
etc.
1. It may detect the slightest adultera-
tion, as well as an imitation.
2. It may determine whether or not the
article is spoiled or has undergone any
degree of fermentation.
3. It may reveal any accumulation or
development of micro-organisms. Thus
scarcely an adulterated drug, meat, or
oleomargarine can keej) its secret when
placed under the microscope.
(To be Continued.)
Experiments which have been con-
ducted by M. Herbert, a French physi-
cian, show that bromide of potash when
used for some time accumulates in the
tissues, especially in the cartilages and
the bones. M. Richert reported having
made the same observation respecting the
kidneys.
ORIGINAL ARTICLES.
83
THE INFLUENCE OF DRESS IN PRODUCING THE
PHYSICAL DECADENCE OF AMERICAN
WOMEN.
H. KKI.I.OCK;, M. ])., I'.^TTI.K CREEK.
( (.Continued. )
The proper action of the chest may be
aptly compared to that of a pair of bel-
lows. The lower ribs, to which the strong
breathing muscles are attached, serve as
the handles. The breathing apparatus of
a woman whose waist is constricted by a
corset or tight bands, is nearly as much
embarrassed in its action as would be a
pair of bellows with the handles tied to-
gether. The clavicular respiration, so
conspicuous in women who constrict the
waist, is not seen among savage women,
nor in a woman whose respiratory organs
have not been restricted in their action
by improper clothing. That this mode
of breathing is abnormal might be fairly
inferred from the structure of the upper
part of the chest, which is certainly not
such as to suggest any considerable de-
gree of mobility. But this mode of
■breathing is not only abnormal, but, as I
think I have already shown, it may be
productive of disease. This is true of
ordinar}- respiration, but it is most em-
phatically true of forced respiration, such
as is induced by singing or active mus-
cular exercise. Under the imperative de-
mand for an increased supply of air, the
respiratory muscles are made to act with
undue ^'iolence. In consequence of the
constriction and the compression of the
abdominal walls by the corset, this ab-
normal force is largely expended upon
the organs of the pelvis, which are forced
down out of position. The pelvic floor is
more yielding than the rigid walls of the
upper chest, and is depressed, thus laying
the foundation for chronic displacement.
A civilized woman wearing the common
dress cannot expand her waist more than
one fourth of an inch when taking a deep
inspiration. Expansion must occur some-
where, and the abnormal mode of dress
necessitates that it shall be at the upper
and lower extremities of the trunk. The
grater resistance of the upper ribs, and
the yielding character of the structures
which form the pelvic floor, lead to a
lowering of all the organs which are de-
pendent upon the latter for support.
The tracings which I shall present also
show an important fact as to the influence
of constriction of the waist upon breath-
ing. These tracings were made with a
pneumograph, the tracings obtained by
which represent the whole of the respira-
tory movement. Fig. i, Plate V., repre-
sents normal respiration. Noting the time
relation between inspiration and expira-
tion, it will be observed that expiration is
perceptibly longer than the movement of
inspiration. I find this relation to be, on
the average, about five for inspiration
and seven for expiration. Fig. 2 is a
fac-simile of the tracings given by the
same person while wearing a corset, who
without a corset gave the tracings of
Fig. 1. It will be seen that there is an
increase in the time of inspiration as com-
pared with expiration, which one would
naturally expect from the resistance of-
fered by the corset. It will also be noticed
that a marked change in the form of the
tracing is produced by the constriction of
the waist. The expiratory portion of the
tracing, which appears above the horizon-
tal line, drops suddenly instead of making
.a gradual decline, as in normal respira-
tion. The tracings obtained from the
woman in the corset show most clearh' an
abnormal resistance to the respiratory
action.
In natural breathing, the action is chiefly
at the waist, although the entire trunk
wall, and every organ within the trunk par-
ticipates in the movement. The action
begins with expansion, first at the sides,
and then in front, then a slight elevation
of the upper chest, and, in forced respira-
tioa^slight drawing in of the lower abdo-
men at the same time. In ordinary respi-
ration, there is simply a lifting forward of
the whole front wall of the chest and ab-
domen, the movement extending all along
the line from the u})per end of the breast-
bone to the pubis.
The so-called abdominal respiration is
unnatural and unhealthful ; indeed, it has
been in many cases productive of serious
injury. Teachers of elocution and vocal
music often instruct their pupils to breathe
abdominally ; that is, to give prominence
to the movements of the lower abdomen in
breathing. When the waist is constricted,
the inability of the chest to expand at
the sides compels an exaggerated move-
ment downward, so that the viscera are
forced down into the abdomen to an unu-
sual extent. In natural respiration, the
expansion of the waist, or increase in cir-
cumference of the trunk at its center,
prevents this excessive downward move-
ment. It will be readily seen how, by
violent efforts to force the breath down-
84
ORIGINAL ARTICLES.
ward with the waist confined so as to pre-
vent proper expansion, the supporting
ligaments of tlie various viscera might in
time be so stretched as to produce a
general sag of the abdominal contents.
Correct breathing is as necessary to the
health of the pelvic and abdominal vis-
cera as to a healthy condition of the
lungs ; for the respiratory act not only
pumps air ni and out of the body, but
draws blood to the heart, assisting par-
ticularly the portal circulation, and thus
also aiding in the absorption of the prod-
ucts of digestion, and so facilitating the
digestive process. It is quite possible,
also, that the rythmical movements im-
parted to all the viscera of the trunk by
normal respiration, are a sort of vital
gymnastics, essential to the health of each
organ.
It is evident that, in its interference
with the proper respiration, as well as
from the mechanical injuries which it in-
flicts, the common mode of dress, which
involves constriction of the waist, is the
most potent means of impairing the health
and vigor of the whole body, and may
justly be reckoned as perhaps the greatest
of all factors in the general decadence in
physical vigor so apparent among women
of the present and rising generation.
That there has not been a general rebell-
ion against this unnatural and mischief-
making mode of dress on the part of the
intelligent women of this enlightened
age, is probably .due to the popular but
fallacious idea which seemes to W so
thoroughly fixed in the minds of both men
and women, that woman is " the weaker
vessel," and naturally subject to a'lments
and weakness and general physic. J ineffi-
ciency from which men enjoy immunity.
Any one who has made himself familiar
with the activity of the woman of savage
nations, or even the women of the peasant
classes in civilized countries, must have
recognized the fallaciousness of this popu-
lar idea, which had its birth in the age of
chivalry, and has come down to us along
with numerous other fancies and supersti-
tions which have no foundation either
in natural experience or physiological
science.
The average civilized woman is certainly
very much inferior to the average civilized
man in physical vigor. The constancy of
this observation has led both the profes-
sion and the laity to regard women as
naturally weaker than men. But that
this is not necessarily so, is shown by
the constant experience and observation
of travelers among uncivilized tribes.
Travelers in China are often astonished
at the immense loads which Chinese
women carry upon their shoulders. Some
years ago I saw a woman in the market-
place at Naples, Italy, carrying off upon
her head an immense load of vegetables,
which recpiired two men to place in
position. De Saussure relates that when
he had finished his observations in the
valley of Zermatt, he packed a collection
of mineralogical specimens in a box, and
called for a porter to carry it out of the
valley, as the mountain roads were too
steep to be traveled by four-footed ani-
mals of any sort. After a fruitless search
for a man who was able to transport his
box of specimens, he was finally told if
he wished a porter to carry his package,
he must employ a woman, as no man
could be found who was able even to
lift the box. He accordingly engaged a
woman who offered herself for the service,
and stated that she carried the heavy box
of minerals over the steep mountain roads
without the slightest injury either to it or
to herself. Stanley reports that the two
hundred women porters whom he em-
ployed on one of his expeditions, proved
to be the best porters he ever had in
Africa.
When in England, a few years ago, I
made an expedition into the " black coun-
try " for the purpose of studying the wo-
men brick-makers and nail-makers of that
region. I found at Lye some of the finest
specimens of well-developed women I ever
saw anywhere — women who had spent
all their lives in brick-yards or before the
forge, swinging the blacksmith's hammer
and making the anvil ring. These women
never go in out of the rain for fear they
will get wet and take cold, and although
working in mud and water a great share
of the time, have no other protection for
their feet than shoes, often full of holes
and almost without soles and wholly in-
adequate to protect the feet from water.
They are constantly engaged in lifting
heavy weights. One woman I saw tossing
and kneading upon a block a mass of
clay, which, as I found by actual test,
weighed over sixty pounds. She handled
it in her hands as though it were only a
small mass of dough ; and although thus
employed from early morn until late at
night, she was in no way disabled by her
occupation. A physician of long experi-
ence, who practiced in the place, assured
me that so far as his practice among wo-
men was concerned, it amounted to noth-
>
<:
S6
ORIGINAL ARTICLES.
ing in a gynecological way, but that his
obstetrical practice was very large. Not
long ago, a public meeting was held in
Birmingham, England, by the nail-mak-
ers of that district, for the pur]:)Ose of
])rotesting against the employment of
women in the business of nail-making.
The reason given by a prominent member
of the association for this objection to the
employment of women, was that by this
kind of labor a woman became so " un-
sexed " that she could outwork a man,
continuing her labor hours after a man
was completely used up.
These facts, and many others which
might be cited, show that woman is not
necessarily so much weaker than man.
The weakness of woman is not due to natu-
ral constitution, but to a vicious mode of
dress and neglect of physical exercise, al-
though, possibly, heredity has some in-
fluence in the matter at the present day.
(To be Continued. )
LESSONS IN BACTERIOLOGY.
BV PAUL I'AQUIN, M. D., D. V. S.
EXPLANATION OF PLATE. V.
Fk;. I. Pneographic tracing, showing llie respi-
ratory movements of a healthy woman. That por-
tion of the curve above the base line represents
expiration : the curve l)elow the line represents in-
spiration. I'his tracing was obtained by means of
a new form of pneumogra])h, or pneograph, which
represents the whole respiratory movement, and
Avhich I have elsewhere described.
Fk;. 2. Pneographic tracuig furnished by a
woman wearing a corset. The subject was the
same person w ln) furnished the preceding tracing,
and the tracing was made with the same instrument
adjusted in the same manner. The evident increase
in the length of the expiratory movement, or rather
decre se in the length of the inspiratory movenient,
as well as the change in form of the expiratory
movenient, are strongly suggestive of the interfer-
ence with respiration occasioned by constriction of
the waist.
Fl(".. 3. A corset-choked woman (copied from a
fashion plate).
Fii;. 4. A healthfully dressed woman.
Fk;. 5. This and the succeeding hgure are in-
tended to show the real origin of Inists and bustles.
The woman whose figure has been destroyed l)y
corset-wearing requires an artificial bust in front
and a bustle l)ehind, to restore the natural cur\es of
the figure.
Fk;. 6. A woman w ith a natural figure who has
no use for either bustles or artificial busts.
RadicalTreatmentfor Consumption.
— A P>ench surgeon having experimented
successfully upon animals, undertook an
operation for the radical cure of a pa-
tient suffering from incipient tuberculosis,
removing the i)ortion of lung diseased,
and with such success that the patient
made a good recovery, and at the time
of presentation, no evidence of disease
could be discovered.
Lesson IX. — Experiments on Anlmals.
Fart /.
All that has been said in our lessons
so far, converges into this question : Ex-
periments on animals. The object of
touching upon it is to show that a number
of diseases are really due to microbes, and
to demonstrate how one may verify this
fact.
In order to get positive })r()of that a
given disease is due to a particular mi-
crobe, it is necessary to establish four
conditions, viz. : a. To demonstrate the
constant existence of the same microbe in
the same malady and in no other ; b. To
determine clearly the morphology and the
chemical and physiological properties of
this microbe ; c. 'Vo isolate it in a state of
purity and cultivate it outside the living
organism ; d. To reproduce the original
disease by inoculation in animals of the
microbe thus ctdtivated, and to find it in
the tissues of the animal so inoculated.
The animals used for inoculations vary.
Dogs, cats, rabbits, guinea-pigs, mice, rats,
chickens, and pigeons have been used.
White mice, because of their low price,
their prolific nature, and their suscej)-
tibility to many microbic diseases, offer
many advantages over the others. They
offer particular advantages to busy men
without a laboratory. They may be kept
in metallic boxes — such as a metallic
cracker box, or a wooden one lined with
metal, with a cover profusely perforated,
or with a wire screen for cover. This box
is half filled with sawdust covered with a
little cotton batting. The food should
consist of oats, and white bread soaked in
water. A dozen mice may live in a box a
foot and a half or more in diameter. The
sawdust needs to be changed about once
a month. Mice used in experiments are
isolated each in separate glass jars, cov-
ered with a perforated glass or metal cover
sufficiently heavy to prevent the animals
from lifting it. These should be thor-
oughly cleansed and filled a third or a
fourth full with sawdust. To raise mice
in the laboratory, the couples should be
separated in different boxes, and when the
females are near term, they should be iso-
lated in glass jars as above. After the
young have their eyes open, they and the
different mothers may be put together in
ORIGINAL ARTICLES.
87
one box. They will get along fairly well.
But old males are quarrelsome, and some-
times devour the young.
The rabbits may be kept in cages so ar-
ranged as to allow of daily cleansing. A
better way is to keep the adult rabbits not
actually in use, in a large box stall, with
plenty of straw, etc. They may be fed
oats, cabbage, etc., and should be pro-
vided with water. The subjects under ex-
periment must be isolated and kept in
clean cages. Rabbits may be raised eas-
ily for laboratory purposes. But if one
would have the best results, the females,
when nearing term, should be separated
from the males and put in a large, warm
box, with sawdust or dry earth, and dry
leaves, or straw, or cotton for nests. The
males often kill the young, if left with
them. The little ones should not be put
with larger, strange rabbits in a closed
place ; the progenies of about the same
age may be raised together, thus insuring
less fighting later.
Guinea-pigs may be kept in cages like
rabbits, and raised somewhat on the
same principle.
Dogs need special places and thorough,
daily cleaning. They are disagreeable
brutes to deal with, as they sometimes
howl continually.
Cats are not much better subjects, and
are not easy to inoculate, owing to their
too handy claws.
Fowls may be kept in ordinary cages,
in isolated places, and used when needed.
(To be Continued.)
» — •^
Digestion of Milk in the Young. —
Dr. R. Romme, who has investigated this
c^uestion thoroughly, concludes as follows
from a part of his observations : The
first action on the milk when it reaches
the stomach, consists of coagulation on
the one hand, and caseification on the
other, under the action of a special fer-
ment secreted in the gastric juice by
glands in the stomach. This ferment is
related to other soluble ferments of the
economy. After Hammerstein : One part
of this ferment is capable of coagulating
420,000 })arts of casein ; and Soxhlet has
calculated that the quantity of ferment
contained in the stomach is sufficient to
provoke, in thirty minutes, the coagu-
lation of 6000 liters of milk. The action
of the ferment requires a certain length
of time to manifest itself, and the coagu-
lation is effected the more readily the
greater the quantity employed. Elevated
temperatures, from i45°F. upward, abolish
the action of the ferment. The most fa-
vorable temperature is about 92°F. I'he
acids equally coagulate the milk, as is well
known, only the process is not the same
in the two cases, and the coagulum differs
a great deal according to whether it is
produced by acid or a special ferment.
Arthus and Pages define the differences
of action thus : " The casein of milk is
precipitated by an acid, and is caseified
by the /^7 /^-ferment."
The notion still existing, then, in the
minds of many, that lactic acid alone pro-
duces the coagulation in the digestion of
children, is not sustained by Dr. Romme's
observation. These researches may lead
to some important discoveries of practical
\'alue in the feeding of infants.
A Thermogenous Substance in
Urine. — M. Paul Binet has isolated from
human urine a substance which is capable
of producing fever by hypodermic injec-
tions. The substance is found chiefly in
the urine of tuberculous persons, but it
exists also in the pathological urines of
other classes, and even in normal urines,
though with an inferior degree of activity.
By injection, it acts with particular inten-
sity on tuberculous guinea-pigs or those
which have suffered inoculation of tuber-
culosis. However, it is possible to ob-
serve under certain conditions a fever in
and sound animals, particularly the young,
females, in lactation. Subcutaneous in-
jections provoke, in these conditions, an
elevation of temperature of 1° to 3° F.;
the maximum is reached generally about
the third hour after the injection, and the
fever lasts between four and five hours.
M. Binet has practiced injections on eight
tuberculous guinea-pigs, and seventeen
sound guinea-pigs ; the substances used
were respectively a glycerine extract di-
luted with water, and an aqueous solution
of an alcoholic precipitate. These injec-
tions, 185 in number, have never produced
any abscess. Of the tuberculous guinea-
pigs, every one had a rise of temperature.
Of the seventeen sound guinea-pigs, nine
presented a rise of temperature ; but in
all of them it was less constant, and
milder than in tuberculous cases. The
effects produced by the urines of tubercu-
lous subjects (human) have been, in most
cases, more pronounced and more ele-
vated than those produced by other patho-
logical urines, or by normal urine.
The results of further experiments in
this line will be awaited with interest.
88
TRANSLATIONS AND ABSTRACTS.
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE MORPHOLOGY AND BIOLOGY OF THE
YEAST FUNGUS.
BY DR. JOHANNES RAUM, WARSAW.
Translated from \^\& ZcitscJirt/t far Hygictu\ Vol, X. No., i.
bv H. W. Loeb, A. M., M. D., St. Loui.s, Mo.
I The article with the aboxe title is entirely too voluminous
to be translated in full for Uie B.AcrEKiouxiic.Ar, World .\y.n
Modern Medicine. The translator, however, mindful of the
value of the paper and of the interest taken in itbj' American
scientists, has translated that portion which refers to the plates,
and which e.vplains and elucidates them. J
I. Saccharomvces Cerevisi^e I.
(Figs. 1-14, frontispiece.)
A QUANTITY of purc ciilture was intro-
duced into a glass of beerwort, and placed
in the incubation apparatus at a tempera-
ture of 25° C. Soon afterward bubbles
of carbonic acid arose from the bottom to
the surface of the liquid, and later a white
foam appeared. In twenty-four hours the
fermentation was well established, the yeast
collecting in a considerable quantity at the
bottom of the vessel. It may be remarked,
by the way, that I obtained the beerwort
used from one of the best breweries in this
country. Out of this I made a sterilized
mixture of ten per cent of grape sugar and
live per cent of malt extract, with a hundred
parts of spring water. All of my yeast ex-
periments succeeded excellently with this.
To make specimens for microscopical
examination^ a sterilized platinum probe
was introduced into the midst of the cul-
ture, and the preparation spread in a thin
layer upon the slide, either drying it in
the air, subsequently drawing it cautiously
through a flame, or after Lukjanow's
method, first fixing it with sublimate,
and then drying it. In order to differen-
tiate the morphological details within the
yeast-cells, I used (xaule's fourfold stain.
However, when, on account of the diffu-
sion of t]ie staining, it was found un-
satisfactory, I then made use of the
stain suggested by Ernst, which consists
in treating the specimen with a slightly
warmed solution of meth}l-blue (Lofller'sj
and with a cold solution of Bismarck
brown. By the use of homogeneous im-
mersion, there could be seen in the center
of the cells a variable number (one to
fifteen and more) of large, spherical,
black granules, while the surrounding
protoplasm appeared more or less uni-
formly brown. (Figs, i to 5.) We were
unable to demonstrate any structure in
the granules, nor was it possible to ob-
serve any close relationship between their
size and the dimensions of the cells which
contained them. A large granule which
lay in a small cell surrounding it could
often be seen. With reference to the posi-
tion of the bodies within the cells, it was
evident that they were either central, or
as was frequently the case, they were
placed at the periphery. In the speci-
mens of oval yeast-cells, these granules
were generally grouped at one or both
poles. In their external arrangement,
they exhibited an almost constant regular-
ity, being either in circles or segments of
circles. By reason of their staining, the
black granules must be indentified with the
so-called sporagenic granules of bacteria.
Besides the already mentioned stain of
Ernst, other staining methods permitted
us to settle the question as to the gran-
ules, especially Loffler's methyl-blue with
the subsequent decolorization by means
of acidulated alcohol ; the hsematoxylon of
Bohmer and Delafield, however washing out
the preparation beforehand with alcohol ;
finally, eosin, or rose-bengal, and after-
staining with methyl-blue. Neither car-
bolic fuchsin, Platner's nuclear black, nor
methyl-green acidulated with acetic acid,
gave any positive results. Zimmerman's
method for plant-slides, recommended by
Altmann, was without avail.
While no granules in proliferation ap-
peared in the cells, we nevertheless could
observe them at the entrance of the
sprouts. Their contents must at least in
many cases be considered viscid, for they
do not always retain the same spherical
form in passing the connecting layer be-
tween the mother-cells and their daughter-
sprouts, and they seem sometimes to
extend in length, and to be cast into the
cells. In this migration, a scattering of
the substance not infrequently occurred.
(Figs. 6 to II.) In general, my impression
is that while the mother-cells retained the
greater portion of the before-mentioned
black granules, they delivered the smaller
portion to the sprout-cells. So far as my
experience reaches, all cells in a true
yeast culture at the height of their de-
velopment, old or young, are found con-
taining black granules, in the mother-cells
as well as in the sprout-cells.
TRANSLATIONS AND ABSTRACTS.
89
With reference to the determination of
the chemical nature of these black bodies
which were discovered in the yeast- cells,
I prepared a series of reactions upon the
yeast-cells of different ages. In the first
place, they were exposed from 24 to 48
hours to the influence of artificial gastric
juice, in a thermostat at 40° C. After the
artificial digestion and the subsequent
•washing with alcohol, the granules disap-
peared, so that none were visible to the
eye, although the before-named stains had
been used. The same result occurred
following contact with a five per cent
solution of caustic potash for a short
time. Simply treating the yeast with boil-
ing alcohol produced no effect upon the
•color-reaction. Perosmic acid did not
produce in these the customary reaction
for fat. The solution of iodide of potas-
sium left a diffused yellow or reddish-
brown color. The first of these appeared
in those cells which were in the state of
hunger, while the others occurred where
the cells were well nourished. In using
the word "diffuse," I wish to state that
the iodine reaction does not indicate any
specific morphological constituents of the
cells. I have often seen cells in the cen-
ter of which there appeared larger por-
tions of matter of a reddish-brown tint,
and yet I have nexer made up m\' mind
just what conclusion to draw with refer-
ence to the relation between those por-
tions of matter and the accumulation of
granules, etc. It must be further observed
that the complete non-appearance of the
iodine reaction frequently coincides with
a greater or less accumulation of granules.
I did not recognize the blue coloration,
which is indicative of strength. I would
not leave this circumstance unmentioned,
from the fact that Ernst did not attempt
to determine the presence of carbohydrates
in his sporagenic bacterial granules. Warm
ing the yeast preparation with Million's
reagent gave a uniform redness to the en-
tire cell contents. I have repeated the
micro chemical reaction upon all of my
yeast experiments, and have obtained the
same results.
In the culture of yeast upon fixed nutri-
tive media at the ordinary temperature of
the air, the black granules are formed ;
however, there must be added to the agar
or gelatine a slight amount of grape-sugar.
The absence of the sugar or the presence
of glycerine (six per cent) prevents this
condition of affairs. When, for example,
the agar was mixed with two per cent of
^rape sugar, the formation of s^ranules
coincident with the fermentation took
place just as lively as before, especially
at a temperature of 25° C. (77^ F.). In
about two weeks, the multiplication of
granules gradually subsided. The cells,
which we had previously observed rich in
granules, now appeared poor, and some
seemed entirely devoid of granules. In
addition, we saw some, which besides a
larger or smaller granule, showed one or
more pale-colored, round-shaped vacuoles.
(Fig. 14.)
The spores exhibited an unsxmmetrical
retention of the stain. (Figs. 12 and 13.)
When the specimens were stained with
methyl-blue and Bismarck brown, no mix-
ing of the stains occurred, with the excep-
tion of the black granules which were
situated at ihe periphery of the spores ;
however, the spores took up the blue stain
while the protoplasm generally was affected
by the brown. The spores commonly ex-
ceeded in size the so-called granules, and
approached that of the vacuoles. Their
number does not seem to be greater than
that of the vacuoles ; the maximum num-
ber in a cell noticed by me was four.
With reference to their j^osition in the
cells, it may be stated that they are some-
times irregularl}' scattered, and sometimes
placed along the longitudinal axis of the
cell. In the center one may often see
light spots ; however, at the periphery
may be seen small, black granules which
are identical with those already mentioned,
and which are found either solitary or
united in larger groups. The shape of the
yeast spores was generally circular, but
often they appeared egg-shaped. Among
the well stained examples, we not infre-
quentl)' came across some forms of the
same size, sometimes smaller, which were
stained with Bismarck brown. I was un-'
able to discover a nucleus containing a
nucleolus such as Zalewski saw.
When the yeast was placed in agar not
containing sugar, the vacuoles and spores
of the above-mentioned variety were
formed, except that there was a luxuriant
de\elopment of black granules. I also
obtained spores upon plaster of paris
(Hansen), which I allowed to stiffen in
the shape of an obliqe plane. Similarly,
I obtained the spores in distilled water,
and upon filter-paper (Wasserzug). In the
later phases of their growth, in which the
spores assumed successive volumes, the
surrounding protoplasm gradually van-
ished, and the spores then appeared lying
free, after the manner of their former ar-
rangement.
90
TRANSLATIONS AND ABSTRACTS.
II. Saccharomyces Elijpsoideus.
(Figs. 15-23.)
In these as well as in the following
cases, the same methods of cultivation
and preparation as in the above-men-
tioned experiments, were used. We had,
in this particular, the opportunity of ob-
serving with the help of the microscope
that the number of large, black granules in
each individual cell is small. (Figs. 15
and 16.) But in size, position, and group-
ing, they are in conformity with the sac-
charomyces cerev. I. The same thing holds
in general with regard to the spores. (Figs.
17-19.) The spores are regularly round
in shape, and they contain numerous
dark-colored granules which lie mostly on
the periphery. Among the well-colored
spores, there ajjpeared some detached
structures of a slightly brown color, here
and there, which were more or less nu-
merous, and contained little protoplasm.
We observed among the spore-containing
specimens of the yeast in the old cultures,
>and also in the cells, that the greater num-
ber contained small, black granules (Figs.
20 and 21), which were distributed irregu-
larly in the protoplasm. Cells containing
vacuoles were by no means infre(iuently
seen. (Figs. 22 and 23.)
III. Saccharomyces Ellipsohjeus II.
(Figs. 24-29.)
The granules just spoken of do not
appear to attain such luxuriance in gen-
eral in this form of yeast plant, as in the
two varieties just mentioned. Among the
smaller specimens of the structures we
perceived larger masses similarly colored
black, which evidently resulted from the
union of the smaller granules ; and among
the spore-containing cells we found some
which, besides the spores, held a number of
black granules. (Fig. 26.)
Again, quite frequently, cells were found
which lodged, besides one or more well
colored spores, some bodies which ap-
peared identical with these, but which
were stained, either with Bismarck brown
(Fig. 28) or slightly with methyl-blue.
(Fig. 27.) Small black granules were rare
in spores of the Saccharomyces EUip-
soideus II.: i^renerallv they were solitarv.
IV. Saccharomyces Pastorianus I.
(Figs. 30-38.)
There appears at first sight a distinct
difference between the long, cylindrical
forms of these cells, and the three classes
of round or oval specimens of yeast plants
just considered. Further, this yeast-fun-
gus is noteworthy on account of the size
of the granules. Very frequently we find
only a single large ragged granule, some-
times two, which might easily be mistaken
for a nucleus. However, the absence of
an interior structure, and above all the
irregularity of its contour, weigh against
this conclusion. (Figs. 30-34.)
In many yeast-cells there were large
numbers of small globules. (Figs. 35 and
T,6.) Their share in the proliferation
could be easily observed by the eye ; one
could see them slipping and pouring into
the sprouts. (Figs. 37, t^^, and 39.) We
found in the older cells one or several
round vacuoles and sometimes black gran-
ules. (Figs. 40-43.) The young sprouts
were also covered with vacuoles. It is a
fact worthy of mention that the yeast-cells
may attain their development without a
distribution of black granules. (Fig. 45.)
Here and there we met with young yeast-
cells, which contained vacuoles, but no
indication of a black colored substance..
(Fig. 46.)
The spores of the saccharomyces pasto-
rianus are smaller than" the forms of yeast
plant previously described ; yet the circu-
lar forms are also seen, and they act iden-
tically under staining agents. Their size-
often depends upon the black granules.
I have never found more than three spores,
in a single yeast-cell. Among the well-
colored spores I have observed frequently
some light-brown colored bodies. (Figs.
47 and 48.) The vacuoles, too, in certain
specimens appeared to be able to distrib-
ute themselves. (Figs. 43-48.) In Fig. 47
some black granules are visible.
V. The Saccharomyces Cerevisve
(Figs. 49-62)
Which I have isolated from the commer-
cial compressed yeast of this country, ex-
hibit much more pronounced phenomena
of fermentation than the saccharomyces
cerevisise first described. Under the mi-
croscope, the cells themselves and their
divisions show at first the same propor-
tionate dimensions as the granules, spores,,
and vacuoles.
The former, which vary in number and
size, have an irregular contour when they
are larger, and are circular when smaller..
By staining with Delafield's haematoxylon'
and saffron, the granules take on a marked
violet tint, while sections of the proto-
plasm are more deeply colored. (Figs.
49, 50, and 51.) In the older cultures, by
staining with methyl-blue and Bismarck.
TRANSLATIONS AND ABSTRACTS.
91
brown, large, formless, irregular black
masses become visible. (Fig. 52.) In still
older cells, we observed larger single
black granules, and near the center vacu-
oles which were almost completely color-
less. (Fig. 53.) In old cultures of beervvort,
I observed yeast-cells, within which were
visible s])herical aggregations of larger or
smaller, black or deep brown granules.
(Figs. 54, 55, and 56.) These last forms
seem to be especially important in the so-
lution of the question of the occurrence
of nuclei in the yeast-cells.
When in examination the granules were
grouped in the form of a spheroid, in the
center of which lay a large granule, we
might entertain the suspicion that it was
a (]uestion of nucleus among nucleoli.
But when we observed a whole row of
transition forms, we could readily deter-
mine that it was a special arrangement
of the granules, rather than of genuine
nuclei. For the traditional type of the nu-
cleus, there are wanting, above all things,
the nuclear structure and membrane.
Furthermore, it is hardly probable that the
genuine nuclei would exist in the condi-
tion which our drawings indicate, and then
disappear. However, it must not be said
that from other standpoints the nuclear
character of the black granules can be so
easily denied. It may be that Altmann's
theory of the structure of the nucleus de-
pends ui)on this.
Dark granules are occasionally found in
some of the spores, but generally those of
a certain size. The spores lie sometimes
without order and sometimes correspond
to the long axis of the cell. (Figs. 57, 58,
and 59.) In Fig. 59 is seen a small blue
process of a spore. In some yeast-cells
which were colored with Bismarck brown,
there were circular forms observed; vacu-
oles are not absent in these forms. A
specially interesting form is shown in Fig.
62 ; in this are seen two lengthy cells,
which, from a transient inspection, would
give one the impression of a single cell.
In one of these the presence of four spores
is noticed, in the other only a single well
colored spore is apparent ; while the
other portion of the cell claims attention
on account of four circular vacuoles. It
is worthy of remark that the vacuoles, so
far as the size and arrangement of the
long axis of the cell are concerned, corre-
s])ond to the natural form of the blue-col-
ored cell. The contents of the small
black granules, with res]ject to the vacu-
oles and spores, are beautifully illustrated
in the object mentioned. We see that the
granules are found really only on the
periphery of the vacuoles.
('Jo l:)e Continued. )
Variola and Vaccine. — Dr. Chauveau,
Professor in the Museum of Natural His-
tory of Paris, communicated to the public
a }-esuvie of his researches on the subject
of the transformation of the virus of small-
pox into vaccinia, or vaccine : —
It is well known that a number of phy-
sicians and most of the people believe that
vaccine, or vaccinia, produced from the
bovine species for the purpose of vaccina-
tion against smallpox, is nothing else than
smallpox virus itself, modified by succes-
sive passages through the animal organism.
The Commission of Lyons, France, under
the direction of Dr. Chauveau, has estab-
lished, it seems very positively, that (as
has long been believed by most think-
ing scientists) this is not the case.
The virus used for vaccination (cow-pox
or horse-pox) is certainly a close relative
of the virus of smallpox, and it is perhaps
legitimate to admit that they were derived
from a common source or from one an-
other, in centuries past. But at this time
they are a distinct species, and it seems
impossible to reduce them to a single
species by the known methods and arti-
fices of experimentation. Inoculations of
smallpox in the horse and in cattle pro-
duce variola in them, and the introduc-
tion of the virus thus produced in these
animals, gives to man variola itself. It was
found that the animals inoculated with
smallpox became immune against vaccinia,
just the same as man inoculated with yac-
cinia becomes immune against variola.
The symptoms of these different viruses
in animals vary considerably, and there
can be no mistake made in the diagnosis.
Messrs. Haccius and Eternod of the
Vaccinal Institute of Lancy, Geneva, pro-
duce a vaccinal lymph cultivated on calf,
which is said to be transformed from vari-
ola, and not very long ago published their
conclusion that variola and vaccinia are
probably identical. M. Chauveau, in ex-
perimenting with this lymph, found that it
contained, in reality, the true virus of
smallpox, and therefore it is a dangerous
article to use for vaccination. Vaccine,
then, should not for practical purposes
be considered as an attenuated variola
virus, for the two are now distinct, and
both are strong viruses of their respective
si)ecies, whatever their origin may ha\e
been.
92
BACTERIOLOGICAL NOTES.
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Micdicine. from original sources. |
The Action of Common Salt on
Bacteria. — In Archive filr Hygiene, Vol.
XL, \). Go, C. J. de Freytag explains his re-
searches on the action of chloride of so-
dium on certain bacteria. He found that
the bacilli of charbon are killed after two
hours, while their spores are still alive
after six months. The bacillus of typhus
resists at least five months ; that of Rou-
get (French swine plague), two months.
The bacilli of cholera are destroyed in six
or eight hours ; the streptococcus of ery-
sipelas was still alive after two months ;
the staphylococci resist at least five
months ; the bacillus of tuberculosis is
not dead after three months, nor is that
of diphtheria after three weeks.
Action of the Gastric Juice of Man
on Pathogenous Germs. — M. G. Kur-
loff and K. E. Wagner, in a Russian article
analyzed by Mr. Heidenreich, in the Ce//-
tralblatt filr Bacteriologie und Parasiteii-
kunde, give the result of investigations
concerning the action of the gastric juice
of man on disease germs. In the first
place, they ascertained that the micro-or-
ganisms found in the stomach do not live
in the gastric juice of a healthy individual
longer than from a half hour to an hour,
and perish more or less rapidly according
as the juice is more or less acid. The
average number of microbes found in a
healthy stomach was 700, a quantity too
insignificant to admit of a notable action
in the digestion. The bacillus of anthrax,
the spirillum of cholera, the bacillus of
typhus, tetanus, blue pus, glanders, and
the staphylococcus pyogenes aureus per-
ished generally at 37° C. (or about 99° F.),
in a half hour ; the bacillus of tuberculo-
sis, and the spores of the anthrax bacillus
resisted twenty-four hours. On the other
hand, the first series named, prospered
in gastric juice neutralized or rendered
slightly alkaline. The gastric juice was
taken from the stomach of a healthy man
by means of a sterile stomach-pump.
Messrs. Kurloff and Wagner conclude as
follows : —
" I. There are no special or constant
micro-organisms in the stomach ; those
which arrive there perish rapidly, and are
without action in digestion.
'•2. The gastric juice destroys patho-
genous microbes energetically, and if they
happen to penetrate into the intestines,
this effect is produced independently of
the gastric juice as such.
''3. Only the sporiferous organisms,
such as the bacillus of tuberculosis, the
bacillus of charbon, and staphylococcus
pyogenes aureus may resist the action of
the gastric juice. The others perish in a
half hour.''
-*• — • — ^-
Influence of Temperature on the
Bactericide Action of Light. — A
great number of investigators, including
Roux, Tyndal, Duclaux, and Strauss have
investigated the property of light upon
microbes. More recently Mr. Santori
Saverio {Aumili deW Inst it 11 to d'Igiene
Sperinientele dell' Universite di Ro)na,
\o\. II., Series 2, p. 121) has taken up the
([uestion with special reference to the in-
fluence of temperature on light and its
bactericide action. The following is the
conclusion to which he has arrived : —
1. The bactericide action of solar heat
manifests itself with great energy, even
when it is not accompanied by an elevated
temperature.
2. The violet and red rays of solar heat,
isolated as much as possible by means of
colored glass, do not cause the death of
micro-organisms, nor any visible changes
in their (level()i)ment.
On the Structure of Bacteria. — The
scientific world has about uniformly ac-
cepted the theory that the nucleus is an
indis])ensable element of the normal cell.
The only ground for doubt seems to exist
in the fact that the morphology of bac-
teria is not clear, and that it is uncertain
whether they contain any nuclei. Prof.
Butschli of Heidelberg has, not long since,
contributed an important discovery bear-
ing upon the structure of bacteria, tending
to prove that even these minute organisms
are provided with nuclei. Krnst, as far
back as 1888, disco\ered corpuscles in
bacteria, or rather granulations which
were colored by the ordinary coloring
agents of nuclei, notably haematoxylon.
He concluded that each of these granula-
tions represented a nucleus. Prof. But-
schli in studying the chromatiuni okenii,
a bacteria belonging to the sulphurous
group, discovered a nucleus that he could
stain with haematoxylon. Under the col-
ored annular layer of the chromatiinn ex-
ists the uncolored central portion which
BACTERIOLOGICAL NOTES.
93
contains granules of sulphur. In the in-
dividuals fixed by alcohol and colored by
hsematoxylon, the central portion is stained
more than the rest. In some cases the as-
pect of the bacteria is that of the cell with
its nucleus. The central portion of the cell
exhibits a spaced structure ; it is not pro-
duced by a dissolution of the granules of
sulphur, and it is chiefly observable in sam-
ples fixed by osmic acid or picro-sulphuric
acid. The structure of the color ring is
clearly seen in these preparations, and as
a rule, there is a unique layer of radial lines
which join the central i)art of the cell to
the membrane.
In the specimens fixed by absolute alco-
hol and colored with ha^matoxylon, may
be seen, in the central portion, a number
of granules which may be distinguished
by their coloration of reddish- violet of the
acid haemotoxylon, while the substafice of
the nucleus presents the blue coloring of
the alkaline haematoxylon.
Tubercular Germs and Hospital
Dust. — According to the Times and Reg-
iste?% Prof. Foa has been investigating
hospital dust in one of the hospitals at
Turin. He selected a room in which
there were six tuberculous patients ; then
scraping the wall on a level with the night
table, he injected some of the dust into
three guinea-i)igs, of which one remained
alive, and one died in twenty-four hours
of pyaemia. The other being killed at the
end of three weeks, was found to be af-
fected with general tuberculosis. This
shows the importance of keeping hospitals,
and we might add, lecture rooms, churches,
and all other places where human beings
congregate, free from dust.
Destruction of Microbes by Amoe-
boid Cells in Uiflammation. — Dr. Ar-
mand Ruffer, in a number of the Br it is Ji
Medical Joui'ual^ presented the following
conclusions to some of his experiments ; —
" The inflammatory phenomena con-
secutive to the introduction of the symp-
tomatic bacillus under the skin of the
guinea pig, have a productive and useful
character, and the destruction of microbes
at the point of inoculation is produced en-
tirely by amoeboid cells contained in the
inflammatory exudate."
Since then. Dr. Ruffer has made experi-
ments with the bacillus of Chauveau, by
inoculation on the rabbit, wiiich animal
was regarded as refractory to this disease
by Arloing, Cornevin, Thomas, Roux,
Nocard, and others, and he concludes as
follows : —
" The immunity of the rabbit against the
bacillus of Chauveau is only relative, and
not absolute. This relative immunity is
not due to the want of nutritive matter,
for, if the dose is large enough, the bacil-
lus is easily cultivated in the tissues of the
rabbit."
This leads to the belief that the natural
immunity of the rabbit against this particu-
lar bacillus does not depend on the want of
nourishment in the tissues, nor on the ex-
clusive power of the phagocytes to des-
troy all the microbes, but that various
causes operate in the fight against the
invasion. It brings to mind the idea that
in man, immunit}' against certain maladies
is perhaps always only relative, and that
the chief method of protection rests on
a number of natural means of protection
of the organism, which a certain large
quantity of microbes might overpower
The Bacillus of La G r i p p e. —
Through the kindness of Dr. Fred R. Bel-
knap we have just received a copy of a
German paper containing a report of a
recent exhibition by Prof. Pfeiffer, son-in-
law of Prof. Koch, before a meeting of
German medical gentlemen of high stand-
ing, recently held in Berlin, of the newly
discovered germ which is the cause of
la grippe. As w^e understand the report.
Prof. Pfeifler discovered the germ two
years ago, when the epidemic w-as prevail-
ing so extensively, but was not at that time
able to confirm his discovery by a suffi-
cient number of experiments to warrant
him in presenting it to the public with en-
tire assurance. During the prevalence of
the present epidemic he has had ample
opportunity to study the organism, and
has obtained what he believes to be posi-
tive proof of its nature. He finds the
germ to be a bacillus, and much the small-
est organism of this sort which has ever
been discovered, its length being only one
half that of the minute germ which pro-
duces septicaemia in the mouse, although
its diameter is the same. The bacilli
usually occur two together ; are so small
and short that they often look like mi-
crococci, and may be cultivated. They
sometimes occur in chains. The last-
mentioned fact accounts for their not
being discovered before, as they have
been mistaken for the streptococcus,
which they very closely resemble. The
bacillus is found chiefly in the mucous
membrane and the sputa.
H4
EDITORIAL.
The Bacteriological World
AND
MODERN MEDICINE.
ITKI.ISHKl) .MON'IHI.Y HV IHH
MODERN MEDICINE PUBLISHING CO.
SrHS(-Kii'TiON Prick :
$2.00 ])er Annum. Single Copies, 25 Cents.
Battle Creek, Mich., January, 1892.
TO OUR SUSCRIBERS.
The Bacteriologicai, World enters its
second year of existence wedded under
the name of Bacteriological AV^orld and
Moj)ERN Medicine, as seen by our last
two numbers. We beg again to assure
our readers that, notwithstanding the re-
duction of subscription price, the change
does not indicate any retrenchment in our
bacteriological studies, but rather an in-
crease in quality if not also in quantity,
with the addition of discussions on differ-
ent topics of modern medicine.
In greeting our friends, and the public
interested in medical science, and ex-
tending to all our heartiest good wishes
for 1892, we take the opportunity to an-
nounce that the subscription of every one
who paid for the year 189 1 expired with
the December number of that year. We
trust that all will renew, and that many new
friends will join us, and aid us in our en-
deavors to disseminate information on the
various subjects of bacteriology, and the
different departments of modern medicine,
such as electrotherapy, massotherapy, bal-
neology, etc., etc.
OUR COLLABORATORS AND CONTRIBUTORS.
Doubtless our readers are gratified to
find the names of so many prominent
scientists of various nations on our list.
It is good evidence that during the
year the Bacteriological World and
Modern Medicine will not lack for inter-
esting and useful matter from the most
reliable authorities on the most vital sub-
jects of medical science. Reference to
our title page will convince our readers of
the strength of the corps of writers and
medical thinkers who have consented to
present some of their choicest thoughts,
and the results of some of their researches,
before the American medical fraternity
through our columns. We are still nego-
tiating to secure the names of other promi-
nent men of science, and we are pleased
to announce that Prof. Metchnikoff of the
Institute Pasteur of Paris, in a recent let-
ter to us, advises that he will, as soon as
consistent with his present engagements,
contribute to the Bacteriological WoRLr>
AND Modern Medicine. The renowned
advocate of phagocytosis needs no spe
cial introduction to our readers.
THE GERMICIDAL PROPERTIES OF MILK.
Dr. Freudenreich, after a series of ex-
periments on the action of raw milk on
bacteria, has come to the conclusion that
it possesses remarkable germicidal proper-
ties. He claims that the bacillus of cholera
in fresh cow's milk dies in an hour ; the
bacillus of typhoid fever in twenty four
hours, while other germs die at the end
of varying periods. He further found
that milk exposed to a temperature of
131" F. loses this germicidal property, as
does also milk that is four or five days old.'
These experiments will set the physicians
to thinking very seriously on the advisa-
bility of sterilizing milk for infants' food,
or for food of adults. W5 were just con-
gratulating ourselves on the fact that a
means of preventing the introduction of
disease into the human body through milk,
had been discovered in sterilization. Ac-
cording to Dr. Freudenreich, one might
conclude, at first thought, that we were
mistaken in our expectations and confi-
dence, and that raw milk is, after all,
preferable for human consumption. While
this view of the case seems reasonable,
yet, in our judgment, it should not obtain;
I A notice of this was given on page 60 of the December
nunil;er of the HArTEKior.ooicAr. WoKi.n.
EDITOIIIAL.
95
for the experiments in question do not
indicate that the sterilization of milk
should not still continue, and be considered
a great source of protection against the
germs which may be found in this fluid.
In fact, the object of the artificial sterili-
zation of milk is : First, to deprive the milk
of its fermentive properties, that is, to
destroy the micro-organisms that cause
it to ferment ; and, secondly, to destroy
the microbes of disease that may acci-
dentally be in them. The first object
named is the chief one.
Whatever Dr. Freudenreich may find
concerning the microbicide powers of
milk upon disease germs, it is evident that
raw milk is not a destroyer of all germs
which produce irritant or septic poisons.
It is only sufficient to let milk stand, and
allow all kinds of germs that may, to live
at the expense of it, to prove this to any
one. Consequently, sterilization is needed
to destroy those organisms which milk in
its raw condition is unable to destroy, and
these are certainly the most common
as well as the most dangerous of the
germs of milk, particularly in infant
foods. It is not so much to destroy the
germs of typhoid fever, or tuberculosis, or
any other disease, that sterilization is rec-
ommended, but to destroy germs which
cause the transformation of the various
substances composing the milk, and create
nefarious products. Granted that raw
milk is a bactericide of certain disease
germs, this does not militate against its
sterilization for the other deleterious or-
ganisms which it does not destroy. If,
for instance, the bacillus of cholera dies
in an hour in fresh cows' milk, and the
death of the bacillus of typhoid fever oc-
curs at the end of twenty-four hours, arti-
ficial sterilization can hasten this destruc-
tion, and kill these germs within a few min-
utes. So, from a practical standpoint, no
matter what may be the germicidal prop-
erty in the milk, it does not follow that
one is warranted to depend on it alone
for the sterilization of milk.
The demonstration of the experiment-
alist named, has a great scientific value.
Showing, as it does, the microbe-killing
power of this composition, this experiment
proves, or at least indicates, that milk for
a certain time contains the properties of
certain other vital fluids of the body, such
as blood-serum, and it also suggests that
probably the transmission of certain dis-
ease germs from animals to man through
raw milk as generally utilized, is, in a
measure, prevented by its natural powers.
We cannot see that the discovery should
in any sense be taken as an indication of
a safeguard against individual diseases
produced by milk ferments, particularly
the various and numerous maladies of the
alimentary canal. We would not even
consider it a sufficient safeguard against
the transmission of such germs as those
of typhoid fever or other pathogenic germs
of a similar nature, because frequently
milk is drunk very fresh, several hours
before the time which it would require to
kill them. p. p.
-• — • — •*-
THE HYGIENE OF VALVULAR DISEASE OF
THE HEART.
The time when the physician, consult-
ing with a patient suffering from organic
disease of the heart, was justified in send-
ing him away with the statement that
nothing could be done for him, is, fortu-
nately for this class of invalids, long in the
past. The patient suffering from organic
disease of the heart, who falls into the
hands of a physician who follows a rou-
tine practice in all cases of this sort, may
be, however, equally unfortunate with the
patient suffering from the same malady
fifty years ago.
It is undoubtedly a common custom
with physicians who are consulted by
patients suffering from valvular disease
of the heart, to administer digitalis in
some form as a matter of routine practice,
without taking into careful consideration
the condition of the heart as regards com-
pensation. When one' considers the po-
tency of this drug, and its power to pro-
duce functional disturbance when used
under conditions in which it is contra-in-
90
EDITORIAL.
dicated, it is clearly apparent that this
practice is much to be lamented. It
doubtless many times occurs that patients
suffering from \alvular disease of the
heart, with full or excessive compensa-
tion, have been made to suffer from func-
tional disturbance of the heart, which,
in the natural course of the disease, might
not have appeared for years. The per-
son suffering from this stage of organic
disease of the heart really requires little
or no medication. Regimen and the em-
ployment of such simple hygienic meas-
ures as the patient can himself administer,
are all that the average case demands.
Dr. O. Fraentzel, Professor of Medicine
at Berlin, lays down the following hy-
gienic rules for a person suffering from
valvular disease of the heart, when com-
jjensation exists : —
The patient should not live higher than
the first [second] floor, so as to avoid the
condition of the heart so easily produced
by ascending stairs. In the winter he
should have an apartment facing the
south ; in summer he should live in apart-
ments facing the north. He should dress
according to the season — neither too
warmly nor too lightly. He should wear
flannel, woolen stockings, and shoes with
thick soles, so as to avoid wetting the feet.
He should accustom himself to sleeping
on a hard hair mattress. He should take,
once or twice a week, a walk in the oj^en
air of a distance proportionate to his
strength, but nexer exceeding an hour and
,a half. After eating, he should rest for an
hour or two.
The dietary should be carefull}' regu-
lated. All exciting foods must be inter-
dicted. The patient should also be for-
bidden to take a large amount of food at
one time.
According to Dr. Fraentzel, the patient
should take three meals a day, with break-
fast consisting of a pint of milk and a
little'bread and butter. He says : " Coffee
must be avoided, for it often produces
palpitation of the heart, irregular pulse,
and increases the sensation of oppression,
if it exists."
The author advises that the mid -day
meal, taken at twelve or one o'clock,
should be the principal meal of the day.
All spiced and fat foods must be avoided,
especially fat fish.
The evening meal should be as sparing
as possible, so as to secure to the i)atient
refreshing, calm, and prolonged sleep.
The author considers the reduction of
the quantity of drink a matter of import-
ance. In patients who are emaciated, one
simply interdicts excess of fluids, recpiir-
ing the patient to drink with small swal-
lows, and to take no more liquid than is
strictly necessary to quench thirst. Kut
in corpulent subjects, especially those in
which there is a tendency to oedema, one
must reduce the quantity of fluids to a
quart and even less/*?/" diem. At the be
ginning, this regimen is often very diffi-
cult to support, but the patient soon
habituates himself to it, and appreciates
the beneficial eftects thus secured, which
appear from one to two weeks after this
regimen is begun. Beer and champagne,
as well as coffee, are especially interdicted.
When deficient compensation becomes
evident, the use of digitalis should, accord-
ing to the author, be avoided as long as
possible. The use of tincture of valerian
often secures, in his hands, complete and
durable re-establishment of the compen-
sation. Baths and exercise are often use-
ful, according to M. Fraentzel, but must
be used with discrimination. He says of
the em})l()yment of Swedish movements :
" One obtains, in many cases, results truly
brilliant, manifesting themselves by a con-
siderable increase in the energy of all the
functions of the body. . . . The same thing
can be said concerning baths."
I. H. K.
COLD BATHS IN TYPHOID FEVER.
It is encouraging to note that the pro-
found faith which the profession seemed
to have placed in antifebrin and antipy-
rin, and various other toxic agents, as a
means of lowering the temperature in
fever, is beginning to wane. The writer
EDITORIAL.
9'
has often seen patients suffering from ty-
])hoi(l fever who were almost in a state of
collapse as the result of large doses of
antifebrin or antipyrin ; the temperature
was subnormal, extremities cold, pulse
almost imperceptible, and the fact in-
dicative of a state bordering on that ob-
served as the result of a severe shock.
There are numerous drugs by the admin-
istration of which the temperature may
be loweretl, but the effect obtained is
always toxic, and it is a (piestion well
worthy of consideration, whether the pa-
tient is likely to suffer more from the
elevation of temperature than from the
dejjressing effects of the drug by the ad-
ministration of which the temperature is
lowered.
Recent experiments seem to show that
in fever there is not usually a very great
increase of heat production, but that the
rise of bodily temperature is due rather to
decrease of heat elimination. What is
desirable, then, is not the administration
of a drug by which the heat production
shall be checked, but the employment of
means by which heat elimination shall
be increased.
The best means of increasing heat
elimination are the various methods of
applying cold to the surface. Large com-
presses consisting of a folded sheet wet
in cold water, the cold wet sheet pack,
cold sponging, the graduated cool bath,
and the cool enema are the best means of
lowering the temperature by aiding heat
elimination. The temperature can almost
always be brought down by this means
from }4° to 2°, and when lowered in this
way, the temperature usually remains at a
lower point for some hours, whereas, when
the temperature is brought down by the
administration of a drug, it quickly rises
again.
We are glad to note that these means
of lowering the temperature, particularly
the cool bath, are rapidly coming into use
in this country. They have for some
time been the regular treatment for febrile
conditions in France and Germany. This
method was adopted some little time ago
by the German Hospital at Philadelphia,
as the result of which the mortality in
typhoid fever has been reduced to 4 or 5
per cent, a great contrast with the fatality
of 17 percent, which previously prevailed.
The Hospital of the University of Penn-
sylvania, the Presbyterian Hospital, The
Pennsylvania Hospital, and the Johns
Hopkins Hospital of Baltimore, have re-
cently followed the example of the Ger-
man Hospital in introducing these means
of treating fever. We have relied upon
these means in the treatment of typhoid
fever for nearly seventeen years, and with
the most satisfactory results. In one in-
stance we treated thirty cases of typhoid
fever in succession, without losing a sin-
gle case. The absence of severe compli-
cations was particularly noticeable in
these cases. Severe intestinal ulceration
occurred in only one case, and there was
marked delirium in only two other cases.
A caution ought not to be forgotten
whenever cold is recommended in the
treatment of typhoid fever cases. It
should be remembered that the purpose
of the cold application is to facilitate the
elimination of heat. If the surface is al-
ready cold and has a bluish appearance,
then, of course, cold applications should
not be made. Instead, a hot blanket
pack or a hot bath should be adminis-
tered. A large hot enema is, in these
cases, a very valuable means of overcom-
ing the spasm of the cutaneous vessels,
thus bringing the blood to the surface and
encouraging the elimination of heat. Cold
should never be applied in such a manner
as to produce prolonged chilliness, as this
will defeat the very purpose for which the
application is made. The surface must be
kept warm. This rule is imperative.
The writer has frequently seen the tem-
perature reduced from 104'^ or 105'^ F.
to 101° or 102'^ within two hours, by the
application of the blanket pack, woolen
blankets being wrung out of hot water
and snugly wrapped about the patient.
In such cases, the application of cold
might be fatal in its results. Cold appli-
cations are a very powerful therapeutic
98
EDITORIAL.
means, and may do great damage'^ instead
of good when not properly applied.
Dr. E. C. Elliott, resident physician in
the St. Agnes Hospital, Philadelphia, re-
ports a reduction of mortality in that hos-
pital from 26.6 per cent in 1889, and 24.6
per cent in 1890, to 6.5 per cent in 1891,
after the adoption of the cold bath as a
means of reducing temperature, j. h. k.
The Relation of the Will to the
Passions. — A confirmed thirst for the
use of alcoholic liquor is, at some period
at least, evidently tlie result of a diseased
condition. Though the desire for it may,
for some cause or other, be formed at an
early date, yet it is a very difficult thing
to control without constant dietetic care,
earnest efforts of the will, and all other
means which our common Father has
placed at the command of man. But that
the organism may become so diseased by
alcohol that the will loses control of some
of the faculties, is evident to all who with-
out any bias, and unmindful of theories
or pet ideas, have observed the lives of
drunkards closely, for the sake of arriving
at the truth. There can be no question
but that diet has a great influence on the
character of man, and that bv the different
stimulating foods and beverages certain
appetites are increased, and in some de-
gree abnormal passions developed. No
enlightened man can deny that man is an
aggregation of living cells capable of being
influenced individually and collectively
by the nourishment of which they ]:)artake,
or the material with which they are per-
force brought in contact. Stimulating
diets and exaggerated ingestions of food
tend, by direct action on the cells and by
the resultant effects on the nervous sys-
tem and its faculties, to increase the ap-
petites and lower the power of resistance.
p. p.
sterilizing catgut for surgical purposes
which included among other measures the
boiling of the catgut. Boiled catgut might
make a very palatable broth in the absence
of more wholesome food, but would
scarcely do for the ligation of an artery.
Silkworm-gut, as well as silk, stands boil-
ing well, but catgut and kangaroo tendon
cannot be sterilized by heat without ren-
dering it useless for surgical purposes.
We supjjosed everybody knew this. But
perhaps the writer referred to did not
mean what he said, or is the victim of a
printer's error or a slip of the pen.
-» — •--•-
We were surprised to notice recently,
in an Eastern medical journal, in an
otherwise very able article by a talented
writer and acute observer, directions for
Micro-organisms and Alcohol in
Digestion. — Unscientific minds, and
those looking at the i)roperties of alcohol
from one point of view only, or, in other
words, studying only one side of it, viz.^
the striking features of alcoholism, are not
prei)ared to admit that, in so-called mod-
erate quantities, it is harmful. The experi-
ments which have been made in various
countries, on the action of alcohol (or the
various liquors containing alcohol), on
the tissues of the body, all tend to prove
that water is abstracted from the tissues
with which it comes in contact, and that
the substance composing the structure is
more or less hardened. Under this influ-
ence, the stomach or intestines which re-
ceive a habitual (juantit)' of alcohol, must
be interfered with in their natural secre-
tions necessary for digestion. As a conse-
quence, the food that enters the alimentary
canal fails of complete digestion ; the di-
gestible portions fail to be entirely trans-
formed by the digestive fluids before be-
ing absorbed into the circulation, for as-
similation. The micro-organisms of the
mouth, the micro-organisms of the food,
and the various kinds of ferment-jiroducers
that enter the digestive tract, then prey
on the undigested portions that are in the
organs, cause them to decompose, putrefy,
and produce more or less poisonous or
irritating products, such as ammonia,
scatol, alcohol, etc., and doubtless some
exceedingly toxic substances, such as pto-
maines, tox-albumins, toxic proteids, etc ,
REVIEWS.
n
etc. Thf effect, then, of microbes in an
alimentary canal weakened by alcoholic
beverages, is to produce not only dys-
pepsia, but auto-intoxication by the prod-
ucts of food-decomposition.
From this point of view, it seems to us
unwise for doctors to prescribe so-called
alcoholic stimulants in certain cases of
dyspepsia. This is not the only reason
or ground for rejecting this mode of treat-
ment, but, from a bacteriological stand-
point, it is a source of complication of a
positive character not to be overlooked.
p. p.
Reviews.
The Microscope and Its Revela-
tions. By Wm. B. Carpenter ; 7th edition,
with the first seven chapters entirely rewrit-
ten by the Rev. W. H. Dallinger, L. L. D.,
F. R. S., etc., with 21 plates and 800 wood
engravings. Publishers, P. Blakiston, Son
& Co., Philadelphia. This cyclopedia of
information on matters pertaining to mi-
croscopy— for this book almost deserves
the title of cyclopedia — is perhaps the
most complete work of its kind in the
English language. It is understood that
the Rev. Dallinger has spent a great deal
of time in editing this new edition. It was
time well employed for the medical world,
and all those interested directly or in-
directly will reap great benefits from the
contents of the new volume of over 1,000
pages. The illustrations are all good and
the text clear. It is a splendid book.
Precis d' Analyse Microbiologique
des Eaux. By Dr. Gabriel Roux, Di-
rector of the Municipal Bureau of Hy-
Ljiene of the citv of Lvons, France.
Publishers, J. B. Baillere et Fils, 19 Rue
Hautefeuille, Paris, France. A book of
over 400 pages, containing the technical
methods employed by the author in water
analysis ; also a summary of the diagnoses
of the bacteria of water.
Both from a technical and from a scien-
tific standpoint, this work is an admirable
treatise. It is j)ractical, concise, and con-
densed. It is illustrated by seventy-three
good engravings representing apparatus
and micro-organisms. Few books ar-e
more needed nowadays than good works
on the subject treated by this one, and
perhaps none on the market ia better
adapted to fill the want than it is. The
great role that micro-organisms of water
play in the causation of disease, makes it
incumbent on the medical profession to
study it more and oftener than before the
properties of microbes were known ; and
notwithstanding the imperfections in the
process of research on the subject, every
truly meritorious book of this character
should be hailed with delight. We are
glad of the appearance of this excellent
publication.
Consumption : How to Prevent it
and How to Live with it. — By N. S.
Davis, Jr., M. D. ; Philadelphia, F. A.
Davis. This little work is especially in-
tended for the laity, as is indicated by the
following from the author's preface : '' I
have found it difficult in brief conversa-
tions to impress upon consumptives the
necessity or rigidly executing certain sani-
tary rules, whose fulfillment is essential
to successful treatment of their disease.
This is especially true of patients who live
at a distance and are seldom seen. I
therefore prepared for my patients a series
of hygienic rules, with brief explanations
of the effect of their execution. From
these rules this small volume has grown.
I find that treatment is not persistently
pursued unless a patient fully appreciates
the chronic character of consumption,
and the need of advice and treatment for
years, and especially when the disease is
least active. Consumption is the greatest
])lague of our civilization. I have felt
that the public should be better informed
as to its nature and causes, for many of
the latter can be avoided."
We heartily approve both of the pur-
])ose of the author in the preparation of
this little work and the manner in which
the purpose has been executed. The
medical profession has been exceedingly
remiss in dut\' in the matter of educating
100
EDironiAL.
the public respecting the prevention of
chronic disease, and, as Dr. Davis puts it,
''how to live with it." The majority of
chronic invalids are incurable, in the
strict sense of the word, and the best,
and often the only thing that can be done
for them is to teach them how to so ad-
just their habits in life as to keep in check
the malady which may have in part dis-
abled some vital organ, and ameliorate
the sufferings and inconveniences growing
out of the disease, as much as possible.
Dr. Davis here presents the consumptive
with a book which gives him exactly the
information he ought to have, and which
will doubtless be the means of saving
many lives, and giving to many more
whose lives have been to some extent
blighted by an incurable malady, many
years of comparatively comfortable and
useful life. The nature and prevention
of consumption, hygiene for the consump-
tive, including a judicious consideration
of the subject of climate, and the medi-
cinal treatment of the disease, are among
the interesting subjects which receive a
practical and discriminate treatment by
the author.
The little work ought to be in the hands
of every consumptive, and if some one
will now undertake the same task for a
half dozen other chronic maladies, such
as chronic dyspepsia, Bright's disease,
and rheumatic gout, some progress will
be made in the direction of popular med-
ical education of the people, one of the
crying needs of the times, and the only
successful means of exterminating the
greatest pests of the age — quackery and
the patent-medicine business.
Nursing in Abdominal Surgery and
Diseases of Women. — By Anna M.
Fullerton, M. D.; Philadelphia. P. Blakis-
ton Son & Co. This admirable little work
fills a want which has heretofore not been
met. The after-care of patients in ab-
dominal surgery is a matter of almost as
great importance as the operation itself.
The great decrease in the fatality of ab-
dominal ojjerations which has been at-
tained bv Tait and his followers in recent
years, is more attributable to the adoption
of new methods in the after-care of pa-
tients than to modifications of operative
procedures. This little book expresses
the most approved views respecting the
duties of the nurse in relation to the pa-
tient prior to, during, and after the opera-
tion. The directions given are plain and
concise, and the result of wide observa-
tion and extended experience. Some sur-
geons, like the writer, require the contents
of the bowels to be removed on the second
rather than the third day. As a rule we
should not wish to have ice-cold applica-
tions made to the head after abdominal
operations, on account of the increased
tendency to chill or shock which might be
thereby produced.
This little book ought to be in the hands
of every trained nurse who has anything
to do with the care of abdominal or
gynecological surgical cases.
Catalogue of Chemical and Phys-
ical Apparatus. — Henry Heil Chemical
Co., St. Louis, Mo. This is truly a mag-
nificent book, worthy of being on the shelf
of every one who may need any kind of
physical, chemical, bacteriological, or mi-
croscopical apparatus, scales, etc., etc.,
and scientific books and chemicals. It
contains nearly 450 pages, and is pro-
fusely illustrated with cuts of all manner
of scientific apparatus. A splendid feature
of this catalogue is its perfect index to the
thousands of articles it mentions and ilhis-
trates. Every college, university, labora-
tory, and all interested in scientific work,
should procure a copy.
Practical Bacteriology. — By Thos. E-
Satterthwaite, M. D. ; Leisure Library.
Geo. S. Davis, publisher, Detroit, Mich.
This little book is what it claims to be,
a practical treatise on bacteria for the use
of medical men and others.
Practical Notes on Urine Analysis.
By W. B. Canfield, M. D. (ieo. S. Davis,
publisher, Detroit, Mich. An excellent,
condensed, practical treatise that may
benefit every practitioner and will be
found very useful for students.
The Laboratory of Hygiene
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul PaQUIN, M. D., Director.
iVrONTHLY BLJIvLETTIN
Battlk Crekk, Mich., jANawuN , 1892.
CATGUT AND SILK LIGATURES.
Ix our Xoveinber number, an editorial ap-
peared, giving' the substance of experiments
made by Klemm {Bulletin Gnifirnl de Th^ropeii-
tique), concerning- tiie infection of sni-gical
wounds by catgut. These experiments, he
states, developed tlie fact that catgut, though
thoroughly sterilized when used, deconij)Oses,
and offers a, medium for the deveIoj)ment of
germs, while silk has no sucii properties of dis-
turbance. By request of the Superiutendent of
the Laboratory of Hygiene, the Director has
undertaken a series ol experiments with a view
of verifying or dispi'oving' Klemm's assertions,
and also with a view of establishing further
what kind of catgut ligatures, if any, are per-
fectly sterile.
In the first place, cultures wei'e n»ade with
eight different kinds of catgut, as follows: —
A. Chro mated No. 1, Lister Manufactur-
ing Co.
B. Turpentine or i)ine gum (?), manufac-
tured by C. ^r. Ende.
C. Alcoholic medium (?), INTyron E. Myer
ALanufacturing Co.
1). Surgeons' Chromic Acid, manufactured
by Siiarj) tV: Smith.
E. Surgeons' Carbolic Acid, manufactui-ed
by Sharj) & Smith.
F. Juniper, Lister Manufacturing Co.
,G. Carbolized gut, manufactured by Seabury
& Johnson.
H. Chroma ted No. 3, Lister Manufactur-
ing Co.
h\ sei'ies No. 1, a bit of catgut from each of
these specimens was snipped with a sterile pair
of scissors, and dropped without washing
into neutral liquid beef broth. In series No. 2,
a bit of each specimen was washed in sterile
watei" and di"oi)ped into sterilized beef broth.
Thirty-two cultures were niade, two of each
kind, for each series. In the first series (No.
1), made with unwashed catgut, there was not
a single growth of germs. In the second series
(No. 2), two tubes developed gi-owths, which,
however, undoubtedly came from contamina-
(10
tion while washing, because repeate<l cultures
made afterward from the same catgut in the
same way, pi'oduced no gi-owth. So it is safe
to conclude that all these specimens (which
were old ones, and had been a long tinie in
the sterilizing fluid) were perfectly stei-ile and
all equally good from this standpoint.
Then a series of experiments were made upon
two i-abbits, as follows : With rabbit No. 1,
the skin was washed thoroughly with soai>
and water on one side, and then witli a weak
solution, 1-5000 of bichloiide of mei-cury.
Four sterilized needles were threaded with liga-
tures A, B, C, and D respectively', and each was
passed under the skin in the manner of sewing
a wound, in the washed side of the I'abbit. The
extremities of these bits of catgut w.ei-e tied to-
gether in the manner of sutures. Then four
silk sutures which had been in the same solu-
tions respectively as contained the catgut liga-
tures, for a pei'iod of seventy-two hours,
were inserted likewise between each of the gut
ligatures, thus making a row of eight ligatures
of catgut and silk alternately, begininu,- with
the foruier and ending with the latter.
Precisely the same thing was done with rab-
bit No. 2 with catgut ligatures E, F, G and H,
and silks which had been soaked in th<'ir re-
spective fluids.
The result was as follows : At the end of
the third day, the pus in each suture-cavity
was studied. It was found that the number
of micro-organisms in each of the catgut sut-
ures was, in average, ten times larger than in
the silk sutures, the number being gi-eater
in the cavity nmde by the largest caliber of
catgut, and snmller with the finest kind. The
quantity of the suppuration was greater in
every case of catgut suture than in the silk
sutui'es.
At the end of the fifth day, two of the catgut
sutures, and two of the silk sutures of each
rabbit were cut out; the cavities of each suture
])resente<l an increase of micro-organisms, but
pro|)ortionately the same relation as shown
by the first study of them. In studying the
bits of ligature, it was found that the cat-
1)
102
LABORATORY OF HYGIENE.
4»ut was Hoftening- mihI was liarboi'iiig' a miui-
ber of germs; it seemed to fiiriiisli a pabu-
lum for tlieir growth, the larger si)eeiiner)s of
«ntiire being, in one or two instances, thor-
oughly impregnated with microbes. The silk
suture was also impregnated with germs, al-
though in a smaller quantity, and they were
rather on the exterior of the thread than
through it, as a washing in sterile water of
both the catgut and of the latter demon-
strated.
At the end of theeiglith day, suppuration of
the catgut was still continuing, but that of the
finest kind of sutures used was much less than
that of the coarsest, the latter being very pro-
fuse. In the silk ligatures, suppuration was
slight; scarcely' less, however, than that of
the finest of the catgut. On this day, the
two remaining catgut ligatures and silk liga-
tures in each rabbit were cut close to the body,
at each extremity, leaving a portion of each in-
side of the skin ; theu tlie surface of the body
was washed witli bichloride of mercury, tlie pus
pressed out, and the openings were washed as
well as possible with a disinfectant.
On the ninth day, rabbit No. 1 died from in-
fection developed from an oedema surrounding
the inroad made by the largest of the catgut
sutures left in. All the open suture wounds
seemed normal, being in a nice way of healing.
Each of the cavities where the bits of sutures
had been left in the skin were split open, and in
each case the ])uw of the catgut was more pro-
fusethanin thatin the silk cavity, but in neither
case was it very great. The finest gut threads
had about liquefied and disappeared.
On the tenth day each wound of i-abbit No. 2^
which still contained a bit of suture inside, was
split open. In one of the catgut cavities, quite
a, little abscess burrowing under the skin into
the niuscles had been formed. The catgut, a
large one, was decomposed and almost lique-
fied, and on a microscoi)ical examination pre-
sented a mass of microbes. The other, a small
catgut thread, had been all destroyed, and had
disappeared, and the wound was healing. One
of the silk ligatures had been i)ulled out by ac-
cident, and the wound was j)ractically closed.
The other silk ligature was still inside of the
skin; suppuration was slight.
The relative quantity of microbes, as pre-
sented by colonies on ])late-culture, was as
follows: —
Culture made on the fifth day from four dif-
ferent catgut ligatures developed 362, 568,
601, and 627 colonies respectively.
Four plate-cultures made from four different
silk sutures in the same nmnner, with about
equal proportions of material tVoni a silk
suture, developed 21, 28, 42, and 150 colonies
respectively.
Cultures made on the tenth day in the same
manner from catgut and the silk, ^ave about
the same relative proportions of colonies in
their growth, exce[)t one silk sutuiv (Milture
which developed 205. In no case of catgut
ligature were the number of colonies below 300.
We conclude that Klemm is correct in his
opinion that catgut should be excluded from
surgical practice, and that the reason why
more infection follows its use than in the use of
silk, is that it offers ])abulum for the develop-
ment of germs. Thecatgut becomes moistened
and softened in the tissues, both by the warmth
and the natural liquid material, and offers, as
soon as it is free from the disinfecting material
(which gradually takes place, and seems com-
plete about the tliii'd, fourth, or fifth day), a
non-resisting medium for the development of
micro-organisms ; so they begin to grow at the
expense of it, notwithstanding the living resis-
tance of the tissues surrounding it.
In the case of the silk suture, it is only very
slowly that the germs can develop, because
they have to grow at the vei-y outset at the
expense of living tissues or their secretions, or
at the expense of blood, the latter being usually
the first pabulum for their development. They
encounter from the very beginning more or less
resistance from the animal cells and the micro-
bicide fluids of the tissues, and it is only after
they have succeeded in destroying some of the
cells in their neighborhood, by the properties of
their diastase and by the poisons which they
genei-ate, that they are (capable of reproducing
themselves in greater numbers and gradually
infecting the wound. Klemm, in our o|)inion,
is justified in rejecting catgut sutures and giv-
ing preference to silk.
BACTERIOLOGICAL STUDIES OF DR. KELLOGG'S
ASEPTIC DRAINAGE-TUBE.
OcTOBKR 11, 1891, by request of Dr. Kellogg,
Supt., the Director of the Laboratory, began
a series of investigations concerning the nature
of the njaterial of the wounds of three patients
lying in the Sanitarium Hospital, which were
daily drained by means of a certain device
whicli Dr. Kellogg has improvised. (See figures
,of the drainage-tubes, pages 106, 107.) The
following is a brief account of the studies: —
Case 1. Abdominal opening of several inches
(operation on uterus performed several days
befon^ by Dr. K.). Cultures A, D, C, of fluid
LABORATORY OF HYGIENE.
103
beef brotli. beef and gelatine, and beef and
agar-agar, respectively.
Material of inoculation of tube A was from
t-lie mouth of stationary drainage-tube. Re-
mained sterile.
Tube B, material from inside walls of drain-
age-tube, remained sterile. •
Tube C, from material drawn from the abdo-
men through drainage-tul)e (about ten drojjs
used), remained sterile.
Case No. 2. Abdominal wound as case 1.
Drainage-tube in position a few days.
Cultures D, E, F, of fluid beef, beef and gela-
tine, and beef and agar, res[)ectively. The cul-
ture made and methods of inoculation and
origin of material were in Q\evy respect the
same as for case 1, and the results were likewise
negative.
The last syringe-full of serous fluid drawn
from this wound through drainage-tube, was
carried to the laboratory, and six beef broth
tubes and four agar-agar tubes were inocu-
lated. One of the latter developed, aftei- two
da^'s, at a temj)era.tui-e of 80° F., one single
colony of staphylococcus ])yogenes aureus.
It began with a very fine point, as if but a sin-
gle germ had been inoculated.
Case No. 3. Abdominal wound from surgical
operation similar to the first two cases. Made
two cultures, G and H, liquid beef, and gelatine
and beef, respectively. G was inoculated from
material from inside the mouth and edges of
the mouth of drainage-tube. It presented after
thirty six hours (at 80° F.) the staphylo-
coccus pyogenes aureus in snmll numbers, and
a few bacilli.
H, inoculated with material from inside walls
of body of tube, also ])resented, after thirty-six
hours, a few cocci. Fluid bi-ought to laboratory
and analyzed microscopic^ally faih'd to reveal
any germs, but on making a plate culture, it
developed, in four furrows made crosswise with
the inoculatius wire, ten colonies of cocci and
no bacilli, from which we may conclude that
the bacilli seen in previous cultures were from
contamination in manipulations.
Dr. Kellogg had predictefl, for sonie certain
reasons pertaining to some irregularity, that
this case would reveal moi-e impurity than
the other, and it proved to be the case.
Further Experiments \A^ith Vaccine. — Since
the last issue of the Bacteriological Would,
we have to report theresult of a series of expei-i-
ments undertaken to enlighten us on the fol-
lowing points : 1. What degree and what kind
(generally speaking) of microbic contamina-
tions of vaccine are dangerous. 2. Are the air
germs which fall on the i)ui-e vaccinia pus-
tules when dipping the points, sufficiently nu-
merous to be considered harmful?
Series A. Commercial vaccine crust bought
in the market, presenting by culture five spe-
cies of microbes, three of which were capable,
when isolated and in sufficient uumbei-s, to
cause various disturbances ranging from local
abscesses and oedema to general septicfBinia
and death. A particle as large as a pea was
crushed in a. clean sterile watch-glass in sixty
minims of sterile distilled water, with a sterile
glass rod. After mashing, standing, and mac-
erating an hour, ju-otected from air impui'ities,
in a cool place, six rabbits were inoculated with
eight drops each hypodermi(?ally at the side.
Every one developed a swelling, one an ab-
scess, one a diffused oedema, and one a hard
enlargeuient which lasted several days.
Series B. Vaccine crust developed purposely
in the most cleanly mannei* on the white tegu-
ment of a very healthy calf. Cultui-e developed
one pus geiMu and two hai-mless ones. A bit of
crust, size of a ])ea, was mashed and niacerated
as in series A, for an hour in a cool place. Six
rabbits were inoculated hypoderuiically at the
side (flank) with eight drops each. Four de-
veloped noticeable swellings, two of which were
somewhat diffused, one of the two forming
a small abscess. Two i-abbits had small en-
largements barely perceptible by cai-eful digi-
tal examination.
Series C. Five vaccine points of commerce,
showing by culture three kinds of foreign germs,
of which one was pathogenic, weie ])laced in
60 minims sterile distilled water, and allowed
to renmin an hour in a cool place. Micioscop-
ical analysis of five other i)oints of this same
package (evidently from the same ciop) de-
monstrated but few foreign germs to each
])oint. Eight drops from the liquid well sjiaken,
were inoculated hypodermically into each of six
rabbits. Two developed a swelling i-eadily no-
ticeable, and one of these a diffused oedema ra-
diating two inches from the point of inocula-
tion. One of the others had a barely noticeable
enlargement at the i)oint of inoculation.
Series J). Five vaccine points having been
dipped twice in same pustules one day apart;
i. e., second dipping one day after the first, by
removing the second scab, as is frequently done
by commercial establishments. The crop was
cultivated with care on a. heal thy calf, anda.llthe
manipulations done in as cleanly a manner as
possible. Microscopical analysis and cultures
after the first dipping developed two harmless
air germs. Five points were (Iropi)ed in a di-am
of stei-ile distilled water after the first dipping,
and soaked for an hour in a cool place. Six
rabbits inoculated with eight dro[)8 each of
104
LABORATORY OF HYGIENE.
this fluid failed to produce any enlargement ex-
cept a slight inflaniniatoi-y action at tlie point
of inoculation, whicli disappeared early. It may
have been induced partly by the vaccinia cocci ;
but there were no pronounced effects as in
case of inoculation of more impure virus. Aftei*
the second dipping, the vaccine pointscontained
three kinds of i)athogenic bacteria. Five points
wei-e soaked an hour at cool temperature in a
dram of sterile distilled water. Eight di'ops
were inoculated hypodermically into each of six
rabbits, and three of them developed marked
enlargements, and one a slight abscess. The
other three remained practically intact. It will
be obsei'ved that under the scabs of the i)us"
tules at this second dipping, there was consider-
able ])us (often mistaken for pure coagulated
vaccine lymph), and pus germs almost as nu-
Tiierons as in an artificial culture. All this was
wiped off as clean as could be done with a clean
cloth and sponge, but evidently many of the mi-
crobes remained notwithstanding the cleansing.
Series E. Ten vaccine points from vaccine
produced with the greatest care. By cultures
and microscopical examination, these points
demonsti:ated but two kinds of foreign germs
and very few in number. One was a pus germ
— the stai)hylococcus pyogenes aureus. Five
points were ])ut in one dram of sterile distilled
water in a test-tube (No. 1), and' the five others
in one di-ani of sterile water in another tube
(No. 2). The first virus (tube 1) was inoculated
in doses of eight drops each into six i-abbits.
Only one presented a characteristic swelling
— an enlargement with slight diffusion. The
other ])resented little or no disturbance.
The vi)-us of tube No. 2 was inoculated after
remaining in the sterile water for six hours at
a warm tempei'uture. The liquid by this time
was very turbid ; inoculations of eight drops
each into six rabbits developed marked en-
largements in four, among which one abscess
was formed, and one death occurred. The
other two rabbits had slight enlargements
which subsided in a few days.
Conclusions: —
1. The degree of purity of virus is in ratio
with the number and kind of foreign germs it
contains — the fewer they are in number, their
specific property considered, the safer it is.
2. Air germs that fall on points and in pus-
tules while charging the former, providing the
air is as pure as it can be made, and all the an-
tiseptic precautions necessary' be taken, are not
sufficient to make the virus dangei-ous to use.
3. Comparatively sale vaccine may, natu-
j-ally, be made impure and dangerous by allow-
ing it to remain in water at a warm tempera-
ture.
Technique.
To Mount Cover-Glass Preparations in Canada
Balsam. — Most of those who use a microscope
have pei-haps been taught different methods of
applying the Cjfnada balsam to the slide and
cover-glass, but in the majority of cases the
method in vogue is to drop a little balsam on
the upper surface of the slide held horizontally,
or on the face of the cover-glass preparation,
and then stick the two together as near as
possible to the center of the slide. The incon-
veniences of this method are as follows : In the
first place, it is difficult to center the balsam,
thoroughly, because the fingers holding the
balsam are in the way of vision, and the drop
is often larger than necessary, or is not centei-ed
well. Again: by this method the Canada bal-
sam is turned upward for a Jime, and fre-
quently until the cover-glass is applied, and
dusts from the air which fall on it adhere and
remain in the mount. The Director of this
Laboratory has loug since employed the follow-
ing method : Taking the clean slide with the
left hand, — the thumb and the index-finger hold-
ing it in a horizontal position about opposite
the chest, so he can look through the glass
downward, — he takes a tube of filtered Canada
balsam such as we have in the market, and
presses yery gently a small droj) in the center
of the slide on its under surface. By this means
he can see the droj) coming out of the balsjim
tube up to the slide, and he can center it as
exactly as his eyes can measure, and can make
it as large or as small as he pleases, and all
the time the balsam is protected from the
falling dusts of the room. The balsam being
on undei' surface of the slide, it is then laid
down, the balsam downward, with one end rest-
ing on something, making an angle between the
slide and the table, to prevent the balsam fi'oni
touching. Thus it is protected from flying dust
until ready for use.
When the cover-glass pi-epai'ation is ready
(that is, when it is ready to be applied to the
balsam), it is lai<l on a pai)er, smeared face uj)-
ward, and taking up the slide, one end betweeii
the thumb and index-finger of the left hand,
and the other end between the index-finger and
thumb of the right hand, he a[)plies it on the
upturned face of the cover-glass. He is thus en-
abled to see the cover-glass through the slide,
and can center it much better than if the slide
was turned upward and cover-glass dropped
on it. This being done, he revei-ses the slide,
and with the cover-glass upward, passes it to
and fro ovei* the blazeof a lamp or a gas-jet un-
til sufficiently cooked, if specimens will permit.
BULLETIN OF the
Medical and Surgical Sanitarium,
Battle Creek, Michigan.
Thk purpose of this department is to constitute, together with the Bulletin of the Laboratory of Hygiene, a record of the
scientific work in the Medical and Surgical Sanitarium located at Battle Creek, Michigan, an institution incorporated as an
organized and self-supporting charitable enterprise, all the earnings of the institution being devoted to charitable and medica
work, and the advancement of scientific medicine.
ANTISEPTIC DRAINAGE IN ABDOMINAL
SURGERY.
Thi:re lias recently been niucli discussion
among- gynecological surgeons regarding the
best methods of securing comi»lete asepsis in
connection with drainage after laparotomies.
Various methods have been proposed, the chiej
of which are tlie following: —
1. Filling tlie drainage-tube with gauze, al-
lowing the fluids to drain out by capillary
action.
2. Avoiding the useof the syringe for evacuat-
ing fluids, and removing the fluid by forceps
and bits of cotton passed down the drainage-
tube (Kelley's method).
3. The use of a piece ot twisted gauze as a
capillary drain, without using the glass tube.
The evident purpose of these suggestions is
to avoid something, by means of which the
fluids of the abdomen have heretofore been so
likely to become infected that it has by the
best operators been considered hazardous to
leave the tube in place more than two or three
days.
Lawson Tait told the writer two years ago
that the drainage-tube gave him more anxiety
and trouble than any other one matter con-
nected with abdominal surgery. AVhen the
<lrainage-tube was left in more than two or
three days, if managed in the ordinary way,
the accumulating fluids being evacuated by
some sort of suction apparatus, the fluids
almost invariably became turbid by the devel-
opment of bacteria of various sorts; and suj)-
puration, likely to be followed by a flstula or
slow healing of the wound, was almost certain
to result.
In their efforts to secure asepsis in connec-
tion with the drainage tube, various experi-
menters who have sought to solve the problem,
have not, so far as I can learn from reading
the reports of their results, a clear idea of the
real cause of the infection through the drain-
age-tube. Some have entertained the idea
that the microbes gi-adually found their way
down the tube by a growth along its inside
surface. Others have believed that a similar
10
growth took place along the outside surface of
the tube.
In the opinion of the wi-iter, neither of these
suppositions recognizes the true source of in-
fection, except in certain cases in which there
has been gross neglect of asepsis in the dress-
ing of the wound at the time of operation, or
in its after management.
A simple experiment will convince any one of
the real source of infection when the drainage-
tube is evacuated b3^ suction. Take a bottle,
fill it two thirds full of fluid, and pass into
it a drainage-tube through a perforated rubber
cork. The drainage-tube should be introduced
sufficiently to submerge all the lateral open-
ings of the tube. Now draw out some of the
fluid from the bottle by means of any of the
suction appliances used for the purpose, and
note the result. It will be observed that as
soon as suction begins, the fluid in the tube
begins to sink below the common level of the
fluid in the bottle, it continues to fall until it
reaches one of the lateral openings or the bot-
tom of the tube, if the suction is strong. It
will then be observed that several bubbles of
air escape from the tube into the surrounding-
liquid and pass up into the air space of the
bottle, external to the drainage-tube. A mo-
mentary consideration of the conditions pres-
ent will show the absolute necessity of this
action. The mouth of the bottle being tightly
closed, it is evident that no fluid except that in
the tube itself can be evacuated from the bottle
without the admission of an equal amount of
air; that is, for every ounce of watei* taken
from the bottle, an ounce of air nmst be ad-
mitted. The air is drawn down the drainage-
tube, and passes up into the interior of the
bottle outside of it.
This is precisely what happens in the evacua-
tion of fluid through a drainage-tube placed in
the abdomen, when the same means is em-
ployed. Whatever quantity of fluid is with-
drawn, an equal amount of aii-, carrying its
load of germs of various sorts, enters the
drainage-tube and passes out into the abdomi-
nal cavity. It should be noticed, also, that
the current of air which is drawu into the tube
is concentrated upon tlie tissues which lie
'>)
106
SANITARIUM BULLETIN.
about the lowei- end of tlie drainage-tube.
The fluid wliich is being" drawn out doubtless
carries away with it a large share of tlie gern)s
introduced, but as the air bubbles up into the
al:)doininal cavity, many germs must be carried
Ayith it.
The writei* became convinced more than two
y^ars ago that this is the wery method by
which infection occurs in the use of the drain-
age-tube, an<l set about devising means to j)re-
vent it. The first method employed was to plug
the mouth of the drainage-tube, after introduc-
ing the rubbei- tube of the evacuating syringe,
with cotton, so that all the air which entered
the tube as the fluid was evacuated, would be
filtered tlnough the cotton. This method, if
carefully managed, is I'eally efficient, but as a
more j)ositive and certain method, I arranged
a sinj|)le device wliich is shown in the accom-
panying cut. It consists, as will be seen, of
the following ])arts: A, the cotton filter — a
simple thistle tube filled with cotton and cov-
ered with sheet lint. B, a wash bottle. t\ a
drainage-tube ])recisely like an ordinary drain-
age-tuVje, except that it has a, lateral opening
leading into a small short tube near its upper
end. Z>, an ordinary evacuating syringe, the
tube of which passes through a i-ubber cork by
which the upper end ©f the drainage-tube is
closed while the fluid is being drawn out. The
woiking of this device will be remlily under-
stood. As the fluid is drawn into the evacuat-
ing syringe, air is drawn down through the
cotton filter, bubbles up through the wash bot-
tle, passes through the i-ubber tube into the
drainage-tube outside the i-ubber tube tli rough
which the fluid is evacuated. By this means
the air which enters the drainage-tube is thor-
oughly filtered.
This device, or some modification of it, I
have employed for the last
.year and a half with excel-
lent i-esults. In one case the
di-ain age-tube was kept in
ten days without the ap-
pearance of any turbidity of
the evacuated fluid. Two or
three days later, however,
the fluid became slightly
turbid through neglect* of
the necessary aseptic pre-
cautions on the part of the
nurse. In another case,
where the tube was ke|)t in
1)1 ace four days, very careful
bacteriological exam i na-
tions were made by Prof.
Paquin, Director of tlie Lab-
oratory of Hygiene. Ex-
aminations were made of
the outer surface of the
tube, the inner surface, and
of the fluid evacuated. No
growths of any sort ap-
peared.
In a laboratory experi-
ment, in which a flask was
made to represent the ab-
dominal cavity, and bouil-
lon the fluid to be evacu-
ated, the fluid remained
perfectly sterile during two
weeks, although a portion
of the fluid was daily evacu-
ated by means of the device
above described. The fluid
finally became infected by
accident, through the ap-
paratus being accidentally
disturbed.
Figs. 2, 3, and 4 indicate forms of the de-
vice which are equally efficient. In No. 2,
the lateral tube is avoided, both tubes passing
through the cork. The tube for the adniission-
of air is indicated larger than is necessary, and
the evacuating tube smaller. In Fig. 3, the
thistle-tube containing the cotton is connected
directly with the drainage-tube, instead of
with the wash-bottle. If the apparatus is care-
fully used, this method is equally effective with.
SANITARIUM BULLETIN.
lOT
tlie aTr;iii<>einpnt ill wliicli tlie wasli-bottle was
employed. The jirincipul advantage of the
wasli-bottle is to indicate that the apparatus is
working perfectly, and that no air enters which
does not pass througii the filter. Thefluid con-
tained in the wash-bottle is a mixtureof chloro-
form, alcohol, and glycerine. One advantage
of the wash-bottle is that the air which enters
the abdominal cavity is charged with the odor
of chloroform, which is a powerful antiseptic.
Fig. 4 shows the simple method which \ first
employed, and which, by the exercise of great
care, may be perfectly effective. The perfo-
rated tube is simply surrounded by cotton at
the mouth of the drainage-tube, the cotton be-
ing sufficiently pa.cked to secure iirojier filtra.-
tion of the air. In employing any of these
devices it is necessary to disconnect the syringe
ench time it is filled. A
few points should be
mentioned respecting
the care of the drainage-
tube and the device for
evacuating the fiuid : —
In dressing the wound
the drainage-tube is sur-
rounded with moist
gauze heavily loaded
with iodoform. The
drainge-tube is lightly
plugge<l with cotton wet
in 1-1000 bi-chloride so-
lution. A broad jiiece of
sheet rubber is slipi)ed
over the upper end of the
drainage-tube, as ])ra(;-
ticed by Thornton, of
London. The evacuating syringe and tube are
kept immersed in a 1-1000 bi-chloride solution.
When the evacuating device is to be used, the
hands are first sterilized as lor a surgical oper-
ation. While handling the evacuating appara-
tus, the hands are kept wet with the 1-1000
bi-chlori<le solution, so that if any germs be
found lingering upon the fingers, and left be-
hind ujion the drainage-tube, an efficient anti-
dote will be left with them.
This device may seem somewhat complicated,
and its use troublesome. This is not the case,
liowever, and after once becoming accustomed
to its use, scarcely more time is required than
in the employment of the ordinary means.
The objections to which the other methods
referred to as having been proposed appear to
us to be open, are as follows: —
1. When the drainage-tube is plugged with
gauze, the lower end of the plug, as Dr. Joseph
Price has very well observed, becomes almost
im])ervious to fluids and the coagulation of
fibei', so the {ilug is I'eally a very inefficient
drain.
Another disadvantage of this method is that
fragments of debris and clots which are fre-
quently removed when the suction method is
employed, are left behind and serve as a nidus
for the development of microbes and a starting
point for inflammatory processes. It is some-
times impossible to remove every ])article of
detritus in certain cases, even by washing the
abdominal cavity in the most thorough man-
ner. These articles gravitate down to the
drainage-tube and by the suction method may
be drawn out, but are almost certain to Ije
left behind when the tube is filled with the
gauze iilug, although now and then some small
particle may be found adhering to the end of
the plug when it is drawn out.
Fig. 2.
Fig. 3.
Fig. 4.
The suction method has, undoubtedly, some
influence in drawing in thefluid from the terri-
tory surrounding the end of the tube, while the
capillary drain is compelled to act against
gravity, and when large tumors have been re-
moved, does not iiave the assistance of the
abdominal tension, which, if normal in degree,
might in many cases render this method of
drainage quite efficient.
Dr. Kelly's method is exceeding tedious, and
has many of the same disadvantages as the
gauze plug, since it does not remove the detri-
tus and does not draw in fluids which maybe
lying in the neigiiborhood f»f the tube, but
which are prevented from freely gravitating
toward it by the close contiguity' of the intesti-
nal folds.
This method offers another disadvantage
which appears to us to be very considerable.
The passing in of many ])lugs of cotton, one
after another, might serve to pump in a large
quantity of germ-laden air, and this would fa-
108
SAXITARIUM BULLETIX.
cilitateitifectioii. Nevertlieless, thebaeterioloji-
ical studies made in connection with Dr. Kelly's
method showed very good results, altliougli in
several instances infection did occur.
The <i;anze drain is certainly open to nianj^
serious objections. It may fii'st be objected to
on the grounds mentioned with reference to
the gauze plug for the glass drainage-tube. In
addition, it is liable to become misplaced.
There must certainly be \^y\ great danger of
displacement of the lower end, so that one can-
not be confident that the drain leaches to the
lowest part of the abdominal cavity, or that it
has remained whei-e placed at the time of the
operation.
One is often in doubt as to whether the
drainage-tube should or should not be em-
ployed. The rule Ijlid down by Tait 1ms been.
When in doubt, drain. Nevertheless, the in-
conveniences and dangers of the drainage-
tube when employed in the usual manner, must
lead many times to a decision to omit its use,
even when on some accounts its employment
would be very desirable. If the surgeon could
feel that the drainage-tube could be em-
ployed with perfect safety, and without any
danger whatever of infection, or delay in the
healing of the wound, he would certainly em-
ploy it more frequently than he otherwise
would, and in so doing would sometimes
avoid disaster to his patient and disappoint-
ment to himself.
In the Bulletin of the Laboratory of Hygiene
for this month will be found a, detailed account
of the bacteriological observations in connec-
tion with the device desci-ibed in this article.
.r. H. K.
THE VALUE AND USE OF INHALATIONS IN
THE TREATMENT OF DISEASES OF THE
RESPIRATORY ORGANS.
BY H. M. DUNLAP, M. D.
Sanitarium, Battle Creek, Mich.
What constitutes the best method of treating
diseases of the respiratory organs, is a ques-
tion which should occupy a large place in the
minds of all medical men. There is no other
class of diseases so prevalent, nor so fruitful in
the destruction of human life. Statistics bear
us out in this. It is true that much attention
has been given to the consideration of tubercu-
losis, its etiology and pathology, and within
the last few years many have labored to dis-
cover some new remedy which should be a spe-
cific in all cases. As a result, niany poor
victims of this disease have undergone experi-
mentation with hydrogen sulphide gas, Wei-
gart's hot air apparatus, and various other
medical fads, until finally Koch's tuberculine
created universal excitement, but like all the
other panaceas has also practically fallen out
of use.
All of tlipse efforts are commendable, not-
withstanding their failure as pjuiaceas: and if
the desired end could be attained, it would
yield one of the greatest blessings ever be-
stowed on humanity. Inthis,asin other linesof
woi-k, there is dangei- that, in onr effoi'ts to ac-
complish a great good, our minds shall be
drawn away from some of the smaller every-
day matters, which are consequently neglected;
yet these, if faithfully attended to, might in t\w
end 3'ield a more abundant harvest of good.
Thus, in the efToit to discover a cure foi- pul-
monary tuberculosis aftei- it has become devel-
oped as such, we are in danger of neglecting
some of the su!)posed less importantconditions
which may in reality be the recruiting agents
which help to fill the ranks with new victims of
this formidable malady. This is true in a sj^e-
cial sense when we consider the many pulmo-
nai-y conq)lications of hi ffrippe, which seems
to have liecome an annual visitor.
Would it not be well, then, to consider whether
we are nmking the best use of many of the old
remedies, and whether we are employing the
best methods for their administration? To my
mind, tliei-e is much room for improvement in
the old methods generally employed, not only
in tuber(!ulosis and those diseases which tend
more directly to favor its production, but also
in nearly all diseases of the respiratory organs,
including the entire tract from its beginning in
the nasal passages, to its end in the air cells
and lung tissue surrounding them. I have
given considerabre attention to the treatment
of diseases of the respiratory apparatus by
means of local applications directly to the part
affected. I have not been able to discover any
good reason why we should not treat diseases
of this class on exactly the same principles
that we employ in disease of other parts of the
body. It is not impossible, nor even difficult,
to bring medicinal agents directly in contact
with every part of the mucous membrane of
the air passages, not excepting the frontal
sinuses and other cavities communicating with
the nasal cavity. In the treatment of those
cases in which the mucous and submucous
tissues are invoh^ed, whether acute or chronic,
there are two essential points on which success
depends: —
1. Whatevei- agent is used must reach every
part involved.
2. Its action on the tissues must be main-
tained as constantly as possible.
SANITARIUM BULLETIN.
109
The first depends on the method of admin-
istration, the second, on the frequency of
application, and the character of the agent
employed.
I hav^e obtained far better results by the fre-
quent use of mild, soothing, and protecting
remedies, than by the use of the harsh and irri-
tating spryj^s formerly so strongly advocated
by many writers. I find this principle applies
Fig. 1.
equally well in the treatment of each region of
the respiratory tract. Of course, in the throat
and nose we must use the necessary surgical
measures in those cases requiring them, but
aside from this I use only non-irritating agents,
and those which are absorbed slowly. The
petroleum product now on the market under
various names, such as "lavoline," liquid al-
boline, glymol, etc., I find ver^' valuable, many
useful agents being readily soluble in it. I
have, however, in a very large number of cases
obtained the most satisfactory result from the
use of balsamic solutions, variously consti-
tuted. I find that quite a large number of
drugs can be applied in solutions of this char-
acter. When a vei-y fine spray of these solu-
tions is inhaled, the balsam is deposited on the
mucous membrane, owing to its
moist condition which occasions the
precipitation of ^the balsam, and is i
slowly absorbed. Thus the effect of
all the constituents' of the solution
is prolonged far beyond that which |
can be obtained in any other way.
In acute cases, I have the inhalations
taken once an hour or once in two
hours; in chronic cases, four to six times daily.
This, of course, renders it necessary that the
patient be able to administer the inhalations
himself.
Itisas necessary to have the proper meansfor
administration as it is to have the proper rem-
edy to administer. A great variety of appara-
tus have been designed for this purpose, from
the simple inhaler to the most complicated and
expensive instruments. I have experimented
with a great many of them. Some are entirely
inefficient, many are not durable, and many
are so complicated and expensivethat they can
only be used in office treatment. For general
purposes, I have found the class known as neb-
ulizers the most desirable. Not finding an
instrument which fulfilled all the conditions
which I deemed necessary, I have had one con-
structed after my own design, of which the ac-
companying cut (Fig. 1) is an illustration. It
consists of a strong bottle to the top of which,
by means of a metal collar, is firmly secured a
hard rubber cap, from the side of which project
three horizontal tubes of hard rubber, one for
the attachment of bulb, one for the inhaling
mask, and the third acting as an inlet to the
air when inhaled. To the under side of cap, and
communicating with bulb, is attached a hard
rubber spraying tube which reaches to near the
bottom of bottle. As shown in cut (Fig. 2) it
consists of three parts which are detachable,
and therefore may be cleaned with the greatest
facility, and admits of the use of any kind of
solution. This alone enables us to use the bal-
sam solutions. The spray is driven against
the side of the bottle, where it breaks into a
fine cloud which will float in the air for a long
time. This very fine spray may be inhaled
through the mask without the slightest laryn-
gial irritation, and has been demonstrated to
reach the air cells of the lungs, and if taken
through the nose every part of the respiratory
tract is reached.
By using the nasal tube in place of the mask
and closing the inlet tube with the cork, the
medicated air can be forced into middle ear,
frontal sinuses, and other cavities, thus being
of great value in many cases of catarrh, both
acute and chronic. All parts are practically in-
destructible, and owing to the simplicity of
construction and application, it may be used
by the patient at home, under his doctor's
direction, without any difficulty, thus admit-
ting of frequent application, upon the thera-
peutic importance of which too much cannot
be said.
The following are a few of the formulae which
have given excellent results, applied by the
above method : —
110
SANITARIUM BULLETIN.
FORMULA NO. 1.
9? Oil Scotch Pine gtt. x.
Oil Cinnamon gtt. x.
Oil Bay gtt. x.
Oil Eucalyptus gtt. xxx.
Menthol Crystals gr. x.
Tr. Benzoin ozs. ii.
ms. et, sig: to be nsed with nebulizer.
The above formula T have used in many cases
of subacute and chronic catarrh with very sat-
isfactory results, when used with sufficient fre-
quency. I also use it largely as a base for
other solutions.
9; Cocaine Muriate grs. x.
Sol. No. 1 ozs. ii.
nis.
This is valuable in the first or congestive
stage of acute inflammations.
9 Creosote (pure beechwood) m. xx.
Sol. No. 1 oz. i.
ms.
This formula gives good results in cases of
pulmonary or laryngial tuberculosis, in con-
junction with creosote enemata, as recom-
mended in a recent number of this journal.
This seems to me to be one of the most ra-
tional methods of treating this disease, and is
highly recommended by many of the leading
French physicians.
In cases where there is an excessive amount
of secretion, either of the nasal or bronchial
mucous membrane, 1 have found the following
very useful : —
9 Balsam of Peru drs. ii.
Oil Copaiba m xx.
Sol. No. 1 dr.i.
ms.
For hay fever I use the following : —
9 Cocaine Muriate grs. x.
Quinia Sulph grs. xx.
Alcohol gi'. i.
Acid Hydrochlorine gtt. x.
Sol. No. 1 ozs. ii.
Dissolve the quinia in the alcohol and acid,
then add the other ingredients.
The above are samples of solutions having a
balsamic base. Many other valuable combina-
tions might be suggested. Almost any of the
tinctures and fluid extracts may be used with
the above instrument.
For example: —
3 Tr. Stramonium dr. i.
Tr. Lobelia
Tr. Ipecac a a drs. ii.
Tr. Opii Camphor qs. ozs. iii.
ms.
Very pi-ompt relief in attacks of spasmodic
asthma, follow tiie use of the above.
As examples of solutions with the petroleum
oils, we have the following: —
3 Oil Cinnamon gtt. xx.
Oil Eucalyptus drs. ii.
Oil Wintergreen. gtt. xxx.
Menthol Crystals grs. xxx.
Liquid Alboline ozs. iii.
ms.
5t Canjphor
Menthol a a
Rub in mortar until liquefied; make a 10 to
20 per cent solution in alboline.
The above formulae give some idea of the
variety of medicinal agents which may be ap-
plied directly to the affected parts; in fact any
substance which is soluble in either alcohol,
oil, or water, maybe used.
BIENNIAL REPORT OF THE MEDICAL
SUPERINTENDENT.
(Continued.)
MEDICAL DIETETICS.
From the very founding of this institution,
the subject of diet has received large considera*
tion as a remedial measure. Indeed, one of the
purposes of the founders of the Institution was
to provide the means for the careful study of
dietetics from a practical standpoint, and to
furnish the different classes of invalids with
food suited to their special requirements.
Twenty-five years ago, at the beginning of
this enterprise, such an attempt was looked
upon as at least wholly unnecessary and un-
called for, if not discreditable, by the great ma-
jority of physicians, since many of the most
eminent medical authorities almost wholly ig-
nored the subject of diet in the treatment of the
sick. Those who, like the writer, were special
pupils with the late Austin Flint, Sr., or who
sat under his teaching at Bellevue Hospital
College, will recall the remark not infrequently
made by this distinguished physician and
teacher — one who at that time represented the
foremost medical thought of this country, if
not of the age — which fairly illustrates the state
of medical opinion on the subject of dietetics at
that time. Said the Professor: "If a dyspeptic
says to you. Doctor, what shall 1 eat? when
shall I eat? and how much shall I eat? say to
him in reply. Eat what you please, eat when
you are hungry, and eat until your hunger is
satisfied." Doubtless such advice, which at the
present day seems in the highest degree absurd
and antagonistic to scientific medicine, was at
that time practically; as good for the patient
SANITARIUM BULLETIN.
Ill
as would have been a carefully prepared bill of
fare, since medical dietetics was at that time al-
most an unknown science, and he could scarcely
have obtained wholesome foods had they been
ordered. The preparation of eggnog, beef tea,
and nauseating panadas practically exhausted
the skill even of the trained nurse in the prepar-
ation of special foods for invalids; and, as a rule,
the articles of food set befoi-e the average inva-
lid were such as would in almost any case have
laid the sick man's cook under suspicion of con-
spiracy against his life, if he had not been
known to be a well-meaning friend instead of
an enemy, although, alas, sadly astray in his
manifestation of friendship.
Through the labors of Bouchard, Dujardin
Beaumetz, Leube, and other French and Ger-
man investigators, there has been in the last
dozen years such a flood of light thrown upon
the process of digestion and its disorders that
at the present time there maybe said to be a
real science of dietetics; and a physician who
has given the subject a sufficient amount of
study, maj'^ now prepare for his patient a
dietetic formula with almost the same pre-
cision, and with better grounds for positive
expectation as regards results, than in the
preparation of his medicinal prescriptions.
Notwithstanding this fact, however, the sick
man still suffers for the want of means for car-
rying out the prescription of a wise and intelli-
gent physician. The developments of the last
few years have shown that a most important
relation exists between tlie various forms of
digestive disorders and chronic diseases of the
kidneys, liver, lungs, mind, nerves, and, in fact,
Qvery organ and tissue in the body. Diabetes,
Bright's disease, biliousness, neurasthenia, and
hysteria as frequently require careful adjust-
ment of the dietary to a patient's nutritive
wants, as do the myriad forms of diseases here-
tofore recognized and promiscuously classed as
dyspepsia.
The studies of Bouchard upon the toxic prop-
erties of the various excretions of the body,
especially the urine, bile, and fecal matters,
and his discovery that the greater part of the
poisonous ptomaines upon which these toxic
properties depend, are generated by microbes
in the alimentary canal, are of almost start-
ling importance in their relation to the dietetic
treatment of disease, since it has been clearly
shown that the quantity of ptomaines devel-
oped in the alimentary canal may be regulated
almost to a nicety by control of the regimen
of the patient, with the exception, of course, of
cases in which the body is invaded by such
virulent and tenacious, but fortunately short-
lived microbes as those which constitute the
specific cause of typhoid fever, cholera, etc.;
and even in these maladies the regulation of
the diet is a matter of utmost importance, as
by this means the quantity of ptomaines pro-
duced, and consequently the intensity of the
systemic poisoning, may be diminished in a
notable degree.
The key-note of the dietetic treatment in a
host of maladies was struck by Bouchard in
the formulation of the term "intestinal asep-
sis." Clear the alimentary canal of germs, rid
it of toxic ptomaines, and the host of maladies
remote from the organs of digestion, and ap-
parently not intimately related to them, as
well as almost all known digestive disorders,
will quickly disappear. The conditions of hu-
man life do not render complete asepsis possi-
ble, but by an intelligent and scientific man-
agement of the dietary, this condition may be
approached so closely that under the favorable
conditions secured by the highest attainable
degree of asepsis, the vital forces will often
rally with remarkable rapidity, and the system
throw off the yoke of a chronic malady in a
manner apparently marvelous and inexplic-
able, although previously, under methods which
ignored the important relation of diet to an
aseptic state of the stomach and intestines, no
progress has been made.
As before remarked, medical dietetics has
been for many years made a careful study and
a subject of experimentation in this Institution,
and every case is studied carefully with refer-
ence to the possible relation of dietetic errors,
and the want of accurate adjustment of the
kind or amount of food taken, to the nutritive
demands of the body.
A careful physical examination is madeof the
stomach by means by which the size and loca-
tion of the stomach are determined with very
considerable accuracy, and such chemical and
other tests are made as will determine the
functional activity of the stomach, not only as
regards the secretion of gastric juice but also
as regards muscular activity. In all cases re-
quiring it, the contents of the stomach are sub-
mitted to careful microscopical and chemical
examination. Thesefacts added to the history
elicited from the patient, furnish a foundation
for the preparation of the dietetic prescription,
which it is presumed, at least, should be better
adapted to the wants of the patient than the
bill of fare made up by himself in his blind
attempts to reconcile his digestive organs to
the insults which are presented to them in the
mixture which constitutes the greater part of
the ordinary bill of fare.
The Diet Kitchen.— In order to supply the
necessarily varied demands of a large number
112
SANITARIUM BULLETIN.
of invalids, a diet kitchen with skilled cooks
who have been especially trained in the prei)a-
ration of food for invalids is absolutely essen-
tial. Quite a little army of persons are thus
employed continually at the Sanitarium in
meeting the wants of three or four hundred
guests, whose varied conditions and fickle appe-
tites can only be met by the most skillful cater-
ing. The regulation bill of fare of the average
health-resort, hotel, or boarding-house, is, to
say the least, illy adapted to suit the gustatory
and alimentary wants of the average invalid.
Indeed, the Israelites had no more difficult task
in their efforts to make bricks without straw
than has the stomach — especially an invalid
stomach — in the effort to make good blood,
brains, nerves, bones, and tnuscles, out of fried
ham, Sai'atoga chips, pate de foie gras,
Welsh rarebit, pickled tripe, Worcester sauce,
mince pie, cold tea, and ice-cream.
There is indeed but a small proportion of
the articles offered on the ordinary hotel or
boarding-house bill of fare — indeed we might
include the menu of the great majority of pri-
vate families — which thejinvalid suffering with a
real serious stomach disorder could venture to
eat, without taking his life in his hands. The
articles named above, and others equally de-
testable to the undepraved taste and equally
destructive to good digestion, never appear on
the Sanitarium bill of fare; but our menu al-
ways offers a great variety of wholesome,
well-cooked, and daintily served articles suit-
able for persons in health, and, in addition, a
large variety of tempting articles prepared
especially for the needs of a mixed multitude of
invalids. The following is a sample bill of fare,
neither better nor worse than what is encoun-
tered by patients at theSanitarium table everj'
day in the year: —
SANITAKIUM MENU
Friday, Sept. 4, 1891.
DINNER
SOUPS
Pea and Tomato
MEATS
Roast Mutton Baked Fish
Potato
Beefsteak
VEGETABLES
Mashed Potato
Egg Macaroni Scalloped Tomatoes
Stewed Celery
BEVERAGES
Caramel Coffee
Milk
BREADS
Graham Bread Corn Bread Patent Flour Bread
Plain Oatmeal Crackers Graham Crackers
Toasted Whole-Wheat Wafers Patent Flour Crackers
Granola Oatmeal Biscuit Wheatena
Cream Toast Zwieback Dyspeptic Wafers
Pearl Wheat
GRAINS
Graham Grits
Rice
SAUCES
Strawberries Pears Black Raspberries
DESSERTS
Melon Apples Farina Blancmange
In addition to the general table, what are
known as diet-tables are provided, at which a
great variety of extra dishes are furnished.
The following list represents the extra dishes
furnished at the diet-table on the above date: —
Cream barley soup, green corn pulp, plum
porridge, Graham grits, avenola, granola, dry
gluten, corn meal gruel, vegetable broth, gluten
gruel, cream, prunes, lemon apples, and pears.
An equal number of dishes is furnished every
day, the list being changed, day by day, for
variety. The yjatients at the diet-tables are as-
sisted in the selection of their foods by means
of the diet-lists in which the various foods, sev-
eral hundred in number, which are furnished at
the diet-table, are classified, the various classes
being designated by numbers or letters. For
example, the following is Diet-list No. 1, which
contains articles allowed to patients who are
taking a strictly milk diet.
Diet-list No. 1 is as follows : INIilk, hot milk,
boiled milk, steiilized milk, cream, junket,
buttermilk, milk with lime water, cream wnth
lime water, koumiss, malted milk.
Diet-list No. 2 contains dishes into the com-
position of which enter milk, eggs, and grains.
Diet-list No. 3 consists of dishes wholly com-
posed of fruits and grains. Diet-lists Nos. 4
and 5 contain more complex dishes, and such
as r€»quire more vigorous digestion.
Diet-list A is wholl3' composed of unfermented
breads, as follows : Toasted cream rolls,
zwieback, corn puffs, whole-wheat puifs, Gra-
ham gems, whole-wheat gems, blueberry gems,
rolls, sticks, crisps, Graham flakes, fruit rolls,
beaten biscuit, gluten wafers, whole-wheat
wafers, Graham crackers, fig sandwich, apple
sandwich, hoe-oake.
Diet-list B is made up of fermented breads.
Diet-list E, containing about sixty different ar-
ticles, is prepared with special reference to the
needs of patients suflfei-ing fi'om dilated
stomachs. Diet-list H is lor diabetics.
The requirements of other morbid conditions
frequently encountered are similarly met by ap-
propriate lists. By this means the patient is
given opportunity to select from a large va-
riety of foods which are adapted to his condi-
tion, without being obliged to study and ponder
the question whether this or that is likely to
agree with him. This habit of introspection,
or inquisitive peering almost incessantly into
one's stomach, or indeed, keeping under min-
ute observation any part of the internal
anatomy, is a most pernicious practice, the
common prevalence of which among dyspep-
tics, is one of the greatest obstacles met with
in the treatment of this disease. When the
patient sits down at the diet-table, bearing in
SANITARIUM BULLETIN.
113
mind the numbers or letters which he finds
upon his diet prescription, lie has only to select
from those dishes which bear the same numbers
or letters, such as he finds suited to his taste,
without givinga moment's thought to the com-
patibility or incompatibility of the dishes with
one another, or with his digestive apparatus.
The number of meals which the patient takes
is determined by the amount and quantity of
food prescribed for him, and the ability of his
stomach to digest. It is sometimes as neces-
sary and appropriate to order four or even six
meals per diem in a given case as to prescribe
one meal a day, or even no food at all by the
mouth or stomach for a day or two or a few
weeks, rectal alimentation being resorted to.
In connection with the dietetic treatment of
a patient, a close watch is kept of the urine.
The amount of urea, and especially of total
solids, is carefully determined b3^ frequent
analyses, and in some cases the toxic value of
the excretions is also carefully studied by tlie
admirable methods developed hy Bouchard, the
eminent French pathologist.
By the plan above outlined, the problem of
supplying the dietetic needs of several hundred
invalids is dealt witii in a manner which must
be considered satisfactory, if the results are a
proper criterion for determining its value.
Those who have been accustomed to take their
meals at the most fashionable hotels are often
loudest in their praise of the elegant cuisine
and delicately prepared dishes which the Sani-
tarium bill of fare provides in such profusion
and variety. The tempting bill of fare placed
before the new-comer nt the Sanitarium is often
a surprise to him, as he had perhaps pictured
to himself, instead of the delicately prepared
and daintily served menu, a bill of fare savoring
largely of the old-fashioned sick-room diet, or
ill some way tainted with hospital smells or
medicinal formulae. The universal commenda-
tion which this department of the Institution
elicits from patrons may be justly considered a
triumph of the effort which has been made in
the direction of the development of medical
dietetics through the patient and almost con-
tinuous researches and experimentation which
has been carried on by Mrs. Kellogg during the
last ten years, in the experimental kitchen con-
nected with the Institution.
(To be Continued.)
ANTISERTIC.
PRORHYUACTIC.
DEODORANT.
LISTERINE
NON-TOXIC.
NON-IRRITANT.
NON-ESCHAROTIC.
I^OIitlVdXJIv-A.* — Listerine is the essential antiseptic constituent of Thyme, Eucalyptus
Baptisia, Gaultheria, and Mentha, Arvensis, in combination. Bach fluid drachm also contains
two grains of refined and purified Benzo-boracic Acid.
I>O^E^» — Internai^i^y : One teaspoonful three or more times a day (as indicated), either
full strength or diluted, as necessary for varied conditions.
LISTERINE is a well-proven antiseptic agent — an antizymotic — especially useful in the
management of catarrhal conditions of the mucous membrane ; adapted to internal use, and to
make and maintain surgical cleanliness — asepsis — in the treatment of all parts of the human body,
whether by spray, irrigation, atomization, or simple local application, and therefore characterized
by its particular adaptability to the field of
PREVENTIVE MEDICINE— INDIVIDUAL PROPHYLAXIS.
LiSTEiR.insrz;
Destroys promptly all odors emanating from diseased gums and teeth, and will be found of great
value when taken internally, in teaspoonful doses, to control the fermentative eructations of
dyspepsia, and to disinfect the mouth, throat, and stomach. It is a perfect tooth and mouth wash,
indispensable for the dental toilet.
Descriptive Literature upon Request.
LAMBERT PHARMACAL CO., ST. LOUIS. MO.
AGENCI ES:
S MAW SON & THOMPSON,
LONDON, E. C.
ROBERTS & CO.,
PARIS.
S. PAPPENHEIM,
BERLIN, IV.
VILANOVA HOS. Y CIA.
BARCELONA.
PUBLISHERS' DEPARTMENT.
The Texas Sanitarian is a new and most
worthy and interesting journal of preventive
medicine and hygiene, under the management
of Dr. T. B. Bennett, Austin, Tex. The two
first numbers at once place this practical
magazine among the foremost scientific jour-
nals of the country. We trust it will be fully
appreciated.
Lippincott's Magazine for February, 1892.
— Frontispiece (portrait of Mrs. M. E. W.
Sherwood); "Roy the Royalist," by William
Westall; " TheManagingEditor" (the Journal-
ist Series), by Julius Chambers; "Febi-uary,"
by Louise Chandler Moulton ; " The Hackney-
Horse" (interview with Dr. R. S. Huidekoper),
by Louis N. Megargee; "Across the Sea," by
Philip Bourke Marston; "Secretary Rusk's
Crusade," by Julian Hawthorne; "Sonnet,"
by Elizabeth Carpenter; "The Board of Trade
and the Farmer," by Henry Clews; "The Am-
bassador," by Charles Converse Tyler; "Jer-
myn's Portrait," by Clara Lanza; "Days of
my Youth," by St. George Tucker; "Swim-
ming" (Athletic Series), by Hermann Oelrichs;
"Prince Gallitzin, Priest and Pioneer," by
Hester Dorsey Richardson; "Since the Begin-
ning," by Kate Putnam Osgood; "Recollec-
tions," bv Mrs. M. E. W. Sherwood; "Intangi-
ble," by Kate B. Lathrop ; " The English Spar-
row," by Mary Isabella Forsyth; "Names vs.
Initials," bv Jane de Forest Shelton; "As it
seems;" "With the Wits" (illustrated by lead-
ing artists).
The Medical Fortnightly. — A journal of
Medicine, Surgery, Microscopy, and Pharmacy,
edited by Dr. Brausford Lewis, St. Louis, Mo.
Few magazines have made their appearance
with more promise in medical journalism. Dr.
Lewis is an experienced editor, and the first
number of his new publication is full of solid
matter and good thoughts for the doctors.
We bespeak complete success in his enterprise
and congratulate the proprietor.
The Laboratory OF Hygiene (Sanifearium),
J. H. Kellogg, M.D., Sup't; PaulPaquin.M.D.,
D. V. S., Director. Vaccine Department. — The
vaccine produced here (from a purely scientific
and humane standpoint, and not for profit) is
the purest to be obtained in the country. It is
propagated in a new building fitted especially
for the production of vaccinia as free from any
and all impurities as is possible. No vaccine is
sent out before it is tested as to its safety and
activity, both by microscopical and bacterio-
logical analysis. Physicians and the public
may rely on the absolute safety of our prod-
ucts. No other institution is operated on the
same aseptic and scientific principles. We
guarantee safety in regard to the virulent
germs and filth which render so many of the
commercial products useless or dangerous. 10
points, fl.OO. Bacteriological World and
Modern Medicine, with ten points, $2.00. Ad-
dress, Good Health, or Modern Medicine Pub.
Co., Battle Creek, Mich.
PURE GLUTEN
BISCUIT
The undersigned have for several years been mivnufacturing a pure gluten for
a few physicians. We are nov*^ prepared to furnish to the medical profes^sion the
only pure gluten biscuit manufactured in America. For samples and prices address
SANITARIUM FOOD CO., Battle Creek, Mich,
0
c
o
o
0
t>..
Cv^
'^
y> ''
i <J 0 ■
■*^
%
#^
%
MORPHOLOGY OF THE YEAST -PLANT.
(See page 125.)
XH
• •
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH., U, S. A., FEBRUARY, 1892. NO. 4.
Original Articles.
OBSERVATIONS ON STAINING THE FLAGELLA
ON MOTILE BACTERIA.^
BY VEKANUS A. MOORE, M. D.,
Washington, D. C.
From a microscopical standpoint no
branch of the investigation of micro-or-
ganisms is, perhaps, more interesting than
the study of the flagella on motile bac-
teria. As their discovery has shown the
structure of these organisms to be much
more complex than was before supposed,
the determination of the number and ar-
rangement of these minute appendages
with which the various species are pro-
vided, is important, not only from the
knowledge thus derived of their structure,
but also as a possible aid in the differen-
tiation of closely allied species.
The fact that certain motile bacteria
were provided with flagella was made
known early in the history of bacteriology,
but there seems to have been no method
devised, until a comparatively recent time,
by which they could be carefully studied,
or by which their presence on other mo-
tile forms could be shown. The difficulty
in detecting the flagella on bacteria in a
fresh condition is well illustrated by the
investigations of Dallinger and Drysdale,
who saw only a few of these appendages
in a preparation of bacterium ^termo after
an incessant examination of nearly five
hours. Although our instruments and
methods have been much improved since
that time, I believe that at the present
time the satisfactory demonstration of fla-
gella on living bacteria is one of the most
difficult tasks known to microscopists.
It is through the development of the
staining processes that the demonstration
of these appendages on the great majority
of motile bacteria has been made possible
iRead before the American Society of Microscopists,
August, 1891.
and, in many cases, comparatively simple.
As early as 1877, Koch succeeded in stain-
ing the flagella on a certain number of the
larger saprophytic bacteria. Since then
other methods have been devised, which
are applicable to the smaller and also the
pathogenic forms. By the aid of these
methods the flagella have become recog-
nized as forming a part in the morphology
of motile bacteria. This fact is impor-
tant, as any difference found to be con-
stant between the character of the flagella
of two bacilli, will be as significant in
differentiating them, the one from the
other, as the presence or absence of
spores or a difference in the form or size
of the bodies of the germs themselves.
It is for their differential value that a
knowledge of the flagella may render
valuable service to the practical bac-
teriologist.
In 1889, Loefller published a method in
which he introduced the principle of a
mordant in staining the flagella and cilia
on micro-organisms. By subjecting the
preparations to the action of a mordant
before they were brought into the stain-
ing fluid, he succeeded in staining a con-
siderable number of bacteria. There were,
however, many motile forms on which
these appendages could not be detected. '
This fact led to further investigation,
which resulted in the discovery of the
principle " that the alkali-producing organ-
isms required an acid mordant, and the acid-
producing organisms required an alkaline
mordants This was based upon the re-
sult obtained by Petruschky ^ who had
found that a large number of bacteria
would convert the action of a neutral
medium (liquid) into either an acid or
an alkaline during their multipli<:ation.
The importance of Loeffler's method in
the acquisition of our knowledge of the
flagella of bacteria has prompted me to
present it here, in a form as condensed as
possible, both for its own value and as a
basis for my subsequent remarks. The
1 Centralblatt f. Bakteriology u. Parasitenkunde, Bd. V.
{1889), p. 625.
116
ORIGINAL ARTICLES.
formulae for the preparation of the mor-
dant and staining fluid, together with the de-
tails in their application, are as follows : —
The mordant, to lo c. c. of a 20 per
cent aqueous solution of tannin, 5 c. c. of
a cold saturated solution of the sulphate
of iron, and i c. c. of an aqueous or alco-
holic solution of fuchsin, methyl-violet, or
" Wollschwarzlosung," are added.
The foregoing solution is to be regarded
as the standard or stock solution to be
used, and one which is successfully em-
ployed in staining the flagella of cer-
tain microbes; but for others the addition
of an acid or alkali is necessary. Thus
for the comma bacillus it is necessary
to add to the 16 c. c. of mordant ^
to I drop of a solution of sulphuric acid,
equivalent to a i per cent solution of so-
dium hydrate. For the typhoid bacillus
I c. c. of a I per cent solution of sodium
hydrate must be added to the 16 c. c. of
mordant. By first determining whether
the germ in question is an alkali or acid
producing organism, the necessary quan-
tity of the acid or alkaline solution to
be added to the mordant can easily be de-
termined by actual experiment.
The staining fluid consists of a saturated
solution of crystal fuchsin in the ordinary
aniline water. As the aniline water is
very nearly neutral, a saturated solution of
fuchsin in it is sufficient. Better results
may possibly be obtained by adding to this
as much of a i-iooo solution of sodium
hydrate as is necessary to bring it almost
to a point of precipitation.
Cover-glass preparations should be made
of the bacteria to be studied in such a
manner as to avoid all albuminous material.
This is best accomplished by transferring
a very small quantity of the growth from
an agar or gelatine culture to a drop of ster-
ile water on a cover-glass, and thoroughly
mixing ; a small quantity of this is con-
veyed to a second cover-glass and treated
in a like manner ; and again, from the
second a third preparation is made. By
this treatment the albuminous substance is
sufficiently diluted, and the bacteria are
isolated in an aqueous medium. The prep-
aration is allowed to dry in the air. Ster-
ilized hydrant water is preferred to distilled
water for diluting the culture. It is of the
utmost importance that the cover-glass
should be free from all impurities. The
film on the cover-glass is fixed by heat,
but care must be taken not to overheat the
preparation. The desired temperature can
be obtained by holding the cover between
the thumb and index-finger, over the flame.
instead of passing it through the flame by
means of forceps.
By this method overheating is avoided.
After heating, the film on the cover-glass
is covered with the mordant, and held over
a flame until steam is given oif. It is then
removed, and after ^ to i minute the
cover is rinsed in water, then in absolute
alcohol, and again in water until the mor-
dant is completely removed. Care must
be taken to remove all traces of the mor-
dant from the cover-glass, as it would
form, if present, a very troublesome pre-
cipitate with the staining fluid. The film
is then covered with a few drops of the
staining solution, and the preparation
again heated until the solution begins to
vaporize. It is then removed from the
flame, and after allowing the stain to act
for about i minute, the cover is washed
in a stream of water. The preparation
can be examined immediately in water, or
allowed to dry and be mounted in balsam.
The bacteria with their flagella should be
deeply stained, resting upon a colorless
background if they are distributed in a
purely aqueous substance, but if albumen
is present, they are surrounded by a uni-
formly feebly stained medium, the intensity
of which depends upon the quantity of
albumen present.
By the use of this method the flagella
have been stained on not only a large
number of saprophytic, but also on all of
the known motile, pathogenic bacteria.
Unfortunately the results usually obtained
by this process are not satisfactory for
the differential purposes suggested in a
previous paragraph. The difficulty is not
in simply demonstrating their presence,
but in the inability to determine the num-
ber and arrangement of these appendages
on the individual bacteria. In all of the
preparations that I have examined, that
had been stained by this method, there
were a large number of bacilli which ex-
hibited no flagella, while on the others
the number was variable ; but lying be-
tween the bacilli were a greater or less
number of flagella that had become de-
tached from the bodies of the germs, pre-
sumably during the process of prepara-
tion. This is especially prominent in
preparations of bacteria that are provided
with a considerable number of these ap-
pendages, such, for example, as the hog
cholera and typhoid bacilli. This fact
renders it difficult, if not impossible, to
determine the number of flagella with
which the individual bacteria of a given
species are provided.
ORIGINAL ARTICLES.
nr
Notwithstanding this difficulty which I
have met, the method has given such sat-
isfactory results in the hands of A. Messea,
an Italian investigator, that he has pro-
posed a systematic classification of bac-
teria based upon the number and arrange-
ment of the flagella. This classification
is as follows : —
I. Gymnobacteria.
2. Trichobacteria,
i 3.
Monotricha.
Lophotricha.
Amphitriclia.
Pei'itricha.
The Monotricha have one flagellum at one
pole of the bacillus {Bacillus pyocyamiis).
The Lophotricha have a tuft, or bunch, of
flagella at one pole of the bacillus {Ba-
cillus of blue 77iilk). The Aviphitricha
have a flagellum at each pole {Spirillum
voluta7is). The PeritricJia are provided
with rows of flagella {Bacillus typhosus).
Kruse^ in a review of Messea's article
says that this classification can have only
a secondary value. It is evident that it
would conflict very seriously with the
natural grouping of the Scliizomycetes, as
for example, the Monotricha would in-
clude bacilli spirilla and at least one
micrococcus (the motile micrococcus de-
scribed by Ali Cohen).
In order to find some process by which
I could determine more definitely the
minute details respecting the number,
size, and arrangement of the flagella, es-
pecially on the hog-cholera and typhoid
bacilli, I have made a considerable num-
ber of tests with Loefller's and other
methods,^ and with various modifications
in both the preparation of the solutions
used and in the technique of their appli-
cation. The result of this experimental
work has been very largely negative, but the
careful testing of each step in the various
processes, especially that of Loeflier, has
been productive in revealing a few facts
which are deemed worthy of notice. Some
of these have suggested certain slight
modifications in the technique of Loef-
fler's process which promise to be of
considerable value in the further study of
these structures. As his method has al-
ready been quoted, I shall refer only to
those sections of it for which modifica-
tions are suggested, or which, for other
1 Centralblatt f. Bakteriologie u. Parasitenkunde Bd. IX
(1891) r. 107.
sTrenkmann's are the only methods, other than Loeffler's,
that I have found to be of any special value. They involve,
however, practically the same principles as those given by
Loeffler, and consequently need not be discussed here. For
reference and titles of the various articles on the demonstra-
tion of the flagella on motile bacteria, see bibliography.
reasons, are deemed worthy of special
remark. These are as follows : —
I. The Distribution of the Bacteria on
the Cover- Glass. — It is of the utmost im-
portance that the bacteria be properly
isolated in the preparation. This can be
accomplished very satisfactorily by the
following process : The cover-glasses,
after being thoroughly cleaned, are spread
on a level tray. On each cover-glass is
placed, by means of a flamed pipette, a
moderately large drop of sterile water
(distilled or hydrant). This will spread
over the entire surface of the cover, if it
has been properly cleaned. The end of
a flamed platinum wire is very gently
touched to the surface growth of an agar
or gelatine culture of the germ in ques-
tion, after which it is very carefully im-
mersed two or three times in as many
places in the water on each cover-glass.
A sufficiently large number of bacteria
will adhere to the end of the wire to make
from four to ten preparations. The
cover-glasses are then placed in an incu-
bator at a temperature of about 36° C,
where they are allowed to remain until
the water is evaporated.
Many of the bacteria by means of their
power of locomotion will become sepa-
rated from the clump of germs introduced
by the wire, and will be found, on the dry-
ing of the preparation, to be distributed
very satisfactorily around these centers.
This natural separation of the bacteria
prevents the breaking off of the flagella by
staining or other artificial means employed
in securing the necessary distribution and
isolation. In this manner I have isolated
the bacteria in a preparation, so that in
many fields not more than a score of germs
could be seen, and the excellent condition
of their flagella warrant my recommending
this method of preparation. The fact that
the bacteria are properly isolated over
only a small portion of the preparation is
not necessarily an objection. Our hopes,
however, are not yet fully realized, for there
will generally be a few, often many, de-
tached flagella lying between the bacteria,
some of which are partially or wholly
deprived of their appendages. I have fre-
quently observed clumps of flagella which
gave the appearance of those belonging to
an individual germ, the body of which had
disappeared. As these were found in prep-
arations made from old cultures, they sug-
gest the possibility that the body of the
germ is first to degenerate, or else that
through some physiological process the
flagella are detached from the bodies of
118
ORIGINAL ARTICLES.
the bacteria after a certain age is attained.
These hypotheses are strengthened some-
what by the fact that in preparations from
older cultures there appears to be a greater
■number of detached flagella.
2. The Composition of the Mordant. —
The mordant recommended by Loeffler
seems to be the most satisfactory of any
thus far suggested for general use. I
I have found, however, that a mordant
which contains only lo per cent tannic
acid can occasionally be used with advan-
tage. It can be more easily and thor-
oughly removed from the specimen, and
consequently the formation of a trouble-
some precipitate with the staining fluid
occurs less frequently. It was found that
with \\\^hog-chole7'a bacillus it gave equally
as good results as the one containing 20
per cent tannin ; with the typhoid bacillus
it was not so satisfactory, and with a wate^'
bacillus a 20 per cent tannin solution in
the mordant was necessary to secure the
staining of the flagella. From a limited
number of experiments, it seems quite
probable that a variation in the quantity
of the tannic acid in the mordant may be
of much service in staining the flagella on
certain bacteria where difficulties are ex-
perienced with the use of the mordant
prepared after Loeffler's formula. Al-
though I have tried a considerable num-
ber of the '"fixing agents," I have thus far
been unable to stain flagella with the use
of any mordant not containing tannic acid.
In applying the mordant, I have met
with better results by allowing it to act
for from three to four minutes. A con-
venient method of heating the mordant
on the cover-glass is to pass it several
times through the lower portion of the
flame, which heats it sufficiently and pre-
vents spattering. A safer method is to
heat the preparation for the required time
in a watch-glass containing the mordant.
The heating of the cover-glass to fix the
film is also an important condition in
the success of the operation. Loeflier's
method has *the objection that it is diffi-
cult to heat the preparations uniformly.
I have employed a hot-air chamber for
this purpose, and after a series of experi-
ments ranging in temperature from 90° to
180° C. and in duration from one fourth
to five minutes, I have found that I could
obtain the best results by heating the
preparation for one minute at a tempera-
ture of about 120° C. Little, if any,
difference was noticed in preparations
heated at a temperature varying from
i2o°-i4o° C.
3. The Reaction of the Mordant. —
Experiments have shown that the state-
ment made by Loeffler, that an alkali-
producing organism required an acid mor-
dant, and an acid-producing organism an
alkaline mordant, need not be taken in a
very strict sense. This is illustrated with
the hog-cholera bacillus. As it is an al-
kali-producing germ it would be necessary,
according to Loeffler's statement, to add a
certain quantity of the acid solution to
the mordant in order to stain its flagella.
Dr. Theobald Smith stained the flagella
on this bacillus by the use of the neutral
or standard mordant.^ Further investi-
gation has shown that the flagella can
be stained by the use of the mordant
containing a variable quantity of either
the acid or sodium solution, good results
being obtained when as much as 3 c. c. of
either solution was added to the 16 c. c.
of the mordant. It is better to add the
sodium solution just before the mordant
is to be used. I have also found that the
flagella on the typhoid bacillus, an acid-
producing germ, can be stained by the
use of either the acid or alkaline mordant.
This deviation from Loeffler's results with
the typhoid bacillus may possibly be due
to the age of the germ, as the one I used
had been preserved by means of subcul-
tures, for several years. The same range
in the reaction of the mordant was found
to be applicable to a few other bacteria.
4. The Staining Fluid. — I have found
that carbol fuchsin (10 c. c. of a saturated
alcoholic solution of fuchsin, 100 c. c.
of a 5 per cent soJution of carbolic
acid) gives equally as good, if not better
results, than the aniline water fuchsin
recommended by Loeffler. It also has
the advantage that it can be kept for a
much longer time, and consequently is
ready for use at any moment. It has a
less tendency to form a precipitate with
any trace of the mordant that might be
left on the cover. I have also stained the
flagella very nicely with Loeffler's alkaline
methylene blue.
5 . The Age of the Cidture to be Used. —
A careful examination of the growth from
cultures of certain bacteria shows that the
flagella can be stained on these germs
from cultures varying in age from 20
hours to several weeks. For simply dem-
onstrating their presence any aged cult-
iDr. Smith pointed out that the reaction of the culture
liquid with some bacteria may be either acid or alkaline, ac-
cording as glucose or other sugars are present or absent.
These undergo fermentation with the formation of acids. In
liquids free from sugars the reaction becoVnes speedily alka-
line. Petruschky's classification of bacteria as acid or alkali
producing is thus shown to depend largely on the composition
of the culture medium.
ORIGINAL ARTICLES.
119
ure, within the limits mentioned, can
be used. In old cultures the flagella are
more broken, and a larger number of
detached appendages are observed. I
have obtained my best results with a
culture that had grown for about 48
hours. The surface of agar seems pref-
erable to gelatine for cultivating bacteria
for this purpose.
In testing the various methods and their
modifications, I have stained the flagella
on a considerable number of bacteria,
among which I will mention a large motile
bacillus quite common in Potomac water,
the bacillus flitorescefis liquefaciens, and the
bacillus coli communis. The latter one,
like the typhoid bacillus, is provided with
rings of flagella, and consequently belongs
to \}ci& peritricha. The flagella on each of
these species have been stained by the
use of both an alkaline and an acid mor-
dant.
iVlthough a large amount of work has
been done to develop satisfactory meth-
ods for staining the flagella on motile
bacteria, there seem to be many condi-
tions that are not yet fully understood.
These must be carefully worked out by
actual experiment before we will be able
to determine accurately the specific char-
acter of the flagella on the different
species of bacteria.
No flagella have been found on the
swine-plague and other non-motile bac-
teria, although a very large number of
specimens have been stained by the same
methods that I have successfully em-
ployed with the motile forms. This, to-
gether with the fact that with certain
motile bacteria, at least a few flagella can
be seen in every stained preparation,
eliminates from the writer's mind the
doubt that has occasionally been ex-
pressed, that the long, wavy or spiral fila-
ments seem to radiate from the bacteria,
or, lying between them, do not belong to
the germs with which they are associated.
I am indebted to Dr. Theobald Smith
for suggestions which he has offered from
time to time during the prosecution of this
work.
BIBLIOGRAPHY.
1. Cohn, F. Untersuchungen tiber Bacterien. Beitr'dge
zur Biologic der PJlanzen. Bd. I (1872), p. 127.
2. Dallinger, IV. H., and Drysdale, y. jf. On the Exist-
ence of Flagella in Bacterium Termo. The Monthly Micro-
scopical Journal (London). Vol. XIV (1875), p. 105.
3. Dallinger, W. H. On the Measurement of the Diam-
eter of the Flagella of Bacterium Termo. Jour, of the Royal
Mic. Society. Vol. I (1878), p. 169.
__ 4. Koch. Robert. Untersuchungen iiber Bacterien. Beit-
rage zur Biologie der PJlanzen. Bd. II (1877), p. 416.
'-^. Neuhauss, R. Ueber die Gisselen an den Bacillen der
Asiatischen Cholera. Centralblattf. Bakteriologie u. Para-
sitenkunde. Bd. V (1889), p. 81.
6. Loeffler., F. Ein neue Methode zum Farben der Mikro-
organismen im besonderen ihren Wimperhare und Geisseln.
Ibid. Bd. VI (1889). p. 209.
7. Loefflcr. F. Weitere Untersuchungen iiber die Beizung
und Farbung der Geisseln bei den Bakterien. Ibid. Bd. VII
(1890), p. 625.
8. Trenkmann, Dr. Die Farbung der Geisseln von Spi-
rillen und Bacillen. Ibid. Bd. VI (1889), p. 433.
9. Trenkmann, Dr. Die Farbung der Geisseln von Spi-
rillen und Bacillen. Ibid. Bd. VIII (1890), p. 385.
10. Dowdeswell, G. F. Note sur les Flagella der microbe
der Cholera. Annales de Micrographie. T. II (1890), p. 367.
11. Smith, Theobald. Einige Bemerkungen iiber Saure
und Alkalibildung bei Bakterien. Centralblattf. Bakteriolo-
gie u. Parasitenkunde. Bd. VIII (1890), p. 389.
12. Moore, V. A. A Review of the Methods of Demonstrat-
ing the Flagella on Motile Bacteria with Special Reference to
the Staining Processes. American Monthly Microscopical
yournal. (1891) p. 15.
13. Messea, A. Contribuzione alio studio delle ciglia dii
batterii e proposta di una classificazione. Rivista d'igiene e
sa?iita publica. No. 14 (1890), p. 513.
INFLUENCE OF THE CONTINUOUS CURRENT
ON MICROBES, PARTICULARLY ON
CHARBON BACTERIDIA.
BY M. M. APOSTOLI AND^ LAGUERRIERE, OF PARIS.
(Concluded.)
Fifty-first Series {July 2, i8qo), Streptococcus
Pyogenes Aureus. Apparatus No. j.
The experiments made gave no result,
the cultures having attenuated themselves
before the operation.
Fifty-second Series (July 10, iSqo)., Charhon.
Apparatus No. j.
1. Apparatus No. 3, placed in ice, re-
ceived a culture of anthrax broth. Posi-
tive thermometer, 6^°; negative, 5^ °.
This temperature is owing to the fact that
we did not wait sufliciently long for the
refrigeration to take place.
The positive electrode, in aluminum,
was rolled around a piece of lead.
2. The inoculation made before the
passage of the current killed the inocu-
lated guinea-pigs.
3. A current of 200 milliamperes of 2
minutes' duration, did not in the least
modify the virulence of the positive pole.
Guinea-pigs were killed by inoculation ;
sowings created virulent cultures.
4. A current of 200 milliamperes of 5
minutes' duration gave the same results.
N. B. The oxygen being absorbed at
the positive pole, rendered that pole in-
different.
Resume and General Conclusions.
The preceding experimental researches,
which extended from October 23, 1888,
to July 10, 1890, complete the reading
that we presented to the Academy of Sci-
ences, April 28, 1890.
These researches can be subdivided into
three successive stages, denoting a pro-,
120
ORIGINAL ARTICLES.
gressive advancement in the development
of the scientific principles that we have
undertaken to eliminate.
First Stage. — The study of the action
of the cofistajit galvafiic airre?it, the poles
being placed at a short distafice frojn each
other in a homogeneous media, aiid ifi a
single testing-tube. Simultaneous utiliza-
tion of the thermal action and of the
electrolytic action : Here the negative
chemical polar action attenuated th^e
near inverse polar positive action by the
recombination of acids with the bases,
and the final action was in a large meas-
ure reduced to a simple thermal, a wit-
ness and effect of the electrolytic and
chemical labor, first that of analysis and
then that of synthesis.
In fine, what attenuated or killed the
media of culture in this first series of ex-
periments, was especially the considerable
elevation of the temperature which, in the
operatory conditions in which we were
placed, had been able to reach nearly ioo°
C, without making it necessary to invoke'
an additional electrical action.
In these conditions, and very naturally,
extractions made in any media of culture
on which experiments are made, have been
found to be influenced uniformly and
equally (in a variable way according to
the dose employed, of course), without
our being able to discern any difference
between the topographical and polar ac-
tions.
The following conclusions deduced from
this first series of researches were con-
signed to the Academy of Sciences August
12, 1889, in a note folded and sealed : —
" I. The action of the constant galvanic
current is en rapport direct with the inten-
sity of the current estimated in milliamferes.
''2. All things being equal, to secure one
and the same intetisity, it is not essential to
attach very much importafice to the duration
of the application, the intensity of the cur-
rent being ahvays the principal factor of the
effects obtai7ted, provided, hoivever, that the
applicatio7i is at the minimum of a duration
of from five to ten minutes.
'* 3. A current of ^00 milliamperes or
more, applied for five nmiutes, kills con-
stantly bacteridia of charbon. The sow-
ings done with the culture thus treated
remain sterile, a?td the inoculation on the
guinea-pig is ineffective.
" 4. A current of from 200 to 2^0 mil-
liamperes, applied for five minutes, does not
surely and constaiitly destroy the virule7ice ;
a few guinea-pigs die. but 7nore slowly tha7i
the wit7iesses i7ioculated co77iparatively with
the sa77ie culture that has not been subjected
to the curre7it.
" ^. A current of too 77iillia77iperes and
more, even after a7i applicatio7i of thirty
77ii7iutes, does 7wt destroy the virulence ; an
atte7iuatio7i is produced which increases
with the inte7isity of the current, and which
accuses itself by the fact that the inoculated
guinea-pigs die one or two days later than
the witnesses.^''
Second Stage. — In the same preced-
ing instrumental conditions (with the same
testing-tube and the same media of cul-
ture), we have suppressed the thermal in-
fluence to appreciate the pure and simple
electrolytic action.
Here the conclusions were somewhat
similar to those of the first series, which
we have just expressed. There was, how-
ever, this difference : a much more intense
current was necessary to attenuate or kill
the virulence. This was owing to the fact
that, to a certain extent, the very near
polar actions (in the conditions in which
we are placed) attenuate themselves recip-
rocally by the secondary synthesis which is
formed by the union of the acids with the
bases.
Third Stage. — Study of the two purely
isolated polar actio7is and of the 'inter 771 e di-
ary or i7iterpola7y action.
Here we could equally utilize at pleas-
ure the chemical or electrolytic action and
the thermal action as related to each other
— or we could eliminate experimentally
the latter action (the thermal action) to
study only the polar and intermediary ac-
tion disconnected from all calorific in-
fluence.
It is especially to this last series of re-
searches in the laboratory, that we have
given our attention ; and we hope soon to
be able to complete them in utilizing, at
one stroke, the thermal and chemical ac-
tion, as is done normally in the applica-
tions of electrotherapy to man.
The following are tlie general and defi-
nite conclusions of this third series of
experiments, which determine the study
of the simple electrolytic action : —
1. I71 a homogC7iic 7nedia, a galva7iic cur-
re7it, co7ista7it a7id without proper actio7i,
or suis generis, 07i 77iicrobia7i cultures.
2. The only action clearly discernible
appears at the positive pole.
3. There is (in the experimental condi-
tions in which we are placed) no se7isible
actio7i at the 7iegative pole or i7i the chain
of the i7iterpola7y circuit.
4. This actio7i is purely che7nical, or elec-
trolytic, ajid is due particularly to the oxy-
ORIGINAL ARTICLES.
121
ge?i that is ge?ierated, liberated, and accu-
mulated at the positive pole ; indeed if this
oxygen is absorbed at the moment of its
degagement or liberation, there is restored
to that pole, become active and micro-
bian, all, or a part of its action, natural
or indifferent, for the microbes, as in the
other points of the circuit.
5. This action of attenuation on mi-
ci'obes is cojitrolled^ in pa7't^ by the lairs
of elect 7'oly sis ^ and is pi'oportionate to the
intensity of the cnrrent and to the dura-
tion of its application.
Howbeit, there are grounds for the fol-
lowing reserve : A current of 50 milliam-
peres applied 30 minutes does not produce
the same effect that one of 2oo.milliamperes
does in 5 minutes, — the first does not kill
microbes, the second does, which shows
that in order that the microbial! action
may act efficaciously, it must first have
quite a high intensity, and that the dura-
tion of the application is a secondary
factor, which intervenes in an especial
manner only when the required intensity
is obtained.
6. The microbian action or antiseptic of
the positive pole, in a media of. distinct cult-
ure, and entirely separated from the nega-
tive pole, exercises itself i7i more feeble doses
than in our first series of researches, where
the two poles, being contiguous, attenicate
their reciprocal chemical action.
Hence, here the positive pole does not kill
at 50 milliamperes during an application
that can vary from 5 to 30 minutes ; but
beyond 50 milliamperes, the attenuatioft
commences and increases progressively to
become constajit after 5 ?nifiutes, between
100 and 1^0 milliamperes.
7. A feeble current, below 50 milliam-
peres, can bring back the virulence in a
media of culture where it had been pre-
viously attenuated, and can exert a revivi-
fying action on microbes, due to the pres-
ence of oxygen in a small quantity. Thus,
the guinea-pigs inoculated before this ex-
periment, do not die, v/hile those who are
inoculated after it, succumb.
THE APPLICATION OF THE MICROSCOPE IN
MEDICAL, MEDICO-LEGAL, AND
LEGAL DIFFICULTIES.
Diet in Gastric Neurasthenia, or
Nervous Dyspepsia. — Dr. Bilfinger, an
eminent German physician, recommends
{Allg. medecin. Centralztg.^ that the diet
of a person suffering from this disease
should be as bland as possible, and sug-
gests a modified vegetable diet, consisting
chiefly of milk and oatmeal porridge, or
other farinaceous foods. Peas and beans
are also recommended ; acorn coffee
should be used in place of the coffee bean.
BY FREDERICK GAERTNER, A. M., M. D.,
PITTSBURG, PA.
Member of Society of Physicians and Surgeons, Berlin.
(Concluded.)
LEGAL MICROSCOPY.
Legal microscopy is certainly a unique
and extremely interesting study, not only
to the attorney but the physician as well.
The development of this subject is due
principally to Geo. E. Fell, M. D., who
has bestowed upon it the most scientific
and accurate study.
Microscopy in its application to legal
questions is a novelty, and the most sur-
prising results are anticipated from the
application of the microscope in the ex-
amination of legal documents, currency,
and all printed and written matter, includ-
ing forgeries, mutilated wills, and other
documents.
More than once has the microscopical
examination lighted the path of the attor-
ney, detected the work of the forger and
mutilator, and shielded the innocent or
convicted the guilty.
The microscopical examinations of le-
gal documents of all kinds presents a wide
range of observation. We may first begin
with the characteristics of the paper of the
document, which may enable us to ascer-
tain many important facts ; for instance,
a great similarity might indicate, with
associated facts, that the documents were
prepared about the same time, or by the
same person ; a marked dissimilarity
might be an equally important matter.
Secondly, the differences in paper may ex-
ist in the character of the fibers composing
it, the finish of the surface, the thickness,
modifying the transmissibility of light, the
color, etc. All these points may be accu-
rately compared and differentiated by use
of the microscope. Thirdly, the ink is to
be considered and examined. In case an
addition has been made to a document
within a reasonable length of time, the
different inks may be distinguished from
each other. The following differences be-
tween the inks may be apparent : —
Some inks in drying assume a dull,
others a slimy surface. If in sufficient
quantity the surface may become cracked,
presenting, when magnified, the appear-
ance of dried clay. It is well to note
whether the ink forms an even, somewhat
122
OBIQINAL ARTICLES.
regular border, or spreads out to some
extent. Fourthly, the color of the different
inks studied by transmitted or reflected
illumination, is of the greatest impor-
tance.
This difference of inks, in one case in-
vestigated by Dr. Geo. E. Fell, at least
proved the addition of certain words which
completely annulled the value of a docu-
ment involving several thousand dollars.
In another case where words were written
over the original writing so as to cover
completely, the difference of inks could
still be detected by a microscopical exam-
ination. Fifthly, erasures and additions are
the principal points of consideration in the
microscopical examination of documents.
There are two distinct modes of making an
erasure ; first, by a sharp instrument, and
secondly, by a chemical preparation. The
former is more commonly employed, and
is usually accomplished by scraping the
paper with a sharp knife until the writing
is invisible to the naked eye. Under the
microscope every stroke of the pen is visi-
ble, and even the color of the different ink
may be revealed.
The more skillful mutilator employs a
chemical preparation. The ink becomes
soluble under the action of the chemicals
used, and then is easily removed by means
of a blotter or absorbent cotton. This
also is an imperfect method, the letters
may be readily traced under the micro-
scope. Usually the chemical leaves a
stain, and the fibers of the paper are more
or less injured by its action, thus leaving
evidence that the erasure has been made.
Geo. E. Fell says the eye of the individ-
ual making the erasure is certainly not
sufficient, and even with the aid of a hand
magnifier the object may not be effectually
accomplished. The detection of an era-
sure made by a knife is a very simple
matter, and may be accomplished by a
novice. An investigation may be made
by simply holding the document before a
strong light, and this is usually all that is
necessary to demonstrate an erasure of
any consequence. This is, however, a
very different matter from tracing the out-
lines of a word or detecting the general
arrangement of the fibers of the paper, so
as to be enabled to state whether writing
has been executed on certain parts of the
document.
On several occasions I have been able
to detect additions made to certain docu-
ments, two of which were wills. The
additions were made in the following
manner : —
First, there was an erasure, then words
were written over the erasure. With the
microscope I could detect both erasure
and addition ; also the different colors of
inks used, and next, the most important
characteristics, namely, the strokes of the
pen, and finally, the general execution.
A microscopical examination of legal
documents, such as U. S. currency, wills,
and all other printed or written matter,
must consist always of the above-men-
tioned observations. The general mode
of execution includes the comparative ex-
pression of the original writing and that of
the additional. Especial attention must
be given to the shading, the formation of
letters both in the downward and upward
strokes, capitals and small letters, punctu-
ation marks, etc. All these points must
be taken into consideration in making
a microscopical analysis.
In the examination of commercial pa-
pers and documents, such as contracts,
agreements, wills, notes, checks, etc., to
detect a mutilation or forgery, the appli-
cation of the microscope is certainly the
most accurate and reliable, as well as the
easiest and simplest method. It is cer-
tainly the best method of establishing the
genuineness of an autograph.
And finally, we will discuss one of the
most important branches of legal micros-
copy, and that is the detection of coun-
terfeit currency, both American and
foreign. The detection of counterfeit
U. S. currency has long puzzled mer-
chants, bankers, and even expert cashiers.
But now the most skillful counterfeiter
can no longer defy detection. The ex-
pert microscopist cannot be deceived.
The same rules must be observed in the
microscopical examination of currency
as in the examination of written and
printed documents, but a certain addi-
tional observation is necessary ; examine,
first, the quality of the paper used ; sec-
ondly, the execution and finish of the bill ;
thirdly, the grade and color of the inks ;
fourthly, the printed condition of the bill
including the autograph ; fifthly, the most
important characteristic by which a genu-
ine bill is distinguished from a counter-
feit, viz., the red line running lengthwise
across the bill.
This line in a genuine bill is a red silk
thread woven into the paper, while in
a counterfeit it is simply a line drawn with
red ink.
Medical common sense is of more
value than a drug-store of medicine.
OBIGINAL ARTICLES.
123
LESSONS IN BACTERIOLOGY.
BY PAUL PAQUIN, M. D., D. V. S.
Lesson IX. — Experiments on Animals.
Part II. — Inoculation.
iN^this part of our lesson we shall deal
with inoculation of animals. The mode
of inoculating an animal, and the spot
chosen, depend on the object in view;
for instance, if it is desired to produce in-
fection merely, it is immaterial where and
how the inoculation takes place, provided
it does take place through the medium of
the virus to be tested, without extensive
local injury. But if it is desired to pro-
duce symptoms similar to a given disease,
and as much as possible under the cir-
cumstances usually attendant on the oc-
currence thereof, then it may become
necessary to use such processes as will be
deemed advisable for the purpose. It may
be necessary, for instance, to produce dis-
ease by inhalation of the germs, or by
inoculation in certain portions of the nerv-
ous system, for instance the dura mater,
or by inoculation within a bloodvessel, or
by the introduction of cultures under
the skin. It will be observed, therefore,
that the processes of inoculation to be
pursued, depend on the object intended,
taking into account the nature and proper-
ties of the micro-organisms.
In most of these operations, inoculation
is comparatively painless, for usually it
is done hypodermically. There is no
necessity, in such instances, to use any
anaesthetics. In other instances, it is
necessary, both to save pain and to make
matters easy, to use anaesthesia. This is
demanded in cases of trephining, for
instance for inoculation with rabies.
For that purpose rats or mice may be
placed under a glass with a wad of cotton
or a sponge moistened with ether or
chloroform ; ether is preferable. They
will soon succumb, and they can then be
handled easily. These animals are very
susceptible to ether, and can be kept
under its influence very easily, after they
are tied. With guinea-pigs and rabbits
it is more difficult, as both are very liable
to die of asphyxia, and it takes a great
deal of practice to become accustomed to
the degree of anaesthesia which these ani-
mals will stand.
In small animals like mice, a mere in-
fection may be produced by scarifying
the ear and rubbing in the virus. Sub-
cutaneous injections can be practiced
anywhere in them, but it is better in the
back. If one desires to produce infection
by scarification on the body, it is neces-
sary first to cut the hair close and clean
the spot well. In larger animals, like the
cat, the guinea-pig, and the rabbit, subcuta-
neous injections may be made in the thighs,
side, back, and almost any place where
the skin is comparatively loose.
The instruments used to inoculate, are,
the hypodermic syringe, if a liquid ;
forceps, if a solid body ; or a lancet-
needle or scalpel, if the material is to be
rubbed into scarifications. A syringe is
used every time that a considerable
amount of virus liquid is to be inocu-
lated. A pair of sterilized forceps serve
to introduce beneath the skin a solid in-
fectious body.
The material for inoculation is usually
from pure cultures; if these are liquid,
a sufficient quantity is drawn with a
sterile pipette, dropped into a clean
watch-glass, and the syringe is filled. If
the culture is in a solid medium following
the line of the inoculating needle, it is
difficult to get sufficient material without
cutting into the mass, or adding a little
sterilized distilled water to wash the cul-
ture out of its cavity, when it can be drawn
with a pipette or emptied directly into a
watch-glass. If it becomes necessary to
cut into the medium, the process of ex-
tracting it from the test-tube varies accord-
ing to whether it is a solid, gelatine or
agar-agar, or again, blood serum. In
case of gelatine, the tube is dipped in hot
water until the edges on the surface in
contact with the glass, melt, and then the
contents are emptied into a watch-glass.
If it is an agar-agar, heat will not dissolve
it enough to get the same effect. In this
case the tube is warmed a little, the pipette
is thrust to the bottom of it, and by blow-
ing a strong puff through it, the culture
will be made to loosen, and if handled
properly, to leap out of the tube and fall
into the watch-glass. This requires a little
skill. If it is serum, it is necessary to
take a long-handled, narrow-bladed knife,
sterilized, and cut the moss in the tube ; no
amount of heat, or any other process, will
safely loosen it from the glass.
If it is desired to inoculate into the
circulation, larger animals than the mouse
or rat should be used ; the rabbit is pref-
erable. In these, intro-venous injections
should take place in the ear and leg. For
inoculation in a vein of the ear, take a
long towel and wrap the rabbit firmly, so
that only the head will project, and, in
124
ORIGINAL ARTICLES.
the language of Salmonsen, ^' wash the
ear with 2 per cent of carbolic acid solu-
tion, partly to disinfect it, and partly to
make the vessel more apparent ; let the
assistant hold the animal's head and com-
press the base of the ear so that the veins
will swell, seize the ear between the thumb
and forefinger by the left hand, so that
it is slightly tense over the side of the
forefinger, thrust the canula carefully
through the skin ; now let the assistant
release the end of the vein and then
inject slowly with the forefinger and
thumb." When the vein has not been
pierced, the fluid swells the skin in the
neighborhood of the puncture ; then it is
about useless to try to enter the vein
from that point ; another vein ought to
be chosen or another point of the same
one. The vein running along the edge
of the ear posteriorly is a good one for
injection. Some operators prefer to make
an incision through the skin at the side
of the vein, then bring the vein and the
incision in juxtaposition. It is then easy
to introduce the hypodermic needle by
having to pierce only the walls of the
vein instead of having to pierce, besides,
the skin covering it.
For injection into a vein of the leg,
wrapping of the animal should take place
in the same manner, leaving only one hind
leg loose. The rabbit is then held by an
assistant in a proper manner — preferably
by holding the rabbit in his lap. One of
the veins in the lower extremity of the leg
is found, the hair clipped close, the spot
washed with a 2 per cent carbolic acid
solution, and the canula is then steadily
pushed through the skin into the vein,
where it is held by the pressure of the
thumb.
Inoculations may be practiced in the
peritoneal cavity, in the plura, in the
arachnoid cavity, etc. In the two former
cases, the most simple processes consist
in measuring the quantity, inserting the
syringe through the walls until the cavity
is reached, and emptying it by pressure.
In the case of the arachnoid cavity, it is
necessary to trephine the bone, of course,
before operating.
Inoculation is also practiced in the an-
terior chamber of the eye — a delicate oper-
ation which can be successfully practiced
only with a great deal of care, and by one
well acquainted with the anatomy of the
eye, and well equipped.
In order to test the properties of viruses,
inoculations of this character are not alone
sufficient ; it is also necessary to try to
produce the disease that is supposed to be
due to germs, by causing their growth in
the organs in which they usually occur in
accidental cases. For example, in tuber-
culosis, infection may be provoked by in-
halation of cultures and by ingestion, in
order to sow the germs both in the lungs
and in the alimentary canal. In various
fevers, skin diseases, nervous affections,
etc., etc., it is often required of the experi-
mentalist or investigator to try means of
inoculation or of infection, by the various
channels through which the disease may
take place accidentally.
In experiments by inhalation, the great-
est care should be taken to prevent the
access of the germs to the respiratory or-
gans of the manipulator. Contrivances
such as would be suggested by the occasion
should be used with due consideration
of the fact that powdered virus must not
be allowed to float where men can breathe
it. The animals should be in tight cages,
and receive the air only through tight-fit-
ting plugs of cotton in holes. To throw
in the powder, use a long rubber tube en-
tering the cage by a tight-fitting aperture,
and attach an atomizer or a powder-blower
at a safe distance. This kind of experi-
ment is dangerous with all kinds of viruses,
for we do not always know which are and
which are not pathogen.ic to man. When
it is known that a virus is pathogenic to
man, such as tuberculosis, then no precau-
tion can be too great. Numerous experi-
ments can be made by the physician,
student, and investigator, that cases and
circumstances will suggest at the time. It
is needless to say more on this point.
To Prevent Diphtheria. — It is be-
lieved that children may be prevented
from taking diphtheria when the disease
is prevalent in the neighborhood, or when
it has broken out in the family, by spray-
ing the throat every two or three hours
with peroxide of hydrogen. The pure
solution of fifteen volumes' strength should
be used with an ordinary atomizer. It
should be applied freely every two or
three hours. This preparation is one of
the best germicides known, and if thor-
oughly used in this way, will perhaps
prevent the microbes, which are the cause
of this disease, from obtaining a foothold
in the mucous membrane. However, its
use should not lead to neglect of isolation.
Dr. Smith has recently called attention
to the fact that the complications which
occur in scarlet fever may be prevented
by the same means, if employed early.
TRANSLATIONS AND ABSTRACTS.
125
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE MORPHOLOGY AND BIOLOGY OF THE
YEAST FUNGUS.
(Concluded.)
BY DR. JOHANNES RAUM, WARSAW.
Translated from xhc Zeitschr if t fur Hygiene, Vol. X, No. i.
by H. W. Loeb, A. M., M. D., St. Louis, Mo.
(^See Frontispiece.^
VI. The Small White Yeast Plant
(Figs. 63-67) differs in spore-formation
from the white yeast fungus of Lindner.
Their cells, generally spherical in form,
often contain isolated black granules.
(Figs, d-}) ^^^^ 64O I^ ^^ sprout-cells
which still remain with the mother-cells,
were observed these granules which seem
disproportionately small in the beginning
of proliferation. In yeast treated with
plaster of Paris or in distilled water,
spore formation and proliferation occur.
The sprouts seem uncommonly luxuriant.
I saw, frequently, mother cells laden
within ten sprouts. The yeast cells in
these cases become funnel-shaped. This
state is apparent when the preparation is
treated in daylight with a two per cent
solution of perosmic acid and short sub-
sequent staining with Loeffler's methyl-
blue (Fig. 65), while, after the use of
perosmic acid alone for one hour, only a
darker shade of this form results. The
Ziehl-Neelsen carbol-fuchsin produces
elegant pictures. These funnel-shaped
vacuoles seem to be identical with the
funnel-shaped forms described by Han-
sen. The spores are solitary, of a cir-
cular form, and possess small, black
granules.
VII. Saccharomyces Glutinis.
(Figs. 68-75.)
The cells, which are not large but oval,
contain in the height of their development
larger or smaller, more or less numerous
black granules. They lie in part in the
center and in part near the poles of the
cells, sometimes single, sometimes united in
larger collections. (Figs. 68-70.) In none
of the forms mentioned did I observe spore-
formation ; on the contrary, I found in
the older cells the funnel-shaped vacuoles
already mentioned which exhibit the same
reaction as the small white yeast fungus
when treated with perosmic acid and
methyl-blue. (Figs. 71-73.) In addition
this form may be very small. (Fig. 72.)
The proliferation seems to be of two pos-
sible kinds, by division of either the black
granules or of the funnel-shaped vacuoles.
(Figs. 74, 75.) I did not examine the
process of fermentation.
VIII. Yeast Obtained from Kefir.
(Figs. 76-81).
This form presents small dimensions.
Correspondingly the black granules are
much smaller than in the forms mentioned
heretofore. In grouping and number they
agree. It is worthy of note that in num-
ber and position of the granules in the
sprouts, they resemble the mother-cells.
(Figs. 76-81.) Neither spores nor vacuoles
are visible. Fermentation not observed.
Perhaps we deal, in this, with torula.
(Hansen's opinion.)
IX. Yeast from Sauer Kraut
(Figs. 82-9^)
When isolated, appeared as round, some-
what large cells. In size, position, and
grouping, these agree with what has been
already said. (Figs. 82-84.) In old cult-
ures wholly uncolored, vacuoles were ob-
served, of which the protoplasm, together
with the large granules therein contained,
crowd along the cell wall, in crescentic
forms. The cells often grow in length.
The black granules, which are never want-
ing in the young sprouting cells (Figs. 87,
^'i), were found in some samples. In later
stages of the development of the culture,
we met lengthened forms without nuclei,
which, however, could always be trans-
planted by proliferation. (Figs. 84-90.)
No spores. Fermentation weak.
X. Black Yeast (Figs. 91-99)
Presents no appearance of fermentation in
sugar-containing solutions. It contains
the black granules so interesting to us,
sometimes in the middle and sometimes
placed at the end. Vacuoles and sprouts
occur, but no spores.
In older cultures a lot of sprouts are
formed, which contain either a smaller or
larger granule. When the individual cells
increase, they throw out branches with
mycelia visible on the transverse walls.
They contain, in the neighborhood of this
wall, granules which, however, do not
exhibit the characteristic black coloring,
(Figs. 91-99-)
126
TRANSLATIONS AND ABSTRACTS.
In addition, pictures of the monelia
Candida (Figs. 100-106) are shown, which
were obtained by staining with methyl-
blue and Bismarck brown. I refrain from
giving a description of these, preferring to
recommend the detailed works of Plant
and Roux-Linossier.
BIBLIOGRAPHY.
1. Raum. Zur Aetiology des Tetanus ; Zcitschrift fur
Hygiene, 1889, Vol. V, p. 509.
Stein HAUS. Die Aetiology der acuten Eitertragen : Leip-
sig, 1889.
2. Ernst. Ueber den Bacillus xerosis und seine sporen-
bildimg ; Zeitschriytfur Hygiene. 1888, Vol. IV, p. 25. Ueber
Kern- und Sporenbildiing in Bacterien; Idem. 1889, Vol. V,
P- 428.
3. Zimmerman. Bettrage zur Morphologic und Physiolo-
gic der pflanzenzelle ; Tubingen, 1890, Vol. I.
4. ScHWARZ. Die Morphologische und Che7nische Zusam-
jjiettsetzung des Protoplasinas ; Beitrage z. Biologie der
Pflanzcn, von Cohn, 1887, Vol. V, No. i.
5. Errera. Sur le Glycogtne chez les Basidiotnycttes ;
Extrait des Bulletins. 3d Series, Vol. VIII, No. 12, and the
Memoires de I'Academie Royale de Belgique, 1885, Vol.
XXXVII. Ueber den Nachweis des Glykogen bei Pilgen;
Botanischc Zeitschrift, 1886, p. 316. Anh'dufungen und Ver-
brauch von Glycogen bei Pilzen; Botan. Centralb., 1887, Vol.
XXXII.
Wortmann's Review 0/ Errera" s Work; Botannische Zeit-
schrift, 1886, p. 200.
6. Zalewski. Ueber die Sporenbildiing in den Hefezellea;
Verhandlunge7i und Sitzungsber der Krakaner Akadefnie
der Wissenschaft, 1886, Vol. XIII, p. 124.
7. Stir les Spores chez les Le^nires ; Bulletin de la Societe
botanique de France, 1888, Vol. CXXX.
8. Centrallblatt f ar Bacteriologie tmd Parasitenkunde,
1888, Vol. Ill, No. II.
9. Review in Centrallblatt fur Bacteriologie und Parasi-
tenkunde, 1880, Vol. Ill, No. II.
10. Plant. Mene Beitrage zur systeinatischen Stellung
des Soorpilzes in der Botanik, Leipsig, 1887.
11. Roux-LiNOSSiER. Recherches morphologiques sur le
champignon duMuguet; Archiv. de Medicine Experimentale
et d'anatomie pathol, 1890, Vol. II, No. i.
-•^ — ♦ — *-
DIPHTHERIA AND GLANDERS BACILLI.^
Investigations Conckrning their Develop-
ment, AND the Coloring of the Latter
IN Sections, According to Improved
Methods.
BY MAG-NONIEWITCZ.
Translated for the Bacteriological World and Modern
Medicine by S. E. Weber, V. S., Lancaster, Pa.
It has long ago been observed by many
authors, that different kinds of bacilli do
not in all cases retain their form, but in
their development deviations will occur,
that may be observed in the stained or
unstained condition of the same. Few
authors have given this matter sufficient
consideration for a clear illustration.
Heidenreich pointed out, that the tuber-
cle-bacillus, in the true sense of the word,
does not appear as a little rod, but al-
ways exists as a chain of round bodies,
surrounded by a common sheath, and in
form throughout appears as a little rod.
1 Archiw weteriwarnuich na-uk (Archiv fiir Veterinarwissen-
schaften). (Aus dem bakteriologischen Cabinet des Dorpart
Veterinar Institutes.) " Oesterreichische Monatsschrift fur
Tierheilkunde."
Una and Lutz observed a similarity in
the syphilis and leper bacilli. Babes and
Ernst say that in all bacteria special
forms are contained, which, according to
staining, and on account of being sur-
rounded by protoplasm, make it plainly
distinguishable, and in some larger bac-
teria of this special form, can be recog-
nizedVithout previous coloring. Through
the work of Archangelski the same occur-
rence in anthrax is sufficiently illustrated,
where in the blood they are found as mi-
crococci ; whereas those set forth from the
culture of such blood contain beautiful
unfoldings of anthrax bacilli.
Supported by these declarations the au-
thor deals with his own observations upon
the development of the diphtheria and
glanders bacilli.
The diphtheria bacilli, thriving in a
nourishing substrata as well in the temper-
ature of an ordinary room as in the " ther-
mostat," were fully developed, and normal
in the first two or three days, just as those
described by Fraenkel, Flugge, and others.
In the following days appeared under the
mass of the normal bacilli, some in a
changed form, whose number increased
until at last nearly all had taken on a
form peculiar to themselves.
These changes of form began with this :
that at the ends and along the body of
the bacillus club-like thickenings made
their appearance, that were hardly notice-
able without staining. If we treat the
bacilli preparation with a weak alkaline
methyline solution and then with a weak
solution of Bismarck brown, the thicken-
ings will appear intense blue or black,
and sometimes reddish-black ; whereas the
other part of the little rod will remain
uncolored, or of a weak bluish tint. In the
younger bacilli (say ten days old) in the
stained condition they appear as little
round nodules with irregular contour ;
older bacilli contain round, sharp-edged
bodies. Shorter bacilli whose ends were
thickened had the appearance of dumb-
bells. Longer bacilli consisted of a row
of round bodies. Those present between
the round bodies in the unstained or
slightly stained condition were apparently
four-cornered, with their sides pressed in.
The protoplasm between the little round
bodies repels the staining material accord-
ing to the degree of development of those
bodies, and at last is fully indifferent to
it, for it remains unstained and is not fur-
ther visible, but still existing. We can
conclude from this, that those consisting
of little chains of 2, 3, 4, or more micro-
TRANSLATIONS AND ABSTRACTS.
127
cocci, misplaced by artificial movement,
still remain in coherence. In old cultures
of diphtheria bacilli, such little bodies ex-
ist in large numbers, and yet the author
was not successful in keeping them sepa-
rate in his cultures.
In cultivated glanders bacilli a similar
process is found. In their course, the
same case was observed, i. e., the appear-
ance of little round bodies that were in-
tensely stained, and whose development
was more rapid than that of the diphthe-
ria bacilli. Their sides remained regu-
larly parallel, and only very seldom were
unimportant thickenings observable.
In the glanders bacilli appear occasion-
ally, at one end, a little round body which
does not occur in the diphtheria bacilli.
These bodies are not so regularly placed
in the glanders bacilli, but those in the
intermediate space are of various size.
The breaking up of this small body of the
glanders bacillus, is brought about very
slowly and only toward the period of its
full development. In the more abundant
breaking up, we observe a weakening of
the life process and virulence of the little
rods.
During all these changes the bacilli still
remain mobile in the same degree. The
development of little round bodies in the
glanders bacilli is not one of accident,
and only apparent in the culture process ;
but the same is also met with, when they
are developed in other media, as in the
organism of an affected animal. In un-
stained preparations we observe, in the
first place, only little rods, and in most
of them also little round glistening bodies,
reminding one of micrococci.
In the stained preparation we observe,
in the first place, glanders bacilli exclu-
sively ; in the next place, bacilli and in-
tensely colored granular micrococci ; and
in the third place, the bacilli are wanting,
but instead, micrococci are present in vast
numbers. Glanders bacilli with fully pre-
served contours of two or three diameters,
containing intensely colored bodies, were
easily found in matter from a glanderous
ulcer, or nodule, from a guinea-pig that
had been affected for four or five weeks,
or from a sub-acute case of glanders in the
horse. Normal and uniform colored glan-
ders bacilli without mixture of micrococci
were observed in man, in field-mice, and
in guinea-pigs that had been sick two or
three weeks, and in a case of acute glan-
ders in a horse. Considering the same
form of glanders, where micrococci only
wpre met with exclusively, we may point
out that these forms happen in the course
of a chronic case in the horse. We find,
then, in glanderous matter, the bacilli, sep-
arate from which are a number of micro-
cocci, whose diameter does not exceed,
generally, the thickness of the bacillus, and
yet we meet micrococci with larger diam-
eter. Thin sections will almost always
show that besides micrococci, can be
pointed out a few bacilli which contain
little round bodies.
Free micrococci were very seldom found
separately, but mostly formed in colonies
of various sizes. These micrococci appear
somewhat larger than those inclosed by the
bacilli, and in the smallest colonies we can
recognize them as being placed two or three
in a row. From these results, in reference
to the changes of the glanders bacillus in
animal stroma, the author draws the fol-
lowing conclusions : —
First, the glanders bacilli have in the
first stages of their development (in acute
cases) all the qualifications of the charac-
teristic bacillus.
Second, there appear (in the cause of a
sub-acute case) in the bacilli, peculiar
little round bodies, which are easily
broken and color intensely, while the
protoplasm in this stage will color only
feebly. At the same time are found
present in small numbers, free little round
bodies.
Third, finally (in chronic glanders) we
find little round bodies predominating
and only very few bacilli, which at the
same time contain little bodies. In this,
the fixed process is fully analogous to
that of the glanders bacilli, both in the
culture preparation and in the animal or-
ganism ; the only difference being that the
development of the little round bodies
and the breaking down of the bacilli oc-
cur incomparably slower in the animal
economy than in the culture preparation.
As to the nature and vegetative proper-
ties of the little round bodies of the diph-
theria and glanders bacilli, the author was
unable to determine anything positive.
For each case, in the foregoing results
of microscopical diagnosis of glanders in
the horse, the author thought he could
always find room for further considera-
tion. He must be content thus far with
this account of the characteristics of
the specific bacilli of glanders, a certain
diagnosis of which is as yet very difficult
to make, while they are sometimes wholly
absent in the horse, and are only met with
as micrococci.^
1 See Method of Staining, Technique, in this number.
128
TRANSLATIONS AND ABSTRACTS.
Pyoktanin for Ozaena. — Dr. Demme,
assistant to Fraenkel, of Berlin, claims
excellent success in the treatment of
ozaena by the use of a 20 per cent mixt-
ure of pyoktanin and lanolin. The oint-
ment is applied by means of a little
tampon of cotton, with which a sort of
massage is applied to the interior of the
nose, the application being continued
about one half minute to each nasal
cavity.
to^ — • — *
Methyl-Blue in Acute Nephritis. —
P. Netcha'ien, of Moscow, reports success
in the treatment of acute Bright's disease
by the administration of methyl-blue.
Three doses of one half grain each of
methyl-blue are administered daily. The
immediate effect of the remedy was to
quadruple the quantity of urine secreted,
the patients passing 3200 to 3600 c. c.
daily. The albumen casts and general
dropsy as well as cardiac and pulmonary
symptoms quickly disappeared. A com-
plete cure was secured in from nine to
seventeen days in the three cases tried
by this method. The idea of the author
is that the remedy acts by destroying
the microbes upon which the disease de-
pends.
^ — • — 4
Immunity and Treatment of Swine
Erysipelas and other Infectious Dis-
eases J — Doctrines on the subject of
immunity abound. It seems that every
investigator who finds a means of pre-
venting a disease by some method or
other, concludes that he has discovered
the cause of immunity. This comes per-
haps from the universal desire to be the
discoverer of the great principle. Few
stop to think that all the modes of con-
ferring immunity, so far, are only so
many different processes which in their
time need explanation. In our opinion.
Dr. Mc Laughlin, of Austin, Texas, has
given expression to the truth concerning
the underlying laws of immunity I How-
ever, every one of these studies and proc-
esses adds to our practical means of pre-
venting disease, and is therefore of great
value.
Ascites with Abdominal Tumors.
— Ascites not infrequently exists with
large abdominal tumors in consequence of
an obstruction of abdominal circulation
arising from the weight of the tumor.
But there are cases in which ascites is
present with a comparatively small tumor.
1 See August and September (1891) numbers, Bacterio-
logical World.
I have met two cases of this sort in which
the amount of fluid which was withdrawn
from the abdominal cavity at the op-
eration, was 36 pounds in one case, and
30 pounds in the other. A pedunculated
fibroid in the first case, weighed 5
pounds, and in the second case, a
double papilloma weighed 2 pounds. In
the first case, 250 pints of fluid had
been withdrawn by tapping within three
months. M. Pascal {La Semai?ie Medicale)
considers that ascites in these cases may
be due either to tortion of a pedicle and
great mobility of the tumor, causing fric-
tion in the peritoneum, or an excessively
rapid growth of the tumor, causing a
stretching of the investing structure of the
peritoneum. Tumors of the omentum are
likely to be accompanied by ascites.
J. H. K.
Creosote in Pulmonary Tubercu-
losis.— Sommerbrodt, a German physi-
cian, in the Berliner Kli7iische Woehen-
schrift, recently gave a summary of his
experience in the use of creosote in cases
of pulmonary tuberculosis, during the last
nine years. He employs it as a remedy
in doses of from 1-4 to 15-50 grams
daily. He administers the remedy by the
stomach in divided doses, beginning with
a very small dose, and gradually accus-
toming the patient to its use. He con-
siders this creosote (pure beech-wood)
th-e most valuable of all medicinal agents
in the treatment of tuberculosis. He re-
ports complete cures in the early stages
of the disease. He has employed creo-
sote as a remedy for thirteen years, and
with increasing confidence. We have, for
some time, made use of beech-wood creo-
sote in cases of pulmonary tuberculosis,
employing it as an emulsion with the yolk
of Qgg, by enema ; found no difficulty in
using %-i gram doses, administering the
medicament at night at the hour of retir-
ing. We have commonly employed this
remedy in the form of an emulsion, and
the results observed have been very ex-
cellent ; in several instances the number
of bacilli have been materially lessened,
the patient has usually gained in flesh,
night sweats and fevers have diminished,
and there has been a marked improve-
ment in the general condition of the
patient. In some cases, however, the
disease has been so far advanced before
treatment that only temporary benefit has
been secured. A more extended report
of these cases will be given at a future
time.
TRANSLATIONS AND ABSTRACTS.
129
Acetic Acid in Chronic Laryngitis.
— Dr. J. Scheimmann, of Berlin, reports
success in the treatment of cases of chronic
laryngitis by means of inhalations of a 2
' per cent or 3 per cent solution of acetic
acid for ten minutes two or three times
a day. A little of the same solution was
injected into the larynx every day. Un-
der this treatment the thickened mem-
brane in the larynx became Softened, and
the thickening disappeared.
The Micro-organisms of Under-
garments. — Dr. Hobein, in Zeitschrift
filr Hygiene, Vol. X, p. 218, reports that
he has investigated the relative receptivity
of clothing for the micro-organisms found
in the body. He has observed that the
relative freedom of clothing from the mi-
crobes with which they come in contact
upon the skin, depends upon physical
qualities ; that is, the denseness or loose-
ness of the texture, the folds that it may
form, its thickness, and its power of
shrinking after washing. He concludes
that flannel retains more microbes than
any other texture, containing from three
to six times more germs than linen or cot-
ton fabrics. Woolens exposed to vapors,
retain a great many more germs after
washing than before ; silks, on the other
hand, are not modified. The author at-
tributes this difference to the well-knov/n
property of woolens to shrink after wash-
ing. Dr. Hobein concludes that dense
textures should be considered the most
proper, from a bacteriological standpoint,
hence the necessity of using this kind for
surgeons' aprons.
We should think this also an indication
to nurses, concerning the proper material
to wear. It would probably be irrational,
however, to conclude from this observa-
tion, that underclothing should not be
made from woolens, even though such
cloth retains more microbes than silks,
cottons, and linens ; indeed, as expressed
by a critic of the report, perhaps this very
fact should influence one to choose woolen
undergarments in preference to other tex-
tures,— their receptivity for microbes,
and their property of retaining them, con-
stituting a means of purifying the surface
of the body not to be rejected.
Fever by the Action of Soluble
Pyocyanic Substances. — M. Charrin
presented to the Academy of Science of
Paris, through M. Bouchard, a note in
which he states that the injection of the
soluble substances of the pyocyanic bacil-
lus produces a reaction such as Koch's
lymph produces. One of the principal
symptoms of this pretended reaction con-
sists in the elevation of central temoera-
J.
ture. This symptom has been observed
by M. Charrin in patients who receive the
microbic substances manufactured by the
pyocyanic bacillus, which is very different
from the bacillus of tuberculosis. He
makes the following reports : —
" An adult affected with pulmonary
tuberculosis in the third degree, entered
the Lariboisiere Hospital. The 8th, 9th,
and loth of September, 1891, this patient
had hemorrhages of the lungs. The nth,
in the morning, the blood reappeared in
abundance in expectorations. At 10
o'clock, during full hemorrhage, we in-
jected under the skin 3 c.c. of soluble prod-
ucts (of the pyocyanic bacillus). From
this moment the blood ceased to appear.
About noon, it was thought prudent to ad-
minister again, 3 c. c. At i o'clock the
patient is suddenly taken with shivering,
dyspnoea, with profuse transpiration, etc.;
the rectal temperature, which was slightly
under 102° F. in the morning, went up to
near to6° F. During the evening, the ac-
cidents gradually subsided. In the morn-
ing the thermometer had descended to its
habitual degree of the preceding days."
M. Charrin states that this patient had
other hemorrhages, and that all were ar-
rested by the same injection; but knowing
by this experience the danger of large
doses, the injections did not exceed, after
this, I c. c. to 2 c. c, under which no fever
of importance arose.
"The 9th of September, 1891, a young
girl recovering from typhoid fever, received
2 c. c. of pyocyanic toxin. At the moment
of this injection in the morning, the ther-
mometer registered slightly below 100° F.
It arose during the evening of the night
following to nearly 104° F. ; it fell again,
at the expiration of thirty hours, to 100°. "
M. Charrin gave other instances of the
injection of pyocyanic toxin followed by
high fever, and says that it would be easy
to multiply such instances.
Besides the importance of this discovery
of the reaction produced by other bacte-
rial products than those which were at one
time attributed only to Koch's lymph,
these results indicate the direct value of
bacterial products in therapeutics. They
support the theories advanced by M.
Bouchard, concerning the action of mi-
crobic matters in arresting hemorrhage by
their effect on the vaso-dilator and the
vaso-constrictor centers.
130
BACTERIOLOGICAL NOTES.
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Medicine, from original sources.]
Influence of Temperature on the
Bactericide Action of Light. — A
great number of investigators, including
Roux, Tyndal, Duclaux, and Strauss, have
investigated the influence of light upon
microbes. More recently Mr. Santori
Saverio {A^inali deW Iiistituto d' Igiene
Sperimentale dell ' Universite di Roma,
Vol. II, Series 2, p. 121) has taken up
the question with special reference to
the influence of temperature on light
and its bactericide action. The follow-
ing is the conclusion to which he has ar-
rived : —
1. The bactericide action of solar heat
manifests itself with great energy, even
when it is not accompanied by an elevated
temperature.
2. The violet and red rays of solar heat,
isolated as much as possible by means of
colored glass, do not cause the death of
micro-organisms, nor any visible changes
in their development.
3. Micro-organisms resist longer the ac-
tion of solar heat, in a desiccated state
than in a damp or humid condition.
4. There is no notable difference be-
tween the time necessary to sterilize a
culture of charbon spores and that required
to sterilize a culture of charbon bacilli.
5. The action of solar light is the more
rapid the higher the temperature.
6. The action of electric light furnished
by a lamp of 900 candles and kept within
80 centimeters of the culture, is much
inferior to solar light.
7. The spores of the bacilli of charbon
exposed to this electric light in a dry state
at a temperature between 18° and 20° C,
or between 66° and 68° F., are still alive
after 24 hours.
8. When, on the contrary, the tempera-
ture was between 40° and 44° C, (or 104°
and 1 1 1 '^ F.), — a common thing in culture-
tubes exposed to the sun, — their death oc-
curred after and between 12 and 24 hours.
The Influence of "Wood-smoke on
the Life of Bacteria. — Mr. Tassinari,
who established, some time since, the bac-
tericide action of tobacco-smoke, was fol-
lowed in this line of experiment by
Serafini and Ungaro {^An7iali deir Insti-
tuto d^ Igiene Sperimentale deW Universite
di Roma, Vol. II, p. 99), who experimented
with smoke, such as is used in the preser-
vation of foods, such as smoked meats.
Mr. Forster had already made analogous
experiments with tuberculous meats, by
which he proved that ten days of smoking
the meat did not destroy the germs of
tuberculosis. Messrs. Serafini and Un-
garo tested the influence of smoke on the
bacilli of cnarbon, the staphylococcus
pyogenes aureus, and the bacillus subtilis,
and they found the two first-named were
killed after 2^ hours, the last after 3^/^
hours, and the spores after 18 hours.
The temperature was compatible with
the life of the organisms, or about 77° F.
Desiccation was not notable, either. Ex-
periments touching on the action of the
different products of incomplete combus-
tion, bring tliem to the conclusion that
it is not the carbonic acid, nor the acetic
acid, nor the nitrous acid, nor nitric acid,
nor ammonia, which confer the bactericide
property to the wood-smoke, for they
were excluded from this smoke, but that
it was due to the empyreumatic prod-
ucts they contained.
fc ♦ <
A New Toxine in Urine. — Griffiths,
of Edinburgh, who has been studying the
ptomaines eliminated by urine in scarlet
fever and diphtheria, reports, among
other toxic agents, the discovery of an
extremely poisonous substance which is
closely allied to creatinine, one atom of
hygiene in the creatinine being replaced
by the radical propyl. It is curious that
a comparatively inoffensive substance
should become so intensely poisonous
as to be capable of producing death
within a short time after administration,
under the influence of the microbes pecul-
iar to diphtheria or scarlet fever. A
practical suggestion growing out of the
observation, is, that it would be well to
withhold beef tea, beef extracts, and the
use of other meat preparations, as well as
solid flesh foods of all kinds, in cases of
scarlet fever and diphtheria, and to sub-
stitute milk, fruit juices, and farinaceous
foods, which are generally recognized as
being more suitable for patients under
most febrile conditions.
Klebs has made a similar observation
respecting cholera nostras, having dis-
covered a ptomaine which proves to be
methylguanidine, an extremely poison-
ous substance evidently derived from
guanidine, a substance possessing very
little toxic power.
BACTEBIOLOQICAL NOTES.
131
Certain Actions of Tuberculine. —
Messrs. Bouchard and Galezowski, in nu-
merous experiments, have recognized that
Koch's tuberculine contains a substance
which always provokes vascular dilatation
with exudation and diapedesis, but chiefly
in regions where its effects are solicited
by a local irritation, as in local tubercu-
losis. In rabbits, tuberculine produced
albuminuria, hematuria, peptonuria, renal
congestion, and pulmonary congestion.
Sometimes, in sound animals, veritable
pulmonary catarrhal affections were pro-
duced, and pulmonary congestions with
diapedesis. It always produces, in the
sound guinea-pig, a notable dilatation of
the vessels of the papilla of the optic
nerve. An extensive and very interesting
explanation of these and many other facts
concerning tuberculine are published in
the Comptes Rendus of the Academy for
October, 1891, pp. 524—529.
The Leprosy Bacillus. — According
to a recent number of the Indian Medical
Gazette^ Drs. Rake and Buckmaster, mem-
bers of the Indian Leprosy Commission,
have at last succeeded in cultivating the
leprosy bacillus. This has been many
times before attempted, but without suc-
cess, although the bacillus itself has long
been familiar to bacteriologists, the tissues
of leprous patients being found crowded
with the microbes, which in some respects
closely resemble the bacillus of tubercu-
losis. The medium through which the
experimenters succeeded in growing the
bacillus, was a serum obtained by means
of a blister. The secondary growths or
cultures of bacilli, were obtained upon
agar-agar and gelatine. Experiments in
inoculation are being made, but reports of
results have not yet reached us.
The Microbe of La Grippe. — Cornil
and Chantemesse (Z« Semaine Medicate)
assert that the microbe recently described
by Pfeiffer, of Berlin, was described two
years ago by Babes, a little later by Ko-
valsky, and by Canon simultaneously with
Pfeiffer. In a recent study of the subject
made by themselves, they injected a drop
of blood from an infant suffering from
the disease, into the vein of the ear of a
rabbit ; the next day the microbes were
found present in the blood of the rabbit
in great numbers. A careful measure-
ment of their length showed it to be
about one twentieth of the diameter pf 3.
red blood corpuscle, or about one sixty-
thousandth of an inch.
The bacillus was found to grow well in
sweetened bouillon. A large monkey was
inoculated by throwing two drops of a
culture in bouillon into the nasal cavity.
The result was a severe attack of la grippe,
in which the bowels were affected by a
profuse diarrhea. The bacilli were found
in the blood of the monkey in great num-
bers. The febrile state of the disease
continued two or three days, and then
it was followed by a period of subnormal
temperature, as in human beings.
The disease in rabbits is longer con-
tinued ; the animals become emaciated,
lose their appetite, and retain the bacilli
in the blood for two or three weeks.
The bacillus of influenza seems to pre-
dispose the system to attacks from the va-
rious other microbes, which is the cause
of the frequent complications which at-
tend this disease.
When grown in bouillon, the microbes
do not destroy the transparency of the
liquid, and hence the growth is scarcely
appreciable to the naked eye.
The bacillus of influenza is very diffi-
cult to distinguish because of its extreme
smallness, and the difficulty of staining
it. The culture grows slowly at 37° C.
(98.6° F.) in gelatine and in sweetened
bouillon, but it is with difficulty trans-
mitted from one culture to another in
artificial media.
-» — • — •-
The Bactericide Property of Urine.
— In the Centralblatt filr Bakteriologie
und Parasitenkunde, Vol. VIII, p. 457,
Prof. Lehman gives his opinion based on
experimentation, concerning the bacteri-
cidal property in the fresh urine of man.
It had been observed, many times, that
the germs of infectious maladies are sel-
dom found in urine, whereas they fre-
quently infest the kidneys. This was
attributed to the filtrating action of the
kidneys. Prof. Lehman jointly with Dr.
Richter, has discovered that urine is really
germicidal, and that to this, probably, is
due the fact that infectious maladies rarely
contain the germ of the disease itself.
These experimentalists believe that the
bactericide action is due principally to
the acid phosphates contained in the urine;
for neutral urine is generally devoid of
this quality, while a solution of these salts
at the concentration found in the composi-
tion of urines has the same bactericidal
property,
132
EDITORIAL,
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
$2.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., February, 1892.
" DANGEROUS SCIENCE."
Under this caption, the Farmers^ Re-
view gives warning against the conclusion
of Dr. Henry F. Formad, of New Jersey,
who, after examination of the milk and
meat of tuberculous cattle, takes a decided
stand in opposition to the prevailing views
upon the subject. He says that he is
convinced that the dangers arising from
the use of the milk and meat of cattle
affected by tuberculosis, are much over-
drawn. Experiments were made upon
some guinea-pigs which were inoculated in
the anterior chamber of the eye with milk,
and after eight weeks no tubercle bacilli
were discovered. He also made examina-
tion of the meat of cattle, but has never
been able to find the germ. Apropos,
the Farmers^ Review says : " Some of our
scientists are apt to carry their investi-
gations of disease to dangerous conclu-
sions ; dangerous, because people are
inclined to take for granted as absolutely
correct, all the finding of such men,
whether it be plausible or not."
This point is well taken. It is true that
numerous scientific investigations come
before the public in such language as to
mislead the masses. We have no doubt
whatever that the results of Dr. Formad
justify his conclusions, but they do not
justify the conclusion that tuberculosis
is not transmissible from cattle to human
beings. It may be true that in the public
mind, and among general practitioners,
the dangers have been overestimated, but
it is certainly not so among those who
have studied the question closely and
calmly. The many reports made to the
late Congress of Tuberculosis in Paris,
have demonstrated as positively as can
be, in view of the nature of the malady,
that tuberculosis is transmissible from ani-
mals to man, and is transmissible from
man to animals, and also between ani-
mals. Dr. Formad's experiments merely
prove that in his cases he has failed to
transmit the disease by inoculation and
to discover the germs in the diseased ani-
mal. This negative result cannot disprove
the great number of positive results pre-
viously obtained by a great many in-
vestigators, of undoubted ability and of
unquestionable reputation. Indeed all the
negative results that can be adduced by
experimentation or observation could not
disprove one positively authenticated af-
firmative result. So it comes to this :
Dr. Formad's observations show, prob-
ably, that the disease is not as universally
dangerous, so far as transmission from
cattle to man is concerned, as is gener-
ally supposed by the public, in the sense
that perhaps not as many cases of tu-
berculosis originate from this source as
is generally supposed. I say '^probably,''
and I use the further word ^^ perhaps "
purposely, because the evidence is not
sufficient to warrant the unqualified ac-
ceptation of the conclusion.
It requires a great number of experi-
ments and investigations on a subject of
such vast proportions and possibilities,
to establish an entirely reliable conclu-
sion. And after a sufficient number of
inquiries of the most critical character
have been conducted for a sufficient length
of time, the fact will still remain that
tuberculosis has already been proven con-
tagious, therefore transmissible, and that
the tubercle bacillus which is found in
human tuberculosis, or consumption, and
that which is found in cattle tuberculosis
are identical. The disease is the same,
and due to the same virus ; it follows that
its transplantation is liable to take place
from animals to man. No amount of re-
EDITORIAL.
133
search can disprove this already estab-
lished fact.
The great need to-day is for scientists
to put their shoulders to the wheel with
more unanimity, having at heart the good
of the public rather than private advance-
ment and glorification. It is far from our
purpose to attribute personal motives to
the print of Dr. Formad. There is no
question that his work has been done very
sincerely and well. We make this remark
simply because, in a general sense, when
one examines the numerous monographs
and publications that come to the editor's
table, one feature strikes the mind at once,
and that is, that the public, for whose
good all scientific advancement should be
directed, receives abstract reports, from
which erroneous conclusions are often
deduced. It is evident, from the publica-
tions of the public press, that Dr. Formad's
print has resulted in creating the impres-
sion very generally, to the effect that we
need not fear tuberculous cattle or milk
from such animals. Certainly this is not
warranted by his experiments, and we be-
lieve that Dr. Formad does not give color
to any such conclusions. What the people
need to be guided by, is just the reverse
of this impression, which is true, viz., that
tuberculosis is contagious, liable to be
transmitted from animals to man, and
therefore we cannot take too much care
in isolating all centers of infection, no
matter of what character. p. p.
-^ — • — ♦-
ACTINOMYCOSIS.
The famous case of J. B. Greenhut and
others, vs. the Members of the Live-stock
Commissioners of Illinois, to recover
damages alleged to have been suffered
by the plaintiffs by reason of the quaran-
tine of certain cattle affected with acti-
nomycosis, and the subsequent disposi-
tion of the same, better known to the
public under the name of " the lumpy-
jaw cattle-case of Illinois," has attracted
universal attention, not only in this coun-
try, but in foreign countries. A great
number of experts were called by the
defence to prove the contagiousness of
this malady, and a few were called by the
prosecution to disprove this fact. It is
noteworthy that the latter gentlemen,
though declaring upon oath that they did
not believe in the contagiousness of acti-
nomycosis, admitted upon cross-examina-
tion that the disease is due to a germ or
parasite.
The unfortunate fact about this question
of actinomycosis lies in the denial, by a
few physicians and veterinarians, of the
specific, transmissible nature of this mal-
ady. In reading the testimony closely,
one is forced to the conclusion that the
very same men who deny the contagious-
ness of the infection must have a wrong
conception of what contagiousness means
in a general sense in the public mind, and
at the same time realize that the disease is
truly transmissible, since they admit that
it is either microbic or parasitic. The
general public do not make all the fine
distinctions of the medical world, in speak-
ing or thinking or treating of diseases.
The word "contagious," with the laity, is
a synonym of the word "catching," or
transmissible. It does not matter by what
particular means transmission takes place;
it is the fact of the transmission itself
which is the all-important one, and it is
this fact, too, that scientists who are truly
desirous of benefiting humanity should
take into account. The members of the
medical and veterinary professions may
have different views on a number of details
on the subject of the pathology of actino-
mycosis and the physiology of the parasite
that produces it ; but there is not one of
them, if he has studied at all, who can
successfully deny, or even doubt, that the
fungus known as actinomycosis is in reality
the producer of the affection. This being
known and realized by every one, it follows
that the malady must necessarily be trans-
missible in one way or another. It is not
necessary even to make extensive investi-
gations and observations to verify this
logical conclusion, to which the very na-
ture and etiology of the affection forces
134
iJBiTOEiAL.
one. It is, therefore, to say the least,
strange that any scientist can take the
stand, and upon oath declare that actino-
mycosis is not contagious, knowing all the
time that when he says, '' Not contagious,"
in the court-room, the public, ignorant of
technical terms, supposes he means, " not
transmissible."
But even if the disease were not conta-
gious, is it not wrong for medical men to
pursue a course that is liable to lead the
public to ridicule hygienic laws, and to
make light of the strenuous sanitary ef-
forts made throughout the world to pre-
vent humanity from eating diseased meat
of any kind ? Is it not indeed unsafe for
the people to eat flesh from an animal
suffering even from a non-specific dis-
ease ? Is it not dangerous, under certain
conditions, to eat even the meat of a
healthy animal, when it has been affected
by micro-organisms after death ? Should
we not therefore direct all our efforts to-
ward educating the people to the end
that all diseased meats, no matter what
the malady, are unwholesome ? There is
no occasion for extreme or sensational
teaching, but the truth should be told.
Even the experts who hold that they
would not fear to eat meat from cattle
having suffered from actinomycosis are
morally wrong in teaching to others that
such a thing is safe and wholesome.
They know themselves that it is not safe ;
and even though actinomycosis may not
be transmitted to one case out of ten
thousand people who partake of the af-
fected flesh under the conditions attend-
ant on the preparation of meat for the
table, this does not destroy the fact that
it is sometimes transmitted, or liable to
be, and that the flesh itself is unwhole-
some and unfit for human food. The
Board of Live-stock Commissioners of
Illinois has shown a determination
equaled only by the manly spirit and
the strict conscience of its members and
Secretary. They have been untiring in
their efforts, and, through them, the
medical world and the public have been
put in possession of more facts concern-
ing actinomycosis than were ever before
published at large. It is to be hoped that
they will continue their endeavors until
the truth is accepted.
After having the case under considera-
tion forty hours, the jury reported its in-
ability to agree, — a fact due, in no small
measure, to the conflicting testimony of
the experts of the prosecution, who, ad-
mitting the parasitic nature of the affec-
tion, denied that it was contagious or
transmissible. p. p.
-*• — • — ••-
MISDIRECTED SURGERY.
Some years ago, when a pupil assistant
to Mr. Lawson Tait, in a conversation
one day respecting the proper indications
for an operation of ovariotomy under dif-
ferent conditions, Mr. Tait referred to the
excessive frequency with which the opera-
tion was being performed by some Ameri-
can surgeons, especially by tyros who had
had no adequate preparation for this im-
portant branch of surgical work, and whose
operations must, to a large extent, be de-
nominated mutilations rather than scien-
tific surgery. Mr. Tait remarked that the
same state of things prevailed for a few
years after he first demonstrated the ne-
cessity of removing the uterine appendages
for other diseases than tumors of large
size. As an illustration, he mentioned the
following circumstance : Having read a
paper before a certain English medical
society upon diseased ovaries, and sub-
sequently visiting the same society at one
of its meetings, he was greeted by a num-
ber of physicians with soup plates full of
ovaries which they triumphantly presented,
but which were, almost without exception,
perfectly healthy organs. If a careful
pathological examination were made of
the ovaries removed by some operators in
other countries besides England, a state
of things somewhat similar, though we
trust not quite so bad, might be discov-
ered.
In England, the activity of professional
rivalry, and the influence of some success-
EDITORIAL.
135
ful suits for malpractice based upon an
unnecessary operation for removal of the
ovaries, have brought about a healthy
change, so that, at the present time, the
people as well as the profession recognize
the fact that every surgeon is not an
ovariotomist, and has not the moral right
to undertake operations of such gravity
as those which involve the opening of the
abdominal cavity, without having first se-
cured to himself the necessary opportu-
nities for becoming a competent operator
in this line of surgical work. As a result,
patients upon whom this operation is per-
formed usually fall into the hands of com
petent and reliable surgeons, and unneces-
sary ovariotomies must be comparatively
rare. It will be fortunate for the women
of America when a similar state of things
comes to prevail in this country. The
rashness with which some surgeons rec-
ommend to their women patients the op-
eration of ovariotomy, and the apparent
delight displayed by some operators in
cutting into the abdomen, is truly appall-
ing to all intelligent and conscientious
medical men. Many a patient's life has
been sacrificed to this reckless, and we
might even say criminal, surgery. If the
laity knew one half the truth upon this
question, it would be sad for the medical
profession, as respect for the profession
as a whole would be lessened, since the
public do not discriminate closely between
an honest, competent medical man and an
adventurer who has invaded the sacred
precincts of medicine, as a commercial
enterprise, and with no other aim than a
mercenary one.
In our opinion, every ovariotomist
ought to preserve what he removes as an
evidence of the necessity for the opera-
tion performed. This has been the cus-
tom of the writer for years, and it is a
practice which not only affords the honest
operator the best possible justification of
his work, but is also greatly in the inter-
est of science, as it facilitates careful
comparison of the morbid conditions with
symptoms and the results of operation.
J. H. K.
To Render Tobacco Harmless. —
Science, in a recent number, publishes the
following : —
" Smokers may be pleased to learn that
Dr. Gautrelet, of Vinchy, claims to have
discovered a method of rendering tobacco
harmless to mouth, heart, and nerves,
without detriment to its aroma. Accord-
ing to him, a piece of cotton wool steeped
in a solution (5 to 10 per cent) of pyro-
gallic acid, inserted in the pipe or cigar
holder, will neutralize any possible effects
of the nicotine. In this way not only
may the generally admitted evils of smok-
ing be prevented, but cirrhosis of the
liver, which, in Dr. Gautrelet's experi-
ence, is sometimes caused by tobacco,
and such lighter penalties of over-indul-
gence, as headache and furring of the
tongue, may be avoided. Citric acid,
which was recommended by Vigier for
the same purpose, has the serious disad-
vantage of spoiling the taste of the to-
bacco."
It is a pity that science should have to
search for antidotes for poisons used by
man, for absolutely no other purpose than
the gratification of an unnatural appetite
or passion. It may be true that the ef-
fects of nicotine will, in a manner, be
neutralized by this antidote, but the fact
remains that the useless appetite is not
destroyed, and that the satisfaction of it
must still continue to draw on the system
in various ways, notably, by the' extraor-
dinary and harmful salivation. p. p.
Tobacco Insanity and Nervous-
ness.— A terse monograph from the pen
of Dr. L. Bremer, one of our honored
collaborators, has recently reached us.
It is a pamphlet based upon an article
read before the St. Louis Medical Society,
in October, 1891. The doctor writes
from personal observation, and personal
knowledge of the effects of tobacco. He
himself used the weed for a long time,
and gave it up, under the conviction that
its effects were baneful. He has also had
years of experience in dealing with the
insane of the St. Vincent's Institution,
136
EDITORIAL.
St. Louis, Mo. The pamphlet will be
read with a good deal of interest, and
will do much good to those among whom
it may circulate. To demonstrate the
convictions of the author, I quote from
one of his pages: —
" That tobacco really does cause insan-
ity, is evidenced by the magic effect seen
in some cases after a discontinuance of
the drug, when the patient's condition is
still such that he is not wholly inaccessi-
ble to reason, and has will-power enough
to abandon the habit. Thus, I have seen
the beginning of melancholia with suicidal
impulses, hallucinations of various kinds,
forced actions, besides the precursory
symptoms of insanity, such as insomnia,
crying spells, prsecordial anxiety, fears of
impending evil, — that ' something is go-
ing to happen,' — impotency, vertigo, begin-
ning of impairment of memory and judg-
ing-power, and even the lowering of the
moral tone, — all of which, and a host of
other symptoms were attributable to
chronic tobacco intoxication. This ap-
peared after freedom from the habit was
established." p. p.
The Germicide Properties of Cin-
namon.— It is printed throughout the
country that M. Chamberland, of Pas-
teur's Institute, in Paris, has discovered
the antiseptic power of the essence of
cinnamon. He claims that it destroys
all kinds of germs in a few hours. It is
not the first time that this fact has been
brought before the public. It is said that
it was used long ago, during the plague in
London. It is doubtful, however, whether
the rationale of its use was understood ; it
was rather an empirical practice. Science
has now explained the ground for its bene-
ficial effects. It is recommended, as a
consequence, that a decoction of cinna-
mon be taken freely by persons living in
places affected by typhoid fever or cholera.
We might go further, and say that pos-
sibly it would be a fine disinfectant of the
mouth. Cinnamon bark could be chewed,
and the essence could be used by itself
with a tooth brush. The nature and origin
of certain maladies, such as diphtheria,
suggest that if people A^ould cleanse their
mouths thoroughly morning and evening
and after each meal, using a borax solu-
tion, say for rinsing purposes, and a few
drops of cinnamon essence on the brush
afterward, the germs of this disease would
likely be destroyed. A number of other
germs enter the system through the mouth,
and could be destroyed by proper anti-
septics. Among these, may be included
the bacillus of tuberculosis, the pneu-
mococcus, and various parasites of the
alimentary canal, among which quite a
number develop in the mouth first, and
then are swallowed down with water or
food, or enter the air-passages with the
flow of atmospheric air inhaled. The
properties of cinnamon in such cases,
make its use practical and rational.
Common salt as a tooth powder, is an
excellent antiseptic, as is also bicar.
bonate of soda. p. p.
-* — • ■ <
T'wo Newly Observed Peculiari-
ties of Feminine Physique. — In com-
paring the results of the strength meas-
urements of each important group of
muscles in the body for one hundred
men and one hundred women, two facts
are very conspicuous : —
1. As a uniform law for men, the total
strength of the arms is found to be almost
precisely two thirds of the total strength
of the legs, while in women the total
strength of the arms is scarcely one half
the total strength of the legs.
2. Comparing the muscles of the upper
chest (pectorals) in the average man and
average woman, the woman is found dis-
proportionately strong in this region.
For example, the strength of the pectoral
muscles of the average woman is found
to be 6i per cent of that of the muscles
of the average man, whereas the total
strength of the arms in an average woman
is only 47 per cent of the total strength
of the arms in the average man.
J. H. K.
REVIEWS.
137
Reviews.
The Physicians' Leisure Library.
— Detroit, Geo. S. Davis. The publisher
of the Physicians^ Leisure Library has cer-
tainly shown remarkable tact in selecting
popular and practical medical subjects,
and presenting them to the medical pro-
fession in a form so attractive and con-
venient, and so cheap that it is no wonder
the appreciation of the profession for lit-
erature in this form has been shown by
the rapid and enormous sale. We have
recently received the following numbers
of this series : —
Lnfectious Diseases, by Carl Liebermeis-
ter, in two volumes, treating on miasma
and miasmatic contagious diseases, in-
termittent fever, typhoid fever, measles,
scarlet fever, smallpox, vaccinia, vari-
cella, rubella, and diphtheria. The au-
thor presents many ideas new to Ameri-
can readers, and the volumes are well
worth perusing.
The Etiology, Diagnosis, and Therapy of
Tuberculosis, by Prof. H. Von Ziemssen.
The views expressed in this work are
based upon the theory of the bacillary
origin of tuberculosis, of Prof. Koch, and
are a great advance over the teachings of
the older text books. In an interesting
discussion of the heredity of tuberculosis,
the author mentions the interesting re-
searches of -Bollinger, of Munich, who
found the tubercle bacilli frequently pres-
ent in the lymphatic glands of children
who had died of measles, especially the
glands located about the root of the
tongue. These children had previously
been apparently healthy, neither tuber-
culous nor scrofulous symptoms being
present. This observation explains the
frequent occurrence of tuberculosis after
measles, and emphasizes the folly of those
mothers who think it wise to expose their
children to measles while young, so that
they will not have the disease when old.
Measles does not introduce the tuber-
cular germs into the body, but calls into
activity those which are present, which,
without such an exciting cause, might
be entirely destroyed by the tissues.
Bright' s Disease^ by A. L. Toomis, M.
D. This is an admirable resume of what
was known upon this subject at the time
the work was written, in 1888. We are
glad to notice that the author makes use
of the interesting and remarkable obser-
vations of Bouchard respecting urinary
poisons, and their possible influence upon
the kidneys.
The Tre aliment of Morphia Disease, by
Erlenmeyer. This little manual consists
of a single chapter in the compenduous
work on the "Morphia Habit" published
by Dr. Erlenmeyer, and relates solely to
the treatment of this psycho - neurosis.
The work is eminently practical, and the
method of treatment for the most part
agrees with the method which the writer
has worked out and has been employing
for the last fifteen years ; namely, quick
withdrawal, — that is, withdrawal of the
drug within a few days, instead of extend-
ing the attenuation of the doses for some
weeks, as is proposed by some. The
writer has found this method far more
satisfactory, and involving less discomfort
to patients, than any other, and has rarely
observed any degree of suffering, the se-
verest symptoms being readily controlled
by warm baths, massage, applications of
electricity, and other non-medicinal meas-
ures of treatment. Little benefit has ever
been observed in the use of substitutes.
Dyspepsia, by Frank Woodbury, M. D.
This is really a very practical little work,
and we take pleasure in noting that the
writer gives special prominence to the
hygienic treatment of disease, and is fa-
miliar with the researches of Bouchard,
and those of most other recent and reli-
able authors. We cannot agree, however,
with the statement of the author in his
introduction, in which he says, " Com-
parative anatomy shows that man's digest-
ive apparatus in its type repeats character-
istics found both among the carnivora and
the ruminants," from which he concludes
'^ that for him a mixed diet is most suit-
able," A further study of the subject
138
REVIEWS.
from the standpoint of comparative anat-
omy would, we feel sure, have convinced
the doctor that man is not a mixture of
the carnivora and the herbivora, a sort of
cross between these two races as regards
his teeth and his diet, — a dietetic hybrid,
so to speak, — but is himself a typical
representative of a special class of ani-
mals, in which he is associated with the
monkey and man-like apes, such as the
gorilla, chimpanzee, and allied species.
These animals constitute a class by them-
selves, the frugivora, the peculiar char-
acteristics of which find in man the high-
est and most perfect type. If comparative
anatomy proves anything whatever re-
specting the habits of any class of ani-
mals, it distinctly declares the human
race to be naturally frugivorous rather
than semi-carnivorous.
How to Disinfect Otcj- Homes, by Dr.
B. W. Palmer, This brief manual sets
forth the germ theory, the theory of anti-
sepsis, the relative value of the various
germicides, and the principles to be re-
garded in the use of antiseptics and disin-
fectants, with practical directions for the
application of disinfectants. It is a very
practical little manual, which has doubt-
less saved many lives.
Microscopical Diagnosis of Tuber-
culosis.— By Paul Paquin, M. D., Little
Blue Book Co., Battle Creek, Mich. One
does not need to read more than a page
of this concise little work to recognize
the fact that the writer is master of his
subject, and not only knows how to study
bacteria, but also has a remarkable faculty
for imparting the results of his studies,
and knowledge gleaned from the work of
others, to those who wish to make them-
selves familiar with this new but highly
important branch of medical science.
The work is so concise and practical that
it embodies within 48 pages, comprising
12 chapters, all that it is really necessary
to know for the microscopical study of
tuberculosis. The following are the head-
ings of some of the principal chapters :
" The Microscope and Other Instruments,"
" Principle, Object, and Effect of Stain-
ing," '' Mounting," " Collecting Sputum,"
'' Staining Fluids, and Their Use," " Modus
Operandi," '' Staining Bacilli of Tubercu-
losis in Milk, Pus, Articular Secretions,
etc.," " How and What to See through a
Microscope," and "The Bacilli of Tuber-
culosis." Two other chapters,' entitled
respectively, " Remember " and '' Don'ts,''
embody the quintessence of a great amount
of most important and practical informa-
tion. One of the characteristic features
of the work is a new method of staining,
discovered by Prof. Paquin, which shows
the bacilli most distinctly beautiful in pink
against a green background. We have
never seen the bacillus so clearly dis-
played by process as is shown by this
method, which is not only described but
illustrated by three colored plates. It is
not too much to say that this little work
ought to be in the hands of every physi-
cian.
[Books Received.]
The Psychic Life of Micro-Organ-
isms. — By Fred. Binet ; translated from
the French by Thomas McCormack. The
Open Court Publishing Co., Chicago, 111.
Price 75 cts.
The Ethics of Marriage.— By H. S.
Pomeroy, M. D., Boston. Funk & Wag-
nails, New York, publishers. $\.
Changes in the Red Blood-Corpus-
cles, in the Pernicious Anaemia of
Texas Cattle-Fever.— By Theobald
Smith, Ph. B., M. D., Washington, D. C.
Reprint from The Transactions of the
Association of American Physicians.
Land Liberation as a Public
Health Measure. — By George Homan,
M. D. Republican Press Ass'n, Railroad
Square, Concord, N. H., publishing Co.
Public Health and Municipal Gov-
ernment.— By John S. Billings, M. D.,
United States Army. The American
Academy of Political and Social Science,
Phila., Pub. Co.
The Law of Nature. — By Fred. M.
Taylor, University of Michigan. Ameri-
can Academy of Political and Social
Science, Phila., publishers.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
XlONTTHIvY BUI^IvETTIN.
Battle Creek, Mich., February, 1892.
MICROBE OF ABSCESS IN LA GRIPPE.
In two abscesses of a case of la grippe, —
one which had had all the typical symptoms
and had finally presented abscesses here and
there on the limbs, notably on one hand, — pus
was taken with a stei-ile hypodermic syringe,
examined microscopically, and then inoculated
in beef broth. In all the examinations, numer-
ous cocci — presumably of the kind known as
micrococcus pyogenes aureus — were found min-
gled with the pus. Cultures made, revealed no
other kind of micro-organisms. It seems that
the abscesses were complications, and not due
to the micro-organisms of la grippe alone.
Possibly this organism only weakened the tis-
sue resistance and rendered these fit soil for the
pus cocci to develop, for it was impossible to
tiud the bacillus described by Pfeiffer and others
as being the germ of la grippe.
-^ — » — ^-
Pseudo vs. True Gonorrhea. — It is well known
that pseudo-gonorrhea is frequently mistaken
for the true specific malady of that name; and
it is equally well understood, at least theoretic-
ally, that in either case the malady is commu-
nicable. The Director, a few weeks since, had
the opportunity of making some observations
from a bactei-iological standpoint on these two
maladies. (There are, by the way, perhaps
more than two kinds; i. e., more than the true
specific urethritis and the pseudo-gonorrhea.)
In the case presented, a male, there was a dis-
charge from the urethra. It was thick and
slight, and had existed but a short time. He
appeared a moral man, was clean, and vouched
that his life had been pure. He had a wife from
whom alone this disease could have been con-
tracted, if from any one. She, he stated, had
had a slight thick, creamy discharge for some
time and was frequent.
Microscopical analysis revealed an exceeding-
ly pure culture of cocci, in zooglea. They were
not attached to epithelial cells nor to pus cor-
puscles. The pus cells, in fact, were not so nu-
merous as in gonorrhea proper. The character-
istic appearance was the enormous number ot
these exceedingly fine cocci, mostly all in large
swarms. "Diplos" and " tetrads" were absent.
The patient's wife was then called for and
examined. She presented a thick, creamy dis-
charge. Microscopically, it presented numerous
epithelial cells, few pus cells, and exactly the
same fine cocci as were present in the husband's
case. The material was a veritable culture of
these fine organisms. It is evident that she
communicated this pseudo-gonoiThea by her
leucorrheal discharge.
Compared with the discharge of a true case of
gonorrhea which was presented for treatment
at the time, the writer noticed a marked difter-
ence in the size and grouping of the microbes, —
the organisms of the pseudo-gonorrhea being-
smaller, by far more numerous, and grouped in
numerous characteristic zooglea, nonadherent
to pus cells or tissue cells, as occurs in the true
affection.
These preliminary observations may lead us
to some important diagnostic points. We are
interested now in the comparative results of
cultivation and other tests.
-• — • — ^-
The Morphology of the Bacillus of Tuber-
culosis.— The beginner is often puzzled, and
often misled in analyzing sputum from a diag-
nostic standpoint, because he finds so much
difference in the size and appearance of the
bacilli of tuberculosis in a given specimen, or in
different specimens of the same case, or in speci-
mens of different cases. It is not uncommon to
find these organisms so small in appearance
that to the eye, with a % objective say, they ap-
pear as mere short hair lines, barely percepti-
ble. With the same stain and under the same
power, another specimen may reveal mostly
isolated spherical bodies, like fine cocci, which,
however, are evidently forms of the bacilli or
their spores. At other times, the bacilli ap-
pear very large and as positive rods. And
again, they appear as fine chains of cocci, here
enclosed in a sheath which gives the whole or-
ganism the appearance of a bacillus, without
any sheath apparent, or only the debris of a
(139)
140
LABORATORY OF IIYOIENE.
slieath. The Director of this laboratory has
soug'ht to explain these differences to his own
mind, and has come to the following- conclu-
sion : —
That the bacilli of well-developed cases of
tuberculosis with large cavities, are usnaliy
larger than those of milder cases.
That fresh sputum from mild cases rarely
shows beaded chains.
That bacilli in sputum allowed to decompose
or becotneold in vials, say, without desiccation,
gradually take a marked beaded appearance,
tliough staining may give them a bacillus
shape.
That Heidenreich's idea, that the so-called
bacillus of tuberculosis is not a bacillus in the
true sense of the word, 'because of this beaded
chain af)pearance, is not entirely correct, as
these spherical bodies are doubtless spheres
produced under special circumstances.
The same staining processes are usually more
effective in liquefied fresh sputum, in the same
length of time, than in old sputum, allowed to
putrefy, doubtless because the stain fixes with
more diflSculty on the spores than the sheath;
the former being more numerous and more
vital in old sputum than the frf'sh enveloped
forms.
Mouth Antisepsis. — M. Laborde recently
stated before the Academy of Medicine, of
Paris, that he had for a number of years, ex-
cellent success in the prevention of coryza by
rinsing the mouth and nasal cavity two or
three times a day with a 1-1000 solution of
carbolic acid, the solution employed to be as
hot as possible.
M. Magitot called attention to the observa-
tion of M. Vaillard that in cases in which the
saliva was septic in consequence of the presence
of streptococcus pyogenes from a small alveo-
lar abscess, the saliva became inert after thor-
ough cleansing of the mouth with antiseptic
solutions,
M. Netter found the pneumococcus in the
mouth of a patient who had suffered from
pneumonia more than a year before; the same
observer found the streptococcus pyogenes, the
cause of erysipelas and septicaemia, in the
mouth of healthy persons.
It is only necessary that there should be a
solution of continuity either in the mouth, the
irespiratory organs, or in the intestinal canal,
such as might be produced by an inflamma-
tory disease; as, pharyngitis, bronchitis, or
typhoid fever, to give rise to infection of the
general system.
Tt is certainly important that the mouth and
nasal cavities should be kept in as nearly an
iiseptic condition as possible, it being well
known that the mouth is the principal door
of entrance to the system of the microbes of
the air, and furnishes conditions favorable to
the development of a large proportion of the
germs usually present in the air. Although
these mici-obes seldom find their way into the
deeper aii- passages in consequence of thp pro-
tecting iiifluenceof the ciliated epithelium which
carries constantly upward to the mouth a
stream of mucus in which the invading mi-
crobes are likf^ly to be captured, it is neverthe-
less true that with the saliva, these organisms
are swallowed in great numbers, so that the
stomach is continually receiving foreign germs
which may include in their number those of a
deadly character.
The mouth should be kept in an aseptic
condition by thorough washing several times
daily, and the use of such an antiseptic as naph-
thol in a solution of 1-1000 of water, oi" car-
bolic acid in equal proportion. If the teeth
and all portions of the mouth are kept thor-
oughly cleansed from fragments of food and
foreign matters, the development of those
microbes that find entrance to the mouth will
be less rapid, and a comparatively aseptic con-
dition of the mouth may be easily maintained.
Cavities in the teeth are especially favorable to
the development of microbes. The nasal cav-
ity may be kept aseptic by careful cleansing
with a solution of common salt in watei', — a
teaspoonful of salt to a pint of water. The
solution may be used with an atomizer giving
a strong, coarse spray, or it may be drawn
into the nose from a saturated sponge. The
use of the salt solution should be followed by
a solution of some good antiisej)tic in a mineral
oil. The following is an excellent formula:
Pipmenthol, 3J^ parts; eucalyptus, 3^ parts;
oil wintergreen, 1 part; Alboline, 31 parts.
Peroxide of hydrogen is also an excellent
means of cleansing the mouth. Its irritating
properties are very slight, so that it may be
used in a pure state, if preferred, or one part of
the peroxide to one or two parts of water. A
tablespoonful of this solution held in the
mouth for four or five minutes, will not only
destroy the germs which may be present, to a
large extent at least, but will also oxidize the
minutefragments of dead organicmatter which
maj^ not have been removed by the tooth-
brush.
»■ — • — m
The Bacterium Coli. — There is, perhaps, no
single species of the vast family of microbes
which is at the present time receiving more
earnest, we may say anxious, attention, than
the bacterium coli. The fact that this microbe
is always present in the body in vast numbers,
gives to the suggestions which have been made
LABORATORY OF RYGIENE.
141
respectinp^ the pathological significance of this
microbe, an almost unrivaled importance. In
a communication upon this subject, made a
few days ago ;to the Society [of Biology, of
Paris, M. Le Sage states as follows: —
''The researches which I have made with
M. Macaigne upon the bacterium coli com-
mune, have led me to the following conclu
sions: The normal bacterium coli is not path-
ological for animals when the inoculation is
made with a moderate dose, that is to say, a
cubic centimeter (^th dram) of a bouillon cul-
ture, a dose which kills animals when the viru-
lent bacterium coli is employed,
"The difference between these results, and
those obtained by Escherich appears to be due
to the large doses which this author employed.
"Diarrhea, for example the simf)le diarrhea
of infants, renders the bacterium coli virulent,
especially in summer diarrhea.
"Cadaveric invasion does not take place with
the normal bacterium coli in a subject hav-
ing neither diarrhea |nor intestinal ulceration,
within twenty-four hours after death during
the winter. In summei*, this invasion may be
obsei-ved. Diarrhea, intestinal ulcerations,
and pulmonary lesions favor cadaveric inva-
sion by the bacterium coli, which in these con-
ditions sometimes becomes virulent.
"The normal bacterium coli exists in nearly
all stomachs. Whatever may be the chemical
conditions of the stomach, the microbe tends
to assume the saprophytic form, and is not
virulent.
"The microbe found in the pathological
manifestations of the bacterium coli in man, is
always virulent; that is to say, one cubic centi-
meter of a bouillon culture will kill a guinea-
pig, a rabbit, or a mouse.
"The bacterium coli found in the intestines
of children who have died of cholera infantum,
or of infectious enteritis, is always virulent.
At the autopsies in such cases, cadaveric in-
vasion may always be observed, appearing to
be facilitated by the virulence of the microbe;
and the bacterium coli found in the invaded
tissues is as virulent as those of the intestine.
"The bacterium coli isolated by MM. Gilbert
and Girode from many cases of cholera nostras
in the adult, possessed great virulence. The
same was found to be the case by MM. Chante-
messe, AVydal, and Legry.
"In cases of grave diarrhea, bacterium coli
is usually found alone in the intestine.
"The pathological bacterium coli has a con-
stant and durable virulence (more than seven
months in one case), but of variable intensity.
" Thebacterium coli cholerique, as MM. Gilbert
and Girode term it, is the most virulent. In
successive experiments, it always produced in
animals septicaemia, resulting in death in from
one to three days.
"The bacterium coli which one finds in an
artificially induced suppuration, has less viru-
lence, and always retains its pyogenetic char-
acteristic; for its constant effect in animals is
to produce, not a general infection, but ab-
scesses which kill in five or more days, but
which may heal.
"The bacterium coli, even when very viru-
lent, may be attenuated and become pyoge-
netic, but cannot recover its first virulence.
The same individual may present septic bacte-
rium coli in the intestine, and the pus-produc-
ing bacterium coli in the lung."
Elimination of Microbes by Urine. — This in-
teresting subject has recently been studied by
M. Enriquez, who reported to trie Society of
Biology at its meeting of Jan. 30, 1892, some
experiments which he had conducted for the
purpose of determining whether or not the
elimination of microbes was confined to some
particular part of the uriniferous tube. In his
experiments, the animal selected for experiment
was a cat. Making a section of the cervical
portion of the spinal cord, he injected into the
veins a culture of different microbes, at the
same time making intravenous injections of
the same microbes in other cats whose spinal
cords were intact. In cats which had under-
gone section of the spinal cord, secretion
was suppressed; in others, where the cord had
not been divided, a variable quantity of urine
was found in the bladder, and in each case,
cultures of the microbe injected were obtained.
In three of the five cases in which the cord was
divided, the microbes were found in sections of
the kidney, and cultures were obtained in al|
five of the cases. The microbes were found in
the cortical and pyramidal substances of the
kidney, being always most numerous in the
cortical substance.
The author concludes from his experiments,
that the elimination of microbes is independ-
ent of the aqueous secretion of the urine, a
function of the glomerule.
Latency of Diphtheria Germs. — In a discus-
sion which occurred before the French Academy
of Medicine, at its meeting of Feb. 2, 1892,
M. Vallin called attention to an interesting
observation (made by MM. Roux and Yersin.
These bacteriologists examined the bowels of
healthy children who had been placed beside
children suffering from diphtheria in a hospital
for children, and found almost constantly the
pseudo-diphtheritic bacillus, which although
142
LABORATORY OF HYGIENE.
an attenuated bacillus, is nevertheless capable
of becoming infectious in certain conditions.
According- to M. Vallin, similar researclies have
been made at a school in Normandy situated
on the sea-shore in a place where there had been
no diphtheria for a long time, and yet the same
bacillus was found.
These observations explain very satisfac-
torily the frequent development of diphtheria
where it has not existed for a long time before,
and without any apparent cause of new infec-
tion. One certainly' cannot approve of the
experitnent of placing a child suffering from
some other disease, beside a diphtheritic pa-
tient; but the results of this experiment and
the others mentioned, show very clearly that
the microbes of diphtheria may become attenu-
ated in the mouth, and there retained for an
almost indefinite period, in a comparatively
harmless form, ready to develop into a most
virulent and deadly disease when the condi-
tions happen to become such as to enable the
attenuated microbe to recover its virulencv.
Technique.
Staining Glanders Bacilli. — Dr. Mag-Nonie-
witcz, in a note translated for the Bacterio-
logical World and Modern Medicine, by Dr.
S. E. Weber, veterinarian, Lancaster, Pa.,
says : —
For the staining of sections of the glanders
bacilli, the author recommends the following
method, which has given him the best re-
sults:—
First, The section is taken out of alcohol,
then put in Loeffler's methyl-blue solution (or
caust. pot. 1-10,000).
Second, After this it is washed in distilled
water and placed in a J^ per cent solution of
acetic acid and tropaeolin. This mixture is of a
Rhine-wine-yellow color. The time necessary
for the section to remain in the solution de-
pends upon its thickness. For thin sections, it
is sufficient to merely dip them quickly, while
thick ones can be left in for two or five seconds,
and sometimes longer. In this way the sections
may be colored pretty strongl^^, and the bacilli
can be plainly recognized.
Third, The sections must be thoroughly
washed in distilled water, or may be immersed
in the same; by means of which the acetic acid
and tropaeolin will be thoroughly removed, and
at the same time a pretty large part of the
color from the stroma.
Fourth, Spread a section carefully upon the
slide, remove the superfluous water with filter
paper, and dry the preparation thoroughly in
the air or over a spirit lamp.
Fifth, To make the dried preparation trans-
parent, it is treated by dropping on xylol; the
longer it lies in this, the plainer become the
organisms.
The further microscopic examination can be
made in xylol, cedar oil, or Canada balsam.
Other oils will remove to a great degree the
color from the bacilli.
In this method of coloring the preparations,
the stroma will appear more or less bluish,
and the bacilli are set forth in a very plain
black color. The favorable result of this method
is this, — that the preparation, after removal of
the color and washing, is not affected by alco-
hol (absolute after Loeffler or dilute after Una),
or removed by strong, uncolored ethereal oil
(clove, origanunj, anise oil, etc.).
A Test for Carcinoma. — Dr. H. J. Stites, of
Edinburgh, recommends the use of a 5 per cent
solution of nitric acid (British Pharmaccepia),
as a differentiating reagent for tissues sus-
pected of containing carcinomatous portions.
During an operation, a portion of the tissue
excised is washed thoroughly in water to re-
move the blood, then placed in the solution for
ten minutes. The carcinomatous structure ap-
pears dull white, resembling egg albumen, in
contrast with the unaffected tissue the appear-
ance of which is translucent and gelatinoid. It
is to be hoped that this test will prove reliable.
It may be of much utility for diagnostic pur-
poses, and to limit the surgeon in the extent of
excision in any given case.
The Preparation of a Thermogenous Sub-
stance from Urine. — Put one literof urineinto a
largeglass; acidulate with phosphoric acid, add
1 c. c. to 2 c. c. of a concentrated solution of
chloride of sodium; neutralize with lime water
and a little soda lye, until it has the appearance
of precipitated flakes. Let the precipitate set-
tle; decant and filter; wash this precipitate in
strong alcohol; let it dry, and macerate in 10
to 12c. c. of glycerine during two or threedays,
and then filter. If four or five volumes of
alcohol are added to the glycerine extract, a
flaky precipitate is formed, which, gathered on
a filter, redissolves in water. One may inject
either the glycerine extract diluted in water, 1
to 5, 1 to 7, or 1 to 10, or the aqueous solution
of the flaky precipitate. A short ebullition
does not destroy the activity of a thermogenous
substance.
This is a method which has been used by
M. Paul Binet in his tests with substances ex-
tracted from urine of tuberculous persons, and
from human beings suffering from other mala-
dies, as well as from sound cases.
BULLETIN OF the
Medical and Surgical Sanitarium,
Battle Creek, Michigan.
The purpose of this depailnient is to constitute, together with the Bulletin of the Laboratory of Hygiene, a record of the
scientific work in the Medical and Surgical Sanitarium located at Battle Creek, Michigan, an institution incorporated as an
organized and self-supporting charitable enterprise, all the earnings of the institution being devoted to charitable medical work,
and the advancement of scientific medicine.
BIENNIAL REPORT OF THE SUPERINTENDENT.
(Continued.)
REPORT OF THE HOSPITAL DEPARTMENT.
The erection of a surgical hospital in con-
nection with the Battle Creek Sanitarium was
made necessary by two important features of
the work of this Institution : —
1. The character of the patients who visit this
Institution is such as necessarily to include a
large number of cases requiring the use of surg-
ical means. The long and successful career of
the Institution has created for it a constitu-
ency reaching into all parts of the United
States, so that its patients come from great
distances, and not infrequently from isolated
towns where the inaccessibility of first-class
medical skill or hospital advantages has led
them to neglect their cases until medical and
surgical intervention are the only means of
relief. It cannot be denied, also, that the con-
ditions of life at the average hospital are
usually repugnant to the tastes of refined and
cultivated people, who are able to secure more
comfortable accommodations. Every hospital
is a blessing of untold worth to a community
in which it is located, and to the classes for
which hospitals are usually intended, viz., the
indigent or the victims of accident, to the
wants of which they are, for the most part,
admirably adapted and well calculated to
accomplish the good purposes for which they
are intended. But a delicate invalid woman,
reared in luxury and accustomed to every
comfort and to being carefully protected from
every unpleasant sight and sound, can scarcely
find, even in a very well regulated public hos-
pital, the conditions likely to prove either con-
genial or conducive to recovery. The wide
recognition of this fact has given rise to a
multitude of small institutions, called private
hospitals or sanitariums in all parts of the
country; in fact, at the present day, almost
every leading gynecologist or sui-geon has a
private institution of his own, which, perhaps
for the want of a better name, he calls a "sani-
tarium," so as to get rid of the opprobrious
term "hospital."
It must be admitted that the prejudice against
hospitals is enormouslj^ exaggerated in the
public mind. Even those the least worthy ot
being presented as models of hospital construc-
tion and management can scarcely be consid-
ered as furnishing a counterpart of the hospital
and hospital life described by Charles Dickens,
whose writings should doubtless be held largely
responsible for the existing popular prejudice
upon this subject. A good private sanitarium
must be regarded as a vast improvement over
the average hospital, and yet the special ad-
vantages offered by these institutions are
scarcely such as to entitle them to be called
sanitariums, if this term is to be allowed any
specific significance as regards the nature of
the institution to which it is applied. Few of
them are more than comfortable homes fur-
nished with nurses, and, in exceptional cases,
facilities for the employment of massage, elec-
tricity, and a few of the simpler hygienic
methods employed at large and well-organized
sanitariums. Nevertheless, the work done in
these private sanitariums is far more success-
ful than that of the average hospital, owing to
the better care and more agreeable surround-
ings enjoyed by the patients.
2. Another reason for equipping a hospital
in connection with the Sanitarium, was its
isolation. Had the Institution been located
in the immediate vicinity of some large city,
quite possibly the managers would have felt
disposed to refer their surgical cases to some
neighboring hospital, owing to the large num-
ber of non-surgical patients and the press of
other medical work. But the great distance
to such institutions, and the increasing num-
ber of patients requiring surgical aid who
a ueared among its patrons, gave rise to a
d mand which the managers were compelled to
meet in providing first-class surgical advan-
tages in connection with the Institution.
3. A third reason which may be mentioned as
in the minds of the managers in their plans for
the establishment of a surgical hospital, was
143)
144
SANITARIUM BULLETIN.
the desire to witness the advantages of com-
bining the best advantages for surgical work
with equally good advantages foi- the prepara-
tion of the patient for the needed operation,
and such after treatment as would secure all
the possible advantages of the operation, and
restore the patient to his home and friends in
the best possible condition.
The managers of the Institution sought, in
all their plans for the hospital, and in its erec-
tion and furnishing, to supply the very best
possible facilities to be attained with our pres-
ent knowledge of hospital construction and
equipment. They endeavored to profit by the
experience gained by the Superintendent in
visiting the best hospitals in Europe and this
country, and spared no pains nor expense in
supplying the conditions requisite to complete
asepsis in surgical work.
The Hospital furnishes accommodations for
100 patients at the present time, and can ac-
commodate half as many more, as a portion of
the'building is now used for lecture rooms for
the Training School for Nurses, and for the
cooking school and the experimental kitchen.
The ^following are a few particulars about the
Hospital, which may be of interest: —
It is located on an eminence commanding a
wide sweep of picturesque country. The soil is
a coarse, porous gravel for about 60 feet, so
that drainage is perfect. Extraordinary pre-
cautions are .taken respecting sewerage, drain
and soil pipes, hoppers, etc. The sewer is con-
nected with the large smokestack, and is com
pletely isolated from the building. The air in
the'^^sewer-pipe is changed so constantly that
there is no chance for the accumulation of sew-
er-gas.
The ventilation of the Hospital is ddubtless
superior to that of any similar institution in
the country. The fresh air supply is admitted
warm to the corridors of each floor, the regis-
ters being so placed as to equally distribute
the air throughout the corridor. Each room
is supplied with its own outlet for impure air,
which is placed beneath the window in the out-
side wall of each room and connected with an
independent duct in an inside wall. This plan
secures a constant current of air toward the
individual rooms, and this prevents the dis-
persal of odors through the ward. Hospital
smells are conspicuous by their absence. The
air iu the Hospital is at all times as pure and
fresh as that out of doors, 10,000 to 15,000
cubic feet of air jjer hour being admitted for
each occupant of the wards. The position and
the construction of the Hospital are such as
to furnish from nearly every window a delight-
ful outlook, a great advantage to convales-
cent patients. In the construction of the
Hospital gieat pains were taken by the in-
troduction of non-conducting material into
the walls to prevent the inequality of the tem-
perature of rooms, and the disagreeable and
sometimes dangerous cold currents which are
the result of cold exterior walls.
The Hospital has one of the best operating-
rooms in the country, furnished with every
appliance and accessory provided by modern
surgical handicraft. The suite of operating
rooms consist of —
1. A preparation room, in which the patient
and everything about him, are rendered thor-
oughly aseptic; then the operator and all
assistants, and even visitors, are also required
to cleanse their hands in the most thorough
manner possible, to lay aside their outer gar-
ments and put on aseptic gowns reaching from
neck to ankles, before entering the operating-
room proper.
2. A room adjoining the operating room,
opening into it, in which the anaesthetic is ad-
ministered. In this room, convenient for im-
mediate use, are kept all the medicinal agents
useful as restoratives in case of the occuiTence
of dangerous symptoms from the anaesthetic, —
shock, etc., and in addition, galvanic and
laradic batteries ready for use, and an ap-
paratus for the administration of oxygen by
forced respiration, always charged with a
supply.
3. A room also adjoining and opening into
the operating room, to which the patient is re-
moved for the application of the dressings and
partial recovery from the anaesthetic before
being removed to the ward room. In this
room is also kept a supply of antiseptic solu-
tions of various sorts, antiseptic dressings, etc.
4. A room for the sterilization of instruments
by both steam and heat, and for the distilla-
tion and heating of water. By the aid ol an
automatic apparatus, an ample supply of dis-
tilled water, hot and cold, is kept constantly
on hand. Contained in an adjacent room, is a
larger apparatus for the sterilization of bed-
ding by heat.
Ordinary brooms are not used iu the ward, in
consequence of their disposition to disperse
dust. Carpets are also discarded, the floors
being kept in a highly polished state by the
frequent application of dressing, so that the
amount of atmospheric dust is kept at a mini-
mum. The purity of the air of the operating-
room is still further increased by means of a large
air filter through which the air is drawn by an
electrician. As an evidence of the extraordinary
degree of air purity obtained, we may mention
the fact that three sterilized potatoes exposed
SANITARIUM BULLETIN.
145
n the operating room while in nse during tliree
hours, gave the following results: No. 1 re-
mained sterile. No. 2 showed only two small
colonies, and No. 3 three colonies. The potatoes
were so placed in different parts of the room as
to give fairevidencerespecting the number of air
germs present. The result was regarded by Dr.
Paquin, Director of the Sanitarium Laboratory
of Hygiene, as a very remarkable one. Of
course, credit, must be given to the fact that the
country air with which the Hospital is sur-
rounded is naturally much freer from microbes
than the dust-laden atmosphere of a great city.
The absence of smoke, city smells, and pave-
ment rattle, is an advantage much appreciated
by the patients of this Hospital.
The annexed tabulated statement represents
the surgical work done in the Hospital within
the two years covered by this report: —
The above record of 674 surgical cases, more
than two thirds of which were of a very grave
character, is certainly one which is seldom
equaled. [Since Oct. 1, 1889, 119 operations,
including eighteen ovariotomies, one nephrot-
omy, and more than fifty other grave opera-
tions, have been added to the above list, mak-
ing a total of nearly 800 operations, the total
number of deaths remaining the same.] The
small number of deaths in the large number of
ovariotomies, which included a very large pro-
portion of bad cases as shown by the detailed
history of the cases, and the morbid specimens
removed, which are carefully preserved in every
case, is considered especially worthy of note.
Including three cases operated upon immedi-
ately prior to Oct. 1, 1889, there was a succes-
sion of fifty-two ovariotomies without a death.
A still better record of successive successful
cases has since been made, but as the record
has not yet been broken by death, its publica-
tion is reserved for some future time. The
total record of the Hospital in ovariotomy now
stands, March, 1892, 150 ovariotomies, with
five deaths.
A'^brief review of the cause of death in each of
the cases in which a fatal result occurred will
still further emphasize the excellence of the
record of recoveries made in this Hospital.
The following is a brief statement of the causes
of death, the cases being mentioned in the or-
der of their occurrence.
Case 1. The patient was suffering from severe
pelvic inflammation and abscess. The abscess
had been opened through the vagina and a
large amount of pus evacuated. The patient
was better for a time, but the fever returned,
and other symptoms of pus formation in a
point inaccessible from the vagina. An ex-
ploratory incision was made. The whole'con-
tents of the pelvis were so massed together by
exudate that it was found impossible to re-
move the appendages. No large accumulation
of pus was found. The patient's symptoms
continued to get worse, and a few days later,
her temperature having risen very high, the
wound was opened, the abdomen washed out,
and an attempt made to remove the numerous
foci of inflammation and pus formation, which
was fairly well accomplished, but the patient
continued to sink in consequence of the sys-
temic poisoning, and died the following day,
probably not from the operation more than
from the original disease.
Case 2. The patient, a man, was brought to
the Hospital unconscious, having fallen in an
elevator shaft a distance of forty feet, striking
upon the head. At the earnest request of the
friends an effort was made to save his life by
trephining the skull, which was much de-
pressed at several points. A large part of the
brain was found disintegrated, and many large
clots in the cranial cavity. The patient con-
tinued unconscious and died a few hours after
the operation, certainly not from the opera-
tion but from the injury.
Case 3. The patient had for years suffered
from pelvic inflammation and pelvic abscess;
was in a most miserable condition; had been
confined to her bed up to within a few days of
her visit to the Hospital. On operating, found
double pyosalpinx. There were three open-
ings connecting the pus sacs with the intestines.
These were carefully closed. The patient left the
operating table with a fair prospect of re-
covery, although the operation had been quite
a severe one, owing to extensive adhesions.
She died, however, of shock, the nigh b foil owing
the operation. The case was evidently a hope-
less one without an operation, and the pa-
tient's life was constantly threatened by a
renewal of the inflammatory attacks, and she
was in a. most miserable condition.
Case 4. A case of epithelioma of the cervix.
Almost the entire cervix uteri was destroyed.
The patient was in a very feeble state. The
uterus and appendages were removed by vag-
inal hysterectomy. The patient seemed to have
a fair prospect for recovery, but died of peri-
tonitis on the second day. The fatal result in
this case may have been attributable to the
fact that a violent retching of the patient
during the operation caused a knuckle of the
small intestine to appear in the wound. The
intestine was carefully disinfected and pushed
back, but this unfortunate and unpreventable
accident may have been the cause of the pa-
tient's death.
Case .5. The patient, an elderly woman, suf-
146
SANITABIUM BULLETIN.
fering from epithelioma of the cervix uteri far
advanced, had recently been in a Hospital in
Chicago, where operation was declined and the
patient sent home. She was brought by friends
who with the patient insisted that an operation
should be performed if there was the slightest
hope of recovery. The operation of partial
amputation of the cervix was performed, it be-
ing impossible to remove the entire organ,
owing to the lateral extension of the disease.
The patient died the night following the opera-
tion, of shock.
Case 6. In this case, although the patient
recovered from the operation, some time later
a fecal fistula appeared in the wound, and
afterward opened into the bladder. The pa-
tient died some months after the operation,
from exhaustion. Tn this case the diseased
structures removed were completely imbedded
in masses of inflammatory exudate which in-
volved the intestines extensively. The intes-
tines were not torn at the operation, but
apparently the intestinal wall broke down
subsequently, giving rise to the fistula.
Case 7. The patient had suffered for many
years from an abdominal tumor, the character
of which had not been fully understood. Had
had repeated attacks of pelvic inflammation
which had kept her a bedridden invalid for
many years. Had been for several months in
the Woman's Hospital of New York, in prepara-
tion for operation, which was finally declined,'
the patient being advised to wait until life was
unendurable, as the hazard of the operation
was likely to be great. Tt is probable that the
tumorwas at that time believed to befibroid in
character. The patient was in a most miser-
able condition, having waited as advised until
it seemed impossible to live longer as she was.
The condition was found to be cystoma of each
ovary with most extensive and firm adhesions
everywhere. The adhesions were carefully
broken up and the operation completed satis-
factorily. The operation was necessarily some-
what prolonged, and the patient was very weak
at the close. She died a few hours later of
shock.
Case 8. The patient eufl'ered for a number of
years from a fibroid tumor of the uterus, which
was very large and troublesome, and a source
of constant pain. She had been treated for
several months by means of electrolysis, but
without success, as the tumor continued to
grow. The appendages were removed, and the
operation completed without unfavorable
complication of any sort. Vomiting from the
anaesthetic following the operation was exceed-
ingly severe, and continued in spite of every-
thing that could |be done |for the 'patient, until
her death, on the fifth day following the opera-
tion. The causeof death appeared to be exhaus-
tion from severe vomiting. The patient had
had similar attacks of vomiting before, from
some slight cause, which, had nearly ended fa-
tally.
Case 9. The patient, a man aged about 60,
had a tumor in the right side below the ribs,
and extreme jaundice. Puncture of the tumor
with a hypodermic syringe showed it to be a
distended gall bladder. The patient was in
such a feeble condition that operation was
delayed for a day or two, hoping that he would
rally. He continued to fail, however, and at
the operation two days later it was found that
the gall bladder had ruptured. Two quarts of
bile were removed from the peritoneal cavity.
There was no rise of temperature, and no
aggravation of symptoms following the opera-
tion. The patient suffered some less pain than
before, but died the third daj'^ afterward. It is
certainly a question whether death was at all
hastened by the operation, which consisted
simply of an exploration and evacuation of the
bile, and washing out of the abdominal cavity.
The cause of obstruction of the gall-duct was
cancer of the head of the pancreas.
Case 10. A case of double pyosalpinx with
extensive adhesions of the appendages. A few
days after the operation, decided symptoms of
peritonitis appeared. The wound was opened
and the abdominal cavity washed out, but the
patient died a few hours later.
Case 11. A case ii which the ovaries and
tubes were imbedded n inflammatory masses.
The operation was completed satisfactorily, but
the patient died of shock the night following,
probably the result of individual idiosyn-
crasy, as she was of a peculiar nervous tempera-
ment, and was greatly depressed before the
operation.
Case 12. An enormous fibroid of the uterus,
weighing after removal forty pounds, firmly
adherent everywhere, enormous veins connect-
ing the tumor with the abdominal walls. There
was much hemorrhage at the operation, but
the patient left the table in good condition,
did well for twenty-four hours, then sank
rapidly. After death the abdominal cavity was
found filled with serum. The cause of death
seemed to be the loss from the blood of such an
enormous quantity of serum after the hemor-
rhage of the previous day. ''Everything possible
was done by compression of[the"tumor before
removal, and by the sub-cutaneous injection of
a weak saline solution after the operation.
Case 13. This case was similar to the" preced-
ing— a fibroid of the uterus, weighing twenty
nounds, with extensive adhesions. The pa-
SANITARniM BULLETIN.
147
tient died of shock the night following the op-
eration.
Case 14. An exploratory incision in the case
of malignant disease of the uterus, with ascites.
The exceedingly friable tissue of the growth
was slightly wounded by the blunt trocar used
ill the evacuation of the fluid, which rendered
necessar^^ packing with iodoform gauze. The
patient did well for several days. Some daj's
after the removal of the packing, and nearly a
week after the operation, the patient began to
sink rapidly, and died in a few hours, probably
from the recurrence of the hemorrhage.
Case 15. Malignant disease of the rectum,
of nearly three years' standing. The operation
of excision was performed. The disease ex-
tended so high that the peritoneal cavity was
involved. The patient did not rally after the
operation, and died of shock the next day.
Case 16. Male; exploratory incision with ref-
erence to a mass in the right side, of unknown
character. It was found to be malignant dis-
ease of the omentum, which extended to the
anterior wall. The patient had been failing
rapidly before the operation, and continued to
sink afterward, and died without inflammator3'^
reaction, two days after the operation. He
was sinking so rapidly before the operation
that he must have died within a few days.
Case 17. In this case the patient died while
under anaesthetic undergoing an operation
for inguinal hernia. The operation had been
completed, and the sutures were being closed
when the patient began vomiting. The retch-
ing ceased very soon and the patient breathed,
but in a somewhat feeble manner. The pulse
could not be felt at the wrist. Artificial res-
piration was employed and normal respiratory
movements returned. The pulse also* returned
to the wrist. The patient again stopped
breathing, the pulse disappeared, and al-
though vigorous and long-continued efforts for
respiration were made, they were unavailing.
Junkers inhaler was employed, and no chloro-
form was administered after the appearance
of warning symptoms. This case is interesting
from the fact that the pulse disappeared while
voluntary respiratory movements still con-
tinued. The amount of chloroform used dur-
ing the operation was very small, and its
administration so gradual and uniform,
through the use of Junker's inhaler, that it is
difficult to account for the occurrence of death
otherwise than by the supposition that the
patient had an idiosyncrasy which rendered
him unusually susceptible.
It is of interest to note in connection with the
above, that in three cases, and perhaps four,
the patient died, not from the operation, but
from the disease for the relief of which the
operation was undertaken, so that justly, but
thirteen instead of seventeen cases should be
put down as attributable to operation (making
the record thirteen deaths instead of seven-
teen, in nearly 800 cases, or about one and one
half per cent).
It is also a consolation to the surgeon to
know that in each of the fatal cases with the
possible exception of three cases, there was no
chance for life without an operation, and in
two of those cases the chance for life was a,
very poor one, and the patient's condition
very miserable indeed.
J. H. Kellogg, M. D.
OPERATION.
Amputation, fingers
hand
leg
toes
Anal fistula
Ankylosis of knees, forcible extension
Aspiration of chest
for ascites
Atresia, partial of vagina,
Bubo excised
Calculus of bladder
Canthoplasty
Cervix uteri, amputation of, for cancer
Cicatricial contraction in hand, operation for relief of
Circumcision
Cleft palate
Coccyx, removal of
Cystocele .
Cystotomy, perineal for vesical cancer
Epithelioma of ear
'6
a>
'zi
U
0)
a>
<a
>
x>
>
o
.d
a
o
o
P.
^
s
<0
a
l-H
(15
S^;
«
P
1
1
1
1
, ,
2
2
1
1
3
2
1
1
1
2
2
1
1
1
1
2
2
1
1
2
2
1
1
1
2
2
1
1
1
1
1
1
1
, ,
1
1
1
Cause of Death or Failure
tuberculosis.
Shock, patient being very
feeble.
148
SANITARIUM BULLETIN.
OPERATION.
Hemorrhoids
Hernia, inguinal
umbilical
Hysterectomy, abdominal
vaginal
Inguinal glands removed
Laparotomy, for acute peritonitis ,
exploratory incision, malignant disease of uterus. ,
imbedded cyst
for ruptured gall-bladder
sutured wound in small intestine
exploratory incision for cancer of omentum (male)
Mammary gland, excision for cancer
tumors of »
Mole of eyebrow removed
Necrosed metatarsal bone removed
Necrosed humerus, removed
Nephrectomy
Nephrotomy
Ovariotomy
Perineum, partial laceration
complete laceration
Polypus, rectal , . .
uterine
Rectal ulcer
Recto-vaginal fistula
Rectum, excision of for cancer ,
stricture of ,
Round ligaments, shortening of . . ,
Strabismus, tenotomy for
Tenotomy of thigh muscles ,
Testicle, excision of ,
Trephining frontal sinus for abscess
mastoid abscess
skull
Tumor, cystic, of labia
fatty, of chest
fibroid, of cervix uteri , . .-
enlarged lymphatics of the neck removed . . , ,
tuberculous gland of axilla removed
tuberculous gland of neck removed
urethral ,
Urethral dilatation for disease of bladder (female) ,
fistula
Uterus, amputation of cervix
cervix laceration of repaired . ,
curetting ....
Varicocele
Vesico-vaginal fistula
Minor surgical operations requiring an anaesthetic
Totals .
S
140
T3
0)
>
o
P3
0)
o
1— 1
4)
140
3
2
1
1
1
3
1
2
5
2
2
1
1
1
1
1
8
7
1
1
1
1
1
1
1
. .
1
1
5
5
5
5
2
2
1
1
1
1
1
1
2
1
I
129
124
5
3
2
26
26
1
2
2
13
j3
. .
2
2
3
2
1
1
1
1
1
68
65
3
2
2
2
1
I
3
3
1
I
1
1
I
1
1
5
5
2
2
1
1
2
2
1
1
8
8
4
4
1
4
3
1
37
37
90
90
7
7
1
1
42
674
42
643
14
17
ts Cause of Death or Failure.
Ansesthetic.
Shock.
Peritonitis.
Old pelvic abscess.
Internal hemorrhage.
Cancer of pancreas.
Original disease.
Disease returned in one
case.
( 1 persistent vomiting,
■| 1 fecal fistula, 1 per-
( itonitis, 2 shock.
Undiscovered fecal im-
paction.
Shock.
Concussion of brain.
A NEW METHOD OF OPERATING FOR
HEMORRHOIDS.
Since the travelino; pile doctor demon-
strated the possibility of curing' hemorrhoids
by other means than the ligature, and other
remedies in vogue previous to the last dozen
years, a great variety of methods of dealing
with this little dangerous but troublesome con-
dition, have been proposed. I have investi-
gated all of tlie proposed methods, and have
made a practical trial of most of them, and
finally have adopted a method which, so far as
I know, is essentially novel, although not
wholly new in principle.
This method, which I have employed for the
last two years, requires the use of a special
instrument which I have termed a hemorrhoid
snare, the construction of which is shown in
SANITARIUM BULLS TIN.
149
the accoinpanyiiia: nnf.. The inatrument was
made lor riie by Geo. Tiernanu & Co.,. of New
York, after designs which I furnished them. It
can, of course, be used for other purposes than
operation for hemorrhoids, and since it has
some novel features, the following brief descrip-
tion may be of interest: —
The instrument consists of the following
parts: —
A, a rod with screw thread at one end carry-
ing a nut, and perforated at the other end to
receive a loop of wire.
B, a handle of spring steel, one blade of which
is free to move when the handle is pressed, the
position of the movable blade being retained
by a ratchet.
C, an actuating sleeve, one end of which, when
in use, rests firmly against the nut, the other
end being forced back by the movable handle,
thereby forcing back the rod.
d.
D, a canula into which the wire
loop is partly drawn after having
been threaded through the rod, after
the plan of Sajou's snare.
In use, a piece of No. 5 uuaunealed
piano wire about two and one half
inches in length is looped into the
roil which projects just beyond the
end of the canula when the nut is
screwed out as far as possible. By
a few turns of the nut the rod is drawn in so
that the ends of the wire loop are hidden within
the canula. The instrument is then ready for
use.
The instrument can be made of any size,
adapted for an ear, nasal, or throat snare.
The rod is easily withdrawn for cleaning pur-
poses. 1 find the instrument very convenient
for any purpose for which a snare is useful.
In the use of the instrument a pair of forceps
is put through the loop; with this the hemor-
rhoid is seized and drawn into the loop, which
is at the same time pressed well down around
the base of the hemorrhoid. By compression
of the handles of the instrument, the loop
is drawn into the canula sufficiently to con-
strict the hemorrhoid. If necessary, one or
two extra turns are given to the nut to
tighten the loop still fui-ther. Dropping the
snare, the forceps, still holding the hemorrhoid,
are grasped with the left hand, and the hemor-
rhoid is seared off by means of a small paquelin
cautery point or a galvano-cautery knife hela
in the right hand. Care must betaken that the
heat employed is not too great. My custom is
to sear the hemorrhoid off at a black or low
red heat, and then hold the cautery in contact
with the stump long enough to dry it some-
what. As soon as the operation is completed,
the ratchet is released, the bar carrying the
loop of wire pushed back into the instrument,
and all is in readiness for attacking another
hemorrhoid.
In the case of large hemorrhoids, I formerly
sometimes observed slight searing of the sur-
rounding tissues due to the heat of the cau-
tery, and sometimes the metal speculum would
become unpleasantly heated, but this difficulty
is entirely obviated, even without the use of an
ivory shield, by having an assistant maintain
a stream of air upon the field of operation by
means of a pair of hand bellows, or preferably
a pair of blow-pipe bellows. This not only
keeps the tissues cool, but at the same time
keeps the field of operation wholly free Irom
the smoke arising from the
burned tissues. The opera-
tion in ordinary cases is ac-
complished so quickly that
this is entirely unnecessary-,
but I mention it as a means
of enhancing somewhat, in
some cases, the comfort of
the patient after the opera-
tion and the convenience of
the surgeon during it.
This mode of operation
has the following advan-
tages over most others: —
1. It is extremely expeditious, only as maniy
seconds being requited as the old method of
ligature required minutes.
2. It is aseptic. Nothing is left behind to
decompose and give rise to absorption of sep-
tic matters, as is the case when the method of
ligature is employed.
3. The results of the operation are under
perfect control. Whether the method of liga-
ture or injection of carbolic acid or other
liquids, is employed, the resulting inflamma-
tion may extend much farther than is desired.
I have known several cases in which severe
phlebitis resulted, and in some instances worse
consequences, from both methods.
4. As dilatation of the sphincter is not
required in this method internal hemor-
rhoids may be removed without the use of
chloroform or ether, the operation being prac-
tically painless. It is only necessary to inject
a small amount of cocaine into the tissues
before applying the snare, to render the opera-
tion so nearly painless that even a very sensi-
tive patient will undergo it with very little
complaint.
150
SANITARIUM BULLETIN:
5. Suffering after^the operation is ver3\.mucli
less than after any other method which I have
ever tried, and the recovery much more rapid.
6. There is no danger of secondary hemor-
rhage, as after the use of the galvano-cautery
snare, since the cauterization of the stump is
very much more thorough than is possible
when a heated wire is employed.
Anyone who will make a fair trial of this
method will, 1 am sure, be pleased with it, as it
renders the operation much quicker and easier
than with any of the clumsy forms of clamps
which have been used in connection with the
cautery in the removal of hemorrhoids. After
using this method in nearly two hundred cases,
J would not willingly go back to any of the old
methods. 1 invariably operate with an Ailing-
ham's speculum, which 1 have modified by the
addition of a convenient handle, and a fenes-
trated slide. This instrument was also made
for me by Geo. Tieman & Co., of New York.
-• — • — -•-
CLINICAL REPORTS.
Melancholia,. — The patient, Mrs. VV , aged
G2, referred by her physician, entered the
Sanitarium, after having suffered from mel-
ancholia for more than a year, the disease
gradually advancing until the patient had be-
come quite unmanageable, requiring a constant
attendant. She had attempted starvation by
refusing all food, and was exceedingly de-
pressed, and at times violent. The course of
treatment pursued was absolute rest in bed,
and feeding by nutritive enemata of yolk of
egg and peptonized beef. After some improve- •
men t, the patient beginning to eat, the diet was
changed to milk, fruits, and grains, prepared in
a vari^ty of ways.
Treatment consisted of massage three or four
times weekly, daily sponge baths, applications
of faradic electricity every other day, alternate
hot and cold sponging of the spine, fomenta-
tionsover the stomach and liver daily, or every
other day, thorough evacuation of the bowels
daily by large enemata or colo-clysters, and
after the first three weeks, daily exercise in the
open air. At the beginning of treatment, the
patient had a YQvy foul breath, coated tongue,
bowels extremely inactive and prolapsed; the
stomach dilated and prolapsed, its lower bor-
der lying an inch below the umbilicus.
After five weeks* treatment, the patient was
completely restored to mental soundness,
cheerful, bright, natui-al in niiinner, hopeful,
and happy. She had gained ten pounds in
weight, had a clean tongue, a good appetite,
was active physically, taking considerable ex-
ercise daily, and with every prospect of her
restoration to health being permanent. The
melancholia was evidently due to the disorder
of the stomach. Doubtless a large number of
cases of melancholia have their beginning in
gastric neurasthenia.
Phantom Tumor. — M.vs. Z., aged 44, was
sent to the Hospital from a neighboring State
for the removal of a tumor in the left side.
The patient had an operation several years
ago, at which time both ovaries were removed,
but for some reason the left fallopian tube was
not removed. The physicians who had exam-
ined the patient believed the tumor to be due
to dilatation of the unremoved tube. On ar-
riving, the patient complained greatly of ina-
bility to breathe on account of the pressure of
the tumor, and insisted on sitting up in bed the
greater part of the night panting for breath.
Her attendants thought she suffered greatly
from interference of the tumor with respiration.
On examination, I found a large hard fumor
projecting considerably above the common sur-
face of the abdomen and confined almost wholly
to the left side of the abdomen, although ex-
tending slightly to the right of the median line.
On introducing two fingers into the vagina,
passing them up as high as possible, 1 was sur-
prised to be unable to find any tumor inter-
nally, even when making a very firm downward
pressure upon the tumor with the other hand.
I was still more surprised, a moment later,
when the patient had become interested in con-
versation, to find that the tumor had disap-
peared altogether, and that no trace of it could
be found by either external or internal manipu-
lation. The abdomen was flat and flaccid, and
could be pressed to the posterior abdominal
wall everywhere. Suddenly the patient recol-
lected herself, and the tumor reappeared exactly
as before. Upon calling the patient's attention
to the fact that the tumor had disappeared for
several minutes, she stated that it often did so,
i-emarking, "It goes up my back, but 1 can
bring it down again," and she did. Further
examination convinced me that the tumor was
wholly external to the abdominal cavity, and
was simply the adipose tissue of the abdominal
wall drawn into a rigid mass by voluntary
contraction of the muscles. On making the.
patient stand upon her feet, this fact was still
more apparent. A considerable amount of
sub-cutaneous fat rendered the lower part of
the abdomen very prominent. Grasping the
protruding mass, I found it perfectly soft, and
evidently unconnected with any internal struct-
ure. Then asking the patient to bring the
tumor forward, which she did by violent con-
SANITARIUM BULLETIN.
151
tractions of the diaphragm and abdominal
muscles, I could readily feel the mass of adi~
pose tissue harden between my hands, assum-
ing the identical shape of the supposed tumor.
These observations taken in connection with
other symptoms in the case, showed it to be
clearly one of hysteria. After a few days'
treatment, including moral discipline, the pa-
tient was sent home disabused of the idea
which slie seemed to have held quite sincerely,
that she was suffering from a tumor and
needed some operation.
Disastrous Effects from a Mistaken Diag-
nosis.— Miss , aged 34, was sent to the
Hospital by her physician for removal of an
abdominal tumor. Examination showed the
patient to be suffering from a large tumor
which filled the whole abdomen. The impres-
sion given by palpation was that the tumor
was partly solid and partly fluid. It was evi-
dently firmly fixed to the abdominal walls,
which showed there had been extensive perito^
nitis. The patient had been examined by a
leadinggynecologist and the tumor pronounced
to be fibroid of the uterus. Electrolysis had
been employed, and peritonitis had occurred
shortly after the last application, indicating
the electrical application to be the probable
origin of the inflammation. The tumor in-
creased with extraordinary rapidity after the
occurrence of inflammation, and had continued
to develop until the patient's condition was no
longer endurable, and although regarding an
operation as likely to be fatal in its results, the
patientand herfriends, as wellashermedical ad-
viser, had recommended resort to surgery as a
last hope, other means being evidently useless.
The operation was begun as an exploratory
incision, and with some uncertainty as to the
nature of the conditions to be dealt with. On
opening the abdomen, the tumor was found to
be a multilocular ovarian cyst, and was found
to be adherent everywhere; but the adhesions
being recent, they were broken down with com-
parative ease, and the resulting hemorrhage
was readily controlled by sponges. The most
troublesome part of the operation was the sep-
aration of the tumor from the sigmoid flexure
of the colon, to which it was very firmly at-
tached, as also to the peritoneum of the right
iliac fossa. These adhesions were very firm and
vascular, and bleeding was controlled with con-
siderable difficulty. The tumor was safely
removed, however, and the patient made an
uninterrupted recovery. Dr. Kellogg'e system
of aseptic drainage was employed. On 7'emoval
of the drainage-tube on the fourth day, the
wound healed by immediate union. The
highest temperature after the operation was
100.8° F. This case illustrates the importance
of correct diagnosis in connection with the em-
ployment of electrolysis by Apostoli's method.
Exudate about the Pedicles Removed by Pel-
vic Massage. — The patient, Mrs. , had been
a confirmed invalid for many years as the re-
sult of chronic ovaritis, salpingitis, and retro-
version of the uterus with adhesions, the result
of frequent attacks of pelvic peritonitis. The
appendages were removed, and the uterus re-
placed and srcured in position by shortening
the round ligaments, both operations being
performed at the same time. The appendages
were so thoroughly united with the surround-
ing tissues that the pedicles were somewhat
broader than usual, which was, perhaps, in
part at least, the cause of inflammatory action
in the vicinity of the pedicles a few weeks after
the operation, the result of which was quite
extensive exudate about the pedicles. The
tissues were extremely sensitive, and the pa-
tient was unable to walk without pain.
Under the daily employment of massage,
combined with vaginal douches and packing
the vagina each day with cotton pledgets, the
tenderness rapidly lessened, and at the end of
three weeks the exudate had disappeared, the
patient was free from pain, and returned home
in better health than for many years previous.
In another case similar to the preceding —
that of Mrs. C. , in which the removal of the
diseased appendages required very extensive
denudation of the adjacent tissues, although
there was not very pronounced evidence of in-
flammatory action after the operation, a few
weeks subsequent a mass of exudate was found
at the point from which the left appendage was
torn. The exudate disappeared entirely as the
result of three or four weeks' treatment, which
was essentially the same in character as that
described above.
Another patient, Mrs. , had suffered for
years from the results of acute pelvic inflamma-
tion, which had left behind extensive exudate
in the region of both broad ligaments. As the
result of pelvic massage administered for ten
minutes daily, the exudate almost entirely
disappeared, and the uterus and other struct-
ures became very much more movable, the
pain and tenderness disappearing.
Pelvic Hematocele and Phlebitis of Right
Limb. — The patient, aged 42, suffering from
a large uterine myoma, entered the Sanita-
rium early in December, with a morning tem-
perature of 101° F., and an evening tempera-
ture of 103° F. She had had several chills,
and extreme pain in the lower abdomen some
days before, since which time the fever had con-
tinued with exacerbations. There was also
15L>
SANITARIUM BULLETIN.
g-reat swelling; of the right leg from phlebitis.
The pain was constant and severe. The treat-
ment employed was fomentation of the lower
abdomen and leg two or three times daily and
packing of the leg in moist cotton, covered with
large masses of dry cotton so as to maintain a.
constant temperature. The hot vaginal douche
was taken twice daily. At the end of three
weeks, the patient's temperature was normal,
the (jedema and tenderness of the leg had dis-
appeared, and the patient was convalescent.
Nervous Headfiche. — Mrs. S., aged 46 years,
£1 delicate little woman, married, the mother of
several children, had suffered foi' five years
fron) very severe nervous headache. The at-
tacks of migraine were sometimes so severe as
to occasion muscular spasms, and recurred
every few days. From month to month the
paroxysms became more frequent and severe.
The treatment in this case consisted of a
milk, fruit, and grain diet; the application of
massage, light, baths, tonic applications of
electricity, and revulsive applications to the
spine. After three weeks the nervous \^m^-
oxysms disappeared entirely, the patient
gained rapidly in strength, and at the end
of ten weeks returned home well.
Chronic Malarial Poisoning Cured without
Quinine. — Mrs. S,, aged 55, had been suffering
for several weeks from malarial fever. The
chills had recurred every other day for 42 days,
notwithstanding quinine had been used in the
largest admissible doses. Her temperature
remained above normal all the time, the usual
morning temperatui'e being 100° F., and the
evening temperature 103.5° F. Urinary an-
alyses showed albumen present to tlie extent
of one third the bulk of each sx^ecimen tested,
after allowing the test tube to stand for
several hours. As the quinia had done no
good, and also considering the condition of
the kidney, its administration was discon-
tinued. The patient was made to drink hot
water freely, and by means of hot packs, fomen-
tations over liver, stomach, and bowels, free
activity of the skin was encouraged. Each day
an effort was made to anticipate the chill by
wrapping the patient; in warm blankets and
placing rubber hot water bottles about her.
By this means the periodicity of the chills was
broken up, althougii they still occurred irregu-
laris'^, and the albumen was diminished to one
twelfth the bulk of the urine. After a few weeks
of this treatment, 20 grains of quinia per diem
were administered on two alternate days, but
with no effect whatever upon the chill or the
fever, and the albumen was increased to one
third. The eliminative treatment was again
j*esumed and employed more vigorously,
the patient being kept in a state of mild per-
spiration constantly for nearly two weeks. Un-
der this treatment, only oneslightchill occurred,
and the albumen was reduced to a mere trace. *
The temperature has now been normal for
several weeks, the patient eats and sleeps well,
is gaining in strength, and instead of being
confined to her bed, goes about quite freely, the
only impediment to locomotion being a sore-
ness of the legs due to thrombosis involving
successively both femoral veins, which occurred
as a complication early in the history of the
case. The swelling has nearly disappeared from
thelimbs and they are rapidlygaining strength
under daily local applications of electricity and
massai>e.
RECORD OF SURGICAL WORK IN THE SANI
TARIUM HOSPITAL FOR JANUARY, 1892.
The Surgical Staff of the Hospital are as
follows: —
J. H. Kellogg, ]\f. D., Surgeon-in-Chief.
H, M. DunJap, M. D., ophthalmologist and
aurist.
Kate Lindsay, M. I)., gynecologist.
Surgical Assistants: A. J. Hoenes, M. D.;
Addie J. Johnson, ]\f. D.; Lillie B. Wood,
M. D.; Ruth Bryant, M. D.; Mrs. S. M. Baker,
matron of surgical ward.
The regular operating days in the Hospital
are Mondays and Thursdays; but the pressure
of urgent cases frequently requires operations
on other days.
Owing to the prevalence of In. grippe, from
which one of the Hospital surgeons suffered
severely, as well as a number of the nursf^s, no
operations were perloimed in the Hospital dur-
ing the first part of the month of Januai*y .
The following report of operations performed
during the month of January, is from the rec-
ords kept bjDr. A. J. Johnson, the House Phy-
sician of the Hospital: —
January 13.
Cystic Tumor of Labium. — Patient aged 38,
sent by Dr. . Large and painful cyst in left
labium, caused by obstruction of the duct of
Bartholin'sgland ; had been incised sevei-al times
withoutbenefit; removed both cyst and gland;
immediate union.
Epithelioma of Cervix Uteri. — Patient aged
52; sent by Dr. .Martin. The disease involved
the fundus utei-i and had extended into the left
broad ligament, rendering complete removal
impossible; removed as much of the diseased
tissuesaspossible with curette and scissors, and
applied chromic acid. No febrile reaction fol-
SANITARIUM BULLETIN.
n\
lowed the operation, and tlie patient returned
home in a few days.
January 14.
Trachelorrhaphy. — Tvfo cases. The first pa-
tient ag:ed 31. Had suffered for years from men-
orrhagia. Bi-lateral laceration, requiring two
sutures on one side, three on the other. Anti-
septic dressing. Recovery complete, witiiout
febrile reaction. The second case, aged 30
yeftrs, sent by Dr. Graybill. Double laceration
of cervix, with vegetations of endometrium.
The curette removed a great quantity of fung-
oid growths. Cervix repaired by sutures, two
on one side, four on the other. Excellent re-
€Overy.
Fatty Tumor of Mammne. — Patient aged 30.
Sent by Dr. . Had suffe)-ed for a number of
years from painful tumor of left breast; re-
moved with cocaine. Wound closed with deep
sutures. Immediate union.
January 17.
Removal of the Coccyx for Coccygodynhi. —
Mrs. B., aged about 30, had been examined
and treated by an "oriftcial" surgeon, for
"pockets and papillae," and also for "rectal
ulcer," but was not materially benefited, and
still supposed herself to be suffering from the
rectal ulcer, as she had thus been informed by
an "orificialist." On examination, found the
rectum slightly congested, but no evidence of
ulcer, and no pockets or papilla?, except such
as nature has provided to every human being
for a useful purpose. The coccyx was found
€urved in to an unnatural degree, and great
tension and tenderness of the structures con-
nected with it. As electrical and other applica-
tions gave the patient no relief, the coccyx was
removed, with the result that the patient was
relieved from her distress, and the "rectal ul-
cer" healed without any operation upon the
rectum,
January 18.
Varicocele. — Patient aged 24. Had suffered
from painful varicocele for 14 years. Excision
of a portion of the diseased veins. Recovery
without febrile reaction.
January 19.
Ovariotomy.— Fatient aged 24. Had scar-
let fever when young. Always suffered from
extreme menorrhagia, bearing down; contin-
ued suffering from which no treatment gave
relief Removed appendages. Right ovary
cirrhotic, cystic, and contained small hoemato-
€ele. Left ovary a shriveled mass of cirrhotic
tissue. Good recovery.
January 20.
Ovariotomy.— Vatient aged 65. The patient
believed a tumor to have existed nearly 20
years; had recently been growing rapidly, and
was painful. Incision S% inches. Removed
multilocular cyst weighing 9 lbs. Time of
operation 15 minutes. Good recovery without
febrile reaction.
Complete Laceration of Perineum. — Patient
aged 40. Laceration occurred nine years be-
fore at birth of hydrocephalic child. Entered a
hospital two years ago, and had an operation
performed for restoration of pei'ineum, but
the operation, unfortunately, was unsuccessful.
Perineum entirely destroyed, and septum di-
vided to the extent of two inches. Operated
by a modification of Tait's method. Result
perfect; the patient has complete control of
both fluid f(eces and flatus.
January 24.
Ovariotomy. — Patient aged 31, Incision
two and one half inches. Removed cyst of
broad ligament weighing ten pounds. Left
ovary cystic and cirrhotic, also removed.
Good recovery.
Curetting — Tra chelorrh a p hy - Shortening
of Round Ligaments. — Patient aged 18; bad
laceration of cervix. Profuse menorrhagia.
Complete retroversion following child-birth.
After curettage, the cervix was i-epaired, and a
pessary placed, after which the round liga-
ments were shortened. The curettage and
trachelorrhaphy were completed in thirteen
minutes. The operation of shortening the liga-
ments occupied fifteen minutes. Good re-
covery.
January 25.
Ovariotomy. — Patient aged 19. Sent by Dr.
Avery. Incision three inches; multilocular
cyst of right ovary. Deep sutures. Left
ovarj'^ also diseased. The patient was very
weak before operation, having had continuous
fever for many weeks. Good recovery. Tem-
perature became lower immediately after
operation and soon became normal.
Ovariotomy., and Shortening Round Liga-
ments.— The patient had suffered for years
from retroversion and severe pelvic pain; ten-
der mass in left ovarian region. Uterus firm;
bound by adhesion. Found ligaments and
drew them partly out. Median incision two
and one half inches; broke up adhesion of
uterus; removed the appendages; found cyst-
oma of right ovary; both ovaries cirrhotic,
adherent, and tubes occluded. Recovery good.
Shortening Round Ligaments.— Fatient aged
33. Had suffered for years from retroversion
and ovarian pain; uterus fixed by adhesions.
Broke up adhesions by conjoined manipula-
tions. Shortened ligaments by Dr. Kellogg's
method. Recovery excellent.
154
SANITARIUM BULLETIN.
January 26.
Ovariotomy. — Patient aged 63. Well until
within a few weeks. Abdomen began to en-
large three weeks before; greatly distended
with fluid. Suspected malignant disease; ex-
ploratory incision revealed ovarian fibroid on
left side as large as the fist; a similar tumor
half as large on the right side, llemoved both
appendages; washed outcavit3\ Patient made
a good recovery. Ascites did not return.
Ovariotomy. — Patient aged 34. Sent by Dr.
Greene. Chronic intractable disease of appen-
dages; incision two inches. Right ovai'y cys-
tic, cirrhotic; left ovary cystic, cirrhotic, con-
tained hsematocele. Extensive adhesions on
both sides. Time of operation sixteen min-
utes. Patient made a good recovei*y and re-
turned home, well.
Crushfid Hand. — Boy aged 7. First phalanx
of thumb, index, and middle fingers, terminal
phalanx of third finger ground to shreds. The
principal arteries of the thumb not being de-
stroyed, the fragments were brought together,
the terminal phalanx of the third finger treated
likewise. The first and second fingers were am-
putated. The parts were washed thoroughly
in a hot solution of bi-chloride, 1—2000. Heal-
ing was rapid and without suppuration.
January 27.
Curettage of Uterus and Trachelorrhaphy. —
Patient aged 44. Uterus large; retro verted;
extensive menorrhagia; laceration of cervix-
Removed a large quantity of vegetations, and
repaired cervix in the usual mariner. Re-
covery without febrile reaction.
Partial Atresia, of Vagina. — Patient aged
17. Remarkably well developed in other re-
spects, but presented one inch within the introi-
tus vaginae, a firm circular band scarcely large
enough to admit the tip of the little finger.
Had never had any injury; had never suffered
from anj^ local disease; hymen perfect.. Dilated
the constriction with rectal dilator. Packed
vagina with iodoform gauze. No febrile reac-
tion.
Shortening Ligaments. — Patient aged 26,
Had suffered from introversion for many years ;
not benefited by pessaries on account of tender
ovaries; confirmed invalid. Shortened liga-
ments three and one half inches each; operation
completed in sixteen minutes. Good recovery.
Ovariotomy.— Vaitient aged 43. Sent by Dr.
Malone. Had tender mass in region of right
ovary, also in left ovarian region, a tender
mass; had been advised by a consulting physi-
cian that an operation would probably be
fatal. Patient very fleshy; four inch incision
required. Found large left hydro-salpinx
closely adherent to the intestines and sur-
rounding tissues by old adhesions; removal
extremely difficult; right ovary buried in a
mass of inflammatory exudate and adhesions;
had to dig it out. It was necessary to remove
the intestines from the abdominal cavity
during the operation. They were carefully
wrapped in hot towels and returned in good
order. Good recovery.
January 28.
Curettage for Metrorrhagia.— Fa,t\ent aged
19. Uncontrollable metrorihagia for several
weeks ; great quantity of vegetations removed ;
uterus irrigated with hot bi-chloride solution;
hemorrhage ceased at once. Excellent re-
covery.
Shortened Round Ligaments — Curettage. —
Patient aged 27; retroversion for several
years; profuse menorrhagia; shortened liga-
ments four inches. Good recovery.
January 31.
Curettage — Adhesions Broken Up. — Patient
aged 49. Retroversion foi- many years, causing
great mental depression; uterus adherent;
menoi'rhagia; broke up adhesions by con-
joined manipulation; removed vegetations by
curettage, and placed pessary. Recovery with-
out febrile reaction. Patient greatly im-
proved.
Perineorrhaphy. — Patient aged 38. Lacera-
tion had begun eight years })revioU8; not quite
complete; bad rectooele; operation by Tait's
method. Time, eight minutes. Good recovery.
Total number of operations during the half
month covered by the report, twenty-five, of
which eight were ovariotomies. All made good
and speedy recoveries.
How to Increase the Haemoglobin of the Blood.
— M. Zuntz, of Berlin, has called attention to
some experimental researches which indicate
that the only means necessary for increasing
the amount of haemoglobin in the blood, is to
increase the proportion of albuminoid elements
in food. This may be done, either by increas-
ing the amount of flesh food, eggs, and milk,
or better still, in many cases, by keeping the
patient upon a diet consisting largely of milk
and whole grain preparations, such as oat-
meal, Graham grits, cracked wheat, etc., and
especially the leguminous seeds, peas, beans,
and lentils. It must not be forgotten, how-
ever, that carbo-hydrates and hydro-carbons
are necessary, as well as albuminous elements.
Hov^^ Oxygen is Used in the Body. — M. Ley-
den, of Berlin, has determined, experimentally,
that of the oxygen taken into the body through
respiration, the heart uses from 3.3 to 10 per
cent, the muscles of respiration 10 per cent,
and the digestive apparatus from 20 to 25 per
cent.
[See Bulletin Laboratory of Hygiene.]
the:
• •
Bacteriological World
AND MODERN MEDICINE.
VOL I. BATTLE CREEK, MICH., U. S. A., MARCH, 1892. NO. 5.
Original Articles.
THE ATTENUATION OF VIRULENT MICRO-
ORGANISMS.
BY PROF. F. G. NOVY, M. D.
Ann Arbor, jVIich.
One of the most fruitful paths into
which the science of bacteriology has
been directed in recent years is that lead-
ing to the study of the physiological vari-
ations which pure cultures of well-known
and acknowledged pathogenic micro-or-
ganisms undergo under certain peculiar,
or rather, abnormal conditions. The re-
markable discovery which paved the way
into this unknown and mysterious field
was made by Pasteur in 1880, who found
that cultures of the germ of chicken
cholera, when exposed to air for a long
period, lost their virulence, in other
words, became attenuated ; and that such
attenuated cultures, when inoculated into
a susceptible animal, rendered it immune
against inoculation with the most virulent
material. The next step taken by Pasteur
was to apply a similar method of attenu-
ation to the bacillus of anthrax, and the
same result was obtained. He demon-
strated that the • bacillus of anthrax,
when cultivated for many days at a tem-
perature slightly above the normal, lost
its virulence to such a degree that it no
longer produced fatal results on inocula-
tion into animals. The culture obtained
by growing the bacillus at a temperature
of 42°-43° for a period of 24 days, and
known as the pj'emier vaccin, was no
longer fatal to the experimental animals,
but did not protect them against the viru-
lent germ. Such protection, however,
was obtained when subsequent to an in-
jection of the premier vaccin, another
injection was made with a culture (the
deuxihne vacciti) grown at the same tem-
perature as above, but only for a period of
twelve days.
But even before Pasteur, immunity had
been obtained in animals by Toussant, by
inoculating them with anthrax blood
which previously was either heated to 55°
for ten minutes, or mixed with a one-per-
cent solution of carbolic acid. Cham-
berland and Roux (^Comptes Re7tdus \ '^80)
found that carbolic acid in the prop ^r-
tion of 1-600 effected complete attenua-
tion in twenty-four days at a temperature
of 35°.
In 1884 Chauveau observed that when
the anthrax bacillus was grown under a
pressure of 7-9 atmospheres of oxygen
for 7-8 generations, its virulence was
diminished to such an extent that it no
longer was fatal to sheep and cattle,
though still dangerous to guinea-pigs.
In 1889 he extended his observations on
the action of oxygen, and showed that
these cultures, with decreased pathogenic
properties, when submitted to the further
action of oxygen, under pressure, could
be brought to a point where complete loss
of virulence occurs, so that the cultures
were no longer fatal to even the most sus-
ceptible animals, as mice, rabbits, and
guinea-pigs. And what is still more re-
markable is the fact that these cultures,
with apparently their virulence totally
lost, are still capable of producing im-
munity in animals, that is to say, their
vaccinal properties are preserved although
their virulent properties have apparently
entirely disappeared.
From the facts thus presented it will be
seen that there are various conditions
which may effect an attenuation of the
anthrax bacillus, and accordingly, we
find almost as many explanations offered.
Pasteur formerly held that oxygen was
the chief element involved. Koch and
his pupils on the other hand have attrib-
uted the attenuating influence as due
solely to increased temperature.
156
ORIOINAL ARTICLES.
There can be no question as to the
influence exerted by an abnormally light
temperature, but to assert that oxygen
under ordinary atmospheric conditions is
without influence, is unwarranted. From
Chauveau's experiments we know that oxy-
gen under pressure is a very sure and ef-
fective agent for accomplishing this end,
and there can therefore be no doubt but
that oxygen under normal conditions will
exert this same influence though to a less
degree. For that reason it is now held
by the French school that the attenuating
causes are to be sought for in the action
of oxygen at an abnormal temperature.
But there are undoubtedly other con-
ditions which at times come into play
and exert a marked tendency to accom-
plish the same result. We have had fre-
quent occasion to observe that anthrax
cultures which, when first inoculated into
agar tubes, were highly virulent to white
rats, when kept at the ordinary tempera-
ture for several months had no effect on
these animals, whether young or old.
The cultures which had thus lost their
virulence with respect to the white rat,
possessed undiminished virulence so far
as the rabbit and guinea-pig were con-
cerned, and all that was necessary to bring
them back to their original high virulence
was to pass them through one of these
animals.
This initial loss of virulence may be
explained in several ways. Thus, the oxy-
gen of the air, acting over a long period
of time, may be the attenuating agent ; or,
the waste products which, generated by
the growth of the germ, impregnate the
soil upon which it grows, and by virtue
of their noxious properties exert an at-
tenuating influence ; or, it may be due to
diffuse sunlight.
It may be said that this condition is
brought about only when the bacillus is
in a vegetative condition, and before spore
formation has resulted. This, however,
is not true ; for we have repeatedly ob-
served that the same initial loss of viru-
lence was obtained when the micro-or-
ganism was left in the spore condition for
a long time, at least several months, on
agar.
The investigations of recent years have
shown that bacteria yield waste products,
or products of tissue-change, which may
exercise a very marked effect upon the
growth of the organism which produces
them. Thus, in lactic acid fermentation
the activity of the bacillus inducing it is
gradually lessened in proportion as the
quantity of acid is formed ; and when this
amount reaches .075-. 08 per cent, the
growth entirely ceases ; and if allowed to
act beyond this point, death of the micro-
organism results. The same is true in
butyric acid, or in urea fermentation, and
has always been recognized in alcoholic
fermentation induced by the yeast, where
the process ceases when the amount of
alcohol formed reaches about fifteen per
cent. Again, a very large number of the
common forms of bacteria produce car-
bolic acid and derived compounds, and it
is easily conceivable how the accumulation
of these .products may exert decided
germicidal properties. That the infec-
tious micro-organisms produce highly
poisonous compounds which may be al-
kaloidal or proteid in nature, is well
recognized.
Toussaint's experiment, already referred
to, showed that carbolic acid, in the
proportion of i— 100, acts as an attenu-
ating agent, and it is reasonable to sup-
pose that a like action will be exerted by
similar toxic products generated by other
germs. From the work of Chauveau we
know that compressed oxygen, a power-
ful attenuating agent, is without effect
upon the ready formed spore, exerting
its specific action only on the vegetative
cell. It is therefore improbable that the
oxygen of the air, under ordinary atmos-
pheric pressure, should exert any attenu-
ating influence upon the spores in an agar
tube.
The action of light as an attenuating
agent must not be lost sight of. Diffuse
sunlight appears to exert no special in-
fluence, but with direct sunlight it is quite
different. The experiments of Duclaux
and Arloing show that anthrax spores are
killed in a few hours by an exposure to
the direct rays of the sun, and that before
destruction takes place they pass through
a stage of attenuation.
The most plausible explanation that
can be offered, then, is that this initial at-
tenuation is brought about by a prolonged
exposure to the injurious action of the
metabolic products of the cells proper.
In this same way is to be explained the
so-called natural attenuationysfYiic)! certain
infectious micro-organisms undergo when
transferred from their usual habitat, the
animal body, to the ordinary artificial
culture media. Not only are the condi-
ORIGINAL ARTICLES.
157
tions of their growth different, but they
are constantly being exposed to the action
of their own waste products, which, as
we have seen, are capable of exerting
marked deleterious action upon the proto-
plasm of the cell. .
Artificial attenuation, on the other hand,
can be brought about by a variety of fac-
tors, most of which have already been
spoken of. These are exposure to ab-
normally high temperatures, to com-
pressed oxygen, to direct sunlight, to the
action of chemicals (including metabolic
products). Under the latter class are all
the experiments of Toussaint with carbolic
acid, and Chamberland and Roux with
carbolic acid and bichromate of potash.
We have made a series on the action of
carbolic acid and mercuric chloride on the
anthrax bacillus, and have not only suc-
ceeded in attenuating the bacillus, but
also in producing immunity in animals
with such cultures. The results of this
work, carried on in conjunction with one
of my students, Mr. Geo. F. Sucher, will
be reserved for another paper.
The attenuation of infectious micro-
organisms is a fact which can be demon-
strated or brought about in a number of
ways. The explanation of this fact,
however, is quite obscure at present, but
its solution unquestionably lies in the
study of the chemical products of the
virulent and attenuated forms. Morpho-
logically there is little or no difference in
these two conditions ; and, if there is an
alteration in the cell protoplasm itself or
in its physiological function, this will be
evidenced by an altered cell metabolism.
This field has already been approached
by Behring, who has shown that the viru-
lent anthrax bacillus yields more acids
than does the attenuated form, but the lat-
ter, on the other hand, possesses a greater
reducing power. In further accordance
with this view are the observations of
Brieger and Frsenkel that the non-virulent
Loeffler's diphtheria bacillus yields a non-
poisonous albumin, while the virulent
micro-organism produces a highly poison-
ous toxalbumin.
The following represents the composi-
tion of leukaemic blood, according to
the analyses of Freund and Abermayer :
Water, 895.8; solids, 104.2 ; albumin and
haemetin, 72.0 (haemoglobin, 35.0) ; pep-
tone, 12.3; fats, 7.1; lecithin, 3.8;
cholesterin, 2.1 ; salts, 9.8.
T. Araki has studied the formation of
lactic acid and glucose in the organism,
and the results obtained can be briefly
summarized.
1. Well-fed dogs, rabbits, and chickens,
kept in an atmosphere in which the oxy-
gen contents had considerably decreased,
secreted urine containing lactic acid,
glucose, and albumin. This is undoubt-
edly due to deficient oxidation in the
organs, and so also are the following
results to be explained.
2. If the animals were in a condition
of starvation and then subjected to the
same experiment, lactic acid and albumin,
but no glucose, could be detected in the
urine.
3. Exposure to carbonic oxide pro-
duced the same results as under No. i
in well-fed animals ; and as under No. 2,
if previously in state of starvation.
4. Intoxication with curara, keeping
up artificial respiration, developed sugar
and lactic acid in the blood in dogs and
frogs.
5. In strychnine poisoning of frogs, glu-
cose and lactic acid appeared in the
urine.
6. The urine of epilepsy (3 cases) con-
tained albumen and lactic acid, but no
sugar. {^Zeitschr. f. Physiol. Chem. l^,
335')
THE INFLUENCE OF DRESS IN PRODUCING THE
PHYSICAL DECADENCE OF AMERICAN
WOMEN.
BY J. H. KELLOGG, M. D., BATTLE CREEK.
(Concluded.)
The practical bearings of this question
are too evident to require more than
mention.
I. It is evident that pelvic disease in-
volving the displacement of organs is only
a part of a general disorder in which
every organ below the diaphragm may be
involved, and any system of treatment
which addresses itself exclusively to the
disorders found present in the pelvis,
must be unsuccessful. Here is to be
found the secret of the failure of so many
methods and systems which have been
proposed for the relief or cure of pelvic
disease, particularly displacements. I do
not hesitate to make the assertion that
any method of treatment, either medical
158
OniOINAL ARTICLES.
or surgical, which does not address itself
to the removal of the causes of the dis-
order as well as to its effects and ameliora-
tion of symptoms, must result in failure.
Temporary relief, often apparent cure,
may be effected, but sooner or later the
patient will find himself in the same
wretched condition as before. This ex-
plains the almost universal failure of
pessaries, local application of electricity,
operations upon the perineum, and the
various forms of anterior and posterior
colporrhaphy, operations for shortening
the round ligaments, ventro-fixation of
the fundus, and a great variety of other
methods and procedures which have been
adopted for the relief of the various forms
of displacements of the pelvic organs.
The pessary sometimes succeeds, provided
there is some coincident change in the
habits of the patient which increases
the strength of the musclfes of the waist
and abdomen. But in my estimation
nothing can be more absurd than to
thrust a pessary up among a mass of
prolapsed abdominal and pelvic viscera,
stretched away from their normal moor-
ings, jostling one another about in the
abdominal cavity, swaying in whatever
direction the body happens to incline.
No wonder that such patients often com-
plain that the pessary gives pain. Cer-
tainly it is no marvel that ulceration,
ovarian irritation and inflammation, and
even salpingitis, are not uncommon results.
Thirty years ago. Banning undertook to
effect a cure of pelvic disorders by means
of braces which supported the trunk in a
natural position. The weak point in this
system was its inability to give strength
to the weakened muscles. An external
skeleton consisting of an iron frame-work
is no more efficient in developing the
muscles of the trunk than one composed
of hickory or whalebone stays. The " Nep-
tune's girdle," or ^' umschlag'' of the old
German water cures, not infrequently per-
fected cures by allaying local congestions,
irritation of the abdominal sympathetic
ganglia, and especially by supporting the
relaxed abdominal walls, and holding up
in position the prolapsed viscera. Pa-
tients are sometimes cured by being sent
on long journeys abroad, in which they
gain muscular strength and vigor by
mountain-climbing, horseback-riding, and
the active exercise necessarily involved in
sight-seeing.
Cures have been effected by each of
these and other haphazard methods of
treatment, but they were accidental, and
not due to scientific methods, and pa-
tients were not infrequently made worse.
I have known of cases in which young
women were injured for life by being
advised by their physicians to exercise
in a gymnasium, without the same care-
ful prescription as to the kind and amount
of exercise to be taken as a judicious
physician would give respecting the ad-
ministration of a powerful drug.
2. It must be evident that a large share
of the symptoms present in cases belong-
ing to the class which is generally referred
to the gynecologist, are really due to dis-
orders of other organs, which are involved
in the general disturbance, or as the
French call it, desequilibratioti, of the vis-
cera of the lower half of the trunk.
Most women suffering from pelvic dis-
eases complain of pain when on the feet,
dragging pain in the bowels and the lower
portion of the back, pain at the extreme
lower end of the spine, soreness and pain
in the region of the navel, a feeling of
lack of support in the lower abdomen, a
sensation commonly described as gone-
ness at the pit of the stomach, weakness
of the lower limbs, pain in the back, crawl-
ing, tingling, numbness, stinging, and other
sensations in the legs, cold hands and feet,
burning of the soles and palms. Some-
times the patient says she is only com-
fortable, when on her feet, when holding
up the bowels with the hands. Such
patients tenaciously cling to the corset,
because they evidently need some sup-
port. These patients also often complain
that when they undertake to stand with-
out a corset, there is such a sinking at
the stomach that they are compelled to
sit down. The evident cause is the drag-
ging of the prolapsed bowels and stom-
ach, occasioned by the relaxation of the
abdominal muscles by which the branches
of the pneumogastric and sympathetic
nerves are put under an unnatural strain.
It is evident that in these cases a large
part of the symptoms are due, not to the
pelvic disorder, but to the general disease
of which this is a part.
If we expect to cure a woman who is a
chronic sufferer from pelvic disorders, we
must treat the patient rather than the
malady. This is a principle which ap-
plies, in fact, to most chronic disorders ;
and a failure to recognize this principle
is the rock upon which professional effort
often splits. It is as hopeless to under-
take to cure such maladies by the usual
routine methods, which are addressed to
local symptoms and conditions only, as
ORIGINAL ARTICLES.
159
to expect to kill a noxious weed by pick-
ing off its flowers or a few of its leaves.
The whole disease must be eradicated,
root and branch. This can only be ac-
complished by the removal of all the
morbid conditions which are the real
causes of the multitudinous symptoms
by which the disorder is recognized, and
for which it is often named. Rational
treatment of this class of diseases must,
then, include, first of all, the adoption of
a proper dress, which will be one in which
every muscle of the trunk will have per-
fect freedom to act. The patient must be
instructed to have her dress measure taken
with the waist fully expanded, and to
allow an inch or two for growth, in the
hope that to some degree she may over-
come the deformed condition which she
has induced by ignorant obedience to
fashion, rather than to the laws of physi-
ology and the dictates of common sense.
Health corsets are a device of the devil
to keep women in bondage who are seek-
ing for deliverance from the weakness and
misery from which a really healthful mode
of dress might emancipate her. Shoulder-
braces and harness of every description
are, on the whole, a snare and a delusion.
The only correct principle is to suspend
everything from the shoulders by means
of waists which will equally distribute
the weight upon natural bearings, and
at the same time give latitude for the
greatest freedom of waist movement.
If all women would at once adopt a
healthful mode of dress, probably half of
our profession would be obliged to seek
some other calling. Certainly, at the
present time, more than half our busi-
ness consists in efforts to repair damages
which ignorant women have inflicted upon
themselves. Neither a proper knowledge
of the requirements of the body, nor a just
consideration of the principles of beauty,
justifies the popular mode of dress. The
idea that a small waist or a round waist is
beautiful, is a mischievous and dangerous
notion, which ought to be eradicated from
the public mind. Nature never made a
waist round, slight, or tapering, as though
it were chiseled out of a block of wood,
and why should we allow ourselves to be
persuaded by the fashion-mongers that a
thing which from an artistic standpoint is
truly hideous, is otherwise than monstrous
and repulsive ? An artist who would
make a nude figure with the waist molded
after a French corset, would not be al-
lowed to exhibit his work in any respect-
able gallery.
A singular illustration of the inconsist-
ency of human nature is to be found in
the fact that the same artist who takes so
great care of his "■ model's " figure that he
will not allow her to wear a corset, or sub-
ject herself to waist constriction of any
sort, never thinks to criticise his wife, who
squeezes herself into a French mold of the
latest pattern, regardless of the fact that
the circumference of her trunk is decreased
by several inches at the middle, only at
the expense of a commensurate increase
below the waist, making an unsightly pro-
tuberance of displaced adipose tissue,
relaxed abdominal muscles, and a promis-
cuous assemblage of stomach, bowels, kid-
ney, spleen, and other things, which have
been forcibly ejected from the snug cor-
ners in which nature carefully stowed them
away, and thrust into an unnatural and
unsightly mass below. We see in the
enormous busts and bustles which fashion
prescribes, an evident attempt to cover up
the uncouthness of form which the corset
and other fashionable modes of torture
have induced, by means of these excres-
cences, and by their aid to approach as
far as possible to the ideal figure, which,
in its native grace and beauty, requires no
such accessories.
LONDON MEDICAL NEWS.
BY W. B. JONES.
M. R. C. S., Eng., L. R. C. P., Lond., Science Scholar,
St. Bartholomew's Hospital.
[special correspondent.]
Hysterectomy. — Dr. Champneys of
St. Bartholomew's Hospital, recently
performed a vaginal by sterectomy for
malignant disease of the uterus. After re-
moving the diseased parts, the two layers
of the peritoneum were allowed to fall to-
gether, the vagina being packed with sub-
limate gauze. The patient (a woman of
about 58) made a rapid recovery, the tem-
perature not going above 99.2° F. Mr.
Harrison Cripps and Dr. Champneys also
removed by abdominal section a uterine
fibroid weighing 12 lbs. The stump was
secured extra-peritoneally by the serve-
hand, and the patient made a good
recovery.
Dr. Berry Hart, Edinburgh, reports a
case of vaginal hysterectomy for car-
cinoma cervices in early pregnancy. The
patient was aged t,2>^ ^^^ 3 months before
admission had flooding at her period with
a discharge for 2 months after. The
cervin was found to be enlarged and fun-
160
ORIGINAL ARTICLES.
gating, the parametruin was quite free, the
uterus was enlarged. The uterus was
removed, and the patient made a good
recovery.
La Grippe and Dengue. — Dr. Robert
W. Felkin, Edinburgh, considers that in-
fluenza is the self-same disease as dengue,
such as he has witnessed in Africa. In
dengue, an attack may last from one and
a half to three or four days, when there
may be a remission of symptoms, the re-
mission lasting two to four days, when, if
the patient be not carefully treated, a
second paroxysm occurs. The first rash
occurs on the first to the fifth day, and a
second may appear on the sixth to the
seventh day of the disease. It may be
red, smooth, and continuous, as in scarlet
fever, or rough and dark, as in measles.
There may be pain in the testicle with
hydrocele. Also in the female, uterine
hemorrhage and miscarriage may occur.
In a recent case under Dr. Felkin's care,
a lady, who was in the eighth month of
pregnancy, was ill five days with influenza.
She became red as a lobster and lost a
good deal of blood. Dr. Felkin was
called, and found the membrane ruptured,
and delivered her at once. Two days
afterward, she had a second rash, which
was popular, with a temperature of 103°-
8°, and also a second attack of coryza. Out
of 100 women, 60 suffered from menstrual
irregularity and 79 from ovarian pain. In
one case, a girl of 12 years and 3 months,
who had never menstruated, was seized
with influenza, and on the fourth day lost
a considerable amount of blood, the rash
appearing on the next day.
Trephining for Cerebral Hemor-
rhage.— Dr. W. Stewart, of Leith, has re-
ported a case of successful trephining for
middle meningeal hemorrhage at the point
of center coup. A man, aged 46, fell into
the dock, striking a wooden pile. He be-
came unconscious 20 minutes after the
fall. He had convulsive seizures, begin-
ning with dilatation of pupils and con-
jugate deviation of the eyeball to the
right, then spasms of the left side of the
face, left arm, left side of the body, and
left leg, followed, after an internal of 20
seconds, by convulsions of whole of 7^ight
side of the body. As this seizure passed off,
the eyeballs deviated to the right. A scalp
wound was found leading to unfractured
bone i^ inches above base of left mas-
toid process. Blood escaped from the
right nostril only. Dr. Stewart trephined
over the middle meningeal artery on the
right side. About six ounces of blood
escaped, but the bleeding stopped on re-
moval of the disc of bone. The wound
was dressed, and the convulsions ceased^
the patient making a good recovery and
resuming work in 2^ months.
Trephining for Epilepsy. — Mr. Har-
rison Cripps, of St. Bartholomew's Hos-
pital, has recently operated upon epilepsy
by trephining. Both cases have been suc-
cessful, the fits not having recurred.
Immunity against Pneumonia. —
Drs. G. and F. Klemperer [Berliner Klin-
ische Woche?ischrift~\ have conducted exper-
iments on the immunity against, and the
cure of, pneumonia. They found that
any nutrient medium in which the pneu-
mococcus had grown, even after removal
of the coccus itself by filtration, immun-
ised against the pneumococcus-septicse-
mia. Also they found that an exposure
to a temperature of 60° to 65° C, for one
or two hours, made the immunising solu-
tion more efficacious. In all cases a cer-
tain time elapsed after the introduction of
the immunising matter before the immu-
nity was obtained ; in introvenous injec-
tions it was 3 days, in subcutaneous, 14
days. The serum of the blood of animals
whose immunity against large doses of
virulent cultures was established, was
found to cure pneumonia already in prog-
ress, if introduced into the circulation.
The temperature fell to normal in 24
hours in 12 cases.
The authors consider that the blood
serum of immune animals cures by ren-
dering harmless the poison which the pneu-
mococci have already formed. They call
this poison " pneumotoxin ; " it has been
isolated and causes the pyrexia. After it
has lasted a few days, another substance
— " anti-pneumotoxin " — is formed, and
counteracts the pneumotoxin. They found
that the post-critical serum of blood of
persons who had recovered from pneu-
monia, cured rabbits ill of that disease.
The pneumococcus may live in the human
body on sound mucous surface without
doing harm.
Resistance of Sputum Pneumococ-
cus.— Dr. Bordoni-Uffreduzzi, of Turin,
has experimented on the resistance of the
pneumococcus of sputa to the operation
of drying and exposure to diffuse daylight
and to the rays of the sun. He found the
resisting powers great. Inoculations from
sputa that had been dried for 55 days,
caused the death of rabbits in 4 days
from diplococcal septicaemia.
TRANSLATIONS AND ABSTRACTS.
161
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE RATIONAL TREATMENT OF HEPATIC
AFFECTIONS.^
BY DUJARDIN BEAUMETZ,
Member of the Academy of Medicine, Physician to the
Couchin Hospital, Paris.
ANTISEPTIC FUNCTION OF THE LIVER.
General Considerations. — The size of
the hepatic gland has long attracted the
attention of observers. The Chinese,
struck by the color of this gland, attrib-
uted all the various modifications of col-
oration in the skin to disorders having
their origin in the liver. In the time of the
ancient Greeks, it was upon the appear-
ance of the liver of immolated animals,
that the diviners based their predictions.
Plato made it the seat of desires, and
Hippocrates, the origin of the veins ; but
it was Galen who attributed to the liver
the most important role. According to
him, this organ furnishes to the blood the
nutritive juices necessary to its formation,
and in addition, it secretes not only the
bile, but the atrabile. All dyscrasic mal-
adies, according to the physician of Perg-
amos, are dependent upon hepatic dis-
turbances.
We should not forget that the ancient
Greek physicians frequently observed
these disorders of the liver. Hepatic
congestions are very often observed in
the southern part of our Continent, and
at the present day, Greek physicians
remark the frequency of the bilious
state complicating inflammatory disor-
ders. Until the seventeenth century, the
ideas of the physician of Pergamos pre-
vailed, and the bile, especially the atra-
bile, played a preponderant role in the
pathogeny of humeral affections ; but the
discovery which was made on June 23,
1622, in the Anatomical Amphitheater of
Pavia, by Prof. Gaspard Aselli, of Cre-
mona, relegated the functions of the liver
to a decidedly inferior rank. Aselli dis-
covered on opening the liver of a dog,
the chyliferous vessels, and, convinced
lA series of lectures delivered by Prof. Dujardin Beau-
metz, published in the Bulletin General Therapeutique, and
translated expressly for this journal.
of the importance of this discovery, he
cried, '' Eureka ! " after the example of
Archimedes ; and since that time, the im-
portant role which had previously been
attributed to the liver, has been attrib-
uted to the chyliferous vessels.
In spite of the efforts of Paracelsus
and Boerhaave, who revived the ideas of
Galen, and wished to make of the liver
an abdominal heart, these notions were
not generally received, and the liver, con-
sidered as an organ devoted simply to
the secretion of bile, occupied only a very
inferior rank in the glandular system of
of the economy.
However, pathological anatomy had
pointed out, as mere curiosities, some in-
teresting facts ; but these were only iso-
lated cases, and it is not until the middle
of the eighteenth century that we find the
first work devoted especially to the study
of hepatic diseases. This treatise was by
Bianchi, and bears date of 1725. It was
entitled, ''Historica Hepaticae." From
this time, we find appearing successively,
in England, the treatise of Saunders in
1768, of Bath in 1777, and finally the
first French work appeared in 1812, writ-
ten by Portal. This treatise is of the
most mediocre character, and it is rather
a reproduction of English works than an
original work of the author. Since that
time, some very important work has been
done upon the pathology of the liver :
Frerichs in Germany; Murchison, Harley,
and Robert SaumBy in England ; Charcot,
Hanot, Gilbert, and Chauffard in France,
have furnished us some precise facts upon
hepatic pathology, which will be useful
in the course of these lessons.
But do not expect me to treat, in these
lessons, upon all affections of the liver.
I refer you to what I have already said
in my " Clinique Therapeutique ; " in this
lesson I propose something different.
Taking for a foundation the recent dis-
coveries which physiology has made re-
specting the hepatic functions, I shall
give you in these general considerations,
the clinical and therapeutic conclusions
which result from these researches.
These physiological labors have re-
stored the liver to the rank which it should
occupy, and one may say that if by its
volume and its weight it occupies the first
place among the glands of the body, it
should also be recognized that this first
place cannot be disputed by any other
glandular system. The liver has, then,
162
TRANSLATIONS AND ABSTRACTS.
reacquired to-day, the high importance
which Galen attributed to it.
Considered as a whole, the liver pos-
sesses two great functions : it is a diges-
tive gland ; it is a blood gland. As a
digestive organ, the liver is the seat of
the following important functions : It is
a barrier interposed between the digestive
tube and the rest of the system, to arrest
and destroy alkaloids and toxines intro-
duced into the digestive tube as foods or
medicines. It is thus the organ of anti-
sepsis.
The liver is, in addition, charged with
the secretion of bile, which, as you know,
plays a very important part in the regular
action of the digestive tract.
Finally, it is the organ of a function
which is peculiar to itself, viz., the regu-
lation of the glycogenic functions of the
body, that is to say, to furnish to the
blood the exact amount of sugar neces-
sary for the maintenance of life.
One might add still to these important
functions, another, viz., the regulation of
•the absorption and production of fat.
As a blood organ, the liver may not
only be considered as an abdominal
heart, but it also plays an important part
in relation to the blood globules and in
the production of vital combustions and
of animal heat ; that is to say, in the pro-
duction of urea.
Considered then from the point of view
of its digestive functions, we shall have
to study the liver as an organ of antisep-
sis, as a biliary organ, as a glycogenic
organ, and as a fat-producing organ.
From the point of view of its blood-
functions, we shall have to examine the
liver as a hsemato-poietic organ, and as a
calorigenetic organ.
I propose to study each one of these
functions of the liver by itself, and will
commence with the liver as an organ of
antisepsis. I shall overlook the fat-pro-
ducing function of the liver, but shall
dwell lengthily upon each of the other
functions of this organ.
Each of my lessons will be divided
into two parts ; in one I will show that
the functions'which I attribute to the liver
may be. established upon a physiological
and anatomical standpoint. Then in
the second part, we will, from these facts,
draw some clinical and therapeutic con-
clusions.
In taking a general view of the ques-
.tion of the liver as a destroyer pf poi-
sons, we are enabled to distinguish three
periods. In the first, mineral poisons
were especially studied. Orfila, then Pa-
gannuzzi and Lussana demonstrated that
mineral poisons accumulate in the liver ;
arsenic, lead, murcury, and iron may be
recovered in the hepatic gland.
Since this period, it has been empha-
sized in legal medicine that the liver
should be taken in judicial autopsies for
the purpose of examination for the poison
supposed to have been administered.
In the second period, which commenced
in 1877, by the labors of Schiff, Hegger,
and then Jacques, the destructive action
of the liver upon certain vegetable alka-
loids, such as curarine, daturine, mor-
phine, strychnine, etc., has been ascer-
tained.
Finally, in the last period, the dis-
covery was made that not only vegetable
alkaloids were destroved, but that the
toxines and tox-albumins were also de-
stroyed by the liver with extreme rapid-
ity. These discoveries were the result
of the important work of Bouchard, and
the remarkable thesis of his student
Roger, published in 1886, from which I
borrow the greater part of the facts which
form the basis of this lesson.
What are the methods employed by
physiologists in the study of the special
action of the liver upon poisons ? These
processes are numerous, and may be
summed up in three groups : the more
primitive, that which was employed by
Orfila, consisted in analyzing the sub-
stances of the liver, thereby searching
for the toxic cause of poisoning. Schiff
employed a process much more physio-
logical. He made a comparative study of
the results of injecting medicinal alkaloids
by the veins of the general circulation
and by the veins of the portal circulation.
He thus demonstrated the difference in
toxic effects, of doses administered by
these two ways. He employed this
method especially with the rabbit and
the dog.
For inferior animals, the frog, for ex-
ample, Schiff employed another very
ingenious proceeding, which was to de-
prive the frog of its liver, an operation
comparatively easy of performance, and
which allows the animal to survive for
three or four days. He then compared
the toxic action of the vegetable alka-
loids in healthy frogs and in those de-
prived of their livers. Hegger and
TRANSLATIONS AND ABSTRACTS.
163
Jacques, of Belgium, employed quite
another proceeding, — that of an artificial
-circulation according to the method of
Ludwig. They proceeded as follows :
Immediately after having killed a dog
and ligated the portal vein, also the in-
ferior vena cava vein, they removed the
liver, preserved that portion of the side
of the organ which is adherent to the
diaphragm, and also the diaphragm ;
placing the organ thus removed from the
body, upon a support, they made pass
through it a current of water or blood,
and then examined the effect upon the
toxic agents which had been introduced
into the portal vein.
Let us add, finally, that Bouchard and
Roger have also studied the blood of the
general circulation and that of the portal
vein from the point of view of their toxic-
ity, and also that of the inferior vena cava.
Let us now examine, as briefly as possible,
the results furnished by these different
researches. I will be very brief concern-
ing the action of the liver upon the min-
eral substances. Arsenic, copper, anti-
mony, and mercury accumulate in the
liver. Roger, who has undertaken these
experiments, has shown that the liver has
no action upon the salts of potash or of
soda ; that, on the contrary, the action
is very marked upon the salts of iron.
When one injects by a mesenteric vein a
solution of lactate of iron, the toxicity is
three times less than, when the injection
is made into the veins of the general cir-
culation, I shall recall, in relation to
this claim, that Pagannuzzi, of Padua,
had previously insisted upon this point,
and that Lussana had maintained that the
reconstituent effects, and especially the
haemato-poietic properties of the ferrug-
inous preparations were due to the action
of the salts of iron upon the hepatic cells.
The ferruginous preparations introduced
through the digestive organs to the liver,
when eliminated by the bile, are recov-
ered from the surface of the intestine by
the portal veins.
The action of the liver upon vegetable
alkaloids is very important. Hegger, in
1873, "^'^^s the first to call attention to
this destructive action of the liver, but
we are indebted to Schiff for the most
interesting work upon this subject, which
appeared in 1877. Three years later ap-
peared the work of Jacques, which was
still more complete and of the greatest
interest. Finally Roger has reviewed all
these experiments and completed them.
The accompanying table, which I ex-
tract from the last named work, shows
clearly the action of the liver upon alka-
loids and how great is this destructive
action in the case of certain alkaloids.
The figures in this table speak for them-
selves, thus : for quinine in the case of a
rabbit, the fatal dose per kilogramme of
the weight of the body, is .9 gr. when
one injects the poison by the veins of the
ear; it requires 2.5 gr. when the poison
is injected into an intestinal vein, or
nearly three times as much. The figure
is still higher for atropia ; in the case of
the rabbit, 6 gr. produce death when in-
jected into the vein of the ear, and 3.0
gr. when injected into the intestinal vein.
The liver here destroys more than three
fourths of the poison.
For hyoscyamine in the frog, the fatal
dose after removal of the liver, was only
one half that previously required.
But it is with nicotine that the destruc-
tive action of the liver attains its maxi-
mum, at least for the frog. In a healthy
frog, it requires 34 milligrammes (half a
grain) to produce death. After the liver
has been removed, 8 milligrammes (^ of
Substance injected.
Species of animal
employed.
Condition of animal..
Method of injection.
Average No. Gr.
required
to cause deatb.
Sulpho-vinate of quinine
Hydrochlorate of morphia
Sulphate atropa
Hyoscyamine. ........
Rabbit
Healthy
Healthy
Healthy
Healthy
Without liver. . .
Healthy
Healthy
Vein of ear
•9
2.5
5-4
10.5
.6
3-0
30
1-5
3-
1-5
.04
.1
Rabbit
Vein of intestine
Vein of ear
Rabbit
Froji
Vein of intestine
Vein of ear
Vein of intestine
Lymph sac
Dos:
Lymph sac
Sulphate strychnia.
Vein iutrular ... .
Rabbit
Vein mesenteric
•Curare
Vein of ear
Vein of intestine
164
TRANSLATIONS AND ABSTRACTS.
gr.) suffice to produce the same result.
In relation to the nicotine, the method
of procedure is such as to show clearly
that it is the hepatic tissue which acts in
this case. The process consists in tritur-
ating the alkaloid with the hepatic sub-
stance, then injecting it into the veins of
the ear.
While without trituration, seven milli-
grammes are necessary for each kilo-
gramme of the weight of the body to
kill the rabbit, after trituration with the
liver, 15.34 milligrammes are required.
What therapeutic deductions may be
drawn from these results? — Some con-
clusions of the highest interest.
This destruction of vegetable alkaloids
by the liver explains the great difference
which exists between the administration of
medicines by the mouth, and by the hypo-
dermic method.
When administered by the mouth, drugs
may be modified by the action of the gas-
tric juice and of the other digestive fluids,
but they meet especially that living barrier,
the liver, which in part destroys them.
Nothing of the sort occurs when the hypo-
dermic injection is employed, hence the
interest we have in the propagation of the
hypodermic method when alkaloids are
used.
This fact was known long ago, as re-
gards curare and certain venoms of ser-
pents. It was known, in fact, that one
may practice suction of the wound made
with poisoned arrows or by venoms of
animals without experiencing the least
poisonous effect, and Claud Bernard had
even carried the analysis of this problem
farther with curare, showing that it was
not the gastric juice to which this diminu-
tion of toxicity should be attributed, esinc
in injecting the mixture of curare and gas-
tric juice under the skin, it caused the
death of the animal as before. To-day
we have the explanation of this fact in
the destructive action of the liver.
It is probable that the liver does not
completely destroy the alkaloids. It
must store a certain portion, which, later,
eliminated by the bile, is thrown into the
intestine. This fact explains the cumula-
tive effects of certain alkaloids or gluco-
cides. We see, at times, toxic effects
produced by long-continued therapeutic
doses. It is probable that this effect
may be explained either by a diminution
in the destructive action of the liver, or
by the fact that, the bile throwing into the
intestine a quantity of the toxic sub-
stance, an accumulation occurs in the
intestine, which being added to that
introduced by the mouth, converts a
therapeutic into a toxic dose.
But the most interesting point in this
question of the anti-septic function of the
liver is that which relates to the animal
alkaloids. Some physiologists have been
for a long time struck by the fact that in
spite of the introduction by the digestive
tube of numerous toxic substances, man
exhibits no phenomena of poisoning.
Stich was the first to formulate the fact
that there must exist some point in the
economy where these poisons are neutral-
ized, which he thought to be a true dialyz-
ing membrane preventing the penetration
into the system of poisons contained in
the intestine. Hofmeister attributed this
property to the white globules of the
blood.
After the publication of the works of
Schiff, the destructive role of the liver was-
recognized, and Lautenbach was the first
to express this fact in the most precise
fashion. He maintained that the liver
not only destroys the poisons introduced
into the economy, but also, that in the
physiological condition, the system pro-
duces a poison which is destroyed by the
hepatic gland as rapidly as produced.
The work of Lautenbach appeared in
1877.
Since then the work of Bouchard and
the successful experiments of his student
Roger have established the fact that one
of the most important functions of the
liver is to destroy not only the toxines
introduced with the food, but also those
which are produced by the living or-
ganism.
What is the origin of these toxines ?
They have four origins : first they are de-
rived from the foods which are introduced
into the digestive tube. When we use as
food animals which have been killed
more than three days, we introduce, there-
by, a certain amount of toxic ptomaines.
I do not wish to return to this question of
alimentary ptomaines, which I have al-
ready considered in my lessons,^ and I
refer you, upon this point especially, to-
what I have said upon the subject of
prophylaxis through regulation of the-
dietary, and upon the vegetarian reg-
imen.
The second origin of these poisons^
1 Hygiene Prophylactique, 1890, p. 193.
TRANSLATIONS AND ABSTRACTS.
it;5
which also concerns the digestive tube, is
found in the fermentations which take
place within the alimentary canal. Tanret
had first shown that the gastric juice in
acting upon albuminoid substances, pro-
duced some substances giving the reac-
tion of alkaloids. It was then shown
that, especially in morbid conditions of
the mucous membrane of the stomach
and intestine, a great amount of these
toxic substances are produced, constitut-
ing together a condition termed intestinal
putridity.
A third source of poison destroyed by
the liver, is the result of the action of
numerous microbes which are found in
the digestive tube in normal and abnormal
conditions, from the mouth to the anus,
— microbes which secrete diastases and
toxines.
Finally, the last origin is to be found
in the living of the cells of the body.
Gautier, in fact, has shown that the ani-
mal cell manufactures toxines, as well as
the vegetable cell, and these toxines are
eliminated by the intestine. We shall
see, when I shall speak to you of the
biliary function of the liver, that the bile
is a means of elimination of these poisons,
more active, perhaps, than the kidneys.
In summarizing, then, these several
sources of toxines, we must recognize it
as an undeniable fact that the intestinal
contents include a great quantity of alka-
loidal substances of a toxic nature, which
would penetrate the system, if, thanks to
the portal circulation and the antiseptic
function of the hepatic cells, they were
not each moment destroyed and neu-
tralized.
How can one demonstrate, experiment-
ally, the preservative function of the
liver? — By two experiments which fur-
nish evidence absolutely positive in
character.
The first consists in taking a certain
quantity of the toxic products found in
the intestine, and inoculating an animal
with them, the rabbit for example, and
making with them comparative inocula-
tions, employing a vein of the general
circulation, as a vein of the ear, in con-
trast with a branch of the portal vein ;
or one may employ the same products in
the inoculation of healthy frogs and those
which have been deprived of the liver.
This was done by Roger, and the follow-
ing table shows the result at which he
arrived : —
Putrid substances (alco-
holic extract
Peptones
Carbonate of ammonia. . .
Lactate of ammonia
Alcohol
Beef bile
Human urine
Alcoholic extract
of intest'l matters
Rab's.
Dogs.
Method of injection.
Periph-
eral v.
22.2
I .69
.29
•63
7-77
4.0
34-3
Portal V.
54-2
4.07
.40
I-I3
9-44
6.0
67.4
Relative
toxicity.
2.31
2.4
1. 61
1.8
1 .2
1.5
2.0
Frogs.
This table shows very clearly the pre-
servative function of the liver.
But the second mode of procedure
gives results still more striking. It con-
sists in the study of the difference in tox-
icity between the blood of the hepatic
vein and that of the portal vein. The
toxicity of the defibrinated blood of the
dog, as shown by the injection of rab-
bits is as follows : —
No. of c.c. required
to kill a kilogramme
of rabbit.
Blood in general 24.4
Blood of the hepatic vein 23 . 3
Blood of the portal vein 9.0
We see, then, that while the blood of
the hepatic vein has a toxicity slightly
inferior to that of the blood in general,
represented by 23. 3 c. c. per kilogramme of
rabbit, that of the portal vein is repre-
sented by 9 c.c. ; that is to say, its toxicity
is more than three times as great.
I have thus shown you by irrefutable
evidence, that the liver arrests not only
mineral poisons but also vegetable alka-
loids and animal toxines.
In what portion of the liver is the seat
of this special antiseptic property ? Upon
this question, Roger has sought to carry
the point as far as possible. He has
shown us, as I have already stated, that
it is the parenchyma which possesses
this special property, having the power,
when mixed with toxic substances, tO'
diminish their toxicity. It is probable
that it is in the hepatic cell itself that
poisons are destroyed ; for, according to
Roger, there is always a direct relation
between the glycogenic functions of the
liver and its antiseptic functions. Roger
166
TRANSLATIONS AND ABSTRACTS.
thought, even, that perhaps sugar or some
modification of the glucoses might, by
acting upon the vegetable or animal alka-
loids, diminish their toxic properties.
These points being established, we will
now consider what conclusions clinical
therapeutics may draw in relation to the
treatment- of disease. This I will make
the subject of my next lesson.
THE ACTION OF BACTERIAL PRODUCTS ON
YASO-MOTOR CENTERS.
Dr. C. H. Bouchard recently pre-
sented before the French Academy of
Science, a note on the above subject,
which is of a great deal of interest to the
medical world. We here present a digest
of it : It was established by Conheim
that the chief phenomenon of inflamma-
tion, is the diapedesis of the white cor-
puscles of the blood. He admitted that
" the passage of the leucocytes outside
of the vessels was the consequence of a
vascular modification produced by the
action of phlogogenous causes acting
directly on the vessels." Physiologists,
before and since the discovery of Con-
heim, have tried to interpret various
other phenomena in inflammation, and
particularly vascular dilatation. Some
of them persist in thinking that the nerv-
ous system impressioned at its peripher-
ical extremities at the point of action of
the morbific cause, suffers either a paraly-
sis of its vaso-constrictor centers, or an
•excitation in its vaso-dilator centers, and
upon either hypothesis, the vascular dila-
tation which is produced by reflex means,
places the vessels in a favorable state for
the passage of the white blood corpuscles
through their walls.
In 1890, Massard and Bordet estab-
lished the fact that leucocytes possess a
•certain irritability which causes them to
proceed in solutions toward certain at-
tractive substances, particularly bacterial
matters. This irritability is called in
French, chimiotaxique, and is identical
with a peculiar irritable property of cer-
tain vegetable cells demonstrated by Pfef-
fer. This property causes the white cor-
puscles to advance from the most diluted
portions of a solution containing attrac-
tive matter, toward the most concen-
trated part. It was thought that this
•discovery had in it a new theory of dia-
pedesis. At this moment, then, there are
three theories of the phenomenon of dia-
pedesis : {a) That which attributes it to
a primitive alteration of the vessels ; {]))
to a reflex action producing secondary
dilatation of the vessels ; and {/) the ac-
tivity proper of the leucocytes. These
three theories are adaptable to the new
idea which recognizes local infection as
the cause of inflammation in the majority
of cases.
Dr. Bouchard has recognized from the
beginning, the particular irritability of
leucocytes which caused these organisms
to travel in the seat of the tissues of a
local infection from the parts in which
the bacterial products are the most di-
luted, to those where they are the most
concentrated, arriving thus to the point
where they are at the maximum of con-
centration, that is to say, in contact with
the microbes. This progress of the
leucocytes is a preliminary phase of phag-
ocytosis, which takes place only when
contact occurs with the microbes, when
theenglobing of the latter occurs. Thus,
phagocytosis is reduced to these two
terms : englobing and intro-cellular di-
gestion, which, however, presupposes a
search of the bacteria by the white cor-
puscles, which itself is preceded by dia-
pedesis. The impression has gained
ground that in inflammation, and more
generally in the fight of the organism
against local infection, there are, among
other things, three acts which succeed
and complement each other: i. Diapede-
sis, which Conheim has indicated to us ;
2. The search for bacteria, which Massard
and Bordet have pointed out : 3. Phago-
cytosis, which Metchnikoff has revealed to
us. Massard and Bordet think that the
two first-named phases constitute only
one ; that the attraction by bacterial
products on leucocytes is sufficient to
make them migrate through their vascular
walls. But Dr. Bouchard has opposed
this view, because of the fact that the
plasma of the blood which constitutes
the inflammatory oedema, passes with
them, — oozes even before them, — and
may get out without them, and yet it is
not believed that the plasma has any irri-
tability such as is understood to exist in
leucocytes.
He has demonstrated further, that one
of the bacterial products, by its general
action on the economy, renders impossi-
ble the chief act of inflammation, viz.,
diapedesis. Charrin and Gamaleia have
TRANSLATIONS AND ABSTRACTS.
167
completed the demonstration, in estab-
lishing the fact that this special product
opposes equally the issue of plasma and
the inflammatory vascular dilatation.
This is produced by the paralyzing power
of this substance on the vaso-dilator
centers ; it acts on the nervous system,
modifies and prevents active vascular
dilatation. Bouchard has termed it "an-
ectasine." Anectasine prevents local dia-
pedesis by its general action, no matter
by what process one may try to provoke
it ; it paralyzes the vaso-dilator centers,
thus preventing inflammatory congestion
and inflammatory oedema. Bouchard has
thought that it is also by this paralyzing
property of the vaso-dilator centers that
it opposes diapedesis. He has succeeded
in preventing it by intra-venous and also
by subcutaneous injection of anectasine,
both by introducing it into a spot remote
from the seat of the attractive substances
secreted by the microbes, and also by in-
troducing it directly in their midst. An
important property of this anectasine is,
that it prevents not only the issue of
plasma and white corpuscles, but also of
the red blood corpuscles to which no chim-
iotaxic irritability is attributed. In fact,
it stops hemorrhage. Bouchard has ob-
served it in man in five cases of haemop-
tysis, and in three cases of intestinal
hemorrhage. Anectasine does not inter-
vene in inflammatory processes, unless it
be as a moderator, or as an agent of re-
straint. From this point of view it may
take its place in antiphlogistic remedies.
There is another bacterial substance
which Bouchard has pointed out, the
general action of which is the excitation of
the vaso-dilator center, and which brings
in the region whence proceeds the irrita-
tion, a more energetic reflex congestion,
a more abundant exudation, and a more
intense diapedesis, just the reverse of
the substance above described. In cer-
tain organs, such as the kidneys, lungs,
and retina, its vaso-dilating action maybe
manifest even without provocation. This
substance which is antagonistic to anect-
asine is named '■'■ ectasine.''^ He has dis-
covered it in Koch's tuberculine.
It will be observed that this knowledge
of the action of these bacterial sub-
stances, to the effect that in some in-
stances the vessels may restrain the pas-
sage of white blood corpuscles and even
all the other elements of blood, to the
point in fact of preventing hemorrhage.
or may on the other hand, allow excessive
migration of leucocytes and effusion of
plasma, is of a great deal of importance
to the practicing physician, and a subject
which promises very fruitful indications
in therapeutics. p. p.
-* — • -— •-
Pain and Inflammation of Dental
Origin. — Dr. Hugenschmidt (Z^ Semaine
Medicate) admirably sums up the differ-
ential symptomatology and treatment of
the two principal classes of pains of
dental origin. In the first class, the cause
of the pain is acute inflammation of
the pulp of the tooth ; in the second
class, the cause of the pain is an inflam-
mation of the periosteum covering the
alveolus. The characteristic symptoms
of acute pulpitis are, intense neuralgic
pain in the region supplied by the fifth
nerve, the point of the maximum inten-
sity being at the root of the affected
tooth, which is the seat of the disease.
The pain is increased by the inhalation
of cold air, or taking into the mouth
any hot or cold liquid, or bringing in
contact with the tooth any hard sub-
stance, as the seeds of fruits. The
pain may be constant or intermittent ;
it is often lancinating in character, and
frequently there will be found sensi-
tive points on the temples, or just below
the orbit of the affected side. Examina-
tion of the affected tooth will usually dis-
close a carious cavity which has extended
so deep as to have reached the pulp
cavity. The proper treatment is to wash
out the cavity carefully by means of
a stream of warm water injected from a
small syringe, using also, if necessary, a
stilette with a little bit of cotton wrapped
about the end of it. After the cavity has
been thoroughly emptied, a bit of cotton
should be placed in the cavity, after
having been saturated with either of the
following solutions : Menthol, i8 grs.,
chloroform, 30 grs. ; or, hydroclorate
of cocaine and hydrochlorate of morphia,
each, 4 grs., and creosote sufficient to
make a paste of the consistency of cream.
If neither of the above mixtures can be
obtained, pure creosote or carbolic acid
may be employed. Great care must be
taken to avoid burning the surrounding
parts. A minute bit of cotton moistened
with acid should be placed in the bottom
of the cavity, and then the cavity should
be filled with dry cotton ; the last bit of
168
TRANSLATIONS AND ABSTRACTS.
cotton may be advantageously moistened
with collodion, which will exclude the
fluids in the mouth. When the pain is
due to periostitis, it is different in char-
acter; the pains, though lancinating, are
continuous, never intermittent, only ceas-
ing when the inflammatory products have
found their way to the surface.
The seat of the cause of the inflamma-
tion is usually a dead pulp. The tooth
which is the seat of the inflammation,
becomes more and more sensitive, until
it cannot be touched without severe pain,
and the patient cannot eat on the affected
side. The tooth is not sensitive to cold
air, and very little or not at all sensitive
to hot or cold liquids. During the first
twenty-four hours the inflammation may
sometimes be relieved by freely bathing
the gum in the neighborhood of the af-
fected tooth with equal parts of laudanum
and tincture of iodine. Care must be
taken not to apply the remedy too freely.
Bathing the gum with a mixture consist-
ing of 5 grams tincture of iodine, i gram
tincture of aconite, 9 grains of hydro-
chlorate of cocaine is still more power-
ful in relieving the inflammation, but
in the majority of cases, the only means
of radical cure will be removal of the
pulp of the tooth, or extraction of the
tooth.
The important point is to recognize
the difference between inflammation of
the alveolar periosteum, and an acute
pulpitis. J. H. K.
Analogy of Migraine to Epilepsy.
• — Dr. Ch. Fer^, physician of the Hos-
pital Bicetre, of Paris {La Semaine Medi-
cale), calls attention to the fact that, in
certain cases of chronic migraine, there
is a condition entirely analogous to
that commonly known as the epileptic
state. The epileptic state is character-
ized by a convulsive period and a period
of relaxation and weakness. In the first
period, the convulsions, while not con-
tinuous, recur before the stupor of the
preceding attack has ceased. In mi-
graine, the attacks may occur in a con-
tinuous series ending in a period of pros-
tration or stupor. M. F6r^ has observed
three cases of this kind, of which one is
especially interesting. The patient was
a man of forty-three years of age, of an
arthritic family ; he had been subject to
migraine since the age of eighteen years.
Besides these effects, the patient enjoyed
good health, and had no other nervous
troubles.
The attacks of migraine in this patient,
were confined to the right side of the
face; the disease was at first simple in
character, but since 1870, following a se-
vere chill, the attacks had been accompa-
nied by sensory and motor disturbances
of a varied character, among which were
homonymous hemianopsia, scotoma, pho-
topsia, a sensation of ocular tension with
hyperaesthesia of the integument about
the left eye ; roarings and whistlings in
the left ear, and disturbances of the gus-
tatory sense (a taste of ink), and also of
the olfactory sense (an odor of copper),
heaviness, and paresis of the left side
of the face and of the tongue, also of
the left arm, and sometimes of the entire
left half of the body. The paretic phenom-
ena persisted during a period of time va-
rying from a half hour to two hours after
the attack, then gradually disappeared.
For eighteen years these attacks of
migraine were repeated about twice a
month; then in 1888, following pro-
longed insomnia, the attacks began to
appear in series of four, five, and even
nine, followed by a greater paresis than
before, and profound stupor. One day
the patient remained unconscious for
about eleven hours. On another occa-
sion, during the period of stupor, the
patient left his bed without knowing it.
One attack was followed by complete mo-
tor aphasia, which, however, soon disap-
peared. This time, neither sleep nor
stupor followed the attack. It was after
this attack that M. Fere saw the patient
for the first time. He prescribed hydro-
therapy and bromide of potash, which was
at first given in doses of four grams (60
grains) daily. But the crisis continued
about twice a month, until the dose of
bromide of potash was increased to eight
grams (120 grains) daily. The attacks,
however, were less intense than before,
and with a dose of six grams (90 grains)
per day, they were rarely followed but in
sleep. From the day when the patient
commenced taking eight grams of bro-
mide of potash per day, he has had only
one attack," which was without either sen-
sory or motor complications, and it has not
been followed by a subsequent attack, al-
though sixteen months have elapsed. The
bromide of potash has been tolerated at
the dose named, and has produced no
other inconvenience than some acne
TRANSLATIONS AND ABSTRACTS.
169
which has rapidly disappeared under the
remedies used to secure intestinal anti-
sepsis. J. H. K.
» — • — ^
New Treatment for Chronic Lar-
yngitis.— This disease which, in its dry
form is sometimes termed pachydermy of
the larynx, has long been recognized by
all specialists as a disease exceedingly
difficult to cure, — indeed, practically in-
curable, usually ending in complete aph-
onia, either constant or intermittent. The
disease is most frequent in persons addicted
to the use of alcohol. Dr. J. Scheimann,
assistant in the Laryngological Polyclinic
of Berlin, has recently observed that
local applications of feeble solutions of
acetic acid are a very efficient means of
treatment of this obstinate disease. The
remedy applied is as follows : The
patient is made to inhale two or three
times daily, for ten minutes at each time,
a two or three per cent solution of acetic
acid pulverized by an atomizer. A small
quantity of the solution is also thrown
into the larynx every day, by means of a
syringe. It is said that the treatment is
not disagreeable for the patient, and that
under its influence the thickened parts be-
come more transparent, the tissues soften,
and the thickening disappears. The voice
also returns and the hoarseness gradually
disappears.
Antisepsis at Bergmann's Clinic.^ —
The present disposition is to replace an-
tiseptics by more perfect asepsis, which
is more certain, more effective, and less
dangerous for the tissues and the opera-
tor. The instruments are first mechan-
ically cleaned by a brush, and rubbing
with unbleached linen, to which Berg-
mann attributes the greatest efficiency, as
a means of removing from the instru-
ments fatty matters which produce bac-
teria from the action of chemical disin-
fectants.
Sterilization of Dressings. — Bergmann
employs sterilizing ovens through which
steam is made to pass from above, down-
ward. To avoid handling, dressings are
previously placed in metallic boxes, the
sides of which are perforated. These
boxes are wrapped up after the steriliza-
tion, thus avoiding handling the dress-
ings. The boxes are submitted to the
action of steam in an oven for three quar-
1 Archivfur Klinische Chirurgie, t. XLII, p. 123.
ters of an hour, and are not opened until
the dressing is to be applied.
Sterilization of Metallic Instruments. —
After cleaning by the brush and un-
bleached linen, the instruments are steril-
ized, either by steam, hot air, or boiling
water. The proceeding recommended as
the most simple, is, first to brush with
soap and water, then boil from ten to fif-
teen minutes in a one-per-cent solution of
carbonate of soda ; fifty per cent more
soda should be added if the water is hard.
After cooling, and during the operation,
the instruments are placed in boiled wa-
ter containing one half per cent each of
carbonate of soda and carbolic acid.
After operation, the instruments are
first washed in pure cold water, then im-
mersed and brushed vigorously in a one-
per-cent solution of soda to which soap
has been added ; then rinse and finally
polish with a polishing stone and alcohol,
or with a bit of chamois skin. Lastly,
wash with a solution of carbonate of soda,
and carefully dry.
The brushes are sterilized by boiling
in the soda solution for twenty or thirty
minutes, and are kept immersed in a one-
half-per-cent solution of corrosive sub-
limate. J. H. K.
»■ — • — ^
Antiseptic Treatment of Burns. —
Mr. A. E. Maylard, B. S., Glasgow, has
had great success in the antiseptic treat-
ment of burns. His method is as follows :
The clothes having been removed, the
wound is washed with a solution of per-
chloride of mercury (1-2000), then cov-
ered by green protective (oiled silk)
steeped in the solution. Over this is
placed a piece of boracic lint, wrung out
of the same solution, and this is again
covered by gutta percha tissue. The
whole is enveloped in sublimated gamgee
tissue and then bandaged.
The advantages claimed are : i. The
parts are sterilized by the burn, and are
kept sterile. 2. No active inflammation
takes place, and hence no further death of
tissues. 3. No copious purulent discharge.
4. Infrequency of removal of dressings.
5. Little or no pain connected with such
removal. 6. No offensive odor. 7. The
necrosed tissue is rapidly thrown off by
the growth of healthy granulations. 8.
The resulting cicatrix is the least possible,
from the fact that the parts are preserved,
which might otherwise, from septic influ-
ences, have died. 9. The process of
healing is unimpeded by any local dis-
turbances, w. B. J.
iro
BACTERIOLOGICAL NOTES.
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Medicine, from original sources.]
Eberth's Bacillus and the Bacillus
Colli.— MM. Rodet and Gabriel Roux
{La Semaiiit Medicale') maintain that
the simple passage of the bacillus of
Colli through the human organism trans-
forms it into the typhoid bacillus of
Eberth. Their theory is, that this does
not occur in all persons, but only in those
persons who are susceptible to typhoid
fever. MM. Chantemesse and Widal con-
tend that the difference between these two
organisms is always maintained. While
most of the characters of these two or-
ganisms are very similar, the last-named
experimenters maintain that the typhoid
bacillus differs from the bacillus of Colli,
in that it will not produce the fermenta-
tion of lactose (milk sugar) in bouillon,
while the bacillus colli causes the
prompt fermentation of lactose and the
coagulation of milk.
Phagocytosis and Immunity. — An
interesting discussion has been going on
recently in the Pathological Society of
London, in which the various theories of
immunity are considered. The disputants
are chiefly divided into two classes, the
phagocytocists and the humoralists. Dr.
William Hunter, Assistant Physician to
the London Fever Hospital, presented
many cogent facts and consistent argu-
ments, which seemed to reconcile the ad-
verse positions held by the chief defend-
ers of the two theories. According to
Dr. Hunter, the facts in a simple case of
immunity are briefly these : In an unpro-
tected animal, a subcutaneous inoculation
with virulent bacteria produces general
infection without local change, while in
protected animals, inoculation with the
same bacteria produces a local inflamma-
tion with a great gathering of leucocytes,
but no general infection. It is evident
that some change in the body of the
animal is the cause of this phenomenon.
The question under discussion involves the
nature of this change. Bacteria produce
three forms of poisons : i. Toxines, easily
diffusible substances of an alkaloid nature,
which act in a manner similar to vege-
table alkaloids ; 2. Those diffusible sub-
stances which are of a proteid nature.
and which are very imperfectly known.
These are termed tox-albumins ; 3. A
class of substances which are known
as proteins, belonging to the class of
albumoses, which are derived from the
bodies of the bacteria. The first two sub-
stances, which are very active poisons,
are derived from the bacteria when they
are alive and active. The proteins are
derived from the bacteria when dead or
dying. This class of substances has the
remarkable property of attracting leu-
cocytes. Metchnikoff has shown that the
leucocytes possess not only the scaveng-
ing power to pick up and destroy dead
matters found in the blood, but the ability
to capture and destroy invading microbes.
Behring and Nissen have shown that
the power which the body possesses, of
resisting certain bacteria, is proportional
to the antibiotic or germicidal properties
of its blood serum, it being shown by ex-
periment that the serum of animals ren-
dered immune, has strong bacteria-killing
power, while that of the ordinary animal
furnishes a favorable medium for the
growth of bacteria. This last-named fact
forms the basis of the doctrines of the
humoralists. Dr. Hunter well maintains
that it is illogical to attach to the serum
and plasma of the blood, which are them-
selves the product of cell action, a
greater power than is granted to the cell
itself. Whatever properties the serum
and plasma possess, they must have de-
rived from the cells by which they are
formed. The experiments of Metchnikoff
have shown that these cells, which are
largely concerned with the formation of
plasma and serum, the leucocytes of the
blood, the lymphocytes and the cells of
the spleen, are particularly active as phag-
ocytes. The weakness of the humoral
theory is also shown by the persistence
of the immunity in certain cases. The
fluids of the body are certainly more
changeable than the cells, and it is evi-
dent that the permanency of immunity
must be due to the changes in the cellular
structures of the body. These two doc-
trines, the phagocytic and the humoral,
are evidently mutually complemental ;
one is incomplete without the other,
though certainly the humoral theory
must be regarded as subordinate to that
of the phagocytosis.
J. H. Adami, M. A., M. B., of Cam-
bridge {British Medical Journal, March
5), sums up the results of researches of
BACTERIOLOGICAL NOTES.
171
as related to pneumonia, in the following
succinct manner : —
*'i. Immunity against pneumonia can
be bestowed upon susceptible animals by
introducing into the tissues the sterilized
products of growth of the pneumococcus.
This immunity is, in general, but of a
temporary nature.
"2. Such immunity induced by injec-
tion of bacterial products does not imme-
diately manifest itself ; indeed fourteen
days must elapse before the simple prod-
ucts bring about their effects. But if
the sterilized products heated either to
io6° or 107.5° F. for three to four days,
or to 140° F. for two hours, then injec-
tions induce immunity within four days.
"3. The warmed vaccine leads to a
reaction of but short duration ; the un-
warmed brings about a long-continued
febrile state, at the end of which the ani-
mal becomes immune.
''4. Thus the fever with its elevation
of temperature, and the antecedent heat-
ing of the vaccinial material induce the
same result. One or other process would
seem to be necessary in order that steri-
lized bacterial products develop immunity.
''5. But further, the blood serum of a
protected animal injected into the veins
of a susceptible animal, confers immedi-
ate immunity. There is no delay. Evi-
dently, therefore, some substance is
present in the blood serum of an animal
made immune — a substance not present
in the sterilized culture fluids of the
pneumococcus. The bacterial products
therefore, do not per se bring about im-
munity, but through the febrile reaction,
some other body having immunity-con-
ferring properties, is gradually developed.
" 6. What is more, this same substance
has curative properties, acting, not so
much on the pneumococci themselves (for
in its presence these continue to prolifer-
ate), but upon the poisons or toxines
manufactured by them.
"7. Hence Klemperer and Klempft-er
distinguish two proteids, the pneumo-
toxine which can be isolated from cul-
tures of the pneumococcus, and the anti-
pneumotoxine to be obtained from the
serum of immunized animals."
tains an anti-toxic substance which is an
antidote for the poison of tetanus. They
call this substance "The Anti-Toxine of
Tetanus."
M. Schwarz has recently reported the
case of a young peasant, 15 years of age,
who received a wound upon the left fore-
arm while gathering walnuts. Curiously,
his sister, some time before, had received
a wound by falling, in the same place,
and subsequently died of tetanus. Some
days after the accident, there were some
symptoms of contraction in the left arm,
then in the jaw, in the face, and finally
in the legs and the muscles of the back.
The young patient was at first treated by
chloral and hot baths, then by subcutane-
ous injections of phenic acid, but without
result. The contractions became gen-
eral, and tetanic crises followed. Subcu-
taneous injections of 15 centigrammes of
anti-toxine were then made, the substance
being furnished by the serum of a dog,
which had been rendered refractory to
tetanus. The patient complained of
strong burning sensations in the region
of the injection, then experienced some
sensations of relief, but the contractions
were not diminished in intensity. The
next day, a second injection of anti-tox-
ine was made, the same quantity being
employed, and an injection of 25 centi-
grammes was made the day following,
and on the next day, another injec-
tion of the same amount. On the morn-
ing of the fourth day the patient was so
much improved that he could easily open
his mouth, and could eat with appetite,
employing his hands in eating. On the
fifth day he was entirely well.
■-^ — ♦ — •*-
Traumatic Tetanus Cured by Anti-
Toxine of Tetanus. — MM. Tizzoni
and Cattani showed last year, that the
blood of animals which has been artifici-
ally rendered restrictive to tetanus con-
Diminished Bactericide Property
of the Blood Serum of Rabbits Vac-
cinated against Pneumonia. — Under
this head, M. Mosny recently communi-
cated to the French Society of Biology
the following note : —
''The serum of rabbits vaccinated
against infectious pneumonia, is far from
being a bactericide, for pneumococci,
when placed in it, are insured a longevity
greater than that observed in any of our
artificial culture mediums. They pre-
serve, in fact, all their vegetative action,
and in part also, their virulence, during a
month at least ; while, at the end of four
days, the same pneumococci placed in
the serum of unvaccinated rabbits, lose
their virulence and their vitality.
172
EDITORIAL.
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., March, 1892.
THE ABUSE OF TONICS.
There is perhaps no class of remedial
agents more abused than tonics. The
abuse consists both in the excessive use
and the misapplication of this class of
agents which, within a restricted field,
possess an indisputable and important
therapeutic value. The misuse of tonics
is doubtless the outgrowth of a miscon-
ception of the real nature of this class of
remedial agents and its limitations. Many
physicians also seem to lose sight of the
fact that tonics are, as has been aptly said
of drugs in general, two-edged swords,
which are as capable of mischief as of
benefit. Indeed, when the true nature of
tonics, as is true, in fact, of most medic-
inal agents, is thoroughly understood, it is
apparent that even in cases in which they
accomplish the maximum of benefit, there
is also a certain amount of injury inflicted
upon the organism, so that the effect ob-
tained is really and simply the difference
between the mischief done and the good
accomplished. If the difference is on one
side, the total result is benefit; if on the
other side, the result is harm. This prin-
ciple holds good with regard to most reme-
dies, whether the means employed is a
drug or a non-medicinal agent.
The popular idea of a tonic is well ex-
pressed in the following definition, which
we find in the National Medical Diction-
ary : " An agent which augments grad-
ually and permanently the strength and
vital activity of the body or its parts."
A stimulant is defined by the same author-
ity as being " an agent which f increases
the functional activity of any organ or
series of organs." The distinction made
seems to be that a stimulant produces
temporary excitement, whereas a tonic
produces a permanent increase of strength
and vital activity.
A careful study of the physiological ef-
fects of the various stimulants and tonics
very clearly shows that upon the point in
question there is really no difference what-
ever. The only way in which strength
and vital activity can be really increased,
is by an increase of the metabolic proc-
esses of the body. Alcohol and strych-
nia may be taken as good representatives
of the two classes of drugs named stimu-
lant and tonic. What is their effect upon
the metabolic processes of the body? The
experiments of T. Lauder Brunton and
others have shown conclusively that both
alcohol and strychnia lessen oxidation in
the system. In the case of both drugs this
is due to the toxic effect of the drug upon
protoplasm. The metabolism of the body
depends upon oxidation. Without oxida-
tion there can be no tissue change and no
evolution of energy. How then can an
agent which lessens oxidation produce a
permanent increase of strength and vital
activity ? Here is a paradox which no
writer upon therapeutics has explained.
Alcohol produces an apparent increase
of strength ; we say apparent, because
the experiments of Parkes and others have
shown that the actual amount of work
done by a person under the influence of
liquor, is less than without it. That the
effect of alcohol (which is essentially the
same as that of other stimulants) is only
thg^ of excitation, an effect which is very
transient in its influence, was well shown
by experiments made upon the soldiers
of the British army during the Ashantee
campaign. It was found (quoting Lauder
Brunton, italics ours) that " when a
ration of rum was served out, the soldier
at first marched more briskly, but after
about three miles had been traversed, the
effect of it seemed to be worn off, and he
then lagged mo?'e tha?i before.'^ These
EDITORIAL.
1Y3
experiments, as well as many other simi-
lar ones, show clearly that the effect of a
stimulant is simply to increase the evolu-
tion of energy, but not to replenish the
sources of energy in the body. In con-
nection with the experiment referred to,
experiments were also made in the use of
beef- tea, which were shown, to use Dr.
Brunton's words, '' to have as great a
stimulating power as rum."
Now what is the effect of strychnia?
Again quoting Dr. Brunton, who is as
good authority as can be mentioned in
connection with the subject : ''The most
marked feature in the general action of
strychnine, is the great increase which it
produces in the reflex excitability of the
spinal cord and other reflex nerve-centers.
. . . When the dose is large, this increase
is so great as to cause convulsions and
death. . . . The drug lessens oxidation of
protoplasm and oxidation taking place
in the blood." It is evident then that
strychnia lessens the process by which
energy is naturally developed within the
body, while at the same time increasing
the excitability of the nerve-elements, and
thus leading to an increase in the ex-
penditure of the energy stored up within
the body. In other words, strychnia, like
alcohol, increases the expenditure of en-
ergy, without increasing its production,
but on the contrary, lessening those tis-
sue-changes upon which the development
of energy depends. It is also noticeable
that the effect of strychnia, when used in
small doses, is precisely the same as that
produced by doses sufficiently large to
produce death, only less in degree.
A careful study of the matter will con-
vince any candid person that the only
real difference between the drugs called
stimulants and those called tonics, is, that
the reaction following the excitation pro-
duced by those called tonics, is less im-
mediate, and hence less apparent than in
the case of those drugs which are termed
stimulants. One reason for this, in the
case of strychnia, is in the fact that the
drug is slowly eliminated. This char-
acteristic of the drug should always be
kept in mind in its use, since it gives to
strychnia a cumulative effect which some-
times results disastrously through the fail-
ure of the kidneys to eliminate the poison
with the usual degree of activity. Strych-
nia seems to be one of the most lethal
of drugs, in consequence of the fact
that the only outlet for the poison is
through the kidneys. One of its most
marked properties, when taken in a large
dose, or when its cumulative effects are ex-
perienced, is to cause contraction of the
arteries of the kidneys, thus lessening
their activity, and, in extreme cases, caus-
ing complete suppression of the renal
functions. A case recently came under
our professional care, in which convul-
sions had been produced by ordinary
medicinal doses of the drug, doubtless the
result of lessened activity of the kidneys.
A ready resort to tonics in the great vari-
ety of cases in which there is lack of energy,
lowered nerve-tone, mental or physical de-
pression, weak digestion, sexual weakness,
and similar morbid conditions indicating
low nerve-tone, is often productive of the
greatest mischief. Suppose, for example,
a man is suffering from depression as the
result of excessive work, either mental or
physical : a tonic preparation containing
strychnia or nux vomica will give him in-
creased power of activity; in other words,
by increasing the excitability of the nerve-
cells of the brain and spinal cord, the
disposition for activity is increased, and
consequently the patient not only con-
tinues his over-work, but may actually
increase his daily expenditures of energy.
What must be the necessary result? The
drug administered, diminishes oxidation,
and hence lessens tissue-change and force-
production, while at the same time, through
the deceptive sensation of increased ca-
pacity for work which it produces, it is in-
creasing the amount of force expended.
There can be but one result ; sooner or
later the patient finds himself completely
bankrupt in energy, and in a worse condi-
tion than before. The writer's profes-
sional experience has brought him in
contact with a large number of just this
174
EDITORIAL.
class of cases. The patient had hoped
much from every tonic employed, includ-
ing the use of strychnia, which had often
been pushed almost to the point of actual
poisoning, and the constant observation
has been that no real headway was made
toward permanent recovery, so long as the
patient was kept in a state of artificial
excitability by the use of tonics. The
bad effects of this unscientific method in
therapeutics is most apparent in cases of
sexual debility, in which strychnia and
other powerful tonics have been used for
their aphrodisiac effect. Un^er the in-
fluence of the drug, the patient is made to
believe that his sexual powers have been
fully restored, and is thus led to further
indulgence of the very kind which has led
to his diseased condition.
In the case of mineral tonics, the slow-
ness of their elimination is often a source
of great mischief to the system. Mercury,
which in small doses is held to be a tonic,
iron, and all the metallic salts are to a
considerable extent taken out of the gen-
eral circulation and stored up in the liver.
The same occurs in a lesser degree in some
other structures of the body. Doubtless
great mischief sometimes results to the
liver through this fact. An inactive liver
is not likely to be greatly benefited by
the accumulation within its structures of
a mineral substance which, in the case of
mercury at least, must be highly detri-
mental to the vital activity of the cells.
The vast quantities of iron used in this
country, as a tonic, must be responsible for
an enormous amount of liver inactivity.
The fact is indisputable that great mis-
chief is done to vast numbers of patients
through reliance placed upon tonics as a
means of restoration to health. Tonics
are sometimes undoubtedly useful as a
means of temporarily relieving conditions
of depression, especially when the de-
pression is of such a nature as to cause
the patient to become dispirited and mel-
ancholy ; but when used in such cases, the
reliance upon the tonics should only be
temporary, and the greatest care should
be taken to see that the causes which
have induced the depressed condition are
removed, otherwise the tonic will be
likely to do more harm than .good. Re-
stricted by this rule, the use of tonics
would be reduced so greatly that the
great majority of the long list of remedies
named would probably disappear from
our materia medicas, and the few remain-
ing ones would seldom be resorted to,
since through a removal of the cause,
most of the patients would recover with-
out resorting to remedies which are the
most abused, and we think we might al-
most say, the least needed, of all rational
therapeutic agents. j. h. k.
-^ — • — *-
AN EXCELLENT OPENING FOR A MEDICAL
MISSIONARY.
We are glad to place before the read-
ers of the Bacteriological World and
Modern Medicine, the following circu-
lar issued by two ladies, Mary and Mar-
garet Leitch, who have for seven years
been missionaries in Ceylon ; the address
of the ladies is No. 17, Layfayette Place,
New York : —
''We are very desirous of finding a
fully qualified physician to go as a med-
ical missionary to Ceylon under the Amer-
ican Board. We would be truly grateful
to you if you could direct us to any one
who you think would be a suitable candi-
date. He should have had a good gen-
eral and a thorough medical education,
with some hospital or private practice.
He should be a man of earnest piety who
would consecrate his talents to the serv-
ice of Christ. He should possess sound
health and some executive ability, as the
work he will be called to do among 316,-
000 people in the northern province will
be a large and important one. He should
be a married man. We are hoping to
find one who, with his wife, would be
able to go to Ceylon at least by the end
of this year. He would be expected to
take up and extend the work of the late
Samuel F. Green, M. D., a missionary
of the American Board for twenty-two
EDITORIAL.
m
years in Ceylon, who, during the last
years of his stay in that island, treated,
with the aid of his native assistants, as
many as 10,000 patients a year. The
salary of the doctor and his wife ($1,200
a year, the salary usually paid to mission-
aries in Ceylon), also the amount required
for outfit and passage, have been secured.
' ' In Ceylon there is a large, comfortable
mission house ready for their use, also a
dispensary, and a building for medical
students ; and the funds are now being
pledged for the erection of a large hos-
pital, the American Board having author-
ized us to secure $10,000 for that object.
There will be an income from the coun-
try from fees of paying patients and Gov-
ernment grant which will amount to over
$1,000 a year, which may be used in the
conduct of the work. The endowment
of ten beds in the hospital, and of ten
scholarships, has been given or promised,
also the sum of $90,000 is promised, in
legacies legally executed, toward a gen-
eral endowment. There are at present
eight missionary families in the province,
working in connection with the American
and two English missions. There are
about 3,000 native communicants in the
churches of these missions, and about
15,000 children in their mission schools.
There are several higher educational in-
stitutions, girls' boarding schools, an in-
dustrial school, and a flourishing college.
Tamil is the vernacular of the people, but
the English language is becoming widely
known. The field is an exceptionally
attractive one, and the outlook hopeful.
-•- — * — *-
Indigestibility of Cheese. — Von
Klenze {^Allgemeine Medizinische Central
Zeitung) has recently made a series of
very careful experiments for the purpose
of determining the degree of digestibility
of cheese, which is so largely used with
the idea that it is an aid to digestion.
Dr. Klenze studied the digestibility of a
large number of different kinds of cheese,
employing an artificial digestive fluid,
which contained, however, a quantity of
fresh gastric juice. The conditions sup-
plied, were as favorable as possible for
rapid and complete digestion. Here are
some of the results : Length of time re-
quired for the digestion of Emmenthaler,
Gonzoler, and Neufchatel was eight
hours ; Romadour required nine hours,
and Kottenberger, Brie, Swiss, and all
but two of the eleven remaining varieties
required ten hours for digestion. When
it is remembered that the stomach diges-
tion of an ordinary meal is usually com-
pleted in four or five hours, and in a vig-
orous stomach in even less time, it is
apparent that cheese is a great hinderance
to digestion rather than an aid to it, and
that there is not even the semblance of
a foundation for the old distich, —
"Cheese is a mighty elf
Digesting all things but itself."
That cheese is indigestible is not to be
wondered at. Microscopical and bacteri-
ological studies of cheese show that it
swarms with microbes of various sorts,
and, as is now well« known, the flavors
characteristic of the different varieties of
cheese are wholly due to the products of
microbic action ; the older the cheese the
more numerous the microbes, hence the
greater probability that its presence in
the stomach will set up fermentative or
putrefactive changes in the food-sub-
stances which have been eaten. Prof.
Vaughan's researches have shown that
cheese always contains a larger or smaller
amount of tyrotoxicon, and doubtless
also the microbes by which this power-
fully toxic agent is produced. Cheese
must certainly be regarded as a question-
able article of diet. It should be men-
tioned, however, for the benefit of those
who will insist upon retaining it in their
dietary, that its most noxious properties
may be neutralized by cooking. If the
sterilization of milk is a wholesome and
advantageous proceeding, certainly the
sterilization of cheese is a dietetic duty
which ought not to be neglected, since
m
EDITORIAL.
milk contains only about 6,300,000,000
microbes per quart, while the proportion
of these organisms found in cheese is
vastly greater. j. h. k.
Removal of the Appendages for Epi-
lepsy.— Dr. Joseph Price recently read
an interesting paper before the New York
Neurological Society, entitled, ''The Surg-
ical Treatment of Epilepsy." The plea
of the author was not in favor of opera-
tions upon the perineum, but was in favor
of the removal of the uterine appendages
as a means of curing the disease of epi-
lepsy in women. Tait showed, years
ago, that the removal of the appendages
has a decidedly modifying influence upon
the disease, especially in those cases in
which the paroxysms occur only at the
menstrual period, or in which the parox-
ysms were greatly aggravated at that
time. The paper was not received with
the great enthusiasm which might have
been expected from a society devoted to
the study of nervous disorders, neverthe-
less the facts presented by the author ap-
pear to be cogent, and while we can
scarcely indorse the idea some years ago
expressed by Tait, that every epileptic
woman ought to have her ovaries exam-
ined when the disease does not yield to
other means of treatment, yet we feel
sure that there are cases in which the op-
eration is indicated. Nearly two years
ago, the writer removed the appendages
of a young woman who began to suffer
from epileptic paroxysms occurring only
at the menstrual period and almost imme-
diately after the first appearance of men-
struation. Since the operation, but one
or two slight attacks have occurred. The
patient is practically well. In a similar
case operated upon more recently, suffi-
cient time has not yet elapsed to deter-
mine the permanent results. j. h. k.
-»^ — • — -«-
The Cause of Chronic Degenera-
tive Disease of the Spinal Cord.
— In a paper read by Dr. Charles L.
Dana, before the Congress of American
Physicians and Surgeons last October,
primary degenerations were classified as
follows : —
I. Locomotor ataxia ; 2. Lateral sclero-
sis ; 3. Compound scleroses ; 4. Mul-
tiple sclerosis; 5. Progressive muscular
atrophy.
The usually recognized incurability of
these affections renders the discovery of
their cause a matter of great importance,
especially as such a discovery might lead
to the development of means for arrest-
ing the further advance of the disease,
even though it might not be cured. The
theory which Dr. Dana accepts as the
most probable, is that which he terms
''The Toxine Theory." Sclerosis is re
garded by Dr. Dana, not as a result of
inflammation, a process which is now
generally recognized as concerning only
connective tissues and blood-vessels. The
microscope indicates the chief change to
be gradual decay and death of the nerve-
fiber and cell. In some sclerosis, as that
of locomotor ataxia, this process is ac-
companied by the development of leuco-
maines or tox-albumins, which irritating
substances may perhaps be charged with
setting up those changes which are no-
ticed in the connective tissue elements in
this disease. Analogy certainly seems to
favor the idea that degenerative processes
in nerve-tissue are due to the presence
of an organic poison of some sort which
may be the result, either of a germ poison
in the body, or of some change in the
cells produced by a germ present at some
previous time. The frequency with which
degenerative changes follow typhoid
fever, measles, scarlet fever, smallpox,
and syphilis, is a circumstance which
accords well with this theory.
This view is certainly a somewhat
hopeful one, as it holds out the promise
that at some future time, perhaps in the
near future, we may discover some means,
either of eliminating or of antidoting the
poison by which these destructive changes
are provoked.
REVIEWS.
ITT
Reviews.
Stories of a Country Doctor. — By
Willis P. King, M. D., Kansas City, Mo.
Hummell and Parmele, Drexel Building,
Phil., publishers.
The expectations of all those who know
Dr. King will be aroused for a treat in
anticipation of reading this book (2nd
edition), and they will not be disap-
pointed, if they can enjoy a good laugh.
It is a very interesting and a most amus-
ing volume. It relates, as only Dr! King
can relate, the trials, tribulations, and ex-
periences of a country doctor in the South-
west. The " doctor " has been made the
hero of a good many works of fiction and
of a number of humorous publications,
but we doubt if truly professional ex-
periences have ever furnished ground for
a more readable and enjoyable book. It
is one of those light and mirthful publica-
tions which dispel the blues from the
young country doctor's brains, and will
provoke laughter in the city physician.
A dollar spent in its purchase will be many
times repaid in the recreation that it will
give to both mind and body.
Is Man too Prolific?— By H. S. Pome-
roy, A. M., M. D. Funk & Wagnalls,
publishers. New York.
Syphilis in Ancient and Prehistoric
Times. — By Dr. F. Buret, Paris, France-
Translated by A. H. Ohmann-Dumesnil,
M. D., St. Louis, Mo. This is the first
volume of this work (to be completed in
three). This volume is remarkable for its
thoroughness, its thought, and its practical
and scientific value. It must have en-
tailed enormous, patient research, and
consumed a great deal of time. If we are
to judge of the two volumes to come by
this one, as we are doubtless justifiable in
doing, we can say that the work will prove
a most valuable addition to medical litera-
ture, both in a historical and practical
sense. The notes of the translator are
not the least in practical importance.
They constitute a very useful addition,
and will be read with interest. The trans-
lator is to be congratulated on the success
of his arduous task, and the English-read-
ing physician will find the volume a rare
specimen of usefulness in his profession.
Tables for Doctors and Druggists.
— By Eli H. Long, M. D. A most useful
accessory to the library of every prac-
titioner and every druggist. It contains
five tables : Solubilites ; Reactions and
Incompatibles ; Doses and Uses ; Specific
Gravities, Poisons and Antidotes. An ex-
cellent book. Geo. S. Davis, publisher.
Ethics of Marriage. — ByH. S. Pome-
roy, M. D., New York; Funk & Wag-
nalls. The author of this book takes
high and strong grounds against the sins
committed under the cloak of matrimony,
one class of which the author denomin-
ates ''The Perversion of Marriage," and
calls ''The American Sin," a term which
was first used on the other side of the
Atlantic. Under this head are considered
the various methods by which unborn
human life is destroyed. We are glad to
see that the author takes the strongest
possible ground against this heinous
crime. The book deals with various
other questions, such as "The Family
and the State," "The Mission of the
Child," "Heredity," "Woman's Work,"
"Over Population," etc. We heartily
commend the work as being sound and
wholesome, and in no respect uncertain
in its tone. We trust it may have a wide
circulation.
The International Medical Annual
for 1891. — Edited by P. W. Williams,
M. D. ; New York, E. B. Treat. The repu-
tation which the "International Medical
Annual " has won for itself renders enco-
mium scarcely necessary. Within a space
of not quite 600 pages, the author, aided
by a long list of able physicians, surgeons,
and medical authors, condenses the es-
sential features of progress in the various
departments of medical science within
the last year. The concise, yet thorough
and practical manner in which the vari-
ous subjects are treated, enables the
178
BEVIEWS.
author to compress into this small com-
pass the essentials of the new discoveries
which have been made in remedies and
treatment for disease, new medical inven-
tions, progress of sanitary science, clima-
tology, and other departments of hygiene,
and various other practical branches of
medicine, so that this volume may fairly
be pronounced to be the most valuable
for the general practitioner of all the
medical publications of the year. The
work is well printed, and is illustrated by
a number of chromo-lithographic plates.
The publisher announces that he has
already in press foi^ early publication, for
1892, the tenth volume of the ^'Annual,"
which will contain over six thousand ref-
erences to disease and remedies, making
a volume which ought to be in the library
of every physician.
The Dog in Health and Disease. —
By Prof. Wesley Mills, M. A., M. D.,
D. V. S., etc. D. Appleton Co., pub-
ishers.
This work of 400 pages is a magnificent
presentation of the origin, history, breed-
ing, education, and general management
of the dog in health, and his treatment in
disease. It has t,^ full-page cuts, besides
colored plates and many other illustra-
tions. We think it is by far the best
English work published on the subject,
to date. It is written in the clear and
interesting style well known to Dr. Mills,
and cannot fail to prove of much value to
lovers of the canine, and of natural his-
tory. It is a volume worthy of close in-
spection ; we have no doubt it will receive
the consideration which it merits.
The Essentials of Bacteriology. —
By M. V. Ball, M. D., Assistant in Mi-
croscopy, Niagara University, Buffalo,
N. Y. W. B. Saunders, 913 Walnut St.,
Philadelphia, publisher.
This little book of 159 pages, is per-
haps the most concise and practical com-
pendium which we have yet seen, upon
the subject of which it treats, in the En-
glish language. It is a well illustrated
volume, in which everything relating to
micro-organism to date, is stated, tersely
and in a practical way. It cannot fail to
render a great deal of service both to
physicians in practice, to students, and
to laboratory workers. Its price, one
dollar, is certainly very low for the great
amount of material which it presents.
On Double Consciousn ess. — By
Fred. Binet. The Open Court Publishing
Co., Chicago, 111.
Monism and Milliorism. — A philo-
sophical essay on causality and ethics, by
Paul Carus, Ph. D. F. W. Christern,
37 West 23d St., New York, publisher.
The Idea of God. —By Paul Carus,
Ph. D. The Open Court Pub. Co., Chi-
cago, 111.
The Ethical Problem.— By Dr. Paul
Carus. The Open Court Pub. Co.,
Chicago, 111.
The Work of Medicine for the
World.— By C. H. Hughes, M. D., St.
Louis. Published by the Alienist and
Neurologist, St. Louis, Mo.
Tobacco, Insanity, and Nervous-
ness.— By Dr. L. Bremer. Meyer Bros.,
druggists, publishers, St. Louis, Mo.
Price-list of Veterinary Instru-
ments.— Jacob J. Teuffel & Bro., 114
S. loth St., Phila.
Femoral and Ventral Hernia in
Women, and the Kangaroo Suture. —
Two articles illustrated in one monogram,
by Henry O. Marcy, A. M., M. D.,
LL. D., Boston. W. J. Dorman, pub-
lisher, Phila.
The Scientific Rationale of Modern
Wound Treatment. — By the same au-
thor. Printed at the office of the American
Medical Association, Chicago, 111.
Apparatus for the Collection of
Dust and Fungi, for Microscopical
and Biological Tests. — By Samuel G.
Dixon, M. D. Geo. S. Davis, publisher,
Detroit, Mich.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
NlOIsnrFILY BULIvKTTIN
Battle Creek, Mich., March, 1892.
A PECULIAR CASE OF MALIGNANT DISEASE
OF THE UTERUS.
Mrs. F., age fifty-two, had suffered from a
pelvic disease for one and a half years previous
to her introduction into the Sanitarium, Dec.
10,1891. Had a bloody discharge from tlieva-
gina, more or less constantly during the above
period. She was suffering ivom hemorrhoids,
constipation, cold extremities, broken sleep,
tient was placed on the operating table, when
the cervix was found badly diseased. On the
left it was almost entirely gone, and on the
right some excrescences protruded and bulged
into the vagina. The entire uterine wall
seemed invaded. Some of the pathological tis-
sue felt dense and at other parts it felt softer.
Considerable infiltration seemed to involve the
latter side of the OS and uterus. In stretching
tiieinouth open a largequantity of offensive})ns
was discharged. Dr. Kellogg excised theprom-
FlG. I. 500 DiAM.
and various functional disturbances. The dis-
charge followed the menopause and continued
to this date. She complained of pains in the
left ovarian region over crest of ilium. The di-
agnosis arrived at was malignant disease of
uterus, probably extending into the broad liga-
ment. Microscopical examination, so far as
the tissue itself was concerned, indicated sar-
coma, but itwasnot satisfactory. Throughout
this diseased tissue there existed a filamentous
growth (vegetable) to be described further,
which gave to the case a decidedly peculiar
character. On the 13th of Jan., 1892, the pa-
(1
Fig. 2. 500 DiAM.
inent growths and curetted all thedisefised por-
tions thoroughly. 'J'he i)Us and tissue, being
gathered, wei'e submitted to microscopical ex-
amination. The following is the report
thereof: —
The pus presented no special interest which,
from a purely microscopical standpoint, needs,
mention at this moment. Cultures under way
may bring some interesting features, which, in
such an event, will be reported later. The pecul-
iarity of the case existed in the pathological
tissue itself. Histologically, it had the chaiac-
ter of a sarcoma, but throughout its structure,
79)
180
LABORATORY OF HYGIENE.
appeared ramifications of filaments which
seemed to belong- to the class of micro-organ-
isms known ascladothrix. (See frontispiece and
accompanying cut.^ ) On making the sections,
after freezing the tissue, those filaments,
branching in various directions, presented the
appearance of mycelium penetrating between
the cells of the tissue. They were quite loose,
and on breaking up the fresh tissue could
be separated and isolated from the section.
Unstained, they were not distinguishable, but
stained with haematoxylon they presented a
dark appearance with bright spaces or spots
(as if spores were present) at regular intervals.
Now the question arises, Was this vegetable
growth a secondary complication, or was it the
primary cause of the diseased tissue? It is pos-
sible that the pathological condition only af-
forded a proper field for the parasitic develop-
ment. Yet it is not improbable that at the pe-
riod of the menopause, these organisms began
to develop somewhere about the uterus and
gradually invaded its wails, therebj' producing
the condition explained. Perhaps further
studies will clear the doubts, as the pa-
tient, after curetting, and painting the sur-
faces well with iodine, made a fair recovery.
Should the disease reappear, the uterus will
probably be excised, when further investiga-
tions will be instituted. Should the cure be
complete, we will have a good indication as to
the nature of the malignancy or benignancy of
the case. If a true sarcoma, not due to this
parasite, the case is likely beyond redemption
by the operation done to date. p. p.
INFECTIOUS ABORTION.
Infectious abortion has been known in live
stock for a number of years. Investigations of
this disease have been made in France among
cattle and sheep by Prof. Nocard and others.
The writer had an opportunity of investigating
this malady somewhat cursorily in cattle in the
State of Missouri. In Illinois, Dr. Williams,
then of Bloomington, made an inquiry of in-
fectious abortion in mares, for the United States
government. It seems pretty well understood
by all these investigators, that the cause of
this (like all other infectious maladies), is
some form or other of micro-organism, or per-
haps an association of micro-organisms under
certain circumstances. Dr. Williams made some
tests by the introduction into the vagina of a
iThe cuts are from excellent photographs made by Prof. H.
J. Detmers, Columbus, Ohio, from a poor mount. They are
not intended to show the nature of the tissue, but merely the
filaments and their location.
portion of the placenta from fresh cases of
abortion, and, I believe, succeeded in produc-
ing the malady in one case out of seven. It
seems, however, that there have never been any
prolonged and satisfactory bacteriological
studies supported by inoculations and trials
of other kinds, with cultivated virus, with per-
haps the exception of the work which has
been done here and there, at various intervals,
by some European authorities, concerning
abortion in cattle.
A few weeks ago I was called to Montana, to
institute researches concerning an outbreak
of abortion in the famous Daley ranch at
Kiverside, Bitter Root Valley, Mont. Mr.
Marcus Daley, having perhaps a million and a
half dollars invested in that mammoth insti-
tution, and having lost in the neighborhood
of |75,000 worth of colts and mares through
this malady, had decided to search for the
cause by all possible means, and desired that
all scientific and practical tests should bemade,
for the purpose of arriving at the bottom of
the trouble. The object of my visit was to
study the cause, from a bacteriological and
pathological standpoint, and also to make
such experiments and investigations as might
be found necessary', upon the ground. It was
found that out of some 30 odd cases of abor-
tion, in every instance, the disease existed
between the placenta and the uterus; a dis-
organization of tissue had taken place there,
and loosened the two organs. It was found
that at the outset, probably only a small
colony of micro-organisms began the work of
destruction in some portion or other of the
adherent uterine and placental walls, and by
gradually gaining ground, the separation be-
came more and more extensive until finally
expulsion took place.
In cases in which the disease occiirred just
about the time of parturition, or say a week
or two before, birth was hastened, and some-
times the foal was born alive but died within a
day or two, sometimes a few hours after birth.
The naked eye lesions, when perfectly fresh, were
as follows: The loosened portion of the pla-
centa was smooth, soft and slimy to the touch,
and very friable. It was easily torn, and the
surface affected, very readily scraped with the
nails or a knife. After a few hours, the parts
were grayish in appearance. Sometimes this was
the case at the time of expulsion, denoting, very
likely, still more transformations of the affected
parts by the action of micro-organisms. The
lineof demarkation between these diseased por-
tions (there was only one, more or less
extensive), and the healthy portion of the
placenta, was unmistakable. The latter one
LABORATORY OF HYGIENE.
181
had the characteristic red appearance to the
eye, and sound solid feeling to the touch which
is always found in ordinary cases of abortion in
mares, while adjoining was the peculiar appear-
ance of the dead diseased tissue, as just de-
scribed. From the nature of the lesions and
their locality, it seems evident that the intro-
duction of the micro-organisms occurred by the
vagina. From the fact that the mares pre-
sented no premonitory symptom, and that it
was therefore impossible to detect, more than
an hour beforehand, any animal that was about
to abort, and that no record exists as to pre-
existing ieYer, it seems quite likely that the
vii'us could not have been introduced into
the placental region by the circulation of the
mother. However, tests are being made to de-
termine that point, if possible. But that the
disease is transmissible, is unquestionable; the
history of the cases referred to demonstrates
this fact yevy well.
The first cases that occurred were separated
a mile or two from other ranches. Several
cases took place in this first outbreak. Then
the animals which had been exposed, and I
think some that had aborted, were transferred
to another ranch, where some other brood
mares were grazing. Some sixteen or eighteen
days afterward, the disease broke out in the
latter place. This is only one instance point-
ing to the transmission of the disease. There
are other facts connected with this outbreak,
which point to the same conclusion, but
which I need not relate here.
The preventive treatment instituted at the
outset, was such as was suggested on general
principles by the nature of infections, i. e.,
quarantine of the healthy stock away from
the diseased animals and infected grounds;
quarantine of those which had already abor-
ted, on the ground where the abortion took
place. An antiseptic douche to be wisely ad-
ministered was also recommended for the ani
mals which had been exposed and had not yet
aborted, in order to keej) the vagina and the
vulva as free from micro-organisms as possible.
The microscopic study of the disease, and of
these micro-organisms is yet incomplete, and it
is possible that it will take some time to come
to a satisfactory conclusion. We can say con-
clusively, however, that one form of cocci
largely predominated in the diseased walls, and
is possibly^ connected closely with the disease
from an etiological standpoint. Bacteriolog-
ical researches at the Laboratory of Hygiene
in this Institution are now under way, and we
hope, ere long, to be able to present further
points of interest and of practical utility to
those interested. Experimental tests are under
way; more will be hereafter instituted to sift
this question as thoroughly as possible.
We trust that these investigations, conducted
at great expense to Mr. Marcus Daley, may be
of utility not only to the owners but to the
country at large. p. p.
DISINFECTION OF BUILDINGS, ETC.
Among the most interesting investigations
which have ever been made, from a sanitary
standpoint, are those concerning the disinfec-
tion of buildings. In order to put this phase
of sanitary science on a more rational basis
than the mere washing or general fumigation,
steaming, etc., it is necessary not only to study
the nature of the organisms existing in the
building to be disiniected, but also their loca-
tion, their protection by various furniture, wall-
material, and even realize the quantity of
germs existing. M. Duclaux, in the Annales
de r Inst i tut Pasteur, P'ebruary number, pub-
lishes an excellent review of the studies which
have been made of the disinfection of walls.
From this article we quote largely, and receive
inspiration for these notes.
In the first place we must remember that in
any kind of building, the floors, walls, etc.,
vary a great deal, not only in their physical
structure, conformation, and the kind of ma-
terial forming them, but also in regard to the
temperature and the surroundings which make
them more or less favorable for germs. For
example, the walls, the ceiling, and the floor of
a parlor must necessarily differ greatly from
those of a bedroom, a kitchen, or a dining
room, and again, from a garret. On the other
hand, fromabacteriological standpoint a room
in which a tuberculous person has lived differs
from a room in which a variolous patient or a
diphtheritic patient has sojourned. Again, we
find that a room bathed in sunlight, receiving
a great deal of daylight, is likely to be poorer
in the quantity of germs than one which is kept
darker, or in the shade. The damp ceiling, at
warm temperature particularly, harbors also
more germs than a dry wall, at any tem-
perature. Again, a wall painted with oil is
likely to be poorer in quantity of microbes
than one with a rough surface in which they
can be harbored. It is therefore quite reason-
able to expect a varying quantity of germs in
the same building, according to the conditions
and kind of walls, flooring, ceiling, etc. This
has been found universal, and proven by Es-
march in the best work which has been pub-
lished on the subject. In his work he states
182
LABORATORY OF HYGIENE.
that lie lias found on a square portion of wall
of 5 centimeters, ^ernis in the following- quan-
tities: Stable-stall, limed walls, 7,087 colo-
nies; laboratory, a glue paint, 115; labora-
tory, wooden door, 30; sitting-room, velvet
wall, 19; same room, at another point, 158.
These quantities were gathered with a fine,
sterilized wet sponge, and it is very doubtful,
says M. Dnclaux, whether tliey represent the
proper ratio. They areprobably not sufficiently
high, for the method employed, and possibly
the nutritive substance, may not have been
sufficient to demonstrate all the colonies which
could have been found. M. Gerloczy has dis-
covered a vast number of germs left after
using tlieEsmarch method, by simply scraping
the walls and their surface. The above quan-
tities, then, are likely to be too low.
Here is another tabulation of colonies found
in various parts of another building, — the
Hygienic Institute. The germs were gathered
at a man's height: side of window, 6,070 colo-
nies; side of window at a point adjoining the
first, 6,391; opposite side same window 3,185;
opposite side, at a point adjoining the preced-
ing, 2,170; near the stall of an animal, 14,200;
a meter higher, nearer the animal, 1,386.
Investigations demonstrate thatthenumbers
decrease as we get higher from the ground, and
in fact, that there are very few germs on the
ceilings. The germs which have been found in
all buildings b3" various investigators, among
whom we may mention Canalis, Cornet, Kruger,
Emmei'ich, Friedlander, Ullmann, and Kelsch,
include a number of pathogenous forms, such
as the bacillus of tuberculosis, pneumococcus,
streptococcus of erysipelas, the bacillus of
tetanus, and various pus and septic germs. It
is against these dangerous elements that a
good disinfection of the floors and walls of a
building is necessary, particularly in hospitals
where sickness has prevailed.
But it must not be expected that by even the
very best of disinfection we can realize the ab-
solute destruction of all these germs. It is
only possible to realize a safe medium, or rather
a cleanliness by which the dangerous germs will
have been sufficiently destroyed or modified to
make the rooms comparatively harmless. "A
good disinfection," says M. Duclaux, "ought
to include the following conditions: 1. It must
insure the integrity of the walls and of the
material, such as paper, paste, etc., that forms
their covering; 2. It must be harmless to those
applying it, and for those who will inhabit the
disinfected apartment; 3. It must be easily
applied, and cheap; 4. It should be efficacious."
People generally have little fear of the germs
of any disease, until they have been affected by
them, and then it is sometimes difficult to dis-
infect enough to satisfy them. Theoretically, it
is expected to kill every germ of whatever de-
scription in a building. Practically, this cannot
be reached. Of all these conditions of disin-
fection, it is evident that efficacy, though men-
tioned last, is the most important of all. If it
is possible to have an efficacious disinfection,
cheaply applied, so much the better, and it is a
condition that ought to be sought; but if it is
impossible without some cost, then efficacy
ought to be the chief point considered.
Esmarch has proposed various methods
of disinfection, which we may consider in our
next.
Technique.
Clear Agar-Agar Culture Medium. — Every
workei' knows how difficult it is to obtain a
clear, solid medium when agar-agar is used
as solidifying agent, and every one knows also
that sometimes it is darker and more cloudy
than at others, although precisel.y the same
method was used, the agar being of a different
origin. It frequently happens that with the
best care and the best filti'ation, even when al-
bumen of egg is used, the medium remains
too dark, or at least far from satisfactory, so
far as transparency is concerned. This I am
sure, often comes from dirt in the agar used.
I have not experimented extensively with the
following simple precautionary measure, but
two or three recent trials make me believe that
the medium can usually be much improved by
it. It is this: cut the agar-agar fine with scis-
sors, put in a large flask (or measuring-glass),
add a large amount of warm water, and shake
violently. Pour off this water and add a fresh
quantity, shake again and pour off as before.
Repeat the operation three or four times, al-
ways being careful to allow the agar to settle
before decanting. Sometimes better results
are obtained by leaving the agar in the third
water, say about an hour or two, and then
shaking and decanting. A cotton cloth may
be used to filter the water off the agar-agar
thus washed. In a word, it means a thorough
rinsing of the agar before heating or melting it
in any waj'.
-• — • — «-
Blood Fermentation. — Blood allowed to fer-
ment by the action of the (various) microbes
which prey upon it, produces carbonic acid,
ammonia, volatile fatty acids, and fixed com-
pound nitrogenous substances.
BULLETIN OF the
Medical and Surgical Sanitarium,
Battle Creek, Michigan.
The purpose of this department is to constitute, together with the Bulletin of the Laboratory of Hygiene, a record of the
scientific work in the Medical and Surgical Sanitarium located at Battle Creek, Michigan, an institution incorporated as an
organized and self-supporting charitable enterprise, all the earnings of the institution being devoted to charitable medical work,
and the advancement of scientific medicine.
BIENNIAL REPORT OF TBE SUPERINTENDENT.
(Continued.)
SANITARIUM METHODS.
It may not be inappropriate to present in
this report a brief resume of the general princi-
ples which underlie the medical work of a sani-
tarium conducted on rational principles, or at
least whicli should underlie the work of such
an institution, and the methods employed.
The word "sanitarium," or "sanitorium,"
was first employed to designate resorts for
invalid soldiers, which were frequented not for
the purpose of enjoying any special medical
advantages but for the benefit of pure air, sea
bathing, and cheerful surroundings. This is
practically the sense in which the term is still
very largely employed, as it is applied to a
great number of institutions which are in-
tended as resorts for invalids, but which offer
as attractions simply climatic advantages or
the supposed virtues of certain mineral waters
from springs or artesian wells. But consid-
ered as a medical institution, a sanitarium, or
at least a medical and surgical sanitarium, is
a product of modern medical progress, and
represents rational medicine in its most ad-
vanced and most progressive form.
It is everywhere recognized that within the
last quarter of a century the science of medi-
cine has made marvelous progress. Indeed, it
may be said that more real advancement has
been made in scientific medicine within the pres-
ent century than in all the centuries which have
preceded it. The central and fundamental idea
in the work of this institution is the thought
that health-getting is not a matter of magic
nor of pill-swallowing, but rather a matter of
training and education. The chronic invalid is
sick, usually because he has neglected to supply
the conditions necessary for health, or because
he has by long-continued violation of the laws
of health in various unhygienic practices, de-
veloped evil tendencies and morbid activities
in his various bodily organs. The cure of such
a patient must consist chiefly in a course of
systematic training by which he will be edu-
cated out of his evil ways into l)etter ones —
by which his abnormal vital functions will be
trained to normal and healthful activity. This
course of training necessarily includes such dis-
cipline and regimen as will influence every dis-
ordered function. It involves absolute control
of the entire life of the invalid. All his habits
of life must be systematically conformed to
such rules and principles as will efficiently and
curatively modify his disordered vital processes.
Health is as much a matter of growth and
development as is the growth of a tree or of a
crop of wheat, and is as much dependent upon
material conditions. By proper control and
modification of his nutritive processes, the
chronic invalid may be gradually grown or
trained out of disease into health. By rais-
ing his whole vital status and improving his
general physical tone, morbid conditions are
left behind, the normal rhythm of vital activity
is re-established; and health comes, not as the
result of ingenious antidoting of morbid condi-
tions, but as the result of the working within
the body of that occult force recognized by the
ancients, but so often forgotten in modein
times, the vis medicatrix Naturse. For two
thousand years physicians busied themselves in
hunting over the world of chemical compounds
and botanical products, not even neglecting the
animal world, in search of specifics or antidotes
for disease; but modern medicine has taught us
that it is the duty of the physician to study his
patient as much as his malady, and to remem-
ber that it is the patient whom he is to cure
rather than his disease. When the patient is
cured, his disease has vanished, but, on the
other hand, one may succeed admirably in the
cure of a disease and yet find his patient even
worse than before.
A large share of the patients who visit the
Sanitarium have had their diseases cured many
times. Their torpid livers have been cured
again and again by cholagogues and liver
stimulants of various sorts. Their diseased
kidneys may have been many times "cured " by
"Kidney Cures" and various vaunted specifics.
Their indigestion has been cured scores of
times by acids and alkalies, digestants, pep-
(183)
184
SANITAMIUM BULLETIN.
tones, tonics, elixirs, stomachics, etc. Their
nerves have been toned up and toned down to
the satisfaction of many successive medical
advisers; nevertheless they are still sick, and
have not infrequently reached a condition in
which their jaded livers, kidneys, stomachs, or
nerves have ceased to "react" to the remedies
administered, so that in sheer despair they
have "thrown physic to the dogs," and have
abandoned themselves to their fate, or have,
through the encouragement of some friend or
advice of their physician, sought the Sanita-
rium as a sort of court of last appeal.
This is just the class of patients to which a
sanitarium ought to be adapted. The tem-
porary relief afforded by various medicinal
agents is no longer of service. Radical means
must be adopted, and for the successful em-
ployment of such means a well-regulated insti-
tution with its trained corps of attendants,
its systematic rules and regulations, is abso-
lutely indispensable.
The main idea in the Sanitarium, then, is
health culture. The sick man is led to reform
his unhygienic ways and is taught to do works
of supererogation health ward.
First of all, the physician must be familiar
with the condition of his patient. On the ar-
rival of the patient at the Sanitarium, a care-
ful account of his case is taken in writing. He
is questioned respecting his father and mother,
his grandparents, his uncles, aunts, brothers,
and sisters, and sometimes more distant rela-
tives. The purpose is to learn as much as
possible of the quality of his constitutional ten-
dencies, etc. His own personal history is care-
fully investigated, inquiry being made respect-
ing the diseases from which he has suffered,
his personal habits, etc. Then a careful inquiry
is made into his present illness and its history.
Every department of the body is systematically
investigated — digestion, respiration, circula-
tion, nervous system, etc.
After eliciting from the patient as much in-
formation as he is himself prepared to give
of his case, a careful physical examination is
made. The heart and lungs are carefully ex-
amined, not only by the stethoscope and other
ordinary means, but in cases requiring it, the
sphygmograph, pneumograph, pneograph, and
other instruments of precision are brought
into the right position. In fact, in making a
physical examination of a patient, the methods
of a physiological laboratory are very largely
utilized. The advantage of getting this precise
knowledge of the patient's case is beyond
estimate, as it enables the physician not only
to ascertain the patient's condition with gi'eat
accuracy, but also enables him to determine at
a very early period whether there is or is not
a change for the better. A principle which is
conscientiously observed in this institution is
to retain no patient under treatment who is not
improving, or is not likely to improve, and
hence the anxiety to discover at the earliest
moment possible any positive indications re-
specting any change in his condition for bet-
ter or worse.
An examination of the stomach includes not
only an inquiry of the patient respecting his
condition, and looking at the tongue, but a
careful examination of the stomach itself by
palpation, succussion, clapotement, and in
some cases by introducing a tybe into the
stomach and withdrawing a portion of its con-
tents for examination. By these methods the
exact size of the stomach and its real physical
state are accurately determined, as is also the
condition of the other abdominal viscera.
Each patient who enters the institution is re-
quired to present for examination, the entire
amount of urine passed in twenty-four hours.
This twenty-four-hour specimen is carefully ex-
amined quantitativelj' as well as qualitatively
The analysis includes not only a statement of
the acidity or alkalinity, but the exact degree
of acidity or alkalinity. The amount of urea
is also determined, also the exact quantity of
sugar and of albumen, if these constituents are
present. Examination is also made for the
presence of toxines, ptomaines, etc., and for any
other morbid elements which can be discovered
by minute chemical analysis or by the micro-
scope.
If a patient coughs and expectorates, a bac-
teriological study is made of the expectorated
matters. If the patient presents symptoms
which indicate a disease seated in the nervous
system, a very elaborate investigation of the
condition of the nerve centers is undertaken.
The condition of the various reflexes, superfi-
cial and deep, together with the condition of
the various classes of sensory nerves, are care-
fully studied. B3' the ingenious chronometer
of Ch. Verdin, a determination of the rate
of transmission of nerve energy is made in this
class of patients, not only for the individual as
a whole, but in many cases for individual parts
of the body. Comparison is made between the
two sides of the body. Determination is also
made not only for the time required to, feel and
indicate a sensation, but for the time occupied
by the brain in recognizing the sensation. Co-
ordination is carefully tested, and any s^'mp-
toms looking toward an organic affection of
the brain or spinal cord are carefully studied
with reference to an exact localization of the
disease.
SANITARIUM BULLETIN.
185
So far as possible in stomach disorders, the
length of time required for absorption and the
kind and degree of acidity present in the
digestive contents at different times follow-
ing a meal, are considered questions of impor-
tance to be determined by careful chemical
study.
Before a prescription for exercise is made the
patient is subjected to a careful study of his
physique and the condition of his muscles.
Any lateral or posterior curvature of the
spine, or other bodily defects^ are carefully
noted, the exact strength of each group of
muscles in the body, as indicated by a delicate
and exact mercurial dynamometer, is recorded^
and a chart made by which his weak points
may be instantly recognized.
Such an examination furnishes the founda-
tion for an exact and rational prescription for
the patient. If the examination of the lungs
indicates a disease of these organs, and the
patient's temperature shows a high degree of
activity, he is required to rest for some days
until the activity of the disease has subsided
under appropriate treatment, then will begin a
series of exercises accompanied with inhala-
tions, lung expansions with pneumatic appa-
ratus, etc., for the purpose of expanding the
lungs and increasing the amount of oxygen
absorbed, properly medicating the diseased
surfaces and fortifying the patient's system
against disease. Special attention will be
given to supplying him with very nutritious
food taken in such quantities and at such
times as will stimulate his nutrition to the
highest degree.
If in case of disease of the heart, the exami-
nation indicates excessive heart weakness, per-
haps with dilatation, the patient must have
carefully graduated exercises of such a charac-
ter as will strengthen the heart, combined
with such Swedish movements, massage, and
baths as will increase the surface circulation
and thus relieve the heart. If the heart is en-
larged by overgrowth from excessive compen-
sation, rest in bed with absolute proscription
of all exercise for one, two, or even three or
four weeks, becomes a necessary prescription,
the patient's strength at the same time being-
maintained and even augmented by passive ex-
ercise administered in such a way as not to ex-
cite the already over excitable heart.
The examination of the stomach will give the
necessary indications respecting diet; as, for
example, if the patient has a stomach which is
dilated, its walls so weakened and relaxed as to
be almost incapable of contraction, he must be
provided with food which is well disintegrated,
and hence will require little labor on the part
of the stomach, and his digestion must be as-
sisted mechanically by massage, either manu-
ally or mechanically administered to the stom-
ach and abdomen atproperintervals after each
meal. If the chemical analysis of the content*
of the stomach shows a deficiency of hydro-
chloric acid, this must be supplied, and the
stomach glands must be reinforced by the de-
velopment of better blood and the employ-
ment of proper vital stimuli, such as electricity^
massage, etc., to increase their activity.
So with every class of invalids. Each must
have his specific wants considered and met by
treatment. The nervous must not only receive
a suitable prescription for diet, etc., but must
be trained to self-control. The neurasthenic
■ must be taught how to conserve nervousenergy
and how to cultivate nerve tone. The hyster-
ical and hypochondriacal must be convinced of
the dangers arising from self-inspection and
self-centering of the mind, and must be cajoled
into a healthful activity of mind and body.
A man with a bad stomach or weak liver
must be taught how to give his stomach and
his liver an easy time.
Thechronic pill swallower must be weaned from
his doses, and the paripatetic valetudinarian
must be enthused with an ambition to become
something better than a traveling museum of
maladies. The woman who takes an inventory
of her symptoms every morninglest one should
have disappeared over night, must be jostled
out of her invalid ruts, and must be inspired
with a wholesome hatred of disease and an
earnest determination to escape from itsthrall-
dom.
The whole institution must be kept full of
sturdy ideas about health and wholesome liv-
ing. Its very atmosphere must breathe of life
and every room must be kept aglow with
mental and moral sunshine through the agency
of active and sympathetic physicians and effi-
cient, good-natured nurses and attendants.
The prescription for exercise recognizes every
possible condition which can modify muscular
effort. Slioi-t-breathed patients, those suffer-
ing from organic disease of the heart, must be
shown how to get the benefits of exercise by
slow and moderately heavy exercises executed
without "strain." The aged, and those who
are permanently crippled by rheumatism or
gout, must be taught the same lesson, and
must especially be shown how to develop re-
spiratory activity, although it may be too late
to increase their lung capacity.
The obese, anaemic, the sedentary, and those
who have become neurasthenic through idle-
ness, must be made to work out their salva-
tion b3' vigorous labor at the rowing machine.
186
SANITARIUM BULLETIN.
the pulley weights, the Swedish gymnastics,
and in the tread-mill. So much for general
regimen.
Every patient i-eceives careful prescriptions
for diet and exercise as well as for baths, medi-
cines, when required, etc. Among the facilities
afforded by the Sanitarium, in addition to
those already referred to, are the following: —
Extensive bath rooms, affording facilities for
the employment of all recognized hydro-thera-
peutic measures; thafc is, every form of bath,
general and local, hot and tepid, temperateand
cold, as the case niay require; vapor baths,
Turkish baths, electric baths, electro-vapor
baths, etc. The last addition to this depart-
ment is the electric-light bath, in which the ad-
vantages of radiant heat are utilized. The heat
from the incandescent electric light is found to
penetrate a long distance into the body. In
fact, when the unclothed body is surrounded
with a multitude of glowing electric lights, it
may be said without exaggeration that every
fiber of the body is illuminated by exposure to
the powerful influence of this remedial agent.
It has been shown that plants grow under the
influence of the electric light as under the influ-
enceof sunlight. Seeds germinate, and various
vital processes are carried on as though ex-
l^osed to the action of the sun's rays. The
electric light bath is pei'haps a complete sub-
stitute for the sun bath, and has the advan-
tage that it is under absolute control. A.i\y
degree of effect desired can be produced. This
bath was originated in the Sanitarium, and
has not, so far as we know, been employed
elsewhere.
Special attention is given to massage, with a
corps of nurses and attendants including more
than thirty trained manipulators. The sys-
tem employed is in some respects peculiar to
the institution, although not absolutely novel.
It is made up of the most valuable features of
the French, German, English, and Swedish sys-
tems of massage, and is modified, of course,
to suit individual cases. In the manual Swed-
ish movement department, manipulators who
have been carefully trained by trainers direct
from Sweden, do most eflBcient service in this
line. The system is not employed in a hap-
hazard way, as it is not left to the manipula-
tors themselves, but is as carefully prescribed
as medicines or any other class of curative
agents.
The mechanical Swedish movement depart-
ment is unique. It includes a larger number of
different effective machines than will be lound
anywhere else in the world. A larger share of
the machines employed have been invented and
made especially for use in this institution, and
with the exception of the few which have been
copied, are not in use elsewhere. Additions are
made to this department to accomplish some
new thing, or to accomplish an old purpose in
a more effectual manner.
The electrical department includes the most
elaborate outfit to be found in any hospital or
institution of any sort in this country. The
electrical currents are dosed with the great-
est care, not only as regards the strength of
current employed, but also as regards the
amount of actual electrical work done during
the application.
Lectures two or three times a week give pa-
tients practical instruction in wholesome liv-
ing, domestic hygiene, etc.
Physiological and chemical investigations
are constantly being carried on at large ex-
pense for the purpose of determining the value
of new remedies and developing new remedial
agents. Such investigations are useful not
only in their results but in maintaining in the
institution and among the workers connected
with it, a scientific spirit which cannot but be ol
great practical advantage to those who seek
aid through the advantages offered by the
establishment.
This institution has been conducted, practic-
ally upon this basis for now nearly twenty years,
and its phenomenal growth may fairly be ac-
cepted as evidence that the idea which domi-
nates the enterprise, and which has been briefly
outlined in the foregoing, has a sound basis.
Thousands of cases which have drifted about
for years, and had finally been given up as in-
curable, have been restored to health by a few
months of health training here. The advan-
tages of this method of treatment, especially in
chronic cases, is coming to be generally recog-
nized among physicians. This is clearly shown
by the fact that a lage share of the patients
treated in the institution at the present time,
are either sent by physicians or come with their
full concurrence and encouragement.
INTERESTING CASE OF RUDIMENTARY UTERUS,
OVARIES, AND ATRESIA VAGINA.
The patient was an American woman aged
forty-six years, had been married twenty-two
years, was well developed physically, a woman
of average intelligence and good personal ap-
pearance. She was brought to me by her hus-
band for examination with reference to a pos-
sible operation for relief of her condition. On
examination, I found the vagina to be entirely
absent. The external genitals were fully and
normally developed in every respect, but at the
SANITARIUM BULLETIN.
187
usual seat of the ostium vaginae I found only
two Bmall pouclies about lialf an inch deep
Fig. I. Showing Rudimentary Vagina at V.
and separated by a thin septum, looking really
like a rudimentary double vagina. The most
careful examination revealed no further trace
of a vagina.
On examination through the rectum with a
sound in the bladder, it was at once evident
Fig. 2- Showing at V the Rudimentary Vagina, and
AT U THE Rudimentary Uterus.
that the uterus, if present at all, must be ex-
tremely rudimentary. By very careful exam-
ination, I was able to make out clearly the
arching structures of the broad ligaments, ;iiid
in the center, a small nodule not larger than a
hazel-nut. On the left side, in the region where
the left ovarv should have been located, 1 made
out a similar nodule still smaller, but found
nothing more than a slight thickening of the
structures in the right ovarian region.
The patient had never menstruated. At a
previous examination by a gynecologist of
good standing, she had been told that both
the ovaries and the uterus were entirely ab-
sent. I was enabled, however, in my examina-
tion, to make out the presence of an extremely
rudimentary uterus; and from the factthat the
patient had developed all the external physio-
logical characteristics of a normal woman, the
breasts being well formed, and the external gen-
itals perfectly developed in eYery particular,
I think it impossible that the ovaries could
have been entirely absent. On careful ques"
tioning, I could obtain no trace of the slightest
suggestion even of a menstrual period at any
timeduring her life, and was surprised when the
patient remarked that although she had never
menstruated, she had passed through the
"change of life." Further questioning elicited
the fact that for %, few years back the patient
had had "hot flushes," and the various vaso-
motor and other nervous disturbances usually
experienced by wom^n passing through the
menopause. These symptoms had entirely dis-
appeared within the last year or two.
Coen, of Bologna, a few years ago reported
the case of a girl born at the end of the eighth
month of gestation in whom there was absence
of both uterus and vagina. In this case, both
kidneys were also absent, although the ovaries
and fallopian tubes were present.
A case similar to the present one was re-
ported to the New York Obstetrical Society five
or six years ago. In this case, as in the one
above mentioned, there weretwo small external
pouches at the seat of the ostium vaginae. A
small pouch had been formed behind these
openings in the fossa novicularis, the result of
attempts at coition. No pouch of this sort
existed in the case which I have reported
above. The patient experienced normal sexual
desire until within a few years, or at least be-
lieved that she did. The accompanying figures
represent, as nearly as possible, the conditions
found in this case.
Baths in Typhoid Fever. — In a recent lecture.
Dr. E. J. Janeway of New York, recommends the
use of cool baths in typhoid fever, beginning at
96° and cooling down to 70°. The later effects
in reduction of temperature are even greater
than the immediate.
188
SANITARIUM BULLETIN.
REPORT OF SURGICAL WORK IN THE SANI-
TARIUM HOSPITAL FOR FEBRUARY, 1892.
February 1.
Adhesions Broken C/p. — Patient aged 49.
Uterus re trover ted, enlarged, and adherent.
Constipation from mechanical obstruction.
Uterus forcibly replaced by conjoined manip-
ulation; retained by pessary. No febrile re-
action.
Urethral Dilatation.— Patient aged 45. Di-
lated urethra; found granuloma three fourths
inch from meatus; removed by curette; after-
ward applied pure carbolic acid. Cured.
Ovariotomy — Shortening of Round Liga-
ments.— Patient aged 26. Had been an invalid
for many years, from ovarian disease; uterus
retroverted; shortened ligaments. Made me-
dian incision 1% inches; broke up adhesions of
uterus; found both appendages badly diseased.
Ovaries cirrhotic, adherent; removed appen-
dages. Good recovery.
Removal of Polypus of Rectum. — Patient
aged 37; had suffered for mouths from irrita-
tion of rectum ; occasional hemorrhage. Found
tumor of the size of a filbert at the base of the
posterior wall, an inch and a half from orifice;
removed by Dr. Kellogg's rectal hemorrhoid
snare and Pa quel in cautery.
Varicocele. — Removed a section of about two
inches of the mass of enlarged veins; ligated
the ends and placed them between the lips of
the external incision, which was closed with
deep sutures. Recovery without febrile re-
action.
Rectal Fissure. — Patient aged 24; had suf-
fered several weeks from fissure of the rectum
resulting from constipation. Dilated the
sphincter with bivalve speculum. Recovery
complete.
Forcible Replacement of Uterus. — Patient
aged 26. Retroversion for a. number of years;
uterus had never been replaced; could not be
restored by manipulation. Uterus was lifted
to its position by conjoined manipulation un-
der anaesthesia, considerable force being re-
quired. Pessary placed; no febrile reaction.
Curetting Uterus — Removal of Synovial
Bursw.— Fatieut aged 32; had been suffering
from persistent menorrhagia for some months.
Had several synovial bursse on back of each
liand; removed vegetations by curetting; dis-
sected out bursse; closed the wound with
sutures. Recovery. One bursse which was not
completely removed, returned.
February 7.
Curettage oi ZJ^erus.— Patient aged 37; men-
strual flow profuse and very frequent; uterus
measured 3J^ inches; removed vegetations with
curette; irrigated with hot bi-chloride solution.
Good recovery.
Circumcision. — Patient aged 6; insomnia;
nervous and irritable; complete phymosis;
slit foreskin and united by half dozen sutures.
In three weeks the patient had remarkably im-
proved physically; good appetite; sleeping
well; nervousness and irritability disappeared.
Shortening of Round Ligaments. — Patient
aged 34. Retroversion for many years; pro-
fuse menstruation. Curetted; shortened liga-
ments by Dr. Kellogg's method. Good re-
covery.
Fibrous Tumor of Face. — Patient aged 38.
Fibrous tumor of moderate size overlying
the malar bone. Had developed after a car-
buncle from which patient suffered a number of
years ago. Excision. Recover3\
Vaginal Fistula. — Patient aged 33. Fistula
resulted from an abscess in the right labia 20
years previous. External orifice nearly 2
inches from the inner border of the vulva; fist-
ula about 3 inches in length. This was cu-
retted and afterward washed with peroxide of
hydrogen. Did not heal completely. Subse-
quent excision required.
February 11.
Epithelioma of Cervix — Curettage. — Patient
aged 61; sent by Dr. Hamilton. Found epi-
thelioma of cervix which had invaded the vag-
inal tissue for a considerable distance on each
side, also the broad ligaments. Disease too far
advanced to admit of a radical operation.
Cut away as much as possible of the diseased
tissue with scissors and curette. Dressed anti-
septically; patient Was able to return home in
a few days.
Fibroma of Mamma. — Patient aged 49; suf-
fering from tumor of breast; began some
years ago, but did not increase in size until a
few months ago, after a second injury; since
then, had been growing rapidly and had at-
tained the size of an egg. Very painful; found
tumor completely encysted; easily removed;
wound closed with deep sutures, and healed by
immediate union. Examination of tumor
showed it to be a fibroma.
Amputation of Cervix — Excision of Labial
Cjs^.— Patient aged 46. Presented a very long
conical cervix uteri; a troublesome labial cyst,
due to obstruction of the duct of Bartolin's
gland. Amputated the cervix; closed wound
by sutures; excised the cyst and Bartolin's
gland. Operation completed with little hemor-
rhage. Immediate union.
O variotomy.— Patient aged 46 . Had suffered
for many years from ovarian disease; had
found no relief by treatment. Median incision 2
SANITARIUM BULLETIN.
189
inches; found both ovaries enlarged and cirrho-
tic; large hsRmatocele in right ovary. Removed
both appendages; time, 20 minutes. Good re-
covery.
Small Uterine Polypus — Curettage. — Pa-
tient aged 42; menorrhagia. Patient had
suffered for some time from menorrhagia. Ex-
amination disclosed a small uterine polypus;
removed by scissors, and cauterized base; cu-
retted uterus. No febrile reaction.
Curettage — Shortining Ligaments for Re-
troSexion. — Patient aged 40; unmarried, had
had suffered for many years from retroversion
and retroflexion; menorrhagia. Dilated and
straightened uterus; removed vegetations by
dull curette; introduced Dr. Kellogg's self-
retaining stemy pessary and shortened each
ligament S% inches. Time, 20 minutes.
Trachelorrhaphy — Perineorjrhaphy — Curet-
tage.— Patient aged 26; had sufl'ered from
metrorrhagia and other troubles resulting
from laceration of the cervix uteri and per-
ineum for a number of years. Depth of uterus,
S% inches. Removed vegetations with dull
curette; repaired cervix after Emmet's method ;
repaired perineum by Tait's method. Time of
perineorrhaphy 2^ minutes; of the three oper-
ations, 25 minutes. Good recovery.
February 18.
Shortening of Ligaments — Perineorrhaphy. —
Patient aged 30; retroversion; laceration of
perineum; rectocele. Shortened ligaments 4:%
inches; each repaired perineum by Tait's
method, using 4 sutures. Time of perineor-
rhaphy, 4 minutes.
Shortening Ligaments. — Patient aged 39;
retroversion of many years' standing; had
suffered from pressure of rectum on the uterus
for many years; not benefited by pessaries.
Shortened ligaments 3 inches each; time, 20
minutes. Good recovery.
Ovariotomy. — Patient aged 35; had suffered
from ovarian trouble for 13 years; had been in
bed much of the time; recently her mind had
become disturbed. Incision 2 inches; found
double pyo-salpinx; appendages removed.
Good recovery.
Epithelioma of Cervix Uteri Curettage. — Pa-
tient aged 44; cervix uteri nearly gone; vagi-
nal tissues invaded on one side; disease
evidently extending to rectum. Curetted thor-
oughly, and applied chromic acid, as the dis-
ease was too far advanced to admit of radical
treatment.
Hemorrhoids — Case 1. — Patient aged 27^
was almost completely helpless from suffering
ANTISEPTIC.
RROPHYI-ACTIC.
DEODORANT.
LISTERINE
NON-TOXIC^
NON-IRRITANT.
NON-ESCHAROTIC
I^OI^3dCXJIviV» — Listerine is the essential antiseptic constituent of Thyme, Eucalyptus
Baptisia, Gaultheria, and Mentha, Arvensis, in combination. Each fluid drachm also contains
two grains of refined and purified Benzo-boracic Acid.
I>O^E^. — iNTERNALi^Y : One teaspoonful three or more times a day (as indicated), either
full strength or diluted, as necessary for varied conditions.
LISTERINE is a well-proven antiseptic agent — an antizymotic — especially useful in the
management of catarrhal conditions of the mucous membrane ; adapted to internal use, and to
make and maintain surgical cleanliness — asepsis — in the treatment of all parts of the human body,
whether by spray, irrigation, atomization, or simple local application, and therefore characterized
by its particular adaptability to the field of
PREVENTIVE MEDICINE — INDIVIDUAL PROPHYLAXIS.
]:,istz;e.i:n:e;
Destroys promptly all odors emanating from diseased gums and teeth, and will be found of great,
value when taken internally, in teaspoonful doses, to control the fermentative eructations <rf"
dyspepsia, and to disinfect the mouth, throat, and stomach. It is a perfect tooth and mouth, wash^
indispensable for the dental toilet.
Descriptive Literature upon Request.
LAMBERT PHARMACAL CO., ST. LOUIS, MO.
AGENCIES:
S MAW SON & THOMPSON,
LONDON, E. C.
ROBERTS & CO.,
PARIS.
S. PAPPENHEIM,
BERLIN, W.
VILANOVA HOS. Y Cli.
BARCELONA.
190
BACTERIOLOOIGAL JSTOTES.
and loss of blood occasioned by the presence of
a large number of bleeding- hemorrhoids; re-
moved with Dr. Kellogg's rectal hemorrhoidal
snare and Paquelin's cautery. Time, 10 min.
Case 2. — Patient aged 30; a small but very
painful hemorrhoid on posterior wall of rec-
tum; removed by snare and cautery.
Ovariotomy. — Patient aged 27; had suffered
many years from ovarian disease; had been in
a hospital once before for operation, but her
courage failed, and she left. Found cirrhotic
and cystic condition of both ovaj-ies ; haema-
tocele in right ovary. Removed appendages;
good recovery.
Shortening Ligaments. — Patient aged 26;
had suffered from retroversion for many years;
tenderness of left ovary. Shortened ligaments
4 inches; ovaries and uterus both restored
to position. Good recovery.
Ovariotomy.— Vait\e\\t aged 27; had not
been well since miscarriage, fouryears ago; had
been under treatment without relief. Had been
in hospital for several months, but practically
no better; both ovaries cystic and cirrhotic;
haematocele in right ovary; both ovaries and
tubes adherent. Removed both appendages.
Good recovery.
February 23.
P^a ricoce/e.— Patient aged 28. Had suffered
great pain from varicocele for several years.
Removed section of large veins securing the
ends by silver wire, Aveling's coils and shot;
closed the wound with deep sutures; immedi-
ate union; good recovery, without febrile re-
action. Wires removed on fourth day.
Ovariotomy — Shortening Round Ligaments.
— Patient aged 38; had had ovarian disease
for a number of years; not relieved by previous
treatment in sanitariums and elsewhere sub-
sequently; constantly getting worse; uterus
retrovei'ted; shortened ligaments 4 inches and
removed appendages. Good recovery.
Shortening Ligaments. — Patient aged 33;
retroversion for 13 years, which varied and
long-continued treatment failed to cure. Liga-
ments shortened 4 inches by Dr. Kellogg's
method; time, 12 minutes. Good recovery.
Nephrotomy. — Patient aged 25; sent by Dr.
Hartman. Mass in legion of right kidney, fill-
ing right half of abdomen; the mass was very
hard, but palpitation gave a suspicion of lluc-
tuation ; median incision just above the umbili-
cus; intei-nal palpation gave distinct fluctua-
tion and showed the mass to be in the region of
the right kidnej' and with a broad base. Ab-
dominal incision closed. Lumbar nephrotomy
performed. Two quarts of pus withdrawn.
No febrile reaction.
Summary. — Total number of operations in
February, forty-three. A good recovery from
the operation occurred in each case. No death
in the Hospital during the month. \ ^
A DERARTMEINIT
OF THE
SflNITflRIOM LflBORflTORY OF HYGIENE
Has been established for the purpose of producing
VACCINE OF A STANDARD PURITY,
SUPERIOR to ANYTHING which has HERETOFORE been OFFERED to the PROFESSION.
The prejudice which has existed against vaccination, especially among the ignorant
classes, although not by any means wholly confined to this class, has found its foundation in the
disastrous results occasionally following vaccination, which afford unmistakable evidence of
blood poisoning, and of the presence in the vaccine of SOMETHING, the introduction of which
into the human system could not be regarded otherwise than most undesirable.
The bacteriological studies of vaccine undertaken by Prof. Paul Paquin, while in charge of
the Bacteriological Laboratory of the State University of Missouri, and State Sanitary Veterinaw
rian of that State, as well as those which Dr. Paquin has conducted since becoming Director of the
Sanitarium Laboratory of Hygiene, have shown most conclusively that the "something" which
works "not wisely but too well," not infrequently as the result of vaccination, is not the vaccine
virus proper, but is a morbid and foreign element consisting of various pathological germs, some
of which are capable of producing, under favorable circumstances, fatal effects, which accounts
for the occasional deaths resulting from vaccination.
Prof. Paquin has demonstrated that by the exercise of vigilant care and the employment of
suitable methods, vaccine may be produced which is free from these dangerous elements; and the
purpose of adding to the Sanitarium Laboratory of Hygiene a department for the development
of vaccine, has been to place in the hands of the profession, vaccine which can be relied upon for
securing the protective influence for which it is employed, without the production of grave or un-
pleasant symptoms from the action of foreign germs.
VACCINE LABORATORY, Battle Creek, Mich.
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47
PARASITES OF MALARIA.
XHE
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH., U. S. A., APRIL, 1892. NO. 6.
Original Articles.
MICRO-ORGANISMS OF THE MOUTH.'
BY JOHN H. LINSLEY, M. D.
Prof, of Pathology and Bacteriology, Medical Department
University of Vermont, Pathologist to the New
York Infant Asylum, etc.
Mr. President, and Gentlemen of the Vermont
State Dental Society : —
I very much regret the limited amount
of time I have had in which properly to
conduct many practical researches into
some of the surprisingly numerous varie-
ties of micro-organisms which either find
their habitat in the- oral cavity, or are
simply resting strangers, or loungers, as I
might say, in this locality.
While I shall exhibit to you some
flourishing so-called pure cultures of
bacteria, whose ancestors were removed
from carious teeth, inflamed gums, and
improperly cleansed ''grinders," I have,
necessarily, been obliged to resort to the
latest text-book- on the subject, and to
the various papers and articles which
have recently appeared in medical and
dental periodicals, both domestic and
foreign, for the recognized varieties of
germs infesting the mouth, their rela-
tively respective frequency, etc.
It is an interesting fact in the history of
bacteriology, that the first authenticated
record and drawings of bacteria were
made from micro-organisms discovered
in mucus from the human mouth, by
Leewenhoek, in 1683. From this time
until about i860, but little progress was
made in this subject, and the rapid strides
and the accumulation of important data
accomplished in recent years, have been
very largely due to the improvement and
1 Paper read before the annual meeting of the Vermont
State Dental Society at Burlington, Vt., March 17, 1892.
'^ " Micro-Organisms of the Human Mouth," Miller.
perfecting of optical instruments. The
fortunate discovery by Koch of the use
of artificial, solid, transparent food-
media, was of scarcely secondary impor-
tance in the development of bacteriology,
by facilitating the separation, culture, and
examination of germs.
A brief description of the more com-
mon culture-media used for separating
and growing organisms of the mouth, to-
gether with the methods employed in ob-
taining pure cultures, will be of interest
to those of you who are unfamiliar with
the details of bacteriological investiga-
tions.
Nutrient Gelatine. — This is composed
of beef-juice, or beef-extract, to which is
added from 5 per cent to 20 per cent of
best French gelatine, -^-^ per cent dried
peptone, and ^ per cent common salt.
The reaction must be neutral, or very
slightly alkaline. The addition of i to
2 per cent sugar improves the medium
for the growth of mouth bacteria.
This material is easily prepared,^ and
is largely employed, especially for plate
or dish cultures. It is unfit for use in
the incubator, as the gelatine is liquefied
at a temperature above 25° C. The
characteristic growth of many bacteria is
better exhibited on this substance than
on the following : —
Nutrient Agar- Agar. — This is pre-
pared^ similarly to the foregoing, only
that I per cent to 2 per cent of agar-agar
is used, instead of the 5 per cent to 20
per cent of gelatine. (For detailed di-
rections for the preparation of these
media, reference to the text-books on
bacteriology is advised.)
Boiled Potato. — This is a very simple
and valuable nutrient medium. Any
sound potato can be used, excepting
those which crack open, or become
1 This can be obtained already prepared of Eimer and
Amend, 205 etc. Third ave., N. Y.
2 This can also be bought of the same firm.
192
ORIGINAL ARTICLES.
mealy on boiling. The potato is care-
fully washed and scrubbed with a stiff
brush (an ordinary nailbrush answers
very well), and the "eyes" and any un-
sound portions removed ; it is then
soaked for one hour in a i-iooo bichlor-
ide of mercury solution, and finally
boiled in a steam sterilizer, or cooking
steamer, for one half or three quarters
of an hour. It is then placed in a moist-
chamber, or covered glass dish, which
has been sterilized, and in the bottom of
which has been placed a piece of filter,
or blotting paper, slightly moistened with
I-2000 bichloride solution.
If the proper precautions have been
observed in their preparation, potatoes
thus treated will remain germ-free indefi-
nitely, and can be used any time at a
moment's notice for the planting of ma-
terial from which cultures are desired.
Many bacteria exhibit their most charac-
teristic growth on this medium, and but
few germs are known which refuse to ex-
ist upon it.
Occasionally a micro-organism is met
with which requires for its full develop-
ment, a different soil from any of the
three media just enumerated. In such
cases other substances are used, such
as sterilized blood-serum, starch-paste,
boiled hen's ^gg, etc.
Liquid media are also employed in the
cultivation of micro-organisms generally,
as well as those from the mouth, but
more especially for studying the progress
and phenomena of putrefaction, fermen-
tation, decomposition, etc., occasioned
by the action of bacteria. Such media
are bread-juice, peptonized beef-bouillon
(to which has been added 2 per cent of
sugar, with occasionally the addition of
starch), urine, milk, watery extracts of va-
rious plants or grains, juice of fruits,
saliva (to which some nutritious substance
has been added), etc.
Pure cultures are obtained by transfer-
ring a minute quantity of a colony from
a glass plate, or Petri dish, on the end
of a sterilized platinum needle, to a tube
of nutrient medium, where it is planted
by either thrusting the needle directly
through the middle of the solidified cul-
ture medium in a test-tube, then twisting
the needle a few times between the
thumb and fingers, and carefully with-
drawing same (the so-called "thrust,"
"puncture," or "stab" culture); or by
drawing the point of the impregnated
platinum needle, which has been slightly
bent, across the surface of the medium,
which has been allowed to solidify in the
tube in an oblique direction (the so-
called "scratch," or "surface" culture).
Considerable w^ork and investigation
in this line, can be done by the practic-
ing dentist or physician, without invest-
ing in an expensive outfit. At least it is
quite practicable for any practitioner
who desires to determine the existence
of any particular species of micro-organ-
ism in certain cases, to himself inoculate
a prepared tube of gelatine, or agar, with
the suspected material, and send the
same immediately to a bacteriologist for
further treatment, examination, etc.
The following is a procedure I have
employed in the investigations of this
subject, and is, as you will admit, ex-
ceedingly simple and quite satisfactory :
I use the glass phials of various sizes
used by some wholesale drug houses for
holding physicians' samples, of pills, par-
vules, tablets, etc. These phials are
sterilized, filled for from i to 2 ctm. with
sterilized gelatine, or agar, and their
mouths closed with the ordinary cotton-
w^ool plugs.
When a patient comes under treatment
having a lesion of the mouth, teeth, or
gums, the bacteria of which it is desired
to cultivate, the dentist sterilizes an ex-
cavator, by passing it back and forth
through the flame of his spirit lamp or
Bunsen burner, a few times, and carefully
removes a bit of material from the mouth,
and pushes it just into the gelatine in the
prepared bottle. The same day, at the
first opportunity, this is sent to me, and
dish-cultures, etc., are subsequently made
from the specimen.
To review all the varieties of bacteria
which have thus far been described and
obtained (over 100 species) from the
buccal cavity, with their individual pecul-
iarities, etc., would require several papers,
each fully as long as the present one.
I shall therefore confine myself to
the consideration of a few of the more
prominent and frequently occurring vari-
eties, and afterward offer some comments,
applicable, in a general way, to the
subject.
It has been customary for many ob-
servers to classify every thread-producing
germ which they find in the buccal
cavity, as leptothrix buccalis. This is to
be deprecated, as there are several bac-
ORIGINAL ARTICLES.
193
teria of the mouth which form threads.
The name leptothrix buccalis (like bac-
terium termo) designates no particular
organism possessing peculiar character-
istics, and the name no more deserves to
be retained than "denticola," ''Buhl-
mann's fibers," etc. ; the less so since it
has always been the expression for an ob-
scure and erroneous conception.
Morphologically, as well as physiologic-
ally considered, leptothrix buccalis has
been regarded as a veritable wonder. It
has been said to perforate and split up
teeth, its elements to cause all kinds of
diseases in the buccal cavity, to pene-
trate into the lungs, the stomach, and
other parts of the body, and everywhere
to manifest a destructive influence.
As absolutely nothing was known con-
cerning the biology and pathogenesis of
this organism, all sorts of wonderful
properties were ascribed to it. It is
therefore high time to banish this con-
fusing name from bacteriological writings
(Miller).
Miller suggests the name of leptothrix
innominata for those germs of thread-like
growth, whose biology is too illy under-
stood to place their relation to other
bacteria of the mouth.
Let us, for a moment, consider what
the inducements are which the mouth,
as a whole, offers to wandering, home-
less "bugs," that they so readily and
promptly enter these premises, and not
only obtain their own individual liveli-
hood, but unceremoniously at once pro-
ceed to increase the members of their
households. As pertinently stated by
one observer,^ the mouth forms "a kind
of hot-house, or forcing-ground, for
their cultivation." Dr. Bergtold^ says:
"If one could find a perfectly sterile
mouth, he could also see at once that
the opportunities for seeding it, so to
speak, are excellent, in that every indi-
vidual is more or less constantly taking
in air and also food and drink through
that channel, and in both these actions
there are received numberless spores and
other forms which, later, give us growths
of bacteria.
The organic and inorganic substances
found in the mouth, are the following :
I. Normal saliva ; 2. Buccal mucus ;
3. Dead epithelium ; 4. Dental tissue
1 Woodhead, "Bacteria and their Products," p. 337.
2 "The Mouth as a Center of Infection," W. H. Bergtold,
M. D., Dental Cosmos, Vol. 43, No. 2.
human saliva
and in those
reported by
softened by acids ; 5. Exposed pulps ;
6, Exudations of the gums, conditioned
by the irritation of tartar, etc.; 7. Ac-
cumulation of particles of food.^
The carbohydrates and albuminous
substances furnish the greatest nutriment
for bacteria, and are almost constantly
in the mouth. They are found between
the teeth, in cavities in the teeth, and
also upon their surface, and in any
depressions.
Perfectly pure, mixed,
has no toxic properties,
cases which have been
Pasteur, Valpian, Gautier, and others,
in which "unadulterated human saliva
caused more or less morbid phenomena,"
it must be suspected that the samples
used were, in some manner, contaminated.
Mixed with the various deposits of
bacteria, etc., always present in the
mouth, saliva may possess most energetic
toxic properties, having many times
proved fatal even, as is abundantly dem-
onstrated by numerous recorded cases.
It is also probable that the saliva has
far less antiseptic properties than is often
ascribed to it, and the undisturbed growth
of micro-organisms in the buccal cavity
would seem to sufficiently support this
view.
The diastatic action of the ptyalin of
the saliva changes starch into a variety
of sugar, variously termed dextrose, mal-
tose, or ptyalose, which, as soon as
formed, produces an excellent culture
medium for those germs concerned in the
process of fermentation.
According to Miller'^ there are six
different micro-organisms which are al-
most invariably present in every mouth.
They are : —
1. Leptothrix In7io77iinata. — This oc-
curs as thin, more or less zigzag threads.
Found in the soft white deposit on teeth
in every mouth. Is stained faint yellow
by a solution of iodine in iodide of po-
tassium solution, slightly acidulated with
lactic acid.
2. Bacillus Buccalis Maximus. — Occurs
as isolated bacilli, or threads, more often
as "tufts of threads." Is the largest of
mouth bacteria. Is stained brownish-
blue more or less deeply, with the iodine
solution.
j". Leptothrix Buccalis Maxima. — This
occurs as long, thick, straight, or curved
. 1 " Micro-Organisms of the Human Mouth," Miller, p. 37.
2 Idem, p. 69
194
ORIGINAL ARTICLES.
filaments, somewhat similar to bacillus
buccalis maximus. ... It is found in
the mucous deposit upon teeth. Is not
stained by the iodine solution.
4. Jodococciis Va ginattts. — Occurs
singly, or in chains of from 4 to 10 cells.
Chains have a sheath, and cells appear as
flat discs, or as more rounded, even
squares. Occurs in all unclean mouths.
Not stained with the iodine solution.
5. Spirillum SpJitigemtm. — This is seen
as rods, curved like commas, having very
active spiral movements. Found in all
mouths, especially in unclean ones. Is
the soft deposit on the margin of inflamed
gums of dirty mouths. Stains more
readily than the foregoing.
6. Spirochaete De^itimn (denticola). —
Found as spirals of very irregular wind-
ings and unequal thickness. It is found
under the margins of the gums, when
covered with a dirty deposit, and slightly
inflamed, or in other words, gingivitis
marginalis.
There are a great many mouth-bacteria
proper, not invariably found in every
mouth, which are uncultivable, and
whose pathogenesis is unknown. Among
them, Miller found a bacterium of enor-
mous dimensions in the mouth of a dog
suffering from pyorrhoea alveolaris, which
he has called leptothrix gigantea.
There are also three or four kinds of
germs from the mouth which give a blue
or violet reaction with iodine, and from
20 to 40 varieties which are cultivable,
partly non-pathogenic, partly of un-
known pathogenesis. The buccal cavity
is a favorite locality for many varieties
of chromogenic, or color-producing bac-
teria. These are widely diffused in nat-
ure, and occur abundantly in water, in
the air, and in varibus places.
In the mouth they are less numerous
than the colorless germs, and probably
on account of this preponderance the
color is not visible when in this locality,
but is readily developed during the cult-
ure of these micro-organisms on many
of our culture media.
Among the colors produced by differ-
ent species of mouth bacteria, Miller
gives a yellow produced by at least eight
kinds of bacteria ; green, by five ; red or
reddish, by three; blue, brown, orange,
black, etc.
To study any of the bacteria micro-
scopically, particles of matter containing
them must be taken from the mouth and
mounted directly on cover-glasses, after
which they may be examined fresh and
unstained ; or (after being carried through
the flame of a Bunsen burner or spirit
lamp three times) be stained and mounted
permanently.
Many of the germs found in the buccal
cavity are, of course, accidentally pres-
ent, having been deposited just previous
to an examination, and would remain
only a short period.
The micro-organism^s I have just men-
tioned as being termed mouth-bacteria
proper by Miller, are found in all healthy
conditions of this cavity, but the variety
and number are more or less greatly aug-
mented when any morbid condition what-
ever occurs, such as inflamed gums,
wounds, etc., of the mucous membrane
of the mouth, dental caries, ulcera-
tions, etc. Of these. Miller found by
inoculation experiments on mice, rabbits,
and guinea-pigs, many germs, the inocu-
lation with which produced either death
or a pathological condition of the animals
thus treated.
These he calls '' Pathogenic mouth bac-
teria." Of the varieties separated, the
following were studied more in detail : —
1. Micrococcus gingivae pyogenes.
2. Bacterium gingivae pyogenes.
3. Bacillus dentalis viridans.
4. Bacillus pulpse pyogenes.
The first of these micro-organisms,
(Mic. ging. pyog.) was found several
times in a case of pyorrhoea alveolaris,
in the deposit around the teeth of a very
filthy mouth.
The second (Bact. ging. pyog.) was
found in the same mouth as the forego-
ing, and also in a suppurating tooth-pulp
of a second person.
Bact. dent, virid., the third variety,
was found in the superficial layers of
carious dentine. In cultivation upon
gelatine, this bacterium produces a beau-
tiful opalescent green coloring matter,
which it imparts to the gelatine.
The fourth bacterium (Bacil. pulp,
pyog.) was found in a gangrenous tooth-
pulp. The inoculating material used,
was pure cultures of the different germs,
mixed cultures, and gangrenous pulps,
and the inoculations were made into
pockets beneath the skin of the animals,
and by subcutaneous injections, and in-
jections into the abdominal and thoracic
cavities.
The pockets were made as usual, at
ORIOINAL ARTICLES.
195
the root of the tail, and the injections
with sterilized syringes.
Before giving the results of these in-
oculations, let us see what are the condi-
tions necessary to be fulfilled, in order to
establish unrefutable proof of the patho-
genic nature of any given bacterium.
According to Koch, a micro-organism
must comply with the following requisi-
tions, before its pathogenic character
is determined, — the so-called "Koch's
laws," or '' rules."
First. It must be proved to be present
in all cases of the disease in question.
Secofid. It must, further, be present in
this disease and in no other, since, other-
wise, it could not produce a special def-
inite action.
Third. A specific micro-organism must
occur in such quantities, and be so dis-
tributed within the tissues, that all the
symptoms of the disease may be clearly
attributable to it.
Fourth. After removal from the body
of an affected animal, and its growth in
pure culture, the inoculation of the latter
into susceptible animals, must produce
the disease in question.
Miller's operations were followed by
redness and swelling, abscesses, sup-
puration and gangrene of adjacent tis-
sues, blood poisoning, and in many
cases by death from septicaemia, peri-
tonitis, pleuritis, etc. Inoculations with
mixed cultures proved more dangerous
than when pure cultures were used, and
still more effective when gangrenous pulps
were used, than with mixed cultures.
The diseases caused by the pathogenic
bacteria of the mouth, Miller considers
under six heads, according to the
point of entrance of the infection : i.
Infections caused by a breach in the con-
tinuity of the mucous membrane, brought
about by mechanical injuries (wounds,
extractions, etc.). These lead either to
local or general disturbances. 2. Infec-
tions through the medium of gangrenous
tooth-pulps. These usually lead to the
formation of abscesses at the point of
infection (abscessus apicalis), but also
sometimes to secondary septicaemia and
pyaemia, with fatal termination. 3. Dis-
turbances conditioned by the resorption
of poisonous waste products formed by
bacteria. 4. Pulmonary diseases caused
by the inspiration of particles of slime,
small pieces of tartar, etc., containing
bacteria. 5. Excessive fermentative proc-
esses, and other complaints of the di-
gestive tract, caused by the continual
swallowing of microbes and their poison-
ous products. 6. Infections of the in-
tact soft tissues of the buccal and
pharyngeal cavities, whose power of re-
sistance has been impaired by debilitat-
ing diseases, mechanical irritations, etc.
7. Possible infections by the accumula-
tions of the excitants of diphtheria,
typhus, syphilis, tuberculosis, etc.
(To be Continued.)
LA GRIPPE.
BY PROF. SAMUEL G. DIXON, M. D., AND
R. D. HOWE, M. D.
Academy of Natural Sciences of Rineodophy, Philadelphia'
In view of the news that has been re-
ceived in this country from the other side
of the water regarding the micro-organism
of la grippe, the following facts may be
interesting to the medical profession : —
On the 12th day of January, 1892, we
reported and exhibited to the Academy of
Natural Sciences of Philadelphia, a small
bacillus taken from the mucous membrane
of a child's eye during the febrile stage of
the influenza. On the loth day of
January, 1892, this patient was suffering
with all the symptoms of the onset of this
disease. On the second day the left eye
took on considerable inflammation, and
watered freely. Twenty-four hours later
mucus formed, and the congested condi-
tion began to subside. Forty-eight hours
later the right eye started in with exactly
the same symptoms. As soon as the
mucus formed, microscopic slides were
prepared, which demonstrated numerous
small bacilli, averaging one and three
fourths micro-millimeters in length and
about three fourths of a micro-millimeter
in width.
These bacilli grew on agar-agar at a
temperature of 36° C, forming small,
separated, almost transparent colonies,
giving the surface of the culture medium
a granular appearance. They stained
poorly in the carbal-fuchsin stain, after
remaining in the warm oven for one hour,
and lost this stain readily by passing
through nitric acid, one part to three of
water. We have found them in the fifth
transplantation.
On the morning of the fifth day of
February, 1892, we inoculated a rabbit
196
ORIGINAL ARTICLES.
subcutaneously over the abdomen. That
afternoon the temperature of the animal
rose to 103^^ F., and it seemed sick,
dumpish, and refused to move unless
forced to do so. The day following, the
symptoms were as follows : The tempera-
ture rose to 104!°, nose and mouth were
very dry, eyes suffused and congested,
and a watery discharge from the left eye.
The rabbit would not move without con-
siderable forcing, and absolutely refused
all food.
Upon staining and examining the dis-
charge from the left eye, the small bacilli
were found. The next day the tempera-
ture rose to 103°, and the symptoms
were much the same as the day before.
Mucus was found in the eyes, from which
we grew on agar-agar bacilli similar in
size and appearance to those found in
the child's eye. On the fifth day the
animal recovered.
On the 9th day of February, 1892, a
second rabbit was inoculated in the same
manner, with practically the same re-
sults. The temperature in this experi-
ment ran as high as 105-!^ F., and re-
mained much higher than the preceding
for two days, with rapid fall of tempera-
ture and recovery on the fourth day.
A number of specimens taken from
patients suffering from la grippe, and sent
to the laboratory by Dr. J. W. Wilson
and Morris Longstreth, have enabled us
to demonstrate a bacillus which corre-
sponds morphologically with that found
in the mucus from the child's eye.
We have examined the mucus from
several cases which we supposed to be
ordinary colds, occurring during this
winter's visitation of la grippe, but have
entirely failed to find a like bacillus.
These results would therefore lead us to
believe that the micro-organism above
superficially described, is very closely
and specially associated with our winter
scourge and enemy, la grippe.
-*• — • — «-
THE ATTENUATION OF VIRULENT
MICRO-ORGANISMS.
BY PROF F. G. NOW, M. D.
Ann Arbor, Mich.
( Concluded.)
Albunmi in Normal Urine. — The ques-
tion of the existence of a physiological
albuminuria has been freely discussed in
recent years. The existence of such a
condition has been affirmed from the
theoretical standpoint by Senator, and has
apparently received experimental con-
firmation at the hands of Posner. No
less an authority than Leube, however,
denies that albumin is a necessary con-
stituent of urine, and in this he is sup-
ported by the careful and pains-taking
research of H. Winternitz. Very mi-
ute quantities of albumin, less than .002
per cent, can be detected by the following
method : To 150 c.c. of the urine, add
three times that volume of alcohol, and
set aside for twenty-four to forty-eight
hours ; receive the precipitate on a small
filter, carefully wash with water, and then
treat with dilute acetic acid. The acetic
acid solution is treated with a few drops
of potassium ferrocyanide, and the pre-
cipitate removed by filtration. By means
of a glass rod, transfer a small portion of
the precipitate into Millon's reagent, and
heat. Another portion may be dissolved
in sodium hydrate and treated with cop-
per sulphate (biuret). A modification of
this method can be used to detect in the
urine the presence of peptone arising
from the absorption of pus in deep-seated
abscesses.
Hcemato-porphyrin in the Urine. — Three
specimens of urine having a peculiar dark
red color, developed especially on stand-
ing, were examined by Salkowski {Zeitschr.
f. Physiol. Chem. zy, 286), and shown
to be due to hsemato-porphyrin. A few
similar instances have been reported by
Neusser (1881), Stokvis (1889), and Rank-
ing and Pardington (1890). For clinical
purposes the following method is best
adapted for its detection. About 30 c.c.
of the urine are completely precipitated
with alkaline barium chloride solution (a
mixture of equal volumes of cold satur-
ated barium hydrate solution and barium
chloride solution, i-io); the precipitate
is washed with water, then with absolute
alcohol. The moist precipitate is placed
in a small dish, 6-8 drops of hydrochloric
acid and about as much alcohol added,
the mass then rubbed up into a thin paste,
allowed to stand for some time, or warmed
gently on the water bath and filtered
through a dry filter. If the filtrate is
small, a little alcohol may be used to wash
the residue, but not more than 8-10 c.c.
should be used. If hsemato-porphyrin is
present, the alcoholic extract is colored
red, and will show the two characteristic
absorption bands of hsemato-porphyrin in
RIGINAL ARTICLES.
197
acid solution. If rendered alkaline with
ammonia, it takes on a yellowish tint, and
shows the four absorption bands of
haemato-porphyrin in alkaline solution.
The clinical significance of haemato-
porphyrin would seem to be of consider-
able importance irrespective as to whether
the substance normally gives rise to haemo-
globin, or is the result of decomposition
in the liver of haemoglobin. In either
case a large amount of blood coloring
matter is withdrawn from the system.
Thus far it has been observed only in
women, and of the six cases reported three
ended fatally. It is worthy of note that
the three patients examined by Salkowski
were using sulphonal, and that when this
was withdrawn the urine assumed its natu-
ral color, and that where in one case sul-
phonal was again given, the urine again
became colored dark. Sulphonal was
also used in Stokvis's case, while in that
of Ranking and Pardington acetanilid was
employed. An idiosyncrasy with respect
to sulphonal would seem to exist in these
cases. It is quite probable that haemato-
porphyrin is capable of producing marked
deleterious action in man, although in
animals it is toxic only in very large
doses.
Occurrence of Mucoid Substances in
Ascitic Fluids. — Two substances have
been recently described by Hammarston
{^Zeitschr. f. Physiol. Chem. 75, 202), and
inasmuch as they are not necessarily
identical with pseudo-mucin or its de-
composition products, he designates these
as mucoid substances. One of these, mu-
coid, is precipitable by acetic acid ; the
other is mucin-albumose. Undoubtedly
the parablumin of Hilger, Gusseron, and
others is a mixture of mucoid, or pseudo-
mucin, and albumin. The mucoid, in the
dry condition, forms a fine, grayish white
powder which is not soluble in water ;
but it can be dissolved to a neutral or
slightly acid solution by the addition of
a minimal quantity of alkali. The solu-
tion does not become cloudy on boiling.
It is precipitated by alcohol or acetic
acid, but not if sodium acetate is present.
It gives the color reactions of proteids :
Millon, Adam hie wicz, Xanthoproteic,
and biuret. Trommer's reagent (alkaline
cupric oxide solution) is not reduced on
boiling ; if, however, the solution is pre-
viously heated on the water bath for half
an hour, with 2 per cent hydrochloric
acid, it reduces copper energetically.
The mucin albumose in the dry state forms
a very fine, pure white powder, very
readily soluble in water. The solution is
not affected by boiling ; is not precipi-
tated by acetic acid or by saturation with
sodium chloride, is precipitated by satu-
ration with ammonium sulphate, also by
alcohol. It shows the same behavior with
the proteid tests and Trommer's solution
as mucoid. Elementary analysis gave the
following results : —
MUCOID.
Carbon 5i-4
Hydrogen 6.8
Nitrogen i3-oi, 13. i, 12.4
MUCIN-ALBUMOSE.
Carbon 49-79? 49-87
Hydrogen 6.96, 6.88
Nitrogen, 1 1.42, 1 1.4, 10.8, 11.37
The significance of these mucoid bodies
in ascitic fluids is unknown.
The following analyses of ascitic fluids,
from three distinct cases, are of interest :
Case
No. 'x
Specific gravity
Water
T) .. -J \ Globulin .
Froteids i .1,
\ Albumin .
Mucoid substances. . .
Soluble salts
Insoluble salts
Extractives
Totals
Reducing substances
calculated as glucose
Case
No. I.
Case
No. 2.
1.0125
1.0092
96.8470
0.6120
97-654
0.314
1-3050
0.1 180
0.8305
0.0362
0-2513
0-795
0. lOI
0.825
0.311
100.000
100.000
0.0430
0.0768
I.0I2I
96.830
1.445
0.802
0.034
0.630
0.040
0.219
100.000
0.030
Alkaptonuria. — In 1859 Bodeker iso-
lated from the urine of a diabetic patient
a substance, which, while it reduced
Fehling's solution, did not undergo fer-
mentation in the presence of yeast, and
moreover in alkaline solution absorbed
oxygen, the solution becoming colored
brown to black. This substance was des-
ignated as alkapton. The later investi-
gations of Ebstein and Mliller, Fleischer,
and especially Friibringer (1875), seemed
to show that alkapton was identical with
pyrocatechin, and expressions to that
effect are to be found in most of the works
on urine analysis. Of recent years it
has been shown that other substances
than pyrocatechin may exist in the urine,
and impart the characteristics of alkapton.
198
ORIOINAL ARTICLES.
Thus, Smith (1882) obtained a compound
which he regarded as protocatechine acid.
Barton Brune (1886), using the same
method, obtained a crystalline acid which
was not identical with protocatechine
acid. Marshall (1887) isolated a sub-
stance of similar properties and named it
glycosnric acid. The investigations of
Kirk are especially interesting. In 1886
he succeeded in obtaining an acid, urrho-
dinic acid, which his more recent work
(1889) has shown to be a mixture of at
least two substances — urolencinic acid,
CgHjoOj, and uroxanthic acid. The recent
studies of Wolkow and Baumann {Zeitschr.
f. Physio/. Chem. 75, 228) have demon-
strated the existence of a true alkaptonuria;
and not only have they been able to ob-
tain this substance in a pure condition,
but they have solved its constitution and
source.
The urine which served them for study
was obtained from a man 67 years of age
in whom a short time before carcinoma of
the prostate developed. No relation ex-
isted between the disease and the condi-
tion of the urine, inasmuch as he had
presented evidences of alkaptonuria since
childhood. The urine reduced alkaline
copper solution on warming, ammoniacal
silver solution in the cold, but did not
reduce bismuth solutions. At first the
urine was amber colored, but as soon as
ammoniacal fermentation set in, became
brown or black. The reducing substance
was isolated from the acidulated urine by
extraction with ether ; this solution, on
evaporation, gave a reddish brown syrup,
which, treated with neutral acetate of
lead, formed an insoluble lead salt and
this then purified. The substance was
found to have the formula CgHgO^ -\- HgO.
Owing to its relation to gentisinic aid,
C6H3(OH)2COOH, it was named homo-
gentisinic acid, CeH.COHjXH^COOH.
Its constitution was shown to be
OH
A
[ J CH2COOH
V
OH
It is therefore dioxyphenylacetic aid.
The urolencinic acid of Kirk is a trioxy-
phenylacetic acid, while the glycosuric
acid of Marshall is held by these authors
to be a mixture of these two acids.
An inquiry into the source of homo-
gentisinic acid showed that when tyrosin
was given internally to the patient, it was
excreted almost entirely as that acid.
From this, and other considerations, the
authors conclude that homogentisinic
acid is not an intermediate product of cell
metabolism, but that it arises from tyrosin
in the intestinal canal by the action of
micro-organisms.
Alkaptonuria is therefore due to the
presence of either homogentisinic or uro-
lencinic acids, and possibly at times to
other allied compounds.
LONDON MEDICAL NEWS.
BY W. B. JONES.
M. R. C. S. Eng„ L. R. C. P., Lond.. Science Scholar,
St. Bartholomew's Hospital.
[special correspondent.]
Hot and Cold Applications in Acute
Pneumonia. — Dr. Goodhart, of Guy's
Hospital (Guy's Hosp. Reports, 1880),
has made some observations on the rela-
tive value of hot and cold applications
in the treatment of acute pneumonia.
He first speaks of the injurious effects,
especially on children, of heavy wrap-
pings, blankets, and hot poultices, and
illustrates this by a case of a child who
was suffering from acute nephritis, and on
whom hot packs and hot baths were em-
ployed. When put in the packs, the
temperature rose on diiferent occasions
from 2° to 5° F., and when baths at
110° F. were employed, the temperature
rose from 2° to 3°. The child while in
the pack was restless, respiration was
disturbed, but when taken out of it, she
slept calmly. On the contrary. Dr.
Goodhart has seen much benefit derived
from the use of ice bags and poultices
applied to the chest, especially after hot
poultices have been used. The tempera-
ture ha,s been, in many cases, reduced
from 3° to 5°. However, in some cases,
ice seems to have been of no use, but the
temperature was brought down from 4°
to 7° on various occasions, by antifebrin.
Dr. Goodhart has never seen any bad
effects from cold applications in the
adult. In children, especially in girls,
from 2 to 4 years of age, however, the
effect of ice applications has been detri-
mental. In adults, he considers ice very
useful, especially when combined with
brandy internally, and warmth to the feet.
He quotes Dr. Lander Brunton, who
ORIGINAL ARTICLES.
199
thinks that collapse may be caused by
applying cold over the surface of the
heart, hence the ice bag should be ap-
plied to the side and back. On the
other hand, Dr. Goodhart has seen bene-
fit derived in acute pericarditis by apply-
ing ice to the praecordia. Dr. Goodhart
believes that harm may be done in the
routine use of brandy and meat essences,
•especially in people who are unaccus-
tomed to the use of stimulants.
Lipoma. — Mr. Jonathan Hutchinson
[Annals of Surgery, Oct., 1891] reports
the successful removal of a large diffuse
lipoma of the neck. The growth was so
large that the patient, a gentleman of
middle age, was obliged to keep to the
house and avoid all company. Mr.
Hutchinson made an incision on each
side of the neck, about one inch from the
middle line, down to the anterior edge of
the sterno-mastoid. The growth was
removed with difficulty, being firmly
adherent to the skin above and to the
fascia beneath. A compress of spirit
lotion (^ spirit and 73 rose water) was
applied and the wound healed by first
intention. Mr. Hutchinson attributes the
rapid healing in a great measure to the
use of this lotion. In a second case,
there was a large growth of a similar
nature about the pubes. This was suc-
cessfully removed by Mr. J. Hutchinson,
Jr. This patient also had a fatty growth
in the neck, but it was not of large size.
Three years afterward there was no return
of the growth about the pubes, and under
the influence of entire abstinence from
beer and the use of sulphide of calcium,
the growth in the neck showed a tendency
to diminish, rather than to increase in
size.
With respect to the arrest of hemor-
rhage in such operations as the above,
and in excision of the breast, Mr. Hutch-
inson says that he has, for many years,
used no other means than torsion. The
same surgeon recently amputated a leg, in
the case of a patient suffering from loco-
motor ataxia, where suppuration in the an-
kle joint had followed a perforating ulcer
•of the foot. The amputation was done
through the middle of the leg by Teale's
method. The wound healed, the patient
was fitted with an artificial leg, and the
stump bears the pressure well.
Enteric Fever and its Treatment.
— Dr. Boyd, of Dublin, in the Practi-
tioner, Feb., 1892, gives a paper on "Re-
cent Modifications in our Views of Enteric
Fever and its Treatment." He remarks
that many specific organisms may be
present in the body and remain harmless
so long as the tissues with which they are
in contact are healthy. Now gastro-in-
testinal catarrhs and "bilious" attacks
are very prevalent in autumn. These
catarrhs are produced by a rapid fall of
temperature in the evenings after a warm
mid-day. Murchison says that catarrhal
diarrhoea is often present before the at-
tack of enteric fever comes on. The
baccilli probably find the glandular tissue
of the intestine in a condition of de-
rangement from the effect of the catarrh,
and it becomes the center of their habita-
tion. The entire process affecting the
gland, as far as the typhoid bacillus is
concerned, lasts 14 days. After this pe-
riod the gland is attacked by micrococci of
suppuration, producing the special symp-
toms and temperature after the first fort-
night. Hence an antiseptic is indicated,
one that first acts on the intestine and
not on the stomach. Dr. Boyd uses a
gaseous one, viz., chlorine in an alkaline
solution. In one fourth of his cases the
febrile process is brought to an end on
the 14th or 1 6th day.
Lavage for Dilatation of the Stom-
ach.— Dr. Attfield, of St. Bartholomew's
Hospital \_Practitio7ier'\, has seen great
benefit derived in chronic gastric affec-
tions from washing out the stomach. He
uses an elastic covered silk stomach tube,
half an inch in diameter and 30 inches
long. Slipped over the end of this is an
ordinary red rubber tube 40 inches long,
at the end of which is a rubber funnel.
He claims the following advantages, viz. :
(i) Vomiting is entirely checked, (2)
Pain decreases, (3) Appetite increases,
(4) The bowels act spontaneously, and
(5) The stomach is placed in the best
position to recover from its dilatation.
Origin of the Infection of the Uri-
nary Organs. — M. Achard and M. Hart-
man recently reported a case of acute
cystitis. The patient was obliged to use
a catheter in consequence of an enlarged
prostate. After an accidental abrasion
of the urethra, an acute febril attack oc-
curred, in which the temperature of the
patient rose to 104° F. An examination
of the urine showed bacterium coli in pure
culture.
200
TRANSLATIONS AND ABSTRACTS
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE LIVER AS AN ORGAN OF ASEPSIS — CLIN-
ICAL AND THERAPEUTICAL CON-
SIDERATIONS.^
BY DUJARDIN BEAUMETZ,
Member of the Academy of Medicine, Physician to the
Cochin Hospital, Paris.
Translated by J. H. Kellogg, M. D.
Gentleineji : In the preceding lesson
I have shown you upon what experimental
evidences we base the antiseptic func-
tions of the liver and its action in the
destruction of poisons. I wish to-day to
consider the clinical and therapeutical
results which flow from these physio-
logical properties, and first let us inquire
whether we have any clinical sign by
which we are able to recognize when these
antiseptic functions of the liver are dis-
turbed.
While the appearance of icterus enables
us to affirm that the biliary function of
the liver is disturbed ; while the presence
of sugar in the urine indicates to us some
disturbance in the glycogenic function of
the liver : while, in fine, general and local
signs indicate to us disturbance in the
hepatic circulation, we possess no posi-
tive sign upon which to base a recogni-
tion of the normal or abnormal state of
the antiseptic functions of the liver.
Some experimenters have approached
this problem directly, and have sought to
determine by what means one may be
able to recognize the functional integrity
of a hepatic cell, and they have believed
they have solved the problem of the pres-
ence of urobilin in the urine. Others
have adopted an indirect method, and
taking as the foundation the relation be-
tween the functions of the hepatic cells
and the glycogenic functions of the
liver, have employed experimentally, gly-
cosuria as a means of diagnosis.
Finally, others have approached the
problem of the antisepsis of the liver by
the new methods outlined by Bouchard,
1 A series of lectures delivered by Prof. Dujardin Beau-
metz, published in the Bulletin General Therapentique, and
translated expressly for this journal.
and his school, and they tell us that to
judge of the activity of the antiseptic
functions of the liver it is only necessary
to examine the toxicity of the urine. Let
us examine each one of these methods.
The method which is based upon the
presence of urobilin in the urine is a re-
sult of the researches of Hayem, and his
student, Paul Tissier. These authors
maintain that the presence 'of urobilin in
the urine is always of hepatic origin, and
that it results from the morbid activity of
the hepatic cells.
The detection of urobilin in the urine
is extremely easy, and may be determined
very quickly by examination of the urine
with the spectroscope. The character-
istic line of urobilin is a band which
appears between the lines B and F, of
Fraunhofer. In order that this band may
be well observed, the following conditions
of the urine must be secured : It must be
freshly collected, as the urobilin under-
goes modifications under the influence of
oxygen ; it is also necessary that it should
be clear, which requires filtration ; finally,
it should be acid, a condition secured by
the addition of a few drops of acetic acid,
if required. The spectroscope is placed
against a test-tube containing the urine,
and the apparatus is then directed toward
the sunlight, choosing, if possible, a white
cloud for a background.
If it is desired to measure the quantity of
urobilin by the extent of the absorption
line, it is necessary to use tubes of the
same dimensions, so that the thickness
of the layer of liquid may always be the
same.
When biliverdin exists in the urine at
the same time with the urobilin, the ab-
sorption band is much larger, and neither
the violet nor the blue spectrum is seen.
All these reactions are very simple, and
it is sufficient to have once seen the ab-
sorption band in the urobilin to be able
always to recognize its presence in the
urine ; the only difficulty results from the
simultaneous presence of bilirubin and
urobilin. You will be able, however, by
a very simple process, based upon the
great diffusibility of urobilin, to separate
the urobilin from the bilirubin. For this
it is only necessary to allow a small
quantity of distilled water to fall upon the
urine to be examined, drop by drop, with
great care, to avoid mixture of the liq-
uids. The urobilin will pass into the
water while the bilirubin remains in the
TRANSLATIONS AND ABSTRACTS.
201
urine, and in examining first one and then
the other of the liquids with the spectro-
scope, the urobilin may be recognized in
the water.
We have now to ask ourselves if the
presence of urobilin is characteristic of
morbid activity of the hepatic cells. It
appears that the presence of urobilin has
been determined in the urine in patients
affected with certain hemorrhages, par-
ticularly cerebral hemorrhages. On the
other hand, in a series of researches
which I have undertaken at the Hospital,
but which are not yet completed, in cer-
tain cases of well-established disease of
the liver, I have not found urobilin, but I
believe it may be accepted that with the
exception of cases of cerebral hemor-
rhage, when urobilin appears in the urine
there is a morbid activity of the hepatic
cells. The opposite cannot be absolutely
affirmed since there may exist affections
of the liver without the presence of uro-
bilin. In all cases, this is a very simple
experiment, to which we have recourse
when a hepatic affection is suspected.
I come to the second proceeding, the
employment of experimental glycosuria.
As I have remarked, according to Roger,
there is always a correlation between the
glycogenic activity of the liver and its an-
tiseptic functions. It is sufficient, then,
to know whether the liver is properly per-
forming its functions to enable us to know
whether it is able promptly to destroy
the poisons of the body. Unfortunately
this clinical problem is very difficult to
solve.
We know by the experiments of Colrat,
Couturier, Lepine, and Robineaud, that
when the liver is cirrhotic, if glucose is
introduced into the system, it appears in
the urine. Unhappily, this experiment,
which I have often repeated, is far from
giving positive results, and in many pa-
tients suffering from cirrhosis of the liver
I have not obtained glycosuria. My re-
sults are confirmative of those of Roger,
who, in fourteen experiments in which
glucose was administered to patients
affected with various hepatic disorders,
obtained positive results only in eight
cases, while the results were negative in
six. I shall endeavor, when I speak to
you of the glycogenic functions of the
liver, to demonstrate that one of the con-
ditions of diabetes is the integrity of the
liver. We shall not be able, then, to
count upon this proceeding as a means'
of judging of the condition of the hepatic
gland as a destroyer of poisons. Besides,
this question of alimentary glycosuria is
most complex. It should not be forgot-
ten that, according to Bouchard, the
liver throws into the blood each day 1850
grams (more than four pounds) of sugar,
which is burned by the system, and as
this combustion is dependent upon many
circumstances, such as the season of the
year and the amount of activity or of
repose, the quantity of sugar burned may
vary considerably. I shall return to
these points when I speak of the glycog-
enic function of the liver.
The third proceeding, as I have re-
marked, is based upon a study of the
toxic coefficient of the urine. You are
familiar with the admirable work of
Bouchard and his pupils upon urinary
toxicity, and the conclusions which he
has drawn from a clinical and therapeut-
ical standpoint. I will make a brief re-
st/me of this subject, however, as it in-
volves some points with which it is
important to be very familiar, if one
wishes to appreciate the true value of this
new experimental method.
The method consists in injecting by
the vein of the lobe of the ear of a
rabbit a quantity of urine sufficient to
cause the death of the animal. Bou-
chard applies the term ** urotoxy " to the
quantity of urine necessary to kill a kilo-
gram of the animal. Bouchard desig-
nates by the term ''urotoxic coefficient'*
the fraction of the urotoxy which one
kilogram of a man can produce in twenty-
four hours. In order to fix this subject
clearly in mind, we will make one of
these injections.
Here is the urine of a man who weighs
60 kilograms. This urine has been col-
lected during 24 hours, and the amount
is 1200 c.c. By injecting 50 c.c. of this
urine per kilogram of the weight of the
body of this rabbit, into a vein of the
lobe of the animal's ear, the animal suc-
cumbs. Then 1200 c.c. would kill 24 kil-
ograms of rabbit. Our man weighs 60
kilograms, and kills in 24 hours 24 kilo-
grams of rabbit. We have, then, only
to determine by simple proportion how
much rabbit would be killed by the
amount of urine manufactured by one
kilogram of the man in 24 hours. We
thus determine the quantity to be 400
grams; 24-^60=. 4; .4 of i kilogram,
or 1000 grams-— 400 grams.
:^02
TRANSLATIONS AND ABSTRACTS.
Then the quantity of urinary poison
which one kilogram of man can furnish
in 24 hours, sufficient to kill i kilogram
of living being, is in this man 50 c.c.
This is very nearly the normal amount,
which is about 46 c.c, but in the patho-
logical state it oscillates between 2 and
10 c.c. One can thus define the coeffi-
cient of toxicity : it is the quantity of
toxic matter which the unit of weight
produces in a unit of time. In the path-
ological state this urotoxic coefficient
produced certain variations. It is not
the same during the day as during the
night. During sleep, the man eliminates
from 2 to 4 times less poison than dur-
ing the period of cerebral activity. The
urine of day and of night would not
have the same toxic effects ; while the
urine collected during the night would
produce convulsive seizures in the rabbit
experimented upon, that collected during
the day would not produce this symptom,
but would produce, on the contrary, a
narcotic state. From this a new theory
of sleep has been formulated, according
to which this physiological act is deter-
mined by the accumulation of toxines
producing the narcotic state.
But let us .apply these facts to the study
of the role of the liver as a destroyer of
poisons. In the numerous observations
which may be found entire in the work
of Roger, where the toxicity of the urine
in patients affected with hepatic disease
has been ascertained, we find in the great
majority of cases a notable increase of the
urotoxic coefficient, which would naturally
be predicted, since the suppression of the
physiological functions of the liver in-
volves the suppression of its action as a
destroyer of animal toxines.
This first fact once established, it is
necessary fully to recognize that from a
clinical point of view it can furnish only
uncertain data, and that for numerous
reasons : foremost of which is that
such researches belong more properly to
the laboratory than to the clinic ; and if
in consultation a physician was even able
to place at the disposition of his col-
leagues, a patient, a laboratory, and a
rabbit, many physicians would be embar-
rassed if it were necessary to introduce
into their practice the rabbit as a diag-
nostic sign. Admitting even that this
fact remains simply experimental, it fur-
nishes from the standpoint of the anti-
septic functions of the liver, very uncer-
tain information ; because that in the
majority of diseases of the liver there are
present icterus and other disturbances of
the biliary secretion.
As I have remarked, the bile is much
more toxic than the urine, and while it
requires 45 c.c. of urine to kill one kilo-
gram of living matter, it requires only
5 c.c. of bile to obtain that result. The
bile, then, is nine times more toxic than
the urine. If all the bile should pass
directly into the blood, the individual
would be poisoned in 8 hours, 55 minutes,
while in the case of urine, death would
follow only after 2 days, 6 hours, 32
minutes. So, then, according as the bile
is or is not secreted, the urotoxic coeffi-
cient may vary considerably, and thus this
means may lose much of its value if it is
desired to employ it in a study of the an-
tiseptic functions of the liver.
As we see, then, we may have some in-
dications respecting the condition of the
hepatic cells from the point of view of
their action in the destruction of poisons,
and even if these indications are not of a
very precise character, they enable us,
notwithstanding, in a certain measure at
least, to recognize functional disturbances
of the hepatic gland. I recommend es-
pecially a spectroscopic examination of
the urine, which enables us to recognize
the presence of urobilin, and if the result
is negative, we may employ experimen-
tally glycosuria, or may study the toxicity
of the urine.
(To be continued.)
k « — -*
The Work of the Heart. — M. Lewy,
of the Society of International Medicine,
of Berlin, recently reported the results of
some investigations made for the purpose
of determining the amount of work done
by the heart ; he concludes that this is
less than has generally been supposed.
According to his calculations, the work
accomplished by the heart is equivalent
to raising its own weight 2160 times in
one hour. He finds the leg muscles able
to do an equal amount of work, from
which he concludes that the heart muscle
is not different from other muscles, as
regards the amount of work which it is
able to do*. It must be remembered,
however, that the heart works incessantly
during the twenty-four hours, whereas
the leg muscles are not able to sustain
continued work for more than eight or
ten hours daily.
TRANSLATIONS AND ABSTRAG'l^.
20S
STUDY OF TBE GERMS OF MALARIA.
BY. PROF. B. DANILEWSKY, CHARKOFF, RUSSIA.
(See Frontispiece.)
In Annales De U Ins tit tit Pasteur, V, p.
75^, a long article appears by Prof. Dani-
lewsky giving the details of experiments
and observations on malaria, a compara-
tive study of the parasite in birds and
human beings. The article relates chiefly
to numerous investigations carried on
with birds, but greatly elucidates the
question of malaria in man. At the out-
set the Professor insists on the discovery
that birds suffer like man, not only from
chronic malaria, but also from an acute
affection resembling intermittent fever in
man. From his observation he is of the
opinion that the hematozoa connected with
malaria in man and birds are, to say the
leasts closely connected by their resem-
blance, if not identical. As in man, this
investigator has observed that malarial
microbiosis of the blood in birds may be-
come very severe and cause death. The
destruction of red blood corpuscles oc-
curs as in man. This phenomena causes
very great anaemia, loss of appetite, ex-
haustion, and death. He also observes
the temporary disappearance of the hema-
tozoa and their reappearance after a
time in greater quantities than before,
and this, too, after the birds had been
kept in a laboratory.
These cases show an analogy to those
which occur in human beings suffering
from malaria, apparently cured, but suc-
cumbing to a relapse away from in-
fectious grounds or malarial districts,
without having been again exposed to in-
fluences where the germs existed. These
are cases which do not respond to treat-
ment by quinine. This might be ex-
plained by the fact that at that time the
germs are not amoeboid, but in the cres-
cent form of Laveran, and it has been
demonstrated that quinine acts only on
amoeboid forms. The author insists that
the ordinary hematozoa in the blood of
birds is not simply a sign of symbios, but
truly of a chronic infection. Besides
this, he states that the birds are subject
also to an acute form of the disease. In
birds apparently in good health, in which
the blood contains hematozoa, the red
blood corpuscles are suddenly attacked.
On the interior appear bright red spots
formed by the cytozoa (pseudo-vacuoles).
These bodies increase in size and become
filled with granules of melanine. Their
number is variable. In weak subjects,
there is a blood corpuscle attacked among
several hundreds of normal ones. In
ordinary cases, the proportion is from i
to 20 or 50 ; in more serious affections,,
it is I to 5 or 8. As all microbes of ani-
mal nature, living or developing them-
selves in the interior of cells, are usually
called cytozoa, cyto-parasites, or cyto-mi-
crobes, the author proposes to give to the
malaria plasmodium in man the name of
cytomoeba instead of the ordinary termu
of hoemamoeba ; but as in the bird the
same parasite is not mobile, and is
not, therefore, amoeboid, he proposes to
change the work to cytosporon malariae.
It will be seen, then, that the acute and
chronic forms of malaria in birds and
man are attributed, by this author, to
two different parasites, at least so far as
their appearance is concerned ; the first
having the amoeboid form of movement,
and the second the crescent form, being
non-motile (the parasite of Laveran).
The shape of these organisms, how-
ever, seems to vary greatly, according
to observation, in the same individual.
Sometimes the development appears in
the form of a spore, and again in the
form of a rose or a marguerite. At other
times there are large or small spherical
bodies, and again, various other forms
(as may be seen in plate in frontispiece).
Observations tend to prove that the
chronic form in birds pertains to the pe-
riod of life of the cytosporon, and in man
to the cytomoeba, and the chronic form
corresponds to the existence of the cres-
cent of Laveran. The author establishes
the fact that the chief seat of the action
of the parasite is not the blood, but be-
gins in the generating organs of the blood,.
the spleen, and bone marrow. This is
true in warm-blooded animals and cold-
blooded animals, for investigation has
also been made in frogs.
The facts related tend to prove that
in both birds and man malaria exists in
three forms : First, acute affection with
rise of temperature and symptoms of se-
rious disease. The microbiosis of the
blood is due, in this form, to the pres-
ence of cytosporozoa in birds, and to
cytomoeba in man (malarial typhus of
man).
Second, chronic infection without man-
ifest fever : microbiosis by an attack ot
204
TRANSLATIONS AND ABSTRACTS.
the red blood corpuscles, by the poli-
mitus and the Laverafiia in both birds
and man.
Third, mixed infection \ characterized
by the simultaneous appearance of amoe-
boid forms of acute cases and the poli-
mitus of chronic cases, both occurring
in birds and man.
The following is a table of explanation
of the figures appearing in the frontis-
piece plate. It will be seen by those
who have observed the parasite of ma-
laria in man, that those of birds, frogs,
and lizards, are closely related, if not
identical.
EXPLANATION OF FRONTISPIECE PLATE.
Parasites of Birds. — Figs, i, 2, 3,
4. — The smallest cytozoa in the shape of
pseudo-vacuoles ; Figs. 2, 3 correspond
to the intensive infection.
Fig. 5. — Change of the form of the
cytozoa a under the influence of heat of
39°, 40° centigrade, during 12 to 15 min-
utes.
Fig. 6. — The cytosporozoa in acute
malarial infection from i to 2 days after
the attack of the corpuscles.
Fig. 7. — The same i day later ; the
marguerite form is more marked.
Fig. 8. — Profile view.
Figs. 9, 10, II. — Advance sporulation
of the cytosporozoa; the hcemoglobin
has been chased away by a weak acid.
Figs. 12, 13, 14, 15. — Diverse forms
of cytosporozoa in sporulation with parts
of blood corpuscle (18, 20): Fig. 18 pre-
sents the other clear form of the margue-
rite.
Fig. 21. — The blood corpuscles entirely
filled by the spores of the cytosporozoa.
Fig. 22. — Field of ripe spores of the
cytosporozoa in a blood plasma.
Figs. 23, 24, 25, 26. — Mixed infection
of the corpuscles by the cytosporozoa and
microbe in chronic infection.
Fig. 27. — The cytosporozoa in sporu-
lation and in fan shape (see Fig. 47).
Figs. 28, 29, 30. — The cytozoa of the
chronic infection of the nucleus visible
in the living (the hematozoa of cold
blooded animals).
Fig. 31. — The macrophage from the
liver of a blue jay.
Fig. 32. — Spherical cytozoa of chronic
infection (Laverania ?). Little bodies pro-
vided apparently with double contours.
Figs. TyT^, 34. — Corpuscles transformed
in cytocystes filled with bright fusiform
bodies (spores?); in Fig. 34, outside of
these bodies are some smaller, very
motile.
Fig- 35. — The cytocyste of the blood
in the case preceding, but without being
filled with liquid, and with very fine curved
bodies resembling those of chronic infec-
tion.
Fig. 36. — The rose-shaped body of a
scraped kidney.
Figs. 37, 38, 39. — Psorospermose of
the red corpuscles (?) opaque granulous
spheres (cytocystes) of the kidney and of
the bone marrow.
Fig. 40. — More advanced stage, in the
form of a raspberry ; beginning of seg-
mentation.
Fig. 41. — The ulterior differentiation
of germs in the form of crescent.
Fig. 42. — The cytocyste filled with
germs entirely developed.
Fig. 43. — The cyst is broken and al-
lows the exit of motile germs.
Fig. 44. — Young Laverania (hemogreg-
arines) of the spleen.
Fig. 45. — Laverania formed under my
eyes at the expense of spherical hematozoa.
Hemoparasites of the Frog. — Fig. 46. —
Twin hemogregarina developed at the
expense of pseud-ovacuoles.
Fig. 47. — Intracellular sporulation of
an ''amoeboid" cytozoa in the form of
''fan" or "rose."
Fig. 48. — The cyst with germs in the
form of crescent taken from a kidney.
Fig. 49. — Free motile hemogregarina
in the blood.
Parasites of Lizards. — Fig. 50. — The
cytocyste of the blood with germs of the
hemogregarina ; analogous cyst may be
found in the kidney and spleen. p. p.
Iodoform Injections for Goiter. —
Mosetig recommends the injection of
iodoform dissolved in a mixture of ether
and olive oil as the best means of treating
goiter, the solution being injected into
the throat. He recommends the follow-
ing formula: Iodoform, i dr.; ether, 5
drs.; olive oil aa, 7 drs. M.
Iodoform, i dr.; ether, 5 drs.; olive oil,
9 drs. M.
A hypodermic syringe full of either of
these solutions is injected into the goiter
every three to six days. Mosetig reports
great improvement in all cases treated by
this remedy.
TRANSLATIONS AND ABSTRACTS.
205
Administration of Creosote by
Enema. — That creosote is one of the
most efficacious remedies against pul-
monary phthisis thus far discovered, is
coming to be generally recognized by
physicians who have made a fair trial of
this remedy. The principal drawback to
its use has been the difficulty of intro-
ducing it in sufficient quantities without
producing too much disturbance. The
stomach will tolerate the remedy only in
very small doses. This fact has led to
the adoption of the hypodermic method,
sterilized oil being used as a vehicle. A
much larger quantity can be used in this
way than by the stomach, and recently
some French physicians have even suc-
ceeded in introducing under the skin as
much as a gram a day largely diluted with
oif. This method, however, is painful,
and must be conducted with most scru-
pulous care to avoid serious accident.
As a substitute for both methods, the ad-
ministration of the drug by enema has
been proposed and practiced successfully
for more than a year. An emulsion made
by mixing oil of sweet almonds and the
yolk of Qgg has commonly been employed
as a vehicle ; but Chabaud and Ouiter
recently report the best success in the use
of a watery solution of creosote. They
find that pure creosote rectified from
ordinary beech wood, by distillation be-
tween 200° and 212° C, dissolves in
water in the proportion of i-ioo, and
that this solution is absorbed with great
rapidity. The solubility of creosote is
increased by the addition of 5 per cent of
alcohol. The remedy is easily obtained,
and the evidence of its prompt absorption
appears in the fact that immediately after
its administration, the patient recognizes
the odor and taste of creosote ; at the
end of 10 or 15 minutes, the urine pre-
sents the brown olive coloration charac-
teristic of creosote. The whole dose is
commonly absorbed within 30 minutes
after its administration. The dose at the
beginning of the treatment, should be
seven or eight minims, the quantity being
increased as toleration is acquired. The
dose is to be repeated two or three times
a day, and the quantity may be gradually
increased until the patient takes from 40
to 60 minims per diem.
[After closely watching the results of
the remedy administered in this manner
in a number of cases, we are well con-
vinced of its efficacy, and rely upon this
more than upon any other means of medi-
cation, using all other hygienic means in
connection with this remedy, j. h. k.J
-m' — • •-
Nitrite of Amyl for Chloroform
Poisoning. — Burral rQcommends the use
of nitrite of amyl as a means of rallying
a patient in whom dangerous symptoms
have appeared. From four to ten drops
of nitrite of amyl upon a folded napkin
are held to the nose of the patient ; if
respiration has ceased, artificial respira-
tion should be employed at the same
time. The remedy acts by dilating the
cerebral bloodvessels.
-• — • — ♦-
Lysol. — M. Paul {Bulletin General
TJierapeutique) has been investigating the
composition of lysol, as the result of
which, he has renounced its use. He
finds the solution turbid, resembling a
decoction of quinquinina. The solution
is also unstable, rapidly losing its odor.
He has substituted for lysol a mixture of
40 parts of crelysol, and 20 parts of me-
dicinal soap for a quart of water. This
mixture makes a very nice solution which
does not change, and appears to be more
active than Ivsol.
-». — • — *-
Toxicity of the Urine in Diseases of
the L#iver. — M. Surmont recently re-
ported to the Societie de Biologie, the re-
sult of some experiments made upon ani-
mals with the urine of twenty different
patients suffering from disease of the liver,
with the following results : —
In atrophic cirrhosis the urinary toxic-
ity is double that of the normal condi-
tion, and diminishes when the patient suf-
fers from diarrhea. In a case of hyper-
trophic cirrhosis of alcoholic origin, the
toxicity was sub-normal. In morbid con-
ditions of the liver resulting from disease
of the heart, the urinary toxicity is di-
minished, as is also in the case of the fatty
liver of tuberculosis, and in cancer of the
liver. The degree of urinary toxicity
seems to be related to the condition of
the hepatic cells. In a case of grave ic-
terus, the degree of toxicity was below
normal, but increased rapidly as the pa-
tient began to improve.
M. Roger had observed that in pneu-
monia the toxicity was diminished during
the early part of the disease, but suddenly
increased when the crisis was past.
206
BACTERIOLOGICAL NOTES.
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Medicine, from original sources.]
The Flora of Butter. — Various in-
vestigators have studied the action of
different pathogenic germs in butter, and
M. Krueger has studied the bacteriolog-
ical flora of diseased butter, but there
have been but few, if any, worthy experi-
ments made to demonstrate the quantity
of micro-organisms habitually in butter.
M. Lafar {Archiv. fur Hygiene, XIII, p.
7) has made investigations by making
plate cultures from emulsions of butter,
and has given us the following figures :
In one gram of butter, taken at the top,
he found 47,250,000 bacteria. In a simi-
lar piece, taken from the interior of
the same mass of butter, the quantity was
only 2,465,555. In most of his experi-
ments, he found in butter taken one cen-
timeter below the surface, with a sterilized
knife, from 10 to 20 millions of bacteria
per gram, the minimum being 6,700,111,
the maximum 25,637,681. These figures,
says M. Ed. de Freudenreich, in the Aji-
nales de Micrographie, IV, p. 255", may
appear enormous, but they agree with
those I have found in Emmenthal cheese,
a gram of which also contained several
millions of bacteria.
In seeking to demonstrate the action of
cold temperature on butter, M. Lafar
observes that exposure during fifteen
days at the mean temperature of 9° C.
lowers the number of germs only one
third. When the butter is subjected to
the temperature of the room, the number
of bacteria augments rapidly. There
were at this temperature, 6,700,111 on
December 30, and 35,215, 053 on January
9. There was a decrease in the quantity
of germs as the rancidity of the butter
augmented. At 35°, the rancidity, and
with it the diminution of the number
of bacteria, was produced much more
quickly. The addition of sterilized salt
to butter exposed to cold temperature,
decreases the number very perceptibly,
but even the addition of 10 per cent of
salt does not kill them all. In this case,
the number declined from 25,637,681 to
215,749. It seems that all the germs
except one kind are killed, and this one
resisting salt at this strength is the most
constant in butter. It is the bacterium
butyri colloiduni.
In artificial butter the writer has found
only 847,059 micro-organisms per gram
of butter, including fungi, etc., and one
bacterium not liquefying gelatine. The
flora of this butter, then, is quite different
from that of natural butter.
A Ne"w Bacillus of Malignant
CEdema. — Mr. Klein {Ce?itraibiatt fur
Bakteriologie, X, p. 186), reports the dis-
covery of a bacillus which produces ma-
lignant oedema similar to that produced
by the septic vibrio of Pasteur. He had
inoculated a guinea-pig with some earth
taken from the garden, as is frequently
done in experiments, and the animal per-
ished in thirty-six hours with an inguinal
oedema of the abdomen and thorax. The
liquid from the oedema contained fine
bacilli which resembled somewhat the
vibrio of Pasteur, but their culture distin-
guished them from the former very posi-
tively, inasmuch as they wxre found to be
aerobic, and they never liquefied gelatine.
In the cultures, colonies are visible as
early as the twenty-fourth hour, in the
form of small, grayish, round points.
After forty-eight hours, the colonies ap-
pear on the surface of medium as plaques,
grayish in appearance, but transparent.
After a few days, they have obtained their
maximum of growth, that is, a diameter
of several millimeters. In the same
earth in which this bacillus was discov-
ered, Mr. Klein found, also, the true
vibrio of malignant oedema.
Ptomaines of Measles and Whoop-
ing-cough. — M. Griffiths reported (La
Semaine Medicale) to the Academy of
Sciences of Paris, Feb. 29, the discov-
ery of two new ptomaines. Using the
method of isolating ptomaines from ceils,
which he has employed several years, he
obtained a ptomaine which, when admin-
istered to a cat, produced a very high fe-
ver, and death in 36 hours. He has also
obtained a special ptomaine from the
urine of patients suffering from whooping-
cough, and by comparison, has assured
himself that the same ptomaine is pro-
duced by the bacillus of Afanassieft.
Neither of these ptomaines is found in
normal urine, and both must be the result
of the specific microbe which is the cause
of the diseases named.
BACTERIOLOGICAL NOTES.
207
Alcoholism and Tuberculosis. —
Hector W. G. Mackenzie, M. A., M. D.,
Assistant Physician to the Brompton
Hospital for Consumption, gives in the
British Medical Journal (Feb. 27, 1892)
an analysis of 75 fatal cases of tubercu-
losis, in all of which there was a strong
history of alcoholism ; in only 10 of these
was there any history of phthisis in the
family. In 60 per cent, the liver was
cirrhotic. In 12 of these cases the pa-
tients were over 20 years of age and
under 30 ; twenty-five of the cases were
over 30 and under 40 ; twenty-five cases
were between 40 and 50 ; seven of the
cases were between 50 and 60 ; in five
cases, between 60 and 70 ; and in one
case the age was 73 years. The average
duration of these cases was found to be
much below the general average. The
author states that *' from the histories
given by patients, and from the evidence
afforded by post-mortem examinations,
the conclusion has been forced upon me
that tubercle is more common among the
alcoholic than is generally believed. The
author also adds the following very signi-
ficant and important observations : —
" My experience among out-patients at
the Brompton hospital, is, that a consid-
erable proportion of the phthisical —
especially of the men — have been alco-
holic, and I should say that a history of
alcoholism is a very common antecedent
in those cases where there is no inherited
susceptibility to tubercle. As regards
women, it is impossible to say to what
extent alcohol is responsible for the dis-
ease, it being very uncommon for a wo-
man to own to alcoholic habits.
'^ In alcoholic cases the condition of
the patient is generally worse than would
be expected from the amount of disease
revealed by physical examination. It is
therefore specially important in such
cases, when there are any chest symp-
toms, to examine the sputum for bacilli.
By this means I have been able to make
an early diagnosis of phthisis when the
examination of the chest was negative.
In alcoholic cases, I have found that the
progress of the disease, as a rule, is
rapid, and the prognosis particularly un-
favorable.
''The belief that, as regards people of
any age, alcoholic drinks in excess act as
a preventive of tubercle, I consider not
only not borne out by experience, but al-
together contrary to it. Without post-
mortem examinations, conclusions as to
the absence of tubercle are fallacious and
of no practical value."
^ • — ^-
Recurrent Erysipelas. — Hertz and
Widal {La Semaine Medicale) quote cases
of recurrent erysipelas, in which the dis-
ease seemed to have, as its starting-point,
a patch of chronic eczema. Some blood
drawn from the eczematic spot revealed
the presence of tuberclereptococci which
yielded pure cultures, and were highly
virulent. In one of these cases, 20 re-
currences of the disease occurred within
three months. The patch of eczema
seemed to serve not only as a point of
entrance, but also as an incubating ground
for the invading bacteria.
The Bactericide Substance of the
Blood. — Prof. M. Ogata, of Tokio,
Japan, has established, in connection
with Mr. lashuhara, that mice can be
rendered immune against charbon by the
injection of a few drops of frog's blood
or some serum of dog's blood, both ani-
mals being naturally refractory to the
disease. The mice did not become af-
fected when the injection had been made
from seventy-two hours before, to five
hours after, inoculation with anthrax
virus. The authors did not know then
to what substances in the blood to attrib-
ute this preservative action. Mr. Ogata
has since succeeded in extracting from
the blood of dog and fowl a substance
which seems capable of conferring im-
munity upon susceptible animals ; it
is a substance soluble in glycerine and
insoluble in alcohol and ether. Its
action is not interrupted by alkiline
substances, but is by small doses of
carbolic acid or chlorhydric acid. It is
inactive in the presence of digestive
fluids or at a temperature of 45° C;
mixed with glycerine it keeps its ac-
tivity a long time. It does not pep-
tonize fibrin nor saccharify starch. Ac-
cording to Mr. Ogata, it is a ferment to
which a few disinfectant properties are
attributed, for it destroys the bacilli of
cholera and of typhus. This discovery
will be watched with interest. (Elsewhere
under the head of ''Technique," will be
found the method of preparation of this
substance.)
208
EDITORIAL.
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
$2.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., April, 1892.
BACTERIOMANIA.
We still hear doctors — some years
behind in study and thought, though
having' prestige in the world — accuse
those who base their practice largely on
the teachings of the bacteriologists, of
<* bacteriomania." Even in France, the
country that gave birth to bacteriology,
an occasional protest is sent forth by a
few retardative writers and medical prac-
titioners. It is curious that those men
can offer nothing else in their fight against
micro-biology than mere protests, sarcasm,
and weak attempts at ridicule. They do
not seem to realize that such flimsy at-
tacks clearly show the dense ignorance of
those who indulge in them. In order to
prove the fallacy of a doctrine which ap-
pears at once as plausible as bacteriology,
one must bring forth facts of a more
weighty character than childish or scur-
rilous reflections.
Common sense alone suggests to the
mind the truths of bacteriology, even
when one only reads about the life, hab-
its, and possibilities of microbes. But
when one studies them closely, cultivates
them, inoculates them, produces disease
with them, etc., etc., the fact that their
relation to man, the lower animals, or to
any other medium (dead or alive) in
which they may grow, is that of seed to
soil, is very apparent. Indeed, it is made
evident. Why physicians will persist in
interfering with the progress of a doc-
trine so plainly beneficial to mankind, is
beyond comprehension. It is true there
are *' bacteriomaniacs " who see dan-
gerous germs in every disease. These
are extremists such as exist in every de-
partment of life. They are enthusiasts
who are carried away by others' investi-
gations, and various effects or scope of
the discoveries made from time to time.
If the medical profession will only think
seriously, consider, and sift the thoughts,
arguments, and especially the practical
demonstrations of reliable and cautious
scientists, they cannot fail to see the
rationale of bacteriology from a medical
point of view. Judging from the prints
of a few in this and foreign countries,
who seek to lower the prestige of the
doctrine of bacteriology in medical and
other journals, we are tempted to suggest
that they study the question from a scien
tific and practical standpoint, before criti-
cizing those who have convictions reached
by conscientious work. p. p.
-» — • — ^-
ALCOHOL AS A FOOD.
One of the most absurd arguments in
favor of the use of alcohol, is that it is a
true food. We say this argument is ab-
surd, for the reason that, if true, it is not
in any sense a defense of the common
use of this drug, since no man, unless
absolutely deprived of all other means of
sustenance, ever resorted to the use of
alcohol as a substitute for other food, ex-
cept the periodical drunkard, who on his
occasional sprees sometimes abandons,
for days in succession, ordinary food, in
favor of alcohol.
Alcohol, even if a food, offers no ad-
vantages over other foods. If compared
with such foods as wheat, corn, oats, etc.,
it is at a great disadvantage. Alcohol, if a
food, is also confessedly a poison, which is
not true of any of the foods mentioned,
— nor, indeed, of any wholesome food.
Again, if admitted to be a food, alcohol
is quite too expensive to constitute a sub-
EDITORIAL.
209
stitute for other foods; a bushel of wheat,
for example, which costs less than half
as much as a gallon of alcohol, would
prove, on analysis, to contain at least
three or four times the nutritive value of
alcohol, even admitting the drug to be a
pure nutrient.
But facts show that alcohol is really not
a food. When taken into the body, it
undergoes some chemical changes, but
this is also true of almost every substance
which could be named. Even such min-
eral substances as iron, lead, and arsenic
are changed or oxidized in the body, as is
alcohol, yet these substances are not, in
consequence, claimed to be foods. Al-
cohol lessens oxidation, which has led to
the claim that it lessens the tissue-wastes,
and so, while not exactly a food in a
positive sense, is, in a negative or in-
direct way, a sort of food. But this is
also true of strychnia and a variety of
other poisonous substances. Does this
fact constitute strychnia a food? — Cer-
tainly not. Hence the argument cannot
be allowed as holding good in relation to
alcohol. Dr. Lauder Brunton, who under-
takes to defend the theory which makes
alcohol a food, after asserting that under
some circumstances it might be " a very
useful food," immediately adds, ''As it
interferes with oxidation, it is an incon-
venient kind of food." Most certainly it
must be very i?tco?ivement, since it not
only is not itself a food, but actually in-
terferes with those processes by which
proper food-substances are utilized and
made of service to the body. As a speci-
men of the kind of arguments by which
Dr. Brunton attempts to prop up the
popular fallacy respecting the food value
of alcohol, we present the following,
which possesses all the greater signifi-
cance because of Dr. Brunton's usual
clearness and consistency in his teach-
ings upon questions relating to science or
therapeutics. Speaking concerning the
influence of alcohol upon temperature,
he says : —
''The action of alcohol upon the tem-
perature seems to depend upon two factors.
One of these is its power of lessening
oxidation, but this only comes into con-
sideration with large doses, when this
factor may aid considerably in reducing
the temperature. The other factor is the
dilatation of the vessels on the surface,
which occurs even after moderate doses.
This dilatation allows the warm blood
from the interior of the body to circu-
late more readily near the surface, and
thus subjects it to the cooling influence
of the surrounding air, and also to the
cooling effect of evaporation from the
skin. By increasing the sweat, it may
lessen the temperature of the body, even
when that of the surrounding air is as
high or higher than it, and it will also
cool the blood by freer radiation when
the temperature of the atmosphere is
below that of the body. It is evident
that the cooling effects of alcohol will
thus depend to a great extent on the at-
mospheric conditions of temperature and
moisture to which the person taking it is
subjected, as well as on the quantity of
alcohol. Normally, when a person is sub-
jected to cold, the vessels of the skin
contract and prevent the warm blood in
the interior of the body from approach-
ing the surface and thus becoming cooled ;
but when large quantities of alcohol are
taken, this mechanism becomes paralyzed,
the blood from the interior circulates over
the surface, and is cooled down more and
more until its temperature becomes so
much reduced as to be incompatible with
life, and the patient is frozen to death.
The dangerous effects of alcohol under
such circumstances are well known to the
lumberers in Canada and to Arctic voya-
gers, who dread alcohol and generally
avoid it altogether."
The above is a very excellent argument
against the theory that alcohol is a useful
food. Proper foods are of service to the
body as a means of maintaining the
necessary degree of afiimal heat ; but, as
210
EDITORIAL.
Dr. Brunton clearly shows, alcohol causes
a waste of heat, and to such a degree as
to render its use absolutely dangerous
under conditions where the bodily heat
must be economized. Is it not then
surprising that the doctor should im-
mediately proceed with the following
recommendation of the use of alcohol ?
^'The utility of this self-same action of
alcohol is very evident when a person
comes from a cold atmosphere into a
warm room ; for here the individual may
still remain cold, although in front of a
fire, as the contraction of the surface
vessels now continues and the blood is no
longer able to convey warmth to the in-
terior, just as it was formerly unable to
convey the cold. If alcohol be now
taken, and the vessels dilated, the blood
is allowed to circulate in the surface, soon
becomes warm, and thus diffuses the
warmth equally through the body."
The absurdity of this reasoning must
be at once apparent. In order for the
blood to be warmed during its sojourn in
the skin, the temperature of the surround-
ing air must at least be greater than that of
the body, otherwise heat would be given
off from the body to the air, instead of
the reverse. How often does a person
who comes in from out of doors on a
cold day chilled, find himself in an at-
mosphere above ioo° F. Since the
temperature of the interior of the body is
constantly maintained at about ioo° F., it
is evident that so long as the temperature
of the surrounding air is lower than that,
the blood will continue to be cooled at
the surface of the body, instead of being
warmed. But Dr. Brunton has also shown
(see paragraph first quoted) that the use
of alcohol lessens .the temperature of
the body, ''even when that of the sur-
rounding air is as high, or higher than
it." It thus appears that the use of alco-
hol would be detrimental, even under the
circumstances recommended by Dr. Brun-
ton, unless the person should place him-
self in air of a very elevated temperature.
It is vain for physiologists to longer at-
tempt to prop up the ancient error, that
alcohol possesses value as a food sub-
stance. Its properties are anti-physiolog-
ical, and however useful it may be as
a medicine under some pathological con-
ditions, science does not afford the slight-
est excuse for its use as a beverage, or as
a substitute for any substance which the
physiological needs of the body demand.
J. H. K.
BACTERIOLOGY IN MEDICAL COLLEGES.
The foremost medical schools of the
country — those of four years' terms,
particularly — devote considerable time to
bacteriology ; but the scores of short
term schools still teach but very little
on the subject, and that often very im-
perfectly, sometimes in a few hurried
lectures more or less notable for their
shallowness and inacuracies. Moreover,
there* are schools in America so behind
the age as to teach that bacteriology is
nonsense. It is evident, however, that
the spirit of the medical profession, is
fast approaching the idea that bacte-
riology must have more attention in our
schools. It has become apparent that
the doctor who is ignorant on the subject,
is greatly handicapped from a practical
standpoint.
The fact is, the practical departments
of medicine are often taught in our
schools (many of them existing, as finan-
cial investments or advertising media), to
young men having no education .to under-
stand. They graduate with a head full of
precepts, their memory loaded with lec-
tures and visions of cases seen, but they
have digested nothing. They are loaded
to the muzzle to pass examination, and
after that they must experiment at the
expense of the people, often jeopardiz-
ing lives, and sometimes with fatal results.
It is evident that more general prepara-
tion should constitute the foundation of
medical education. At the very begin-
EDITORIAL.
211
ning of medical studies the principles un-
derlying them should be mastered. His-
tology and the relation of tissues to micro-
organisms should be demonstrated early,
in a practical manner. Laboratory prac-
tice should enter in a large measure into
a student's curriculum. And, as much
as possible, the lectures should be illus-
trated, practical, and not mere oratorical
flights, which are often beautiful, but
empty words. (Oratory in the class-
room, if sustained by practical knowledge
and common sense, is convincing, but
many of the best teachers are poor talk-
ers.) It is to be hoped, for the benefit
of the profession and the people, that
bacteriology will constitute a larger share
of the medical courses of all colleges.
It is not an incidental subject, but an ab-
solutely necessary one. It is essential to
a physician's equipment. p. p.
SCHOOL REFORM.
That many reforms are needed in the
popular educational methods of to-day,
has long been apparent to all intelligent
thinkers who have given any special at-
tention to the matter of education, or
rather, mind and character building, which
should be the purpose sought in the train-
ing to which human beings are subjected
during the developing period. We are
glad to note that some very profitable
discussions of these vital questions oc-
curred at a recent educational meeting
held in Brooklyn, N. Y., Feb. i6, 1892.
The meeting was chiefly composed of
State superintendents of education, presi-
dents of colleges, and men of equal note,
and the discussions and deliberations
• which occurred were more than ordinary
in character.
President Eliot, of Harvard, who has
recently been making a very careful study
of grammar-school and high-school work,
offered many pungent criticisms upon the
methods at present in use, and declared
that the majority of the work done in the
grammar-schools of the present day is
mere ''marking time." He made many
practical suggestions looking toward re-
form which, we are glad to note, were
well received by the convention. Among
these, was the early introduction of al-
gebra, a natural science, as a mathematical
study. Elementary algebra is certainly
less diflicult than some parts of arithme-
tic which are commonly studied in gram-
mar schools, and an early acquaintance
with algebraic methods would unquestion-
ably assist greatly in the understanding of
many arithmetical principles which are
never clearly understood until long after
the study of arithmetic has been finished
and the study of algebra begun. The
early introduction of the natural sciences
in the school course, is a matter which
has long been advocated by many experi-
enced teachers. Many years ago, the
Harpers did a useful work in this direc-
tion by the introduction of a series of
readers devoted almost exclusively to the
natural sciences. Unfortunately, how-
ever, the popularity of these works was
not long continued, probably because
their value was not appreciated. The
young child is far better prepared to study
the natural sciences than abstract sub-
jects, and the influence of these studies
upon the mind of the child in quickening
his perceptions and enlarging his mental
horizon, is of a most salutary character.
It is to be hoped that the value of Prof.
Eliot's suggestions will be recognized by
leading educators throughout the country,
and put in practice at the earliest prac-
ticable date. J. H. K.
-• — • — ■♦-
Intestinal Gymnastics. — In many
cases of chronic constipation, the cause
of the disorder is simply the lack of mus-
cular activity in the lower bowels. Many
methods have been employed for increas-
ing the muscular activity of the intestines,
— such as massage, muscle-breathing, the
galvanic and faradic currents, and a vari-
ety of gymnastic exercises. Walking,
212
EDITORIAL.
horse-back riding, and especially Swed-
ish gymnastics, are certainly very useful
means of stimulating the intestinal peri-
staltis. The purpose of this note is to
call attention to a fact well enough known
to practical physiologists, but perhaps not
so widely known among practicing phy-
sicians as it should be. Physiological
experiments have shown that rapid volun-
tary movements of the external sphincter
ani and the levator ani produce very act-
ive peristaltic movements of the large in-
testine. This effect is produced by the
mechanical excitement of the plexus
myentericus of Auerbach. This curious
automatic center lies between the two
muscular coats of the intestine, and
controls the peristaltic movements. A
patient suffering from constipation should
make powerful movements of the sphinc-
ter ani, and of the levator ani, in as rapid
succession as possible, continuing the ex-
ercise for three or four minutes, or un-
til the muscles are fatigued. The time
chosen for the exercise should be either
before breakfast, or an hour after break-
fast, according to the natural habit of the
individual in respect to the evacuation of
the large intestine. j. h. k.
Astonishing Medical Advice. — A
hospital has recommended that women
whose nerves are irritated by small wor-
ries should calm them by resorting to
smoking ''if their doctors recommend
it." This suggestion has caused a protest
prompted by horror or disgust that the fair
sex should be recommended by medical
authority to assume the pipe, the cigar,
and the cigarette, which, for the most part
in this country, have been monopolized
by men, smoking by women being chiefly
confined, as one writer well says, '' to the
fast and the loose." Some voices have
been raised in defense of the surgeon,
however, Mr. James Payne maintaining
that there is no more reason why men
should have all the benefit of tobacco,
than, as John Wesley observed, *'that
the devil should have all the best tunes.'*
We rather agree with Mr. Payne. If to-
bacco is good for men, no reason can be
offered why it should not be good for
women also. Belladonna, stramonium,
strychnia, opium, and even alcohol as
well as all other drugs with the exception
of tobacco, are prescribed for human be-
ings without distinction of sex ; why then
does the doctor draw the line at tobacco ?
Is there any particular virtue or lack of
virtue in man which renders him suscep-
tible to the therapeutic influence of to-
bacco which women do not share? If
any such sexual peculiarity exists, it has
certainly never as yet been pointed out in
any scientific work on therapeutics. If
the women have been unfairly treated by
not being allowed to smoke when they
feel nervous, when their husbands are
given full liberty to do so, certainly the
injustice ought not longer to exist. If
tobacco-using is good for men, it is good
for women also. Possibly the assump-
tion of the pipe and the cigar by women,
would be the best means of exhibiting to
men the enormous filthiness, harmfulness,
and costliness of the use of the 'weed.
We are inclined to think that the item
of expense would appeal powerfully to
the average smoker. How many men who
smoke half a dozen twenty-cent cigars
per diem would be willing to supply their
wives and daughters with an equal num-
ber of fragrant Havanas every day of the
week? There is a recognizable relation
between smoking and selfishness.
We have no fears that the advice of
the hospital will be followed. The wo-
men of America are coming to recognize,
pretty unanimously, the fact that tobacco *
is an enemy of the virtue of American
women, and of the home, and their voices
are being raised in an outcry against this
invader of the purity and sanctity of the
household ; and before many years, doubt-
less, her hand as well as her voice will
rise in protest at the ballot-box, in the
EDITORIAL.
213
shape of prohibitive laws against this in-
tolerable nuisance, the tobacco habit, the
foreshadowing of which may already be
recognized in the passage of laws prohib-
iting the sale of tobacco to young boys,
and its use by pupils attending the public
schools. J. H. K.
A Fact Useful for a Laparotomist.
— It is sometimes important for a sur-
geon who has made an abdominal section
for any purpose, to know with absolute
certainty in which direction the stomach
lies from a given point of the intestine.
This, of course, can be ascertained by
overhauling the intestine, till the stomach
or the ileo-secal valve is reached ; but
this involves an amount of handling the
intestine which, to say the least, is not
conducive to recovery. Nothnagel has
pointed out the curious fact, that when a
crystal of carbonate of soda is applied to
the peritoneal surface of the intestine, it
will invariably excite its contraction,
which passes upward toward the stomach,
— never toward the rectum.
-•^ — • — «-
An Interesting and Instructive Ex-
periment. — In a recent lecture delivered
before the Pathological Society of Lon-
don {^British Medical Journal, March
19th), Dr. Ruffer related the following
very interesting experiment : —
''If an adult guinea pig be inoculated
subcutaneusly with 6.25 cubic centime-
ters of a pure culture of the bacillus
pyocyaneus, an abcess slowly forms at
the point of inoculation. Twenty-four
hours after the injection, the point of
inoculation is crowded with bacilli and
well-filled phagocytes; but — and this is
ihe important point — cultures made
from the various internal organs prove
absolutely sterile. The bacilli, therefore,
are arrested at the point of inoculation by
the amoeboid cells, and this can be proved
by microscopic examination.
'' Now if, at the same time that we in-
oculate the bacillus pyocyaneus on one
side of the body, we inject on the other
side a large dose of chloral hydrate, which
is yet not sufficient to cause death, and
repeat the dose from time to time, so as
to keep the animal fully anaestheticized,
it invariably dies within forty-eight hours,
and all the organs contain the bacilli in
incredible numbers.
''It is easy to prove that in an anaesth-
eticized animal the leucocytes are inactive.
Let us take two small sponges, fill them
with a pure culture of the bacillus pyocy-
aneus, and place each under a guinea
pig's skin. One of these animals we
leave as a control, whereas we inject the
usual quantity of chloral hydrate under
the skin of the other. Six hours after-
ward, when we take out both sponges,
we find the fluid in the sponge of the
chloralized animal almost as clear as
when it was introduced. A few leuco-
cytes may be seen in it, — ten or twenty
at most in one cover-glasspre paration, —
while the control sponge is filled with a
thick purulent material, which, on micro-
scopic examination, proves to consist of
innumerable well-laden phagocytes. No
wonder, then, that when the leucocytes
refuse their work the bacilli should find
their way into the tissues. We have
vainly sought for any evidence to show
that the fluids of chloralized guinea pigs
are better cultivating media for the
bacillus pyocyaneus than those of a non-
chloralized animal ; in both chloralized
a-nd non-chloralized animals the bacilli
seemed to thrive exceedingly well in the
fluids of the living body. Here we have
another instance of the action by phag-
ocytes in the limitation of disease."
From the above experiment, it is evi-
dent that the phagocytes which are the
chief defense of the body against the in-
vasion of germs, are rendered incapable
of capturing microbes by chloral, and, it
may be justly inferred, by other narcotic
or anaesthetic substances. This statement
seems to agree entirely with the interest-
214
REVIEWS.
ing experiments made by Lauder Brunton,
ten years ago, in connection with Mr.
Cash, by which it was shown that the
oxidizing power of protoplasm is destroyed
by morphia, codia, atropia, nicotine, and
many other substances. The effect of
narcotics is evidently to paralyze the pro-
toplasmic elements of the body. These
experiments are extremely interesting
from a practical and hygienic standpoint.
Do they not clearly teach that the habit-
ual introduction of such substances as
alcohol, tobacco, and possibly even tea
and coffee, into the system may have the
effect of lessening the ability of the body
to defend itself against the attacks of
pathological microbes, which are by all
odds the most dangerous foes to human
health and life ? The conclusion seems
irresistible, and sanitarians will doubtless
seize upon this fact as a powerful rein-
forcement of their arguments against the
alcohol and tobacco habits, as well as
whatever else lessens the resistance and
activity of the phagocytes.
Reviews.
The ABC of Swedish Educational
Gymnastics. — By H. Nissen ; F. A.
Davis, Philadelphia. This little book of
1 02 plates is a vade mecum of Swedish
educational gymnastics, and is admirably
adapted to serve its purpose — that of a
practical manual for the teacher of Swed-
ish gymnastics. The author asks and
answers concisely more than 150 ques-
tions, just such as the student or inex-
perienced teacher would be most likely to
ask. The cuts are, as a rule, good, and
are sufficiently numerous to illustrate
the subject satisfactorily. The positions
shown in a few, we think, might be im-
proved, but this is probably the fault of
the artist and not the author. Any one
interested in Swedish gymnastics will
certainly be pleased with this little
work.
Treatment of Laryngeal Phthisis
By Robert Levy, Professor of Physiology
and Laryngology, Gross Medical College,
Denver, Colo.
This concise paper sums up in a most
admirable manner the therapeutics of
laryngeal phthisis, presenting in a nut-
shell the essentials of what has been
published in recent times respecting the
various new and valuable remedies which
have been offered to the profession for
the last few years. As a concise epitome
of knowledge upon this single subject, the
paper is really a very excellent model.
The author also gives results of his own
work, which are certainly excellent, and
appends a bibliography which will cer-
tainly be of interest to all who wish to
keep themselves posted upon the subject
considered.
Notes on General versus Local
Treatment of Catarrhal Inflamma-
tions of the Upper Air Tract. — By
Beverly Robinson, M. D., New York.
In this excellent paper, the author takes
the ground that many specialists in dis-
eases of the nose and throat have been
somewhat too exclusive in their attention
to the local malady, and have not taken
sufficient pains to investigate the bearing
of the general conditions upon local mor-
bid manifestation. The arguments and
facts presented are such as must convince
any one of the correctness of the author's
position, as indicated in the following
words : —
*' I believe, and I always have believed,
that the true position is held, and only
can be held by the general practitioner
who has sufficient special training to
allow him to be fully appreciative of what
is being done properly in that line, but
who is in daily contact, also, with the
multiform diseases of the human econ-
omy in almost every organ."
The Economic Basis of Prohibition.
— By Prof. Simon N. Patten. American
Academy of Political and Social Science,
Phila. publishers.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
VTONXHIvY BUI^IvEO^IN.
Battle Creek, Mich., April, 1892.
ACTION OF ESSENTIAL OILS AND CREOSOTE
ON CERTAIN BACTERIA.
The director of this department (Lab. of
Hygiene) investigated the influence of the es-
sences of cinnamon, of turpentine, of creosote,
etc., on the microbes of the mouth, and on
the bacillus of tuberculosis, the object being to
determine what effects they may have when
used directly in the form of fine spray and
lotion.
Experiment A. — Mixed plate culture of the
microbes of the mouth (made with the rinsing
of the mouth before using brush in the morn-
ing). A fine spray of essence cinnamon was di-
rected twice daily (morning and night) into the
glass bell containing the cultures, by means of
"The Globe Nebulizer." ^ Each spraying was
<3ontinued ten minutes. The arrangement was
such that a filtered current of air entered with
the spray and passed out again, carrying part
of the material out, almost as in inhalation.
The treatment began when the culture was two
days old and well under way, there being over
^ hundred colonies within four inches square.
During the intervals of spraying, the cul-
ture was kept at a temperature varying be-
tween 75° F. and 80° F., very favorable for
its development. After two sprayings, the
growths seemed retarded. After three spray-
ings (twenty-four hours) they were visibly
modified and interrupted. After four spray-
ings (thirty-six hours) many of the colonies
seemed to have lost all vitality and contracted.
Cultures from these failed to grow. Other col-
onies still alive. Aftei* five sprayings (forty-
«ight hours) few colonies presented living ap-
pearance on the surface, but several were still
alive. Finally, spraying twice a day was con-
tinued until the tenth one (ninty-six hours
after the first), and only after this did the
germs grown on the surface of the plate fail to
develop in culture tubes.
In the bottom of the deeper furrows made
by the inoculating needle, however, live germs
iDr. Dunlap's, of the Battle Creek Sanitarium. Altered
for the purpose.
still existed, and spraying failed to destroy the
growths extending laterally from the depth,
under and within the gelatinous medium until
the sixteenth spraying (156 hours after first
dose), when the material seemed all permeated
or affected by the cinnamon.
Experiment B. — Plate culture like the above
and treated in like manner with essence of tur-
pentine.
The effects were much less noticeable and
much slower. It took six days of spraying
(morning and evening) to alter any growth
perceptibly, with the exception of the smallest
colonies. After this the growths were impeded
and arrested gradually. Two weeks after the
first spraying, the surface germs seemed ar-
rested in their development, but occasionally a
culture was fruitful. In the bottom of the fur-
rows the germs were still alive. All life seemed
extinct after the eighteenth day. Left to itself,
the culture died.
Experiment C. — Three plate cultures of tuber-
culosis were treated, one with essence of cinna-
mon, the second with turpentine, and the third
with the following prescription of Dr. H. M.
Dunlap, of this institution: —
Oil Scotch pine, 10 m.; creosote (pure beech),
20 m.; oil cinnamon, 10 m.; oil bay, 10 m.; oil
eucalyptus, 30 m.; pip menthol, 10 grs.; tr. ben-
zoin, 2 oz.
These cultures were known as 1, 2, 3, of ex-
periment C.
In culture 1, the bacillus of tuberculosis fairly
under way, was interrupted slightly in its
growth after five days of two 10 minute spray-
ings a day with cinnamon. The sixth day the
depression was very apparent. The eighth day
the surface germs appeared dead, but the germs
nearest to the medium were alive. The tenth
day, the germs in the bottom of inoculating
furrows gave evidence of life and produced cul-
tures. Between the tenth and fifteenth day, life
became to all appearance entirely extinct, there
having been used in all, thirty sprayings of ten
minutes each, or five hours of spraying all told,
with intervals of twelve hours between each
treatment, in which the germs had chance to
recuperate. It is possible, however, that many
(215)
216
LABORATOBT OF HYGIENE.
bacilli in the lines of inoculation were still alive
and I should, no doubt, have found it to be so
had I been able to make secondary inoculations
with all points of the interrupted growths.
After the twentieth day of spraying, the cul-
ture was left alone in the most favorable tem-
perature, but growth never again appeared.
Culture 2. Treatment same as the preceding,
but with essence of turpentine instead of cinna-
mon. An accident occurred to this after the
sixth day of treatment, by which some air
germs and fungi invaded the growth, and the
identity of the bacillus tuberculosis became
uncertain, and experiments unsatisfactory^, so
far as the action of turpentine on tuberculosis
was concerned.
Up to the sixth . day, however, the bacilli
seemed very little affected by the turpentine,
the complete destruction of all growths (in-
cluding the invading organisms) did not oc-
cur until after twenty-three days of spraying
(ten minutes evening and morning* as in the
previous cases).
Culture 3. Pure culture of bacillus of tuber-
culosis. Thicker lay^er of medium than in Nos.
1 and 2. Growth very much more abundant
and older by four days. Spraying twice a day,
ten minutes morning and evening with the
creosote prescription above given.
After four days, the growth seemed affected
and slightly interrupted. After six days the
edges of the four large colonies began to con-
tract. The surface began to change slightly
in color. The eighth day the growth was very
plainly interfered with. The tenth day the
colonies began to decline and wither, as it
were. Cultures from the edges and the surface
failed to grow. Cultures from the layer of
germs nearest to mpdiuni in the streaks of in-
oculation developed. Tlie twelfth day things
seemed stationary. Here again, an accident
occurred, and contamination took place by
which it became impossible to follow the action
of this preparation on the bacillus of tuber-
culosis. I had selected this prescription be-
cause it is used by inhalation in cases of pul-
monary tuberculosis.
It is reasonable to suppose, from the above
experiments (the first of several series to be
carried on this year to test the microbicidal
action of different drugs), that essence of cinna-
mon is a powerful antiseptic as has been pub-
lished long since, and may be perhaps used to
advantage for bacterial diseases of the nose,
mouth, throat, lungs, etc., where sprays are
often directed. Turpentine seems much less
powerful. The prescription used in culture 3,
of tuberculosis, was used chiefly to try the
combined effects of cinnamon and creosote.
The effects were encouraging up to the time of
the accidental contamination with foreign
germs.
This is only a preliminary report of progress
and only gives indications of the possibilities
of the bactericides used. Doubtless the results
in a number of tests would vary somewhat.
The luxuriance, richness of medium in nutritive
material, thickness of the soil, and protection
from the chemicals had a great deal to do with
the results. Later, some tests will be made
with these ingredients diluted with excipients
in the manner of prescriptions used in practice.
ONE CAUSE OF ANTAGONISM TO THE
GERM THEORY IN TUBERCULOSIS.
There are still some physicians, even among
the teachers in medical schools, who not only
refuse to admit, but antagonize the teachings
of those who hold that the bacillus of tubercu-
losis is the active cause of this disease. Among
the most prominent men who hold that the
bacillus is only an incidental organism in pul-
monary phthisis, many base their views on the
fact that they have failed to find it in certain
decidedly clear cases, and even in affected tissue
after death, and yet the lesions were positively,
in their estimation, those of so-called "true
consumption.''
There are doubtless many explanations for
these differences of opinion on the subject of tu-
berculosis. But in the writer sestirnation, there
are two things which have misled physicians
in the majority of cases. One is their absolute,
indiscriminate reliance on all methods, chem-
icals, and formulas, under all circumstances;
and the other is the failure to realize that
many germs enter the lungs, which may, under
certain conditions, produce rapid disorganiza-
tion or slow transformations, and act either as
secondary agents to complicate tuberculosis
(perhaps even destroying the bacilli of this
malady), or act as primary microbic factors
in a weak spot.
During the last three years, I have had many
opportunities to test all the stains recom-
mended in the best works for the bacillus of
tuberculosis, and to make many comparative
trials. I have taken the sputum of certain
patients and stained it carefully with a half
dozen or more stains, all of which were rec-
ommended very highly, and sometimes one
would show the bacilli, and another would not.
In order to arrive at'the cause of these fail-
ures, I prepared the following stains carefully^
with as pure samples of dyes as I could procure^
and then made comparative tests with sputum
in which I had, as a rule, already found bacilli.
LABORATORY OF HYGIENE.
2ir
The stains and methods were: Neelsen's, Er-
lich's, Koch's original, Gibbes' new method,
Pittion & Roux's, Paquin's, Biirrill's. With
these seven methods, I found the following: —
Sputum A. — Two drops thoroughly mixed
and broken up in a cover-glass with a blunt
glass rod. Fourteen cover-glasses were smeared;
two each stained according to each of the above
methods. Result: The bacilli were demon-
strated well and clearly by Neelsen's, Pittion &
Roux's, and Paquin's; fairly by Koch's original ;
poorly by Burrill's; and not at all by Gibbes'.
Sputum B. — Known to contain bacilli in
large quantity. Two drops were thoroughly
mixed, and fourteen cover-glasses were smeared,
two of each being stained carefully by the
above named methods. Result: Bacilli clear
and plain by Pittion & Roux's and Paquin's
methods; fairly well by Neelsen's, Burrill's, and
Koch's; not demonstrated by Gibbes'.
Then I purchased Burrill's stain and Gibbes'
stain already prepared, in the market, and
again made tests as follows: —
Sputum C — Full of bacilli of tuberculosis.
Tested Pittion & Roux's, Gibbes', Burrill's, and
Paquin's stains. One drop of sputum was
thoroughly mixed; eight cover-glasses were
smeared; two were stained with each stain.
Result: Bacilli plain with Pittion & Roux's, Pa-
quin's, and Burrill's stains; barely but suffi-
ciently perceptible with Gibbes'. Throe more
mounts were then stained with the latter stain,
and one was reliable for diagnostic pur-
poses; the other two demonstrated no bacilli.
Sputum D. — Bacilli verj' scarce, but clearly
demonstrated previously. One'drop of sputum
was thoroughly mixed as in other cases, and
twelve cover-glasses were smeared, and three of
each were stained with each of the four stains
mentioned. Result: Two of the slides showed
bacilli plainly with the Paquin stain; one
plainly with the Pittion & Roux method ; one
poorly with Burrill's; and none were demon-
strated by the Gibbes method.
With the same stains older, — four weeks
later, — poorer results still were obtained with
Koch's, Burrill's, and Gibbes' stains. The
others were not affected.
A few days ago (middle of April), a friend
made comparative tests of the Gibbes stain
and the Pittion-Roux-Paquin stains with a
drop of sputum full of bacilli, and found them
clearly and profusely with the latter, while he
absolutely failed with the former.
It seems to me that physicians have been re-
lying too much on dyes and stains put on the
market, and have often failed, for this reason,
to find bacilli of tuberculosis where they really
existed. This has misled them.
It is not implied here that any of these meth-
ods are always, or at any time, in themselves
unreliable, for, by previous trials and further
tests, I have had excellent results with Koch's,
Burrill's, and Gibbes', the three processes which
gave the least satisfaction in the above re-
corded cases. The trouble comes, very fre-
quently from the use of inactive (though said
to be C. P.) material in preparing the staining
fluids. The most reputable firms often inno-
cently furnish dyes which are worthless in
microscopy. The authors of the staining
processes and their followers are innocent vic-
tims of innocent chemists.
There is no question of the occasional worth-
lessness of the dyes used in compounding
staining fluids.
Another cause of error, just discovered, is
that the application of heat to a slide, until
the Canada balsam boils, sometimes fades the
stain fixed on the bacilli and they instantly be-
come invisible. This occurs chiefly with certain
fuchsin stains, when it is fixed faintly on the
germs, and discoloration has not been perfect
in the background. I am not just now pre-
pared to say more on this point.
-^ — • — »-
IMPORTANCE OF GOOD STAINS IN ALL
MICROSCOPICAL WORK.
The necessity of procuring any particular
brand of material to prepare stains, or of ob-
taining any particular stain already prepared
by specialists or competent firms, is underesti-
mated. As will be seen by the tests recorded
in the preceding articleconcerning tuberculosis,
it is an absolute necessity to have reliable
stains, to give any value whatever to any at-
tempt at the microscopical diagnosis of tuber"
culosis. Even with the famous formula of
Koch, and the process of Gibbes, both of which
have been in vogue for many years, one may
fail to find the bacillus of tuberculosis in spu-
tum in which it actually exists. Nor is this
failure always due to carelessness in mounting
or staining, as might be supposed, for one may,
with one sample of either stain, find these mi-
crobes in a given specimen of sputum, and with
another sample, prepared with chemicals from
another source, utterly fail with the very same
specimen.
And what is true in regard to stains for the
diagnosis of the bacillus of tuberculosis is true
in regard to all stains used in microscopy. It
is necessary always to have the purest and
most effective stains obtainable. Failure in
staining properly, when one is working from
an artistic or a student's standpoint, is disap-
pointing enough, and misleading, very often
218
LABORATORY OF HYGIENE.
to a baneful degree, as one is sure to find out
sooner or later; but failure to obtain praper
results in staining anything from a diag-
nostic standpoint, particularly where life is at
stake, and the treatment to be used depends
on the microscopical analysis, is a dangerous
thing, which may lead to the most serious
mistakes and painful consequences. If the mi-
croscope is to be depended upon, the prepara-
tions to be studied with it must be properly
made and reliable in every detail in a technical
sense.
Indeed the microscope is worse than useless —
it is often misleading and dangerous — when the
object to be studied to help in diagnosis is
stained with ineffective or unreliable drugs.
The great misfortune about this matter is
that one cannot, so far as I know, determine
in advance, by any other process than repeated
microscopical tests and comparative studies,
wlien a dye is and is not good. This is true at
least of all the coal tar colors. Some of these
may be, so far as analysis can indicate, per-
fectly pure, and yet there is something about
them that renders them more or less unreliable
in the preparation of staining fluids. When
thus compounded, they fail to give the results
expected. .1 have in my laboratory a number
of coal tar colors, obtained from the very best
houses of the country, and which I have no
doubt are pure, and yet many of them are use-
less for staining purposes in microscopy. On
the other hand, I have had magnificent results
with many such products from the very same
houses. The oply two brands of aniline dyes
which have uniformly given me satisfaction
are those of Chemist Griibler and Chemist Mlin-
der, of Germany. Their reagents, too, are ex-
cellent, and always reliable.
Technique.
To Extract Bactericide Substances from the
Blood and Confer Immunity against Charbon.
—Prof. M. Ogata, of Tokio, Japan, gives the fol-
lowing method of extracting a ferment from
the blood to prevent anthrax. He claims that
it has disinfecting properties and power of pre-
venting the growth of micro-organisms. Take
one part of blood or serum from a dog or
chicken, and add from 10 to 15 parts of a mixt-
ure composed of equal parts of absolute alco-
hol and ether. After one or two days, filter,
gather the residue on a filter paper and dry in
the air. Pulverize this in a mortar, add a
little tepid water, or a mixture of glycerine and
water (equal parts) to the quantity of half the
volume of the blood employed. After three
quarters of a minute, filter rapidly through a
cloth, then through filter paper. Add to the
liquid filtered, 10 times its volume of alcohol
and ether. Let it rest, and filter it at the end
of one day. The residue is dissolved in water
(one fourth the original volume of the blood),
then add an equal quantity of glycerine. The
dose necessary to produce immunity may have
to be determined each time because of the va-
riable quantity of ferment contained in the
blood. In his experience, M. Ogata has pro-
duced immunity in mice with half a drop of
glycerine extract, and in guinea-pigs with 2%
drops.
To Clean Slides and Cover-Glasses. — Dr.
Friedrich Knauer {Centralhlatt far Bakteriol-
ogie, X, p. 8) gives the following improved
method of cleaning prepared slides: They are
thrown into a porcelain or glazed dish contain-
ing a half liter of a ten per cent solution of
lysol. A batch of sixty or eighty is placed in a
steam sterilizing apparatus or over a fire for
half an hour. Before they are allowed to cool,
a jet of cold water is directed upon them, rins-
ing them until the water is perfectly clear.
Nothing now remains to be done but wipe
them with a clean, soft cloth, free from grease.
The advantage of this method is that it affords
a thorough disinfection, and does away with
the use of corrosive substances, such as sul-
phuric acid, etc.
Przewaski's Method of Imbedding in Paraffin.
— The Microscope for February contains the
following quotation from a German publi-
cation : —
" Dehydration in absolute alcohol may be
avoided by the use of the following method,
which is cheaper, surer, and applicable to larger
masses: The piece is transferred from ordi-
nary alcohol to anhydrous aniline oil, or oil
containing but little water, and is to remain
there for 24 hours. It is then transferred to
chloroform, which penetrates it and dissolves
out the aniline oil. After a sojourn here of 24
hours, it is placed in a solution of paraffin in
chloroform (40 percent), then in melted para-
ffin, which should be hardened immediately so
that the tissue shall not become brittle.
** Aniline oil may be dehydrated by distilla-
tion or by placing in it a small piece of caustic
potassa. The oil gives the specimen a yellow-
ish amber, translucent appearance, which dis-
appears as the chloroform enters. This method
has the additional advantage of allowing the
use of specimens not entirely dehydrated, the
chloroform taking the water when it is mixed
with aniline oil. Finish in the usual way."
BULLETIN OF the
Medical and Surgical Sanitarium,
Battle Creek, Michigan.
The purpose of this department is to constitute, together with the Bulletin of the Laboratory of Hygiene, a record of the
scientific work in the Medical and Surgical Sanitarium located at Battle Creek, Michigan, an institution incorporated as an
organized and self-supporting charitable enterprise, all the earnings of the institution being devoted to charitable medical work,
and the advancement of scientific medicine.
A NEW METHOD OF PALPATION OF THE
KIDNEY.
Having been engaged for several years back
in a careful comparative study of the relation of
the positions of the several abdominal viscera
and the pelvic organs in cases of disease of the
latter structures, my attention has been especi-
ally called to the various methods heretofore in
use for palpation of the kidney, the liver, and
the other organs of the abdomen. The princi-
pal methods heretofore used have been as fol-
lows:—
1. Examination with the patient lying upon
the back, the shoulders raised, the knees well
drawn up so as to relax the abdominal mus-
cles, the kidney being grasped between the two
hands, the one behind and the other in front.
2. With the patient lying in the Sims' posi-
tion (left for right kidney ; right for left kid-
ney).
3. The introduction of the hand and arm
into the colon. This method has, I believe,
been seldom resorted to. Certainly it is not a
method to be commended for frequent use.
The first two methods mentioned are com-
monly sufficient to demonstrate the position
and degree of mobility of the kidney, but in
occasional instances I have found difficulty in
forming a certain opinion upon these points,
and something more than a year ago I hit
upon the following plan which usually enables
me to settle definitely any question relating to
the position or mobility of either kidney: —
The examination is made with a person
standing upon the feet, the buttocks resting
against the end of a table, or, if more conven-
ient, against the wall. The shoulders are
dropped forward, the arms hanging loo.sely
by the side, the head and chest also thrown
forward by relaxation of the muscles of the
upper part of the trunk, and the patient bends
slightly downward, the center of motion be-
ing the waist, not the hips. By this means
the abdominal muscles are relaxed as com-
pletelj' as possible, while at the same time
through the influence of gravity the abdomi-
nal viscera fall into the positions which they
usually assume with the patient in a standing
position, so that the kidney, if displaced down-
ward, or movable to an unusual degree, may
be easily grasped. The palpation is begun by
crowding the ends of the fingers of one hand
slowly up under the ribs in front, the other
hand making pressure at an opposite point be-
hind. As the front hand is slowly forced down-
ward, if the kidney is out of place, its position
will be readily discovered by the increased re-
sistance, and then by proper manipulation, it
may be seized between the two hands and its
form outlined. By this mode of examination
the kidney may often be grasped between the
two hands when it could not be felt at all in
either of the other positions mentioned.
A modification of this method which pos-
sesses some further advantages, places the
patient in a sitting position, as shown in the
accompaning cuts. With the body in a ver-
(219
220
SANITABITIM BULLETIN.
tical position, whether the patient is sitting or
standing', the kidney is found in the position
which it occupies at all times except when the
patient is lying- in a horizontal plane; whereas,
examinations made with the patient lying
upon the back, fail to detect the kidney in
consequence of its disposition to return to its
normal position when the force of gravity
ceases to act upon it. If the patient is lying
in the dorsal position, the kidney, although
relaxed in the vertical position and dropped
considerably out of place, vafiy settle back into
its usual position, so that the abnormality
would not be discovered.
With the patient bing in the Sims' position,
the slightly displaced or movable kidney may
drop into such a position as to evade the
grasp of the examiner. But examined in the
manner described, which I have termed "The
Relaxed Vertical Position," the kidney falls
into the very position which it usually occupies
when the patient is sitting, standing, or walk-
ing, the conditions under which a displaced
kidney is most likely to give rise to pain.
The information elicited by this method of
examination is exactly what is required for an
exact diagnosis, since patients suffering from
pain as the result of displaced or movable kid-
ney, are often perfectly comfortable while lying
upon the back, or when reclining in any posi-
tion, although they cannot sit erect without
great suffering.
The importance of making an exact diagno-
sis respecting the position of the kidneys and
other abdominal viscera in everj' case is com-
ing to be more and more appreciated by gyne-
cologists. A large share of the nervous and
other symptoms which accompany common
pelvic disorders, and which are usually attrib-
uted to them, will be found in many instances
to depend less upon the pelvic derangement
than upon a disturbance of the normal static
relations of the abdominal viscera. I have be-
come satisfied, from a careful study of the data
obtained in several hundred examinations
made with special reference to this point, that
instead of charging the pelvic disease with be-
ing the direct cause of the distressingly long
category of symptoms and ailments of which
many women complain, the pelvic disorders
themselves, as well as the symptoms wrongly'
attributed to them, are the result of distur-
bance in the positions and functions of the
bowels, stomach, kidneys, and other abdomi-
nal viscera. Hence the folly of treating the
pelvic aihnents alone. Everj"- examination of
cases supposed to be suffering from pelvic dis-
ease should include a careful examination of
the wliole abdomen with reference to the posi-
tion, and so far as possible, the condition of
each of the organs found in this part of the
body.
The accompanying figures show the proper
position of the patient for examination in the
relaxed vertical position.
MICHIGAN CLIMATOLOGY.
Michigan enjoys a climate unequaled by that
of any of the Middle- Western States. It does
not, of course, afford the dry, rarefied air of
Colorado and the far West, nor the tropical
warmth in winter of Florida, and New Mexico.
These climates are required only by special
classes of invalids, .and then, usually, only at
certain seasons of the year; but Michigan af-
fords a typical " temperate" climate, beingsitu-
ated near the center of the temperate zone, and
protected in such a manner as to preserve a
more equable temperature than that of other
States adjoining. Its rolling country and im-
mense tracts of timber protect it to a very great
degree, from the parching heat of the prairie
States, while its location near the Great Lakes,
surrounded on all but itssouthern boundary by
a broad expanse of water, affords a still greater
protection from the severe cold of winter and
the intense heat of summer to which adjacent
States are exposed.
Prof. A. Winchell, formerly State Geologist
SANITARIUM BULLS TIN.
221
of this State, and of world-wide repute, in his
climatological charts of Michigan, remarks as
follows respecting the climate of this highly fa-
vored State: —
"The sinuosities of the several (isothermal)
lines will demonstrate at a glance the peculiar
character of the climate of Michigan, and the
fact that, both in summer and winter, it is
better adapted to the interests of agriculture
and horticulture, and probably also to the
comfort and health of its citizens, than the
climate of any other Northwestern State.
The marked peculiarity of the climate of
Michigan, in these respects, is attributable to
the influence of the Great Lakes, by which the
State is nearly surrounded. It has long been
known that considerable bodies of water exert
a local influence in modifying climates, and
especially in averting frosts, but it has never
been suspected that Lake Michigan, for in-
stance, impresses upon the climatic character
of a wood region an influence truly com-
parable with that exerted by the great
oceans."
We also quote the following paragraphs from
the pen of C. W. Garfield, the able Secretary of
the Michigan Horticultural Society, who has
also given the climate of the State of Michigan
considerable attention: —
"The acknowledged superiority of Michigan
as a fruit-growing State is believed to be very
largely due to the favorable character of its
climate. It is a well-known fact that ilarge
bodies of water, especially if at the same time
they are very deep, yield but slowly to the vary-
ing temperatures of the seasons, holding in
store in their depths a portion of the excessive
warmth of summer until wrung from them by
the angry, biting blasts of winter.
"In Southern Michigan the prevailing winds
are southwesterly, reaching its shores after
having been subjected to the equalizing influ-
ences already mentioned, in passing over nearly
one hundred miles of the open waters of Lake
Michigan, thus affording a partial exemption
from the extremes of temperature which often
operate so disastrously upon . , . the more
Western States.
"From the data given, we deduce the con-
clusion that Michigan possesses a climate com-
pounded of the average temperature of the
summer of the Red River country of the North
(latitude 48 degrees), and that of the winter of
Southern Illinois and Indiana (latitude 40 de-
grees). It mantle of forest also may doubtless
be largely attributed to the increments of
moisture imparted to the winds in traversing
the circumjacent waters, while the exemption
of the State from the occurrence of tornadoes
and cyclones is doubtless due to the equalizing
influence of these surroundings.''
When newspapers are rife with reports of
scores of deaths daily from sun-stroke in the
larger cities and even country districts of ad-
joining States, such a thing is almost unheard
of in Michigan. But what about "Michigan
malaria"? Unfortunately for the reputation
of Michigan as a healthful State, the idea got
abroad many years ago that the principal
feature of its climate was malaria. "Going
to Michigan" was considered almost synony-
mous with "going to have a fit of the ague."
It was not supposed to be possible for a person
to visit Michigan, or even to pass through the
State, without having the "chills." There was,
indeed, some foundation for such a reputation
forty years ago, when the dense, primeval for-
ests which covered her fertile soil were being
cleared off, and the virgin earth for the first
time was turned up by the settler's plow. The
conditions were such as to afford the most
favorable opportunity for the generation of
malarial germs, which, for several years, con-
tended hotly with the early settlers for the
possession of the beautiful peninsula.
Civilization has conquered at last, however,
and "Michigan malaria" is no longer anything
more than a scarecrow which is now and then
brought out by Western land agents, the ad-
vertisers of quack medicines, and the proprie-
tors of "liver pads," as a sharp advertising
dodge.
What was true of Michigan forty years ago,
and for a few subsequent years, was equally
true of Massachusetts, Connecticut, Rhode
Island, and other New England States two
centuries ^ago ; but as the forests have been
cleared away, affording free ventilation of the
soil, the favorable conditions for the production
of malariahave gradually disappeared in Michi-
gan, as well as in the older States.
For sixteen years a meteorological station
has been maintained at the Battle Creek Sani-
tarium for the State and Government Signal
Service. On comparing the reports of this sta-
tion with the reports of the stations located at
Marquette, Traverse City, and Detroit, we find
the temperature during the unusually hot
weather of 1888 — when nearly all sections of
the country suffered from very extreme heat,
persons being smitten down with sunstroke by
the hundred in our large cities — to be as fol-
lows: Detroit, 101° in the shade; Marquette,
97°; Traverse City, 104°; Battle Creek, 96°.
The thermometer only touched 96° on this
single occasion during the entire summer, and
then only for a few hours. Even at this tem-
perature the weather was not so oppressive as
222
SANITARIUM BULLETIN.
to interfere with any ordinary vocation, as
elsewhere, as the heat was tempered by a con-
stant breeze which gave the impression of a
temperature much lower.
At the Sanitarium no one was uncomfort-
able. Patients enjoyed themselves as usual in
the cool shade of our pleasant groves, or, if
they preferred the quiet of the halls and corri-
dors, they were refreshed with a cool breeze
from the mammoth fans, entering the house at
a temperature nearly ten degrees lower than
the out-of-door air, and circulating freely
through the halls. Thus, by the appliances of
art, added to the special advantages afforded
by nature, we are able to secure for our pa-
tients both summer and winter climatic ad-
vantages, natural and artificial, which are, to
say the least, not to be despised.
The Peninsular State has for some years back
been quietly growing into public favor as a
summer health resort. The northern part of
the State affords every year a grateful retreat
for thousands of the half-smothered residents
of the large cities and the sultry and malarious
climates of some of our neighboring States.
The rolling character of the surface in the mid-
dle and southern portions, gives rise to a great
number of beautiful little spring-fed lakes, the
wooded, sloping shores of which afford camping
grounds for thousands who seek to find, during
a summer vacation, rest in the lap of Nature
from the wearing toils of business and profes-
sional life. The whole State is getting to be a
great sanitarium.
Surrounded, except on the southern border,
by immense inland seas, its climate is tempered
by water-cooled breezes, so that the parched
sultry air of other latitudes, during July and
August, is scarcely felt here. There are prob-
ably few localities to be found which afford a
better summer climate than Michigan. A lead-
ing physician who has resided in the State for
more than thirty years, recently remarked, "A
lady patient said to me the other day, 'Doctor,,
where would you advise me to spend the sum-
mer?' I replied, ' If you really wish to find one
of the most comfortable and healthful summer
climates in America, and are determined to
avail yourself of its advantages, regardless of
trouble and expense, I would advise j'ou to go
to — well, go to Michigan.'"
The editor of the Rural Home, Rochester,
N. Y., while on a visit to Michigan some year&
ago, wrote to his journal, as follows: —
'"■1 believe Michigan has more sunshine ta
the acre than New York has, and why it should
be so puzzles me, too. The State is three-
fourths surrounded by water, and within its
area the water surface is large. Yet I never
spend a week or two among the Michiganders
but that I find them blessed with more clear
sky than New Yorkers enjoy. We in Rochester
claim that Lake Ontario troubles our atmos-
phere! Whj- should not Lakes Huron and
Michigan breathe mist over the whole Penin-
sular State, on the same principle? There are
some interesting questions in climatology that
I propose to study up, if the time ever comes
when I may go-a-tishing.
"I write this in Battle Creek, one of Michi-
gan's smartest towns, where five or six years
ago T spent two or three days pleasantly, and
of which I then wrote at some length. It is a
growing place, with decided manifestations of
public spirit and private pluck. Its location is
fine, and its surroundings attractive. There
are manufacturing interests which compel
growth and beget enterprise in the com-
munity; and these, I note, have enlarged their
facilities vastly since my first visit. 1 haven't
learned the city's present population — fifteen
thousand will cover it. An Eastern air of re-
finement, and culture, and good morals per-
vades the town, mingled with much of that
go-ahead thrift so characteristic of tlie remoter
West."
Qj'cinola, a ^ealtbful food.
An Invalid Food prepared by a combination of grains so treated as to retain in the preparation
the HIGHEST DEGREE OF NUTRIENT QUALITIES, while eliminating every element of
an irritating character.
THOROUGHLY COOKED AND PARTIALLY DIGESTED,
This food preparation is admirably adapted to the use of all persons with weak digestion, defective
assimilation, general or nervous debility, brain workers, feeble children, and invalids generally, as
well as travelers and excursionists, who often need to carry the Largest Amount OF NutrimbnT
IN THE SMALirEST BuiyK, which is afforded by Granola in a pre-eminent degree.
ONE POUND MORE THAN EQUALS THREE POUNDS OF BEST BEEF,
In nutrient value, as determined by chemical analysis, besides affording a better quality of nutri-
ment. Thoroughly cooked, and ready for use in one minute. ^
Send for illustrated and descriptive circular of Granola and other healthful foods4:o the —
SANITARIUM FOOD CO,, Battle Greek Mioh:
ADVERTISEMENTS. 223,
NO. 2.- BLUE BOOK FOR THE DOCTORS AND STUDENTS. 5Q CTS.
MICROSCOPICAL
DIAGNOSIS OF
TUBERCULOSIS. "■= ^^^ c^'eV sf^^ir- "^^"'^
By PAtyZ- PAQUIN, M. D.
I^ate Prof, of Comparative Medicine, and Director of the
Bacteriological I^aboratory, Mo. State University ;
Memb. Am. Public Health Ass'n, Am. Medical
Ass'n, Am. Societj'^of Microscopists, Mo. State
Medical Ass'n, etc., etc., etc. ; Editor of
"Bacteriological World ; " Director of
LLUSTRATED.
A little hand-book so clear and so practical that any man vv^ith medical knowledge, or studj'ing medicine or
microscopy, may, after a few hours' conscientious work, learn to diagnose his own cases of tuberculosis in five min-
utes, with a twenty-five dollar microscope, and dispense with the costlj^ aid of experts, and relieve his mind of doubts
•on the findings of the would-be expert micro.scopists, which the ph3fsician too often has to depend upon. Guess not
on the diagnosis of a suspected case of consumption — you risk the life of another ]
Published by the X-^ITOrr^E^ :BrvtrE: IBOOK: OO., 3atile Creek, Mich.
Sample Mounts of Bacilli ot Tuberculosis In Sputum. (Limited Number)
W \
The Author of these little blue books has placed at the disposition of the publishers, a collection of excellent,
practical mounts, which will be found exceedingly useful to beginners. In fact, no one should attempt to diagnose
tuberculosis with a microscope before having become familiar with the appearance of a reliable mount ; besides, in
•doubtful cases, a good mount is very useful, if not indispensable, for comparisons.
■PK'SE. by Mail, each, - T5 Cts. "Microscopical Diagnosis" and
T>vo, - - - $1.00 one Mount, - - $1.05
"The Supreme Passions," "Microscopical Diagnosis," and one Mount, 1.TO
Address, LITTLE BLUE BOOK CO., Battle Creek, Mich.
MMTISBPTIC. m V ^1^ ^ I > W--> W-^ W IV T W""^ NON-TOXIC.
PROPHYLACTIC. I I ^^ I W^ l^ I r^l r ^ NON-IRRITANT.
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I^Ol^IMCUI^A.. — Listerine is the essential antiseptic constituent of Thyme, Eucalyptus
Baptisia, Gaultheria, and Mentha, Arvensis, in combination. Each fluid drachm also contains
two grains of refined and purified Benzo-boracic Acid.
I>OSE^« — Internai,i,y : One teaspoonful three or more times a day (as indicated), either
full strength or diluted, as necessary for varied conditions.
LISTERINE is a well-proven antiseptic agent — an antizymotic — especially useful in the
management of catarrhal conditions of the mucous membrane ; adapted to internal use, and to
make and maintain surgical cleanliness — asepsis — in the treatment of all parts of the human body,
whether by spray, irrigation, atomization, or simple local application, and therefore characterized
lay its particular adaptability to the field of
PREVENTIVE MEDICINE— INDIVIDUAL PROPHYLAXIS.
LiSTz:R.iKrE;
Destroys promptly all odors emanating from diseased gums and teeth, and will be found of great
value when taken internally, in teaspoonful doses, to control the fermentative eructations of
dyspepsia, and to disinfect the mouth, throat, and stomach. It is a perfect tooth and mouth wa^,
indispensable for the dental toilet.
Descriptive Literature upon Request.
LAMBERT RHARMACAL CO., ST. LOU/S, MO.
AGENC/ES:
S MAW SON & THOMPSON, ROBERTS & CO., S. PAPPENHEIM, VILANOVA HOS. Y CIA.
LONDON, E. C. PARIS. BERUN, W. BARCELONA.
PUBLISHERS' DEPARTMENT.
We are glad to note that Dr. E. E. Mont-
gomery, who lias been for a number of years
Professor of Gynecology in the Medico-Chirur-
gical College of Philadelphia, has recently been
elected by the Board of Trustees of Jefferson
Medical College, to the Chair of Clinical Gyne-
cology, with a seat in the faculty. Dr. Mont-
gomery's sound and thorough work in his
department has well earned for him this dis-
tinguished honor.
Work of the Michigan State Board of
Health. — We have received an interesting re-
port of the Annual Meeting of the Michigan
State Board of Health, held April 12, from
which it appears that the Secretary of the
Board has taken action for the suppression of
421 outbreaks of contagious disease within the
last three nionths. From this, it must not be
supposed that Michigan is a more unhealthy
locality than other States, or more subject to
contagious diseases. No one who has not had
an opportunity to become thoroughly ac-
quainted with the work of sanitary authorities
can form any proper conception of the number
of these outbreaks which are occurring every
week, or, we might more properlj'^ say every
day, within the limits of any territory so
large as that of this State. The Michigan
State Board of Health has made a remark-
ably good showing as the result of its efforts
toward the suppression of contagious and in-
fectious diseases. The statistics of the Secre-
taryshowthat a greatnumberof lives are saved
to the State by this means every year.
One of the interesting features reported was
the announcement by the Secretary that cysti-
cerci, the embryonic or encysted form of tape-
worm, had been found in bass from Saginaw,
Mich. As human beings are subject to invasion
by this worm, this is a very important discov-
ery. It has long been known that the embryos
of the broad tapeworm are sometimes found in
fish, but this is the first announcement of the
discovery of the parasite in the fish of this
locality.
Fish inhabiting the sewer-contaminated wa-
ters in the vicinity of any large city, are very
likely to be infected with these and other para-
sites. Prof. Cook suggests that "such fish
should be well cooked." This is certainly a
very pertinent suggestion, but as there might
be some persons who entertain a distaste for
cooked tapeworms, it is quite likely that some
will prefer to choose food not likely to contain
these parasites.
A committee was appointed to visit the city
of Detroit, and study the difficulties which are
encountered by Detroit health officers in the re-
striction of infectious and contagious diseases.
We suspect that the particular diflSculty is the
non-belief of the health officers of that locality
and the sanitary authorities of that city, in the
effectiveness of sulphur fumigation as a means
of destroying the germs of infectious diseases,
since a report recently published by health offi-
cer Duffield seeks to show by statistics, the in-
effectiveness of sulphur fumigation, from the
fact that diphtheria sometimes reappears in a
dwelling which hasbeen fumigated with sulphur.
Dr. Baker, Secretary of the Michigan State
Board of Health, suggests that the reappear-
ance of diphtheria in such cases is not due to the
inefficiency of the sulphur fumigation, but in-
stead, to the persistence of the disease in cling-
ing to the bodies of patients who have suffered
from it. Diphtheria germs have not infre-
quently been found in the mouths of patient*
who had suffered from the disease, some week&
after recovery. It is certainly very difficult to
secure a complete disinfection of the person;
perhaps this may be impossible in many in-
stances. This fact emphasizes the importance
of extending the quarantine of persons suffering
from contagious diseases some weeks beyond
the period at which the patient seems to be
recovered from the disease.
The Mississippi Valley Medical Association
will hold its eighteenth annual session at Cin-
cinnati, Wednesday, Thursday, and Friday,
Oct. 12, 13, and 14. An interesting program
is promised. The President of this Association
is Charles A.L. Eeade, M.D., and the Secretary,
E. S. McKee, M. D., both of Cincinnati.
The International Medical Review is the title
of a new medical journal published at Washing-
ton, D. C, under the editorship of Dr. Charles
Stowell, of that city, formerly Professor of His-
tology in the University of Michigan. With so
able and talented a manager, the journal is
destined to meet with success from the start.
A New Pepsin.— Parke, Davis & Co., of De-
troit, Mich., the well-known manufacturers of
fine pharmaceutical products, have produced
what may fairly be called a new pepsin. In a
recent test of pepsins made by an eminent Euro-
pean authority, we were glad to note that the
American pepsins were ahead ; the most active
pepsins of the large number tested were of
American manufacture. Parke, Davis & Co.,
to whom perhaps more than to any other firm,
is due the great improvement of American pep-
sins, have recently surpassed all their recent
achievements, and indeed those of all other
manufacturers in this country as well as in
Europ)e, by producing a pepsin which is capable
of digesting 4000 timesits weight of coagulated
egg-albumen under the conditions of pharma-
copoeial tests. They claim in reference to this
new product, that "it is prepared by a new and
original process which renders it aseptic, free
from odor, agreeable to the taste of the most
sensitive palate, and superior to any pepsin
hitherto made."
There are pepsins and pepsins in the market,
a great share of which are worthless, some ab-
solutely loathsome and far more capable of
producing a fine crop of microbes and pto-
maines in the stomach', than of aiding diges-
tion. Parke, Davis & Co., seem to be ahead in
pepsin as in many other pharmaceutical prod-
ucts, and the excellencies of the new pepsin
which they offer, will doubtless be appreciated
by the profession.
♦*v s*^-
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CANCEROUS CELLS, SHOWING INCLUSIONS.
TY-i
• '•
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH, U. S. A, MAY, 1892. NO. 7.
Original Articles.
PROTOPLASMIC FOCI-THEORY OF
METABOLISM.
An Elaboration of the Views contained in
THE Paper read by Dr. Morton at the
First Meeting of the American Elec-
tro-therapeutic Association.
BY HORATIO R. BIGELOW, M. D.
Dr. Morton's views, as he has tersely
stated them to me in a private communi-
cation bearing date, Oct. 8, 1891, are' as
follows : —
''In the voltaic couple the initial
chemical exchanges are in the electrolyte
and in the positive plate, not necessarily
or initially in the negative plate to which
the hydrogen goes. But the negative
plate may very easily happen to be per-
oxidized (or oxidized), then here comes
in anabolism, /. e. reconstruction of tissue
and building up of new products (synthe-
sis) ; I say, creation of fats, ferments,
glycogen, and all that the animal builds
or anabolizes. Now the main function
of the living animal is not to build (ana-
bolize) but to destroy (katabolize), afford-
ing waste products and energy ; the animal
releases the potential energy which the
plant has stored up and which the animal
takes in as food. But the animal does
do some anabolic work, and I am claim-
ing (perhaps "very hazardously) that the
anabolic work is due initially to katabolic
work, and is an accidental or rather sec-
ondary process due to the presence of hy-
drogen and its congeners directed to the
negative plate which happens to be oxi-
dized. Thus you may find polarity —
positive and negative — in normal and
morbid processes, but there will be but one
seat of chemical exchanges, and that one
katabolic and electro-positive. That is
why I have said in my paper that all foci
of activity, normal and morbid, are elec-
tro-positive— all katabolic. You may
draw a parallel, and say that the metabolic
cycle of living is also the electric cycle of
the voltaic couple. The tissues oxy-
genize and hydrogenize ; one destroyed
and reduced, or built up ; the electrolyte,
blood and lymph, is the intermediary. wSo
of the voltaic couple (when its negative
plate is to start with, oxygenized)."
These views, as a whole, are altogether
new, I think, however, we shall find, as
we enter into further discussion, that Dr.
Morton does not give sufficient deference
to the real constructive processes of cell
life. It is conceded that energy is lib-
erated whenever chemical union takes
place, and whenever stable compounds
are formed from less stable ones, in which
the constituent atoms were less firmly
held together. A man of Dr. Morton's
mental astuteness would not hazard his
well-earned reputation as a close thinker,
by reiterating the aphorism that ''Life is
change," or that "life and nutrition"
are synonymous terms. Neither at this
late day would he waste any time in seek-
ing to demonstrate what may be consid-
ered as proven. But I may add here, as
being apposite, that I cannot conceive of
metabolism, save as the sum of anabolism
and katabolism. Before entering upon
an extensive examination of this question,
I may be allowed some lengthy quota-
tions from Dr. Martin's work on the
"Human Body, " which very succinctly
state what views are now entertained by
physiologists : —
"The living body is continually losing
matter and expanding energy. So long
as we regard it as working by virtue of
some vital force, the power of generating
which it has inherited, the waste is diffi-
cult to account for, since it is far more
'224
ORIGINAL ARTICLES.
than we can imagine as due merely to
wear and tear of the working parts.
When, however, we consider the nature
of the income of the body, and of its ex-
penditure, from a chemico-physical point
of view, we get the clue of the puzzle.
The body does not waste betause it
works, but works because it wastes. The
working power is obtained by chemical
changes occurring in it, associated with
the liberation of energy which the living
cells utilize ; and the products of these
chemical changes being no longer avail-
able as sources of energy, are passed out.
The chemical changes concerned are
mainly the breaking down of complex
and unstable chemical compounds into
simpler and more stable ones, with con-
comitant oxidation. Accordingly, the
material losses of the body are highly
or completely oxidized, tolerably simple
chemical compounds ; and its material in-
come is mainly uncombined oxygen and
oxidizable substances, the former ob-
tained through the lungs, the latter through
the alimentary canal. In energy, its in-
come is the potential energy of uncom-
bined or feebly combined elements, which
are capable of combining or forming
more stable compounds, and its final ex-
penditure is vinetic energy, almost entirely
in the form of mechanical work and heat.
'' Given oxygen, all oxidizable bodies
will not serve to keep the body alive and
working, but only those which (i) are
capable of absorption from the alimen-
tary canal and (2) those which are oxidiz-
able at the temperature of the body under
the influence of protoplasm. Just as
carbon and oxygen will not unite in the
furnace of an engine unless the fire be
lighted by the application of a match,
but when once started, the heat evolved
at one point will serve to carry on the
conditions of combination through the
rest of the mass, so the oxidation of the
body only occurs under special conditions ;
and these are transmitted from parent to
offspring. Every new human being
starts as a portion of protoplasm sepa-
rated from a parent, and affording the
conditions for those chemical combina-
tions' which supply to living matter its
working power ; this serves, like the
energy of the burning part of a fire, to
start similar processes in other portions
of matter. At present we know nothing
in physiology answering to the match
which lights a furnace ; those manifesta-
tions of energy which we call life are,
handed down from generation to genera-
tion, as the sacred fire in the temple of
Vesta, from one watcher to another.
Science may at some time teach us how-
to bring the chemical constituents of
protoplasm into that combination in
which they possess the faculty of start-
ing "oxidations under those conditions
which characterize life ; then we will
have learned how to strike the vital
match. . . . How the vital spark first
originated, how molecules of carbon,
hydrogen, nitrogen, and oxygen first
united with water and salts to form pro-
toplasm, we have no scientific data ta
found a positive opinion upon, and such
as we may have must rest upon other
ground. . . .
"The human body, like that of other
animals, is, on the whole, chemically de-
structive ; it takes in highly complex
substances as food, and eliminates these
elements in much simpler compounds,
which can again be built up to their
original condition by plants. Neverthe-
less the body has certain constructive
powers ; it at least builds up protoplasm
from proteids and other substances re-
ceived from the exterior; and there is
reason to believe it does a good deal
more of the' same kind of work, though
never an amount equaling its chemical
destructions. Given one single proteid
in its food, say Qgg albumen, the body
can do very well ; making serum albu-
men and fibrin factors out of it for the
blood, myosin for the muscles, and so
on ; in such cases the original proteid
must have been taken more or less to
pieces, remodeled, and built up again
by the living tissues ; and it is extremely
doubtful if anything different occurs in
other cases, when the proteid eaten hap-
pens to be one found in the body. In
fact, during digestion the proteids are
broken down somewhat, and turned into
peptones ; - in this state they enter the
blood and must again be built up into>
proteids, either there or in the solid tis-
sues. The constructive powers of the
body used to be rather too much ignored.
Foods were divided into assimilable and
combustible ; the former serving directly
to renew the organs or tissues as they
were used up, or to supply materials for
growth ; these were mainly proteids and
fats ; no special chemical synthesis was
thus supposed to take place, the living
ORIGINAL ARTICLES.
225
cells being nourished by the reception
from outside of molecules similar to those
they had lost. . . .
^'Several facts may be urged against
this need : (i) Men in tropical climates
live mainly on non-proteid foods, yet their
chief needs are not heat production, but
tissue formation and muscular work. (2)
Carnivorous animals live on a diet very
rich in proteids, nevertheless developing
plenty of animal heat, and that without
doing the excessive muscular work which,
in Liebig's theory, must first be gone
through in order to break up the proteids,
with the production of a non-azotized
part which could then be oxidized for
heat production. (3) Great muscular
work can be done on a diet poor in pro-
teids ; beasts of burden are for the most
part herbivorous. (4) Further, we know
exactly how much energy can be liberated
by the oxidation of proteids to that stage
which occurs in the body, and it is per-
fectly possible to estimate pretty accur-
ately the amount of urea and uric acid
excreted in a given time ; from this sum
the amount of proteid oxidized and the
amount of energy liberated in that oxida-
tion can be calculated : if this be done,
it is found that nearly always, the mus-
cular work done during the same period
represents far more energy expended than
could be yielded by the proteids broken
down."
It is proven also that proteid oxidation
is not the source of the mechanical energy
expended by the body. Martin's con-
clusion is, ''that a muscle works by the
oxidation mainly, if not entirely, of car-
bon and hydrogen." . . . ''Speaking
broadly, the work of the body is carried
on by the oxidation of carbon and hydro-
gen."
Synthesis and Analysis. — In 1828,
Wohler obtained urea by evaporating
ammonium cyanate, and since then many
synthetic compounds have been formed
by chemists. Hippuric acid is formed
by bringing together molecules of simpler
constitution to form a more complex
body. Berthelot obtained formic acid
by heating carbon monoxide with po-
tassium hydrate at 100° C. This was
building up an organic compound from
inorganic sources. Koike formed acetic
acid from carbon disulphide-synthesis,
or the formation of organic compounds
from inorganic materials is effected in
nature by the agency of the vegetable
kingdom. As Rolfe says, "The plant
under the influence of the rays of the sun,
liberates a quantity of oxygen from inor-
ganic constituents, such as carbonic acid,
water, and ammonium carbonate, which
exist in the soil and air, converting them
into those saccharine, oleaginous, and al-
buminious principles which form its tis-
sues and juices, and which ultimately
furnish the animal world with food.
For example, carbonic acid by deoxida-
tion under certain circumstances may
yield mannite : thus 6 C O2 + 7^2 O —
The vegetable organism is chiefly em-
ployed in building up synthetically in-
organic into organic matter, while the
animal analytically reduces organic com-
pounds back again to their original in-
organic constituents.
Oxidatio7i and Fe7'mentation. — While
asserting in a general sense that the pro-
cesses going on in the animal body are
finally analytic, still certain synthetic pro-
cesses do occur, as for instance the con-
version of carbo-hydrates into fat, and
the elevation of the proteids and pep-
tones into tissues of a more complex form.
The downward transformation toward
carbonic acid and urea, which non-nitrog-
enous and nitrogenous substances under-
go, and to which the term metabolism has
been applied, has been the subject of
much study.
The view now generally received is that
increased metabolism is not the result of
increased oxidation, but it is the increase
of the inter-molecular action in the cells
themselves that occasions the demand for
oxygen, and a more active condition of
circulation and respiration. In fever,
the earliest step is the increase of intra-
molecular changes in the cells themselves
under the stimulus probably of the zy-
motic poison ; for when the stored-up
oxygen is exhausted, then a demand for
a fresh supply causes an increased fre-
quency of pulse and respiration, which
continues so long as the stimulus (zy-
motic) acts on the cells and maintains
this abnormal intra-molecular activity.
I7itensity and Che^nical Action. — Helm-
holtz (see Barker's chemistry) regards each
atom of matter as charged with a definite
quantity of electricity, these charges be-
ing proportional to the valence of the
atoms. Thus all univalent atoms have
unit charge, all bivalent atoms a charge
of two units, all trivalent atoms a charge
226
ORIGINAL ARTICLES.
of three units, and so on. Moreover,
he conceives. First, That the same atom
in different compounds can be charged
with units of either positive or negative
electricity ; sulphur, for example, being
in hydrogen sulphide a negative substance,
and in sulphurous oxide a positive one.
And, Second, That their electrical charges
are held more strongly by some atoms
than by others ; an atom of zinc, for ex-
ample, holding its positive charge more
strongly than an atom of copper does its
negative one. Further, an electrically
neutral molecule, whether simple or com-
pound, will have each unit of positive
•electricity, or one of its atoms neutral-
ized by an equal unit of negative elec-
tricity or another atom. As to the
magnitude of these atomic charges,
Helmholtz calculates that they must be
enormous. '*The electricity of one milli-
gram of water," he says, ''separated and
communicated to two balls a kilometer
•distant, would produce an attraction be-
tween them equal to the weight of 26,800
Tcilograms," or, comparing the electrical
attraction between two quantities of oxy-
gen and hydrogen with their gravitational
attraction, he finds the electrical face to
be 71,000 billion times greater than the
gravitational force. Faraday said : ''The
mightiest among the chemical forces are
•of electric origin."
(To be continued.)
MICRO-ORGANISMS OF THE MOUTHS
BY JOHN H. LINSLEY, M. D.
IProf. of Pathology and Bacteriology, Medical Department
University of Vermont, Pathologist to the New
York Infant Asylum, etc.
( Concluded.)
DENTAL CARIES.
It has been proven, beyond doubt, that
-decay of the teeth is caused by two dif-
ferent processes, namely, (a) chemical,
(b) parasitical. The first is a decalcifica-
tion of the enamel, or dentine, or both,
•caused by the presence of acids in the
mouth, which have been formed from the
fermentation of starchy and saccharine
substances, resulting in a softening of
these tissues, after which these latter
form an excellent food-medium for many
varieties of bacteria. The prevention
1 Paper read before the annual meeting of the Vermont
State Dental Society at Burlington, Vt, March 17, 1892.
of dental caries depends, first of all, upon
strict cleanliness of the mouth, the im-
portance of which cannot possibly be
overestimated ; the details necessary for
the proper fulfillment of the same, it would
be superfluous for me to suggest to you.
Undoubtedly good stiff tooth-brushes and
plenty of clean water stand at the head
of all measures of this nature. The next
prophylactic means is the intelligent use
of proper antiseptics.
By far the most perfect germicide
known, that can be at all employed in
this connection, is the bi-chloride of mer-
cury, but the use of this substance is not
without danger. It should not be used
as a wash for the mouth in solutions of
greater strength than i : 2000, and even
then, care must be exercised in its appli-
cation. Other antiseptics which have
been recommended for the buccal cavity,
are salicylic acid, strength of i : 200, or
I : 350, listerine, wintergreen oil, and like
aromatic substances.
In this connection might be noted the
germicidal properties of tobacco, either
the juice of the leaf or the smoke of the
burning leaves. Certain it is, from re-
sults obtained by many experiments and
observations, that tobacco - juice or
smoke, very speedily destroys bacterial
life, but I would not, on this account,
advocate its use, as the evil results of ex-
cessive indulgence in the "weed," more
than counterbalance any possible benefits
resulting from its antiseptic action on
micro-organisms of the mouth.
In discussing the subject of infection,
attention should be directed to the dan-
ger which exists from the spread in va-
rious directions of infectious forms of
bacteria, that are liable to be present in
the mouth. It is not difficult, under cer-
tain circumstances, to excite an inflam-
matory process in the middle ear, the
transmission of septic germs taking place
through the eustachian tubes ; similar
results may also occur from pyogenic
bacteria being carried from the mouth to
the throat, lungs, parotid gland, antrum,
and even to the brain, as stated by Berg-
told. When it is considered, that of all
diseases of a parasitic nature to which
mankind is susceptible, dental caries is
by far the most frequent, the pqssiblilities
I have just mentioned, cannot be charged
as being the improbable and unlikely
speculations set forth by one who is
" cranky " on the subject.
ORIGINAL ARTICLES,
22T
Upon reviewing the various literature
on this question, especially those portions
of it which refer to the dangers of infec-
tion between the dentist and his patient,
the speaker was much surprised to find
no advice offered to the dental profession
by competent bacteriologists, as to the
considerable (and ofttimes great) danger
present to the patient, by pathological
conditions the dentist himself may be
suffering from at the time of operating,
and to point out the necessity of estab-
lishing, by legislative measures if required,
laws or statutes which would prevent the
occurrence of such dangers.
I refer, more particularly, to the jeop-
ardy in which human life is placed when
people are subjected to treatment by a
practicing tubercular dentist. This may
seem, to many of you, as a bit of super-
fluous advice, and you may retort that
such a circumstance is beyond the bounds
of possibility, but I assure you I have
seen a tubercular member of your pro-
fession practicing daily on unsuspecting
or ignorant patients.
My experience with dentists has been
very limited, and therefore I am not in
a position to make any assertion as to
the frequency of such pernicious and
dangerous proceedings ; but the very
fact that my slight personal observations
resulted in the detection of one such
case, naturally suggests a possible more
common occurrence of tuberculosis in
practicing dentists than might be sup-
posed. Since commencing the work
incident to the preparation of this paper,
one of the local members of your pro-
fession has detailed another case, which
was under his own personal observation,
of a tubercular practicing dentist.
The greatest danger, under such cir-
cumstances, is not, as some of you might
imagine, in the infection of the patient
by the transmission of germs through the
medium of the breath of the operator,
but in the reception of tubercular mate-
rial which becomes dry on the handker-
chiefs, clothing, linen, or instruments of
the dentist. The prevention of such
dessication is so extremely difficult and
impracticable, as to be discarded without
serious consideration if such prevention
be presented as a possible prophylactic
measure, to enable the victim of this
malady to continue his professional
work until physically unable to do so
on account of the inroads of the disease.
It is not generally known that bacteria
do not float in the atmosphere in the
moist state, but only do so after desicca-
tion, and then probably to no great ex-
tent, unless aided by more or less strong
currents of air.
Tuberculosis is now almost universally
considered to be an infectious disease,
and of so contagious a nature that I
candidly believe we shall, many of us, see
the day when attention to preventive
measures against possible infection from
cases of this disease, is as regularly in-
sisted upon as are the sanitary require-
ments in cases of smallpox, yellow fever,
and typhus fever (with the exception of
somewhat less vigorous quarantining) at
the present day. The period in which to
accomplish this much-desired treatment
of tubercular cases, will depend upon the
rapidity with which the laity, and pro-
fessional men even, become educated to
the full comprehension of the single and
sole cause of the affection, — the tubercle
bacillus, — and the proper realization of
the benefits to be derived from the adop-
tion of such measures. And to the in-
telligent efforts and advice of the members
of the medical profession, as well as to
the great aid which you, members of the
dental profession, can give, by embracing
each and every opportunity to inform your
patients, especially influential citizens, as
to the true character of tuberculosis,
must the accomplishment of this end very
largely devolve.
Of all the various ways by which
tubercle bacilli find entrance into the
human body (such as from the surface
of the skin through wounds, by contu-
sions, cuts, or otherwise ; from the in-
gestion of milk and flesh from tubercular
cows and animals, etc.), infection by in-
spiration,— by the entrance of the dried
germs through the mouth, and so on to
the lungs, — far surpasses in frequency,
all other methods of transmission. And
this can only be accomplished when the
medium on which the micro-organisms
have been discharged from the body,
dries, or disintegrates, into powder or
dust. For this reason the most danger-
ous source of infection is from handker-
chiefs or cloths on which the sputum
has been received (unfortunately a too
common procedure), and on which it
becomes dry in an exceedingly short
time. Consequently by merely prevent-
ing the sputum of consumptives from
228
ORIGINAL ARTICLES,
drying, the most important kind of in-
fectious matter may be rendered harm-
less.
The first contradiction I have seen, by
competent pathologists (who acknowl-
edge the tubercle bacillus as the essential
cause of tuberculosis) to the statement
that the commonest source of infection
is the inhalation of dried bacilli from
handkerchiefs, linen, clothing, dust from
the floors and ceilings of rooms pre-
viously occupied by tubercular subjects,
etc., was recently made by Dr. J. West
Roosevelt, of New York.^
Dr. Roosevelt maintained that '' there
was much more likelihood of getting an
overdose of the virulent germs " of tub-
culosis "through the alimentary tract,
either by the ingestion of meat, milk, or,
in children, by putting articles of every
nature into their mouths, no matter where
they may have lain," than by the manner
which I have just described. While
recognizing the value of the opinion of
so able an authority as Dr. Roosevelt, I
am convinced that his statement will not
be corroborated by the majority of path-
ologists and bacteriologists in this coun-
try or on the continent. True it is, that
much needless alarm may be created in
the minds of the public, by the advocacy
of too severe and unnecessary measures
of prevention, such as quarantining, etc.,
by prejudiced and over-zealous investigat-
ors, the effect of which would be the
unjustifiable persecution of many poor
victims of tuberculosis, and as I just
suggested, the only proper course to pur-
sue in dealing with this question, is to
persistently and intelligently educate the
minds of the public, as to ihe exact status
of this matter.
Few pathologists, at the present day,
believe in the theory of heredity as a
cause of tuberculosis. It is a fact that
the offspring of afflicted parents often
regularly develop, sooner or later, the
disease, but the explanation is to be
sought in a general impoverished condi-
tion of the organism, as indicated by en-
feebled assimilative and nutrient powers,
which are quite sure to follow as the in-
heritance from unhealthy progenitors.
What I have just said in regard to
transmission, naturally leads to the most
interesting and important problem in
bacteriology, namely, that of immunity,
and I ask your indulgence for a few mo-
ments, in order to state the theories at
this time held in regard to this subject.
As you are all probably aware, two
principal views are advanced to account
for the difference of susceptibility pos-
sessed by different animals to the same
micro-organism, and also that exhibited
by the same animal to different germs.
I might state here, that immunity is of
two principal kinds, to wit, {a) natural,
or inborn, {b^ acquired, or artificial.
The first of the theories of natural
immunity is based on the chemical
germicidal properties of the blood-serum'
and tissue-juices of the body. The
second, or Metchnikoff's theory, attrib-
utes the resisting power which an in-
dividual or animal may possess, to the
so-called phagocytic action of the tissue-
cells of the body, more especially the
colorless corpuscles, or leucocytes, of
the blood.
Metchnikoff believes that the presence
or absence of immunity depends on the
ability or inability of the cells of the
body, to devour and destroy the bacteria.
Such ability may be natural or acquired.
In the latter case, the cells, where they
have once had the opportunity of de-
vouring attenuated micro-organisms with
a milder poison, which nature enables
them to withstand, are so far accustomed
to it, that they can devour the most viru-
lent material with impunity. This can
be effected both by gradual adaptation,
and also by a kind of selection, in which
only the strongest, most vigorous cells
remain, and transmit the acquired faculty
to their descendants. The leucocytes are
but short-lived cells. A permanent re-
sistance of the organism to a disease
which it has once had, or against which
it has been protected by inoculation, is,
therefore, only conceivable if we grant
to the cells the power of transmitting an
acquired property unaltered to their chil-
dren and their children's children.
This hypothesis,^ as must have been
seen, presupposes an extraordinary do-
cility in the protoplasm of the white
blood-corpuscles, to which it atrributes
something like feeling, thinking, and act-
ing,— a sort of mental perception. But
if we raise no objection to this, there re-
main plenty of reasons for combating the
phagocytic theory of immunity.
1 New York Acad, of Med., Feb. 4, 1892, vide Medical
Record, Vol. 41, No. 10.
2 "Text-Book of Bacteriology," Fraenkel. translated and
edited by Linsley — 146 pp.
ORIGINAL ARTICLES.
229
In our opinion, the fact that it is es-
sentially the excretions of the bacteria
which produce, or are able to produce,
immunity, is difficult to harmonize with
Metchnikoff' s hypothesis ; for, if no liv-
ing micro-organisms are present, none
can be devoured, to accustom the cells to
the poison, and prepare the way for re-
sisting more virulent successors. To over-
come this difficulty, it would be necessary
to suppose that the reception of atten-
uated germs acts upon the cells only as a
specific stimulant, to which they respond
by a functional reaction, and that this
stimulating power exists in the same de-
gree, and works in the same manner, also,
in the bacterial products.
The theory of the germicidal action of
the blood-serum, or plasma, is, I believe,
supported by more weighty authority than
is the ingenious one of Metchnikoff.
I have thus forsaken the exact theme
of my discourse from a belief that more
benefit would be derived from the brief
treatment of a subject, at best only partly
understood by the highest authorities in
this branch, but which one who has
devoted much time to practical investiga-
tions, must necessarily be better quali-
fied to handle than the average practi-
tioner.
As yet, we are only on the frontier of
the domain of bacteriology, and have
only obtained comparatively few facts,
or details, of this most interesting and
important kingdom.
What data and facts, investigations into
the interior of this boundless area of un-
explored territory of micro-organic life,
will place us in possession of, time, per-
severance, and unremitting efforts will
prove. We certainly have reason to be-
lieve that the knowledge of such points,
at present undiscovered, together with
their practical application, will be of in-
estimable value to mankind.
PHYSIOLOGICAL MEDICINE/
BY PAUL I'AQUIN, M. \).
The practice of medicine comprises two
different departments : First, the science
of medicine ; that is, the study of the
sciences upon which the physician bases
his preventive or curative treatments ;
5 Paper read before the Missouri State Medical Associa-
tion at Pertle Springs, Mo., May 18, 1892.
second, the art of medicine, consisting
of the application of measures to prevent
and to cure diseases. It is self-evident
from the very nature of things, that
knowledge of the science must precede
the study of the art. It is indeed essen-
tial for the greatest success in the prac-
tice of medicine, that the most important
scientific branches upon which it is based
be well understood. It is true that nu-
merous practitioners have neglected the
scientific branches, and by years of ob-
servations and experimentation in their
daily work, are looked upon as quite
successful, professionally and financially.
It is true that a good number of medical
men have devoted themselves, in their
younger days while at college, and later
while in practice, chiefly to the therapeu-
tical field. It is true also that a great
number of the profession have all their
lives practiced medicine with stereotyped
formulas, scarcely ever varying in any
given condition, or in any special condi-
tion in which they thought they under-
stood the trouble.
But all these facts do not prove that
such practice is satisfactory, wise, just,
and really as successful as it appears. It
must be borne in mind that the reputa-
tion of a physician depends sometimes
as much on his personality, his character,
his behavior, his tact, as on his medical
knowledge and professional success.
For centuries, medicine has been prac-
ticed largely according to stereotyped
rules suggested from time to time in va-
rious countries by the leading authorities
of the profession. We have, as a rule,
been content to limit our endeavors very
largely to the administration of drugs, —
relying on the text-books on materia
medica and therapeutics which gave us to
understand the direct effect of this and
that medicament, as had been realized or
guessed by observation, and a little by
experimentation. Until recent years,
very little account had ever been taken
by the average practitioner, of the physi-
ological effects of the organs of the
body on the medicinal substances, and
very little thought has ever been given to
the effects that an association of drugs
may have in the system from chemical
and physiological standpoints, and still
less attention has been paid to the trans-
formations that may take place in the
drugs and tissues brought in contact in
the body and with the substances created
230
OBIQINAL ARTICLES.
during the process of digestion, metabol-
ism, and the generation and growth' of
micro-organisms in the alimentary canal.
Under the low standard of medical edu-
cation which has existed so long, this
system of practice was necessarily the
only equipment for the young practi-
tioner, who had attended only two or
three short terms of medical studies be-
fore fitting himself for conflict in the
medical arena, and it is still the case for
a vast number of graduates. They are
not prepared by scientific knowledge to do
anything better than to follow as closely
as possible in the footsteps of those who
offer the simplest means of relief from
embarrassment in the various conditions
that they meet in practice. They see a
patient, find a fever, diagnose the case ac-
cording to the best of their ability, then
turn to ft formulary, printed or memor-
ized, prescribe, and feel that they have
done their duty. The prescription may
or may not have a good effect ; it may be
harmless, or it may be harmful ; it may
hasten recovery, or it may hasten death.
In either case, the physician thinks that
he has done the best possible, and he
feels that his conscience is clear. Dur-
ing the last twenty years' scientific ex-
periments and observations by advanced
thinkers in the medical world have
pointed out to us the fact that such prac-
tice is little better than empiricism. It
really constitutes to-day, a passing stage in
the various phases of the evolution of
the science and art of medicine, and those
who still cling to. it and practice medicine
as a trade, are behind the times.
Not many years ago, attempts to treat
diseases by any other means than the ad-
ministration of drugs was termed quack-
ery. Electricity, massage, hydrotherapy,
Swedish movement, and balneology were
considered irrational means of treatment,
beneath the dignity of the physician.
So-called water-cures were laughed at ;
dietetics were considered of secondary
importance ; in fact the laws of nature
governing man's structures and activities
were scarcely taken into consideration,
and the practice of medicine was based
mostly on the orthodox principles and
practice of medicine and materia medica.
We are happy to see a most important
change in the thought of the medical
profession in this respect, and in the
practice of physicians throughout the
world. A few physiologists, untiring in
their efforts to demonstrate the sublime
truths underlying the life of the master-
piece of nature's organisms, have brought
to bear an enormous amount of weighty
facts upon which we can now begin to
base more logically and with more hope
our efforts to benefit humanity in the
prevention and cure of maladies. The
physiology of the unicellular organisms
is now studied as accurately as the physi-
ology of man himself, and the relations
that exist between the lower organisms
and the higher types are boldly brought
forth before the astonished world. Even
each cell of man's body, or at least each
set of cells, is closely scrutinized, sharply
questioned, if I may so speak, and often
forced to give up their secrets to the
human race. So we are at last in a
condition to base our treatments on a
clearer understanding of human nature,
and the laws underlying the vital func-
tions of its wonderful organization.
The medicines given to-day by ad-
vanced medical practitioners, the think-
ers of the profession, are not so often
composed of a half dozen, sometimes
a dozen medicinal agents mingled to-
gether with the object of ''hitting the
nail " somewhere, but are simplified, and
only one or two pure specific drugs, such
as alkaloids, are administered with an
almost positive knowledge of the direct
effect of that particular ingredient in the
system.
Understanding more and more the
intricacies of digestion, the complexity
of the phenomena that take place in the
dissolution and transformation of foods
in the stomach and lower intestines by
the action of the natural secretions and
microbic life ; having grasped the nature
and importance of the action of the liver
on the substances which enter into the
blood, such as poisons administered
from the outside or generated in the
body by the cells of the body itself or
the cells of microbes ; realizing, finally,
the possibility of producing serious irri-
tations and inflammations in various
organs, notably the kidneys, by the ac-
tion of products manufactured in the
digestion of certain foods, dietetics are
now considered more wisely and more
seriously in the practice of medicine.
The good physician no longer starves his
patient on general principles because he
wants food, or crowds him with nourish-
ment when he does not want it, cannot
OBIOmAL ARTICLES.
231
digest it, and cannot assimilate it ; he
seldom now administers foods without
knowing, in some degree, their prop-
erties and effects, but reflects before
feeding, on the possible result of the
ingestion.
In the matter of dress, also, there is a
wide awakening to the necessity of im-
provement. This awakening, however,
has not come primarily from the i^iedical
profession : it has been suggested by
dress-reformers outside of our ranks,
by women who have thought deeply on
the subject, and whom the profession
finds right in a great many things. The
constricting corset — almost severing the
liver, preventing its exceedingly impor-
tant action in the economy, interfering
with the natural flow of the circulation,
compressing the lungs upward, and limit-
ing respiratory action to a narrow space,
crowding down the intestines and the
organs of generation into the pelvis — is
gradually disappearing from woman's
wardrobe in a great many localities, and
giving place to the loose waist. The
physician cannot but hail with approval
this great reform.
In the treatment of various fevers, even
those due to specific organisms, more
rational agencies are now used, because
of our knowledge of the action of the
micro-organisms and the reaction of the
body upon them. Realizing the con-
ditions in which the warrior-cells (the
phagocytes) and the microbicidal sub-
stances of the economy may act, the
system is no longer jeopardized as here-
tofore by a constant administration of
drugs (given too often without knowing
their effect), nor is it starved injudiciously
by forced fasting and forced abstinence
from drink, as was sometimes cruelly prac-
ticed, nor do we rely exclusively on qui-
nine or any of the antipyretics, but,
instead, baths are very frequently used
with decided benefit. In typhoid fever,
for example, the cold-water bath is now
used with great success. Doctors Brand,
Leibermeister, Winternitz, Ziemssen, and
many others in European countries have
used Bouchard's baths, and testify to the
truth of this statement.
In dyspepsia, too, treatment is based
more and more on the knowledge of the
physiology of digestion. Drugs counter-
acting fermention or intended to soothe
pains, are relegated to past nostrums, and
physical treatment, either by Winternitz's
hydropathic stomach-cure, or various
other heating or cooling stimulating
packs are employed, whereby fifty-six
per cent are healed, whereas not eleven
per cent were cured before.
So medical progress is made in the line
of physiological medicine : that is to say,
the practice of medicine is becoming
more and more based on the knowledge
of physiology, — not merely the physiol-
ogy of the most important organs in a
general sense, but the deep physiology of
every organ, every cell of every organ
and every product of every cell of every
organ. The therapeutical means based
on this knowledge are also in a high de-
gree themselves of a physiological char-
acter ; they are not merely drugs whose
effects are such as to produce this or that
chemical reaction or change, whereby
sometimes another disease is brought
about, or a complication worse than the
original disease (or at least as bad) is set
up, but rather, in the assistance of the
natural physiological efforts of the sys-
tem to restoration. Given a case of
paralysis, for example : the advanced
physician who is an expert in nervous
diseases, does not rely on the administra-
tion of drugs which have the effect of
producing contractions or spasms of the
muscles, but puts his patient in the most
favorable condition possible to allow the
normal action of the nervous system on
the body, and for the response of the
muscular system thereto ; and his thera-
peutical means consist largely of gradual,
wisely limited, and cautious stimulations of
a physical character, such as electricity,
massage, Swedish movement, hot and
cold applications to the spine, etc., etc.,
most of which, some years ago were con-
sidered unworthy of confidence, and were
found chiefly in the hands of charlatans,
being used without scientific or other
than general knowledge of their action.
This paper was written to bring to the
minds of the medical profession a sug-
gestion, and that is, that even now, at
least in the smaller centers, we depend
too largely on drugs, and study the phys-
iological means of the prevention and
cure of disease too little.
Modern Treatment of Furuncles. —
Spohn recommends cotton compresses
saturated with the following solution :
Hydrate of chloral, i dr. ; aqua, glycerine,
aa, 4 dr.
232
TRANSLATIONS AND ABSTRACTS,
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE LIVER AS AN ORGAN OF ASEPSIS — CLIN
ICAL AND THERAPEUTICAL CON-
SIDERATIONS.^
BY DUJARDIN BEAUMETZ,
Member of the Academy of Medicine, Physician to the
Cochin Hospital, Paris.
Translated by J. H. Kellogg, M. D.
(Concluded.)
I WILL now pass to the therapeutic con-
•clusions which follow from the facts which
I have presented.
In diseases of the liver or any infec-
tious maladies of whatever origin, it is
of the first importance to maintain in its
integrity the ability of the liver to de-
stroy the toxines ; we ought even to seek
to increase its activity in this respect.
To accomplish this, two classes of means
may be employed : —
1. To increase the glycogenic function
of the liver, since, according to the re-
sults of physiological experiment, there
is an intimate correlation between its
glycogenic and its antiseptic function.
2. To restrict, as much as possible, the
sources of poisoning of the organism so
as to reduce to a minimum the quantity
of toxines which the liver must destroy.
Let us examine each of these points ;
first, as regards the augmentation or the
increase of the glycogenic functions of
the liver; and I shall dwell upon this
point in another lesson, — that the glyco-
genic function of the liver is diminished
by abstinence from food and elevation
of bodily temperature. With regard to
abstinence, it is necessary that a patient
suffering from febrile disturbances and
disturbances of the liver should receive
as nourishing food as possible. It is
well to be highly nutritious, but it must
fulfill certain conditions of which I will
speak in connection with the second
point under consideration, namely, the
suppression of the causes of poisoning
of the system. We shall see, in fact, in
1 A series of lectures delivered by Prof. Dujardin Beau-
metz, published in the Bulletin General Therapeutique, and
translated expressly for this journal.
relation to this point, that food is one of
the most active sources of this poisoning.
To the necessity of properly nourish-
ing the febrile patient is joined another
necessity, that of lowering his tempera-
ture. In looking at the matter exclusively
from the point of view of the antiseptic
function of the liver, it is necessary to
combat abnormally high temperature.
We may accomplish this double object,
either by baths, cold or warm, — prefer-
ably warm baths in my judgment, — or by
the employment of a group of medicinal
agents belonging to the aromatic series.
But these drugs present the disadvantage
of diminishing the urinary secretions and
thereby diminishing the excretion of the
toxines.
In his experiments, Roger seems to
have demonstrated that glucose, of itself,
modifies the toxicity of vegetable or or-
ganic alkaloids. We may from this fact,
draw the conclusion that sugar, and
glucose in particular, might be advan-
tageously utilized in infectious diseases,
and that it might be necessary to add
sugar to the drinks of patients suffering
from these affections. But this is a point
which requires further investigation.
Still more important is the great ques-
tion which I now approach, that of re-
stricting, as much as possible, the sources
of infection of the system. One may say
that in all affections of the liver, no mat-
ter of what sort, this precept applies.
In the preceding lesson, I have shown
that the animal toxines have four origins :
They are found in the foods introduced
into the digestive tube ; they result from
the fermentations which occur at different
periods of the digestive act ; they are
secreted by microbes which abound in
the intestinal tube ; finally, they result
from the acti«vities of the cell life of the
body.
To these four origins, it is necessary to
add a fifth, a pathological or therapeutic
origin, — toxines manufactured by the
microbic cause of infection, in that group
of diseases to which I have given the
name of toxi-infections.
We sometimes administer poisonous
alkaloids with a curative object.
In the treatment of all patients suffer-
ing from affections of the liver, it is
necessary to use great caution in the
administration of alkaloids by the mouth,
and particularly as regards certain alka-
loids, such as morphia, quinine, and
TRANSLATIONS AND ABSTRACTS.
233
atropia. Only the hypodermic method
should be employed, since it has been
demonstrated that the special destructive
action of the liver upon vegetable alka-
loids is lessened or absent when the liver
is diseased, so that poisoning by thera-
peutic doses of the alkaloids is likely to
occur when these drugs are administered
by the mouth.
As regards the other causes of infection
which I have enumerated above, we are
able to combat or lessen them by three
classes of means: i. By intestinal anti-
sepsis. 2. By encouraging the elimina-
tion of the toxines. 3. By diminishing
the cellular activity. Let us study each
of these means.
Intestinal antisepsis, which constitutes
the basis of this special method of medi-
cation, comprehends in itself three classes
of means : antiseptic drugs, purgatives,
and lastly, alimentary regimen. At the
head of antiseptic drugs must be placed
salol and salicylate of bismuth. I have
already given in my '■^ Noiivelles Medica-
iiones " (2nd series), the reasons which
have led me to consider salol as the best
medicinal antiseptic.
I shall content myself with a brief re-
sume of the reason for this preference :
Salol is but slightly irritant, and always
well supported by the digestive organs.
It is but slightly soluble and decomposes
into phenic and salicylic acids only in
the alkali medium ; that is to say, in the
intestine. If I add that this salicylate of
phenol is relatively but slightly toxic, I
shall have demonstrated the superiority
of salol over iodoform and napthol here-
tofore employed, and which are always
toxic and irritant.
I place salicylate of bismuth on nearly
a par with salol. It agrees well with
both the stomach and the intestine. I
utilize the two substances in the form of
tablets, of which the following is the
formula : Salol, salicylate of bismuth,
bicarbonate of soda, aa 2^ drams.
Divide into 30 tablets.
As to the napthols, I have not aban-
doned them, but I have utilized them in
enemas, employing large enemas with
one quart of the following solution :
Napthol a, 75 grains. Divide into 20-
powders. Dissolve each powder in one
quart of water.
I prefer napthol a to napthol b, be-
cause it is more soluble and more active,
being at the same time less toxic. I am
aware meantime that napthol a, is more
irritating than napthol b, but in a dose of
three grains to the quart of water, these
irritating properties are extremely slight,
and in the great majority of cases this
solution is well borne.
To introduce the solution I do not use
an irrigator, but recommend a very simple
enteroclyster, which has been constructed
forme by Galante, — a fountain syringe
with long rectal tube.
The manipulation is as simple as pos-
sible. One introduces the tube into the
rectum as high as possible, then intro-
duces the liquid slowly, keeping the
patient in a horizontal position. It is of
course understood that the liquid intro-
duced is not to be retained, but must be
discharged almost immediately.
So much for medicaments. I pass now
to the purgatives. Purgatives are useful
only when there exists constipation which
resists the enemas of napthol solution, of
which I have spoken. In these cases it
is necessary to employ laxatives.
You may use cascara and its extract
cascarina, as well as all the purgative
waters, and particularly Spanish waters,
which, owing to the large quantity of
mineral matter which they contain, may
be administered in small doses in the
morning before eating. Such are the
waters of Rubinat, pf Caravana, and of
Villacabras.
The alimentary regimen plays a pre-
ponderant role in the therapeutic group
to which is given the name of intestinal
antisepsis. Here is the triumph of the
vegetarian regimen.
The regimen which I defend, and which
you will find presented in its entirety in
the recent work of Dr. Bonneloy on
vegetarianism, is composed, as you know,
of eggs, milk, farinaceous substances,
green vegetables and fruits, and to enable
you to keep well in mind this regimen,
I here reproduce the formula : The pa-
tient should be nourished exclusively by
milk, eggs, farinaceous substances, green
vegetables, and fruits, a. Take at least
one quart of milk a day. b. Eggs may
be taken in all forms, c. Farinaceous"
foods should be taken in the form of
puree, — puree of potatoes, of beans, of
lentils, milk porridge, gruels, porridges
of wheat, rice, barley, maize, oatmeal,
and macaroni. d. Green vegetables
should be very well cooked. (Puree of
carrots, cooked salads, peas and green
23-1:
TRANSLATIONS AND ABSTRACTS.
beans.) e. Fruits should be cooked,
with the exception of strawberries and
grapes.
If the patient insists upon eating meat
you should permit only well cooked and
gelatinous meats.
You should forbid fish, game, moUusks,
snails, and cheese, because of the toxines
which are rapidly developed by putrefac-
tion in these foods.
You should also forbid fat broths, and
give the preference to lean soups ; the
potash contained in bouillon (beef tea,
meat broths, etc.) is noxious to the gly-
cogenic functions of the liver and also
to its antiseptic functions.
You may permit sweetmeats and con-
fections. You have seen in the preced-
ing lesson that sugar aids hepatic anti-
sepsis.
So much for intestinal antisepsis. The
second indication to fulfill is to eliminate
the toxines formed in the system ; and
this you will accomplish by encouraging
diuresis by the free employment of
slightly alkaline drinks, or by making use
of milk. You should have care, in ad-
dition, to encourage the action of the
skin, recommending ablutions with warm
water to which cologne water has been
added, and even soap for oily skins, fol-
lowing the baths with energetic friction
with a horsehair glove.
Finally, to diminish the leucomaines
resulting from the organic work of the
cells, you will remember that exaggerated
work increases in notable proportions the
production of toxines, and by the ex-
pression '* exaggerated work" I mean
not only muscular but intellectual work.
Thus overwork, which is the cause of
the accumulation of toxines, must be ab-
solutely forbidden.
Such is the summary of the therapeutic
and hygienic means which should be em-
ployed. It remains for me to indicate,
in conclusion in what cases we shall be
able to apply these curative measures.
We have seen that there is correlation
between the glycogenic functions of the
liver and its antiseptic functions. When
I speak of the glycogenic functions of the
liver 1 shall endeavor to demonstrate that
the integrity of the glycogenic function is
itself equivalent to the integrity of the
physiological functions of the liver. The
liver can only act upon the poisons when
in a state of health.
This first conclusion admitted, the
second immediately follows. It is that
all the affections of the liver will modify
to a greater or less extent its antiseptic
action, and when these affections are ac-
companied by lesions sufficiently pro-
found to destroy the hepatic cell, this-
antiseptic function will be destroyed.
Then, in all affections of the liver, we
should employ the means which I have
indicated, since this protective barrier
established between the intestine and
the rest of the body is more or less de-
stroyed.
But while diseases of the liver require
on the part of the physician an antiseptic
plan of treatment, still more do in-
testinal affections, and especially those
which are accompanied by putrid fer-
mentation, require the same method of
treatment to prevent disease of the
liver consecutive to intestinal putridity.
Bouchard, in fact, has shown that in all
patients affected or suffering from dila-
tation of the stomach, to which it is
necessary to add those suffering from
dilatations of the large intestine, as
Trastour and Malibran have shown,
there were intermittent hepatic conges-
tions.
These congestions result from the ex-
aggeration of the antiseptic function of
the liver, by which the destroying action
upon the poisons is very greatly increased
in consequence of the augmentation of
the production of intestinal toxines.
When one follows these cases of dilata-
tion of the stomach or of intestine, he
observes these congestions following di-
gressions from the proper regimen, or
the abandonment of antiseptic medica-
tion.
In presenting to you the subject of
dilatation of the stomach and gastric neu-
rasthenia, I have shown that this con-
gestion of the liver explains in these
patients the renal displacement.
Finally, in infectious maladies with
putridity, to avoid hepatic complications
it is necessary to employ the same plan
of treatment.
In conclusion, do not forget that if the
liver is a destroyer of poisons, it also
produces, especially in certain species of
' animals, a very active toxine. You are
all familiar with poisoning by shellfish.
It is produced by the toxalbumin secreted
by the liver, — mitylotoxine. When I speak
of the biliary function of the liver, and
of urticaria of hepatic origin, I hope to
TRANSLATIONS AND ABSTRAGl^.
235
demonstrate that man also produces,
when the liver has been affected, a toxine
analogous to mitylotoxine, and which
produces, when the bile which contains
it is absorbed by the intestinal mucous
membrane, urticaria of variable inten-
sity. Here, also, for the cure of these
urticaries of toxic origin, the intestinal
antisepsis which I have explained must
be applied.
In the next lecture I shall study with
you, the liver as a bile-making organ.
INTRA-CELLULAR PARASITISM OF CANCEROUS
NEOPLASMS.
BY M. SOUDAKEWITCH,
Prosector of the Institute of Pathological Anatomy, Kieft,
Russia.
Translated, frojn Annales de U Institut Pasteur
by Paul Paquin, M. D.
(See Frontispiece.)
An observing person initiated into the
pathogenesis and the microscopical tab-
leau of the different infectious maladies,
does not easily admit that microbes play
a part in the etiology of the development
of epithelial and connective neoplasms.
Ordinarily, in fact, microbes do not con-
struct; they destroy. The neoplasms
encountered in microbic diseases, are
constituted only by leucocytes and other
mesodermic phagocytes.
In none of these affections do we ob-
serve progressive modifications of the
tissues, such as epithelial tissues, for ex-
ample, and if, in some affections of the
skin, as leprosy, cutaneous tuberculosis,
we observe an intense development of
the papillary layer, it is not to the direct
influence of bacteria that it is due. Mi-
crobes seem to evade epithelial tissue.
The role of microbes in the develop-
ment of acute condylomas {condylomata
acuminata^ is not well established.
It is not astonishing, therefore, that
bacteriological researches have not given
positive results on the subject of the
etiology of carcinomas ; the labors of
Nedophile, Scheurlein, and Koubassow
have -not solved this question, which is
therefore to be renewed.
Within the last five years I have seen
descriptions grow more and more fre-
quent of various bodies in the cancer
cells. A few authors have taken these
inclusions for sporozoa or organisms akin
to them.
Other savants believe that these bodies
are only leucocytes having penetrated
into the cancerous cells, where their pro-
toplasms undergo partial degeneration.
It is evident that we cannot deny the
possibility of a partial degeneration, for
instance, hyalin, fatty or mucous degen-
eration of the cells. The supposition of
Stendener, in 1868, of an invagination of
cancer cells one into another, is also per-
fectly plausible, particularly in view of
the so rapid development of certain
cancers, and the resistance of the ad-
joining tissues. I will nevertheless try
to prove in this article, that most of the
bodies inclosed as described in the
cancer-cells, should be regarded as foreign
products ; I will say, even as true para-
sites belonging to the group of sporozoa.
In examining, from time to time, car-
cinomas operated upon in the surgical
clinic of Prof. Rineck, or emanating
from autopsies, I have often been able
to observe, at some times, intra-cellular,
and at other times, intra-nuclear bodies ;
they appeared as round or oval-shaped
cavities, sometimes with distinct walls.
Rarely, have I seen in them one or sev-
eral central or eccentric granulations.
In the fall of 1890, Prof. Morosoff placed
at my disposal a tumor of the parotid
gland, operated upon by himself. Mi-
croscopical examination demonstrated
the fact that this tumor was a glandular
cancer. It contained numerous intra-
cellular and intra-nuclear inclusions ; we
could find often five or ten on a single
visual field. These bodies had a round
or oval shape, and resisting walls.
Their dimensions differed from that of
a mere point to that of a much larger
spot. It the later cases, the nuclear sub-
stance was completely pressed back and
atrophied. Unfortunately, I found no
contents in these cavities (the tumor was
preserved in MUUer's fluid, and then in
alcohol). During my sojourn in Paris,
I exhibited preparations of tliis cancer
to M. Metchnikoff, who pronounced the
inclosed bodies parasites.
After my return to Russia, I began to
study various cancers, particularly the
glandular cancers. I first examined ma-
terial from the Institute of Pathological
Anatomy, preserved in MUller's fluid and
alcohol, beginning with the numerous
cancers of the mammary gland, examin-
ing always the lymphatic ganglia taken at
the primordially diseased seat.
23G
TRANSLATION^ AND ABSTRACTS.
The sections made with Reichert's mi-
crotome were inclosed in celloidine and
were colored by diiferent methods. I
employed chiefly boric-carmine, taking
for a supplementary color aqueous methyl-
blue, iodinized green, or hematoxylin and
eosine.
I have studied, now, fifty-nine cases of
cancers (of the mammary gland, of the
lower lip, the lachrymal glands, the brain,
the liver, the stomach, the duodenum,
the oesophagus, the tongue, the testicles,
and the rectum).
I have always found inclosed intra-
cellular and intra-nuclear bodies ; in cer-
tain cases they were very numerous, for
example in the carcinoma of the mam-
mary glands. In other cases, they were
more scarce ; there was not an example
in which they were absent. On examin-
ing the preparations, I chose vacuoles
inclosing contents of some sort, without
forgetting the possibility of error, and of
confusion as indicated above.
My observations permit me to give a
plate of figures (see frontispiece) repre-
senting the clearer forms that I have
observed. In order to economize space
and simplify the drawings, I thought I
could occasionally omit the reproduction
of the bodies of the cells and their
nuclei. Fig. i represents the first nu-
cleus which attracted my attention. A
cancerous cell of the mammary gland
contained a regular spherical body which
had been pressed back, and plainly com-
pressed the nucleus. This body ap-
peared as a bubble with resisting walls ;
on the anterior surface of the walls ap-
peared small, bright, rounded grains ;
they were plainly visible because of the
intense coloration of the walls by the
haematoxylon. These bodies inclosed,
were unquestionably strangers to the
cancerous cell, and it was impossible to
confound them with a nucleus or degen-
erated protoplasm, or with leucocytes.
The remainder of the figures are dis-
posed on the plate (up to No. 25) accord-
ing to the gradual march of the complica-
tion of their structure. Each inclosed
body is provided with a more or less
thick capsule. Their forms are varied,
occasionally round (Figs. 2, 3, 19, 23),
at other times irregular, somewhat in the
order of an amoeboid cell (Figs. 9, 10,
II, 12); and again, vermiform (Figs.
13, 14), or semi-lunar (Figs. 15, 16, 20).
In some of them, around the amoeboid
bodies appears an annular layer of finely
granulous substance (Figs. 17, 18). I
have also observed a formation analo-
gous to a nucleus (Figs. 15, 20, 21), and
finally a true nucleus having affinity for
stains, especially nuclear stains (Fig.
22). At last I found in a cancerous
cell, another smaller one having a dis-
tinct capsule (Figs. 27 and 52), or they
may be regarded as double inclusions
(Fig. 53). The contents of the inclu-
sions are sometimes multiple, occasion-
ally voluminous (Figs. 31, 32), and again,
very minute (Fig. ^1,).
In comparatively rare cases, there were
two, three, and even five bodies inclosed
in one cell (Fig. 28). These bodies were
always smaller than when in isolated in-
clusions.
All the figures represented in this ar-
ticle, as well as in another series of ob-
servations by myself, confirm more and
more my idea that the cancerous cells
contain parasites.
In preparations of cancer made at dif-
ferent epochs and preserved in Fleming's
liquid, I have found small cells in those
of a cancer ; they were inclosed in the
interior of vacuoles with distinct walls,
emanating, evidently from the solidifica-
tion of the protoplasm (Figs. 29 and 30).
It was therefore necessary to await
new cases and modify the method of
hardening. In the month of November^
1 89 1, my honored colleague. Dr. Fovor-
sky, met with (in an autopsy in the Mili-
tary Hospital) an extensive carcinoma-
tous condition of the abdominal cavity.
He was good enough to put this material
at my disposition ; it was the pancreas,
which in this case had evidently served
as the primordial seat of the neoplasm.
He found, furthermore, a marked can-
cerous infiltration of the retro-peritoneal
ganglia and the lymphatic ganglia of the
mesentery. The liver, the spleen, the
lungs, and the small intestines contained
voluminous metastasis. The lesions of
the small intestines presented themselves
as round ulcers with borders plainly in-
filtrated. There was a pronounced can-
cerous degeneration of the ganglia of the
right flank. This tumor had the dimen-
sions of a pigeon's Qgg. The anterior
vena cava was plugged 1.5 centimeters,
partly by a pale coagulum of the blood,
and partly by a cancerous thrombus.
I preserved my material, as a rule, in
Muller's liquid, but I also cut off little
TRANSLATIONS AND ABSTRACTS.
23r
pieces in the most typical and non-degen-
erated regions, which were divided into
two parts ; one was placed in Muller's
fluid, the other in a solution of i per
cent of osmic acid. I operated thus, in
order to be able to compare the results
of the two methods.
The pieces remained during two days
in the osmic acid, and were then trans-
ferred to Mliller's fluid for from three to
five days. After a careful washing in
water, they were transferred to alcohol
more and more concentrated, until com-
pletely hardened.
The sections made from pieces which
had not been included in any matter were
easily colored with the old hsematoxylon
of Ranvier.
The pictures which I observed on the
first preparations disappointed me. On
a slightly yellowish background of the
preparation one could see, besides the
nuclei colored as usual, spherical and
regular formations disseminated and col-
ored pure violet, more or less intense.
This coloring was exactly analogous to
that produced by aniline violet.
The structure of the cancerous nodosi-
ties was perfectly typical. In the prim-
ordial seat, the picture of the sound
glandular cancer was observed, while the
metastasis presented a growth of con-
nective tissue, and offered a cirrhotic
character. The cancer cells were dis-
tinguished by their great dimensions ;
their protoplasm was normal, with fine
granulations, sometimes consisting of
brilliant spherical and homogeneous
points. These points did not take color-
ing-matter ; sometimes among them were
dispersed a few drops of fat much smaller
and colored black with osmic acid. We
could observe on the preparations the
progressive transformations of proto-
plasm in homogeneous grains. These
cells which I had previously observed
in other cases, had much analogy with
the hyalin cells of the granulomas of the
rhinoscleroma. However, the granula-
tions of the latter were uniformly fine, and
I had not observed any large gathering.
The violet bodies had very different
dimensions, /. e., from that of a coccus
to that of the cancerous cell itself.
Often, some small or large formations,
olive in color, were visible ; they did not
take on stain. All the inclosed bodies,
with rare exceptions, had a distinct cap-
sule with double contour.
It was rare that two completely similar
bodies were found in the preparations.
They all differed in their dimensions and
in their varied structure. The simplest
body had the aspect of olive rounded
masses of colloidal consistence more and
more complicated.
(To be continued.)
fc — • — *
New Methods in Skin-Grafting. —
A Russian physician, P. Modlinsky,
has succeeded in filling up large spaces-
from which diseased bones have been re-
moved, by allowing the cavity to fill with
blood clot, and then, after the clot has
begun to organize, grafting upon it pieces
of skin of considerable size. He reports
good success.
An American physician has succeeded
in restoring hair to a bald place on a man's
scalp, by grafting portions of hair-bearing
skin from the scalp of a healthy man.
The grafts were made by means of a
punch, and involved the whole thickness
of the skin. Recent experiments seem to
show that it is not necessary, as has for-
merly been supposed, that skin-grafts
should be exceedingly small, only that
*they should consist of the more superficial
layers.
» — •^
Vesication for Incontinence of
Urine. — Harkin has suggested the ap-
plication of a vesicating agent in the
region of the neck, as the best method of
treating incontinence of urine. This is
favorably reported by EnglisTi physicians
who have employed it, it being claimed
that a cure was always found, even in
most inveterate cases which had resisted
all other methods of treatment.
A New Method of Treatment of
Spina-Bifida. — M. Berger recently re-
ported to the French Academy of Medi-
cine a case of spina-bifida involving
the lumbar region of the spinal cord,
in which he had effected a cure of this
defect in development, by opening the
sac and filling the deficiency in the
osseous structure of the vertebrae with
a portion of bone cut from the omo-
plate of a young rabbit. The cure was
absolutely complete at the end of four
weeks, the union of the bone inserted with
the vertebrae being perfect. A paraplegia
which existed before the operation was
not relieved.
238
BACTERIOLOGICAL NOTES
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Medicine, from original sources.]
Some Modes of the Transmission
of the Bacillus of Tuberculosis. —
Prof. Samuel G. Dixon, who has made
a number of experiments on the subject
of tuberculosis, to the end of bringing
about a better sanitary condition in the
country, has demonstrated that in walk-
ing along the streets, or in buildings, such
as railway stations, public halls, etc., the
women's dresses that touch the ground,
raising more or less dust, and gathering
a considerable amount of dirt, also ac-
cumulate dangerous germs. He states
that from one of these dresses dragged
over the streets a few times, he was able
to demonstrate the presence of seven
bacilli of tuberculosis on an inch glass
slide on which a little of the dirt from
a dress had been dusted. He draws at-
tention to the fact that these dresses thus
contaminated, are afterward brushed or
dusted off in the homes, in the ladies'
drawing-rooms, etc., most of which are,
perhaps, more or less poorly ventilated.
It is easy to realize how a sufficient num-
ber of the bacilli of tuberculosis, and
even spores, may thus be liberated in the
air and then inhaled into the lungs.
The Bacteria of Melons. — Dr. Byron
Halstead in the Botanical Gazette, Nov.
II, 1891, describes a disease of melons
and cucumbers on specimens from Ban-
gor, Maine, and the central parts of New
Jersey. To prove that the diseased plants
were suffering from the result of the life
of micro-organisms, numerous inocula-
tions were made with the bacteria found
in the diseased parts. The result was
conclusive. The inoculated parts soon
rotted and became affected in the man-
ner in which the original disease presented
itself. Experiments were conducted also
with seeds. Two lots, consisting of six-
teen seeds, had been planted in two dif-
ferent pots, both of which were placed
in the same conditions and surroundings.
One of the pots was watered with water
containing these bacteria, and only two
germinations resulted, both of which died
shortly, while in the other pot watered
with pure water, the germinations pro-
duced good plants.
A New Diplo-Bacteria found in the
Blood and Urine of La Grippe Pa-
tients.— MM. Teissier, G. Roux and
Pittion, made a report at the Academy of
Sciences, Paris, very recently, concerning
a new pathogenous diplo-bacteria found in
the blood and urine of persons suffering
from la grippe. They had noticed such an
organism as far back as May, 1891, and
had seen then that an intra-venous in-
jection of them into the rabbit always
produced a disease having some analogy
with human la grippe. Since then they
have made a number of experiments, and
have obtained some important results.
Cultures made from blood of patients,
placed in beef broth at 37° C. appear
fertile at the expiration of from thirty-
six to forty hours, and contain ele-
ments in groups and fine chains, short
and immobile, resembling streptococci.
Until October last, these gentlemen had
failed to find anything beside these ele-
ments, but since then, they have seen
them associated with isolated organisms
in the form of diplo-bacilli, occasionally
visible on a fresh preparation, and abso-
lutely like those which they had extracted
from urine the day that (the blood
ceasing to be fertile) the urine primi-
tively sterile, became fertile. They are
not yet ready to affirm that the presence
of these elements are not mere associa-
tions of microbes. The investigators
give a number of experiments on rabbits
which lend color to the theory that acute
poisoning was produced by the injection
of products manufactured by those germs.
Bacteria in Peritoneal Serum of
Strangulated Hernia. — Some investi-
gations have been made as far back as
1883, by M. Nepveu, and later, in 1886,
by M. Gane, concerning the cause of the
peritoneal infection in hernia, and bac-
teria had been observed by them in the
exudation ; but not until M. Bonneken
(Virchow's Archiv. Vol. CXX. p. 7), had
any experiments been made for the pur-
pose of studying the bacteria in their ac-
tion. M. Bonneken experimented on dogs,
in which he purposely produced strangu-
lated hernia. The germs found in the
exudation in all the stages of strangula-
tion, he was able to identify with those
contained in the intestine. The species
of germs that he encountered most com-
monly, are thirteen in number, among
which we may mention the streptococcus
BACTEBIOLOOICAL NOTES.
239
coli, brevi, and gracilis. The bacterium
lactis (aerogenes), and the bacterium coli
co7fimunis. The author has not clearly
determined how the passage of the germs
from the intestines takes place, but it
seems probable that it is through the lym-
phatic vessels.
The Resistance of Virus of Pneu-
monia in Sputum. — Dr. Bordoni-Uffre-
duzzi {Centralblatt fur Bakteriologie, X,
p. JOS) reports his experiments on the
resistance of the germ of pneumonia to the
action of the atmospheric air and light in
buildings. He placed small particles of
sputum on pieces of linen and allowed
them to dry in a room, either in diffused
light or exposed to sunlight, during the
months of May and June. At various
intervals he inoculated rabbits with the
virus triturated in sterilized water. In
the first series of experiments (diffused
light), rabbits inoculated after 2, 5, 7, 8,
and 19 days, died of characteristic septi-
C3emia due to the pneumonia diplococcus
of Fraenkel. Another series of rabbits
inoculated 5, 10, 15, 25, 30, 35, 40, 50,
55 days after dessication, died from the
effects of the germs. Those inoculated
after 60, 65, and 70 days, lived. In the
the third series (sunlight), animals inocu-
lated with dessicated matters, after i, 2,
6, 9, and 12 hours, died. The last, how-
ever, lived until the eighth day, which in-
dicates the attenuation of the virus.
The Action of Muscular Tissue in
Certain Infections. — It is a well-known
fact that muscular tissue contains com-
paratively few microscopical organisms
in most infections. In tuberculosis, for
example, few experimentalists have been
able to discover the bacillus in the mus-
cles. M. Arloing mentions that in forty-
two series of practical experiments with
flesh-juice from forty-five tuberculous ani-
mals, seven only were followed with tu-
berculization.
These facts have led M. Tria to insti-
tute researches with a view of explaining
the cause of this condition. In a report
published in Giornale Internazionale delle
Scienze Mediche, XIII, p. 361, he demon-
strates the following facts about muscular
juice : That the bactericide properties of
blood serum and muscular juice are the
same. The juice of dog meat is slightly
more active than that from the flesh of
the rabbit or of the horse. The microbic
destruction is in proportion to the quan-
tity of bacteria inoculated ; that is to say,
it is more or less complete according
as the micro-organisms introduced were
greater in number or smaller. It is also
found that the slight acid reaction of the
muscular tissue seems to have no effect
in producing this result, because the same
was obtained after neutralization.
The Action of Essential Oil Vapors
on the Bacilli of Typhus, of Tuber-
culosis, and of Charbon. — The bac-
tericide action of the essential oils has
been well established by a number of
experimentalists. Recently, however, M.
Omeltschenko (^Cefttralblatt filr Bakteri-
ologie, IX., p. 8is) has made experiments
which not only confirm the views held
previously, but establish also the quan-
tity of vapors necessary per liter of air.
He arrived at this fact by using specially
contrived culture flasks, and passing
through them air impregnated with the
vapors to be studied. Among the results
obtained he gives the following : The
bacillus of typhus is killed by air satur-
ated with essence of cinnamon or essence
of valerian, in 45 minutes ; o gr. .0005 of
the first essence per liter of air was
necessary, while 0.0082 was necessary of
the second. The bacillus of tuberculosis
is killed by the vapors of cinnamon in
23 hours, the air containing o gr. .018
per liter. It is killed by essence of lav-
ender in 12 hours, o gr. .0078 per liter,
being the amount necessary. The essence
of eucalyptus destroys this germ also in
12 hours, but the degree of saturation
must be o gr. .0252 per liter. Among
his conclusions we find that the vapors
of essences contain a considerable degree
of activity as disinfectants when the air
saturated with it is constantly renewed.
When the degree of saturation dimin-
ishes, the vapors destroy the germs at
the beginning, but after that they only
prevent their growth. Regarding their
germicidal properties, he classifies the
essences according to their strength, as
follows : The essence of cinnamon, the
essence of fennel, essence of lavender,
essence of cloves, essence of thymus, es-
sence of mint, essence of annis, essence
of eucalyptus, essence of terebinth, es
sence of lemon, essence of rose. The
two last-named, lemon and rose, are very
slight disinfectants.
240
EDITORIAL
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
$2.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., May, 1892.
THE AMERICAN MEDICAL TEMPERANCE
ASSOCIATION.
This Association, founded by Prof.
N. S. Davis, M. D., of Chicago, who
has long enjoyed the respect and con-
fidence of the entire medical profession,
and is familiarly known as the father of
the American Medical Association, will
hold its second annual meeting in con-
nection with the meeting of the American
Medical Association at Detroit, June 9.
The exact place and hour have not yet
been determined but will be. announced
later. The object of this association is
thus stated in the '*Plan of Organization
and By-Laws : " —
. ''The objects of the Association are to
advance the practice of Total Abstinence
in and through the medical profession,
and to promote investigation as to the
action of alcohol in health and disease,
and it aims at being a bond of union
among medical abstainers scattered all
over our country. It admits as mem-
bers regular medical practitioners who
are practical abstainers from all alcoholic
liquors as beverages.
''Members are not required to sign
any pledge, but if such, for any reason,
cease to be total abstainers, it is expected
that notice of withdrawal from the As-
sociation will forthwith be sent to the
Secretary. The liberty of members in
prescribing alcohol as a medicine is en-
tirely uncontrolled."
This effort to organize the members of
the medical profession who are them-
selves abstainers from the use of alco-
holic liquors as beverages, and interested
in the promotion of temperance princi-
ples, is certainly a most laudable one.
Dr. N. S. Davis was one of the pioneers
in investigations respecting the physio-
logical effects of alcohol. Nearly fifty
years ago Dr. Davis published the results
of most interesting experiments which
showed the inutility of alcohol as a food
substance, and its deleterious effects upon
the human body. These experiments
were probably the first which clearly
demonstrated the fact that alcohol lowers
the bodily temperature and thus involves
a waste of energy. Richardson and other
experimenters took up this line of inves-
tigation and corroborated the results of
the early experiments of Dr. Davis. It
is certainly very opportune that a pio-
neer in this line of investigation should
be the founder of the American Medical
Temperance Association. A similar as-
sociation has existed in England for
many years, and great good has resulted
from its propagation of temperance prin-
ciples.
At a meeting of the State Medical So-
ciety, Dr. Davis read an able paper in
which he expressed very clearly and em-
phatically his position as regards the use
of alcohol as a beverage and his belief
in its inutility as a remedy. Dr. Davis
would have alcohol discarded not only
from the sideboard but from the dispens-
ing case as well.
While the writer has never taken the
position that alcohol should never be
used under any circumstances as a rem-
edy, he has, in a practice of nearly
twenty years, found few occasions for its
use, and is more and more convinced
that while certain therapeutic effects can
be evidently obtained by this drug, there
are other drugs by which the same results
can be equally well accomplished, so that
it may be eliminated from the list of
EDITORIAL.
241
therapeutic agents, if not without some
inconvenience, certainly without any ma-
terial loss. J. H. K.
VARIOUS MICROBES IN TUBERCULOSIS.
There seems to be a surfeit of preach-
ing on the subject of tuberculosis ; in
fact, we scarcely find a medical journal
which does not present something new or
old on the subject every month. There
is good reason for this continual discus-
sion of the problem, for it is the most
unfortunate, most widely disseminated,
and perhaps one of the most misunder-
stood maladies to which mankind is sub-
ject. In some States, as high as one
fifth of the death-rate is due to tubercu-
losis, while in very few States is it lower
than one fifteenth of the total mortality
per year. In many quarters, physicians
may be classed as fatalists, so far as this
malady is concerned, for they look upon
it as incurable, and direct their efforts to
nothing more than a palliation of the
most distressing symptoms, such as the
alleviation of the cough, night-sweats,
etc. Indeed, they actually give it as
their opinion that consumption, so-called,
is always fatal, and nothing can be done
to permanently benefit the afflicted. As
an English writer has well said, *' There
is no more unfortunate belief extant in
the medical profession."
It is true that the great majority of tuber-
culous persons die, but this does not war-
rant physicians in folding their arms and
contenting themselves with merely offer-
ing a few formal words of sympathy. For
every disease there is doubtless a remedy ;
and if the specific remedy against con-
sumption has not been found, it is not
for us to say that it will not be discovered
some day. Perhaps there is no such thing
as a specific agent to absolutely counter-
act any given disease, but we have very
good grounds for believing that against
every ailment of the human body, there
exists somewhere in nature an antidote
more or less capable of counteracting the
destructive tendency.
Consumption is one of the most com-
plicated maladies to which man is sus-
ceptible. Besides the bacillus of tuber-
culosis, which is doubtless the primordial
living factor in producing alterations
whenever found, there are numerous-
other organisms, in certain organs at
least, which may and do complicate to a
very serious degree the nature of tuber-
culosis. In fact it is doubtful if the
germs of tuberculosis alone could always,
in every susceptible organism, produce
such deadly transformations if they were
not aided by other agents appearing
in the field before or after the appear-
ance of the first lesions. Perhaps every
human being at some time or other has-
inhaled some of the true germs of con-
sumption, and yet comparatively few suc-
cumb to the malady. This indicates a
natural resistance on the part of the ani-
mal organism, and also that the germ
must find a proper soil for development ;,
it cannot grow well without a fertile me-
dium for nourishment. There are many
cases of pulmonary consumption, so-
called, in which, for years, there may
be hacking, spitting, and coughing with
a discharge of considerable muco-pus
and innumerable germs of various kinds,
and no bacilli of tuberculosis can be
found ; but if watched closely, at some
period or other, this microbe also may be
found, and then the disease will progress
rapidly, and death result in a short time.
Is there not reason to suppose that in
these cases other germs than those of
tuberculosis were the agents that pre-
pared the field for the latter to grow ?
Do we not sometimes find chronic cases
of what we term bronchitis, lung-troubles
with cavities even, in which no germ
of tuberculosis can be found, although
numerous other germs are present ? It
would seem that these first lesions are
not due to the bacilli of tuberculosis.
This view is supported by the fact that in
242
EDITORIAL.
some post-mortem investigations in which
the bacilli had not been found during life
serious lung-lesions are sometimes present
without a single one of these germs.
In the judgment of the writer (basing
his opinion on several years' experience
in analyses by means of microscopic in-
vestigations as well as in observations
of patients) there are many cases that
are diagnosed as true pulmonary tuber-
culosis which are not due to the bacilli
of tuberculosis, but are chronic lesions
following some acute or sub-acute lung-
disease, in which other microbes than
those of the bacilli of tuberculosis pro-
duce the alterations. The pus and a
number of other products in the lungs,
often result from the growth of organ-
isms entirely different from the bacilli
of tuberculosis. In such cases it is not
uncommon to find the latter germs ap-
pearing at some state or other of the dis-
ease, hastening the malady to a fatal ter-
mination. The termination might have
been different had this organism not been
introduced. Indeed, persons suffering
from chronic lung lesions sometimes live
to an old age, and at no period can the
germ of tuberculosis be found ; but death
will result more surely and more quickly
if this germ appears after the lungs have
already undergone a considerable trans-
formation. On the other hand, there is
no doubt but that there are many cases
of pulmonary phthisis which begin at the
very outset with the growth of the bacil-
lus of tuberculosis. Possibly the lungs
are always in some way or other prepared
for their reception and future growth,
but it may not be by the action of other
germs ; it may be by such causes as a
cold, during which mucus is exuded from
the bronchial tubes, in which the inhaled
bacilli may adhere and begin to generate.
But after the lungs have been weakened
by these, affected here and there by vari-
ous colonies, the other very numerous
microbes of pus, decomposition, etc.,
arrive and act as secondary causes of
disease and complicate the primordial
malady to a very serious degree.
So, in practice, while it is essential to
remember that the bacillus of tubercu-
losis is the essential cause of true tuber-
culosis, we should consider that there
are doubtless many causes of so-called
consumption in which the lesions are not
due to the bacillus of tuberculosis, —
primordially at least, and sometimes they
never appear during any part of the
malady. In other words, there are two
kinds of phthisis, the one in which the
bacillus of tuberculosis is the essential
and primordial factor, and complications
by other germs may or may not occur
later to any serious degree ; the other, in
which the lesions are due to various mi-
crobes acting subsequently to some weak-
ening agency not related to the bacillus
of tuberculosis. The first is always iden-
tical, and may be readily produced by
inoculation ; the latter produces different
lesions, and is not inoculable in the sense
that we may thereby reproduce any given
set of lesions.
This view of the question is supported by
the theory of the contagiousness of tuber-
culosis. That true tuberculosis is trans-
missible by inoculation, many investi-
gators have established. It is possible,
even, to produce it by inoculating the
pure germs directly into the sound ani-
mal. On the other hand, false tubercu-
losis, or so-called pulmonary consump-
tion in which no tuberculous germs are
found, may be called infectious, inas-
much as germs are factors in the case,
but is not essentially contagious, as the
germs which produce the transformations
are common germs of pus, etc., which
may be inoculated anywhere in the body,
producing local lesions which eventually
disappear entirely, or cause septic infec-
tion of a common character, which may
cause death. The first parasite, I repeat,
is one which produces a disease which,
in its nature, lesions, and termination, is
always identical, even when inoculated in
EDITOBIAL.
243
a state of purity, while the latter parasites
may or may not act independently ; they
produce various disorders, and act as in
a wound, as much or more perhaps by
their association than by their isolation.
This form is not so fatal.
It is necessary, then, in the practice of
medicine, to take these facts into ac-
count, and not jump at the conclusion
that every case of suspected consumption
is truly fatal tuberculosis. Very careful
microscopical analysis should be made in
each case, and the strictest possible in-
quiry of the subjects, both from an his-
torical and from a physical point of view
should take place.
There is great hope for a patient suf-
fering from lung lesions in which the
bacilli of tuberculosis are not to be
found, even though these lesions may
be apparently severe ; and there is hope,
even, for true tuberculous patients, if
their case is diagnosed early. The cli-
matology of various countries has been
so well studied, the various physiological
and medicinal means of treatment so
much advanced, that even truly tuber-
culous individuals may be cured, or at
least the disease may be so arrested that
they may live for years. p. p.
MICRO-PHOTOGRAPHY.
In these days of microscopical research
in all the branches of medical science,
the use of photography for the demon-
stration of the revelations of the micro-
scope would seem a very desirable thing
indeed. At first thought, it would seem
that if one could obtain good photo-
graphs of every section of physiological
and pathological tissue as well as of
the micro-organisms found in connection
therewith, a good deal more satisfaction
would be obtained than by any other
mode of illustration, and science would
advance more rapidly. A few authors
seem to have been impressed with this
idea, and now we have books published
in which micro-photographs play an im-
portant part in the illustrations. So far
as bacteriology is concerned, the results
are usually very satisfactory, but as to
the micro-photographs of sections, in
order to demonstrate the nature of the
tissues entering therein, and to give an
idea of the cellular arrangement, micro-
photography is not a success. Its utility
is only relative. It is reduced to the
role of an auxiliary. It cannot repro-
duce with faithfulness the various super-
posed elements of a section, no matter
how thin it may be. With the very best
of section, with the finest of mount, the
microscopist, in order to study the tis-
sues well, must vary the micrometric
screw up and down in order to penetrate
the substance totally and study each plane
satisfactorily. The superposed planes of
a section cannot be reproduced by pho-
tography ; all that can be reproduced at
one time in one picture, is the plane that
is in the proper focus, and even this some-
times is not entirely satisfactory, for cer-
tain colors in one section will give a
more definite and positive picture than
others.
Elective stains make beautiful mounts
of various shades, but photography fails
thereby to reproduce the arrangement
faithfully. As a result, photographs of
sections of tissue, are not satisfactory
to the student ; they do not present to
the eye the idea that is gathered con-
cerning the structure of a given tissue in
reading a text-book, nor do they present
the appearances that one finds through a
microscope in moving the micrometric
screw while studying a specimen. The
draughtsman, on the other hand, can
draw a section, and superpose the planes
which he observes at successive points of
focus in using the microscope. It is not
without misgivings, therefore, that we
see the tendency in certain quarters, to
substitute micro-photographs for draw-
ings in histology and pathology. Though
we would not discourage the use of pho-
•244
EDITORIAL.
tography in this line, we insist that draw-
ing is still by far the most reliable method
of reproduction of microscopical appear-
ances, in normal and morbid histology.
It is true that one may exaggerate in
drawing, and draw too much on his im-
agination, and thus somewhat mislead
the student, but the arrangement of the
various planes of the sections which are
drawn, even if not absolutely correct, is
far superior to the very best photograph
of one plane of any given section.
p. p.
-^ — • — ■•-
REACTION IN COLD BATHING.
The benefit derived from cold bathing
is not due to the abstraction of heat, but
rather to the stimulation of the nerve-
centers through the action of cold
upon the peripheral nerves, from which
results the so-called reaction following
the application. In many cases, how-
ever, especially neurasthenics, dyspeptics,
and anaemic patients, a good reaction
does not occur, and consequently the
beneficial result desired is not obtained.
The class of patients referred to, usually
dread cold water, and if they can be in-
duced to employ baths at all except for
purposes of cleanliness, insist upon a
temperature so high that the effect is
relaxing rather than tonic.
For many years it has been the writer's
custom to employ, in such cases, a warm
bath just preceding the cold application.
Persons who have a most inveterate dread
of cold water, may be, in a short time,
educated not only to tolerate but to enjoy
applications of a temperature even 40° or
50° below that of the body. A conven-
ient method is to administer a full bath
with a temperature of 100° to 105° for a
few minutes before the application of the
cold spray, douche, shower, rubbing, wet
sheet, pack, or plunge, as the case may
be. The higher the temperature of the
warm bath, the lower may be made the
temperature of the succeeding cold bath.
and the more vigorous will , be the reac-
tion produced. It is important, however,
to continue the cold application a suffi-
cient length of time to produce a strongly
tonic condition of the blood-vessels of the
skin, otherwise the patient will perspire
so freely as to require a second cold ap-
plication, which is .not likely to be fol-
lowed by so good a reaction as the first.
J. H. K.
• — • — ^
The Effect of Warm Baths upon
Assimilation. — The beneficial effects of
baths upon assimilation has been recog-
nized empirically from the most ancient
times. It is only very recently, how-
ever, that this subject has been made a
matter of experimental inquiry with the
employment of the exact methods of the
physiological laboratory, so as to place
this class of therapeutic agents upon a
thoroughly scientific basis.
Winternitz, of Vienna, has done much
most excellent work in the determination
of the physiological effects of baths em-
ployed in various ways. Within the last
year or two, some very interesting obser-
vations liave been made by a number of
Russian and other experimenters.
Faddeeff found that the Russian bath
produced in a healthy person an in-
creased assimilation and disintegration
of protes, which is doubtless due to the
stimulating effect of the elevating tem-
perature of the bath.
Grusdew found that the Russian bath
increased the assimilation of the minerals,
especially lime and iron.
Zawadski found that daily tepid baths,
95° F., produced an increased assimila-
tion and dissimilation of protes, and an
increase in bodily weight.
Karvkoff showed that the assimilation
of fats is notably increased by warm
baths.
In view of such facts as these, it is sur-
prising that this important therapeutic
agency should be so much neglected.
The probable cause is a lack of a knowl-
edge of the exact conditions under which
EDITORIAL.
245
"baths of varying temperatures should be
employed, and especially the most uni-
versal lack of convenient means for the
use of this remedy. It is true that the
warm bath may be taken at home, but its
value is greatly lessened when the advan-
tages of a skilled bath attendant cannot
be had in connection with it. j. h. k.
Reviews.
Natural Resistance to Infectious
Diseases. — It has been known, in a gen-
eral way, that the weakening of the or-
ganism tends to lower its natural resist-
ance to infectious diseases. All causes,
in fact, which diminish the natural forces,
and in any way interfere with the full,
strong, natural, physiologicaJl actions of
the economy, favor the receptivity of
micro-organisms and modify the natural
power existing in individuals to resist in-
fection. A great number of experiments
and observations have been made to de-
termine the susceptibility to infection of
animals under various conditions, such
as under fatigue, hunger, etc. Experi-
ments concerning the influence of absti-
nence in lowering natural resistance to
infections have been made recently by
MM. Canalis and Morpurgo. They used
the bacillus of anthrax in their operations,
and demonstrated that in the majority of
cases the organism is very much more
susceptible to disease when it is in want
of food, than when nourishment has
been satisfactory. In several series of
experiments, the results pointed to the
same conclusion, except in some instances
of the inoculation of white rats.
It is important to note that in the
treatment of general infectious diseases,
food ought to play a most important part,
and that it ought to be as natural, as easy
of digestion, and as simple as possible,
thus not overloading the stomach, and yet
giving the body proper and ample nourish-
ment to sustain the natural forces, realiz-
ing thereby the conditions most favorable
for rejecting contagion and infection.
p. p.
Manuel Populaire des Premiers
Soins a Donner aux Maladies et aux
Blesses Avant L' Arrivee du Mede-
din. — This popular manual of the first
care for the sick and wounded before the
arrival of a physician has been prepared
with great care by a commission ap-
pointed by the Society of Hygiene, promi-
nent among whom we note the eminent
Dr. Pietra Santa, the Secretary of the
Society. Among the leading chapters
are, '' General Care in case of Accident,"
'^ Contusions, Sprains, and Dislocations,"
^'Wounds," ''Foreign Bodies in the
Ear," ''Foreign Bodies in the Eye,"
'* Foreign Bodies in the Nasal Cavity,
the Stomach, Respiratory Passages, etc.,"
"Hernia," "Hemorrhages," "Fract-
ures," "Burns," "Insolation," "Freez-
ing
" a
Drowning," "Hanging," "As-
phyxia," " Fall with Loss of Conscious-
ness," "Apoplexy," "Epilepsy," " Pois-
oning," and "Death." We have perused
the work with much pleasure, and would
like to see it translated into English.
Bacteriological Diagnosis. — By
James Eisenberg, Ph. D., M. D. Trans-
lated by Norval H. Pierce, M. D.; F. A.
Davis, Publisher, Philadelphia. Price,
;^i.5o. This translation is not as good as
the original, if we are to credit the ap-
proval of the latter by German writ-
ers. The work, as a whole, presents
some very useful points, and is a handy
guide book, but it presents, unfortu-
nately, some serious errors that may work
harm if we depend upon it for diagnoses. ,
From a bacteriologist's standpoint we
hope that a future edition will soon ap-
pear, from which these mistakes will be
eliminated.
The Hygiene of Consumption. —
By W. John Harris, M. D., I. H. Brown
& Co., Publishers, St. Louis, Mo. This
little book contains most important in-
structions on the subject of consumption.
It is written in plain language, suitable
246
BEVIEW8.
for all classes of readers. It will do
good. But we regret to see in its pages
an evident attempt to discredit the ad-
vances of science concerning the action
of the germ of consumption, the bacil-
lus tuberculosis. In his chapter on the
germ theory the author says, ''It may be
safely said that this specific germ (mean-
ing the bacillus of tuberculosis) does not
exist in the sputa until the disease is well
advanced." The reviewer has analyzed
sputa for the diagnosis of consumption
for seven or eight years, and has many
times encountered ''this specific germ"
almost at the very outset of tuberculosis,
— months earlier than the diagnosis
could possibly be made by any other
means.
The author lays much stress on the
point that there must be a field for the
germ of consumption to grow, and that
this field can be prepared by wasting dis-
ease, exhaustion, overwork, etc. This
is very true and proper. Yet it should
be remembered that in our methods of
living, at least fifty per cent of the peo-
ple always present the conditions enu-
merated, and are therefore always more
or less prepared to develop this germ
wherever it may be "waiting to find
lodgment." It is not true that the
bacilli of tuberculosis are found only
"after suppuration has begun." A fresh
tubercle at its incipiency, presents no
evidence of suppuration as meant by the
author, and yet it contains the bacilli.
Suppuration in consumption is not the
exclusive result of this particular germ,
but is the fermentation, if I may so
speak, of tissue previously affected.
This suppuration is the result of many
kinds of microbes, most of which are
inoculable under certain conditions.
The inoculability of tuberculosis has
been again and again positively proven
by inoculation by inhalation in animals
in the very best of conditions, physio-
logically speaking. The writer himself
has repeatedly produced such cases, and
the bacilli were present from the very
beginning.
The researches of the past twenty
years, the experience of medical scidn-
tists, and the great majority of prac-
titioners do not warrant the conclusion
that the bacillus of tuberculosis is not to
be feared. Dr. Harris firstly points out
the various conditions preparing the
field for the germs to grow, but he should
lay equal stress on the fact that this plant
will grow if the germ is not present.
This question is so important for all
mankind that arguments in favor of any
exclusive theory, as well as the follow-
ing of any special view in our attempts
to cure and prevent the disease, are out
of place. Justice, humanity, science, de-
mand that we direct our batteries at every
possible point of invasion. The germ is
a formidable factor ; indeed, without it
there is no tj-ue tuberculosis , though there
may be many cases of so-called con-
sumption. We must, therefore, if we are
true physicians, take this into account.
Epitomes of Three Sciences. — By
H. Oldenberg, J. Jastrow, C. H. Cornill.
The Open Court Publishing Co., 169 La
Salle St., Chicago, 111. This is a most
instructive little volume, giving an ac-
count of the work done in three different
fields of modern knowledge; viz., Com-
parative Philology, Experimental Psy-
chology, Old Testament History. These
three subjects have a most important
bearing on the religious thought and
views of our time. The little book is
what many will hail with pleasure. Price,
75 cts.
Homilies of Science. — By Dr. Paul
Carus, Open Court Publishing Co. In-
structive essays by a profound philoso-
pher. They are eight in number : Re-
ligion and Religious Growth ; Progress
and Religious Life ; God and World ;
The Soul and the Laws of Soul Life ;
Death and Immortality ; Free Thought,
Doubt and Faith ; Ethics and Practical
Life; Society and Politics. Price, $1.50.
T this Season of the Year,
thousands of Invalids are
seriously considering the
question, —
WHERE
SPEND THE
SUMMER
Where Can I Spend the Months of
July and August, and part of September,
with the Greatest Profit and Satisfaction ?
HE ANSWER
to this question depends
on what the individual
wishes to accomplish by a
summer vacation. If
change and recreation
only are desired, these can be found in a thousand places — at
health and other resorts which abound in almost every State in
the Union, none of which, however, excel the delightful re-
sorts of northern Michigan.
If, in addition to rest and recuperation, the invalid needs a careful study of
his diseased conditions, and an intelligent regulation of diet, exercise, and all other
health conditions, — in other words, scientific health culture, efficiently carried out
by the aid of the best known medical means and appliances, thoroughly trained
nurses and attendants, and competent physicians, — then the choice between the most
desirable places becomes very much restricted. - There are certainly few institutions
in this country where the needs and desires of an earnest health-seeking invalid can
be satisfactorily met. Such places can be counted on the fingers of one hand, and
are. perhaps, little known because of the fact that the managers of such institutions
are conductir\g them in a scientific, and in some instances a philanthropic spirit, and
consequently do not employ as a means of winning patronage, the emblazoned ad-
vertisements, the truth-sacrificing circulars, and other advertising methods com-
monly resorted to by the proprietors of mineral springs establishments, bogus
sanitariums, and other so-called * ' health institutions ' ' and quasi-medical establish-
ments, with which the country abounds.
• The advertisements of these establishments do not appear in public prints or
popular magazines because such advertising is closely akin to quackery, and brings
those who employ it into bad company.
The managers of the Sanitarium at Battle Creek, Michigan, many years ago
undertook to organize a thoroughly scientific institution which would represent
rational medicine in its most advanced form, and would be exactly what it professed
to be — an institution where patients are honestly and fairly dealt with, treated at
reasonable rates, given kind attention and comfort, and opportunity for the recovery
of health under the most favorable conditions. The majority of patients treated in
this institution are sent to it by physicians who by personal acquaintance, or
through the reports of their patients, have become thoroughly familiar with the
character of the institution and its management.
BRIEF DESCRIPTION
OF THE
SANITARIUM.
_ - - - - -
ATTLE CREEK, one of the most beautiful and prosperous cities of Michi-
^ gan, is centrally located in the salubrious Peninsular State. Its population
is 20,000, while its death rate is but seven per thousand. Battle Creek is
situated on two great thoroughfares of railway travel between the East and
the West, being at the junction of the Grand Trunk and the Michigan Central lines ;
and two other railways make it easy of access from the South.
The city has an electric railway and is lighted by electric lights. A great
number of pleasant drives are afforded by its well-kept and shaded streets.
The -Buildings are lighted by a 700-light plant, Edison incandescent system.
Safety Hydraulic Elevators. Outside stairways for fire escapes accessible from
every window.
The Institution affords facilities for baths of every description : Turkish, Rus-
sian, vapor, electric, water baths of all kinds, and the electric light bath. In-
dependent accommodations for ladies and gentlemen, sufficient for 80 persons
at one time. More than 800 feet of glass for sun-baths.
A General Parlor, 40 x 50 feet, is luxuriously furnished with Dhagistan rugs,
easy chairs, etc. The Dining-Room has a seating capacity of 400, is beauti-
fully lighted and ventilated, and always cheerful. No kitchen smells. Cui-
sine unsurpassed ; table service excellent. Everything an invalid needs, and
special dietaries prepared as directed.
VIEW OF GOGUAC LAKE FROM SANITARIUM LAKESIDE GROUNDS.
The Gymnasium, 85 x 45 feet, is supplied with every appliance for exercise, and
furnishes special instruction and class drills in Delsarte and Swedish gymnas-
tics, under a trained director. Exercise by prescription.
The Swedish Movement Department, both manual and mechanical, is the
most extensive in the United States. Vibrating bars and seats, kneaders, rub-
bers, beaters, shakers, and manipulating appliances of all sorts.
The Electrical Department contains every improved appliance for medical ap-
plications of electricity. Galvanic, Faradic, Dynamic, and Static electrical
apparatus and appliances for electrolysis, electro-cautery, etc.
An Aseptic Maternity on the cottage plan ( steam heat and thorough ventila-
tion), provides the best possible conditions for lying-in patients, with expe-
rienced professional attendance and rigorous aseptic management.
Special Departments for surgical cases, eye, ear, throat, and lung diseases,
nervous diseases, genito-urinary diseases of men (non-specific), opium and
alcohol habits, and diseases of women. A kindergarten and nursery, to keep
the children happy and out of mischief.
SUMMER HOUSE AND FRESH-AIR INLET.
Three Fine Greenhouses, maintaining a
magnificent collection of palms and va-
rious tropical flowers and plants, keep the
house filled with bloom during the win-
ter season. Flowers are everywhere in-
doors during the winter season. Patients
can visit the greenhouse at any time
without going out of doors.
Glass=Inclosed Sun-Parlors and Veran=
das for winter sunning and promenad-
ing.
Pure Water from sandstone rock.
There are from 250 to ;:500 Employes in the Sanitarium service the year
round, of whom from 90 to 100 are medical attendants and nurses. Also seven
thoroughly trained physicians, and a large corps of manipulators skilled in
massage and the Ling system of Swedish movements.
The Sanitarium Training=School, in which our nurses are trained, is the
largest and most popular in the United States. Its course of training is
the most complete and
thorough of any school.
Tri= Weekly Lectures on pop-
ular medical subjects by
the physicians.
Abundant Means for Rec=
reation indoors during
inclement weather. Facil-
ities for walking, driving,
and horseback riding at all
seasons.
The Sanitarium is Not a
Pleasure Resort nor a
fashionable hotel, but an
ideal place for invalids
needing good nursing, the
benefits of regular habits
and scientific professional
care and treatment, and who desire to get permanently well.
The Sanitarium Nursery and Kindergarten. This enables mothers to bring
little ones with them without being burdened with their care and supervision.
The children have the advantages of kind and experienced teachers and am-
ple playgrounds.
For Further Particulars, see large circular and card of rates.
J. H. KELLOGG, M. D., Supt.,
Sanitarium, BATTLE CREEK, MiCH.
x./
..-r-"
^^^^rf?**^^'
ON THE LAWN.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
IMONO^HIvY BUI^IvETTIN.
Battle Creek, Mich., May, 1892.
THE ROLE OF MICRO-ORGANISMS IN THE
PRODUCTION OF GAS IN THE ALI-
MENTARY CANAL.
The formation of gaseous matters in the ali-
mentary canal is a verycommon thing in health
and in disease. Though usually considered as
a mere unpleasantness in health, it often consti-
tutes really a more serious condition, particu-
larly when the production takes place in the
stomach, as in cases of sudden and acute indi-
gestion. In disease it is always of a grave
character and often is a most aggravating
complication. The Director of this Labora-
tory^ has made researches on this question,
lasting many months, and from the results ob-
tained (though the work is unfinished) feels
justified in formulating some opinions.
Gas Formation in Healthy Individuals.
— In the first place, we should remember the
physiological condition of the stomach. In
health, this organ secretesacidgastric juice, the
quantity of hydrochloric acid in it being con-
siderable. Food can be properly digested by
this juice only when the acid named is right in
quantity and the gastric secretion as a whole
is normal. In other words, proper digestion in
the stomach depends on normal work done by
it and normal secretion into its cavity, pro-
vided always that, on the other hand, the food
digested be not abnormal in quantity and qual-
ity, and that it be not swallowed too rapidly.
I need not remind the reader here that the di-
gestion of only abuminoids can take place in
contact with gastric juice.
On this basis, we can formulate by way of
repetition the following proposition : —
First, That satisfactory digestion of food
can take place only when the gastric secretion
is normal in every respect.
Second, That the food must be of proper
quality and quantity.
1 Paul Paquin, M. D., Sanitarium Laboratory, Battle
Creek, Mich.
Third, That it must not be too rapidly in-
gested.
Now all these conditions on which proper di-
gestion depends, could only end in more or less
complete failure of this act if some other fac-
tors did not enter to complicate matters. The
portions of food that failed of digestion would
inconvenience the system perhaps, but would
pass on and be expelled from the economy with
the feces. What is it that complicates matters
so as to make indigestion, no matter how trifl-
ing in appearance, a very serious question? It
is the transformation of some of the food
into various products. The digested food is
appropriated by the economy and utilized to
feed the tissues, but the undigested food is de-
composed, and serves to form different sub-
stances among which are the different kinds
of gas.
We could here with propriety go into the con-
sideration of the different products of the de-
composition of food in the alimentary tract,
and point to numerous poisonous substances
which are generated to the great damage of the
organism. These cause headache, melancholia,
dreams, irritation in the kidneys, etc., and
very likely produce also alterations of such
serious nature in the nervous tissues, as to
play a most important part in the causation
of various forms of insanity. But I wish to
consider this time only the production of gas.
It has been suggested that bacteria are the
agents which produce it in the digestive organs,
and some physicians insist on this assumption
without regard to the locality in which fermen-
tation occurs.
For those who know something of the life of
bacteria, it will be readily observed that this
opinion is too broad and sweeping. In fact,
the normal gastric juice contains too much
acid to allow the growth of bacteria. Not
only that, butit actually destroys them in a very
few minutes. So, a great modification of this
fluid must take place before bacteria proper
can grow in the stomach sufficiently to pro-
duce gas in inconvenient quantity. It must
(251)
252
LABORATORY OF HYQIENE.
be impaired by disease or largely diluted with
great quantities of fluids, or the microbes must
be protected against the acid in great masses
of food stuffs. This idea is largely theoretical,
but is a logical deduction from the fact that
the hydrochloric acid of the stomach is a bacteri-
cide. Indeed, if we consider, furthermore, tiiat
bacteria do not as a rule develop at all in acid
substances, for the very reason of the acidity
itself, we can theoretically go further and say
that, in the stomach, unless the gastric juice is
so deficient as to be without hydrochloric acid
— a condition scarcely compatible with life —
bacteria are never the agents that produce
bloating of the stomach.
The writer has made numerous experiments
on the subject, and concludes that gas in the
stomach is produced by fungi introduced with
the food, and at other times under certain con-
ditions, by purely chemical combinations of
certain food elements and elements in the
gastric juice. Every experiment and observa-
tion eliminates the microbes entirely from the
phenomena, even in dyspeptics with greatly
impaired gastric juice.
This view is supported by the fact that fungi
are fermentative agents that may (contrary to
-microbes) grow in presence of acids. But even
they are not liable to produce much fermenta-
tion in the stomach unless the gastric juice is
deficient, or is very largely diluted, or masked,
as it were, by excessive ingestions of easily
fermentible substances, such as fruits and
grains.
Meats are, doubtless, bad elements of food
for those subject to gas on the stomach after
meals, but my experiments pointed to vegeta-
bles as being incomparably more suitable for
fermentation in this organ. This is supported
by what is generally known concerning the
nutrition of microbes and fungi respectively,
the former living better on animal foods and
the latter better at the expense of vegeta-
bles, from which they can produce enormous
amounts of gas. It is only necessary to re-
member the immense quantity of gas that is
produced by fruit, grain (and flour) fermen-
tation to realize this. If' one introduces at
the same time gas-producing fungi into beef
broth or a piece of meat sterilized, and into
vegetable broth or flour or paste sterilized, it
will be made apparent that while the produc-
tion of gas is insignificant in the meat sub-
stances, it is very marked in the vegetable
media.
Consequently, so far as the stomach itself is
concerned, bacteria proper have little if any
thing at all to do in the production of gas, and
the media in which they develop best, i. e., the
animal substances, offer a" poorer soil to the
fungi that may grow in the stomach than da
vegetables.
This is a question of great importance and
significance in the treatment of certain forms
of dyspepsia. I shall say nothing positive here
on the very marked production of gas in the
stomach of persons in which nei ther bacteria nor
fungi can safely be claimed as active agents. In
such cases, the gas begins to form sometimes
instantaneously, while yet eating a meal, two
facts which exclude the acts of living micro-
organisms as factors. I think that chemistry
alone can explain this particular form of gas
production.
Gas in the Lower Intestines. — If bacteria are
practicalh" harmless in the stomach, it is not
so in the intestines, beyond the parts in which
acidity may descend. Here, too, gas may be
produced, but may be by the action of bacteria
proper. Here all kinds of matters may form
the basis of supply for its production. Any
one who understands physiology will realize
readily, however, that the gas of the stomach
and that produced in the intestines vary mate-
rially, both in composition and in quantity.
Besides this, gas in the stomach is usually a
more serious thing in every respect than gas in
the bowels; it is serious by reason of its very
presence, and on account of the obvious disor-
ders which it suggests in the structure and
functions of this indispensable organ.
From the fact that gas, in the smaller bowels,
is not a serious thing compared with its pro-
duction before food reaches the duodenum;
considering that it is a phenomenon of de-
composition and transformation in a portion
of the body obviously meant for this kind of
work; considering that gas herecannot usually
cause anything like the serious complications
that may arise in the stomach, and that it
does not suggest any serious organic disease,
I will not consider it further. I wish only to
point, partly by way of recapitulation, to
some important indications of the foregoing
researches.
First, fruits, grains, etc., under the action
of fungi that may grow in the stomach, may
produce gas in marked quantity ; meats do not.
Second, the condition of the stomach, or the
quantity of food ingested must be abnormal
before gas can be produced in any great quan-
tity. Third, bacteria proper are not the agents
that produce gas in the stomach, but they pro-
duce some in the bowels below. Fourth, there
seem to exist conditions in which gas is pro-
duced independently of any foreign vegetation,
and is likely the result of purely chemical ac-
tion. This I submit as an hypothesis.
LABORATORY OF HYGIENE.
253
The practical suggresfcions of all this is that
raw fruits, like apples, peaches, pears, — all of
which have been tested by the writer, — should
be peeled, or at least washed before eating, thus
avoiding the ingestion of the numerous living
ferment-producers alwaj's to be found in them.
Fermented bread should be avoided, as the
yeast plant, at least in the center of the mass,
is not always destroyed by cooking, and may
ferment again in proper temperature and me-
dium. In other words, judgment should be used
in excluding from the diet of those subject to
bloating of the stomach, all substances that
ferment easily. Besides this, it is well to re-
member that the mouth and various foods con-
taining Igerms may serve as vehicles for the
dissemination of fungi and other micro-organ-
isms. The mouth should be washed before
each meal ; the more aseptic the food the better
for those suffering in any degree from impaired
digestion.
Technique.
STAINING TUBERCLE BACILLI IN SECTIONS.
W. C. Borden, M. D., U. S. Army, in New
Orleans Medical and Surgical Journal, says : —
"The method of staining the bacillus tuber-
culosis, which is hereinafter given, is not origi-
nal with the writer, but on account of its cer-
tainty and comparative ease of working, it is
thought worthy of record. It is the method
now used in the Army Medical Museum at
Washington, D. C, having been adopted by
Dr. Wm. M. Gray, the microscopist of that in-
stitution, after exhaustive trials of other meth-
ods; first, on account of its certainty, and
second, from its allowing of all the manipula-
tion being made with the sections cemented to
the slides, so avoiding the tedious and often-
times damaging handling of the sections with
section-lifters.
"Certainly a method which insures certainty
of result, and provides for the handling of the
sections cemented to the slides so that no part
of them can be torn or lost, offers most obvious
advantages — advantages which will at once be
appreciated by workers conversant with mod-
ern methods of imbedding and sectioning.
"In practice, the tissue to be stained should
be hardened, preferably in alcohol, in pieces not
exceeding % by % by % inch in size, though tis-
sues hardened by any of the regular methods
can be stained. Alcohol is to be preferred, how-
ever, as after its use the bacilli stain more
quickly and brilliantly than when one of the
other hardening fluids, Mujler's for instance,
is employed. If it is desired to examine the
tissue elements, it is well to harden pieces of the
same tissue in Miiller's fluid, and after section-
ing, to stain the sections in suitable dyes for
comparison with the sections hardened in alco-
hol and stained for bacilli. This would, of
course, only be necessary when critical exami-
nation of cellular form was to be made, as the
contrast stain employed in the bacilli staining
process differentiates the tissue elements with
all the distinctness necessary for locating the
relation of the bacilli to the cells.
"After the tissue has been hardened, it is im-
bedded in paraffine, and sectioned in the usual
manner. The sections are then cemented to
the slides with a % per cent solution of gold
label gelatine, made by dissolving 14^ grains
of the gelatine in six ounces of warm water,
then adding 30 grains of chloral hydrate as
preservative, and filtering. Several drops of
this are placed on a slide, a section laid on
top, and the slide placed in a warming oven,
kept at a temperature slightly below the melt-
ing point of the paraffine. In about five min-
utes all wrinkles will have been taken out of
the section, which will lie perfectly flat and
smooth on the surface of the gelatine solution.
The slide is then removed from the oven and
the surplus fluid poured from it, so bringing
the section down into contact with its surface,
after which it is set aside in a place protected
from dust, to remain until the section is flrmly
cemented to it by the drying of the gelatine
solution. The drying may be hastened by
keeping the slides in an oven below the melt-
ing point of the paraffine, but it is best to set
the slides aside until the next day, when the
sections will be found to be perfectly cemented
to them. The paraffine is then removed from
the section by turpentine, the turpentine by
absolute alcohol, the absolute alcohol by 50
per cent alcohol, and this by water, after which
the slides are placed in a 5 per cent aqueous
solution of potassium bichromate for five min-
utes. This renders the gelatine insoluble, and
prevents the sections from leaving the slides
during their necessarily more or less prolonged
immersion in thefuchsin stain. The potassium
bichromate is washed out with water, and the
slides are then placed in a fuchsin stain, which
is prepared as follows: —
"Fuchsin, 1.5 grammes; absolute alcohol,
14c. c; carbolic acid crystals, pure, 6 grammes;
water, 100 c. c.
"Dissolve thefuchsin in the alcohol and the
carbolic acid in the water. Mix the two solu-
254
LABORATORY OF HYGIENE.
tions and let stand for twelve hours, with oc-
casional shaking or stirring, then filter.
" The slides are left in this solution a sufficient
length of time. In tissues j)roperl.v hardened
in alcohol the tubercle bacilli stain very quickly,
generally five minutes being sufficient to stain
them deeply, but in tissues not especially pre-
pared by proper hardening, a longer time will
be necessary. For such tissues, or where ab-
solute certainty of staining is desired, the sec-
tions should be left in the stain twenty-four
hours. Prolonged immersion in the fuchsin
stain does no harm and insures certainty of
results. After a section has been in the stain
a sufficient length of time, it, with the slides to
which it is cemented, is washed in water (under
a tap if desired) until the surplus stain is re-
moved; it is then plunged into the combined
decolorizer, and contrast stain made as fol-
lows:—
"Methyl-blue, 2.25 grammes; absolute alco-
hol, 30 c. c; sulphuric acid, 12 c. c; water,
100 c. c.
" Dissolve the methyl-blue in the alcohol, add
the acid, mix the two solutions, and let stand,
with occasional shaking or stirring, for twelve
hours, then filter.
"The slide is moved up and down in this
solution for a few seconds, and the section
then viewed by transmitted light by holding
the slide up between the operator and the
sky. As soon as the blue coloration from
the methyl-blue solution predominates over
the red color of the fuchsin stain, the section
is immediately washed in water.
"Generally, the red color will at once return,
and if it does, the section and slide must be
again plunged into the methyl-blue solution,
and again washed.
"This alternate immersion in the methyl-blue
stain, and washing in water, should be con-
tinued until, when washed in water, the red
fuchsin color scarcely returns, as it is seen that
the red stain has been permanently nearly re-
placed by the blue.
"This part of the process is the most diffi-
cult, and can only be mastered by successive
trials. Generally, it is the tendency of a be-
ginner not sufficiently to replace the fuchsin
with the methyl-blue, in which case the red
color of the bacilli will so blend with that of
the tissues as to render them invisible. Once,
however, the operator has acquired the proper
experience, he will have no further trouble.
When the section is sufficiently decolorized and
stained in the methyl blue, it is thoroughly
washed in water to remove all traces of the
acid, for upon this depends the permanency of
the stain. It is then, at once, dehydrated with
absolute alcohol. The section should not be
passed through diluted alcohol, but, after wip-
ing the surplus water from the slide, it should
be at once plunged into absolute alcohol, or
else enough of the alcohol should bo poured
over it entirely and speedily to dehydrate it.
The alcohol is removed with turpentine, and
the process completed by mounting in balsam
thinned with xylol.
" In case it is desired to stain sections cut by
the freezing method, they are placed upon a
slide on which a few drops of the gelatine fixa-
tive have been placed, and after about five min-
utes, during which the fixative will have pene-
trated the section, the surplus is poured from
beneath the section. The slides are then set
aside for the gelatine to harden by drying, and
after drying they are placed in bi-chromate
fluid to render the gelatineinsoluble. They are
then manipulated in exactly the same manner
as^the sections cut by the paraffine method.
"The process thus given in detail appears
formidable, but in fact is easily carried out by
one conversant with laboratory methods.
"The details have been carefully given, for it
is by attention to them that the desired result
of certain and clear staining of the bacilli is
obtained. In this method, and especially after
paraffine imbedding, the section being firmly
cemented to the slide, no part of it is lost or
torn, as is usual when handling by the method
generally described. In the case of pulmonary
tuberculosis, even the cells, from the accom-
panying catarrhal pneumonia, which lie loose
in the alveoli, are shown in place, and the bac-
illi, which some of them contain, are clearly
demonstrated.
"The stains given are also most excellent for
staining sputa, and are to he particularly rec-
ommended on account of their certainty. With
them sputa can easily be stained in five minutes.
The sputa must be dried and flamed on the
cover-glass as usual, and a few drops of the
fuchsin stain applied, and thecover-glass heated
until steam is given off.
"After washing in water, immersion for a sec-
ond in the acid methyl-blue solution, and again
washing in water, microscopic examination can
be at once made by wiping the clean side of the
cover, and placing the still wet sputa side down
on a slide. If bacilli are found, and it is desired
to preserve the specimen, the cover is removed
and allowed to dry, after which it is mounted
with xylol balsam.
"The method for sections is also applicable
for tissues containing the lepra bacillus, they
being stained with as much certainty and brill-
iancy as are the tuberculosis bacilli in tissues
containing the latter."
AB VERTI8EMENT8.
Farbenfabriken vorm. Friedr. Bayer & Co.'s
Pharmaceutical Specialties
255
Phenacetine=Bayer
Antipyretic
Analgesic, or
PHENACETINE-BAYER IS A TRUE AND DIS-
TINCT ORGANIC DERIVATIVE, not a mechan-
ical mixture. It is indicated in influenza (la grippe),
in all fevers, with or without pain, rheumatism and rheu-
matoid maladies, neuralgia, bronchitis, phthisis, pertussis,
Anodyne ^^^ the gastralgias. Phenacetine-Bayer acts promptly,
and is both safe and effective. It is supplied in ounces.
tablets and pills.
Sulfonal=Bayer
Hypnotic
Antineurotic
Nerve Sedative
Europhen
Antiseptic
Antisyphilitic
Local Stimulant
Aristol
INSOMNIA OF ALL KINDS YIELDS PROMPTLY
TO SULFONAL-BAYER. It is useful in simple
insomnia and in the cerebral disturbances of insanity.
It is a pure hypnotic, a safe and effective remedy, and
it does not give rise to a drug habit. As its action is
slower than that of the narcotics, it must be adminis-
tered properly {see pamphlet). Sulfonal-Bayer is suppliea
in ounces, tablets and pills.
(A CRESOL^IODIDE lODOFORfl SUBSTITUTE)
AS A SUBSTITUTE FOR IODOFORM, Europhen
is winning an enviable place in therapeutics.
It has a special value in specific lesions; while as
a surgical dressing in ulceration, open wounds, and
septic conditions of the cavities, it has given excellent
results. It is supplied in ounces. Europhen-Aristol,
a combined product consisting of equal parts of each
medicament, is also supplied in ounces.
(A THYMOL=IODIDE IODOFORM SUBSTITUTE)
Antisuppurative
Antiseptic
Cicatrisant
THE VALUE OF ARISTOL in all the morbid con-
ditions formerly treated by iodoform is widely
recognized. In all external traumatisms, in cavital
lesions and in many of the dermatoses it has given very
satisfactory results. As a surgical application, it is safe,
inodorous and non-toxic. Aristol is supplied in ounces.
Europhen-Aristol, a preparation consisting of equal
parts of each medicament, is also supplied in ounces.
DMSCRIPTIVB PAMPHI^BTS F0RWARD:E^D ON APPI^ICATION.
W. H. Schieffelin & Co., New York.
PUBLISHERS' DEPARTMENT.
Important Notice and Removal. — To avoid
lailure or doubtful success iu use of peroxide of
hydrogen, be sure you get Marohaud's Medi-
cinal; no substitute can replace it, statements
of dealers, interested or unscrupulous parties
to the contrary notwithstanding. There is
great inducement to substitute in this article,
for the reason that peroxide made for bleach-
ing and varying trade purposes costs to pro-
duce only a fraction of what Marchand's Medi-
cinal costs, and the unscrupulous druggist or
dealer pockets the difference in profit at the
expense of the physician's reputation for skill
and Marchand's Peroxide of Hydrogen Medi-
cinal.
Put up in 4oz., 8oz., and 16oz. bottles only,
with which every careful physician should be
familiar, in order to frustrate dishonest sub-
stitution and assure success in practice.
Drevet Manufacturing Co.,
28 Prince Street, New York.
Contents of Lippincott's Magazine for
-June. — "John Gray; a Kentucky Tale of the
Olden Time," b.y James Lane Allen; "Early
Editorial Experiences" (Journalist series),
Murat Halstead; "Being his Mother" (a
poem), James VVhitcomb Riley; "Westward
the Course of Empire Takes its Way," Hon.
iohn James Ingalls; "At Dead of Night" (a
poem), Carrie Blake Morgan; "Concentra-
tion" (a poem), Ella Wheeler Wilcox; "Smith-
ers," Maurice Thompson; "Frost" (a poem),
St. George Best; "The Great American Desert,"
William F. G. Shanks; "A Study from Life"
<a poem), SusieM. Best; "On the Idaho Trail,"
William Y. Lovell; "La Crosse" (Athletic
series), Fredei-ick Weir; "The Woman of the
Plains," Patience Stapleton; "The Struggle
for the West," Prof. John Bach Mc Master;
"Before the Storin " (a poem), Robert Love-
man; "Curious Mixtures" (Composite photo-
graphs); "As it Seems;" "With the Wits"
(illustrated by leading artists).
A Choice List of Summer Resorts. — In the
Lake regions of Wisconsin, Northern Michigan,
Minnesota, Iowa, and the two Dakotas, there
a.re hundreds of charming localities pre-em-
inently fitted for summer homes. Among the
following selected list are names familiar to
many of our readers as the perfection of
Northern summer resorts. Nearly all of the
Wisconsin points of interest are within a short
distance from Chicago or Milwaukee, and none
of them are so far away from the " busy marts
of civilization " that they cannot be reached in
a few hours' travel, by frequent trains, over the
finest roads in the Northwest — the Chicago,
Milwaukee, & St. Paul Railway, and Milwaukee
&, Northern : —
Oconomowoc, Wis.; Minocqua, Wis.; Wau
kesha, Wis.; Palmyra, Wis.; Tomahawk Lakes
Wis.; Lakeside, Wis.; Kilbourn City, Wis.
(Dells of the Wisconsin); Beaver Dam, Wis.;
Madison, Wis.; Delavin, Wis.; Sparta, Wis.;
Pewaukee, Wis.; Wausaukee, Wis.; Marquette,
Mich.; Clear Lake, la.; Lakes Okoboji, la.;
Spirit Lake, la.; Frontenace, Minn.; Lake Min-
netonka, Minn.; Ortonville, Minn.; Prior Lake,
Minn.; White Bear Lake, Minn.; Lake Madison-
So. Dakota; Big Stone Lake, So. Dakota ; Elk,
hart Lake, Wis.; Ontonagon, Mich.; Mack-
inaw, Mich.
For detailed information, apply to any cou-
pon ticket agent, or send stamp for a free
illustrated tourist folder, to Geo. H. Heafiord
General Passenger Agent, Chicago, 111.
Malted Milk.— The Malted Milk Co. desire
to call the attention of the medical profession
to the following letter: —
"Malted Milk Co., Racine, Wis.:—
"In January I was attacked with influenza
and pneumonia. During the convalescence 1
was very weak. I bought a 6 lb. jar of your
Malted Milk, and took two tablespoonfuls of
the same every five hours. In a short time I
regained my strength and was able to take up
my practice again. At bed-time I take two
heaping tablespoonfuls of the Malted xMilk in a
cup of hot coflee, and then I can sleep all night.
When I make a trip into the country (1 am a
country doctor), I always take a cup of coffee
and Malted Milk, also when I return. By doing
this I gained 23 lbs. in four weeks, and 1 also
feel well. I do not say that the Malted Milk is
altogether responsible for this, but it certainly
aided me wonderfully.
"By taking malted milk in hot coffee I have
a nutritious drink, as pleasant as a cup of
chocolate, as delicious as a cup of cocoa, and
as stimulating as n cup of eggnogg.
" With many thanks I remain, Yours truly,
"Dr. E.J. Kempf.
''Jasper, Ind., Feb. 27th, 1892." .
We publish the above in full, as it contains
suggestions which will be of value to many
physicians. Samples of this preparation are
furnished free on application to the manufact-
urers.
International Congress of Gynecological
Obstetrics. — This newly proposed association
in the interest of a special branch of medical
science will be organized next September.
This new association will doubtless prove a
great success*, as it will bring together a large
number of the foremost gynecologists of the
world. We have received the following note
from the American secretary of the associa
tion : —
"The following named distinguished gentle-
men have been delegated to represent the
British Gynecological Society at the Interna-
tional Congress of Gynecology and Obstetrics,
to be held in Brussels, Belgium, September 14
to 19, 1892: Robert Barnes. A. S. Simpson,
Granville Bantock, Lawson Tait. Great prep-
arations are being made to entertain visiting
physicians. His Majesty King Leopold will as-
sist at the opening of the Congress. There will
be a grand reception by the Belgian Gyneco-
logical Society; gala perlormance at theGrand
Opera; also a banquet by the Belgian Gyneco-
logical Society; garden party in the gardens
of the royal family, etc.
"For information relating to the Congress,
address Dr. F. Henrotin, American Secretary,
353 La Salle Avenue, Chicago, III."
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CANCEROUS CELLS— Showing Inctaisions of
Parasitic Neoplasms. (See page 266.)
XHE
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH., U. S. A., JUNE, 1892. NO. 8.
Original Articles.
THE STUDY OF IMMUNITY.
BY M. METCHNIKOFF.
Immunity op Rabbits Vaccinated Against
THE Microbe of Hog Cholera.
Where do the microbicidal forces re-
side in the refractory organism ? Are
they in the humors, or in the alimentary
cells, notably the phagocytes which de-
stroy the microbes ? Such is the capital
question which has been aimed at in the
researches of this period on immunity.
The four first monograms which I have
published, have been devoted chiefly to
the solution of this problem. After hav-
ing demonstrated (see articles 2 and 3)
that in the case in which any phagocytory
action exists (as in the charbon of pigeons
and rats), where phagocytes play an in-
contestable role, it has been found nec-
essary to prove that these cells destroy
the bacteria englobed in a state of life.
This proof has been furnished several
times for the charbonous bacteridia, and
for other microbes, particularly the vibrio
Metchnikowii, after which the objection
that the phagocytes would not be capable
of englobing the dead microbes, was de-
finitively refuted.
On the other hand, it has been proved
that the theory which attributes bacteri-
cidal action to substances circulating in
the blood, or secreted by cells in the vac-
cinated organism, is not confirmed by the
study of immunity. The facts invoked
by certain savants (Emmerich and de
Mattel), as demonstrating the existence
of liquid secretions which would destroy
bacteria in a very short time (from 20
minutes to two hours), have been demon-
strated to be inexact. (See our first
article.)
The best argument drawn in favor of
the theory of the bactericidal property of
the humors, is that which is derived
from the property of the serum of guinea
pigs vaccinated against the vibrio Metch-
nikowii. It has, however, lost all its.
importance the moment it has been
proved that this bactericidal force does
not manifest itself in the vaccinated
guinea pig. (Fourth article.)
The facts which I have just cited, as
well as a great number of others, estab-
lished during the last years, have fur-
nished the definite proof that the bacteri-
cidal forces of the organism reside in the
phagocytes and not in the humors.
But the discussion of the problem of
immunity, concentrated in the first place
on the question of the bactericidal prop-
erty of the organism, has led to the deep-
ening, very greatly, of the analysis of the
phenomena of the refractory state. The
humoral theory of immunity has demon-
strated two new factors in the production
of the refractory state, namely, the prop-
erty of humors which attenuate microbes,
that is to say, prevent the production
of toxines. The other property is that
which destroys toxines which have not
been interfered with in their production.
There are two ramifications of the
humoral theory: the theory of the attenuat-
ing property, and the theory of the anti-
toxic or toxinicide property of the humors,
which have been adopted.
Concerning the attenuating property of
humors, its study is simple, because of
the facility of separating the bacteria
cultivated in the humors of vaccinated
animals from these media of culture,
The researches on the anti-toxic prop-
erties of humors are more difficult. Dis-
covered first in the humors of animals
vaccinated against tetanus and diphtheria
(Behring and Kitasato), this property was
afterwards attributed to the sanguineous
liquid of the rabbits vaccinated against
the pneumococcus (G. & F. Klemperer.)
But diphtheria -and tetanus present to
us types of maladies essentially toxic.
258
ORIGINAL ARTICLES.
with special localization of the bacilli
which provoked them. The pneumococ-
cus has the defect of producing very weak
toxines and exceedingly inconstant in
their action.
I have therefore been induced to choose
another species of bacteria, in order to
study the role of the anti-toxic properties
of the humors in acquired immunity. I
have used the microbe of hog cholera, or
the pneumo-enteritis of the hog. This
bacteria provokes in rabbits an acute
disease, accompanied with considerable
generalization of the microbe. It pro-
duces very active toxines, which act with
regularity. The rabbit is very sensitive
to hog cholera, and can be easily vacci-
nated against this disease, and furnishes
quantities of blood absolutely sufficient
for the study of the anti-toxic property.
Another advantage of hog cholera, is the
facility with which even small doses pro-
voke a fatal malady in guinea pigs.
My studies have been facilitated by
the excellent work of M. Selander, exe-
cuted under the direction of M. Roux.
I have been able, repeatedly, to realize
the exactness of his work.
The microbes which have served for
my researches, emanated from the epi-
demic which ran among the hogs in Gen-
tilly, which had been placed at my dis-
posal by Prof. Chantemesse, to whom I
hasten to express my thanks.
I. THE MICROBE OF HOG CHOLERA AND
ITS TOXINE.
The microbe of hog cholera, studied
by a considerable number of observers
(Salmon, Cornil, Chantemesse, Frosch,
Selander, B. Afanassieff, etc.), must be
placed among the genera coccobacillus ;
it can be designated under the specific
name of coccobacillus suinwii, and it is
characterized by the most pronounced
pleo-morphism. The downward extremi-
ties transform themselves into more or
less lengthy filaments, but may also give
rise to veritable cocci. The truly spher-
ical form of the latter is apparent, particu-
larly in the individuals in which only a
half has retained the color (methylene
blue), while the other half has remained
colorless.
But it is not only the alternations of
filaments with bacilli and cocci which is
observed in the evolution of the microbe
of hog cholera. In special conditions of
culture (which will be explained in Chap-
ter IV), this microbe takes the form of
true streptococci. We then observe more
or less lengthy strings of beads composed
of oval cells, or, which is more common,
round cells. In the latter case, we surely
have to do with spherical vegetative
forms, and not with arthrospores, as had
been suspected in other cases of pleo-
morphism.
The variability of the microbe of hog
cholera is manifested again, under other
conditions : In cultures made in broth,
the cocco-bacillus is extremely mobile.
In cultures prepared in the blood, or in
blood serum, as well as in the animal
organism, the same microbe is entirely
deprived of movements.
It is not intended, in the plan of this
study, to explain the morphological and
cultural characteristics presented by the
cocco-bacillus suinum. Accordingly I
will entertain the reader only with the
property of this microbe to produce in
the blood of unaffected rabbits some very
active toxic poisons. This discovery has
been made by M. Selander. After having
strengthened his virus by successive pas-
sages through the pigeon, M. Selander
has observed that the blood of rabbits
having succumbed to an excessively acute
infection, when heated to from 54° to
58^ C. produces in the rabbits a very
characteristic mortal intoxication. Be-
tween the variance of the microbe and
the toxicity of the blood heated to 60,°
he had observed a complete parallelism.
The more the microbe is varied, the more
the heated blood manifests toxic proper-
ties. This blood heated to more elevated
temperatures, loses its toxicity. When
carried to 100° C, it becomes completely
inoffensive. In this respect the toxine
of the microbe of hog cholera is related
to that of diphtheria and tetanus.
In the rabbits, the morbid phenomena
which succeed acute infection produced
by an injection of very virulent virus,
correspond perfectly to the tableaux of
mortal intoxication produced by an intra-
venous injection of toxic blood. In
both cases the rabbits appear sick early
after the injection. The temperature
presents a temporary elevation followed
by hypothermia, which is prolonged un-
til death. In the most acute cases, the
temperature begins to decrease immedi-
ately after the injection of the virus or
toxine. The leucocytes diminish in both
cases, in great proportion. Respiration
ORIGINAL ARTICLES.
259
is at first very greatly accelerated, and de-
creases only before death. Paralysis,
which begin sat the posterior extremity
and extends to the anterior portion of the
body, as well as the pre-mortal convul-
sions, complete the resemblance between
the picture of the infection and that of
the acute intoxication. Autopsy in both
cases give the same results, — for the
most part, negative. The internal organs
present hypersemia ; the spleen is a little
hypertrophied ; the urinary bladder is
empty, only a microscopical examination
reveals at once the great difference.
While the blood of the intoxicated rabbits
is completely sterile (results verified by
cultures), that of infected animals con-
tains immense quantities of microbes of
hog cholera in the form of diplococci, of
short, oval bacteria, or of veritable cocci.
There can therefore be no question
that the cocco-bacillus suinum produces
abnormal, toxic substances in the body
of rabbits, and that this toxine resists a
temperature of from 54° to '^^°, and even
to 60° C, and while the intra-venous in-
jections of large doses (beginning with
1.5 c. c. of blood heated) produces in
guinea pigs a mortal intoxication, the in-
troduction of lighter doses into the blood
circulation or into the subcutaneous tis-
sue, repeated several times, confers solid
immunity to the rabbit against extremely
mortal virus. This result, obtained for
the first time by M. Selander, has been
confirmed several times in my own re-
searches.
The process of vaccination by heated
blood indicated by this author, has served
me for vaccinating a great number of
rabbits. In anaemic injections, at inter-
vals of several days, and sometimes sev-
eral weeks, and in the introduction of
total quantities twice as large as the
smallest mortal dose, I obtained positive
vaccination, without having a loss to
record.
(To be continued. )
DOUBLE CHANCRE A DISTANCE.— AN INQUIRY
INTO SYPHILITIC AUTO-INOCULATION.
Pleuritis Ani. — Dr. Dumesnil, of St.
Louis, recommends for this distressing
affection, the following mixture : Corro-
sive sublimate, 3^ gr. ; ammonium chlo-
ride, 20 gr. ; carbolic acid, i dr. ; glyc-
erine, 2 oz. ; aqua rosacea, 4 oz.
To be applied morning and evening.
In obstinate cases in which the skin is
thickened, a single application of pure
creosote is made.
BY A. H. OHMANN DUMESNIL,
Professor of Dermatology and Syphilology in the St. Loui
College of Physicians and Surgeons.
The question of auto-inoculation in
syphilis was, at one time, a fruitful theme
for discussion and led the way to numer-
ous experiments of the greatest impor-
tance, when viewed in the light of the
results that were achieved. After a lull
of several years the question has been re-
vived in latter years but in a different
form. It is one of the highest importance
from the fact that, should it be established
that auto-inoculation is possible, during
a certain limited period, it would conclus-
ively prove that the disease was still
localized, and the very fact that this
localization existed would render reason-
able attempts to jugulate syphilis by
means of early excision of the chancre
and of the indurated ganglia anatomically
connected with it. The following cases
are interesting as bearing in some respects
upon the question of auto-inoculation,
and as affording examples of a clinical
variety not frequently met with.
Case I. — Mr. B. , about 22 years of
age, contracted a chancre, and presented
himself to Dr. A. C. Bernays for treat-
ment. I saw the patient at this time.
He could not fix the probable time of
infection. Upon examination he pre-
sented a well-marked chancre of the
prepuce on the right side. The indura-
tion was well defined, and the inguinal
ganglia of the corresponding side were
also indurated. In the center of the
lower lip he presented a sore having the
size of a silver half-dime, well-defined, of
a roundish shape and implicating a small
portion of the mucous membrane and
Vermillion border. On both sides of the
inferior maxillary the lymphatic glands
were enlarged and indurated. More es-
pecially was the condition marked upon
the left side. The induration of the labial
sore was very distinct. Patient was sub-
ject to fissures of the lower lip. He was
not aware of handling his preputial sore
and transferring the virus to his lip. In
fact, he rather thought he did not. In
about two months after, a marked secon-
dary eruption appeared, and his hair fell
out. Both chancres healed spontaneously
260
ORIGINAL ARTICLES.
and simultaneously, the induration dis-
appearing in the sores and lympathic
glands at the same time.
Case 2. — Mr. C. presented him-
self to me for treatment, Dec. 22, 1S86.
He presented two chancres. One was
situated upon the mucous surface of the
left side of the prepuce and extended to the
border. It was somewhat larger than a
silver dime, the induration being plainly
apparent to the touch. The lymphatic
glands in the left groin were enlarged
and indurated. The other chancre was
situated in the center of the upper lip
and was a little smaller than a silver
dime. The induration was very marked,
so much so that it partially everted the
lip. The lymphatic ganglia beneath the
inferior maxilla were indurated, not so
markedly so upon the left side as upon
the right. Those on the right, however,
were plainly enlarged. Upon inquiry the
fact developed that the upper lip was
almost always fissured at its central por-
tion in winter, and had been in that con-
dition for quite some time before the
appearance of the sore. On Feb. 22,
1887, two months after the patient first
presented himself, a fine, papular eruption
made its appearance. Upon the face,
back, and legs were pustules scattered here
and there. Mercurial treatment caused
these to disappear in a couple of weeks,
but it was not until March 12 that the in-
duration of the glands, and the chancres
disappeared completely. The restitutio
ad integrum was simultaneous in both
localities. Inquiry elicited the probabili-
simultaneous appearance of
At least, as far as the patient
came on at the same time ;
but he was naturally more solicitous con-
cerning the sore upon his prepuce, re-
garding the other as merely an ordinary
sore due to irritation of the fissure.
Multiple chancres are not rare by any
means. They are quite frequently seen,
if we are to believe the statistics of those
who see many cases of syphilis. Of
course, the relative percentage is not
great in comparison with the grand total,
but an observer who has not seen this
condition has not had many cases under
his care. The same may be said of
extra-genital chancres and more especially
of chancre of the lip. The condition,
however, which I have detailed does not
seem to be one that is frequent ; in fact,
it is a most unusual one ; viz., to have
ties of the
both sores.
knew, they
chancre of the prepuce and of the lip
occur simultaneously. While genital and
buccal mucous patches often occur synch-
ronously, the primary lesion of syphlist
does not seem to affect parts so distian
from each other, nor those particular
portions which I have mentioned. On
this very point F. N. Otis, speaking of
extra-genital primary lesions, says, '' Usu-
ally they (chancres) are rare in propor-
tion to their distance from the genitalia.''
How much rarer must this condition be
when the case is one of multiple chancres,
at such a distance from each other !
An interesting question which is now
suggested is this : In the cases reported
above were the chancres of the same age
and due to the same inoculation in point
of time ? or was there auto-inoculation ?
A consideration of this would lead us to
a critical examination of the question of
auto-inoculation, and the success which
has attended attempts to establish the
truth of its probability. I do not intend
to discuss these questions exhaustively,
but merely analyze a few points and point
out some possible sources of error. In my
opinion, in the two cases which I have
briefly outlined, the chancres of the lip
and of the prepuce in each case were of
the same age and inoculated simultane-
ously. My reasons for this are founded
upon the fact that the induration of the
sores and of the ganglia occurred at about
the same time so far as this was observed.
In the next place, the induration disap-
peared exactly at the same time, both in
the lymphatic glands and in the chancres.
In other words, while the appearance of
the induration could not be exactly de-
termined, the synchronous disappearance
was observed ; and this in two cases.
Had either one of the chancres been due
to an inoculation from the other, we
would expect its induration to appear and
disappear as much later than that of the
primary infecting focus as the period in-
tervening between the appearance of the
one and that of the other.
Now let us examine the evidence ad-
duced to support the possibility of auto-
inoculation, and then we will consider the
probabilities.
P. A. Morrow says, ''The initial le-
sion is unique ; multiple chancres are,
however, by no means rare ; they may be
grouped in the same region, or be dis-
seminated over different portions of the
body.
ORIGINAL ARTICLES.
261
'^ Multiple chancres are almost always
due to the simultaneous inoculation of
a number of rents or abrasions ; they are
not produced by successive inoculations,
as in the case of chancroid.
*'The no7i- auto- inoculability of the
chancre is a rule to which there are few
exceptions, and these only possible when
inoculation is performed _ at an early
period after the appearance of the chan-
cre ; the result is usually an abortive
pustule."
E. L. Keyes has about the same opinion
in this matter. He states that, ''When
the chancre is quite young, and the
organism presumably not saturated with
syphilis, some of the poison taken from
the patient's own chancre may be success-
fully auto-inoculated, producing a second
characteristic chancre upon him. (Puche,
Wallace, Sperino, Bidenkap, Lee, and
others.)"
In Bumstead and Taylor, the main
issue is avoided to some extent, as wit-
ness from the following : ''If multiple at
all, it is almost always true that they
(chancres) are so as the immediate effect
of contagion, and because several rents
or abrasions were inoculated together in
the sexual act. If solitary at first, they
continue to be so ; since successive
chancres rarely spring up in the neigh-
borhood, as in the case of chancroid,
owing to the fact that the virus ceases to
act upon the system as soon as it is once
infected."
Of course, the question is. When does
the system become infected ? or, in other
words, what is the limit to the period
when auto-inoculation is possible, or is it
possible at all ?
The possibility of auto-inoculation from
the primary sclerosis is doubted by a
number of good observers. Fournier, in
giving the differential diagnosis of simple
and syphilitic chancre, states that in the
latter the pus is not auto-inoculable. H.
Leloir says that "the infecting chancre
is not inoculable on the carrier of it, and
this last proposition may be laid down as
an invariable rule {une regie absolue) ; this
characteristic of the non-inoculability of
the infecting chancre is of the highest im-
portance, and may be considered as
pathognomonic." He adds a note in
which he states that, in some exceptional
cases, auto-inoculation see7?is to have
succeeded.
H. G. Piffard says that the "chancre
is not, as a rule, inoculable upon a per-
son bearing it, or upon another who is
already syphilitic."
Berkeley Hill in speaking of the prim-
ary sclerosis of syphilis says that "the
papule is habitually solitary. When there
are more than one, the papules are all of
one age," implying that all were inocu-
lated at the same time.
Alfred Cooper in considering the same
question states that "if several hard
chancres are found upon the same person,
the probability is that they have become
simultaneously developed ; for a sore of
this character is not inoculable, as such,
upon the subject of it."
Jonathan Hutchinson does not seem
to be very favorably impressed by the
doctrine of auto-inoculation. In refer-
ring to the multiple chancres he says that,
" The number of these indurated spots,
or chancres, will depend upon the num-
ber of different places which were inocu-
lated at the same time, just as is the case
with vaccination vesicles. It is not very
often that more than one is seen, and if
there be two, three, or more they are al-
ways at the same stage of progress at the
same time. No new ones are ever pro-
duced subsequent to the full development of
the first. ^ If for the sake of experiment
it were attempted by direct inoculation to
produce others, the attempt would fail ;
just as we should fail to re-vaccinate an
infant, on the eighth day, from his own
spots." While we see that the possibility
of auto-inoculation is mentioned, the
author makes some pretty positive state-
ments to the contrary. I will make an-
other quotation from P. A. Morrow, in
which he states that "the non-inocula-
bility of the secretion of the chancre is
the rule to which there are few exceptions
and these only possible when inoculation
is performed at an early period after the
appearance of the chancre. The four or
five cases reported in which positive re-
sults have been obtained from auto-inocu-
lation of the chancre are of doubtful
authenticity ; the almost invariable result
is an abortive pustule. A distinction
is always to be recognized between the
specific serous secretion of the chancre,
and the inflammatory products of this
same lesion when irritated into copious
suppuration."
With this I will close citing authors,
1 It is possible that certain rare exceptions to this statement
may occur. — H.
262
ORIGINAL ARTICLES.
although a number of others holding
similar opinions could be quoted. Ad-
mitting the auto-inoculability of the
chancre for the sake of argument, the
question which presents itself is this : At
what time does the susceptibility cease,
or, in other words, when is syphilis con-
stitutional ? The rapid recital of a few
cases may throw some light upon the
subject. After this I wish to make a
critical analysis of a few of the reported
successful cases of auto-inoculation.
(To be concluded.)
-* — • — ■*-
PROTOPLASMIC FOCI-THEORY OF
METABOLISM.
An Elaboration of the Views contained in
THE Paper read by Dr. Morton at the
First Meeting of the American Elec-
tro-therapeutic Association.
BY HORATIO R. BIGELOW, M. D.
(Continued.)
In Foster's ''Text Book of Physiology"
it is written: ''Urea is the main end
product of proteid metabolism. Unlike
hippuric acid, and some other constitu-
ents of urine, urea is simply excreted by
the kidneys, being brought to them in the
blood, they apparently, beyond the sim-
ple act of excretion, doing no more than
merely contributing to the stock of urea
in so far as they are ,masses of proteid
material undergoing proteid metabolism
as part of their general life. What are
the immediate antecedents of urea we do
not clearly know ; but it is probable that
they are not one, but several, and indeed
possibly many. We have reason to think
that urea may be formed out of amides
or amido-acids, or out of ammonia itself
by a synthetic process ; and we have in-
dications that this synthesis is effected in
the liver by the agency of the hepatic
cells. But we do not know whether this
synthesis bears only on particular nitro-
gen-holding substances of food or of the
body, or whether it comes into play in
the normal metabolism of proteid mate-
rial. If the kreatin, which is so con-
spicuous a constituent of muscular and
nervous structures, is a stage in the direct
line to urea, then the synthesis would
affect only the sarcosin which the krea-
tin in becoming urea sets free. . . . The
evidence, as far as it goes, tends to show
that the metabolism of proteid is very
complex and varied, that a large number
of nitrogen-holding substances make a
momentary appearance in the body, tak-
ing origin at this or that step in the
downward stairs of katabolic metabolism,
and changing into something else at the
next step, and that the presence in va-
rious parts of the body and in the urine,
in small quantities, of so many varied
nitrogenous crystalline substances form-
ing a large part of what are known as
extractives, has to do with this varied
metabolism. Possibly the transforma-
tions by which nitrogen thus passes
downward take place to a certain extent
in such organs as the liver and the spleen,
which are remarkably rich in these ex-
tractives. But the whole story of proteid
metabolism consists at present mostly of
queries and gaps."
Mc Kendrick (Text Book of Physiology)
says: "The question whether urea may
arise from decomposition only, or from
the synthesis of products of decomposi-
tion, is still unsettled." The same author
writes: " The formation of organic sub-
stances by synthesis in the living animal
body is still very imperfectly understood,
but it is interesting to observe that many
nitrogenous organic compounds have been
formed synthetically by the chemist in the
laboratory. Thus urea, hippuric acid,
glycocin, taurin, sarcoin, kreatin, glu-
cose, and oxalic, lactic, succinic, ben-
zoic, propionic, acetic, and formic acids
have been formed artificially ; but as
yet it has been impossible to prepare
the higher members of the series. It is
probable that in the living body more of
the nitrogenous compounds are formed
by analytical than by synthetical proc-
esses. One well known example of a
synthetical process is the formation of
hippuric acid after the introduction of
benzoic acid with food in medicine. In
these circumstances, benzoic acid unites
with glycocin to form hippuric acid,
which makes its appearance in the
urine —
C7H60,-fC,H,NO,=:CeH,N03+H,0
Benzoic acid. Glycocin. Hippuric acid.
. . . Syntheses play an important part
in building up the complex bodies exist-
ing in living matter, and we may consider
that substances so all-important as fats,
lecithin, and other compounds existing
in nervous matter, haemoglobin itself,
and albuminous bodies, are thus formed.
How such processes are accomplished is
not known, nor must we suppose that
ORIGINAL ARTICLES.
263
there is only one way by which a com-
plex chemical substance may be formed.
It has been conjectured that the elimina-
tion of water plays an important part in
synthetic operations, and that the bodies
thus formed may be regarded as anhy-
drites of substances produced by the com-
bination of the simpler bodies. Much
of our knowledge on these points is still
obscure, but it is remarkable that the
triumphs of chemical science are in the
synthetic production of complex organic
bodies, and it is not unlikely that each
successive step in this direction will lead
to a better understanding of the similar
processes occurring in the body in the
upbuilding of its tissues."
These excerpts and reflections are ab-
solutely necessary to a proper conception
of the views advanced and defended in
the masterly paper of Dr. Morton — a
paper which takes rank among the most
original and scholarly professional efforts
of the past few years. I think also it
may be conceded that, in the main, these
theories of Dr. Morton — theories as yet,
because it is impossible to prove them
inductively — are correct. We have rea-
son to believe that clinical observation,
that the study of the conditions giving
rise to pathological changes, both bear
witness to the electrical polarity of dis-
ease. Chemism itself, it may be, is only
another name for polarity, and aflfinity is
simply an affirmation of the electric con-
ditions of the molecules, which by reason
of this polarity attract or repel each other.
''Contact force" has a small following
nowadays, because absolute contact can-
not be imagined. There must always be
an interposition of the surrounding ether
between atoms and molecules, no matter
how nearly they approach each other.
It is true that certain metals when placed
in contact manifest certain electrical con-
ditions of polarity, and just why this
should happen the physicist does not
know. It is not impossible that the
interposed strata of ether sets up the
change by releasing a latent energy of
the metal which only needed a stimulus
to set it free.
It is important to find out at just what
point in a voltaic cell the chemical action
begins. It is held now, I think, by most
physicists, that the real starting point of
the current is in the cell at the surface of
the zinc where the chemical action is fur-
nishing energy; ''for from this point
there are propagated through the liquid
certain electro-chemical actions which
have the result of constantly renewing the
difference of potential and supplying
electricity to the -\- pole just as fast as that
electricity leaks away through the wire to
the — pole. At the same time it will be
noticed that a few bubbles of hydrogen
gas appear on the surface of the copper
plate." To explain the transfer of matter
through the liquid of the cell, Grotthuss
advanced the hypothesis that the first
effect produced in the liquid is that its
molecules arrange themselves in innum-
erable chains, in which every molecule
has its constituent atoms pointing in a
certain direction ; the atom of electro-
positive substance being attracted toward
the kathode, and the fellow atom of
electro-negative substance being attracted
toward the anode ; that an interchange
of partners (Thompson) goes on between
the separate atoms all along the line, each
H atom uniting with the CI atom belong-
ing to the neighboring molecule, a -|-
half molecule of hydrogen being liberated
at the kathode, and a — half molecule of
chlorine at the anode. Clausius en-
deavors to bring the ideas of Grotthuss
into conformity with the modern kinetic
hypothesis of the constitution of liquids.
These changes are well illustrated in the
rough sketches which Dr. Morton sent
me for private study, and which would
have been elaborated, no doubt, had he
known that I should thus publicly make
use of his handiwork.
1 1
z
f fd. 1 .
C
Ll
z
-i-
Z
o
H
O
H
C
C
Analysis and synthesis.
264
ORIGINAL ARTICLES.
Waste Product.
The zinc, ZTI 0 destroyed, katabolism.
The electrolyte, 0 - - - - - H <icstroyed, katabolism.
The copper, QUL>y reduced, anabolism.
PHYSIOLOGICAL HYGIENE.
z
+
z.
o
H
O
t
O j c
: j
Waste Products and Formed Products.
Waste Product.
The zinc, ZnO
The electrolyte, Qy^/[ p,-x
The; electrolyte, Q + H
The oxide of
copper,
destroyed, kata-
bolism.
destroyed, kata-
bolism.
synthesis, anabol-
ism.
ir^ C\-*-^VA f^ formed product,
UjLlU— vXlS-f synthesis ana-
^ ^ ~ holism.
holism.
The electrolyte in Fig. 2 is first decomposed, as a result Z n
O, a " waste product or not " (say urea) , is synthetically formed
(as you say), but by oxidation and therefore as I understand it
katabolically formed. Next the H unites with the O of the
oxide of copper and forms H2O, a waste product (oxide of
hydrogen). Or both products are synthetical ; if they are
"end products" they are also "waste products." So, as 1
understand katabolism to mean oxidation or combustion, it
may form waste products (end products) like CO H2O, urea,
uric acid, etc., or other products like glycogen, etc.
THE WORK OF A LIVING ANIMAL ORGANISM.
[From a private communication from Dr. Morton, Feb. 3, '92.]
{a) Heat, which undergoes no further trans-
formation.
Primarily \ [d) Electroinotive force, current electricity,
by { detected by current of repose of mus-
katabolism, j cle or nerve and occupied in storing
chemical energy for purposes of func-
tion in muscle, nerve, and gland.
In contraction of muscle,
(a) Heat, secondary.
{b) Electricity, current of action or
negation oscillation.
(c) Mechanical work.
In nervous impulses and function of nerv-
Secondarily j ous substance.
or upon the / [a) Heat, secondary,
exercise of \ {b) Electricity, current of action or
function. \ negative oscillation.
[c] Nerve itupulses, cerebration, etc.
In glandular activity.
[a) Heat, secondary.
\b) Electricity, current of action and
negative oscillation.
(6") Secretion.
There are two sources of heat, one primai^y, the other
secondary ; the latter due to the same explosion or decompo-
sition which produces the function of the part and the elec-
trical reaction.
The primary heat is due to chemical combination (exo-
thermic compounds).
The secondary heat is due to chemical decomposion (endo-
thermic compounds).
The primary is not associated with function.
The secondary is associated with function.
(To be concluded.)
BY PAUL PAQUIN, M. D.
It is too true, we are bound to ac-
knowledge, that the vast majority of
chronic maladies that come under the
care of medical practitioners, fail to get
any relief whatever, and steadily grow
worse and worse under our daily adminis-
tration of this or that drug, this or that
recommendation, which we prescribe to
relieve or to satisfy the anxiety of the
patient, rather than with the hope of do-
ing him much good. Such cases are those
from which we derive the least satisfac-
tion in the practice of medicine ; they
give the greatest uneasiness and annoy-
ance to the practitioner, and the latter
get the least benefit for their pains. Is it
possible for the general practitioner to
adopt a general mode of treatment more
in accordance with the advances made in
our knowledge of physiology? It cer-
tainly is, in a great many cases ; but the
practice presupposes a better knowledge
of physiology, in a good many cases,
than most of us possess, at the outset of
our career at least. Physiological means
of treatment are no more to be fol-
lowed as stereotyped formulas in any
case presenting a given condition than we
should adopt stereotyped medicinal pre-
scriptions. Judgment must be used in
their application, and this judgment
must depend on our knowledge of the
physiology and the pathology of the or-
ganism presented.
So the first step to be taken in individ-
ual progress of medicine, in order that
the best success be obtained by all the
means at command, and the greatest good
may follow, is a better, and broader knowl-
edge of the physiology of man, and the
physiology of the organisms with which
he comes in contact, particularly the
microbes. This can be obtained largely
in practice, but it is the duty of the
medical schools to give a much broader
foundation, a much deeper groundwork
to students, upon which to erect their
medical education.
We have now in the country many
places where chronic cases in which the
medical practitioner fails, can be cared
for. They consist of institutions gener-
ally known under the name of sanitari-
ums, health resorts, etc., in which facili-
ORIGINAL ARTICLES,
265
ties for the application of physiological
means, such as baths, electricity, mas-
sage, Swedish movement, and the regula-
tion of diet are of a superior order, and
can be applied with accuracy, wisdom,
and under the guidance of science.
These institutions are undoubtedly the
best centers for the treatment of chronic
patients, because usually more time,
care, and constancy are required to ap-
ply the remedies than the average prac-
ticing physician is prepared to give, and
also because most of them have not the
proper appliances nor the rooms for them.
Trained nurses for this treatment are
necessary, and do quite as well as the
practicing physician, when the treatment
is based on a scientific prescription.
So it is to be hoped that the younger
men of the profession, particularly those
who are laying the foundation for a med-
ical education, will take into very serious
consideration the fact that they cannot
be fully successful, and cannot render
the fullest amount of service possible or
attainable in the practice of medicine,
unless they prepare themselves by first
obtaining a thorough knowledge of the
physiological laws underlying life in all
its activities, and then base their prac-
tice of medicine thereon. Understand-
ing physiology well, it is not difficult to
.understand pathology, and comparatively
easy to realize what treatments should be
pursued in the various cases which may
confront the physician.
Physiological medicine is the only true
path of medical practice. It places the
physician in his right place, suggesting
very forcibly to the doctor, who usually
considers himself a curer of disease, that
he is only an assistant of nature when
enfeebled.
-» — -• — *-
Treatment of Tuberculosis by
Aristol. — At a recent meeting of the
Therapeutical Society of Paris, Dr. Vogt
presented the report of the committee
appointed by the Society to investigate
the method of treatment of tuberculosis
t)y aristol, devised by Dr. Nadaud, of
Mentone. The report was favorable to the
method. In twenty-three cases of tuber-
culosis, a cure was effected in seven cases.
In these cases the treatment had lasted
from twenty-five to thirty days, and the
patients were still well although three or
four months had elapsed since the treat-
ment was discontinued. In five cases
there had been rapid improvement under
treatment, but relapse during the month
which followed its cessation, requiring a
renewal of the treatment, after which
they had remained well, a third series of
treatments never having been called for.
In three cases in which there were large
cavities, two had died, one of diphtheria,
and the other of tubercular peritonitis.
Those of the patients still under treat-
ment were materially improved. By the
use of aristol the cough is controlled,
expectorations lessened, the night sweats
disappear, the appetite returns, the
weight is increased, and the general
conditions of the body are improved.
A one-per-cent solution of the remedy in
oil of sweet almonds is the form in which
it is used, the solution being injected by
means of the hypodermic syringe. It is
claimed there is but little local pain, and
never inflammation, induration, or ab-
scess at the point of injection. In ad-
vanced cases the solution is modified by
the addition of five per cent of purified
creosote.
Statistics of Anaesthesia. — E. Gurt,
(^Centralblatt far Chiriirgie, n^^ 26, p. 81,
1891) gives an account of the results in
22,625 cases in which different anaesthetics
were employed. Six deaths from asphyxia
occurred, of which all the deaths in 71
occurred in 22,656 cases of anaesthesia by
chloroform. Five cases of grave asphyxia
occurred in 1,055 cases in which a mixture
of ether and chloroform was used.
Massage and Scanty Urination. —
Dr. Marinel, of Brussels, has shown by
practical experim^ts that Dr. Bum is
correct in his view that the secretion of
the kidneys is augmented by massage.
Experiments of others have shown that
massage increases the blood-pressure in
the abdominal viscera. This may be one
of the causes of the increased activity of
the kidneys as the result of a general mas-
sage ; but the authorities before referred
to hold the opinion that the increased
renal activity is due to another cause.
They believe that, as the result of mas-
sage, various poisonous substances are
made to enter the circulation by absorp-
tion from the tissues, and that the activity
of the kidneys is thereby stimulated, it
being well known that a large part of the
work of the kidneys is the elimination of
the albuminoid poisons thrown off by the
tissues.
266
TRANSLATIONS AND ABSTRACTS.
Translations and Abstracts
[The articles in tliis department are prepared expressly for
this journal.]
INTRA-CELLULAR PARASITISM OF CANCEROUS
NEOPLASMS.
BY M. SOUDAKEWITCH,
Prosector of the Institute of Pathological Anatomy, Kieff,
Russia.
Translated, from Annales de /' Institut Pasteur^
by Paul Paquin, M. D.
(See Frontispiece.)
(Concluded.)
The little masses became surrounded
by a new coat, sometimes homogenous,
and again, finely granular (see frontis-
piece, Figs. 4, 5, 8). In certain cases we
observed, besides, a new ring with slim
and regular internals (Fig. 13). Some
exhibited at their periphery a kind of thin
or thick ray ; these were either uniform
in body and sharp at their extremities, or
had slight enlargements at the ends (Figs.
5, 6, 7, II, 13, 14). The external capsule
contained another ring, not so regular,
pleated, and, one would have imagined,
collapsed on itself (Fig. 14). The rays of
certain bodies were longer, could be
colored with hsematoxylon, and resembled
pseudopodes very much (Figs. 3, 10).
The capsule often contained more than
one nucleus ; sometimes there were
many, — 6, 8, 12, and more. Their form
was now spherical, then elliptical ; and
they sometimes slightiy curved in the
shape of rods with swelled extremities
(Figs. 15, 18). Such capsules, contain-
ing several bodies comparatively volumin-
ous, did not color with violet.
There were cells which contained sev-
eral included bodies, up to 15. They
were of about equal dimensions, each
having a separate capsule. Their con-
tents were sometimes alike, and some-
times different. Several times I have
found cells in which inclusions were of
different dimensions and different struc-
ture (see frontispiece of May number,
Fig. 34, and frontispiece of this number,
Fig. 19).
The cancerous cells with multiple in-
clusions were hypertrophied and attained
great dimensions. Finally, the metastatic
nodules contained capsules with multiple
contents ; the latter consisted of granula-
tions, either fine and close together or
arranged in filaments. The granulations
colored deeply in violet by the use of
hsematoxylon. In the center or at the
periphery of the granular mass, we
could observe a little colorless protoplas-
mic patch (Figs. 20, 21).
There were also in the preparations,
several identical forms of leucocytes en-
closed in vacuoles.
Unable to describe the numerous forms
in all their diversities, I will content my-
self with giving here exact figures (front-
ispiece), more demonstrative than any de-
scription. Fig. I represents a metastatic
spot of the liver, comparatively rare.
We could see in it, in one visual field, 28
different inclusions of variable size.
A superficial examination of the first
preparations of this cancer showed me
perfectly that I had to deal with a strange
animal organism, and not with deformed
nuclei, degenerative protoplasm, incor-
porated leucocytes, or invaginated can-
cerous cells. It was much more difficult
to define the nature and the place of this
being in the zoological system. . . .
I made sections from pieces of cancer
of the last described case, after hardening
them in MUUer's fluid. I saw then that
in these new preparations the indubitable
sporozoa that I have just described, had
another aspect, — for example, the phe-
nomena of metachromatia, after coloration
by hsematoxylon, was scarcely observable.
The parasites were very numerous, but
one could not discover in them any trace
of the complicated structure described
above. They resembled somewhat, the
forms represented in the first plate. *
They are mostly bodies tesembling col-
loides closely, or resembling a mucous
substance without the structure which we
find in those preparations.
Such appearances could easily be in-
trepreted as coming from degeneration,
as emanating from protoplasmic degener-
ation of the cancerous cells.
Among the material of the Institute
of Pathological Anatomy, I have found,
again, two cancers of the pancreas (one
secondary after a cancer of the stomach,
the other primary ; both accompanied
by metastasis of the liver), preserved in
Miiller's fluid. On examining the prepa-
rations made with this material, I under-
stood the significance of these intra-cel-
1 The first half of the plate of frontispiece in May number.
TRANSLATIONS AND ABSTRACTS.
267
lular inclusions, sometimes voluminous,
that I had heretofore taken for modifica-
tions of nuclei or for a protoplasmic
degeneration.
Figs. 35 and 36 (frontispiece of May)
present most characteristic inclusions of
these cases.
The tableaux were somewhat different
in the case of a cancer extirpated from
the kidney. Here the inclusions (see
Figs. 37, 2)^, 39, 40, and 41, May number)
had the aspect of spherical bubbles highly
colored by hsematoxylon : their contents
were different.
The three cases which I have just men-
tioned (two of the pancreas, and one of
the kidneys), as well as the fourteen other
cases observed by me in the material of
the l7istitut mentioned (cancers of the
liver, of the mammary glands, of the
testicles, and of the uterus), presented in-
clusions with an aspect similar to that of
the formations which I regarded as true
sporozoa. These observations proved
further, that the first pancreatic cancer
studied had a great interest, not only as
an isolated case of cancer containing nu-
merous true sporozoa, but also as a basis
in the explanation of all other cancerous
inclusions.
I fixed fresh carcinoma with Fleming's
liquid and osmic acid. I constantly ob-
served the presence of parasites. I have
studied, to this date, 18 similar cases
(cancers of the liver, the mammary gland,
lachrymal gland, uterus, and inferior lip).
It is chiefly in the carcinoma of the
liver (in the surgical clinique of Prof.
Rineck) that I have found the greatest
quantity of parasites. The cadaver was
freshly received, so that the autopsy was
made early after death, and microscop-
ically demonstrated that the liver was
completely invaded by a quantity of
nodules, most of them small, and that
the parenchyma was reduced to a mini-
mum. There was no metastasis.
The cancerous cells were very large,
and presented well marked giant asym-
metric karyokinetic figures, hyperchro-
matism, etc. These cells contained
now isolated parasites, then multiple
parasites.
After prolonged coloration with safra-
nine, a few colorations presented meta-
chromatic phenomena, and took on a
p^le violet color (as in the observation of
preparations of the nervous system after
the method of Adamkiewicz). There
were forms resembling very much the
form of rays in the cancer of the pan-
creas (Figs. 19, 20, 28). Others were en-
tirely original (Figs. 22, 23). Very fre-
quently there were found here not only
intra-cellular forms, but also intra-nuclear
forms (Figs. 25, 26) of different dimensions.
In these cases, the cancerous cells con-
tained parasites presenting very charac-
teristic modifications ; their nuclei were
sometimes pressed back and contracted,
and sometimes enlarged (resembling the
monaster stage).
The cellular contours were irregular,
as usual ; but, besides this, they were
provided with long and fine prolongations
in the nature of pseudopodes. I do not
pronounce yet upon this phenomena ob-
served by me previously, on the inferior
lip. I can only indicate an analogous
modification of the renal epithelium of
the Jielix Jioi'tensis, under the influence of
the introduction of Klossia (Pfeiffer,
Protozoen ah Infectioneserregei", II Anfl.
s 75. 76, 77)-
Such are the forms which I have ob-
served. In referring to them, I believe
myself authorized to say that in all the
95 cases of cancers studied by me, I have
found intra-cellular parasites of the class
of sporozoa.
The presence of the parasite caused,
on the one hand, a hypertrophy of the
cell, and occasionally a modification of
its protoplasm, and on the other, differ-
ent modifications of the nucleus, often
in the sense of karyokinesis.
It is only as a plausible supposition,
that I may add that the parasites observed
in different cancers belonged to different
species.
An Improved Transfusion Appara-
tus.— Dr. Samuel Bernheim describes
(^Bulletm Ge7ieral du Thei'apeiitique) an
improved apparatus for transfusion, which
he has employed in experiments in trans-
fusion of the blood of goats as a means
of treating tuberculosis. The various
forms of apparatus heretofore proposed,
have been operated either by a piston or
by a rubber bulb, and haxe been more
or less complicated. The apparatus em-
ployed by Dr. Bernheim has neither bulb
nor piston, and is the simplest possible
device. It consists simply of a piece of
simple rubber tubing with a canula at
either end. This apparatus is intended
for arteriovenous transfusion. The ca-
268
TRANSLATIONS AND ABSTRACTS.
nula designed for the patient is very small,
so that undue pressure is prevented.
The transfusion is accomplished by means
of the arterial pressure of the animal,
which is amply sufficient. The goat is
employed in consequence of its immunity
from tuberculosis. A large canula is in-
troduced into the carotid artery of the
goat, the small one into one of the veins
of the arm which are commonly used in
bleeding.
Of four cases reported, favorable re-
sults were observed in all. One died as
the result of imprudence which produced
an acute pulmonary congestion ; the
others were considered as practically
cured. There may be a great future before
this method of treatment, as it has been
shown by numerous experimenters that
the blood of one animal may replace that
of another of the same class. Brown-
Sequard brought to life a dog which had
been bled to death, by transfusing the
animal with the blood of pigeons. The
experiment was repeated by Glenard twice
with the same animal, using on one oc-
casion the blood of a donkey, on another,
that of an ox. With the simple appara-
tus above described, this operation is re-
lieved of all its dangers, if reasonable
care and prudence are employed ; and it
is quite possible that the time may not be
far distant when the injection of goat's
blood will be recognized as one of the
most important measures in the treatment
of tuberculosis.
Pure Creosote. — The rapid extension
of the use of creosote, especially as a
means of treatment in tubercular disease,
gives special importance to the question
of the purity of this drug. In a learned
communication presented before the So-
ciety of Therapeutics of France, M. Ca-
tillon recently enumerated the following
as the characteristics which should be pos-
sessed by pure beechwood creosote : —
1. The creosote must be completely
colorless, and should remain uncolored
for a long time, even when exposed to
light, and in clear glass bottles.
2. The special odor should not sug-
gest the odor of bitumen, and should be
easily removed by washing with water.
3. The density should be 1080, at a
temperature of 59° F.
4. It should give off nothing in dis-
tillation below 200° C, and should distill
over entirely, between 200° and 212° C.
5. Mixed with equal parts of pure
glycerine, it should dissolve without any
turbidity or whitish opacity. The ad-
dition of water precipitates creosote from
this solution. This solubility in water is
about one part for 100 of water.
7. Creosote should be absolutely neu-
tral, and a drop placed upon blue sun-
flower paper should not change it.
8. It must dissolve entirely in soda
and potash solutions, and give a very
limpid solution, even after the addition
of water ; mixed with an equal quantity
of collodion it should not coagulate, but
should give a perfect solution, which
should preserve its fluidity.
9. When dissolved in ten times its
volume of alcohol, the addition of a ten-
per-cent solution of chloride of iron
should give a faint green color, clear, and
without any bluish tinge.
10. Mixing one cubic centimeter of
creosote with ten cubic centimeters of a
1-50 solution of caustic potash in alcohol
at 95° should give a solid crystalline mass.
According to the experiments of the
author, creosote possessing the above
properties is much more easily tolerated
by the stomach than ordinary creosote,
and can be taken without disturbance in
doses twice as large as those which create
serious disturbance when ordinary creo-
sote is employed.
Creosote is much used in France in the
treatment of tubercular affections, being
employed hypodermically, dissolved in
olive oil. M. Gimbert, who was the first
to employ creosote by hypodermic injec-
tions in large quantities, uses the creosote
in proportions of one part to fourteen
parts of olive oil, which has been washed
and thoroughly sterilized.
The author finds that purified creosote
may be used in even a higher proportion,
as one part to ten.
m m »
Transfusion of Tissue Juices. — The
announcement made three years ago by
Prof. Brown-Sequard, of the remarkable
effects of introducing into the system the
sterilized juice of the genital glands,
created a mixture of amusement and seri-
ous interest on the part of the profes-
sion, while a considerable excitement was
created by newspapers in the minds of
the general public. Failure of the method
to accomplish all that was expected of it
TRAN8LA TI0N8 AND ABSTRA CTS.
269
soon brought it into disrepute, and to-
day it is probably by the majority of
physicians looked upon with contempt.
Nevertheless, M. Brown - Sequard has
maintained the correctness of his obser-
vations and views, and has continued his
experiments, and recently M. Paul has
communicated to the Academy of Medi-
cine of the Society of Therapeutics,
Paris, observations concerning the effects
of the injection of the juice obtained
from nerve tissues, particularly the brain,
which are analogous to those obtained by
Brown-Sequard. The operation is termed
by M. Paul, "nervous transfusion."
M. Paul was led to experiment in this
direction by the idea that he would be
able to obtain the same results with brain
juice that M. Brown-Sequard obtained
with testicle juice. M. Paul repeated his
experiments for more than a year before
announcing his results. In his report of
his experiments he claims complete re-
covery in five cases of neurasthenia, also
complete recovery in one case of tabes
combined with neurasthenia. In the last
case referred to, the patient was 25 years
of age, suffered from lumbar weakness,
difficulty in walking, and complete loss of
intellectual vigor. Ten injections of 2 to
5 c.c. of cerebral juice completely restored
the patient's energies and dissipated his
pain.
In one case of locomotor ataxia — a
man forty years of age — the pain en-
tirely disappeared, and ability to use the
limbs with ease and perfect co-ordina-
tion was restored. In two other cases of
locomotor ataxia the patients were very
greatly improved, the pain being dimin-
ished and the in-co-ordination movements
greatly lessened. The number of injec-
tions in the case of neurasthenia varied
from one to twelve, and in the cases of
locomotor ataxia from forty to forty-six.
The profession will await with interest
the results of further observations.
A New Boric Preparation, — Boro-
borax. — This preparation, discovered
by M. Jaenicke, results from a mixture
of equal parts of borax and boric acid in
boiling water.
The antiseptic and therapeutic proper-
ties of this mixture resemble those of
boric acid, but it has a neutral reaction,
is much more soluble, dissolving at ordi-
nary temperature 16 parts of boro-borax
for 100 of water; at 100^, 30 parts dis-
solve in 100 of water ; at boiling tem-
perature, water dissolves 70 per cent of
the substance.
Boro-borax is readily made by mixing
together in boiling water equal parts of
borax and boric acid. On cooling, the
greater part of the substance crystallizes
out.
Effects of Electrical Currents of
High Potential. — M. de Arsonval {La
Semaine Medicale of recent date, reports
the results of comparative experiments
for the purpose of determining the physio-
logical effects of the different methods of
electrization as follows : —
'' I. The static bath increases the con-
sumption of oxygen, and the production
of carbon-dioxide.
''2. Nothing analogous has been ob-
served with continuous currents.
" 3. The amount of respiratory gaseous
exchanges is obtained without muscular
contraction and without painful phenom-
ena, with alternate currents."
As to the physiological effects of rapidly
alternating currents, the following con-
clusion has been reached : " The danger
presented by these currents is less in pro-
portion as the frequency of alternation is
great ; with alternations in the neighbor-
hood of a million per second, currents
may be passed through the body without
danger, which would produce in the in-
dividual the effect of a thunderbolt if ap-
plied in a dose one hundredth part as
great, but with slow alternations."
These conclusions seem to agree with
those of M. Nikola Tesla, a young Italian
electrician, who has recently been making
some very remarkable and interesting ex-
periments at the Royal Institution in
England. M. Tesla was the inventor of
the first alternate current electric motor.
He has invented a dynamo which supplies
a current alternating 20 times per second.
By the aid of this current, he produces
an electrical light in a vacuum tube with-
out the aid of a filament, and by attach-
ing to the poles of his generator two
sheets of tin foil, one overhead and the
other on a table, the space between be-
comes electrified, and a long vacuum tube
waved about in the space between the
sheets of tin foil glows in the darkness
like a flaming sword. The inventor pro-
poses to run an entire room electrically
270
TRANSLATIONS AND ABSTRACTS.
by plates in the ceiling and floor, so that
vacuum bulbs placed anywhere in the
room will yield light.
But the fact of especial interest to
physiologists is the observation that
these currents of extremely high poten-
tial seem to be without effect upon the
human body. To illustrate this, an ex-
perimenter took an iron bar in one hand
and a vacuum tube in the other, then
connecting the iron bar with a terminal
which was capable of emitting sparks
several inches long, the vacuum tube
was made to glow brilliantly, although
the body of the experimenter was wholly
unaffected. The statement was made that
if the force of current had been -g-i-^ part
that of the current actually employed, it
would have produced instant death.
It would seem that we have only just
begun to get a glimpse of the marvelous
properties of this wonderful agent.
-^ — ♦ — ■*-
Haemostatic Gauze. — For 200 parts
by weight of gauze, make a solution con-
sisting of glycerine, 15 parts ; water, 200
parts; alcohol, 200 parts; tinct. perchlo-
ride of iron, 150 parts. Allow the gauze
to absorb the solution. Press until one
third the . solution has been expressed,
then dry without exposure to light.
Neutralizing Snake Venom. — Dr.
Albert Calmette, in studying the venom
of the cobra, one of the most poisonous
serpents known, found a method of
neutralizing it in the system of bitten
subjects. In a report made in the An-
7iales de ri7istitut Pasteur, Dr. Calmette
states that chloride of gold, in slight
quantities even, neutralizes the toxicity of
the venom. It is known that most of the
physiological alkaloids of animal tissues
have the property to form crystallizable
salts with the chloride of platinum and
chloride of gold. Dr. Calmette found
that chloride of platinum in a one-per-
cent solution makes a gelatinous precipitate
which introduced under the skin is quickly
absorbed, and kills the animal as
promptly as the pure venom. The chlo-
ride of gold, on the contrary, gives a
precipitate of similar aspect, but insolu-
ble. The mixture of this substance, even
in a very feeble preparation with the
snake venom deprives the latter of its
poisoning property. There occurs a re-
action comparable to that of the albumen
of ^gg in the presence of mercuric salts.
Considerable quantities can be injected
under the skin, in the muscles, in the
serous cavities, and in the peritoneum
without the least accident. The tissues
freshly impregnated with a feeble solution
of chloride of gold, are rendered incapa-
ble of absorbing the venom. The author
made numerous experiments with animals,
which sustain this conclusion.
-• — • — •-
The Goat as a Source of Vaccine. —
The experiments which have recently
been made with the injection of the blood
of the goat in the treatment of tubercu-
losis have given rise to the suggestion
that this animal, which seems to enjoy
absolute immunity against tuberculosis,
might prove to be a better source of
vaccine than the calf, which is well known
to be subject to tubercular disease.
It has long been known to veterinary
surgeons that the udder of the cow is a
frequent seat of tuberculosis. In such
cases the calf would be very certain to be-
come affected, and tuberculosis has been
not infrequently observed in calves. It
is consequently possible that tubercular
infection might occur through vaccina-
tion, although such cases must be exceed-
ingly rare, and if the vaccine is produced
with proper aseptic precautions, including
a careful examination of the animal itself
before vaccination, it would seem that in-
fection from this source might be con-
sidered as scarcely possible. Neverthe-
less, research and experiment in every
direction looking toward the conserva-
tion of human life is to be welcomed and
encouraged.
Laveran's Parasites in Intermittent
Fever. — At a recent meeting of the So-
ciety of Internal Medicine, at Berlin,
M. Bein presented an interesting case
in which Laveran's corpuscles had been
found in the blood of a newborn infant
whose mother was confined during a par-
oxysm of intermittent fever. The para-
sites were found in the blood of the
mother also.
M. Bein makes the following summary
of facts respecting these parasites, or
plasmodias : —
"These plasmodias appear in the first
stage under the form of small round cor-
puscles eight to ten times smaller than
red globules. They are transparent and
TRANSLATIONS AND ABSTRACTS.
271
mobile. From the periphery of these cor-
puscles very active filaments are thrown
off. In the operation of growth, the
parasites seize upon the coloring matter
of the red corpuscle in which they are
contained.
''Later, there is observed a true spore-
lation within the interior of the parasites.
'' It is at the moment when this spore-
lation occurs that the initial chill of the
paroxysm makes its appearance.
" By an examination of the blood, then,
we are able to say at what hour the next
paroxysm of fever will appear, and ac-
cording to the number of parasites con-
tained in the blood, one may say whether
the paroxysm will be grave or benign.
''To explain the different types of the
fever, — quotidian, tertian, and quartan,
it may be supposed that the parasites be-
long to several generations which are
each separately involved, and only occa-
sionally give rise to fever when their evolu-
tion is completed.
" Under the influence of sulphate of
quinine the parasites disappear. Methyl
blue gives also a good result."
In the discussion of this paper M. P.
Goodman stated that he had found the
parasites present in only a single case.
Race Deterioration. — Four years
ago, a committee was formed by the
psychological section of the British Med-
ical Association, to make an extended
inquiry into the physical and mental con-
dition of school children. The commit-
tee has been industriously engaged in
their work since its appointment, and
have examined over 50,000 school chil-
dren, of whom nearly 27,000 were boys,
and 23,000 girls. From a report recently
published, it appears that in this number
there were found over 3600 boys, and
over 2200 girls, 5800 in all, who pre-
sented palpable defects in development.
Doubtless there were many more than
this, but the method employed permitted
the inclusion of only such cases as pre-
sented very obvious and visible physical
defects. It thus appears that nearly 12
per cent, or approximately one eighth of
the entire number of children examined
were found to be physically defective ;
and when it is considered that a large
number of these children have not yet
reached an age when inherent morbid
tendencies or deficiencies would be so
obviously apparent as at a later period, it
must be conceded that the showing is a
bad one.
It was also particularly noted that the
larger proportion of defectives was found
among the children of the upper classes,
from which it would appear that deficiency
of food and exposure cannot be held re-
sponsible for this frightful downward tend-
ency, but that it must be attributed to
some other great underlying cause. Just
what this is, has not been pointed out by
the committee, and we have no means
of knowing whether it has formed a defi-
nite opinion upon this point. It may
be suggested, however, that the multipli-
cation of luxuries, excesses at the table,
and in various other directions, and es-
pecially the neglect of physical training
or muscular exercise must be held largely
responsible for this degenerative tendency.
-•■^ — • — ^-
Sputum as a Diagnostic Sign in
Certain Diseases. — It is not only in
tuberculosis that sputum may be analyzed
properly from a diagnostic standpoint ;
indeed, there are quite a number of
maladies in which the microscope ap-
plied to the study of the sputum may
be of very great and very practical value.
Dr. Morris thus sums up the most im-
portant observations in sputum in some
affections, in the Times and Register : —
" In phthisis, we have nummular spu-
tum ; looks like coin ; floats in a clear
liquid.
"In measles we have nummular spu-
tum, which floats in an opaque liquid.
"In bronchiectasis there is stinking
sputum ; also in fibroid phthisis there is
stinking sputum.
" In cancer of the lung, we have sputum
that looks like currant jelly.
"In pneumonia, we have rusty colored
sputum.
" In oedema of the lung, the expectora-
tion is serous.
"Where we have pneumonia terminating
in gangrene of the lungs, the sputum is
exceedingly fetid, greenish or brownish.
"The sputum of chronic bronchitis,
when associated with disease of the heart,
looks like the white of Qgg mixed with
water, and may amount to a quart or half
gallon in twenty-four hours.
"The sputum of chronic bronchitis
when not complicated is large, broad, and
irregular, and is greenish or yellowish."
272
BACTERIOLOGICAL KOTES
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Medicine, from original sources.]
Tubercle Bacilli in Semen. — Foa, an
Italian observer, reports a discovery in a
case of disseminated tuberculosis, of tu-
bercle bacilli in semen obtained from
the vesiculce seminales.
Action of Dog Serum on Rabies
Virus. — According to the British Med-
ical Journal, Evangeliste, an Italian bac-
teriologist, has discovered that the germ-
icidal properties of bacteria prophesied
by Nuttall years ago, and demonstrated
by Buchner and other recent observers,
is active, as regards the virus rabies. It
is true that no positive discoveries have
yet been made respecting the bacteria by
which this virus is produced, although
there can be no doubt that the vital
bacterial element is present in this, as in
other similar poisons. The experiment
showed that the virus was invariably
attenuated when exposed to the action
of dog serum for more than 22 hours,
and was finally destroyed. Pigeons'
blood was found more active than dog
serum.
Nutritive Processes of Microbes. —
M. Charrin reports in La Semaifie Medi-
cale, the results of some interesting ex-
periments which he has conducted for
the purpose of determining something of
the nutritive process of microbes. He
prepared a culture fluid which contained
a solution of phosphoric acid, phosphate
of soda, carbonate of potash, chloride
of calcium, and sulphate of magnesia.
To this he added known quantities of
crystallized asparagin, and then intro-
duced a microbe which produces a green-
ish-blue coloring matter. By means of
the coloring matter produced, the experi-
menter was able to follow from hour to
hour the progress of the assimilation of
the asparagin.
By careful chemical analyses it was de-
termined that 91 per cent of the aspara-
gin was eliminated as ammonia by hydra-
tion, and through the vital action of the
germ itself; 4.6 per cent was organized
into the bodies of the bacteria, and 4.04
per cent entered into the composition
with the specific principles produced.
The conclusions which the author de-
rives from these experiments are that the
pathogenic microbes experimented with
are nourished in essentially the same way
as animals, so that the pathological ef-
fects produced by microbes must not be
studied solely with reference to the me-
chanical or chemical effects produced;
but the fact of the consumption of nu-
trient elements of the system, thus induc-
ing a condition of starvation, must also
be considered.
Infectious Maladies Modified by
Antagonistic Microbes. — Dr. Stanley
M. Ward, of Scranton, Pa., in the Pitts-
burg Medical Review of March, publishes
a very interesting article with the history
of a case, tending to sustain the view that
certain infectious maladies may be modi-
fied by the action of antagonistic mi-
crobes, living simultaneously or succes-
sively in an individual. He points to the
fact that the bacillus of tetanus acts less
potently, if at all, in the presence of sup-
purative micro-organisms ; that the fluo-
rescent bacillus of FlUgge antagonizes the
organism of typhoid fever and pneumonia,
and retards the growth of the cholera
spirilla. Other authors claim that the
bacillus of anthrax is destroyed in contact
with either the diplococcus of pneumonia,
the staphylococcus aureus, or the strepto-
coccus erysipelas. He also points out
that almost a parallel exists between these
facts and the result of Jennerian vaccina-
tion. In the case reported by Dr. Ward,
it seems that membranous croup was an-
tagonized in its development by the action
of varicella, and he points to the possi-
bility of preventing the dreaded manifesta-
tion of membranous croup by the intro-
duction of an antagonistic virus. The
point is worthy of consideration.
Mechanism of the Action of Pa-
thogenous Microbes. — Many hypothe-
ses exist as to the method of action of dis-
ease germs in the econony. It seems that
on the one hand there is a real cellular fight
between microbes and body cells, during
which poisonous matters are secreted on
both sides as a means of defense ; on the
other there is a splitting up of the sub-
stances composing the cells, tissues, and
humors.
BACTERIOLOGICAL NOTES.
273
Role of Oxygen in the Production
of Ptomaines. — The action of oxygen in
the generation of ptomaines in putrefac-
tion is very manifest. Brieger has shown
that it increases the quantity in a marked
degree. Possibly this same action exerts
an important influence in septic maladies
in which such toxines play a fatal role.
A Remarkable New Skin Disease. —
Dr. Savill reports a peculiar epidemic of
skin disease among the aged population of
some London workhouses. It is charac-
terized by desquamation and exfoliation
of large patches of epidermis, so extensive
sometimes as to produce a ''complete
cast of hand or foot." A diplococcus
has been discovered in connection with
the lesions, but it has not yet been ascer-
tained whether it is a new pathogenic
germ or not.
A New Antiseptic Combination. —
Dr. J. de Christmas, in a recent Annales
de I Institut Pasteur, reports several ex-
periments prosecuted by him with the
view of discovering a safe and effec-
tive antiseptic. Among the combinations
tested is the following which he has termed
' ' phenosalyl, " and which though compara-
tively safe is next to bi-chloride of mer-
cury as a microbicide : phenic acid, 9
grams ; salicylic acid, i gram ; lactic
acid, 2 grams ; menthol, . i centigram.
This mixture is prepared by heating the
three acids until liquefaction ; it is very
soluble in glycerine. It is soluble in
water in the proportion of 4 per cent.
[Let some enterprising proprietary med-
icine company patent this or secure a
copyrighted trade mark, and bring to
the physicians a brand new antiseptic
" for the doctor only ! " It would not be
the first of the wonderful new remedies
thus evolved in our free country — too
free and loose in matters of medical
science. — Ed.]
Microbic Action in the Digestion
of Cellulose. — The mechanism of the
digestion of cellulose has always been
a puzzling question to physiologists.
Scarcely anything but hypotheses have
been advanced. M. H. Brown, in a re-
port published in the Journal of the
Chem. Soc, April, 1892, gives an inter-
esting account of his discovery that the
animal does not furnish the diastase to
set free the starch inclosed in grains
swallowed whole by gramnivorous ani-
mals, but the grains themselves furnish
it. It seems that the animal only sup-
plies the necessary temperature and
moisture, and that in this condition the
diastase existing in the grain dissolves the
cellulose and liberates the starch, which
then is appropriated as food by the
animal economy. However, as Duclaux
has well proven, in ruminants at least,
there is another factor in the digestion of
cellulose ; it is the action of microbes.
Though these organisms may not be nec-
essary for the digestion of grains, the long
stay of aliments in the paunch exposes
them to undoubted microbic influences.
These germs belong to the complex group
of ''amylobacter" described by Van
Trieghem.
How the Bacillus Coli Communis
Invades the Organism. — Wm. H.
Welch says that he has found the colon
microbe in one or more organs of the
body in thirty-three autopsies out of
about two hundred. His opinion, well
sustained by observations, is that these
organisms invade the circulation and
thence the organs by lesions of the, mu-
cous membranes of the intestines, such as
hemorrhage, ulceration, perforation, ca-
tarrhal and diphtheritic inflammation,
strangulation, cancer, traumatic injury,
and intestinal suture.
'' The bacteria were found in the blood,
lungs, spleen, kidneys, peritoneum, bile-
ducts, gall-bladder, liver, lymphatic
glands, testicles, tonsils, brain, and
wounds." They were more frequently
found in the lungs and kidneys.
It is of interest to realize that in ty-
phoid fever this germ, which resembles
the typhoid bacillus very closely, may
be mistaken for the latter when the two
are mingled in some organ or other. In
such cases the colon bacilli enter the
tissues by the lesions produced by ty-
phoid fever in the alimentary canal. It
is well known that M. Roux, of the In-
stitut Pasteur, teaches that the colon
bacillus may be transformed into the ty-
phoid bacillus. Welch's excellent work
declares very forcibly against this un-
warranted assertion.
274
EDITORIAL.
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
$2.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., June, 1892.
An original article on Immunity, by Dr.
Metchnikoff, the founder of the theory of
Phagocytosis, begins with this number.
It should have appeared simultaneously
in the Annales de Vlnstitut Pasteur,
Paris, France, and in the Bacteriological
World and Modern Medicine for May,
but miscarried in the mails, and was re-
ceived too late to do better than begin
its publication this month.
SECOND MEETING OF THE AMERICAN MEDICAL
TEMPERANCE ASSOCIATION.
The second meeting of the American
Medical Temperance Association was
Tield at Detroit on Thursday evening,
June 9, 1892, during the meeting of the
American Medical Association. It is to
be regretted that every member of the
American Medical Association was not
present to hear the vigorous utterances of
the veteran pioneer in medical organiza-
tion. Dr. N. S. Davis, the President of
the American Medical Temperance Asso-
ciation, whose annual address presented
the most succinct and cogent resume of
physiological facts relating to the effects
of alcohol upon the human system, to
which we have ever listened. The audi-
ence, although not so large as it should
have been, included a considerable num-
ber of prominent medical gentlemen,
and was a most appreciative one, fre-
quently applauding the timely hits made
b^ the President against the loose prac-
tices of the profession, in prescribing al-
cohol for their patients under the most
diverse and varied circumstances, and
without any proper consideration of the
physiological effects of the drug.
Among the popular errors which Dr.
Davis especially condemns, is -the notion
that alcohol is a stimulant. Dr. Davis
regards alcohol as a narcotic and an
anaesthetic in all doses and under all cir-
cumstances, and quotes experiments by
Reichert and other eminent physiologists,
made upon the heart of the frog, and the
muscular tissues of other animals, which
seem abundantly to support his position
upon this question. Dr. Davis makes no
use of alcohol, even as a medicine, and
has maintained his present practice in
this respect for more than forty years, his
experiments many years ago having led
him to his present views respecting
the influence of this drug upon the
system.
While fully agreeing with Dr. Davis
respecting the ultimate effects of alcohol
upon the system, we have for some years
been of the opinion that a very slight and
fleeting stimulant effect is derived from
the use of the drug when taken by the
stomach, owing to its irritating effects
upon this organ. Alcohol, if applied
to a raw surface produces a smarting
sensation ; if applied to the mucous
membrane of the eye, and even when
taken in the mouth in a pure state, it has
a similar effect. This transient irritat-
ing effect may exert a,temporary stimulat-
ing influence upon the heart and other vital
organs, although as soon as the drug has
been absorbed so that it comes in contact
with the nerve-centers and other struct-
ures, its true effects, which are those of a
narcotic, become speedily apparent.
Interesting papers by Dr. Quimby of
Jersey City, and Dr. Crothers of Connec-
ticut, the Secretary -^of the Association,
followed the address of the President,
and were succeeded by a spirited and in-
teresting discussion of the points pre-
sented in the papers. A committee was
EDITORIAL.
275
appointed to prepare a report upon the
statistics of non-alcoholic medical treat-
ment, and a member of the Association
was requested to prepare, for the next
meeting, a paper showing the injurious
effects of tobacco upon the human sys-
tem. It was also voted that the Presi-
dent's address should be printed in
pamphlet form for wide distribution.
The meeting was, upon the whole, a
very interesting and enthusiastic one, and
all in attendance were sorry that but a
single session could be held. Any per-
son wishing to become a member of this
Association can do so by signing the fol-
lowing statement and sending the same
with one dollar to the Secretary of the
Association, Dr. T. D. Crothers, Hart-
ford, Conn. : —
Being an abstainer from all intoxicating liquors
as beverages, I desire to become a member of the
American Medical Temperance Association, and am
willing to comply with the requirements of its By-
Laws.
Name.
Address.
'. Date.
Any one who has studied the subject of
temperance, from a medical standpoint
will agree with the statement that the
medical profession is largely responsible
for the erroneous opinions which prevail
among the people respecting the use of
alcohol. When a physican recommends
beer or whiskey for one who is weak and
convalescing from a fever, the patient
cannot be easily made to see that alcohol
is not equally good for him when weak as
the result of the loss of a night's sleep or
an extra hard day's work, or when the
emergencies of business impose extra
burdens upon him. If alcohol will give
him more strength in one instance, it will
assist him equally in each of the others.
If the people can be made to understand
that alcohol has no power to impart
strength, but that it is simply a deceiver,
producing the appearance of strength
without any real increase of vigor, a long
step will be taken in the direction of the
suppression of inebriety and the hundred
disorders of the brain, nerves, stomach,
and liver, which follow in the wake of the
drink habit. j. h. k.
-*■ — • — ^-
THE RELATION OF PUTREFACTION TO DISEASE
PHENOMENA IN LIVE TISSUES.
Very properly, the physician sometimes
illustrates the action of certain bacteria
in tissues by comparison with the decom-
position of meat and other substances.
However, there is an important difference
which, in our study of diseases, it is
necessary to note. This difference con-
sists of two things ; first, the life resist-
ance exerted by the live cells in disease,
which is entirely absent in putrefaction j
second, the successive microbe invasions
in putrefaction, each with a more or less
marked action, sometimes antagonizing,
sometimes helping each other, — phe-
nomena usually absent or somewhat lim-
ited in diseases essentially bacterial in
their origin.
The analogy between putrefactive phe-
nomena and the forms of fermentation that
take place in such maladies as anthrax or
septicaemia, for example, is reduced to the
microscopic appearance of the blood and
tissues, and to the fact that there occurs
in both cases a sort of partial trans-
formation of a similar order. But in
special diseases, the specific poisonous
ptomaines generated in the process do
not exceed, so far as known, one each ; in
faction there may be several kinds
produced. Again, in the maladies
named, the tissue cells react on the
m,icrobes ; they fight for their life, and
sometimes of their own accord limit the
action of their enemies, while in putre-
faction there is no fight between the dead
cells attacked and the invaders. The
latter cause a complete annihilation of
their hosts, and transform them fully.
In studying the possible relationship
of the two phenomena we must con-
fess to an affirmative conclusion to this
276
EDITORIAL.
proposition, but at the same time we
should remember always that putrefaction
implies that death preceded the microbic
destruction. When disease occurs, putre-
faction may take place locally, in certain
dead parts, and the rest of the body may
still live, but in all cases death first occurs
in anything in which true putrefaction
begins.
Those therefore, who insist that sep-
ticaemia and putrefaction are identical,
are not exactly correct. The two proc-
esses are of the same order, but not
identical, nor are they due to essentially
similar microbes. p. p.
-». — • — .•-
A MAGAZINE'S PLEA FOR CLAIRVOYANTS.
In the June number of the Are?ia ap-
pears an anonymous article in defense of
''the born doctor divinely commis-
sioned," etc., entitled ''Confessions. — I.
The Physician." The points that the
writer attempts to make, are : —
1. That the doctor is born, not made ;
that the diagnostic power (Dr. Buchanan's
psychometry) is an "innate faculty," as
"music, poetry, marksmanship, and the
trailing power of the bloodhound."
2. That medical colleges, medical so-
cieties, and medical journals are respon-
sible for incompetent doctors, and that
medical education is not indispensable to
the man born with the so-called "sixth
sense " or "diagnostic genius."
3. That creeds in the medical ranks
have codes of ethics based on monopolis-
tic principles.
4. That a "born doctor," no matter
how ignorant of medical science he may
be, should be paid for his "valuable in-
formation." (This is the milk in the co-
coanut).
In answering the writer (who diagnoses
"by intuition," and modestly points to
his own genius and infallibility in this ac-
complishment), we will endeavor to show,
chiefly, the fallacy of the fundamental
basis upon which he tries to build his
case.
In the first place the author assumes that
there is a special sense in nature, which
only a few human beings possess, — a so-
called "sixth sense" or "diagnostic fac-
ulty " or "psychometry. " If this be true,
he is right in many of his conclusions ; if
not, he is wrong in all the deductions
made. We will assert at once that he is
mistaken in his premises. No man pos-
sesses a special, natural, innate faculty of
diagnosing disease other than the percep-
tive intellectual powers rooted in the
organism and common to all men. Of
course it is true that these vary very
greatly in human beings, but it is only in
the matter of degree, and not a difference
of senses.
The variability that prevails among
physicians in their diagnostic power de-
pends upon several conditions, — variable
intellect, variable penetrating power, vari-
able discerning faculties, variable percep-
tive capacity, variable judgment, etc., and
last but not least, upon variable medical
knowledge and experience. The greatest
experts as diagnosticians, do not thereby
indicate to outsiders the existence in
them of a rare special sense, in the
physiological and psychological manner
implied in the Arenas but merely a greater
development of the natural powers which
contribute to the faculty of diagnosing
disease when the individual is properly
equipped.
Suppose it were true that some men are
born diagnosticians ; granting for the
sake of argument that some have special
intuitive power — a clairvoyant faculty
of diagnosis, in other words — what could
they do to relieve suffering humanity ?
— They could only locate the disease;
at the best, they could only indicate
the spot affected. Neither the author
of the clairvoyants' defense, nor Dr.
Buchanan, whom he quotes and ap-
parently follows, dare assert that this
"divine" psychometry carries with it a
knowledge of pathology. If it does
not, of what real good is it independently ?
EDITORIAL.
277
Does it not become imperative to the
supposed possessor of this gift, that he
shall study medicine, understand the nat-
ural condition of the organism, and the
alterations which take place in disease ?
Suppose a ''sixth sense" ''born doctor"
is presented a case of nervous affection :
he may say that the disease is in the
brain ; he may locate even the particular
spot affected ; but what good will this do,
even if he knows materia medica thor-
oughly ? He cannot apply the remedy
safely without understanding the organic
and functional nature of the changes in-
dicated by the symptom, and of the ac-
tions and possibilities of the remedies to
be prescribed. What benefit will it be to
know that a fatal bullet is located in a
certain part of the abdominal cavity, if
one does not know how to remove it?
The defender of psychometry places his
special "sixth sense" on a level with
"music, poetry, marksmanship, and the
trailing faculty of the bloodhound. "
Does he mean that each of these are so
many more special, independent senses?
It certainly looks that way. If so, he
can easily multiply the special senses to
hundreds. Does he not see any differ-
ence between an acquired skill and a
natural attribute ? — the acquired marks-
manship of a rifleman, and the instinctive
trailing faculty of the bloodhound, for
instance? This confusion in the writer's
mind has the advantage of showing clearly
to his readers that he is ignorant of the
fundamental principles of j)sychology,
which are necessary in the discussion of
such questions ; and furthermore, that
his "special diagnostic sense" is imagin-
ary. For, to compare it with music, which
cannot be evolved without training and
study, even in the most musically in-
clined, is to acknowledge that the " innate
diagnostic " power must also be trained
by schooling, though he denies the neces-
sity of it.
Science flatly denies the existence of
this wonderful faculty of "intuitive di-
agnosis." Neither physiology nor psy-
chology supports the idea. It is a notion
born long ago of ignorance, exaggerated
self-confidence and conceit, not a scien-
tific discovery. For the unscrupulous
charlatan, it forms the basis of his pre-
text, to filch fees from the pockets of
sufferers ; and for the honest believer as the
writer mentioned seems to be, it is a veil
blinding his intellect, and smothering his
conscience. The first point of the author
is not made.
'•'But," he may retort, "the sixth sense
is only capable of diagnosing, not sug-
gesting or applying remedies. ' ' Very well
then, we will answer : The sixth-sense man
must go to the college which the writer
denounces, and learn from science suf-
ficiently to use this so-called special
faculty (which is only the natural intelli-
gence, perspicacity, etc.), properly in the
practice of medicine. So the attempt to
prove that medical colleges are harmful
or valueless, is a ridiculous effort, aborted
by the writer's own logic (?). Common
sense readily suggests this. We admit
several shortcomings in medical colleges,
and in the methods of teaching medicine.
We know that they are far from being
what they ought to be ; that there is a
tendency to run them for financial bene-
fit only, — -in fact we know that many are
run for nothing else than the aggrandize-
ment and enrichment of the teachers.
But still, we know that the majority of
doctors trained in such institutions and
by such methods, are incomparably su-
perior to the most adroit "intuitive"
born doctor.
In the third place, the confessing doc-
tor endeavors to establish that the stern
code of ethics in the medical profession,
is merely a dodge instituted and ruled by
monopolistic principles to reap a rich har-
vest in the practice of medicine. This is
the most puerile assertion of the whole
article, when all know that one essential,
feature of medical ethics is directed to-
ward the prevention of all kinds of mo-
278
EDITORIAL.
nopoly, such for example as the patent-
ing of formulas, instruments, etc., and
furthermore, to prevent true physicians
from degrading themselves into becoming
tradesmen for pelf, instead of remaining
true soldiers in the cause of humanity, for a
just compensation. It is unfortunate that
mankind should be so perverted that
we cannot depend upon physicians with-
out such protection against adventurers
which may be in their ranks ; but the
very fact that men are found in this
scientific age, who will assert without a
scintilla of proof (admitting their ina-
bility to explain) the existence of an in-
tuitive (clairvoyant) faculty to diagnose
disease, is a good evidence that the
code, as a regulation, is in the right di-
rection.
Should the ''born doctor" be paid
for his ''valuable information"? The
writer under discussion answers, "Yes."
There being no such thing as a born
doctor in the sense implied, the question
would need no answer, were there not
such things as pretenders, who sail under
this assumption, and others who consci-
entiously believe themselves the posses-
sors of some kind of natural, undefinable
faculty to practice medicine.
This circumstance forces us to reply.
Science, common sense, and experience
absolutely prove the non-existence of the
"sixth sense " in question, consequently
the man who claims to possess it, and
who, under this notion, demands or ac-
cepts fees for "valuable information,"
demands or accepts money in payment
for something which he has never given.
It is therefore illegal, unjust.
Granting again, for the sake of argu-
ment, that this " sixth sense," the born
power to diagnose disease, does exist, it
cannot at the same time infuse knowledge
of botany, chemistry, physics, physiology,
histology, anatomy, pathology, bacteriol-
ogy, therapeutics, etc., etc., all of which
are essential to qualify one to practice
medicine, even after the diagnosis is
made, whether one does or does not pos-
sess "a peculiar intuitive perception
which cannot be explained or taught."
So, even when a doctor believes himself
thus "divinely commissioned," he is not
justified in receiving fees as a medical
practitioner if he has not studied into the
science and art of medicine, because he
does not possess the qualifications that
mankind are entitled to, nor is he cap-
able of rendering the measure of service
that common sense, science, and practical
medical education can and do render,
and that justice demands.
Furthermore, the preaching, teaching,
and advertising of the " intuitive doctor,"
the " born doctor," the "divinely com-
missioned " doctor, are like the claims of
the "seventh child," and the ignorant
"Christian Scientist" deceptions, prac-
ticed wilfully or ignorantly on a credu-
lous public. Surely it is not right that
the deceived should pay (willingly or un-
willingly) for the deception.
Before closing, we must commend the
views of the author in some other points :
First, we believe with him, that Greek and
Latin are not essential to success in medi-
cine. We know that many highly edu-
cated men are failures in the practice of
this art and science ; and we believe with
the author, too, that some system of
weeding should be practiced among those
entering the ranks. Education in the
classics, or in the various departments
of college and university curriculums is
not a guaranty of fitness to practice medi-
cine. Integrity, common sense, charity,
sympathy, intelligence, sound judgment,
and moral principles should be con-
sidered of primary importance. Colleges
ought not to be the sole judges of the
adaptedness and qualifications of doctors.
If the right kind of board of examiners
passed upon the fitness of candidates be-
fore being allowed to practice in any
State, it would improve the standard of
physicians. It is true that a vast army
of medical men are unfit, by nature or by
EDITORIA.
27^
education, or by both disqualifications,
to practice medicine.
There is but one rational basis upon
which to practice medicine ; and what-
ever claim medical creeds may make,
none of them are right if they ignore the
principles which form this basis. From
these principles it is clear that all at-
tempts to cure disease can only be made
in the form of assistance to nature in her
own efforts to restore health. No man
can, by any means whatever, cure any
disease simply by art or science. He can
at best only supply means by which physi-
ological action may be aided in the natu-
ral work of restoration. Consequently,
no system of medicine is right that does
not base its practice in all pathological
conditions, on a broad knowledge of
physiology (which cannot be learned by
intuition). The truest and best physi-
cian is the man of common sense, sound
judgment, integrity, morality, and sym-
pathy, who has acquired a scientific and
practical knowledge in all the depart-
ments of medicine, and does not hesitate
to use physiological means, and anything
rational, to relieve suffering, and aid in
effecting a cure. p. p.
BIOLOGY IN THE STUDY OF CHARACTER.
Accepting as true the old metaphysical
idea that personality is simply lodged in
the individual, and is subject at all times,
in case of sanity, to his control and will,
the great majority fail to see that biology
has any importance in reference to man's
character, other than the pathological
conditions which it may reveal in cases
of insanity ; even this is granted reluctantly.
If it were true that character is such a
special supernatural endowment, — an at-
tribute thus dwelling in man, but not essen-
tially apart of man's organization, — ^then
biology could help us little in the study of
man's characteristics. But in the judgment
of modern naturalists, at least those who
have studied life in the little as well as in
the large (microbes and pluri-cellular
organisms), there is no room to doubt but
that character is rooted in the organic
substance, and depends upon it for its
existence ; it does not come to man as a
separate gift at birth, but it grows from
the very moment of conception, and is
molde-d largely as the body develops be-
fore and after birth. Indeed, we may
safely say that character begins before
conception, as all-powerful influences are
transmitted through the male and female
cells uniting to form the first cells of the
child's body.
Personality, then, is rooted in the very
cells of our tissues, and the proper balanc-
ing of these must have a great bearing
upon the proper balancing of the char-
acter. Morality springs from living tis-
sues, like other integral parts of man's
characteristics. Purity and impurity,
sobriety and inebriety, rest on certain
natural inherited or acquired organic
conditions by which the natural appetites
remain natural or become depraved, and
the power of control remains intact or be-
comes decreased under exciting causes,
such as environment, nutrition, stimula-
tion, etc., etc. Sometimes such exciting
causes, stimulation by liquor drinking,
for example,' contribute to the alteration
of the cells, and become thereby a predis-
posing influence besides.
Biology, then, is a proper means of
investigating man's personality, and the
diseases thereof. It is a most important
factor. In the first place, it establishes
the physical relationship of all animals
and men. 2. It discloses the influences
of nutrition on cell-character. 3. It re-
veals some characteristics of the most
minute individuals, thus supplying means
of comparative study of the most hidden
activities and properties of different or-
ganisms in the animal kingdom.
Biology is the most penetrating, the
most discerning of all direct methods of
analysis of cell-life. Logical deductions
bearing on man's personality can be made
280
REVIEWS.
from comparative studies and biological
revelations, which the uninitiated never
dream of.
In disclosing the influence of food on
cell-life and activity, biology gives posi-
tive evidence that alterations may be pro-
duced in the faculties of the cells, and the
character of the whole organism that they
form, singly or co-operatively. It shows
clearly that an organism may be rendered
passionate, and that all its natural appe-
tites may be decreased, destroyed, or
increased to various degrees of intens-
ity,— even to such perverseness that
some of them will appear as purely ac-
quired vices. No more reliable evidence
is given of this fact, than by the close
study of microbic life. p. p.
-•.■ — • — ■*-
AN INQUIRY INTO SYPHILITIC AUTO-
INTOXICATION.
Among the original articles of this
number, appears by permission, a revised
article by Dr. A. H. Ohman-Dumesnil,
entitled ^' An Inquiry into Syphilitic Auto-
intoxication." The article is expected to
appear this month in another medical
journal of local circulation. Notwith-
standing this fact, Ave believe it of suf-
ficient interest to give it place in our
columns as original matter.
Reviews.
The Diseases of Personality. — By
Th. Ribot, Professor of Comparative and
Experimental Psychology in the College
of France. Translated into English and
published by the Open Court Publishing
Co., Chicago, 111.
This is a delightful book, discussing
disorders of organic matter, the emotions
and the intellect, and treating of the dis-
solution of personality. The work is
based on comparative psychological in-
quiries made by the learned author. It
demonstrates the natural origin of charac-
teristics and how they become diseased.
It is an interesting, instructive, and re-
liable volume.
Dictionary of Treatment. — By Wm.
Whitla, M. D. It is needless to say that
this " Therapeutic Index, including med-
ical and surgical therapeutics" is up to
date. The author's name is a guarantee
of thoroughness. The book contains
some 900 pages, in which the best treat-
ments generally used are tersely and
plainly set forth in brief words. Arranged
as it is, in alphabetical order, it is very
handy for reference. We can recommend
it to our readers, as thoroughly reliable,
and very practical and useful. The
young practitioner will find it of special
interest. Lea Bros, and Co., Publishers,
Philadelphia.
Insomnia and Hypnotics. — By Ger-
main See, M. D. Translated by E. P.
Hurd, M. D. George Davis, Detroit,
Mich., Publisher.
This is another of the very many use-
ful, practical and brief little books of the
Davis '* Leisure Library" series. The
author's name is a guarantee of reliablity,
and the translation does him justice.
The physiology of sleep, the subject of
Insomnia and Hypnotics, treated in this
volume, are questions of great interest
which receive too little attention. Every
doctor should read the book. Price
25 cents.
Are Inebriates Curable ? — By T. D.
Crothers, M. D., Hartford, Conn. A
paper read before the English Society for
the Study of Inebriety, London, Jan.
24, 1892.
This is a thorough and important article
on the subject of inebriety. Dr. Crothers
is undoubtedly one of the best qualified
men in the country to speak authorita-
tively on this question. He is thoroughly
satisfied that inebriety can be, and will in
time be largely controlled by the medical
profession and by legislative acts. This
is a little pamphlet which every doctor
ought to peruse attentively.
T this Season of the Year,
thousands of hivalids are
seriously considering the
question, —
WHLKl
SPEND THE
SUMMER
Where Can I Spend the Months of
July and August, and part of September,
with the Greatest Profit and Satisfaction ?
HE ANSWER
to this question depends
on what the individual
wishes to accomplish by a
summer vacation. If
change and recreation
only are desired, these can be found in a thousand places — at
health and other resorts which abound in almost every State in
the Union, none of which, however, excel the delightful re-
sorts of northern Michigan.
If, in addition to rest and recuperation, the invalid needs a careful study of
his diseased conditions, and an intelligent regulation of diet, exercise, and all other
health conditions,— in other words, scientific health culture, efficiently carried out
by the aid of the best known medical means and appliances, thoroughly trained
nurses and attendants, and competent physicians, — then the choice between the most
desirable places becomes very much restricted. - There are certainly few institutions
in this country where the needs and desires of an earnest health-seeking invalid can
be satisfactorily met. Such places can be counted on the fingers of one hand, and
are. perhaps, little known because of the fact that the managers of such institutions
are conducting them in a scientific, and in some instances a philanthropic spirit, and
consequently do not employ as a means of winning patronage, the emblazoned ad-
vertisements, the truth-sacrificing circulars, and other advertising methods com-
monly resorted to by the proprietors of mineral springs establishments, bogus
sanitariums, and other so-called ' ' health institutions ' ' and quasi-medical establish-
ments, with which the country abounds.
The advertisements of these establishments do not appear in public prints or
popular magazines because such advertising is closely akin to quackery, and brings
those who employ it into bad company.
The managers of the Sanitarium at Battle Creek, Michigan, many years ago
undertook to organize a thoroughly scientific institution which would represent
rational medicine in its most advanced form, and would be exactly what it professed
to be — an institution where patients are honestly and fairly dealt with, treated at
reasonable rates, given kind attention and comfort, and opportunity for the recovery
of health under the most favorable conditions. The majority of patients treated in
this institution are sent to it by physicians who by personal acquaintance, or
through the reports of their patients, have become thoroughly familiar with the
character of the institution and its management.
BRIEF DESCRIPTION
OF THE '^^^^^^'^^
5ANITARIUM.
_ - - - - -
§ATTLE CREEK, one of the most beautiful and prosperous cities of Michi-
gan, is centrally located in the salubrious Peninsular State. Its population
. is 20,000, while its death rate is but seven per thousand. Battle Creek is
situated on two great thoroughfares of railway travel between the East and
the West, being at the junction of the Grand Trunk and the Michigan Central lines ;
and two other railways make it easy of access from the South.
The cit3^ has an electric railway and is lighted by electric lights. A great
number of pleasant drives are afforded by its well-kept and shaded streets.
The Buildings are lighted by a 700-light plant, Edison incandescent system.
Safety Hydraulic Elevators. Outside stairways for fire escapes accessible from
every window.
The Institution affords facilities for baths of every description : Turkish, Rus-
sian, vapor, electric, water baths of all kinds, and the electric light bath. In-
dependent accommodations for ladies and gentlemen, sufficient for 80 persons
at one time. More than 800 feet of glass for sun-baths.
A General Parlor, 40 x 50 feet, is luxuriously furnished with Dhagistan rugs,
easy chairs, etc. The Dining-Room has a seating capacity of 400, is beauti-
fully lighted and ventilated, and always cheerful. No kitchen smells. Cui-
sine unsurpassed ; table service excellent. Everything an invalid needs, and
special dietaries prepared as directed.
VIEW OF GOGUAC LAKE FROM SANITARIUM LAKESIDE GROUNDS.
The Gymnasium, 85 x 45 feet, is supplied with everj^ appliance for exercise, and
furnishes special instruction and class drills in Delsarte and Swedish gymnas-
tics, under a trained director. , Exercise by prescription.
The S^wedish Movement Department, both manual and mechanical, is the
most extensive in the United States. Vibrating bars and seats, kneaders, rub-
bers, beaters, shakers, and manipulating appliances of all sorts.
The Electrical Department contains every improved appliance for medical ap-
plications of electricity, Galvanic, Faradic, Djmamic, and Static electrical
apparatus and appliances for electrolysis, electro-cautery, etc.
An Aseptic Maternity on the cottage plan ( steam heat and thorough ventila-
tion), provides the best possible conditions for lying-in patients, with expe-
rienced professional attendance and rigorous aseptic management.
Special Departments for surgical cases, eye, ear, throat, and lung diseases,
nervous diseases, genito-urinary diseases of men (non-specific), opium and
alcohol habits, and diseases of women. A kindergarten and nursery, to keep
the children happy and out of mischief.
Three Fine Greenhouses, maintaining a
magnificent collection of palms and va-
rious tropical flowers and plants, keep the
house filled with bloom during the win-
ter season/ Flowers are everywhere in-
doors during the winter season. Patients
can visit the greenhouse at any time
without going out of doors.
Glass=Inclosed Sun-Parlors and Veran=
das for winter sunning and promenad-
ing.
SUMMER HOUSE AND FRESH-AIR INLET.
Pure Water from sandstone rock.
There are from 250 to 300 Employes in the Sanitarium service the year
round, of whom from 90 to 100 are medical attendants and nurses. Also seven
thoroughly trained physicians, and a large corps of manipulators skilled in
massage and the lying system of Swedish movements.
The Sanitarium Training=School, in which our nurses are trained, is the
largest and most popular in the United States. Its course of training is
the most complete and
thorough of any school.
Tri=AVeekly Lectures on pop-
ular medical subjects by
the physicians.
Abundant Means for Rec=
reation indoors during
inclement weather. Facil-
ities for walking, driving,
and horseback riding at all
seasons.
The Sanitarium is Not a
Pleasure Resort nor a
fashionable hotel, but an
ideal place for invalids
needing good nursing, the
benefits of regular habits
and scientific professional
care and treatment, and who desire to get permanently well.
The Sanitarium Nursery and Kindergarten. This enables mothers to bring
little ones with them without being burdened with their care and supervision.
The children have the advantages of kind and experienced teachers and am-
ple playgrounds.
For Further Particulars, see large circular and card of rates,
J. H. KELLOGG, M. D., Supt.,
Sanitarium, BATTLE CREEK, MiCH.
x'^
/.-r^
^•^-^i^-ii^'^^'
ON THE LAWN.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
NlONTTHIvY BUI^IvETIN.
Battle Creek, Mich., June, 1892,
POISONOUS PRODUCTS OF DECOMPOSITION.
The results of, the decomposition of meats
and other articles of food are of great impor-
tance to the public, because so much food stuff
more or less altered by putrefactive processes
is placed on the market and sold to consumers.
Many authorities have made critical inquiries
into the nature of the substances produced by
decomposition, and have established the fact
that a number of the chemical products gen-
erated are of exceedingly poisonous character.
However, the nature of these poisons has been
considered very little as yet in this country
by investigators, and the people have not been
taught the truth about them. The public does
not realize the actual effect of the various prod-
ucts that are found, for example, in putrefying
meat. It is not uncommon nowadays, to see
on the menu of the gourmand, several articles
of diet which, on being tasted, prove to be more
or less rotten. If one will visit the so-called
"high-life restaurants" of large cities, and call
for duck, plover, snipe, and various kinds of
** toothsome" game, lie will generally receive
specimens that offend the sense of smell and
taste as putrefying flesh. These are the so-
called "ripe" or "seasoned" articles which
"educated" (I would say, perverted) tastes
relish.
In all these choice (?) morsels thereis an actual
quantity of vaccine generated by this so-called
"seasoning process." Decomposition has pro-
duced some transformations, and has created
some toxications. Though these substances
may not be present in quantities sufficient to
kill, or even to cause serious illness when taken
once or twice, or even occasionally, yet they
are nevertheless poisons; and just as one would
not think of taking even the slightest dose of
strychnine uselessly, one ought not to think of
absorbing these cadaverous poisons at all.
It is not my purpose in this article to de-
scribe the numerous substances which chemists
have isolated from putrefied substances, but
merely to point to one which has long since
been pointed out by Brieger and others. I
have reference to the ptomaine known as nev-
rine. This is a substance which has physiolog-
ical, physical, and chemical properties very
much resembling true nevrine, hence the name
given it by Brieger. Other names have been
suggested, but it is doubtful if they are any
better than this one.
The writer prosecuted the experiments of
Brieger sometime since, and arrived at some
results which the readers of this journal may
feel interested in reading. The process followed
to extract the nevrine from putrefying meat,
was as follows (Brieger's): —
Finely chopped meat was diluted in a certain
quantity of water and abandoned to putrefac-
tion at summer heat for six days. Then it was
boiled and filtered through a cloth by pressure.
Then the liquid was boiled again with animal
charcoal, and allowed to evaporate several
times with absolute alcohol. This boiling in
charcoal and extraction with alcohol was re-
peated until the solution was almost colorless.
At this moment, chloride of platinum was
added to the liquid, and a precipitate was pro-
duced. This precipitate was decomposed by
H'^^S, and the liquid was allowed to evaporate
in vacuo. The residue was treated with abso-
lute alcohol, which generated some little crys-
tals in the form of needles. This is the sub-
stance which Brieger has termed putrefactive
nevrine, as stated above. It has exceedingly
toxic properties.
Experiments were made with this substance
by inoculation in animals (cats, guinea pigs,
and rats). There is very little difference in the
action of this agent in these animals, except
that some are more sensitive to it than others.
From this point of view, as Brieger points out,
the differences are quite marked; cats, for in-
stance, are more susceptible than guinea pigs;
rabbits also sustain its action better than cats.
In experiments with small rabbits, a dose of
.004 milligrammes ol poison demonstrated
symptoms of poisoning, but I had to use from
.04 to .05 centigrammes to produce death with
the symptoms which accompany it.
The action of this ingredient on respiration ~
(385)
286
LABORATORY OF HYGIENE
is quite marked, even in small doses. It be-
comes more frequent, more pronounced; the
mouth is opened larger, and the nostrils are
more dilated. Dyspnopa, in other words, is
more or less apparent, and in cases of fatal
doses, respiration becomes irregular and slower
before death.
The action of this agent on the circulation
cannot pass unnoticed. The cardiac action
becomes very frequent, sometimes so frequent
that it is difficult to count the beats. This
goes on progressively for a short time, and
then gradually diminishes in a certain degree.
In the case of death, the heart beats, even after
breathing has stopped. When the effect of the
drug upon the bowels is marked, it is shown by
great peristaltic movement, causing continued
evacuations which soon become of the consist-
ency of diarrhea discharges. The urine is also
sometimes passed involuntarily.
The pupil of the eye is occasionally greatly
contracted, immediately after the injection of
the drug; it gradually takes its natural shape
or size in a short time afterward. The action
on the secretions is well marked. There is a
sweating of the nostrils and a discharge into
the mouth, and from the lips, of a mucilaginous
liquid. It is a viscous salivation which some-
times continues until death, according to the
dose injected. This phenomenon generally pre-
cedes the embarrassment noticed in the act of
respiration.
In small doses, the action of this chemical is
not sufficient to cause pronounced nervous
troubles. It requires fatal doses generally to
produce anything like convulsions or spasmodic
action of the system. When these symptoms
occur, weakness becomes very apparent, and
the animal can barely carry its weight.
Brieger discovered that atropine is a good
antidote for this putrefactive poison. What-
ever may be the intensity of the convulsions,
salivation, and other symptoms, it seems that
a small quantity of atropine in subcutaneous
injections, generally succeeds in making all
these phenomena disappear; the remarkable
contraction of the pupil of the eye is readily
counteracted.
It will be observed that if there is such an
acute poison as this in putrefaction (and this
is only one of many), meat or any other sub-
stance undergoing decomposition in any de-
gree, ought not to be utilized for consumption.
The inspection of meats in our public markets
is carried on with very little regard, if any, to
this question. It is desired to exclude from the
table such meats as can be traced to animals
which were diseased.before slaughter; yet little
if anything is done concerning the specimens
offered having a slightly greenish tinge, such
as is common to beef and other meats in
warm weather. It is not uncommon to see
in butchers' shops, livers, hearts, and other
organs, black or greenish with the first pro-
cesses of decomposition, offered for sale. In-
deed, many such find their way to our homes
and our tables.
It may be thought that such meats are safe
when well cooked; but it is not so. Cooking
only does away with the living germs. It de-
stroys the germs, but it does not destroy the
poison which they have generated before cook-
ing. In the experiments related above, which
gave results entirely like those of Brieger, it
will be observed that the juice of the decom-
posed meats was boiled repeatedly, and after
that, poison was found which, in minute quan-
tities, was capable of causing death.
Query About the Yeast Plant. — The Director
of the Laboratory some time since received the
following letter: —
"Dear Sir: Is there now, or will there be
sometime in the near future, a chance to get
questions answered through the Bacteriolog-
ical World and Modern Medicine? For ex-
ample: I wish very much to know more about
the yeast germ. In watching the processes of
fermenting bread, I see so many evidences of
animal life, that I cannot resist the conviction
that the active agent is an animal microbe.
Is the evidence absolute and positive that this
germ or cell is vegetable? Or may not a more
powerful microscope than any yet in use reveal
the fact that this and many other microbes
now supposed to be of vegetable growth, are
animals, and give off poisonous excretions as
animals do ?"^
In answering this question, it would perhaps
be unnecessary to go deeply into the nature of
the yeast plant, were it not for the fact that
many persons who have not studied this ques-
tion closely, seem in doubt; but to those who
have studied the smaller organisms closely,
there is no necessity whatever of saying a word
on the subject.
The "yeast germ," as the querist calls it, is
known technically under the name of saccharo-
inyces cerevisiaB, and, according to Dallinger,
they are probably degraded forms of ascomy-
cetes. In their zymotic action and in their
simple character, they resemble somewhat the
bacteria. The organism magnified four or five
hundred diameters appears in the shape of a
iThe writer asks if we will not establish a Question-
Column in this journal. We beg to answer that for this
year we are scarcely prepared to undertake the task.
Perhaps later on we will be able to grant his request.
LABORATORY OF HYOIEKE.
287
globular or ovoid cell, from about 2^00 to
3^0 inch in diameter. The cell may be iso-
lated, or several of them may be connected to-
gether in short strings or series. In the interior
of the cell may be noticed colorless material
(endoplasm) containing usually some vacuoles.
The phenomenon which the writer has ob-
served and compared to animal life, is simply
due to the exceedingly rapid multiplication of
the yeast plant in the proper medium, aferment-
able substance. There is nothing, then, indi-
cating that it is of animal nature; the fact is,
it is absolutely proven, and no one doubts the
fact among scientists, that the yeast microbe is
a plant, and a comparatively large one at
that. A microscope magnifying ten thousand
times more than the best we have, would
not increase the certainty of this, for it is es-
tablished by the nutrition, by chemical tests,
and by reliable microscopical technique well
known to-day.
Technique.
PRACTICAL POINTS IN HANDLING OBJECTIVES
TO OBTAIN BEST DEFINITION.
The Microscope, Wash., D. C, May number,
prints the following important note quoted
from Queen's " Pocket Catalogue: '" —
**If you want to compensate for thinner
cover-glass, set the systems of your objective
further apart; or the same purpose may be
effected by lengthening the tube of your micro-
scope. If, on the contrary, you want to cor-
rect for a thicker cover-glass, set the systems
closer or make your tube shorter.
"I. Thicker cover, longer tube, and opening
systems tend to over-correction.
'"II. Closing systems, thinner cover, and
shorter tube tend to under-correction.
" For the recognition of under or over correc-
tion by the appearance of the object, the writer
has found the method of E. Gundlach to be of
great practical value; and he would urge care-
ful practical study of these appearances as af-
fording a guide to the kind of correction
needed, whether 'under' or 'over.'
"To illustrate the practical use of the above,
suppose, for example, a condition of under-
correction of 'general spherical aberration;'
then either of the conditions named will af-
ford counteraction or correction, i. e., either
thicker cover-glass, longer tube, or opening
systems of objective, whichever may be most
convenient or practicable. It is, of course, in
many cases impossible to alter the distance of
lens-systems, owing to the objective being in a
fixed mount, not adjustable; in such cases one
of the other correctives may be applied."
How to Obtain Pure Cultures of the Bacillus
of Tuberculosis. — Mr. E. Pastor recommends
the following new process: The existence of the
bacillus in sputum being known, the patient is
made to rinse the mouth and throat thoroughly
with sterile water, which is poured directly into
a sterile vessel (large test-tube would do). This
material is filtered through gauze to separate
the largest particles, a little more sterile water
is added, and the whole is shaken violently. A
few drops of this liquid are mixed with gelati-
nous culture which is then spread over a glass
plate. In three or four days, the foreign
microbes show their development. All the
spots thus affected are cut out, and the clear
patches left between them are deposited in
tubes of blood serum. It is rare that theseclear
spots do not contain germs of consumption
which grow later in the serum.
Cultures from tubercles or lung cavities may
be made by the same process of dilution, etc.
GLYCERINE.
Cole, in a note printed in the American
Monthly Microscopies,! , Journal, says: —
"CgH^SHO is the hydrate of the trivalent
radical glyceryl. It is a sweet, syrupy liquid,
obtained by the decomposition of fats and
oils, principally as a by-product in the manu-
facture of candles and soaps. The fatty acids
are used to ma,ke candles and soaps, when
combined with soda or potash. Pure glycerine
is colorless and odorless, freely miscible with
water and alcohol in all proportions; but with
oils it only emulsifies, and does not perfectly
blend. It is a solvent of manj^ alkaloids and
their salts, as well as resins. The purest is
prepared by distillation; although not vola-
tile without decomposition, yet it passes over
undecomposed in the vapor of water, and may
be concentrated by careful evaporation. This
mode of preparing it was patented by Price's
Candle Company, but now much distilled glyc-
erine is imported from Germany. Glycerines of
inferior quality have a disagreeable smell, and
are sometimes colored. Good glycerine should
not be colored after being subjected for two
hours to the action of an added solution of
the nitrate of silver."
Method of Staining the Parasites in Cancer-
cells.— M. Soudakewitch, in a study of the
parasitism of cancers, gives the following
288
LABORATORY OF HYGIENE.
method for staining: The sections are made
with a microtome, inclosed in celloidine, and
colored by different methods. Chief amongthe
stains used are boric carmine, taking for sup-
plementary color, aqueous methylene blue,
iodinized green, or hsematoxylon and eosine.
In 59 cases of cancers thus studied, the author
always found intra-cellular, and sometimes
intra-nuclear parasites (See translations of this
article, in the May number and in this issue.)
any section easily in this manner, including^
magnifications of 600 diameters."
Smith's Method of Drawing. — The Am, M.
Microscopical Journal publishes the following
original method of drawing: " Place the body
of the microscope horizontal; remove the mir-
ror; put the slide on the stage; condense the
light upon it by means of the bull's-eye, taking
care to center the light; attach the concave
mirror to the front of the eye-piece by means of
a spring or a piece of thin wood. Have its
surface at an an^le of 45° with the plane of the
anterior glass of the ocular. This will project
an image of the object on the paper beneath.
If the outer ring of light is circular, there will
be no distortion. With a black cloth exclude
all outer light, covering both your head and
the instrument. Mr. Hopewell Smith draws
Lustgarten's Method of Coloration. —The
claim of Lustgarten that he had discovered the
bacillus of syphilis, is contested by M. Sabour-
aud, of the laboratory of Dr. Taperilt, of the
Hospital St. Antoine, Paris. This method
is as follows : —
1. Sections of syphylitic productions in
cover-glasses smeared with specific exudate of
chancre, are kept during 24 hours at cold tem-
perature, or two hours at about 60 °C. in a col-
oring bath composed as follows: Saturated
alcoholic solution of gentian, violet, 11 parts;
aniline water, 70 parts.
2. Coloration is followed by washing for 10'
minutes in absolute alcohol.
3. The preparation is subjected, during ten
seconds, to the action of permanganate of
potash, in a solution of 1)^ per cent.
4. Finally: decoloration in fresh aqueous
sulphurous acid solution. It will be necessary
to repeat this decoloration as often as will be
necessary to complete it.
Dr. Sabouraud has in vain tried this method.
He has found that it can color the bacillus
of tuberculosis, but it does not seem capable of
demonstrating the germ of syphilis.
ANTISEPTIC.
RROPHYUACTIC
DEODORANT.
LISTERINE
<VOW-TOX/C.
NON-IRRITANT.
NON-ESCHAROTIC
I^OI^ilMCXJ'Iv-A.* — Listerine is the essential antiseptic constituent of Thyme, Eucalyptus
Baptisia, Gaultheria, and Mentha, Arvensis, in combination. Each fluid drachm also contains
two grains of refined and purified Benzo-boracic Acid.
I>OiSE^. — iNTERNAi^iyY : One teaspoonful three or more times a day (as indicated), either
full strength or diluted, as necessary for varied conditions.
IvISTERINE is a well-proven antiseptic agent — an antizymotic — especially useful in the
management of catarrhal conditions of the mucous membrane ; adapted to internal use, and to
make and maintain surgical cleanliness — asepsis — in the treatment of all parts of the human body,
whether by spray, irrigation, atomization, or simple local application, and therefore characterized.
by its particular adaptability to the field of
PREVENTIVE MEDICINE— INDIVIDUAL PROPHYLAXIS.
L,ISTE;E.IISrE;
Destroys promptly all odors emanating from diseased gums and teeth, and -will be found of great
value when taken internally, in teaspoonful doses, to control the fermentative eructations of
dyspepsia, and to disinfect the mouth, throat, and stomach. It is a perfect tooth and mouth wash,
indispensable for the dental toilet.
Descriptive Literature upon Request.
LAMBERT PHARMACAL CO., ST. LOU/S, MO.
AGENCIES:
S \fAW SON & THOMPSON,
LONDON, E. C.
ROBERTS & CO.,
PARIS.
S. PAPPENHEIM,
BERLIN, W.
VI LAN OVA HOS. Y CIA.
BARCELONA.
AJD VER TI8EMENT8.
Farbenfabriken vorm. Fried r. Bayer & Co.'s
Pharmaceutical Specialties
289
Phenacetine=Bayer
Antipyretic
Analgesic, or
PHENACETINE-BAYER IS A TRUE AND DIS-
TINCT ORGANIC DERIVATIVE, not a mechan-
ical mixture. It is indicated in influenza (la grippe),
in all fevers, with or without pain, rheumatism and rheu-
matoid maladies, neuralgia, bronchitis, phthisis, pertussis,
Anodyne ^^^ the gastralgias. Phenacetine-Bayer acts promptly,
and is both safe and effective. It is supplied in ounces.
tablets and pills.
Sulfonal=Bayer
Hypnotic
Antineurotic
Nerve Sedative
EUROPHEN
Antiseptic
Antisyphilitic
Local Stimulant
Aristol
INSOMNIA OF ALL KINDS YIELDS PROMPTLY
TO SULFONAL-BAYER. It is useful in simple
insomnia and in the cerebral disturbances of insanity.
It is a pure hypnotic, a safe and effective remedy, and
it does not give rise to a drug habit. As its action is
slower than that of the narcotics, it must be adminis-
tered properly {see pamphlet), Sulfonal-Bayer is supplied
in ounces, tablets and pills.
(A CRESOL=IODIDE lODOFORfl SUBSTITUTE)
AS A SUBSTITUTE FOR IODOFORM, Europhen
is winning an enviable place in therapeutics.
It has a special value in specific lesions; while as
a surgical dressing in ulceration, open wounds, and
septic conditions of the cavities, it has given excellent
results. It is supplied in ounces. Europhen-Aristol,
a combined product consisting of equal parts of each
medicament, is also supplied in ounces.
(A THYMOL=IODIDE IODOFORM SUBSTITUTE)
Antisuppurative
Antiseptic
Cicatrisant
T'
HE VALUE OF ARISTOL in all the morbid con-
ditions formerly treated by iodoform is widely
recognized. In all external traumatisms, in cavital
lesions and in many of the dermatoses it has given very
satisfactory results. As a surgical application, it is safe,
inodorous and non-toxic. Aristol is supplied in ounces.
Europhen-Aristol, a preparation consisting of equal
parts of each medicament, is also supplied in ounces.
DMSCRIPTIVn PAMPHI^nTS FORWARDED ON APPLICATION.
W. H. Schieffelin & Co., New York.
PUBLISHERS' DEPARTMENT.
Contents of Lippincott's Magazine for
June. — "White Heron" (portrait ot author),
M. G. McLellaiid; "The Newspaper J I lustra-
ter's Story," (Journalist series, illustra-
ted), Max deLipman; "Betrothal" (a poem),
Edgar Saltus; "In a Castle Hall" (a poem)
(portrait ol author), Rose Hawthorne La-
throp; "Peary's North Greenland Expedition"
(illustrated), Benjamin Sharp, W. E. Hughes;
"Clearing Off" (a poem), Harrison S. Morris;
"Unc' Ananias" (illustrated), Molly Elliot
Sewell; "Canoe Life" (Athletic series, illustra-
ted), W. P. Stephens; "The Gates of Death"
(a poem), Flavel S. Mines; "Geographical Fic-
tion," Gertrude Atherton ; "Trials of a Pub-
lisher," Agnes Repplier; "Ashes and Incense,"
Robert Burns Wilson; "An Old Boston Maga-
zine," Joel Benton; "As It Seems"; "With
the Wits" (illustrated by leading artists).
The Mississippi Valley Medical Association
will hold its eighteenth annual session at Cin-
cinnati, W^ednesday, Thursday, Friday, Oct.
12, 13, 14, 1892. An excellent program,
containing the best names in the valley and
covering the entire field of medicine, will be
presented. An address on Surgery will be de-
liveied by Dr. Hunter McGuire, of Richmond,
Va., President of the American Medical Associa-
tion. An address on Medicine will be made by
Dr. Ho bar t Amory Hare, Professor of Thera-
peutics and Clinical Medicine, Jefferson Medical
College, Philadelphia. The social as well as the
scientific part of the meeting will be of the
highest order.
The Mississippi Valley Medical Association
possesses one great advantage over similar
bodies, in that its organic law is such that
nothing can be discussed during the sessions
save and except science. All ethical matters
are referred, together with all extraordinary
business, to appropriate committees — their de-
cisions are final and are accepted without dis-
cussion. The constitution and by-laws are
comprehensive and at the same time simple.
Precious time is not allowed the demagogue or
the medical legislator. The officers of the Pan-
American Medical Congress will hold a confer-
ence at the same time and place.
Charles A. L. Reed, M. D., Cincinnati,
President.
E. S. McKee, M. D., Cincinnati, Secretary.
A New, Safe Method of Administering
Toxic Medicaments. — A new departure in thera-
peutical posology marks a recent enterprise of
Parke, Davis & Co., Detroit, Mich., which is in
the interests of [progress, economy, and exact-
ness.
The .[increased knowledge resulting from re-
search in the fields of botany, chemistry, phys-
iology, pharmacy, and materia medica has
created a demand 'on the part of the medical
profession for the essential or active principles
of drugs in preference to the more cumbersome,
less definite, pharmaceutical preparations which
custom and authority have so long sanctioned.
Not a few alkaloidal principles of drugs have
been isolated, and are now frequently pre-
scribed. The conservative element of the pro-
fession has, however, in view of the toxicity of
certain isolated medicinal principles, and the
acknowledged variety of strength and activ-
ity of products of this character of different
maoutacture, been loath to employ them when
indicated.
The doses sometimes being fractions of a
thousandth or a hundredth, it is not possible
for the physician to always bear them in mind,
and in prescribing he is often in doubt as to
what constitutes the proper therapeutical dose,
and what the dangerous toxic one.
Dr. E. Trouette, in a paper read before the
Paris Academy of Medicine, and published in
the Revue de Therapeutique, entitled " Duodeci-
mal Doses of Toxic Medicaments," proposes a
method of obviating the difficulties hitherto
preventing the general use of many valuable
medicinal principles. The plan he proposes isai,
new method of posology based on the rational
division into twelve parts of the maximum dose
which may be given to an adult in twenty-four
hours.
The advantages claimed for this method are,
first, accidental poisoning need no longer be
feared. Second, dangerous medicaments may
from the outset be given in efficient dose with-
out the least risk.
Parke, Davis & Co. have prepared diuruules
and Diurnal Tablet Triturates of a large num-
ber of toxic medicaments, and will afford the
profession full information concerning this new
method of posology, with reprint of Dr. Trou-
ette's article.
Horlick's Malted Milk is dail3^ coming into
extended use and prominence as a food for
infants and for nursing mothers. Some infants
thrive better on it than on cow's milk, and it is
often retained and assimilated where every-
thing else is rejected.
It is being used not only by physicians in
their practice but in most of the principal asy-
lums and hospitals for children all over the
United States, and seems to be giving excellent
satisfaction everywhere. The factory near Ra-
cine, Wis., is located in the finest farming dis-
trict of the Northwest and is surrounded by
everything favorable to the production of a
perfect infant food.
Two Harvest Excursions via the Chicago,
Milwaukee & St. Paul R'v, on Tuesday, August
30th, and September 27th, 1892.
Where the grasses are kissed by the wand'-
ring breeze.
And the fields are rich with the golden grain;
Where the schooner plows through the
prairie seas
To its destined port on the western plain ;
Where homes may never be sought in vain,
And hope is the thriftiest plant that grows;
Where man may ever his rights maintain.
And land is as free as the wind that blows.
For further particulars apply to the nearest
ticket agent, or address Harry Mercer, Michi-
gan Passenger^ Agent, 82 Griswold Street, De-
troit, Mich.
the:
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH., U. S. A., JULY, 1892. NO. 9.
Original Articles.
STUDY OF IMMUNITY.
BY M. METCHNIKOFF.
II. IS THE SERUM OF VACCINATED RABBITS
BACTERICIDE OR ANTI-TOXIC ?
Rabbits vaccinated by sterilized blood
have always been tested with fresh blood
emanating from pigeons or rabbits having
died from hog cholera. This blood is
inoculated under the skin of the rabbits.
The intravenous injections are avoided
because they are always mortal for rab-
bits, the blood and organs of which, in-
oculated after death, remain, however,
occasionally sterile.
While the witness subjects inoculated
under the skin, died within twenty-four
hours, the vaccinated rabbits, after the
test (or proof), presented only suppura-
tion at the inoculated spot.
When the rabbits thus tested had com-
pletely recovered from their malaise, kt
very different periods (five, six, seven,
eleven, thirteen, sixteen, nineteen, fifty
days after the test of inoculation), some
arterial blood was drawn under strictly
aseptic rules, and was allowed to coagu-
late to obtain the serum. This blood put
in test tubes in quantities of 5 to 10 c. c.
was inoculated with a platinum wire con-
taining blood of pigeon or rabbit which
had succumbed to hog cholera. The
same method has been practiced with
serum of non-vaccinated rabbits.
In all cases without exception, there
appeared a rich culture of cocco-bacillus
suinum in the serum of vaccinated and
new rabbits. A few hours after the sow-
ing in the tub'es, a light cloud developed
uniformly in all the mass of serum. The
next day it was filled with a great quantity
of bacilli of hog cholera, scattered through-
out the liquid. A singular thing, — the se-
rum of vaccinated rabbits developed with-
out exception cultures richer in bacilli than
that of non-vaccinated rabbits.
Examined with the microscope, these
cultures presented quantities of oval
bacteria in the form of mono- or diplo-
bacilli. The chain composed of four
cells or more, was found only exception-
ally in the serum of the vaccinated and
in the serum of the new rabbits.
We may conclude, therefore, that the
serum of the vaccinated rabbits, and even
the serum of those hyper-vaccinated, al-
lows a very abundant growth of the mi-
crobe of hog cholera which develops itself
under an aspect and with forms absolutely
normal.
The serum of vaccinated rabbits incap-
able of killing or of stopping the develop-
ment of the bacteria of hog cholera, would
seem to possess the property of destroying
the toxic substances of this microbe, or
stopping their action in the organism of
rabbits.
To elucidate this question, we have
followed the method employed by M.
Behring ; we have left quantities of toxic
blood (that is to say, blood of rabbits
having died after a super-acute infection
and heated 50° C. one hour), capable of
killing rabbits, in contact with the serum
of rabbits vaccinated or hyper-vaccinated
against the microbe of hog cholera. A
volume of toxic blood with the addition
of a volume of distilled water was mixed
with two, or oftener with four, volumes
of serum of refractory rabbits. The mixt-
ure was preserved in the laboratory in a
cool place during sixteen, eighteen and a
half, twenty, and twenty-four hours.
The same quantities of toxic blood, with
the addition of its volume of water, were
mixed in the same proportions with
serum of new rabbits not vaccinated.
The mixture was preserved during the
same time and in the same conditions as
292
ORIGINAL ARTICLES.
that of the toxic blood and the serum of
the vaccinated rabbits.
Five experiments made with these
mixtures have demonstrated the total
absence of anti-toxic property of the
serum. Notwithstanding the variations
in the individual receptivity, the five rab-
bits which received the mixture of toxines
with the serum of the vaccinated, all died
in forty-five minutes, one hour and seven
minutes, one hour and twenty-five min-
utes, fourteen, and forty hours. The
rabbits inoculated with the mixture of
toxic blood and of serum of new rabbits
died also in the space of eight minutes,
one hour and ten minutes, two hours,
two hours and ten minutes. Another
died only the eleventh day after inocula-
ion. But notwithstanding this long sur-
vival in this witness case, we see that
neitJie?' the serum of the new rabbits nor
the serum of the vaccinated rabbits exerts
any influence on the toxine of hog cholera.
The differences observed in the time
of the death of the rabbits should be
considered rather as the result of indi-
vidual sensitiveness to i:he effect of the
toxines.
The witness rabbits which received the
toxic blood alone without addition of any
serum whatever, died between one hour
and fifteen minutes, and four hours and
eight minutes after the injection. The
blood which served for the experiment on
the anti-toxic properties of serum of vac-
cinated rabbits was withdrawn five,
eleven, thirteen, and nineteen days after
the test inoculation, when the rabbits
presented no more malaise. In one ex-
periment, made with the blood of one
hyper-vaccinated rabbit, the blood was
withdrawn forty days after the last proof
inoculation with the living virus, and four
days after an intravenous injection of 2
c. c. of toxic blood heated to 58° C.
The facts observed do not, therefore,
permit the admission of the existence of an
anti-toxic property of the serum of refrac-
tory rabbits against the mortal virus of
hog cholera.
III. DOES THE SERUM OF VACCINATED RAB-
BITS POSSESS THE PROPERTY OF AT-
TENUATING THE MICROBES OF
HOG CHOLERA ?
Let US now enter into the examination
of the virulence of the cocco-bacillus
suinum cultivated in the serum of vac-
cinated rabbits.
These cultures, injected in the veins or
under the skin of rabbits, give a fatal
disease to all of them without exception,
but the animals always die later than the
witnesses inoculated with cultures made
in the serum of non-vaccinated rabbits.
While those witnesses, after an intra-
venous inoculation of culture in normal
serum, died in a few hours, the rabbits
inoculated with the same doses of culture
in the serum of vaccinated rabbits died
only at the expiration of three to five
days. The survival is still longer after
the subcutaneous inoculations of the same
cultures.
The cultures in the serum of the vacci-
nated giving always a fatal disease, we
cannot conclude that a considerable at-
tenuation of the microbes occurred in
this medium ; nevertheless, we might be
tempted to attribute to this serum a cer-
tain degree of attenuating power on the
cocco-bacillus suinum because the malady
lasts longer. To elucidate this question,
it is indispensable to separate the microbes
developed in the serum of vaccinated rab-
bits from this liquid, for it is possible that
the serum alone may retard the march of
the disease in inoculated rabbits.
As the bacilli of hog cholera produce
a general turbidity in the serum of vacci-
nated rabbits, the only means of separat-
ing them from their medium of culture
consists in isolating them by filtration.
I have used paper filters through which I
allowed the passage of the liquid of the
cultures, and after which I washed in a
few cubic centimeters of a physiological
so-lution of chloride of sodium. Not-
withstanding this washing, a portion of
the substances of the serum naturally re-
mained adhering to the microbes, which,
as we know, are covered by a gelatinous
sheath. Besides this inconvenience, there
are several others : the paper filters cause
the loss of a quantity of microbes which
disappear with the serum and liquid of the
wash. Another portion of bacilli remain
adherent to the fibers of the paper. We
only succeed, therefore, when rubbing
the filter with a sterilized brush, in gath-
ering a fraction of the microbes.
To give me an idea of the influence
that such a method might exert, I have
made a comparative experiment with the
bacilli of hog cholera cultivated in the
serum of a normal rabbit not vaccinated.
A rabbit, inoculated in the auricular vein
with I c. c. of such a culture died seven
ORIGINAL ARTICLES.
293
\ hours and thirty minutes after the in-
jection ; another which received i. c. c. of
the residue of filtration of the same cul-
ture, died only in twenty-one hours (the
weight of the two rabbits was about
equal). There is, consequently, con-
siderable delay in action, after the loss of
microbes occasioned by the filtration and
the wash.
Notwithstanding all the chances in
favor of the diminution of the pathoge-
nous action of the bacilli cultivated in
the serum of vaccinated rabbits, the
death of the rabbits inoculated with
these filtrated cultures and w^ashed
in the manner indicated, always oc-
curred sooner in the rabbits which re-
ceived non-filtrated cultures. In one ex-
periment, the rabbit inoculated with the
residue of the filter died in eighteen
hours, while its witness animal, inocu-
lated with a non-filtrated culture, died
or succumbed only one hundred and
eight hours afterward. Sometimes the'
death of rabbits inoculated with bacilli
freed from serum as much as possible
occurs later, but in this case we ob-
serve, nevertheless, an influence of the
serum.
Thus, two rabbits inoculated with the
residue left on the filter, died in twenty-
nine to forty hours, and their witnesses
inoculated with the same culture not filt-
ered died between eighty-five and two
hundred and forty-four hours.
(To be continued.)
PUTREFACTIVE BACTERIA IN HEALTHY DEAD
ANIMALS.
BY DR. SEGRI TROMBETTA.
Translated from Centralblatt fur Bacteriologie und
Parasitenkunde, by C. A, Cary, B. S., D. V. M.
The epoch-making investigations of
Louis Pasteur have proved that putrefac-
tion depends upon several different bac-
teria. It also depends upon moisture,
temperature, and the presence of oxygen.
Putrefaction takes place after death, and
the bacteria spring from the greater part
of the alimentary canal, pass through the
intestinal walls, multiply, and penetrate
the organs, the blood, and the tissues,
causing all the phenomena that we denote
by the name ** putrefaction." The germs
also enter the body after death, and we
say that putrefaction had already begun
or developed, resembling the greater or
less changes which we, with naked eye,
find in the tissues, the blood, and the
organs.
Hauser, Zahn, and Foder have proved
that these micro-organisms are not in the
blood previous to the death of the healthy
animal. It remains yet to determine at
what period these migrations begin and
how long after entrance, dead blood and
organs remain free.
To determine whether the migrations
succeed or follow, will appear the more
important if one takes into consideration
the fact that these small pathogenic or-
ganisms may be grown with other bac-
teria. We know, for example, that in
this case there are organs and blood to
examine, and bacteria therein to find,
which have nothing to do with the morbid
processes or pathological changes, and
are first after death to enter and con-
tinue putrefactive action. In order to
avoid mistakes it is necessary to deter-
mine how long after death the organs
and the blood remain free from putrefac-
tive germs.
The following questions only will solve
the problem before us : Is there a point
of time after death at which one can say
that neither the organs nor the blood
have been attacked, or visited by the
micro-organisms of putrefaction ? What
is this point of time in the different ani-
mals ? Have temperature, the weight,
and volume of the animal an influence
therein ?
In order to answer these questions, I
have experimented with mice, rats, and
rabbits, — animals which are generally
employed in advanced methods in bacte-
riological institutes. The management
has been as follows : Every animal was
killed by a stroke on the head, and sub-
sequently kept for a certain time at brood
or room temperature, or in an ice chest
(o° to 4° C.) It was then dissected, and
from the blood and the organs stab cult-
ures in agar were made. A glance at
the following tables is sufficient to give
a distinct idea of the entire method
of procedure. I hold it superfluous to
add the control-experiments to the tables.
The sign (-|-) means that the culture has
294
ORIGINAL ARTICLES.
been positive, and the sign (-
that it has been negative.
-) indicates Table VII.— Rabbits at Room Temperature.
Table I. — Mice at Room Temperature.
Time of dis-
c
section
0
4)
1)
a
be
o
after death.
0
>
CI.
3
'A
m
h3
Cfi
t5
J
I
32 hrs.
+
+
+
+
+
2
30 -
—
+
+
+
+
?>
28 ♦*
—
+
4
26 '«
—
—
—
—
5
24 "
—
+
+
+
6
22 '•
—
—
+
7
20 '«
—
+
+
+
8
19 "
—
—
Table II. — Mice in Ice-chest.
I
29 hrs.
+
+
+
__
+
2
27 "
+
+
+
+
+
3
26 "
—
—
+
+
4
25 -
—
—
+
—
—
5
24 -
—
+
+
—
—
6
23 '♦
—
+
—
—
7
22 "
—
—
—
—
—
Table III. — Mice at Breeding Temperature.
I
8 hrs.
+
+
+
+
+
2
7 "
—
+
+
+
3
6i-
—
+
+
—
4
6 "
+
+
—
—
—
5
5i"
+
+
—
—
6
5 "
—
—
—
—
—
Table IV. — Rats at Room Temperature.
I
24 hrs.
+
+
+
+
+
2
22 "
+
+
+
+
+
3
21 "
—
+
+
—
—
4
20 "
+
—
4
+
+
5
19 -
—
—
+
—
—
6
i8i"
—
+
+
—
—
7
18 "
—
—
—
—
—
Table V. — Rats in Ice-chest.
I
29 hrs.
+
+
+
+
+
2
27 "
—
+
+
+
—
3
26 "
+
+
+
+
+
4
25 -
—
—
—
—
—
5
23 "
—
—
—
—
+
6
21 "
—
—
—
—
+
7
20 "
—
—
—
—
Table VI. — Rats at Breeding Temperature.
I
7 hrs.
+
_._
+
—
+
2
6i"
—
+
—
+
3
6 "
—
—
+
—
—
4
5i"
—
—
+
—
—
5
5 "
—
—
—
—
—
6
Time of dis-
section
after death.
0
S
1)
>
C
1)
_4J
CO
c
-a
bi)
c
3
I
2
3
4
5
6
7
26 hrs.
22 *'
21 "
19 -
17 "
i6i"
16 "
+
+
+
+
+
+
+
+
Table VIII. — Rabbits in Ice-chest.
I
24 hrs.
+
2
23 "
—
—
+
—
—
3
22 "
—
—
+
—
—
4
21 "
—
—
+
—
—
5
20 "
—
—
—
—
Table IX. — Rabbits at Breeding Temperature.
I
9 hrs.
+
+
+
+
+
2
7 "
+
+
+
+
+
3
6i "
+
+
+
—
—
4
6 "
—
—
—
From the preceding tables the follow-
ing summary may be derived : —
For Mice . . .
For Rats. . . .
For Rabbits.
At Room
Temperature.
19 hrs.
18 "
16 "
At Ice-chest
Temperature.
22 hrs.
20 "
20 "
At Breeding
Temperature.
5 hrs.
5 "
6 "
The following conclusions are drawn
from the foregoing : —
1. There is a time limit, during which
the blood and organs of the healthy dead
animal remain free from putrefactive
bacteria.
2. This limit for mice, rats, and rab-
bits is as represented in the summary.
3. This limit applies to aerobic germs
and the entire healthy dead animal. That
anaerobic bacteria flourish after the death
of the animal in the blood and organs has
been, for a long time, settled ; but these
have no pathological signification. In
one disease they hasten the putrefactive
process ; in another, on the contrary,
they check putrefactive ravages.
4. The temperature of the ice-chest re-
tarded the wandering of the putrefactive
bacteria in a slight degree, while the
breeding temperature greatly acceler-
ated or hastened their migration and de-
velopment.
ORIGINAL ARTICLES.
295
5. The time when the putrefactive pro-
cess begins varies with the volume of the
animal, but not in direct proportion to it.
In mice, during the first 19 hours the
blood and organs remained free from
putrefactive bacteria ; but the limit
diminished slightly in rats (18 hours),
sinks still lower in proportion to the
volume of the animal in rabbits (16 hours).
So remains the relation at room tempera-
ture, and almost equally does this pro-
portion apply at ice-chest temperature.
Only the breeding temperature hastened
the putrefaction in the small animals ;
this difference is of no special impor-
tance.
6. The putrefaction advanced irregu-
larly. The abdominal organs were at-
tacked first by the bacteria, while the
blood of the same animal remained free.
Among the organs the spleen decomposed
first ; next the liver, spleen, and kidney
together ; also in some cases, the blood
and organs begun to decay at the same
time. Many times one could discover
first in the lungs the previous existence
of micro-organisms. It is apparently
true that these germs are present in the
lungs during the life of the animal. The
blood was only, in one instance, last to
be attacked by putrefaction.
7. The species of animal exerted no in-
fluence upon the process of putrefaction.
DOUBLE CHANCRE A DISTANCE.— AN INQUIRY
INTO SYPHILITIC AUTO-INOCULATION.
BY A. H. OHMANN-DUMESNIL, M. D.,
Professor of Dermatology and Syphilology in the St. Louis
College of Physicians and Surgeons.
(Concluded.)
In the first place I wish to call attention
to a very interesting and brief resume on
the subject by Dr. E. L. Keyes. In one
case (his own) excision of the chancre was
performed before the lesion was twenty-
four hours old and before any induration
had manifested itself. It proved unavail-
ing as far as preventing the general symp-
toms from appearing was concerned. In
commenting upon this the author says :
"This case I consider worthy of record
because it fulfills the most exacting con-
ditions for testing the question still un-
der consideration in the profession, as to
whether syphilis is or is not already a
constitutional disease when the chancre
appears." In Berkeley Hill's case, cited
in the same paper, a man tore his frenum
during intercourse and in less than twelve
hours later had the wound thoroughly
cauterized with fuming nitric acid. A
month later a general syphilis manifested
itself. Leloir relates an analogous case.
A medical student had a suspicious in-
tercourse and watched his penis constantly
for any sign of the chancre. One night
at twelve o'clock nothing was apparently
visible. The next morning he noticed a
macule. This was largely. excised at two
o'clock in the afternoon of the same day,
but the uselessness of the measure was
shown by the appearance of general
syphilitic manifestations later on.
Barthelemy reports a case of undoubted
indurated chancre accompanied by gan-
glionic involvement in which the indura-
tion of the sore persisted for three months,
and of the glands for four months. No
treatment whatever was given, and eight-
een months later no general manifesta-
tions had shown themselves. The author
asks the question. Had I excised the sore
would I not have ascribed the mitigation
(?) of the disease to that operation ? He
might have asked himself, Was the case
one of syphilis ?
Zeissl has observed that the excision of
the induration does not prevent the ap-
pearance of secondary symptoms ; and
Depech has noted, as well as others, that
after excision the induration is repro-
duced at the site of the operation, and
secondary symptoms follow.
Spillmann protests energetically against
the abortive surgical measures employed
in reference to syphilis. To emphasize
his opinion he reports two cases as fol-
lows : —
He excised the chancre and the glands
anatomically connected with it, in a case.
No cutaneous lesions appeared, nor any
implication of the mucous membranes.
Internal treatment was not taken, and
confirmed tabes dorsalis was established.
In the second case a young woman was
supposably infected by her lover. Sus-
pecting that this might occur he caused
her to be very carefully watched for any
signs of a chancre. This lesion was ex-
cised as soon as it made its appearance ;
yet, despite his precaution, roseola of the
trunk and abdomen appeared as well as
buccal and vulvar lesions.
296
ORIGIJSTAL ARTICLES.
In one case I excised the chancre
largely as soon as it appeared. General
symptoms came on nevertheless, in a
mitigated form, it is true.
In some of the cases just given extir-
pation of the initial sclerosis was prac-
ticed as soon as it was possible to do
so, and yet the results were negative.
We must conclude from a clinical point
of view that in those cases the disease
was constitutional at the time the chancre
was excised. The sores were only sus-
pected, as the principal signs of dif-
ferentiation were absent, and it could be
very well argued that, had one been
excised and not been followed by gen-
eral symptoms, the sore was not an
initial sclerosis in spite of confrontation
with the probabilities in the case.
We will now take up some of the re-
ported cases of successful auto-inocula-
tion and examine them critically. First,
we will take the cases reported by Pon-
toppidan (i6). i. Patient with ulcer in
the sulcus coronse, having slight indura-
tion. Inoculated in three places on the
abdomen. On the eleventh day slight
infiltration of base observed.
2. Infection dating back three weeks.
For past fifteen days excoriation on
prepuce and ulcer in sulcus coronae.
Later, sclerosis about urethral orifice.
Three inoculations on abdomen appeared
as papules on the twenty-second day.
3. Infection a month old. Sclerosis
in sulcus coronae. Inoculation showed
papules on the thirteenth day.
4. Infection four weeks back. Inocu-
lation showed elevated reddened places
on the twelfth day. On the nineteenth,
papules, and on the twenty-sixth, a
syphilitic eruption.
5. Infection dating back twelve days.
Inoculation visible on the fourteenth dav,
reddened on the eleventh, and papular on
the eighteenth.
Haslund reports five cases of multiple
chancres due to auto-inoculation, a brief
notice of which is as follows : —
I. Ulcer of prepuce, near frenum, su-
perficial. Six days later indurated, as
also inguinal gland. Two days after,
it was excised. Ten days later, a small
ulcerated point due to the tearing out
of a suture, indurated ; and a few days
later there was found a small ulceration
at the meatus urethrse which became dis-
tinctly indurated. Four weeks later a
macular syphiloderm appeared.
2. Small excoriation of frenum. No
induration. Cauterized with chromic acid
and dressed with chloride of lime. Five
days later wounds became indurated. In
two more days, two superficial erosions,
one on internal surface of prepuce, the
other in the sulcus coronse. In three
days one sore indurated and a new ulcer
in the middle of the balano-preputial
sulcus. Ten days later there were eleven
indurated ulcers. About a month later
abundant macular syphilide. A number
of the ulcers healed, leaving a well-devel-
oped induration.
3. An indurated ulcer on the left side,
in the sulcus coronae. Left inguinal gan-
glia indurated. Two days later an in-
durated ulcer on the inner surface of pre-
puce. A month later macular syphilide
appeared.
4. An indurated ulcer in the sulcus
coronae, a little to the left of the median
line. Three days previously one had
appeared on the right side on the pre-
putial portion of the sulcus coronae.
Ganglia indurated on right side. In
about forty-two days a papular eruption
appeared.
5. Right labium majus affected with
two indurated ulcers ; two smaller ones,
also indurated at posterior commissure
and on perineum to the left of the raphe.
Glands in both groins involved, very
typical on the right side. Five days
later an indurated ulcer on internal
aspect of left labium minus. Twenty
days later macular syphilide appeared.
A critical examination of these cases
would lead us to look upon them as
special pleas. Mracek, in reviewing
Pontoppidan's cases, states that, as proofs
of the auto-inoculability of the chancre,
they have but little weight. In Case i,
of Pontoppidan's experiments we have
an inoculation made with pus , and slight
infiltration observed in the inoculations ;
in Case 2, also, purulent inoculation and
papules appeared on the thirty-seventh
day after appearance of ulcer ; in Case 3,
we have insufficient data, papules appear-
ing ; in Case 4, we have elevated red-
dened places as the result of inoculation,
papules appearing on the nineteenth day,
and one week later a syphilitic eruption ;
in Case 5, the inoculation was visible on
the fourth day and papular on the eight-
eenth. We do not find a description of
an initial sclerosis in any one of these in-
oculations, and the author simply pre-
ORIGINAL ARTICLES.
297
sumes that because lesions appeared at
the site of inoculation they must be
chancres. In Haslund's cases we find
that the ganglionic involvement is always
on the same side as the original chancre
(Cases I, 2, 4, and 5) ; and that when
the other side is involved there are gen-
eral symptoms appearing, or other por-
tions of the lymphatic system are also
involved (Case's i, 3, 4,). In these
cases the auto-inoculations are also sup-
posed to be the result of the action of pus.
Taking the ^oui ensemble, it will occur
to any fair-minded person that these ex-
amples are not satisfactory, nor are the
experiments crucial. In reported suc-
cessful cases we also note that an infil-
trated sore is most generally the result of
the inoculation. Even if an apparent in-
duration takes place, there is no corre-
sponding induration of the lymphatic
ganglia anatomically connected with the
artificially produced lesion, unless it be
at the time that general involvement of
the lymphatic glands takes place.
We must not forget that inoculations,
more especially when pus is employed,
are irritating, and the resulting lesion is
what has been denominated the ''irrita-
tive sclerosis " of syphilis.
Taking all these points into considera-
tion it seems to me that : i. the proba-
bility of auto-inoculation in early syphilis
has not been proven ; 2. while there may
be strong presumptive evidence in favor of
it, it is only at best a possiblility ; 3. the
most crucial experiments prove that ex-
cision of the chancre at the earliest possi-
ble moment is futile and falls short of its
purpose ; 4. in multiple chancres a dis-
tance the lesions are due to the same in-
oculation, as a rule ; 5. in multiple chan-
cres of different ages it is probable that
the younger lesions are merely irritative
scleroses ; 6. experiments so far appar-
ently prove that syphilis is constitutional
at the time the initial sclerosis makes its
appearance.
Note. — The following authorities are among those con-
sulted in the preparation of this paper : —
Practical Clinical Lessons on Syphilis and the Genito-Urinary
Diseases. 1886.
Venereal Memoranda. 1885.
The Venereal Diseases, including Stricture of the Male
Urethra. 1880.
The Pathology and Treatment of Venereal Diseases. 1883.
Lefons sur la Syphilis. 1886.
Materia Medica and Therapeutics of the Skin. 1881,
Syphilis and Local Contagious Disorders. 1869,
Syphilis and Pseudo-Syphilis. 1884.
Syphilis. 1887.
Atlas of Venereal and Skin Diseases. 1888.
New York Medical yournal. April 25, 1885.
Progres Medical. August 15, 1885.
Annates de Dermatologie et de Syphilographie . No. 4,
PROTOPLASMIC FOCI-THEORY OF
METABOLISM.
An Elaboration of thr Views contained in
THE Paper read by Dr. Morton at the
First Meeting of the American Elec- "
tro-therapeutic Association.
BY HORATIO R. BIGELOW, M. D.
(Concluded.)
Now it will be seen that the first action
going on in the cell is a destructive
one — katabolism, oxidation, or whatever
else we choose to call it. The positive
zinc attracts oxygen which is negative.
A zinc atom combines with an oxygen
atom. A recombination of oxygen and
hydrogen takes place all along the line,
leaving hydrogen free at the copper.
Then the zinc which has formed zinc
oxide, changes places with the hydrogen
of the sulphuric acid, and molecules of
zinc sulphate and water are formed.
The initial change is destructive — oxide
of zinc. What the initial impetus is that
is required to separate a molecule of
water we do not know ; and it would be
valueless speculation to argue the matter.
This destruction is followed immediately
by construction, anabolism following
katabolism. It is, however, to be no-
ticed that the synthetical compounds are
formed directly from the products of
decomposition, and while it is not yet
proven to be so, yet there is strong evi-
dence that urea is also formed in the
body in this same way. Now urea, as
Foster says, is the main end product of
proteid metabolism. The synthetical
process of the hepatic cells, which gives
rise to urea, is not unlike the changes
that go on in the voltaic cell. For it is
not at all stretching the imagination to
look upon every cell as a complete bat-
tery, the albuminous liquor of which may
be the electrolyte. To go a step further
we may even believe that each ultimate
division of protoplasm is an electro-posi-
tive or an electro-negative focus, and
that the various changes of nutrition
that go on in the human body normally
or pathologically, are merely evidences of
attraction or repulsion, of destruction or
construction, of analysis or synthesis, of
anabolism or kataSolism.
Cells react upon each other by virtue
of an electrical potential, and disease is
the expression of a difference of potential,
298
ORIGINAL ARTICLES.
by which waste products are formed. Of
course, it goes without saying, that the
primary concept was anabolic, but since
that first great fashioning, life came only
from death. The purely anabolic proc-
esses of metabolism are very few, if in-
deed they exist at all. What are called
synthetical processes do exist, I believe,
and from the nature of things must exist
in a certain definite ratio ; and these may
arise immediately from the analytical
process, and not alone from the prod-
ucts of such analyses. Dr. Morton uses
katabolism and oxidation synonymously,
because he looks upon metabolism as an
expression of the law of a protoplasmic
voltaic couple, or as he says: "By ka-
tabolism I mean oxidation and combus-
tion; the result is a new product — this
may be an end product, H20,C0 , urea,
or not an end product ; oxidation is
synthesis. But the electrolyte undergoes
analysis. The negative plate again is the
seat of synthesis, but it is another kind
of synthesis ; the products are not end
products ; they are just the contrary ; for
they are reduced or as far away from end
products as they can be ; they are not
now oxidizable fuel out of which to make
end products ; but the oxidation at the
positive element makes true end products,
/. e., ultimately oxidized. I would say,
then, in my theory : —
"Positive elements give end products
(katabolism) — synthesis ; negative ele-
ment gives reduced products (anabolism)
— synthesis ; the electrolyte gives decom-
position products — analysis."
By the destructive metabolism going
on in the animal cell kinetic energy is
liberated, carbonic acid, water, and urea
being burnt off in the protoplasm. This
is plainly a katabolic process — one of
combristion. The energy that is stored
in the cell does not equal that which is
expanded, Halliburton (Text Book of
Chemical Physiology and Pathology)
says : "While a cell is alive, it is always
undergoing certain chemical changes.
During assimilation it is building up its
own substance from other material, which
is called food. On the other hand it is
undergoing retrogressive metamorphoses,
and this is especially increased during
activity. The destructive chemical
changes in a muscle are for instance
more marked during its contraction than
when it is not contracting. The chief
destructive changes that occur are of the
nature of oxidation. Carbon unites with
oxygen, and carbonic acid is given off ;
hydrogen unites with oxygen to form
water ; nitrogen is burnt off in the form
of imperfectly oxidized substances, of
which the chief are urea (CONgH^) and
uric acid (C3H4N4O3) ; but other sub-
stances like xanthine, hypoxanthine,
kreatin, etc., are also formed, and will
be generally found in minute quantities
in organs composed of cells ; sulphur
passes off in the form of sulphates.
These combustion changes represent a
transformation of energy ; the potential
energy of chemical affinity is trans-
formed, and exhibits itself partly as heat,
partly as electrical change, partly in the
form of mechanical work." This end
product of urea, of which we know so
little, and yet upon a just knowledge of
which so much depends, may be, prob-
ably is, the result of the breaking up of
the electrolyte. All the elements neces-
sary to disengage electric energy are
present in protoplasm. JVuclein, for in-
stance, is a compound of carbon, hydro-
gen, nitrogen, sulphur, phosphorus, and
oxygen.
Protoplasm contains 80 to 85 per cent
of water and 15 to 20 per cent of solids.
These latter (following Halliburton) are
chiefly proteids,^but in addition, small
quantities of fats, carbo-hydrates, like
glycogen and inosit and inorganic salts,
especially of potassium, are present. By
decomposition within the body, these
"proteid"'or "albuminous" substances,
give oif carbonic acid, water, and urea as
final products, together with other inter-
mediate products. That is, an electrol-
ysis has been originated. Latham,
quoted by Halliburton, shows how, by a
rearrangement of atoms different from
that occurring in normal metabolism,
excess of sugar may be produced in dia-
betes, excess of uric acid in gout, and
certain ptomaines in other complaints.
This rearrangement of atoms may be
due to differences of polarity. The
katabolic changes being the initial ones,
the oxygen goes to the zinc. Berthelot
has shown that the union of oxygen with
haemoglobin is attended with an evolu-
tion of heat. His measurements show
that about 14.77 calories are produced for
each 32 grammes of oxygen combined.
Thus a balance of power is maintained,
an equilibrium of temperature between
the blood flowing to the lungs and the
ORIGINAL ABTIGLES.
299
blood leaving the lungs. This ts an im-
portant factor in the study of the polarity
of pulmonary diseases. During fever
there is great increase of body metabol-
ism, which fact has been established be-
yond all doubt by the study of the nitro-
gen excreta and oxygen consumption at
that time. This is important also in a
study of the polarity of febrile disease.
Diabetes with its sugar, the uric acid
diathesis, also furnish guides for intelli-
gent electrical treatment. The hydrogen
atom, which went to the copper of the
voltaic couple, and which is a most im-
portant element in the animal economy,
plays a prominent role in oxidation. It
matters not whether the element exist in
a chemical compound, or whether it be
free. Onegrm. of hydrogen in combustion
will set free 34.5 calories ; carbon will set
free only 8.1 ; urea, 2 ; albumen, 5.8.
Dr. Morton's theory is a beautiful and
original one, and when thoroughly elab-
orated must give us the only guide possible
to the treatment of disease by electricty,
i. e., disease polarity. The anabolic
processes in the animal economy seem to
me to be more prominent than Dr. Mor-
ton will admit. Part of the matter taken
in by the animal may, by constructive
metabolism, be built up into the tissues
proper ; bone, muscle, and nerve and the
tissues of the various organs ; another
portion may also, after constructive me-
tabolism, be stored up as reserve material
in the form of fat and glycogen ; while
a third portion may, by destructive me-
tabolism, be split up into simpler sub-
stances which may be excreted without
having entered into the composition of
the body. All of these processes are
related to oxidation. Mc Kendrick says
that it is not improbable that in the first
instance constructive metabolism occurs
by which the oxygen, proteids, fats, car-
bo-hydrates, salts, and water are built up
into the highly complex matter, living
protoplasm, and that thus there is for a
short period, a still further conversion of
energy into the potential condition ever
in the animal. ''Contrast now the
plant and the animal — the plant trans-
forms kinetic into potential energy, the
animal transforms potential into kinetic
energy. But neither the plant nor the
animal is wholly concerned in the one
operation."
It is useless to go into the question of
muscular irritability, of stored energy, of
rest and motion, because our knowledge
of these points is not absolute, and be-
cause, too, the subject is far too large to
find place in a medical journal. I be-
lieve, however, that the general princi-
ples enunciated in the paper under dis-
cussion will hold for all conditions of
muscular irritability and nerve innerva-
tion. Starting out with the idea of
polarity in disease, I have been using
the material at my disposal both in my
clinic and private practice as a test, and
so far I have not been disappointed. In
old inflammatory conditions in any part
of the body, the more especially in the
cellular tissue around the uterus, in
gout and rheumatism, the principle holds
good.
Sometimes the plasmatic cells undergo
a sort of decay by accumulating fat in
their interior, and thus afford adipose
tissue ; in this condition they are no
longer susceptible of undergoing trans-
formation ; they are, so to speak, dead.
''But most, though changing form and
becoming almost mummified (stellate plas-
matic cells), preserve, in their latent con-
dition, all their vital characteristics,
ready to wake up if the excitation is
sufficiently strong; in this way they can
furnish new forms, as for instance, cancer,
different tumors, and in general, purulent
abscess globules. Thus the embryonic
cells become pathological." We must
acquaint ourselves thoroughly with the
pathological processes engendering dis-
ease, in order to understand whether such
changes are anabolic or katabolic, whether
the disease in question is electro-positive
or electro-negative, and then if elec-
tricity be indicated, there will be no
trouble in selecting the proper pole.
Pruritus Ani. — In our June number,
page 259, Dr. Dumesnil, of St. Louis, is
placed in an awkward position by errors,
which have unfortunately crept into a
quotation of his writing. We are exceed-
ingly sorry that the mistakes occurred.
However, Dr. Dumesnil's reputation is
so well established, that we feel no injury
will be done him. The extract and per-
scription should have read as follows : —
Pruritus Ani. — Dr. Dumesnil, of
St. Louis, recommends for this distress-
ing affection, the following mixture : Cor-
rosive sublimate, 1% gr. ; ammonium
chloride, 3 gr.; carbolic acid, i dr.; glyc-
erine, 2 oz.; aqua rosse, 6 oz.
300
TRANSLATION'S AND ABSTRACTS
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE LIYER AS A BILE-MAKING ORGAN/
BY DUJARDIN BEAUMETZ.
Member of the Academy of Medicine, Physician to the
Cochin Hospital, Paris.
Translated by J. H. Kellogg, M. D.
(Continued from May Number.)
We have first to examine the biliary
passages, then the bile which flows through
them. I shall dwell briefly upon the
anatomy of the biliary passages, referring
you to the special treatises where you
will find all the information desired re-
specting their anatomical disposition.
I wish only to call your attention to
the fact that the view supported by
Robin and Claude Bernard, that a sepa-
ration existed between the hepatic lobule
and the biliary passages, is no longer
admissible. Robin held that the biliary
passages terminated in cul de sacs, and
that the latter were the organs of the
secretion of bile, while Bernard thought
that the hepatic cell held exclusively the
glycogenic function, the bile being se-
creted by special organs.
It is clearly recognized that the biliary
passages are in direct relation with the
hepatic lobule, and constitute a peri-
lobular and inter-lobular network which
completely envelops the hepatic cell, and
it is in this cell that the act of secre-
tion of the bile is performed. These
canals, joining larger branches, traverse
the liver, enveloped in the capsule of
Glisson, then become the extra-hepatic
biliary canals which end in the ambule
of water. This system is completed by
the biliary reservoir of the gall-bladder,
which plays so important a role in the
pathogeny of biliary calculi.
I should have said nothing respecting
the anatomical organization of these ex-
trabiliary canals, the hepatic canal, the
cystic canal, and the ductus collatus com-
munis, if it were not that several questions
of importance might arise for considera-
tion respecting the mechanism of hepatic
1 A series of lectures delivered by Prof. Dujardin Beaumetz,
published in the Bulletin General Therapeutique, and trans-
lated expressly for this journal.
colic. Struck by the obscurity which
existed respecting the pathology of he-
patic colic, I undertook, nearly twenty
years ago, in 1873, with Audige, a series
of experiments upon the production of
this painful phenomenon. A complete
account of these experiments will be
found in a thesis by Audige, dated
1874.
By introducing foreign bodies into the
bile ducts of a dog, we reproduced, ex-
perimentally, the symptoms of hepatic
colic, and we have shown that in this
disease there is a reflex spasm of the
muscular tunic of these excretory con-
duits, the spasm developing under the
influence of the irritation of the mucous
lining of these passages, which possess a
high degree of sensibility. It remained,
further, for us to be fully convinced of
the reality of this spasm, only to ascertain
whether in man the biliary conduits jpos-
sess the same structure as in the dog. In
the dog, the muscular layer is very dis-
tinct, but in man, in referring to special
works on anatomy, I was struck by the
divergence which exists in many writers
upon this point. Some affirm the exist-
ence of a muscular layer; others, upon
the contrary, deny it. Grancher and Re-
nault, upon being requested to clear up
this question of histology, replied in the
affirmative, — that there existed many fi-
bers in the biliary ducts of man, and if I
add that this layer appeared notably hy-
pertrophied under the influence of obsta-
cles that obstructed the course of the
bile, we have a right to consider hepatic
colic as a colic in the sense which gen-
eral pathology attributes to this word.
We see what conclusions must be
drawn from these facts, in reference to
the relief of this clinical symptom. It
now remains for me to speak of the secre-
tion of bile, and of its composition.
Physiologists are far from being agreed
respecting the quantity of bile secreted
by man. Relying upon experimental re-
searches, Arnold fixed the quantity of
bile secreted daily in the dog, at 8-1 1
grams per kilogram (about 60-100 grains
per pound). Nasse placed the amount
at 12-28 grams. These figures are near
those of Bidder and Schmidt, which are
13-28 grams; but Kolliker and Muller
state the amount to be 32 grams. In
their most recent experiments, of which I
shall speak later, Prevost and Paul Binet
fixed the amount of bile produced each
TRANSLATIONS AND ABSTRACTS.
301
twenty-four hours, at 17 grams per kilo-
gram of dog.
Applying these figures to man (a man
weighing 60 kilograms), we find the
daily amount of bile to be 1000-1500
grams. However, some physiologists
affirm, relying upon experiments made
upon patients with biliary fistuli, that the
quantity does not exceed 700 grams per
twenty-four hours for a man of average
weight. Others maintain, on the con-
trary, that the normal amount is three or
four thousand grams.
The flow of bile is constant, but there
are some circumstances which increase
this secretion, — first, the movements of
respiration ; the layer of the diaphragm
compresses the gall-bladder upon the in-
testinal mass, and tends to empty its
contents into the biliary passages ; it is
a veritable massage of the gall-bladder.
We shall make some applications of
this fact when we study the pathogeny
and the cure of biliary lithiasis.
While eating, and during intestinal
duodenal digestion, the flow of bile is
much greater, and during this time, the
portion of bile reserved in the gall-bladder
is utilized. However, the gall-bladder is
not indispensable, it being known, in
fact, that certain mammals have no bili-
ary vesicles.
Further, in man deprived of the gall-
bladder by a surgical proceeding, or by
an invasion of the gall-bladder by cal-
culi, the biliary functions do not appear
to be modified.
Many circumstances influence the se-
cretion of bile. I shall not refer to all
of these. This would lead me too far ;
but the point which is of greatest interest
in relation to the secretion of bile, is the
action of medicines upon this secre-
tion.
It is known that there exists in thera-
peutics a group of medicines to which
has been given the name of cholagogues.
These are drugs which have the effect of
increasing the biliary secretion.
The study of these drugs is based upon
experiments which have assumed, in re-
cent times, great scientific precision.
Formerly, experimenters were content to
examine the stools or the livers of animals
to which certain medicines had been ad-
ministered. Then Moesler, in 1857, sub-
stituted for this primitive proceeding, a
method of operating much more precise.
Roerhig curarized a dog. Then, after
having established artificial respiration,
he separated the common bile duct, and
introduced into this canal, a narrow tube,
really a drop-tube. Then he counted, in
a given time, the number of drops which
flowed from the tube, and thus determined
the action of the medicaments introduced
into the chest-tube of the animal under
experiment. It should be understood
that the cystic canal was carefully ligated.
In 1875, Rutherford and Vignal pub-
lished their great work upon cholagogic
remedies. The method which they em-
ployed was very similar to that of Roerhig,
only in place of employing a rigid tube,
they introduced into the common duct a
tube of glass to which was fitted the rub-
ber tube itself, terminating in a glass
tube which led into the receptacle which
received the bile.
In 1882, we found a work by Rhoman,
upon cholagogic medicines. Rhoman em-
ployed a biliary fistula. Then came the
work of Baldi, in 1883, that of Packe, in
1884, and finally the extremely interesting
work of Prevost and Paul Binet, upon
which I desire to dwell especially.
The proceeding employed by these
Swiss experimenters, was that of the bili-
ary fistula. After having anaesthetized
the animal, they ligatured the common
duct, and then established a fistula be-
tween the gall-bladder and the abdominal
wall. This operation made upon the
dogs has not disturbed the health of
these animals which have been observed
during many months. A glass tube is
placed in the orifice of the fistula, and
the amount of bile which flows in five
minutes is carefully calculated.
In other works Rutherford and Vignal
have made known to us a series of sub-
stances which occupy an important place
within the scope of cholagogic medicines.
These are, evonymin, phytolaccin, iridin,
juglandin, and daptisin, substances upon
which my student Davet has written a
thesis, and upon which I have long in-
sisted, in my clinical therapeutics.
A certain number of these medica-
ments have remained in therapeutics,
especially evonymin, which to-day is
much used in the form of a pill, 10 centi-
grams each of evonymin and medicinal
soap for one pill. One or two of these
pills are taken in the evening, on going to
bed. Phytolaccin has also been the oc-
casion of a very interesting work of my
colleague and friend. Dr. Desnos.
302
TRANSLATIONS AND ABSTRACTS,
Besides these new studies by Ruther-
ford and Vignal, these experimenters
have classed the different medicaments
according to their cholagogic action.
We are to-day able to compare with the
classification made by the English experi-
menters that which resulted from the
researches of Prevost and Paul Binet.
These experimenters have classed in
four grades the different substances
which they have studied. In the first
grade are those which increase the biliary
secretion to a certain degree. In the
first line are bile and biliary salts ; then
comes urea, which, it should be re-
marked, has produced grave gastro-in-
testinal symptoms following different
substances, essence of terebinthine and
its derivatives terpinol and terpine, chlo-
ride of potash, benzoate and salicylate of
soda, salol, evonymin, and muscarine.
The second group comprises drugs pro-
ducing either only a slight increase in the
amount of bile produced, or a doubtful
or inconstant result. These are bicar-
bonate and sulphate of soda, chloride
of sodium, Carlsbad salts, propylamine,
antipyrine, aloes, cathartic acid, rhubarb,
hydrastis canadensis, ipecac, and boldo.
The third group includes substances
producing ptomaines in the secretion of
the bile. Acholagogues, iodide of pot-
ash, calomel, iron, and copper, trapeoline
(by subcutaneous injection), strychnine
in toxic doses.
Finally, the last group is that which is
constituted by substances which have no
action upon the biliary secretion. These
are, phosphate of soda, bromide of pot-
ash, chloride of lithium, sublimate, ar-
senite of soda, alcohol, ether, glycerine,
quinine, caffein, pilo-caffein, kairine, co-
lumbo, senna.
These results give rise to numerous
reflexions from the therapeutic point of
view, as the bile must be considered one
of the most powerful of cholagogues.
Before this time, bile had been used in
certain hepatic infections complicated
with icterus. I have also utilized the
cholagogic properties of bile by associat-
ing it with oil in the treatment of biliary
calculi. Evonymin, which Rutherford
placed at the head of cholagogues, along
with podophyllon, still retains its first
rank, but the most interesting is certainly
the result obtained by salicylic com-
pounds. Here is also a confirmation
of the experiments of Rutherford, who
considered salicylate and benzoate of
soda as very powerful cholagogues, and
as bile is antiseptic, one understands that
this cholagogic action enters somewhat
into the remarkable effects obtained by
the use of salol and salicylate of bismuth
in counteracting intestinal putridity.
Finally, let us remark that terebinthine
and terpinol, which were not yet known
when the experiments of Rutherford were
made, may be arranged among the medi-
cines having an active effect upon the
secretion of bile.
The conclusions concerning the second
group, that is to say, that which includes
substances producing only doubtful, slight,
or inconstant increase in the secretions of
bile, are also interesting from a therapeu-
tic point of view.
As was remarked by Rutherford, the
salts of soda, and in particular the bi-
carbonate of soda, has very little activity
as a cholagogue.
I have already spoken, in my clinical
therapeutics, of the contradiction which
appears to exist between clinical and ex-
perimental researches, in relation to the
cholagogic action of bicarbonate of soda
waters. I still believe that this action of
the waters of Carlsbad and Vichy is not
due to a cholagogic effect, but to a
modification, a reaction, of the digestive
functions, improving the general health
and the nutrition.
I should remark that sulphate of soda,
which Rutherford indicated as a good
cholagogue, is unreliable according to
the Swiss experimenters. The same is
true respecting the chloride of soda.
Hence the conclusion that the natural
salts of Carlsbad, which include chloride
of sodium sulphate of soda, and bicar-
bonate of soda, cannot be arranged among
cholagogic substances. I should have
remarked respecting aloes, that while
Rutherford placed it as one of the best
cholagogues, Prevost and Paul Binet con-
sider it as a very unreliable cholagogue.
Finally, I find in these experiments a
confirmation of what I have advanced
respecting boldo. It was many years ago,
in 1876, when I first maintained that this
drug was more a diuretic than a hepatic
remedy.
The last group, comprising drugs with-
out action upon the biliary secretion, or
diminishing this secretion, leads me to
speak of calomel. Here again occurs
the same divergence between clinical ob-
TliANSLATIONS AND ABSTRACTS.
803
servations and therapeutic experiments
which we have observed respecting the
alkaline mineral waters.
If there is any one medicine greatly
used in hepatic affections, especially in
England, it is calomel, and its favorable
action rightfully leads to the consideration
of calomel as one of the most powerful
cholagogues of which we are possessed.
Rutherford had previously called atten-
tion to the diminution of the secretion
of bile under the influence of calomel.
• Prevost and Binet urged the same result.
This conformity in their experimental
conclusions must therefore lead us to
consider calomel as an acholagogic drug.
If it has any effect in hepatic disorders,
it is probably by quite another action.
Calomel is, in fact, a very powerful anti-
septic drug, and it is in destroying in-
testinal putridity that it favorably modifies
the functions of the liver. As to the col-
oration of stools normally, this is not
due to the modifications of the bile, but
to a coloration produced by the mercurial
salt itself.
Although Rutherford maintained that
calomel diminishes the secretion of the
bile, he has also maintained, on the con-
trary, that corrosive sublimate augments
this secretion, and the conclusion has
been drawn that it is therefore necessary
to substitute corrosive sublimate for calo-
mel in the treatment of hepatic affections.
According to the experiments of Prevost
and Paul Binet, this substitution should
not be made, for corrosive sublimate has
not produced this cholagogic effect upon
their animals.
(To be continued.)
or diastase. This ferment plays, in or-
ganic oxidations, the same role as heat in
ordinary combustions. Its action cannot
be distinguished from other catalytic proc-
esses, for it acts only in breaking up the
molecular union of the atoms of carbon
and hydrogen.
Organic Oxidations in Tissues. — M.
Jaquet, of Bale, recently reported to the
Society of Biology, of Paris, the results
of a series of researches upon the mech-
anism of oxidation in the body, which
he believes establish the following propo-
sitions : —
1. That the blood alone does not pos-
sess the faculty of oxidation.
2. That the tissues, or an extract of the
tissues, possess active oxidizing powers
in the presence of atmospheric oxygen.
3. That this oxidizing property is de-
stroyed by boiling.
In the presence of these facts, one is
brought to the conclusion that the prin-
ciple active cause of the oxidations in
the living organism is a soluble ferment
Calcareous Food. — In a discussion
concerning the value of bromide and chlo-
ride of calcium, recently introduced as
therapeutic agents by M. G. See, which
recently occurred before the Academy of
Medicine of Paris, M. Dujardin Beaumetz
made the following very pertinent re-
marks, which agree entirely with the ob-
servation of the writer : —
''I wish to return, to-day, to one point
of the communication of M. G. See, —
that which relates to the necessity of
furnishing calcareous elements to those
patients in whom, for any reason, these
elements are deficient.
''Now it appears from the works of
various authors, notably the thesis of
M. Chery I'Estage, — that if one wishes
to introduce into the stomach of a child
or an animal, calcareous substances, it is
necessary to employ, not the pharma-
ceutical substances, but phosphatic sub-
stances already assimilated by nature.
''Among the vegetable products which
contain the largest amount of calcareous
salts, I will mention bran. Bran bread
which has been condemned in the army,
or for those not suffering from calcare-
ous inanition, is, on the contrary, of the
greatest utility to children predisposed
to rachitis. The same is true of beans,
horse-beans, and lentils. You know that
horse-beans are employed in feeding sheep
to cause them to assimilate the phosphates
of lime, and to give them age by harden-
ing their teeth.
"As to pharmaceutical phosphates,
they are not assimilated, and are almost
completely eliminated by the urine or
faecal matters. I am astonished, then,
that in the communication of M. See,
he recommends the administration of the
salts of calcium to furnish calcareous
elements to the system.
"The improvement which follows the
administration of these foods, lacto-phos-
phates, or of chloro-hydro-phosphates of
lime, is due to the happy influence which
these drugs exert upon the glands and the
digestive tube, and not because they in-
troduce the salts of lime into the system."
304
TBANSLATIONS AND ABSTRACTS.
Alcoholism and Insanity. — M. Vail-
lard, the distinguished Professor of Clin-
ical Medicine at the Medical School of
Marseilles, France, has recently published
a series of lessons {'^ LeQons stir VAl-
collisme "), in which he calls attention to
the constantly increasing use of alcoholic
drinks in France, and especially in Mar-
seilles. According to the statistics which
he gives, the consumption of alcohol in
Marseilles has increased from 9700 hec-
toliters in 1878, to 19,675 hectoliters in
189 1, an increase which is vastly out of
proportion to the increase of population,
it being well known that in France the
population has been actually at. a stand-
still until the last year, when there was a
marked decrease, owing to the falling off
of the birth-rate, for which alcohol, with
the use of tobacco, was also shown to be
largely responsible.
According to M. Vaillard, 65 per cent
of the patients admitted to the Hospital
for the Insane, at Marseilles, are chronic
inebriates. These facts are certainly
very instructive for Americans as well
as Frenchman.
-♦^ — • — •-
The Cure of Consumption. — Dr.
Burney Yeo, Professor of Clinical Thera-
peutics, King's College, London, has
great faith in the curability of pulmonary
tuberculosis, especially in the early stages
of the disease. He calls particular atten-
tion to the importance of recognizing the
disease in the pre-tuberculous, or the
pre-phthisical stage. The symptoms are
sufficiently characteristic to render a
diagnosis probably, although not posi-
tively certain. With Prof. Grancher, he
agrees that in the pre-phthisical stage, the
symptoms may be nothing more than a
little debility, a slight cough, pneumonia,
and a slightly quickened respiration. As
the disease advances, physical diagnosis
may detect in certain private areas a
harsh, low-pitched respiration, especially
marked during inspiration, jerky, or in-
terrupted inspiration. These symptoms
are especially important when distinctly
localized and constant. Early hemor-
rhage is useful in calling attention to the
disease before it has reached an incur-
able stage. The principles upon which
the rational treatment of the disease is
based, as laid down by Prof. Yeo, may
be summed up as follows : —
I. Whatever favors the sclerotic or
fibrous evolution of the tubercle pro-
motes the natural condition of cure.
The most favorable cases for cure are
those in which there is absence pf exces-
sive vascular irritability, as shown by
flushing on slight provocation and marked
vaso-motor disturbances.
2. The constitution in general should
be sound, and there should be absence of
marked hereditary predisposition.
3. In some cases, probably, the infect-
ing agent is less virulent than in others,
and doubtless also, the number of invad-
ing germs influence the extent of the
infection and the probability of the
cure.
4. The mode of infection must also be
considered ; that if the germs have
reached the lymphatic channels or the
blood, the wide diffusion of the infection
makes an unfavorable prognosis impera-
tive. Infection through the air is much
more favorable for recovery.
5. The tuberculous patient must be
made to digest as much food as possible.
To gain flesh is of the greatest impor-
tance.
6. A residence in a pure, dry atmos-
phere, is one of the most favorable
conditions for a cure.
The most valuable remedy thus far dis-
covered, and one most widely used at the
present time, and in which the greatest
confidence is placed, is creosote used by
inhalation, and in large doses by the
rectum.
THE CURE OF RABIES BY THE BLOOD
SERUM OF IMMUNE ANIMALS.
A RECENT number of the A?inales de
Micrographie contains an interesting arti-
cle by Tizzoni and Schwarz, of Boulogne,
detailing the results of experiments by
the authors, for the purpose of determin-
ing the value of the blood-serum of ani-
mals protected by vaccination against
rabies. In the treatment of animals af-
fected by the disease, and in rendering
animals immune as regards this affection,
they doubtless undertook, by their re-
searches to solve the following prob-
lems : —
I. Is the blood of animals vaccinated
against rabies capable of destroying in
vitro the virus of rabies, and if so, what
is the substance to which it owes this
property ?
TRANSLATIONS AND ABSTRACTS.
305
2. Does the blood act in the living
organism in the same manner as in vitro,
and may it be employed as a means of
transmitting immunity from vaccinated
animals, to animals not thus pro-
tected?
3. Is the blood of vaccinated animals
capable of curing the disease during the
incubation period of rabies, as well as of
conferring immunity ?
4. Finally : Is the diffusion in the
bodies of animals vaccinated against ra-
bies, of the substance which confers im-
munity limited to the blood only, or does
it extend to the tissues and viscera ?
The following are some of the most in-
teresting results and conclusions reached
by the experimenters : —
1. The serum of the blood of a rabbit
vaccinated against rabies has the power
of destroying in vitro the virulence of
rabic spinal cords.
2. The serum of the blood of dogs
possesses this property to a much less
extent than does the serum of rabbits.
3. The active principle of the rabic
virus is a non-dializable substance which
is precipitated by alcohol ; the precipitate
retaining the activity of the virus, being
little affected by the precipitation. The
active principle is a proteid substance be-
longing to the class of globulins.
4. That th€ blood of animals vacci-
nated against rabies acts in the organism
as in vitro, in destroying the rabic virus,
and this confers immunity upon animals
into which it has been injected.
5. That the serum of the blood of dogs
vaccinated against rabies is much less
active in conferring immunity than that
of rabbits similarly protected by vaccina-
tion.
6. That by the injection of the serum
of vaccinated animals, a curative as well
as a prophylactic action is obtainable.
The general conclusion reached by the
experimenters is the following : In
rabies, as has been demonstrated for
other infections, the beneficial effects of
vaccination are due to the presence in
the blood of a substance capable of con-
ferring immunity, which comports itself
as a globulin, and probably belongs to
the class of enzymes. In immunization,
whether prophylactic or curative, it is
possible to substitute in animals, and
probably also in men, for the anti-rabic
vaccinations which are practiced at the
present day, injections of the serum of
the blood of animals vaccinated against
rabies, with all the advantages which re-
sult from the substitution of an inoffen-
sive substance devoid of virulence, for a
virulent substance, the virulence of which
has been attenuated by dry heat.
Haematotherapy in Tuberculosis. —
The remarkable experiments of Drs.
Bertin and Picq, in the treatment of pul-
monary tuberculosis by the injection of
goat's blood have attracted much atten-
tion. These experimenters seem to have
surrounded their work with every possi-
ble precaution, and to have so far as pos-
sible avoided sources of error. They
have now employed this method in 150
cases with the following results, which we
quote from the Jour7ial D^ Hygiene : —
''At the beginning of the disease the
patient's condition is so much improved
that a cure may be said to be effected.
In the period of softening, very great im-
provement is often obtained, the cough
and expectoration diminishing and the
strength returning, even when all the
classical modes of treatment have com-
pletely failed."
It seems that this method of treat-
ment will probably have a future, and
that it will not fall into disrepute so
promptly as have many of its predeces-
sors. The recent researches in bacteri-
ology have placed the method upon a
sound physiological basis, and there
seems to be a good prospect that further
study of this new mode of combatting
one of the most terrible maladies known
to man, will result in establishing it upon
a sound therapeutic basis.
Atropine for Hypersecretion of
Gastric Juice. — Voinoitch (Zes Nou-
veaiix Re77iedies) recommends atropa
in doses of y^ of a grain, three times
daily, as the best remedy for combatting
hypersecretion of the gastric juice (with-
out hyperacidity), basing this use of the
remedy named, upon the experimental
researches of Netchaeff, upon the inhibi-
tory action of the secretion of the gastric
juice. It is claimed that the remedy di-
minishes the pain, and completely con-
trols the vomiting. An obstinate case
was completely cured by the use of the
remedy, within ten days.
306
BACTERIOLOGICAL NOTES.
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Medicine, from original sources.]
Blennorrhagia. — The Annales De Mi-
crographieT. IV, No. 7, 1892, p. 59, gives
a digest of M. Wertheim's contribution
to the study of blennorrhagia. Concern-
ing the culture of the gonococcus, the
following conclusions were arrived at: —
1. The gonococcus may be easily iso-
lated and cultivated on plates, by using
blood serum. To give it the property of
solidifying, according to M. Hueppe, it
is necessary to add sterilized gelose. In
three days were obtained thus, pure cul-
tures of gonococcus.
2. The cultures thus obtained, when
inoculated in the urethra of man, pro-
voked a typical blennorrhagia, as was
demonstrated by five experiments.
3. The possibility of employing plate
cultures proves that it is not necessary to
sow the matter to be inoculated, in a
thick quantity, because each germ gives
rise to one colony. The cultures in punct-
ures and in furrows succeeded equally
well.
4. The serum of human blood is by
far the best field for the gonococcus, still
meager cultures are obtained in the se-
rum of animal blood and gelose, even
when the blennorrhagic pus is directly
sown.
5'. The well developed cultures on
human serum may be transplanted on
fresh serum after four to five weeks,
on condition of having been protected
against dessication.
6. The virulence is not lost rapidly in
artificial culture media. A culture of
four weeks of human blood was found
still very virulent.
7. The gonococcus develops better,
protected from oxygen than it does when
exposed to its action. In the experi-
ments made to ascertain whether this
germ could produce peritonitis, the ex-
perimentalist found that it was capable
of producing this disease, but that ani-
mals have not all the same receptivity to
it. White mice resist the least, then
come guinea pigs, then rabbits, and
rats. Dogs are almost as a rule re-
fractory. Histological examination of
the walls of the abdomen, show that
the gonococcus penetrates in epithelium
and in the connective tissue, and that it
spreads like other pyogenous germs, —
by means of the lymphatics.
-^ — • — •*-
Behavior of the Typhic Bacillus
in the Soil. — Dr. Justin Karlinski has
recently made experiments to elucidate
the behavior of the typhic bacillus in the
soil. In the Archiv filr Hygiene (XIII.
p. 302), the following conclusions were
given, a synopsis of which is produced
in the Annales De Micrographie (IV. No.
7. P- 354) : —
1. In the experiments made, the typhic
bacillus remained alive in the soil three
months at the most.
2. The duration of the life of the typhic
bacilli buried with dejections in the soil
and abandoned, in their normal condition
is notably less than that of the bacilli
withdrawn from the blood and buried in
the soil in the state of pure culture, which
probably comes from the antagonism that
is made to the former by the various
bacteria of faeces.
3. In the deep layers of the soil, the
typhic bacilli may resist the changes of
temperature and humidity as well as the
action of the micro-organisms of the soil.
4. At the surface of the soil, exposed
to dampness and the sun, they perish
rapidly.
5. Frequent intermissions in the damp-
ness of the soil, when at the same time
this moisture reaches a considerable de-
gree, diminish notably the duration of
the life of the typhic bacilli, either by
being affected by humidity from above
or touched from beneath.
6. In the portions of soils where the
roots of plants penetrate, duration of
their life is very short.
7. During the putrefaction of the or-
gans of typhic cadavers a notable eleva-
tion of temperature exists.
8. In the organs of typhic cadavers
buried in the soil, the typhic bacilli may,
when putrefaction is retarded, and the
access of this specific organism of putre-
faction meets obstacles, be found still
alive after three months.
-^ — • — •-
The Pure Cultivation of Actinomy-
cosis and its Transmissability to
Man. — Most of the experiments which
have been made to date on the subject
of the actinomycosis have not been satis-
BACTERIOLOGICAL NOTES.
307
factory. The results have been discord-
ant, and few men have been able to show
with any degree of justification that their
attempts at cultivation were reliable.
Prof. Max Wolff and Dr. James Israel
(in Virchow^s Archiv, No. io6, p. ii)
report more extensive labor and inves-
tigations of this parasite than ever were
made before and their endeavors seem
to be more fruitful than those of any of
their predecessors.
The origin of their experiment was two
cases of human actinomycosis. In both
cases they succeeded in cultivating the
micro-organism of this disease in a state
of purity on agar-agar, at 37° C, and pro-
tected from the air. The growth of these
organisms was the result of the inocula-
tion of the well-known granules found in
these specific tumors. They succeeded
in cultivating them also on fresh eggs, or
eggs cooked from three to four minutes.
These granules, if well triturated on the
surface of the agar-agar, produce little
granulous spots, hyalin first in appear-
ance, then opaque in the interior and
around the triturated mass.
In order to obtain these results, the
matter inoculated must be well spread,
otherwise the growth appears as a gradu-
ally-forming, whitish areola. In the cal-
tures made by piercing the medium
the latter becomes turbid and soon pre-
sents several small granulations. In
transferring this first culture to the sur-
face of fresh agar-agar, there appears be-
tween the third and fifth day some fine
granulations resembling minute drops of
water or dew drops (not larger than the
head of a pin). These drops coalesce
and form a uniform surface if the virus
has not been thoroughly and thinly spread.
Generally, however, it is not a true co-
alescence, as may be seen with a magni-
fying glass, but a close aggregation of
droplets. A number of other peculiari-
ties are observed by the author, but the
above are the most characteristic. It is
well to know, however, that the confluent
minute drops produce a whitish scum in
which it is impossible to distinguish any
granulation except at the margin. Among
granulations formed, there are sometimes
a few large white ones which usually send
ramifications to the interior of the agar-
agar. The authors state that the organism
is anaerobic, though it is not essentially so,
for it does not demand the total absence of
oxygen ; but in cultures exposed in the air
it grows better in the bottom of the punct-
ure made in the medium. It can be culti-
vated in alkaline broth in which tjie
growth appears as fine scales gradually
falling to the bottom without rendering
the liquid turbid. It does not grow in
gelatine at the usual temperature.
The miscroscopic appearances de-
scribed are varied ; there may be found
rod-shaped organisms, filaments with or
without bifurcation, straight or undu-
lated ; and on the other hand, there may
be present spiral forms and organisms of
the coccus family ; besides this there were
seen in Qgg cultures a network of fila-
ments such as are seen in human ac-
tinomycosis. About the margin are found
occasionally some filaments with swelled
extremities.
The cocci are sometimes sequestered,
but usually they are in the rods and fila-
ments, and may be stained by Gram's
method. The authors do not consider
these round forms as spores, because they
take stain too easily. It will be remem-
bered that Bostr5m, who claims to have
cultivated the actinomyces, considers the
round bodies as spores. The club forms
which are typical of parasites in tumors,
do not appear in culture.
Inoculation experiments were made on
twenty-three animals, one of which was a
subject of control. Of the animals in-
oculated with pure cultures eighteen were
rabbits, three guinea pigs, and one a sheep.
In most of them it was done in the peri-
toneal cavity. The development of ac-
timomycosis occurred in every instance
except in the sheep. The tumors were
revealed in post-mortem examination after
four to seven weeks from the date of
inoculation. The tumors were usually on
the peritoneum. One affected also the
muscles of the abdominal wall. Four
animals kept alive for a long time, de-
veloped tumors that could be felt by pal-
pation from about the seventh to the ninth
month after the infection. Small tumors
from about the size of a lentil to that of
a plum were found in the tissue covering
the abdominal wall, the intestines, the
mesentery, the liver, and other organs.
In all these tumors microscopical examina-
tion demonstrated the typical granules of
the disease. In cultivating these it was
possible to obtain the actinomyces in
a state of purity. The authors think
the organism is a bacteria and not. a
fungus.
308
EDITORIAL.
The Bacteriological World
• AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
$2.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., July, 1892.
A NEW FORM OF ELECTRICAL CURRENT.
M. A. D'Arsonval, assistant to the
eminent Prof. Brown-Sequard, of Paris,
has, within the last year, published the
results of some very interesting and re-
markable studies upon the physiological
effects of various forms of electricity. In
the course of his studies, he has investi-
gated the nature of the current produced
by various forms of induction apparatus,
making a careful comparison between the
different currents produced by graphic
means. The accompanying tracings rep-
resent (i) the curve obtained from a
magneto-electric machine (Clark's) com-
monly used for medical purposes in France,
and (2) the second tracing represents the
curve obtained upon apparatus designed
by D'Arsonval and constructed by Gaiffe,
of Paris. The curves show clearly a re-
markable difference in the currents pro-
duced by these two machines. That
produced by the first machine is irregular,
while the current of the second machine,
although alternating, is smooth and uni-
form, there being no sudden break or in-
terruption of the current, but an alternate
swelling and diminution in opposite di-
rections, the change*4n interruption being
effected at the instant when the zero
point is reached. The smooth, alternat-
ing current produced by the machine of
D^Arsonval has been termed by him
' ' voltaisation sinusoidale. "
The properties of this current are thus
stated by D'Arsonval in a report made to
the Academy of Sciences at its session of
June 27, 1892 (reported in La Semaine
Medicaid), as follows : —
*'In a previous communication, I have
indicated a general method for obtaining
by synthesis the form of the electrical
wave used to excite a living tissue. This
curve which I have called the '■ charac-
teristic of excitation,' shows the electric
excitant from a physical point of view,
and enables us to employ it always in
identical conditions. The numerous ex-
periments which I have made by the aid
of this method, have enabled me to
formulate the following law in a simple
case, such as one of uni-polar excitation :
The intensity of the motor, or sensory, reac-
tion 4$" proportionate to the variation of the
potential at the point excited. Since then,
I have conducted a special study from a
practical medical point of view, of the
electrical effects produced by alternating
currents with sinusoidal variations, and
I have established the following facts : —
'^ I. By regulating the sinusoidal appa-
ratus, one may pass through the body
currents of great intensity without pro-
ducing either pain, muscular contraction,
or chemical action. This absence of
physiological action is, however, only
apparent, for an analysis of the air of
respiration shows that the passage of this
current is accompanied by an increase in
the absorption of oxygen, and in the
elimination of carbonic acid gas.
'' 2. By gradually increasing the fre-
quency of the alternations, energetic
muscular contractions may be induced,
but the contractions are infinitely less
painful for equal intensity than when an
induction coil is used. In these condi-
tions, respiratory combustion is consid-
erably increased, and these currents act
powerfully in modifying nutrition."
The writer has been specially inter-
ested in these researches of Dr. D'Arson-
val, on account of an interesting obser^
vation first made in 1883, when experi-
menting with electrical currents upon
EDITORIAL.
309
different forms of apparatus. Among
other electrical machines employed, was
a small magneto-electrical apparatus, com-
monly known to electricians as a tele-
phone generator, and used in central
telephone stations for generating cur-
rents to ring the bells in the circuit. It
was found that this machine possessed
the peculiar property of being able to
produce powerful but painless muscular
contractions. The writer has had one or
more of these machines in use in the San-
itarium under his charge, since the date
referred to, and described the machine,
together with some of the peculiar proper-
In the Archives de Physiologie, January
No., 1892, Dr. D'Arsonval published the
curves which we present below, which
led the writer to undertake a similar cur-
rent produced by the telephone generator,
and with the result of obtaining the fol-
lowing curve by means of the galva-
nometer of D'Arsonval, and the kimo-
graphion.
A comparison of this curve (Fig. 3)
with that produced by the sinusoidal
machine of D'Arsonval (Fig. 2), shows
at once that the two currents are identi-
cal in character.
We are now engaged in a series of ex-
Fig. 3
ties of the current produced by it, in a
paper read before the Am. Med. Associa-
tion and has, in all, made several thousand
applications of the current under various
conditions. The machine has been ex-
hibited, and its peculiar properties dem-
onstrated to many physicians, among
others. Dr. E. Betton Massey, of Phila-
delphia, who, like others, was at a loss to
understand the peculiar painlessness of
applications of this current, notwith-
standing the remarkably vigorous and
widely extended muscular action pro-
duced by it.
periments for the purpose of determining
the physiological effects of the current,
which we have no doubt will coincide
with those obtained by D'Arsonval with
his machine. We have found it advan-
tageous to modify the machine as recently
reconstructed, by re-winding the arma-
ture with coarser wire, thus producing a
greater quantity of current with a some-
what diminished intensity. As originally
constructed, the machine was capable of
maintaining a current of one ampere over
a circuit presenting a resistance of 20,000
ohms.
310
EDITORIAL
The electro-motor force, is, of course,
diminished by re-winding with a coarser
wire, but we find the current produced
by the change better adapted for thera-
peutic applications to the human body.
J. H. K.
» » ^
PUTREFACTIVE GERMS IN HEALTHY MEAT.
The exceedingly interesting culture ex-
periments by Segri Trombetta, an ac-
count of which appears in another de-
partment of this journal, bring into clear
view facts of very great importance from
a dietetic standpoint. These experiments
show that within sixteen or seventeen
hours after death, at ordinary tempera-
ture, and within twenty-four hours after
death, at the temperature of an ice-chest,
putrefactive processes are already estab-
lished in various parts of the bodies of
rabbits and other animals. The experi-
ments have relation to aerobic germs, the
pathological significance of which are well
understood. When it is considered that
a great share of the flesh of domestic ani-
mals consumed as food, is kept for some
days after the animal is killed, — usually
eight or ten days, and in some instances,
so long as two or three months, — the im-
portant relation of this putrefactive proc-
ess to the dietetic value of flesh food must
be appreciated.
Bouchard has shown that meat juice
extracted from flesh in which a putrefac-
tive process is going on, possesses de-
cidedly toxic properties, and that the
degree of toxicity is directly proportion-
ate to the length of time during which
the putrefactive process has been in
operation. It becomes evident, then,
that the use of flesh food more or less
heavily charged with the toxic products
of putrefactive micro-organisms must be a
source of injury to the vital economy.
That we are not sensible of the influence
of poison on every occasion when such
food is used, is solely due to the fact
that the liver is endowed with functions
which enable it to counteract the in-
fluence of organic poisons by oxidizing
them, or in some other way diminishing
their activity. Nevertheless, it must be
apparent that the imposition of a great
amount of this unnecessary work upon
the liver will result in an interference
with the performance by this important
organ, of its natural and legitimate func-
tions ; consequently its work of eliminat-
ing the natural poisons of the body, in
the production of bile, as well as its
glycogenic functions, must be more or
less impaired. Is it not possible that
this is the source of quite a large propor-
tion of the cases of inactive liver, bilious-
ness, and kindred morbid states which
constitute so large a share of the func-
tional disturbances with which every phy-
sician is called upon to deal ?
The common practice, especially in
England and France, which allows the
process of decomposition to advance so
far as to give to the flesh the term haut
gout, must be recognized as not only un-
wholesome but positively dangerous.
In the light of the researches referred to
in this article, it is no wonder that per-
sons addicted to the use of such food,
which includes in this country a large por-
tion of the flesh consumed as ''game,''
are subject to frequent attacks of bilious-
ness, sick headaches, ''running off at the
bowels," and other conditions indicative
of poisoning. The marvel rather is that
such persons do not suffer more seriously
than they do, and that attacks of fatal
poisoning from such sources are not
more frequent. The fact that fatal re-
sults do not frequently occur, must not
be considered, however, as an evidence
of the innocuousness of such a diet.
The evil results of such transgressions
of the laws of health, are most often
recognized, not in directly fatal conse-
quences, but in indirect ways ; for ex-
ample, the man who uses up his liver
energy in the consumption of ptomaines
taken in with his food, has but little liver
capacity upon which to fall back in case
EDITORIAL.
311
of a fatal emergency arising from expos-
ure to malaria or micro-organisms, the
reception of which the system is not
able to avoid. One cannot always select
to his satisfaction the air which he in-
hales into his lungs, or even control to a
nicety the character of the water which
he drinks ; but he can, if he will, at least
under any but the most extraordinary
circumstances, avoid the dietetic use of
ptomaines in the form of putrefying meat.
In view of these facts, as above stated,
it seems very clear that every State Leg-
islature would be amply justified in the
passage of a law prohibiting the sale of
undrawn fowls or other small animals
which are always in a state of advanced
decomposition when offered for sale in
the public markets, as evidenced by the
greenish color of the flesh, especially in
the abdominal region. j. h. k.
MIXED DRUGS IN THERAPEUTICS.
As the progress of medicine reveals the
contrast between the medical practice of
the past and that of to-day, and also be-
tween the practice of the easy, indolent
physician and the progressive one, we
are sometimes amazed at the combina-
tion of drugs once used, and in some in-
stances still made use of. A prescription
containing from a half dozen to a dozen
ingredients was not uncommon, and still
finds favor among many. The idea seems
to be that, in putting up such remedies,
one or two medicines are mingled for
each symptom noticed in the patient, in
order to hit the disease somehow. That
such methods should have been in vogue
years ago is but natural when we consider
the meager knowledge upon which thera-
peutics was then based, but that such
practices should prevail to-day, is a reflec-
tion upon the intelligence and the industry
of those who favor them. Physiological
chemistry has advanced so much during
the last ten or twenty years, that we are
bound to recognize a principle in the
administration of drugs which should
ever be consulted in the practice of
medicine, and that is the chemical action
or actions which may take place in com-
bining various drugs (even those of purely
vegetable extraction), and the chemical
action or actions which may take place
between these drugs and the natural se-
cretions of organs, and the substances of
the cells of the organs themselves, with
which they come in contact in the very
structure of tissues, by means of the cir-
culation. It is a fact that we do not
know positively the effect of any com-
bination of drugs when once introduced
into the system. We have a general idea
that such and such a remedy produces such
and such a general or special effect, but
we do not know satisfactorily — in fact
often ignore entirely, the immediate chem-
ical action that takes place to produce the
effect ; and when these drugs are mingled,
and chemical alterations take place be-
tween them, we know still less what ef-
fects may be produced on the tissues and
their natural products and functions.
In view of these facts, it is worse than
folly, it is really wrong to make so-
called ''shotgun" prescriptions, and drug
our patients with them. The medical
profession is recognizing that medicines
do not cure, and that they are given
only for the immediate purpose of al-
lowing nature an opportunity to resume
her normal work, and thus perform the
cure of the malady. P. P.
How the Bacillus Coli Communis
Invades the Organism. — In our June
number, page 273, six lines from the bot-
tom, M. Roux, of the Pasteur Institute, is
mentioned as one of the teachers that the
coli bacillus may be transformed into the
typhus bacillus. A friend writes us
(and we have verified it) that this is an
error, that Dr< E. Roux of the Pasteur
Institute, is not the man, but that it is M.
Gabriel Roux, of Lyons, who is the sup-
porter of this theory. We hasten to
make the correction. p. p.
312
EDITORIAL.
BROWN-SEQUARD'S EXTRACT OF THE SEXUAL
GLANDS.
M. Brown-Sequard, who still main-
tains the efficiency of the injection of the
extract of the sexual glands, to which he
called attention three years ago, recently
communicated to the Academy of Sci-
ences a paper upon the subject, giving
further facts in support of his theory.
Prof. Brown-Sequard has maintained
that the sexual glands furnish to the
blood some useful, if not essential prin-
ciples, and that the reason for the feeble-
ness of old age is to be found in the
senile state of the sexual organs, in con-
sequence of which they are not able to
maintain physical vigor. He now be-
lieves that the testicles and ovaries have
three distinct uses in the organism : —
1. Functions in connection with gen-
eration.
2. An influence upon the nerve-centers,
through the absorption of their secre-
tions, which give to men and women the
physical, moral, and intellectual charac-
ters which belong to them individually.
3. A special tonic action which ener-
gizes certain functions of the spinal cord
and of the brain.
A number of cases are cited which in-
dicate remarkable effects from these in-
jections, in one of the most marked of
which, precautions were taken to prevent
the experiment from being complicated
with auto-suggestion, as a source of
error. *
This novel therapeutic means fell so
short of the expectations created by the
first announcements of Brown-Sequard,
that it has been practically abandoned by
practitioners as being of no value.
But if the experiments of Brown-
Sequard have not resulted in giving the
profession a therapeutic means of great
value, they have at least called attention
to facts which indicate very clearly the
enormous injury which must result from
undue exercise of the sexual functions,
and show very clearly, not only the ab-
solute safety, but the positive advantages
of a life of continence, thus leaving no
longer any excuse whatever for those
physicians who sometimes cater to the
morbid propensities of young men, in ad-
vising, or at least sanctioning, the illegiti-
mate exercise of the sexual functions.
The only possible danger hinted at by
Brown-Sequard in a life of continence is
to be found in the super-excitation result^
ing from the absorption of the secretions
of the sexual glands; but, for any possi-
ble danger which might result from such
a cause, an ample safeguard is afforded
in physical work. Muscular exercise is,
in more ways than one, a vital regulator
of the highest value. Excess of food, the
damaging influence of a sedentary life,
and the hypothetical physical evils of a
life of continence, may all be admirably
counteracted by a proper exercise of the
muscles. But the loss sustained by ex-
cessive exercise of the sexual functions is
one which cannot be easily repaired.
The tendency to over-indulgence in
this direction is exceedingly prevalent
among civilized people, and doubtless is
the result of excessive alimentation, the
use of dietetic and other stimulants,
and various social causes. The enor-
mous waste of energy arising from these
sources, is doubtless one of the great
causes of the rapid physical deterioration
of the race, which is easily recognizable
even within the last century, notwith-
standing the considerable increase in
average longevity. J. h. k.
The Opium Habit in India. — The
whole civilized world has for many years
been pointing with scorn at the British
Government for its conduct in relation to
the opium traffic with China, but the
punishment of this national sin is now be-
ing administered in the great spread of
the opium habit in India and Burmah,
and the consequent deterioration of the
native races of these countries.
EDITORIAL.
313
The evils arising from the opium habit
have finally become so great that a com-
mission was appointed two years ago by
the British government, as the result of a
petition addressed to Parliament by the
Society for the Supression of the Opium
Traffic. This Commission has recently
made its report, which is an occasion for
still greater astonishment, and will be, if
possible, an even greater discredit to
Great Britain, if the report receives the
sanction of Parliament, than was the
course pursued by that government to-
ward the Chinese many years ago, in
forcing opium upon them in opposition
to the protective means widely introduced
by the Chinese government. Sir Alex.
Mackenzie and other members of the
Commission, declare that the suppression
of the opium traffic is impossible, with a
population of 220,000,000 people to
control. The Commission also makes
the astonishing assertion that the Chinese
and others consume great quantities of
opium without dam'age, and ''with bene-
ficial results ! " Evidently a commission
for the investigation of a humanitarian
question like this, should have other than
a political basis. Further comment is
unnecessary. j. h. k.
-*- — • — *-
The Decline of Antipyrine. — When
first introduced to the medical profes-
sion, antipyrine was specially commended
as a means of reducing temperature in
febrile conditions. That the thermome-
ter indicated a distinct decline in tem-
perature after the use of this agent, was
received as an evidence of its value as an
antipyretic remedy.
Further experience, however, has not
fulfilled the expectations which were
raised concerning the value of this drug.
It has been found that while it reduces
temperature, it at the same time often
brings the patient into a state of almost
complete collapse. Careful physiological
experiments have shown that the drug
does not diminish temperature by de-
creasing heat-production, but by increas-
ing heat-elimination, and that in small
doses it actually stimulates heat produc-
tion. It is certainly not an over-state-
ment of the fact to say that the majority
of the leaders in therapeutics have
abandoned the use of this drug, in favor
of other less dangerous means.
In the treatment of cases of poison by
antipyrine which have been reported, it
is clearly shown that the drug is a toxic
agent of great power. The majority of
judicious practitioners who have had ex-
perience with the drug, will quite agree
with Prof. Thompson, of New York, who,
in an excellent clinical article on the
"Reduction of Temperature in Typhoid
Fever, " which appears in the fourth vol-
ume of "International Clinics," warns
against the use of antipyrine, and favors
the employment of hydropathic means.
Dr. Sidney Coupland, in an article on
"Cerebral Rheumatism," in the same
work, points out the uselessness of all
antipyretics. He recommends the em-
ployment of cold, externally applied, as
the best means of reducing hyper-
pyrexia. J. H. K.
-^ — •— •-
Prize Essay on Quackery. — Dr.
George M. Gould, of Philadelphia, has
written a most excellent paper on the
subject of quackery, entitled ''Etiology,
Diagnosis, and Treatment of the Preval-
ent Epidemic of Quackery," in which are
said many things which ought to be read
by the laity as well as the profession.
There is great need for the education of
the public in medical matters, to a suf-
ficient extent to enable intelligent people
to discriminate between the honest and
scientific physician and the charlatan.
Dr. Gould is doing good missionary
work in this direction, and proposes to
do more, and to stimulate others to do
likewise, offers a prize of ^100 for an
essay. He proposes a number of sub-
jects for missionary tracts to be distrib-
uted among the people, among which are,
814
REVIEWS,
«^The Patent-Medicine Evil, *' Reasons
why Physicians do not Advertise, " ' ' Rea-
sons why Physicians do not Patent Instru-
ments, Drugs, etc." Further particulars
can be obtained from the author, George
M. Gould, M. D., 1004, Walnut St.,
Philadelphia, Pa.
Dr. Gould very well says : ''What a
disgrace that patent-medicine syndicates
can draw many millions every year from
the diseased, deluded, and poverty-
stricken of our people with a governmental
tax of only 25 per cent upon their mixtures,
while the same people must pay a tax of 60
per cent upon microscopes, and one of
49^ cents per pound and 60 per cent
beside, upon woolen clothing ! "
J. H. K.
Reviews.
Essentials of Medical Electricity.
— By D. D. Stewart, M. D., and E. S.
Lawrence, M. D. Illustrated. W. B.
Saunders, Philadelphia, Publisher.
This compendium is a publication that
the profession needs. Few know enough
about the subject of medical electricity to
utilize it in practice. This volume is an
exposition that fills the want ; it ought to
be in the hands of every student and doc-
tor, if for no other purpose than to infuse
more knowledge on the subject of which
it treats.^ Price $1.
The Modern Treatment of Hip Dis-
ease.— By C. F. Stillman, M. D. George
S. Davis, Detroit, Mich., Publisher.
This is a brief, and yet very full review
of the modern methods of treating hip-
joint disease. It gives no less than 16
special modes, nearly all of which are
well illustrated. Mr. Davis is rendering
the profession a real service in putting
before its members at such a low price,
such authoritative and excellent works
as this and many other recent publica-
tions of the ''Leisure Library" series.
Price, 25c.
Medical Diagnosis. — By Prof. Os-
wald Vrerordt, M. D., Heidelberg, Ger-
many. Translated by Francis H. Stewart,
A. M., M. D., New York. W. B. Saun-
ders, Philadelphia, Publisher.
We never had the pleasure of reviewing
a more thorough, comprehensive, syste-
matic, and complete book than this one.
The numerous elegant illustrations are
very practical, and the text is clear and
concise. Members of the profession un-
acquainted with German, and who can-
not therefore avail themselves of the
original edition, owe the translator and
publishers a debt of gratitude for their
production. We are sure that, as the rare
merits of this excellent work become
known, this debt will be fully paid in a
substantial manner. It is difficult to im-
agine a book superior to this in assisting
in the diagnosis of any disease to which
man is susceptible. Price, net, cloth,
^4; sheep, $5.
The Hygiene of Consumption. — By
W. John Harris, M. D. In our review of
this work in this journal for May, we are
made to say (p. 246, 2nd column, begin-
ning with the 8th line) : "Dr. Harris
firstly points out the various conditions
preparing the field for the germs to grow ;
but he should lay equal stress on the fact
that this plant will grow, if the germ is
not present." The words in Italics
should read " justly " instead of "firstly,''
and "will ?tot grow," instead of "will
grow."
Varieties of the Hymen. — By E. S.
McKee, M. D., Cincinnati, Ohio An in-
teresting little reprint which tersely de-
scribes and illustrates by means of cuts,
nine different varieties of hymen. The
profession is indebted to Dr. McKee for
his painstaking research upon this sub-
ject, the value of which we are glad to
see is recognized abroad in the reproduc-
tion of the cuts and descriptive matter by
Prof. A. Martin, of Berlin, in his "Dis-
eases of Women."
T this Season of the Year,
thousands of Invalids are
seriously considering the
question, —
WHERE
SPEND THE
SUMMER
Where Can I Spend the Months of
July and August, and part of September,
with the Greatest Profit and Satisfaction ?
HE ANSWER
to this question depends
on what the individual
wishes to accomplish by a
summer vacation. If
change and recreation
only are desired, these can be found in a thousand places — at
health and other resorts which abound in almost every State in
the Union, none of which, however, excel the delightful re-
sorts of northern Michigan,
If, in addition to rest and recuperation, the invalid needs a careful study of
his diseased conditions, and an intelligent regulation of diet, exercise, and all other
health conditions, — in other words, scientific health culture, efficiently carried out
by the aid of the best known medical means and appliances, thoroughly trained
nurses and attendants, and competent physicians, — then the choice between the most
desirable places becomes very much restricted. ~ There are certainly few institutions
in this country where the needs and desires of an earnest health-seeking invalid can
be satisfactorily met. Such places can be counted on the fingers of one hand, and
are, perhaps, little known because of the fact that the managers of such institutions
are conducting them in a scientific, and in some instances a philanthropic spirit, and
consequently do not employ as a means of winning patronage, the emblazoned ad-
vertisements, the truth-sacrificing circulars, and other advertising methods com-
monly resorted to by the proprietors of mineral springs establishments, bogus
sanitariums, and other so-called * ' health institutions ' ' and quasi-medical establish-
ments, with which the country abounds.
The advertisements of these establishments do not appear in public prints or
popular magazines because such advertising is closely akin to quackery, and brings
those who employ it into bad company.
The managers of the Sanitarium at Battle Creek, Michigan, many years ago
undertook to organize a thoroughly scientific institution which would represent
rational medicine in its most advanced form, and would be exactly what it professed
to be — an institution where patients are honestly and fairly dealt with, treated at
reasonable rates, given kind attention and comfort, and opportunity for the recovery
of health under the most favorable conditions. The majority of patients treated in
this institution are sent to it by physicians who by personal acquaintance, or
through the reports of their patients, have become thoroughly familiar with the
character of the institution and its management.
BRIEF DESCRIPTION
OF THE
SANITARIUM.
_ ^ - ;^ - -
^ ATTlvK CREEK, one of the most beautiful and prosperous cities of Michi-
^ gan, is centrally located in the salubrious Peninsular State. Its population
is 20,000, while its death rate is but seven per thousand. Battle Creek is
situated on two great thoroughfares of railway travel between the East and
the West, being at the junction of the Grand Trunk and the Michigan Central lines ;
and two other railways make it easy of access from the South.
The city has an electric railway and is lighted by electric lights. A great
number of pleasant drives are afforded by its well-kept and shaded streets.
The Buildings are lighted by a 700-light plant, Edison incandescent system.
Safely Hydraulic Elevators. Outside stairways for fire escapes accessible from
every window.
The Institution affords facilities for baths of every description : Turkish, Rus-
sian, vapor, electric, water baths of all kinds, and the electric light bath. In-
dependent accommodations for ladies and gentlemen, suf&cient for 80 persons
at one time. More than 800 feet of glass for sun-baths.
A General Parlor, 40 x 50 feet, is luxuriously furnished with Dhagistan rugs,
easy chairs, etc. The Dining-Room has a seating capacity of 400, is beauti-
fully lighted and ventilated, and always cheerful. No kitchen smells. Cui-
sine unsurpassed ; table service excellent. Everything an invalid needs, and
special dietaries prepared as directed.
VIEW OF GOGUAC LAKE FROM SANITARIUM LAKESIDE GROUNDS.
The Gymnasium, 85 x 45 feet, is supplied with every appliance for exercise, and
furnishes special instruction and class drills in Delsarte and Swedish gymnas-
tics, under a trained director. Exercise by prescription.
The Swedish Movement Department, both manual and mechanical, is the
most extensive in the United States. Vibrating bars and seats, kneaders, rub-
bers, beaters, shakers, and manipulating appliances of all sorts.
The Electrical Department contains every improved appliance for medical ap-
plications of electricity. Galvanic, Faradic, Dynamic, and Static electrical
apparatus and appliances for electrolysis, electro-cautery, etc.
An Aseptic Maternity on the cottage plan ( steam heat and thorough ventila-
tion), provides the best possible conditions for lying-in patients, with expe-
rienced professional attendance and rigorous aseptic management.
Special Departments for surgical cases, eye, ear, throat, and lung diseases,
nervous diseases, genito-urinary diseases of men (non-specific), opium and
alcohol habits, and diseases of women. A kindergarten and nursery, to keep
the children happy and out of mischief.
SUMMER HOUSE AND FRESH-AIR INLET.
Three Fine Greenhouses, maintaining a
magnificent collection of palnjs and va-
rious tropical flowers and plants, keep the
house filled with bloom during the win-
ter season. Flowers are everywhere in-
doors during the winter season. Patients
can visit the greenhouse at any time
without going out of doors.
Glass=Inclosed Sun^Parlors and Veran^
das for winter sunning and promenad-
ing.
Pure Water from sandstone rock.
There are from 250 to 300 Employes in the Sanitarium service the year,
round, of whom from 90 to 100 are medical attendants and nurses. Also seven
thoroughly trained physicians, and a large corps of manipulators skilled in
massage and the Ling system of Swedish movements.
The Sanitarium Training=School, in which our nurses are trained, is the
largest and most popular in the United States. Its course of training is
the most complete and
thorough of any school.
Tri=Weekly Lectures on pop-
ular medical subjects by
the physicians.
Abundant Means for Rec=
reation indoors during
inclement weather. Facil-
ities for walking, driving,
and horseback riding at all
seasons.
The Sanitarium is Not a
Pleasure Resort nor a
fashionable hotel, but an
ideal place for invalids
needing good nursing, the
benefits of regular habits
and scientific professional
care and treatment, and who desire to get permanently well.
The Sanitarium Nursery and Kindergarten. This enables mothers to bring
little ones with them without being burdened with their care and supervision.
The children have the advantages of kind and experienced teachers and am-
ple playgrounds.
For Further Particulars, see large circular and card of rates.
J. H. KELLOGG, M. D-, Supt.,
Sanitarium, BATTLE CREEK, MlCH.
'^
..^r^ •
-;;^^^^"^'^^'
%♦**
ON THE LAWN.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
NlONXHIvY BUI^IvKXIN.
Battle Creek, Mich., July, 1892.
THE VITALITY OF THE PNEUMOC0CCU8.
M. BoRDONi Uffreduzzi, not long since, made
some experiments concerning" the resistance of
Frenkel's pneumococcus when exposed to dif-
fused sunlight. The writer^ has undertaken
experiments in the same line, which he will now
present. Eight series of experiments were made,
as follows: —
A. Fresh sputum was exposed outdoors on a
piece of sterile cotton cloth, winter tempera-
ture about freezing; sunlight about half the
day.
B. Dried sputum (dried in a watch glass in
the laboratory), exposed outdoors under the
same conditions as in A.
C. Fresh sputum exposed in semi-darkness in
a hall- way in private residence, on a piece of
cotton cloth.
D. Dried sputum exposed in the same place,
and under same conditions.
E. Fresh sputum mixed in soil (earth), non-
sterilized, exposed outdoors at summer tem-
perature, sunlight half the day.
F. Dried sputum exposed as the preceding
specimen, under same conditions.
G. Fresh sputum in earth, sterilized, exposed
outdoors in a place shaded half the day, sum-
mer temperature.
H. Dried sputum in earth, sterilized, exposed
as the preceding specimen.
These specimens had been analyzed and
tested, and found to contain virulent microbes
of pneumonia.
The fresh specimens of A remained virulent
sixteen hours. Six rabbits inoculated, one
after the first, one after the second, one after
third, one after the sixth, one after the twelth,
one after the sixteenth hour, died with a specific
septicaRmia, which the pneumococcus causes in
rabbits. Three rabbits inoculated after the
sixteenth hour resisted, though one was ill for
a few days.
The dried sputum mentioned in B, and ex-
posed to sunlight, freezing temperature, as the
preceding, remained virulent twenty-two hours.
1 P. Paquin.
Of a series of six rabbits, inoculated between
the first and twenty-second hour, five died of
the characteristic septicaemia that the germ of
pneumonia produces. The other was ill but
recovered. Two rabbits inoculated after the
twenty-second hour remained apparently well.
One showed a slight malaise.
In experiment C the fresh sputum was pro-
tected from the influence of light and cold
temperature, being placed in a hall in semi-
darkness, where no direct light penetrated.
The virus retained its virulence for sixty-one
days, and killed between the first and sixty-
first day (the last inoculation being on the last
day) eight rabbits often inoculated. The other
two were ill some days. A rabbit inoculated
on the sixty-third, and another on the sixty-
fourth day were very slightly indisposed, but
lived. Two inoculated still laterremained well.
Some sputum dried as explained in experi-
ment D, and exposed to the same influences,
remained virulent three months, i. e., about
ninety-one days. It killed, during that time,
by septicaemia, four rabbits each week, the last
one being inoculated on the ninetieth day, and
remaining ill six days, when death followed.
Three rabbits inoculated after the ninety-first
day remained well. The temperature of the
hall-way in the experiments C and D, averaged
about 70° F., never being very warm, and
never cold.
In experiment E, the object was to find how
long the virus remained alive and dangerous in
or upon the earth or soil. As is explained in
the beginning of this article, the experiment
was made with fresh sputum mixed with non-
sterilized earth. It was in summer time, and
was kept outdoors where sunlight reached it
about half the day, being in shade the rest of
the time. The result was that the pneumo-
coccus remained virulent sixteen hours. Of
four rabbits inoculated between the first and
sixteenth hour, two died; two were ill, and re-
covered after five days; one, inoculated on the
fifteenth hour, remained ill eight days but re-
covered. After this, inoculation produced no
effect.
(319
320
LABORATORY OF HYGIENE.
In experiment F, where the same kind of
sputum, but dried, was used under the same
circumstances and under the same conditions,
the virus was preserved twenty-eight hours,
three rabbits being killed in the interval, the
last of these inoculations being on the twenty-
eighth hour, and the subject remaining sick
four days before death took place. Inocula-
tion later produced no effect.
It is well to note here that during the time of
exposure of this virus, E and F, in earth in a
shallow dish, there was no rain and no moist-
ure, except that pruduced during night. The
quantity and condition of earth, however, was
such that the virus was practically in the same
condition that it would have been if sputum
had been exposed in the road-way. It was
difficult in this case to determine conclusively
whether the germs of pneumonia also acted or
not, for they were mixed with germs of the soil,
and complications arose in several cases after
the inoculations. However, in each experi-
ment, the specific diplococcus was found in
some of the inoculated subjects, and pure
cultures were made from the earth, during
the growth of which isolation of the proper
germs was possible.
In experiment G, specific virus was mixed
with sterilized earth, moistened with sterilized
water, and put outdoors under the conditions
and circumstances explained for experiments
E and F. The result was that the virus was
still alive and virulent after twenty-six hours.
One rabbit, inoculated just before the twenty-
sixth hour, died ; another, inoculated afterward
(on the twenty-seventh hour), was apparently
not ill.
In experiment H, dried sputum of the same
kind as that in experiment G, was mixed with
earth, sterilized, and placed under the same
conditions, and lived thirty-six hours, killing
two rabbits before that time, but producing no
perceptible effect afterward.
Experiments I and J, which are not men-
tioned in the beginning of this article, were
practically the same as those of E and F, and
G and H, the only difference being that the
earth containing the virus was kept in a shady
place all the time, free as the others, from ex-
traordinary moisture. In this condition the
virus remained alive in non-sterilized earth
several hours longer than the virus mentioned
in E and F, and in sterilized earth remained
also several hours longer than in the experi-
ment in sterilized earth mentioned in G and H.
It may be concluded, i^irs^, that sputum dried
before being exposed remains virulent longer
than fresh virus placed under the same con-
ditions.
Second; that sunlight, as stated by Uffre-
duzzi, quickly destroys the pneumococeus, and
that diffused light modifies it also.
Third; that this germ keeps its virulence
longer in a shady or semi-dark place.
Fourth; that in non-sterilized earth it dies
quicker than in sterilized earth, possibly through
the influence of other germs.
LIVER FLUKES IN CATTLE.
AmonGt the most important investigations
made in the last two years, in this country,
concerning diseases that are of great interest
in hygiene of man or beast, is that made by
Dr. M. Francis, of the Texas Agricultural Ex-
periment Station. This expert had, for three
years previous to the publication of Bulletin
No. 11 of this institution, made very careful
investigation of the liver diseases of cattle in
Texas, whence comes so much of our market
supplies in the West. He has made the dis-
covery of a new parasite in the liver. Not only
did he find many cattle affected with the com-
mon flukes (distowum hepatieuw), but he has
found a new species, to which he gives the name
of distomum Texanicum.
In reference to the health of mankind, the
investigations of Dr. Francis, and the results
obtained, are of a great deal of importance.
The liver of cattle is an article of food found in
every market, and there is practically no re-
striction on the sale of animal organs affected
with any disease not glaringly obnoxious, for
the inspectors of meats are not competent,
as a rule, to judge of the safety or purity of
flesh which, on the surface, may not offer any-
thing extraordinary in appearance, and may
not suggest anything serious from a patholog-
ical standpoint, I have .seen several specimens
of liver of cattle in which distomum hepaticum
existed, without being able to say positively
from external appearance, what existed within.
The transformations that take place in any
such disease, though there may not be any
severe poisons generated by the parasite, con-
stitute, nevertheless, matters unfit for human
food, and the complications that arise in this
particular affection may produce substances
deleterious to health. From a purely econom-
ical standpoint, the investigations have not
less interest, for they indicate a course of pro-
cedure that may limit the yearly financial loss.
I quote the following from Bulletin No. 11,
above mentioned, which I believe of sufficient
interest to appear in these columns. It is the
report of the results of laboratory and field
LABORATORY OF HYGIENE.
321
work. I regret that I am unable at this mo-
ment to present plates of the parasite: —
"the common liver fluke (distomum
hepaticum) .
"This well known parasite occurs in the
livers of cattle, sheep, and goats of Texas, in
sufficient numbers to cause great damage.
The portion of the State permanently infected
consists of the coast counties and the river
bottoms. 1 have found them also outside of
the district indicated, but from the character
of the country I do not regard such localities
permanently infected or a source of infection.
"The permanently infected district, consists
of about two rows of counties along the coast
from the Nueces river to the Sabine river, and
the river bottoms of the San Antonio, Gauda-
lupe, Colorado, Brazos, Trinity, Neches, and
Sabine. The condition along the Rio Grande
has not been determined. Mention should be
made of the Red river bottom in the vicinity of
Texarkana, as infected. The land is mostly
coast prairie, which is flat or slightly rolling.
"Considerable timber occurs along the rivers.
Some portions of the land are hog-wallow
prairie; other portions have large ponds in
which grows a pod-bearing shrub; these are
called * bean-ponds.'
"The river bottoms contain numerous bay-
ous and overflowed places.
"During the rainy season this district be-
comes very wet. The rivers overflow their banks,
and all conditions are favorable for the distri-
bution of parasites. An exception must be
made of stock that frequent the salt marshes
in the district, as these are comparatively free
from flukes.
"Description of the Parasite. — Body flat-
tened, leaf-like, pale brown, irregular, the adult
from 18 to 31 m. m. long, and from 4 to 13
m. m. wide, oblong, oval, or lanceolate, larger
and rounder in front, where it is abruptly con-
tracted in such a way as to present a conical
neck; attenuate and obtuse behind. Skin brist-
ling with numerous little points directed back-
ward. Oral sucker terminal, rounded. Ventral
sucker large, projecting, with a triangular
opening 3 m. m. behind the first. Intestine
with two ramified branches visible through the
skin, and of a deep shade. Penis projecting in
front of abdominal sucker, always recurved.
Vulva very small, situated at the side of the
male orifice or a little behind. Eggs brown or
greenish, ovoid; length from 0,130 to 0.145
m. m.; width from 0.070 to 0.090 m. m.
(Neuman). (Copied from 'Animal Parasites of
Sheep,' by Dr. Cooper Curtice.)
"The habitat of the adult fluke is the bile
ducts of the livers of cattle, sheep, goats, and
other ruminants, and occasionally in other do-
mesticated animals. They are also reported
by Murray in the lungs of Texas cattle. (Am.
Vet. Review).
"The life history of the parasite, as deter-
mined by Leuckart and by Thomas, is exceed-
ingly interesting and wonderful.
"It is briefly as follows: The fertile eggs leave
the adult fluke by the genital pore, in great
numbers. They are carried through the bile
ducts to the intestines, from which they pass
with the excrement. If by good fortune they
arrive in fresh water, the eggs hatch in from 3
to 5 weeks. The little lid on one end of the egg-
suddenly flies open from the struggling of the
embryo within, and soon the embryo escapes.
This embryo is just visible to the naked eye.
It is provided with fine hair-like projections,
called cilia, which enables it to swim with great
rapidity. In some experiments made in this
laboratory some time ago, I was so fortunate
as to witness the escape of the embryo as de-
scribed. The time required for the eggs to
hatch was 36 days in the first instance, and 34
days in the second, when kept in a watch glass
at ordinary temperature.
"This embryo immediately seeks a fresh
water mollusk,into whose body it bores its way
with a beak-like projection with which the an-
terior portion of its body is provided. The
English investigators have found Limnaeus
trunculatus as the host. If the embryo fails to
find a suitable snail it soon dies. Those I had
under observation died in from 8 to 10 hours.
Having a suitable mollusk, the embryo bores
into the interior of its body by a rotary motion
and encysts near the respiratory apparatus.
It is now called a sporocjrst, in whose interior
new forms develop called redise. The redise
produce in their interior other forms called
cercarise, which are active creatures.
(To be continued.)
Technique.
A New Bacillus in Green Sputum. — Adolph
Frick discovered, some months since, a new
bacillus not yet described, in green sputum.
It differs from the other green chromogenous
bacilli, namely, the bacillus pyocynus, bacillus
Ueresceiis liquifaciens, bacillus virescens, which
have been found also in green sputum, and
it differs likewise from the bacillus viridis
pallescens, bacillus Huorescens, bacillus iris.
In cultures made from sputum it gives a green
color, similar to that produced by every known
chromogenous bacillus. The bacillus is de-
322
LABORATORY OF HYGIENE.
scribed by E.De Freudenreich, in Annales de Mi-
crographie, as being a little longer and thinner
than that of typhus. In living individuals, its
length is six or seven times greater than its
width; four to five when mounted in balsam;
the ends are rounded. It is very motile. The
sporulation has not been observed. It grows
well on gelatine without liquefaction, also in
gelose and in broth, to which it imparts a
greenish color. It grows well on potato, and
in milk, in which it coagulates the caseine.
The best temperature is 30° C; from 35° up-
ward the development is slower and less vigor-
ous. The green color at first is somewhat like
green grass; later on it becomes yellowish, and
even brownish. The coloring is insoluble in
alcohol, ether, and chloroform, but soluble in
water, particularly when it is alkaline. Its
germs do not grow when deprived of air. It is
very susceptible to aniline dyes, and may be
staified also by the method of Gram.
-*• — • — •-
A New Method of Coloring Spores. — In Cen-
tralblatt fur BakterioJogie, X, p. 273, Dr.
Moeller describes a method of coloring spores
which has given better results than any process
heretofore employed. It is asfollows : The prep-
aration is allowed to dry on the cover-glass in
the air. It is then passed three times through
ablaze, or plunged two minutes into absolute
alcohol; then it is placed two minutes in chlo-
roform (to destroy fats, etc., which exist in
certain bacteria), and washed in water. The
cover glasses are then plunged from one half
to two minutes into chromic acid at 5 per cent,
then washed in water. Cover with a few drops
of carbolized fuchsin solution, and heat sixty
seconds over a blaze, or until the coloring so-
lution boils once. The fuchsin is allowed to
drain, and the cover glass is then placed in
sulphuric acid at 5 per cent until discolora-
tion; it is then rinsed in water, and finally
allowed to remain 30 seconds in an aqueous
solution of methyl-blue or malachite-green.
The spores are then colored deep red, and the
body of the bacilli blue or green. The length
of time during which chromic acid should be
allowed to act, varies according to the species.
A few trials will demonstrate whether 30 sec-
onds will suffice, or if it will take one or two
minutes. Some take as long as five minutes;
some as short a time as five seconds. Dr.
Moeller employs a 5 per cent carbolized solu-
tion (according to Ziehl-Neelsen) without al-
cohol.
ANTISEPTIC.
PRORHYUACTIC.
DEODORANT.
LISTERINE
NON-TOXIC.
NON-IRRITANT.
NON-ESCH ARCTIC.
I^OI^I%d[UI^A.» — Listerine is the essential antiseptic constituent of Thyme, Eucalyptus
Baptisia, Gaultheria, and Mentha, Arvensis, in combination. Bach fluid drachm also contains
two grains of refined and purified Benzo-boracic Acid.
I>0^]E^« — InTERNAI,i,y : One teaspoonful three or more times a day (as indicated), either
full strength or diluted, as necessary for varied conditions.
LISTERINE is a well-proven antiseptic agent — an antizymotic — especially useful in the
management of catarrhal conditions of the mucous membrane ; adapted to internal use, and to
make and maintain surgical cleanliness — asepsis — in the treatment of all parts of the human body,
whether by spray, irrigation, atomization, or simple local application, and therefore characterized
by its particular adaptability to the field of
PREVENTIVE MEDICINE— INDIVIDUAL PROPHYLAXIS,
L,iSTz;E.iiq:E:
Destroys promptly all odors emanating from diseased gums and teeth, and will be found of great
value when taken internally, in teaspoonful doses, to control the fermentative eructations of
dyspepsia, and to disinfect the mouth, throat, and stomach. It is a perfect tooth and mouth wa&h,
indispensable for the dental toilet.
LAMBERT
S MAW SON & THOMPSON,
LONDON, E. C.
Descriptive Literature upon Request.
PHARMACAL CO., ST. LOU/S, MO.
AGENCIES:
ROBERTS & CO.,
PARIS.
S. PAPPENHEIM,
BERUN, W.
VI LA NOVA HOS. Y CIA.
BARCELONA.
.f/.X
V.
'('.<•
(4 J
I »#■':- vir-" ♦ ® ^*'-
'15^?^
Changes in Muscular Fibers, Resulting from Parasitic Invasion. (Page 334.)
XH
• •
Bacteriological World
AND MODERN MEDICINE.
VOL I. BATTLE CREEK, MICH., U. S. A., AUGUST, 1892. NO. 10.
Original Articles.
STUDY OF IMMUNITY.
BY M. METCHNIKOFF,
This delay in dying after the inocula-
tions with the cultures made in the serum
of vaccinated rabbits is not due to a true
attenuation, but to a special action of the
serum ; this action also manifests itself
with inoculated microbes developed in
their usual medium, and mixed with
serum of vaccinated animals. The ex-
periments confirm fully this idea, as will
be demonstrated in the following chapter.
The serum of the vaccinated acts on the
most virulent bacilli of hog cholera ; but
while the cultures in serum of the vacci-
nated kill after delay, the mixture of se-
rum with virulent cocco-bacilli produces
only a passing disease.
The cultures in broth, made with coc-
co-bacilli developed in the serum of the
vaccinated, were fully as virulent as those
which were prepared with microbes de-
veloped in the serum of new rabbits and
transplanted afterward in broth.
From all these facts, we cannot con-
clude that there is an attenuation of the
bacilli of hog cholera cultivated in the
serum of vaccinated rabbits. As the de-
gree of virulence must be in proportion
to the property of the microbe to pro-
duce its toxines, it would be interesting to
know if the cocco-bacilli cultivated in
the serum of vaccinated rabbits, give to
it toxic properties.
Let us introduce virulent blood with a
platinum wire into two test tubes, one of
which contains the serum of a vaccinated
rabbit, and the other the serum of a wit-
ness rabbit not vaccinated. Let us al-
low the microbes to develop during five
days, and let us sterilize the cultures at
58 ° C. during one hour. The effect of
the inoculation of these sterilized cul-
tures in the auricular vein of rabbits will
show us whether with the one made with
the serum of the vaccinated rabbits there
exist toxic substances. Two experi-
ments undertaken with this object have
demonstrated that the sterilized cultures
provoke a very manifest disease, which
is revealed by the weakness of the animal
and an elevation of the temperature.
The experiments which have been ob-
served explain themselves by the unequal
receptivity of rabbits. This interpreta-
tion is the more admissable that in one
experiment it was a rabbit which had re-
ceived the culture of serum of a vac-
cinated case which reacted the most,
while in the other the reverse took place.
The analysis of the virulence of the
cultures in serum of the vaccinated is
demonstrated by the absence of the at-
tenuation of microbes, and leads us to
admit a very marked action of this serum
in the march of the malady.
(To be continued.)
APPARATUS FOR CULTIVATING ANAEROBIC
BACTERIA, EITHER IN PLATES OR TUBES.
BY J. M. BYRON, M. D.
Director of the Micrological Department of the University
Medical College, New York.
I HAVE used, during the last three years,
with very good results, the apparatus rep-
resented in the cut, for cultivating anae-
robic bacteria both in plates or dishes
and tubes. It enables the operator to
observe his plate or tubes at any time
without inconvenience, replacing them
again if required, in the atmosphere of
hydrogen or any other gas used. It is of
324
OBIOIJSrAL ARTICLES.
very simple construction, and requires
about half a gallon of hydrogen to replace
completely all the air it contains.
The main body of the instrument con-
sists of a cylindrical dish of brass or zinc
(P), eight inches in diameter and two
inches high, the upper edge extending
into a rim three inches wide. On the
circumference of the rim there is a groove
or canal three eighths inches wide and an
inch high (B), into which a long glass
bell, AA, fits. Two small brass faucets
(F) are soldered to the lower part of the
main body.
When the instrument is used, a glass
dish (G) containing a solution of pyro-
gallic acid or pyrogallate of potash is
placed in its lower portion, and a perfor-
ated screen (O), a little larger than the
main body, is set in the position marked
in the cut, to serve as a support to
THE NEW CHEMISTRY OF THE STOMACH.
BY J. H. KELLOGG, M. ]?.
the culture plates (D). The circular
groove (B) is then half filled with min-
eral oil, the cultures plated and set as in
ordinary cases, and the glass bell (A) in-
serted in its place. Hydrogen from any
source is then passed through one of the
faucets (T), leaving the other open for
the air to escape. In about one minute
the air fills with hydrogen, and both
faucets close. If any oxygen remains in
the interior, it is soon absorbed by the
pyrogallic solution, thus leaving an at-
mosphere of hydrogen for the bacteria to
live in. Whenever the cultures have to
be examined under the microscope, the
bell (A) is lifted. When replacing the
culture the same operation of passing a
current of hydrogen is repeated.
This instrument presents, among many
advantages, the facility of hardening the
plates for microscopical examination,
which is a serious drawback in most of
the methods suggested by the ingenuity
of bacteriologists.
The great interest aroused by the ex-
cellent work of Ewald and Boas has waned
considerably, in consequence of the un-
certainty of the results obtained by the
methods recommended for the deter-
mination of the quality of the gastric
juice. Many of their methods were ex-
cellent, and were a decided improvement
upon those previously employed, but one
weak point in their theory has rendered
the results obtained in the practical use
of their methods uncertain and disappoint-
ing. Adopting the views of Bidder and
Schmidt, they assume that the acidity of
the gastric juice is due to free hydro-
chloric acid, when this substance is found
to be present, and hence rely for their
determination of the quality of a given
amount of gastric fluid, upon the results
obtained by means of color reagents which
indicate the presence or absence of free
hydrochloric acid, and a determination of
Bthe total acidity by the ordinary methods
of acidimetry.
In a work entitled '' Chemism Stom-
achal,^'' by Hayem and Winter, which
appeared a few months ago, the faults of
the method pursued by Ewald and Boas,
and indeed by all previous investigators,
have been clearly demonstrated, and a
method described which places the chem-
istry of the stomach upon the same exact
basis as that upon which the chemical
analysis of the urine rests. Indeed, it is
now possible, by the employment of the
method perfected by these eminent in-
vestigators, to determine the quality of a
given stomach fluid with the same degree
of accuracy as one may determine the
character of the urinary secretion, — by
means of well known qualitative and
quantitative tests.
The claims made by Hayem and Win-
ter for their method are so great as to
give rise to a suspicion of unreliability,
were it not for the high standing of the
authors, and for the absence of any good
reason for doubting the claims made and
the accuracy of the chemical methods
employed. The writer has further sought
to assure himself of the accuracy and
reliability of the method proposed, by
devoting himself to a careful study of it
ORIGINAL ARTICLES.
325^
and its practical use, in a sufficiently-
large number of cases to enable him to
say that every statement made by the
authors in their work, concerning their
method, maybe relied upon as absolutely
exact, and that the method may be ac-
cepted as thoroughly accurate and reli-
able, and the greatest advance in the
diagnosis of disorders of digestion which
has been made within the last quarter of
a century.
Briefly outlined, the method pursued
by Hayem and Winter is the following :
The patient is given a test breakfast, con-
sisting of two ounces of stale white bread,
and eight ounces of jveak tea without
sugar and cream (the writer employs hot
water instead of tea). One hour after
the patient begins to eat, the stomach
fluid is withdrawn by means of a tube.
After filtration, 5 c. c. of the filtered
stomach fluid is placed in porcelain cap-
sules designated respectively as a, b, and c.
An excess of carbonate of soda is added
to capsule a. After evaporation to dry-
ness, the residue is calcined, and the
quantity of chlorine present is determined
by means of a titrated solution of nitrate
of silver in the presence of bichromate of
potash. The result obtained, gives the
total chlorine present in the stomach fluid,
all the chlorine not previously combined
with bases having been fixed by the excess
of soda added before evaporation.
Capsule b is treated somewhat differ-
ently, being first evaporated to dryness on
a water-bath, and then dried for an ad-
ditional hour. By this means the chlo-
rine present in the liquid in the form of
free hydrochloric acid, is driven off.
After evaporation and drying for one
hour, an excess of carbonate of soda is
added as before, and the residue is then
calcined and the same method pursued
as with capsule a. The result obtained
represents the total chlorine present
minus the chlorine existing in the form
of free hydrochloric acid. It is appar-
ent, then, that by subtracting b from a,
the amount of free chlorine may be ob-
tained.
Capsule c^ after drying, is calcined
without the addition of the soda, and
the amount of chlorine obtained by the
same method. The result obtained in
this case represents \\v& fixed chlorine, or
chlorine combined with bases, usually
sodium. By this method, three known
quantities are determined : —
1. The total chlorine.
2. The amount of free chlorine, and,.
3. The amount of fixed chlorine.
By comparing the results of the analy-
ses of capsules b and <r, there is found-
to be a difference in favor of b, in case
the fluid examined is a product of normal
digestion ; in other words, the chlorine
represented by b, is in excess of that rep-
resented by c, showing that chlorine exists
in the gastric juice in another form than
that of free hydrochloric acid, and fixed
chlorides. The investigations of Richet,
published a few years ago, showed that a
considerable amount of chlorine exists in
the gastric fluid, combined with albumen
in the process of digestion. By subtract-
ing c from b, the amount of chlorine sO'
combined is determined.
The four quantities thus obtained —
two by analysis and two by subtraction.
— are represented as follows : —
Total chlorine, T.
Free chlorine, H.
Chlorine combined with albumen or
organic chlorides, C.
Fixed chlorine, F.
Having determined these four quantities
by chemical analysis, the total acidity rep-
resented by A, is next determined.
A solution of Congo red is employed as
a qualitative test for the presence of free
acids, and methyl violet, Giinzburg's rea-
gent, or the resorcine and sugar test, is
used to show the presence of free HCl.
The color reactions are, of course, simply
confirmatory of the results obtained by
chemical analysis, but are of compara-
tively little practical value, as they give
no very positive idea respecting the
quantity of free acid present.
T represents the glandular work of the
stomach, including also the amount of
sodium chloride contained in the food.
H and C together (H -J- C) represent
the chemical work of digestion, which
consists of two parts : —
I. The breaking up of the chemical
combination of chlorine with bases, and
the production of free hydrochloric acid.
2. The combination of hydrochloric
acid with albumen, the first step in the
process of hydration by which the albu-
men is converted into peptone.
H represents the amount of free hydro-
chloric acid ready for combination with
albumen ; C, the amount already com-
bined.
It is evident, then, that by a compari-
^26
ORIGINAL ARTICLES,
son of the figures obtained for T, H, and
C, in the case of a given stomach fluid,
with the figures presented by a normal
stomach fluid, we have an exact means of
appreciating any modification of the nor-
mal digestive work which may be the re-
sult of morbid conditions. By a study of
the results obtained upon healthy dogs
and individuals, it has been shown that
the quantity li (free HCl) is always
small in normal digestion, as compared
with C (chlorine combined with albumen
■or organic chorides). It is also found
that combined chlorine (C) contributes
.as much to the acidity of the given stom-
.ach fluid, as the same amount of chlorine
would do if in the form of free hydro-
chloric acid (HCl).
By careful quantitative analysis, it has
been shown that the total acidity (A) is
-chiefly due to H (free HCl) and C (com-
bined chlorine). Lactic acid and acid
phosphates contribute very slightly to the
total acidity of the normal conditions,
hence the formula under normal condi-
tions would be, practically, H-]-C=A.
From this formula may be derived the
, ,, . A— H _ . .
following : — pq — = I. This is not ab-
solutely true, however, as A, in small
part, is made up of acid phosphates,
and in the early stages of digestion
also lactic acid. There are also present
•even in normal cases a small proportion
of neutral or ammoniacal chloro-organic
•compounds, so that normally we find .^6,
instead of i. This quotient is termed
the coefficient of digestion, as it is a means
by which a most important fact respect-
ing the quality of the digestive process
may be determined. This quality is repre-
sented by a, which we may term ''coef-
ficient «. " The use of coefficient a will
be recognized by studying the following
formulae, which result from conditions to
e named : —
In certain morbid states, the combina-
tions of chlorine with albumen, or chloro-
organic compounds, are, in large part,
neutralinstead of acid. Such compounds
are the results of abnormal products of
digestion, and of no use from a nutritive
-standpoint. These neutral substances,
while contributing to the value C, contrib-
ute nothing to the value A, consequently
in a case of this sort, we should have the
formula, A=H-f-C — C, in which C rep-
resents the neutral chloro-organic com-
pounds, instead of A=H-[-C. Transpos-
ing H, and dividing both members of the
equation by C, as before, we obtain the
formula — - — = a — , in which it
is evident that the coefficient a will be
less than normal; that is, less than .86,
because C is below par. The real value
of C is diminished just in proportion to
the amount of neutral organic compounds
present. In cases of this sort, A is always
small in proportion to H and C.
It not infrequently happens, however,
that A exceeds the sum of H and C ; in other
words, we have the formula A=H-f C+x,
in which x represents the amount which
A exceeds the sum of H and C. Trans-
posing H as before, and dividing both
members of the equation by C, we have
— -^ — z=a-[--^, m which it is evident
that coefficient a exceeds the normal
quantity. These cases are those in which
normal digestion is complicated by acid
fermentations.
It is apparent that coefficient a serves
a most useful purpose in two cases, in one
of which it is less than normal, which
indicates that the value of C is dimin-
ished just in proportion to the amount
that A is diminished ; in other words,
that the quality of the work done by the
stomach is bad, just in proportion as a
is less than normal. On the other hand,
when A is above normal, the indication
is, that acid fermentation is present, and
in amount just in the proportion that A
exceeds the normal quantity. We have
here, then, a means of determining two
things, which by all previous methods
have been left undetermined : i. The
quality of the work done by the stomach ;
2. the proportionate amount of acid fer-
mentations present.
Both these facts are of the greatest prac-
tical value. C is the index to the actual
useful work done by the stomach, but C
may be large, and yet the value of the
work done be nothing, in consequence of
the catalytic changes upon which the
chemical work of the stomach depends
having taken a wrong direction, so that
the chloro-organic compounds formed are
neutral instead of acid. This condition
will be shown by coefficient a, without
which it could not be definitely deter-
mined, although it might be suspected
by the diminished value of A. On the
other hand, when A is increased by acid
fermentation, the fact might be taken
ORIOINAL ARTICLES.
327
as an indication of hyperpepsia, instead
of acid dyspepsia, if reliance were placed
upon the total acidity taken in con-
nection with the presence of free hy-
drochloric acid, as shown by color
reagents, and without the determination
of the amount of free chlorine and the
value of coefficient a.
By long and painstaking studies of the
digestive process in healthy men and
dogs. Profs. Hayem and Winter have
established the following figures as rep-
resenting the normal limits of variation
in healthy digestion : —
Normal variations.1
Total acidity (A) (0.180 — .200 gms.)
Coefficient (a) (.86)
Total chlorine (T) (0.300 — 0.340 gms.)
Free HCl (H) (0.025— o.osogms.) \ igo- 22^
Organic chlorides(C)(o. 155 — o.i8ogms.)f' ' -^
Fixed chlorides (F) (0.109 g"^^.)
By the use of the above interesting data,
it is possible to represent the different
states of digestion. In normal digestion
each of the symbols would be followed
by the sign = ; that is, the quantities rep-
resented by each of the symbolic letters in
the formula are within the limits of normal
H-
variation as follows : Ar=a=Tz=^ '
For typical hyperpepsia we have the
following formula : —
H+
A-\-a=T^C^
And in hypopepsia we have the typical
formula : —
A— ^=T— C— j •
It is evident, however, that an almost
infinite number of variations and modifi-
cations of these formulae is possible, ac-
cording as one or all of the different
elements of the digestive work are ex-
aggerated or diminished. We may have,
for example, an increased amount of
gland work on the part of the stomach,
with diminished chemical work, in which
case T would be -|-, and the sum of H
and C — (H + C) — .
We may also have a sufficient amount
of that phase of chemical work which
consists in a liberation of the chlorine
from the bases, together with an abundant
secretion of fixed chlorine, coincident
with the failure of the chlorine to combine
with albumen, in which case our formula
would be T -j- ^_ I =. We may even
1 Quantity of chlorine expressed as HCl.
have an excess of chlorine set free, and
yet a very great deficiency of combined
chlorine, through the failure of the chlo-
rine to enter into normal combination
with albumen. Then we should have
P ' - -j- ; or we may have H -f- with C
— , and the sum of H and C less than
normal, shown by the formula p ~^ l — .
It is evident that H and C considered
separately and together, represent the
useful work done by the stomach, espe-
cially when taken in connection with the
quotient or coefficient a.
In their study of pathological cases^
Profs. Hayem and Winter have employed'
the following simple method of classifica-
tion, which seems to work very well in
practice : —
Considered with reference to the amount
of stomach work done, pathological
cases may be divided into hyperpepsia,
hypopepsia, and an intermediate form,
simple dyspepsia. Typical hyperpepsia.
is expressed by the formula already given,
in which all the qualities are above nor-
mal, or -\-, with the exception of a. It
is rare, however, to find a case in which
there is simply an exaggeration of stom-
ach work. There is, almost without ex-
ception, some qualitative modification of
the digestive process, the recognition of
which is of the highest importance.
This leads to the subdivision of hyper-
pepsia into two classes, quantitative and
qualitative, in which the characteristic
deviations from the normal digestive
process are, respectively, a simple ex-
aggeration of stomach work, and a quali-
tative modification of the character of
the work done.
Both these classes, qualitative and
quantitative hyperpepsia, are again sub-
divided into two varieties, this division
being based upon the simple difference
in degree, the lesser degree being only
an attenuated form of the higher degree of
simple qualitative or quantitative, with
qualitative change. The term ''attenu-
ated " is used to designate the less pro-
nounced variety. We thus have simply
quantitative hyperpepsia, and quantita-
tive hyperpepsia attenuated, and also
hyperpepsia qualitative, and hyperpep-
sia qualitative attenuated.
A still further subdivision of each of the
four classes of hyperpepsia thus made, is
•328
ORIGINAL ARTICLES.
based upon the presence or absence of
acid fermentations ; so that, in all, we
have eight types of hyperpepsia. It
•ought to be mentioned, perhaps, that
Hayem and Winter designate but one
type of the attenuated form of qualitative
hyperpepsia, viz., without acid fermen-
tations, « being — , or=; but the writer
has met several cases of this form of
hyperpepsia in which acid fermentations
were present, and so has taken the liberty
to add to the classification, as completing
the systematic scheme* the type hyper-
pepsia qualitative attenuated, with acid
fermentation.
The basis for the subdivision of cases of
hypopepsia chosen by Hayem and Winter
is a wholly artificial one. They make three
degrees of hypopepsia, in all of which
we of course find A — . Cases in which
A is less than normal, but above loo, are
•designated as hypopepsia of the first de-
gree ; those in which A is less than loo,
and still a measurable quantity, are desig-
nated as of the second degree. Cases in
which A is nothing are placed in the third
class of apepsia.
These three classes are with the ex-
ception of the third, each subdivided, as
in the case of hyperpepsia, into two types,
.according as acid fermentation is present
or absent. In the third class there is no
acidity and hence no fermentation.
With reference to cases of hypopepsia,
the value of A becomes a matter of great
interest. The total acidity is not in-
frequently found to give a very high
figure, notwithstanding the existence of
bypopepsia in a very marked degree, evi-
dently as the result of the excessive acid
fermentation which is very likely to be
present in this class of cases, owing to
the deficiency of free hydrochloride acid,
the natural antiseptic of the gastric juice.
Before the classification of cases of hypo-
pepsia can be properly made, we must
determine the true value of A, that is,
the amount of acidity due to the normal
acid elements of the stomach fluid, the
free HCl (H), and the organic chlorides
•or chloro-albumen compound (C).
The method of Ewald and Boas, which
determines the quality of the digestive
fluid by measuring the acidity and ascer-
taining by color reagents the absence or
presence of hydrochloric acid, is notably
defective, since it practically considers
acidity to be always due to free HCl (H).
Normally, as above stated, A is com-
posed of free HCl (H), combined HCl
(C), and a small amount of lactic acid and
acid phosphates. In pathological cases,
however, the greater part of A may be
composed of acids of the fatty series, —
lactic, acetic, butyric, and formic acids, —
resulting from fermentation.
The determination of the presence of
these acids by color reagents is a some-
what uncertain process, and sometimes en-
tirely fails, while any quantitative esti-
mation relating to fatty acids is quite out
of the question in the examination of
stomach fluids, in consequence of the
small amount of material usually avail-
able in an individual case.
The great advantage of the method of
Hayem and Winter, and its remarkable
exactness, is well shown in the ease with
which it enables us to determine the true
value of A. Returning to the formula
A — H ^ ^ , . , .
— — — = a^ we have, by multiplying
both members of the equation by C, and
transposition, Ar=:(d;XC)-|-H. To as-
certain the true value of A, which we may
designate A', in any given case, we have
only to substitute in this equation the
normal value of a, .86; then making
the simple calculation indicated by the
formula, we have at once the true value
of A. The following case will illustrate
the value of this method in the determi-
nation of the true valueof A : —
In a case of very pronounced stomach
disorder of long standing, the figures
found for A were .313 mgs., and for
a, .514 mgs. It should be remembered
that the figures for A represent the acid-
ity expressed in milligrams of HCl per
100 c.c. of the stomach fluid examined.
In this same case, H was found to be
.056, and C, .050. Following the method
above indicated, we find the value of A'
to be 99, from which we discover at once
that there is an enormous diminution of
useful stomach work, although there hap-
pens to be a considerable amount of free
hydrochloric acid present. The high fig-
ure of a, and the figure obtained for A'
show at once the cause of the hyper-acidity,
notwithstanding the failure of the reac-
tion for fatty acids, which we have found,
as doubtless have most other physicians
who have made a careful study of the
chemistry of the stomach, is to a high
degree unreliable.
The classification of cases of hypo-
pepsia is, of course, based upon the
ORIGINAL ARTICLES.
329
0)
Q.
U
0.
tc
hi
>
QUALITATIVE
1^ I wi
without acid fermentation a — ;= \ x _L
th a. f a+ / ^ "T~
. ,, ^ J < without a. f. « = ;-
A=: — attenuated -^ -^.u „ ^ t
' ( with a. f . . . a -\-
QUANTITATIVE
without a. f «=;-
with a. f a-\-
(L
111
Q.
O
Dl
>■
X
A+ I
■I *A — without a. f a=. ;
. , , , . J ^ without a. f . . . a =;-
|^A+ attenuated I ^^.^j^^f ^^_^'
j without a. f ,
T— ;
( T +
T+
C —
+
(
=;+
c+
H+
-+. (-1-
'^C —
with a. f . -^
! A-
a — ; = T
0- hyperacidity). . a -|-
1^--— «+ T— ;
without a. f a — ; = T — ; = ;-|- ^ "'
with a. f « + T— ;
3RD DEGREE A=0 (Apepsia) \ «. 0 T —
1ST DEGREE
A-(A^-)
ABOVE 0.100
2ND DEGREE
A-(A^-)
BELOW 0.100
= i +
* Types bearing this mark have been observed by the writer and added to the classification of Hayeni and Winter.
T-; = ; + gZ
' + C —
H 0
H 0
C —
H 0
value of A', and not upon that of A. This
^ives rise to a sub-type of hypo-pepsia
characterized by pseudo -hyper -acidity,
in which A is -j although A' is — .
These cases are found in the fer-
mentative type of the first class of
hypopepsia. In the accompanying table,
copied from the work of Hayem and
Winter without change, with the excep-
tion of the addition of a single type, as
before mentioned, the several classes of
hyperpepsia and hypopepsia are repre-
sented by their respective formulae.
Where more than one sign occurs, as = ;
— , or — ; =, -[-, it should be under-
stood, not that these signs occur in any
given case, but that the quantity to which
the signs are attached, may, in different
cases, exhibit either one of the relations as
regards the normal quantity indicated by
the several signs. It should also be added
that the attenuated form of hyperpepsia
quantitative, which is placed by Hayem
and Winter as one of the principal classes
of hyperpepsia, is in the chart placed as
a sub-variety of quantitative hyperpepsia,
which seems to be its most natural place.
In the careful chemical study of more
than loo cases, by the methods of Hayem
and Winter, we have found a constant con-
firmation of their results, and a demon-
stration of the great advantages presented
by this method over all others. We have
also found their classification, on the
whole, eminently satisfactory, although
■quite a number of cases have been met
with which do not fall exactly in either of
the classes described. Some of these are
cases of simple dyspepsia, cases in which
the deviations from normal are so slight
as to be insufficient to allow a classifica-
tion of the case as either hyperpepsia or
hypopepsia.
I have found however, a few interesting
cases in which the type is decidedly differ-
ent from any of those included in the
classification of Hayem and Winter, which
will perhaps require an addition to the
above scheme of classification. My cases,
however, illustrate each of the varieties of
dyspepsia shown in the classification
given above, as well as some new phases,
concerning which further remarks will
be made. (^Xo be continued.)
-*' — • — •-
RESULTS OF PURE CULTURES OF TUBERCLE
BACILLI AND OTHER PATHOGENIC BACTERIA
FROM SPUTUM.
BY DR. S. KITASATO,
Translated from Zeitschrift fur Hygiene, Vol, IX., No, 3,
by Hanau W. Loeb, A. M., M. D.
The statement that it is impossible to
obtain pure cultures of tubercle bacilli
direct from man, without passing through
the bodies of animals, is widely dis-
seminated, in accordance especially with
the views of French observers. How-
ever, the importance of obtaining such
tubercle bacilli from man for experiments
on animals is evident; otherwise the ob-
330
ORIGINAL ARTICLES.
jection might well be made that in pass-
ing through the organs of such animals,
changes might result which would differ
from what occurs in man ; that the ex-
perimental knowledge gained by such
cultures from animals should not be used
without further observation on the re-
lation they bear to human tuberculosis.
In fact these objections have already
been raised.
On this account the duty was assigned
me by Professor Koch, of making pure
cultures of tubercle bacilli from tuber-
culous sputum, and from the closed lung
cavities found in the post-mortems per-
formed at the institute.
The difficulties which opposed the so-
lution of this question, especially in the
cultures from sputum, lay, on the one
hand, in the different developmental
energies of the tubercle bacilli, and on
the other hand, by reason of the inter-
mingling of these bacteria with other
micro-organisms. While the former de-
veloped uncommonly slow and scanty,
the bacteria mixed with the sputum oc-
curring constantly in the mouth were
able to increase very rapidly and luxuri-
antly, and thereby preponderate over the
tubercle bacilli. It was therefore neces-
sary to do away with this admixture in
the mouth.
In order to bring this about. Professor
Koch proposed a procedure by which he
had succeeded previously in the solution
of this question, and by following which I
was enabled to obtain results from the
pure cultures of the tubercle bacilli from
sputum. To this end, the patients were
watched so that they expectorated the
morning sputum, resulting from a true
cough and not from hawking, into steril-
ized double dishes. {Doppelschdlchen.^
The dishes containing the sputum must
be further acted upon. A specimen be-
ing found appropriate, that is, originat-
ing from the deeper portions of the
respiratory apparatus, the sputum flakes
were isolated with sterilized instruments,
and carefully washed in at least ten
double dishes (Petri's preferred) filled
with sterilized water.
By this means nearly all the other
bacteria mixed in the sputum in passing
over the surface of the mouth, are re-
moved.
The sputum in the last vessel is then
macerated under sterilized water ; by
preparing a portion of this for micro-
scopical examination, one may easily de-
termine if any other bacteria but the
tubercle bacilli remain.
This is often successful, so that by
taking a portion of sputum thus prepared
and putting it in glycerine-agar or blood-
serum, pure cultures of tubercle bacilli
are obtained.
The pure cultures from this prepared
sputum differ somewhat from the cultures
taken from tuberculous organs, especially
in the beginning of their development.
Like the latter the first colonies appear
in about two weeks, but they exhibit in
the beginning an entirely different ap-
pearance. They appear as circular, white
opaque specks, which are raised to the
surface of the agar. They are therefore,
moist, glistening, and smooth as colonies
of white yeast, while the colonies of
tubercle bacilli obtained from the organs
are in the beginning dry, dull, and
wrinkled. These differences soon dis-
appear so that in four weeks it is
impossible to distinguish between the cult-
ures from sputum and those from the
organs.
The cultures which I made from closed
lung cavities act as those of the sputum
just described. Nothing else could well
be expected, as the sputum is really the
contents of the cavity. However, it is
not always possible to obtain pure cult-
ures of tubercle bacilli from closed
cavities, because other bacteria some-
times occur even here among the tuber-
cle bacilli, from which a diagnosis must
be made by microscopical cultivation ex-
periments. I would, however, emphasize
that this does not represent a mixture of
different bacteria, but there is constantly
found a pure culture of bacilli or cocci
which is present along with that of the
tubercle bacilli. In my opinion it is
quite possible that these complicating
bacteria present in the pure cultures, play
an important role in the course of the
disease, tuberculosis.
In the production of pure cultures of
tubercle bacilli from sputum and closed
cavities, a further important fact should
be announced, viz., that most of the
tubercle bacilli in the sputum and in the
contents of cavities were dead. How-
ever it was impossible to distinguish by
means of the microscope the difference
between the living and dead bacteria.
They responded to staining agents just
as rapidly and intensely as the other.
ORIGINAL ARTICLES.
e331
and morphologically they exhibited no
asymmetry. Notwithstanding this, the
fact that they were really not living could
be determined in the following way : —
When a larger quantity of sputum or of
the contents of a cavity than is necessary
for the culture experiment, is taken to
place upon the surface of the agar, this
material remains visible in the nutritive
medium for a week, provided evaporation
is prevented by covering the tube with a
rubber cap. Frequently there are in such
a tube, evident particles of sputum or of
the contents of the lung cavity whic?i are
completely sterile ; while in other cases
colonies of tubercle bacilli develop within
the little tubes. When microscopical
preparations of such sterile portions of
the sputum or cavity contents are made,
numerous well-stained tubercle bacilli will
be found. In addition, I have taken these
portions of sputum or of the contents of
cavities so richly charged with tubercle
bacilli, and inoculated guinea pigs, kill-
ing the pigs two months thereafter. In
no case has there appeared a sign of tu-
berculosis.
This experiment clearly shows that the
majority of the tubercle bacilli in the
sputum and contents of the lungs are
dead, yet this could not by microscopical
examination be established until now.
But I have given my attention not
alone to the before-mentioned tubercle
bacilli in tuberculous sputum, but also
to the other bacteria therein contained.
I have, for instance, made the observa-
tion that frequently among the tubercle
bacilli, other colonies of bacteria are so
constantly and numerously found that I
was forced to believe that there had been
such an invasion within the individuals
so afflicted. In fact when an autopsy of
such patients was made, the micro-organ-
ism was found distributed in a pure cult-
ure over the whole lung. In one case,
in which the parasite seen was a small
bacillus, it was found in pure cultures in
all the inner organs. In this manner, I
met with other kinds of bacteria in the
sputum of tubercular patients, which were
constantly present among the tubercle
bacilli, and which were in the posi mortem
examination later demonstrated in the
lung. Three of these were bacilli, two
streptococci, and three micrococci. The
number of micro-organisms found in the
sputum varied very often in the further
observations on this subject.
Besides these, I have noticed still other
kinds of bacteria in the tubercular spu-
tum. In these, however, an autopsy was
not allowed, and hence further observa-
tion was impossible. With reference to
these kinds of bacteria and with regard
to the questions dependent upon their
presence, I am .not able to report further
investigations. Dr. Cornet is concerned
in this problem, and he will later present
his more accurate observations.
Experiments in the Treatment of
Tuberculous Guinea Pigs with Tu-
berculine. — Since the memorable Con-
gress of Berlin, at which Prof. Koch
described the discovery of his famous-
lymph, by which it was hoped that in the
near future human beings suffering from
consumption could be treated successfully,
people all over the world have been anx-
ious to hear more about this treatment
from the discoverer himself. It is al-
ready more than one year since the first
print appeared under the authority of the
celebrated bacteriologist, and the scien-
tific world has been patiently waiting ever
since to hear more from the famous labo-
ratory. Consequently it was with a
great deal of hope that the recent contri-
bution of Mr. Pfuhl, the closest collabo-
rator of Koch, was expected. However,
we do not find in it any more assurances
that Koch's tuberculine will ever be
of any practical utility in the treatment
of consumption than we had received
before. The conclusions of Pfuhl {^Zeit-
schrift fill' Hygiefie^t, Infections Kra7ik-
heiten, ii. p. 24) are : —
1. Small doses of tuberculine are with-
out utility, even when combined with calo-
mel, sublimate, gold, silver, arsenic, creo-
sote, and benzoate of soda.
2. On the other hand, we arrive at very
favorable results with high doses con-
tinued for some time.
3. A regressive modification of the
tuberculous alterations is produced, pro-
bably only when tuberculine gives rise tO'
local reactions.
We must say that not one of these
three conclusions is very encouraging.
The second might give some hope, were it
not for the fact that even this conclusion
is not very strongly supported by the ex-
periments on which it was based.
332
TRANSLATIONS AND ABSTRACTS
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE LIVER AS A BILE-MAKING ORGAN.^
BY DUJARDIN-BEAUMETZ.
Member of the Academy of Medicine, Physician to the
Cochin Hospital, Paris.
Translated by J. H. Kellogg, M. D.
(Concluded.)
Composition of Bile. — Bile has been
analyzed a great number of times. I
shall not dwell long upon its different
constituents. I will leave the consider-
ation of cholesterine to the next lesson,
in which I shall speak of the biliary
calculi.
Biliary salts belong to two groups of
salts of soda, — the tauro-cholate and the
glyco-cholate of soda. The alkalinity of
the bile is due to these salts of soda, a
property which gives it its popular use
for removing spots from clothing. It is
also these intensely alkaline salts, which
contain 90 per cent of soda, which give
to the intestinal fluids their alkalinity.
I place salol at the head of drugs which
combat intestinal putridity, because this
salicylate of phenol decomposes itself
into phenic acid and salicylic acid only
in the presence of the alkalines.
Finally, I must call your attention to
the fact that these salts do not exist pre-
formed in the blood, and that they are
found only in the bile.
I must dwell a little further upon the
coloring matter of the bile. This coloring
matter consists of bilirubin. The reac-
tions by which bilirubin is recognized in
the urine are two. One is obtained by the
actionof nitric-nitrous acid upon the urine.
It produces a series of colors from red to
green. The last alone is characteristic.
The method of examination which ap-
pears to me to be preferable consists in
allowing the urine to fall, drop by drop,
upon the nitric acid contained in a test
tube.
The reaction by iodine is also charac-
teristic. I am surprised to see it not more
frequently referred to, even in classical
1 A series of lectures delivered by Prof. Dujardin-Beau-
metz, published in the Bulletin General Therapcutique,
and translated expressly for this journal.
works. In adding some drops of iodine
to icterous urine, an emerald green color-
ation is the most characteristic reaction
to be obtained. In doubtful cases a more
complex proceeding may be employed.
It consists in precipitating by sulphate of
ammonia, and dissolving the precipitate
in a mixture of alcohol and chloroform,
then obtaining the characteristic reactions
by means of nitric-nitrous acid.
While biliary salts are a product of the
action of the hepatic cell, bilirubin may
be produced outside of the liver. It may
be obtained by submitting haemoglobin
or haematine to the action of nascent hy-
drogen. Besides, it is only necessary to
compare the formulae of haematine and
bilirubin, to see the numerous points of
resemblance which these two substances
present.
C32H32Az40*Fe" + 2H8O = C^aH^eAz^oe — Fe."
Hcematine. Bilirubin.
I cannot allow this question of biliary
pigments to pass, without speaking of
urobilin, to which I have already referred
in my lesson upon the antiseptic function
of the liver.
Between urobilin, bilirubin, and haemo-
globin there are numerous points of re-
semblance, and urobilin may be obtained
from haemoglobin and bilirubin. Urobilin
does not give, in the urine, the reaction
of Gmelin, with nitric-nitrous acid, but a
brown coloration.
Numerous discussions have arisen re-
specting the origin of urobilin. You will
find these presented with much care in
the thesis of Dr. Paul Tissier. We have,
first, the pigmentary theory, which holds
that urobilin is the result of absorption
from effusion of blood in the tissues.
Persons suffering from cerebral hemor-
rhage present urobilin in the urine.
In a case of chronic icterus, urobilin
is seen to take the place of bilirubin.
The haematic theory holds that urobilin,
a modification of haemoglobin and
haematine, is produced outside of the
liver. This is the old theory of
Goubler.
Finally, in the third theory, urobilin is
regarded as exclusively furnished by a
diseased hepatic cell. This theory has
been sustained by Prof. Hayem and his
pupil, Paul Tissier.
While recognizing the fact that in the
majority of cases in which urobilin is
present, there are diseases of the liver
TRANSLATIONS AND ABSTRACTS.
333
there are certain disorders of the blood,
and in some, cases of cerebral hemor-
rhage in which urobilin is found in the
urine, without any disturbance of the
functions of the liver.
However, whatever the origin of bil-
irubin may be, whenever the character-
istic line of urobilin is found in the
urine, we should examine with the great-
est care, and suspect some lesion of the
hepatic cell.
There has been much discussion as to
whether the liver is a gland, properly so-
called, or an organ of excretion. Be-
tween these extreme opinions which hold,
the one that the liver only separates from
the blood the substances previously
formed, and the other which affirms, on
the contrary, that this organ forms the
bile wholly, there is a mixed opinion
which appears to me to agree exactly with
the statements which I have above pre-
sented. It is that the liver, considered
as a biliary organ, is at once a gland,
properly so-called, and an organ of ex-
cretion.
It is a gland proper, since we find in
the bile, tauro-cholate and glyco-cholate
acids which generally exist in the blood.
It is an organ of excretion, since the col-
oring matters of the bile are derived from
the coloring matter of the blood, and
since, also, the bile incloses some toxic
products.
The toxicity of the bile, which remains
for me to examine, has been placed in a
clear light by the works of Bouchard.
Bouchard, in comparing the toxicity of
the urine with the toxicity of the bile, has
shown the following facts : In equal vol-
ume, bile is nine times more toxic than
urine, and the biliary secretion presents a
toxicity six times as great as the urinary
secretions. So that if one admits that
all the biliary secretion remains in the
blood, a man would be killed in eight
hours, while if the same occurred with
urine, two days and four hours would be
required.
Of all the substances contained in the
bile, bilirubin appears to be the most
toxic. It kills in intravenous injections,
in doses of 5 centigrams per kilogram of
rabbit. I should remark that in the ex-
periments of Prevost and Paul Binet, in
which the drugs employed were adminis-
tered by the stomach, toxicity of the bile
was scarcely appreciable, the bile being
administered to animals in forty gram
doses without producing any symptoms.
The liver then, as the kidney, is an organ
of excretion of the toxines of the economy.
Another point which is of the greatest
interest, has been brought to light by the
recent works of E. Dupre. It is that
the bile contains no micro-organisms.
Duclaux had already indicated this fact 3
in the normal state, no cultures had ever
shown the slightest trace of organisms.
This is a fact which, a priori, is very
curious. When one considers the inti-
mate relations between the biliary passages
and the contents of the intestine, in which
microbes are so numerous, we may draw
from the absence of micro-organisms an
important conclusion. It is that the
effusions of bile into the serous cavities
can produce no inflammatory phenom-
ena when the bile is healthy, as has been
demonstrated by Dastre. It should be
understood that we speak here of the
healthy state, for there exists, as we shall
see in the next lesson, biliary affections.
There are often found in the bile, bac-
teria and streptococci, constituting what
has been described under the name of
** biliary infection."
The bile, as I have said, is an anti-fer-
ment ; it prevents the putrefaction of
substances contained in the intestines.
This is so true, that when, for any cause,
the bile ceases to be thrown into the di-
gestive tube, faecal matters produce their
characteristic odor and become putrid.
Bile is, further, a lubricant; it permits
the alimentary canal bolus to pass easily
along the whole extent of the intestine ;
thus its suppression leads to constipation.
Bile is, finally, an alkaline substance.
The acidity of the fsecal matters deprived
of bile provokes the painful colics expe-
rienced by icterous patients as the result
of retention of bile.
Finally, it is the alkalinity of the bile
which assists the emulsification of fats,
and if the bile does not transform the fats
as does the pancreatic fluid, it renders
them more digestible by their emulsifica-
tion. Hence the great emaciation of pa-
tients suffering from chronic icterus re-
sulting from tension.
We see a great variety of symptoms
resulting from an insufficiency of urine to
which the generic name of "uraemia "has
been given. So also a suppression of the
secretion of the bile, or its passage in too
great quantity into the blood, produces a
group of clinical symptoms to which has
334
TRANSLATION'S AND ABSTRACTS.
been given the name of '' cholestraemia,"
among which appear convulsions and
coma similar to those of uraemia.
In the next lesson I shall consider what
therapeutic conclusions can be drawn
from the physiological study of the liver
as a bile-making organ.
MODIFICATIONS OF MUSCULAR FIBERS IN
TRICHINIASIS.
BY M. SOUDAKEWITCH.
Prosector of the Institute of Pathological Anatomy,
Kieff, Russia.
Translated by Paul Paquin, M. D.
(See Frontispiece.)
It has been demonstrated that in the
various inflammatory pathological phe-
nomena of the muscles, the modifications
that take place are generally secondary ;
the inflammatory processes are at first lo-
calized in the connective tissue, and it is
after a more or less prolonged period that
the phenomena extend to the muscles.
In trichiniasis a striking example is given
of the difference. Here we have a pri-
mary lesion of the muscles ; a paranchy-
matous inflammation, in fact. In this
disease the parasites leave intact the in-
termediary tissue, and penetrate directly
into the muscle fibers, where they pro-
voke a serious modification. It has been
well established that phagocytes play
an important role in numerous patholog-
ical conditions produced by the intro-
duction of foreign bodies among the
organisms. The phenomena of phago-
cytosis have been well observed by the
above named author in the disease pro-
duced by trichina. In view of the fact
that the parasites to be fought are com-
paratively large (and it is always possible
to ascertain whether they are alive or
dead), it is interesting to know, in this
condition, what cellular element plays
the role of phagocytes. In all cases
of trichiniasis, the muscular tissue af-
fected was found to react as in the in-
troduction of foreign bodies, producing
the activity of the surrounding elements.
Affected muscular bundles become sur-
rounded, at their periphery, by little cells
with either round and regular nuclei, or
at other times, lobulated nuclei.
A great number of these cells intro-
duced thus into the fissures made along
the muscle bundles, the edges of which
demonstrate semilunar or nearly round
notches, were filled with leucocytes.
The contour of these bundles became
more and more irregular, as if they had
been gnawed. ' The longitudinal and
transverse fissures gradually become more
positive and more marked, until the
bundles produce separate particles of
muscular tissue, which are soon sur-
rounded by numerous groups of leuco-
cytes. These little isolated masses of
muscle are surrounded by the protoplasm
of the enlarged leucocytes. Among the
small cells, there exist occasionally a
few typical giant cells, containing parti-
cles of muscular tissue.
It is plain that muscular tissue, inde-
pendent of the intermediary tissue, re-
acts against the irritation provoked by
trichina. Very soon after the introduc-
tion of the parasite, the contractile
substance suffers a modification of de-
generacy ; the sarcoplastic part augments
in volume. Its nuclei multiply, and the
cellular masses thus formed (resembling
Plasmodia) surround the degenerated re-
gions. Another part of the sarcoplasm
with multipled nuclei gathers around the
trichina in the form of large giant cells.
We have consequently before us a case
of activity of the phagocytes developed
in the interior, and directly at the ex-
pense of the muscular bundles.
EXPLANATION OF PLATE (FRONTISPIECE).
All the figures have been made with ocular 3 and,
the system 3 and 4 of Verick, except Fig. 7, which
was made with No. 9 of Hartnack.
Fig. I. A necrosed muscular bundle transformed
into a separate portion by means of the leucocytes.
In certain places we see the leucocytes introduced
into the interior of the muscular portions, and
lodged in a kind of vacuole. In the lower part of
the figure we see a longitudinal fissure. This is
from a case of trichiniasis in man.
Fig. 2. Muscular bundles of a white rat. The
hypertrophied sarcoplasm with multiplied nuclei
surrounds the necrosed parts of the contractile sub-
stances.
Fig. J. Bundle resembling the preceding one-
with a trichina larva in the interior. Around the
trichina we observe an agglomeration of sarco-
plastic nuclei.
Fig. 4. Transverse section of a bundle similar
to Fig. I.
Fig. 5. Transverse section of a bundle, the con-
tractile substance of which has been, after move-
ment of the parasite, mingled with the sarcoplasm.
The latter presents in A the muscular nuclei in-
which we may observe the erythrochromatic degen-
eracy of the nuclei.
Fig. 6. Longitudinal section of a muscular bun-
dle similar to that of Fig. 5. In the interior of
this muscular bundle we observe a trichina turned'
TRANSLATIONS AND ABSTRACTS.
335
on itself. The sarcoplasm and the nuclei surround
the parasite on all sides. The figure gives a very
clear picture of a mixture of the necrosed and con-
tractile snbstances with the sarcoplasm. This is a
case of trichiniasis in man.
Fig. 7. A leucocyte, containing a bit of necrosed,
dissociated muscular tissue. Another case of
trichiniasis in man.
PHAGOCYTES AND IMMUNITY.
In an interesting discussion before the
Pathological Society of London, relating
to the various doctrines concerning phag-
ocytes and immunity, Dr. Ruffer re-
cently presented some very interesting
facts and arguments in favor of the doc-
trines of Metchnikoff, a few of which we
quote : —
''As to the substances which attract
the amoeboid cells toward the virus, they
have been proved to be the poisons se-
creted by micro-organisms, or contained
in their bodies. It is probable also, that
in some cases these poisons have the op-
posite effect, namely, that of repelling
amoeboid cells. I have lately gained con-
siderable evidence to show that the same
substance may attract or repel leucocytes,
according to its state of concentration.
I may mention one such experiment. If
a small piece of sterilized sponge be
soaked in pure turpentine and placed un-
der a guinea pig's skin, it will be found
that, even after a lapse of twelve hours,
not a single amoeboid cell has penetrated
into the sponge. Sections made through
the sponge and surrounding parts show
that the amoeboid cells have emigrated in
considerable numbers into the tissues
around, but that they are arrested at a
certain distance from the sponge and can
proceed no farther. A piece of normal
sponge placed a little distance off, is
absolutely crammed with amoeboid cells,
though the turpentine sponge contains
none at all.
"Now allow a similar sponge to soak
in a very dilute solution of turpentine in
olive oil, and place this sponge, together
with another containing fine sterilized
olive oil, and a third soaked in pure
turpentine, under the skin of a guinea
pig. After four hours, the sponge in
the solution of turpentine in olive oil is
crammed with amoeboid cells, while the
other sponge soaked in olive oil, contains
but a few, and that in turpentine, none
at all. Here, then, we have the same
substance exhibiting totally different ef-
fects according to the concentration with
which it is applied. It is very probable
that such is the case with bacterial poi-
sons also, and there are already some
experiments which support this view.
Moreover, as Dr. Woodhead has already
pointed out, the same substances which
in a non-resistant animal repel amoeboid
cells, attract these same cells in con-
siderable numbers when the animal has
been artificially protected."
As regards the theory of Dr. Klein,
that leucocytes, instead of being the de-
stroyers of microbes, are selected by them
as favorable places for their development,
or as places for refuge. Dr. Ruffer very
aptly remarks : —
" With regard to what takes place in
the internal organs, the only evidence in
favor of this theory is that micro-organ-
isms are often found in cells. But I
contend that this is , not sufficient.
Should one meet a dead lion and find a
lamb inside, he, knowing the habits of
the lion, would not conclude that the
lamb had taken refuge there. True, after
a surfeit of lamb, the lion might die of
indigestion, but the chances of the lamb
ever getting out alive would be very
small. Similarly, knowing the voracious
habits of the lymphoid cells of the inter-
nal organs, before we can accept this
theory, observations must be^ made show-
ing that the bacilli of their own accord
force their way into the cells ; explana-
tions must also be found for the fact that
the micro-organisms perish in the cells in
enormous numbers ; and lastly, it must be
explained why, according to Bardach,
Soudakewitch, and others, animals nor-
mally resistant against a given microbe
succumb alrriost invariably when the
spleen is removed.
'' Remember also, that phagocytes exert
a distinct choice between two kinds of
microbes. They will leave the bacillus of
tetanus for the micro-bacillus prodigiosus,
and the streptococcus for the bacillus of
diphtheria. This is well illustrated in
the diphtheritic membrane, where at the
surface one can see leucocytes taking in
numbers of bacilli, but leaving strepto-
cocci almost untouched, with the imme-
diate result that streptococci are often
met in the deeper parts of the mem-
brane, and with the remote result
that secondary abscesses occurring in
the course of diphtheria are never due
336
TRANSLATIONS AND ABSTRACTS.
to the bacillus of diphtheria, but to some
other micro-organism.
''The study of the diphtheritic mem-
brane shows the remarkable resisting pow-
ers of leucocytes, for although the tissues
underlying the membrane are necrosed and
dead, the leucocytes have the power of
marching in numbers right up to the ba-
cilli and waging war against them, al-
though many, as I have shown, perish in
the fight."
Respecting the reputed bactericidal
property of serum, Dr. Ruffer makes
the following interesting observations :
''Some investigators, the chief of whom
is Dr. Buchner, of Munich, have laid
great stress upon the bactericidal action
of the serum of resistant animals. I may
perhaps be permitted to express my great
admiration for Dr. Buchner's work and
that of his followers, and I am ready to
allow that the facts, as stated by Dr.
Buchner, are in the main correct; but I am
far from accepting the view that the fluids
of the living animal play any part in the
destruction of microbes in the organism.
"In the first place, let us see what
happens in animals which have under-
gone no protective treatment. If the
bactericidal action of normal serum has
anything whatever to do with the resist-
ance of animals toward a particular kind
of microbe, then whenever the resistance
of an animal against a given microbe is
great, the bactericidal action of its serum
on that microbe should also be marked ;
and that when an animal is not resistant,
the bactericidal action of its serum should
be feeble, or at least slighter than that
of a more resistant animal. A rabbit is
not resistant, and its serum possesses a
strong bactericidal action on the anthrax
bacillus ; a dog is more resistant, and its
serum has no bactericidal action on the
anthrax bacillus. We have one excep-
tion, that is the white rat, which pos-
sesses considerable resistance against
anthrax, and the serum of which has a
strong bactericidal action on the bacillus
anthracis in vitro. But this exception
proves the rule, for when the bacillus
anthracis is inoculated into a white rat,
it thrives at first remarkably well, though
it is ultimately destroyed by the animal's
amoeboid cells. That teaches us another
thing also, namely, that it is impossible
to argue that those phenomena which
occur in vitro exclusively, take place in
the living body.
"Were other examples necessary, I
would draw attention to the fact that, 'n
vitro, the serum of the non-resistant rab-
bit is a bad cultivating medium for the
bacillus pyocyaneus, whereas the serum
of the resistant guinea pig is an excellent
cultivating medium for the same bacillus.
And conversely, I would point out that
the serum of the resistant rabbit is an
excellent cultivating medium for the bacil-
lus of Chauveau, and that of the non-re-
sistant guinea pig a very bad medium for
the same micro-organism. Moreover I
have proved that the fluids of both kinds
of animals when alive, form an excellent
cultivating medium for this same bacillus.
And yet another example of a similar
nature : The bacillus of diphtheria in most
animals is only found at the seat of inoc-
ulation, and in rabbits and guinea pigs
never spreads any farther ; and yet the
serum of such animals is an excellent cul-
tivating medium for the bacillus of
diphtheria."
m- — • 4
The Toxic Nature of Normal Urine.
— A number of experiments have been
made by Bouchard, and since, by some
other investigators, on the toxicity of
urines in various conditions. This is one
of the most fruitful fields of the investiga-
tor,— to determine the causes and nature
of a number of diseases, and everywhere
in civilized countries we find men engaged
in the laudable task. F. Sydney Edkins
makes the following statement in the
Manchester (Eng.) Medical Chronical,
which is of a great deal of interest : —
MM. Mairet and Bosc (^Archives de
Physiologic, April, 1891) refer to the fact
that the toxic nature of the urine has been
ascribed to various particular constituents,
without satisfactory evidence. The urea,
kreatinin, the sodium chloride, and the
potash salts have severally been desig-
nated as the essentially poisonous ele-
ments. Their researches have been in
the direction of discovering the part
played by the water, by oxidation prod-
ucts, by mineral salts, and by coloring
matters.
"Their experiments were performed on
dogs and rabbits. The method of intro-
duction of the particular substances into
the animal's circulation was by intraven-
ous injection, and the introduction was
gradual, the whole quantity injected be-
ing spread over a certain interval. They
found the injection of simple urine to
TRANSLATIONS AND ABSTRACTS.
33r
have the same effects as had been pre-
viously described by Bouchard, — some
amount of contraction of the pupil, a
considerable secretion of urine, slowing
of the respiration, and a quickening of the
heart-beat. The temperature was unal-
tered. As regards the nervous system,
some degree of somnolence was at first
noted, and later, coma and an epileptic
form of convulsions. Finally, the animals
died. Comparing the effects with those
obtained by the injection of the different
substances referred to above, they ob-
tained the following results: —
"After the injection of a certain
quantity of water the animals died.
[Both spring and distilled water were
used with the same result.] The deaths
in this case they referred to the mechan-
ical effects. They found, as would be ex-
pected, nothing to indicate any toxic
nature so far as the water was concerned.
"To obtain a material containing the
oxidation products and the salts, they
decolorized urine with charcoal, and
used this fluid. They also used separately
urea, and sodium, and potassium salts.
They concluded that the salts of potas-
sium had some slight poisoning effect ;
that urea and the salts of potassium and
sodium promoted diuresis, and that the
accelerated heart-beat was to be referred
to the sodium salts. They then addressed
themselves to the coloring matters, which
they isolated and injected as before, in-
traveneously. They found that the in-
jection of the coloring matters by them-
selves had very much the same result as
the injection of urine. They caused con-
traction of the pupil, diarrhoea, abundant
secretion of urine, slowed respiration, and
accelerated circulation. A state of coma
supervened, and convulsions were ob-
served. They therefore conclude that the
coloring matters are the essential cause of
he toxic nature of urine."
Chimiotaxic Value of Tuberculine.
— M. Freudenreich, in the Annates de
Micrographies gives a resume of the
studies of M. Enrico Burci (^Riforma
Medica, Nos. 239 and 240, Oct., 1891),
on the subject of tuberculine. Among
other important conclusions, we note : —
I. Koch's lymph exerts a moderately
attractive action on the leucocytes and
on the migratory cells of the connective
tissue.
2. The chimiotaxic action of the
lymph is moderate in guinea pigs, a
little more marked in rabbits, and still
more marked in dogs.
3. Its chimiotaxic activity seems more
marked on tuberculous guinea pigs at
the seat of tuberculous growth.
4. An injection of lymph preceding
the introduction of capillary tubes (filled
with lymph and introduced under the
skin in order to study their contents at
various intervals) does not modify the
results.
5. After an injection the number of mi-
gratory elements in the seat of tubercu-
lous growth is augumented. It is the
more marked that the inoculation is
nearer to the seat of the disease.
Analysis of Milk by Electricity. —
The Chemicher Zeitung describes a new
method of analysis of milk, which is based
upon the variation of resistance pre-
sented by milk, according as the pro-
portion of fatty matters or of water is
increased. The variation in resistance
may be controlled by the addition of in-
organic salts, but this only adds another
difficulty which those who undertake to
adulterate milk must meet, as without
skilled assistants it would be practically
impossible to arrive at just the right pro-
portions required to meet the demands
of the test.
Arrowhead Poison. — M. Le Dantec
recently reported to the Society of Anat-
omy and Physiology, of Bordeaux, the re-
sults of experimental researches made
by himself in relation to the nature and
origin of the arrowhead poison employed
by the natives of New Hebrides. He
showed by experimentation that the poi-
son was of neither vegetable nor animal
origin, that is, neither curare nor serpent
venom. A bacteriological investigation
showed the poison to contain microbes
which could be cultivated indefinitely.
The poison is obtained from the earth
found in bogs, and investigation showed
that it contains a septic vibrio, and the
tetanus bacillus of Nicolaier. This ob-
servation seems to completely refute the
views heretofore held respecting the
equine origin of the bacillus of tetanus,
since the horse is absolutely unknown ia
the archipelago of New Hebrides.
:338
BACTERIOLOGICAL NOTES,
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
"World and Modern Medicine, from original sources.]
The Bacillus of Typhoid Fever and
the Bacillus Coli Communis. — Messrs.
Rodet and Roux have made extensive
.experiments to demonstrate the direct
relations between the two organisms men-
tioned, and have come to the conchision
that the typhoid bacillus is only a de-
generated variety of the bacillus coli
communis. They do not state, however,
that the bacillus coli communis produces
typhoid fever, but that it may acquire
typhogenous properties.
Messrs. Chantemesse and Widal, on
the contrary, have arrived at the con-
clusion that the Eberth bacillus of ty-
phoid fever is different from the bacillus
coli communis. They bring forward se-
rious arguments against the theory of
Rodet and Roux. Investigators in this
country (notably Welch) also attack the
Roux theory very boldly. It seems
pretty well established that the germ of
typhoid fever is a different organism from
the bacillus coli communis. Another in-
vestigator. Prof. Vaughan, attributes ty-
phoid fever to several germs.
-• — • — ^-
Germs of Oleomargarine. — Drs.
Scala and Alessi, of Rome, have recently
published the results of some studies
undertaken for the purpose of determin-
ing whether disease may be transmitted
bty means of artificial butter. The fol-
lowing resume of these results was pub-
lished recently \VL\kit. Revue Internationale
de Me die in : —
'' The spore-producing bacilli of char-
bon, the staphylococcus pyogenes aureus,
streptococcus, and the bacillus of gland-
ers, in both filtered and non-filtered but-
'ter, resisted a temperature of 104° to 122°
F., for two hours. The streptococcus
pyogenes and bacillus of glanders alone
perished in the filtered butter. Further,
the bacilli of charbon retained their
vitality in non-filtered butter for 46 days,
but only 28 days when the butter was
filtered. All the other germs disappeared
at the end of 30 days. The spore-pro-
'ducing bacilli of charbon retained their
pathogenic properties for more than 30
days in filtered butter, and for an in-
definite period in butter which had not
been filtered. The streptococcus pyog-
enes is no longer pathogenic after
having been subjected to the temperature
above indicated in filtered butter, but re-
mains pathogenic under the same con-
ditions, if the butter has not been filtered.
The bacilli of glanders did not produce
death in the experiments made, but one
death resulted from the bacilli of tuber-
culosis.
"The author recommends that artifi-
cial butter should never be used within
less than 40 days after its manufacture,
the time that should be allowed for the
disappearance of the most dangerous
germs."
The advice given by the authors of the
above experiments is certainly good, but
we would suggest the propriety of consid-
ering carefully the question whether it
would not be better still to make no
use whatever of a food-substance so ex-
tensively contaminated.
Staphylococcsemia. — This is a term
applied to investigations of the system by
the staphylococcus albus or aureus.
M. Stenico, of Florence, reports a case
in which this malady appeared as a
disease. The patient was affected with
intermittent or febrile attacks, resembling
tertian malarial paroxysms. The spleen
was swollen and the lungs congested.
Quinine administered by the mouth had
no effect. Microscopic examination of
the blood showed the presence, during
the intervals between the febrile attacks,
also when the fever was present, of great
numbers of micrococci. The micrococci
were also found in the urine. Cultures
made with the blood and urine upon agar
and gelatine resulted in the development
of colonies in the staphylococcus pyro-
genes albus and aureus. Patient was
cured by intra-venous injections of a
solution of quinine, from which cause the
staphylococci began to disappear.
The Action of Mineral Filters on
Microbic Fluids. — M. Arloing, in a
note to the French Academy of Science,
June 20, gives his experience with min-
eral filters as used in filtering liquids of
microbic origin. He points out that
chemists have demonstrated that these
filters retain a certain quantity of albumi-
BACTERIOLOOIGAL NOTES,
339
noid matters, chiefly diastases. He him-
self saw a few years ago that microbic
products with a phlogogenous property,
lose part of their activity in passing
through Chamberland's filter. M. Roded
and Courmont have made similar obser-
vations on the toxic property of culture
broth. Now that researches on the prod-
ucts of microbes are in order, M. Ar-
loing thought that it would be of utility
to demonstrate the changes which the
filters produce in the proportions of the
different substances serving as media for
microbic life. In his experiments he
selected a liquid which runs from the
pulp of the sugar beet after its fermenta-
tion in a silo. He found that a mineral
filter contained a greater quantity of
•definitely insoluble than soluble sub-
stances, after the action of alcohol. He
demonstrated that the Chamberland fil-
ter impoverishes the liquids that are fil-
tered through it. It abstracts from them
a notable quantity of nitrogenized and
hydrocarbonated organic substances.
The Cause of Immunity, and the
Cure of Infectious Maladies. — M. Em-
merich has observed that the bacilli
of hog cholera, introduced into the or-
ganism of vaccinated rabbits, are rapidly
destroyed, and cannot be found eight
hours afterward in the organs. He at-
tributes this fact to the formation of
poisons having bactericide properties.
M. Metchnikoff attributes the destruc-
tion of bacilli in such cases to the action
of phagocytes. M. Emmerich and M.
Metchnikoff, consequently, have very
different views of the cause of immunity,
and the discussion has been carried on,
on the part of the former at least, with
considerable bitterness. He has made
new experiments, in which he claims that
his first observations have been abso-
lutely confirmed. He concludes by say-
ing that the refractory organism <' de-
stroys the bacilli introduced by injection
in the veins in eight to ten hours, even
when they are injected by the million."
He says the phagocytes play no role what-
ever in the production of immunity, and
presumes that it is the poison contained
in the tissue of the vaccinated animal
which kills the bacteria. He goes much
further and says that the phagocytes may
favor infection by transferring the germs
from one part of the body to another.
It is strange that this observer finds re-
sults so strikingly different from the views
of M. Metchnikoff, which are supported
by so many facts. However, it seems
that phagocytes are not the only factor in
producing immunity ; they are simply one
of the means to that end.
» » -
The Etiology of Suppuration in Tu-
berculosis.— The writer has always held
the view (based on experimental labors
and other observations) that tuberculosis
is generally complicated by the action of
various microbes. Suppuration has often
seemed to be the result of other micro-
organisms than the bacilli of tuberculosis.
However, the experiments with Koch's
tuberculine demonstrate very well that
cultures of tuberculosis, killed by heat,
produce local abscesses when they are
inoculated under the skin of the guinea-
pig. The same thing is produced in tu-
berculosis provoked experimentally ; an
abscess generally takes place at the point
of inoculation. There is nothing strange
in this since a number of other known
germs may produce similar effects.
In order to elucidate this question. Dr.
Tavel made a series of observations in
forty cases of abscesses presenting the
character of tuberculosis ; he made in
each a complete bacteriological analysis,
and also tested these abscesses by inocula-
tion. Dr. Tavel derives from his impor-
tant work the following conclusions : i.
In man tuberculosis of hsematogenous
origin is a mono-infection produced by
the bacilli of tuberculosis exclusively ;
'1. Mixed infections generally proceed
from the exterior; 3. When other bac-
teria are found in abscesses which had no
connection with the superficial parts of
the body, there are generally no bacilli
of tuberculosis; 4. A predisposition of
the tuberculous spots to a hsematogenous
infection is not proven; 5. Clinical ex-
periments and the results of the inocula-
tion of guinea-pigs, seem to demonstrate
that tuberculosis does not exert a pro-
hibitory action on pyogenous bacteria.
The writer has long studied this ques-
tion, and from observations and experi-
ments, has become convinced that tuber-
culosis is very frequently, if not usually,
at some period or another, complicated
by the action of other organisms. The
latter generally appear after the tubercles
have opened.
340
EDITORIAL
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
$2.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., August, 1892.
ETIOLOGY OF SPECIFIC DISEASES.
Still the discussions continue on the
subject of this headline, and while the
bacterian theory, so-called, is accepted by
a majority of the medical world, we find
theorists who advance very different
views. The bioplast theory ; the chemico-
phy steal theory ; the nervo-glandular the-
ory^ and the very elastic theory, given
under the name of ^^ perverted vital
force,'^ are among the notions of the
medical fraternity.
The latest important dissertation on
the subject is by Dr. R. French Stone,
of Indianapolis (before the section of the
practice of medicine of the American
Medical Association, Detroit, June 7,
1892). Dr. Stone's paper is admirable
and thoughtful, yet it cannot be said that
anything more than theoretical ideas,
unsupported by exact science, have been
advanced. Like other antagonists of
bacteriology, and supporters of different
theories, he constructs a plausible ground-
work, on pure speculations, to support
his views, but when the light of science
is applied to it, it is found wanting.
Actual experiments have, repeatedly,
annihilated most of the plausible features
of each and all these theories, while not
one of them brings forth a single experi-
ment or proven fact to disprove the more
exact teachings of bacteriology. The fact
is, that all the theories mentioned which
are not bacterian, can be explained scien-
tifically, by observations, and often by
experimental demonstrations in the bac-
teriological field. They are only so-
many poorly explained phenomena which,
do not militate against bacterian etiology,
but, for the most part, actually support
it, and explain to the scientist many of
the problems which appear darkest to the
medical profession. For example, the
chemico-physical theory is not capable of
explaining, of itself, any specific disease,
while as a factor in the bacterian doc-
trine it supports the latter and explains^
the chemico-physical phenomena at the
same time.
The '■^ perverted vital force ^^ Xh^oxy is
in the same condition ; it simply supports
the ''germ theory," so-called. No bac-
teriologist worthy the title, maintains that
bacteria can produce disease in any or-
ganism without a proper field for its de-
velopment. The perversion of vital force
is simply a special condition of the soil
which offers a proper nutrition for mi-
crobes. No matter how long or how
much the soil is ''perverted," it cannot
produce a specific disease, say, typhoid
fever, unless the specific germs are there
to grow. The latter are the last and de-
termining factors. A piece of land may
be perverted, /. e., rendered fertile, by de-
composition of organic matter on its sur-
face or in its external strata, but even in
this most favorable condition, it cannot
grow wheat without the wheat seed ; the
transformation and exhaustion of soil pe-
culiar to wheat-growing cannot take place
until the development of this plant. So
it is in a specific disease ; the body is the
soil ; the germ the plant. The body may
be called perverted when its forces are
exhausted or weakened, and the tissues
offer then a rich nutrition to germs, with-
out the normal life resistance of healthy
living cells.
But this perverted vital force theory-
could not explain all specific diseases
even if it could explain any of the most
obscure ones which offer such a rich field
for speculators ; there are specific dis-
EDITORIAL.
341
eases which do not wait for a perverted
vital force, for example, charbon. It
does not matter in what condition a sus-
ceptible organism is, it is usually liable to
the accidental transmission of charbon ;
one can always produce this disease by
inoculation (not necessarily with a mixt-
ure of germs and their products) with the
bacilli of anthrax pure and simple, en-
tirely free from other matters, as may be
readily done by filtration, washing, and
comparative inoculation of free germs
and the liquid which has served to wash
them. Can this be explained theoretic-
ally or experimentally by any theory ex-
cept the doctrine of bacterian etiology?
On the contrary, to one who has himself
made these experiments, it solves the er-
rors which theorists are laboring under in
their futile attempts to establish unsci-
entific suppositions. The bacterian doc-
trine is established, both in animal and
plant diseases, and '^ our present state
of knowledge" is ?iot ''an unsettled
problem."
Dr. Stone's article is ingenious, and
arouses most serious thinking ; but not a
single problem in all its arguments and
suggestions is beyond reasonable explana-
tion by bacteriology, even now, in its
crude state. The many difficulties painted
by Professor Hartshorn, of Philadelphia,
and expressed by Dr. Stone in seven
special paragraphs, have been time and
again reasonably elucidated by diiferent
observers and experimentalists the world
over ; indeed some of them are elemen-
tary questions already antiquated.
In one statement Dr. Stone makes the
bold assertion that glanders is ''only of
spontaneous origin, etc." This is abso-
lutely inaccurate, if he means that in
lower animals it ever arises spontaneously
without the germs, as his preceding re-
marks surely indicate, and almost posi-
tively declare. The writer of this criticism
had for many years control of the conta-
gious diseases of live stock in the State of
Missouri, under a special sanitary act.
During this time he has seen over eight
hundred cases of glanders ; has made
over one hundred and fifty post-mortems
in the equine species ; inoculated the
disease repeatedly in guinea pigs, and has
studied the results in various stages ; has
studied the history of almost every one of
the eight hundred cases, and also of some
eight cases in man, some of which he saw
and diagnosed ; has studied glanders dur-
ing five years microscopically and bacteri-
ologically, and he can say that never does
glanders originate any where and in any
condition without the introduction of the
specific germ. Such assertions are well
calculated to detract from the importance
which one might attach to the other asser-
tions.of the paper, and the many arguments
and speculations indulged in. p. p.
THE SURGICAL TREATMENT OF RETROVERSION
OF THE UTERUS.
The frequency and incurability by non-
surgical measures of this morbid condi-
tion is evidenced by the enormous busi-
ness carried on by firms engaged in the
manufacture and sale of pessaries of ev-
ery description. That pelvic pessaries
rarely if ever effect a cure of retroversion,
is a fact with which all practitioners are
familiar. Nevertheless, so many failures
were reported in connection with at-
tempts to relieve this condition by means
of the present device, by Prof. Alexander,
of Liverpool, that the majority of practi-
tioners have relapsed into the old con-
dition of what might be termed "in-
nocuous desuetude," in relation to this
malady.
Perhaps the majority of gynecological
surgeons are to-day considering the
method of shortening the round liga-
ments, as a means of correcting posterior
displacement of the uterus, and, upon
failure, various methods have been pro-
posed as a substitute for it, such as
stitching the fundus of the uterus to the
anterior abdominal wall, attaching the
342
EBITOBIAL.
pedicles of the appendages after ovari-
otomy to the bottom of the wound, fold-
ing the round ligaments in various ways,
attaching them to the abdominal wall, etc.
None of these methods have, however,
met with general approval, and all are
confessed to be, practically, failures by
those who have had an opportunity to
observe the results obtained.
A question of interest to progressive
physicians, is : Must women suffering
from retroversion now be abandoned to
their fate, or subjected to the ultra-radi-
•cal method of vaginal hysterectomy, to
which a few surgeons have resorted as a
last and, we may perhaps say, desperate
means of relief.
In the opinion of the writer, the aban-
donment of the method of shortening the
round ligaments has been too hasty. A
careful study of the subject seems to show
that failures were due, not to any fault
in the principle involved in the operation,
but rather to defective methods, and to
an employment of the operation in cases
requiring more serious operative meas-
ures, such as a laparotomy for the break-
ing up of the adhesions, or the removal
of the diseased appendages.
The difficulty of determining the exact
•condition of the uterine appendages with-
out opening the abdomen, must inevita-
bly lead to occasional errors in diagnosis ;
nevertheless, by the exercise of every
possible care and painstaking in diagno-
sis, it is certainly possible to eliminate
the greater proportion of cases unsuited
to the operation, and the writer has
proven, by the employment of the opera-
tion in nearly 200 cases, that the substi-
tution of better operative methods, and
the .application of proper therapeutic
measures before and subsequent to op-
eration, together with care in diagnosis,
render this operation not only safe and
radical, but a reasonably certain method
of curing this most distressing ailment.
A simple incision, scarcely an inch in
length, -often less than three fourths of an
inch in extent, reaching only to the ten-
don of the external oblique muscle, en-
ables one possessed of skill and experi-
ence to penetrate the roof of the inguinal
canal near the internal rim, by a small
puncture with the point of an operating
knife, and then dextrously to hook up the
round ligament with an instrument made
for the purpose, and quickly weave the
ligament into the adjacent tissues, so
as to secure it, weaving the loop of
surplus ligament into the tendon of the
external oblique muscle. The wound
may be closed with a couple of silk or
catgut sutures, and the operation is
done. The writer has often completed
the operation on one side in four to six
minutes, and on both sides in less than a
dozen minutes. The operation is so
slight, and may be so quickly completed,
that it is even possible to operate without
the use of a general anaesthetic, an in-
jection of a small quantity of a 4-8 per-
cent solution of cocaine being sufficient
to render the patient almost completely
oblivious to sensation of any sort during
the operation.
After having tested this mode of restor-
ing the uterus to a normal position in
nearly 200 cases, extending over a period
of five years, the writer feels justified in
urging that the method of Alexander, re-
inforced by greater care in diagnosis,
and by an improved technique, shall have
a longer and better trial before it is
abandoned, feeling confident that such a
trial will result in the verdict that this
method is, of all that have been proposed,
the most suitable for application, at least
in those cases which do not require a
laparotomy for other reasons. And even
in cases in which the abdomen is opened,
the writer has generally found that short-
ening the ligaments by external incisions
is the best means of permanently fixing
the uterus forward in the pelvis, in cases
requiring any sort of surgical interference
for this purpose.
J. H. K.
EDITORIAL.
34a
The Increasing Prevalence of
Tapeworm. — French physicians have
been considerably agitated over the fact
that while the population of that country
is rapidly decreasing in consequence of
an increased death-rate acting in conjunc-
tion with a decrease in the birth-rate,
tapeworms are rapidly increasing. There
has been considerable discussion as to
the source of the tapeworm so commonly
met with, especially on the Belgian and
Swiss frontiers, and the Mediterranean
shore.
Berenger-Feraud maintains that tape-
worm is chiefly derived from beef, while
M. Colin insists that the pig and the cow
are equally prolific sources of this para-
site. He claims to have discovered, also,
that both these animals are infected by
some species of cysticercus, so that it is
impossible to tell by examination of the
worm whether it is derived from the cow
or the pig. M. Colin also calls attention
to the great frequency with which cysti-
cerci are to be found in the flesh sold in
the public markets.
If a similar investigation were made in
this country, it would doubtless show
that tapeworm is increasing in the United
States with fully as great rapidity as in
France, since there is practically no sys-
tem of meat inspection in this country
capable of protecting, even to a slight
degree, more than a very small propor-
tion of the population. The consequence
is, that not only is the flesh of animals
infected with the embryos of tapeworm,
frequently eaten, thus establishing the
disease in human alimentary canals, but
infected persons are going about scatter-
ing the eggs of the parasite by the mill-
ion, infecting water-courses ^ through
sewerage systems, and thus rapidly multi-
plying the disease in domestic animals
which are used for food, so that a vicious
circle is formed, by which the disease is
bound to increase more and more.
This is only one of the grave questions
relating to the food-supply, and it should
be seriously considered by our legisla-
tive sanitary authorities, for it is cer-
tainly one which demands immediate
attention. j. h. k.
Earthworms and Tuberculosis. —
Lortet and Despeignes recently reported
to the Academy of Science, Paris, some
very interesting studies in relation to the
function of earthworms in the dissemina-
tion of tuberculosis. These authors had
previously shown that earthworms may
preserve in different parts of their bodies,
the bacilli of tuberculosis during man}r
months, and. that they may thus bring
them to the surface of the soil. Re-
cently these scientists have extended
their researches in this direction, and
have determined the important fact that
earthworms, that have become infected
with tubercle bacilli leave behind them
in their faecal matters, as they move
through the earth, tubercle bacilli pos-.
sessed of virulent properties.
Pasteur called attention to a similar
action of earthworms in relation to the
bacteria of charbon, many years ago.
It is of interest to know that the bacilli of
tuberculosis sustain the same relation to
earthworms as that of charbon. With
these facts determined, it is easy to ap-
preciate how a locality may become in-
fected with the germs 'of tuberculosis.
Earthworms harboring the microbes in
their bodies, scatter them about through
the soil, and bringing them to the suface,.
where the excreta containing them may
be dried and pulverized into fine dust
and lifted into the air in the shape of
minute particles which may be readily
inhaled, it is easy to see how a locality
once inoculated with tuberculosis be-
comes permanently infected.
The purpose of this arrangement of na-
ture in the seeming co-operation of or-
ganisms of a low type against human life,
is indeed difficult to comprehend. The
fact, however, is one of importance, and
should lead to the absolute destruction of
544
EDITORIAL.
the sputum in every case of tuberculosis.
There ought to be a law in every civilized
community requiring every person suffer-
ng from tuberculosis to destroy his sputa,
as it is chiefly through this means that
the disease is extended.
Nearly a century ago, the prevalence of
tuberculosis in Naples led to the estab-
lishment of a quarantine against the dis-
ease, similar to that which is maintained
against leprosy in countries where this
latter disease prevails. Known facts
about the two diseases indicate that pul-
monary tuberculosis is a more infectious
malady than leprosy. Its ravages are
more rapidly fatal in their effects, and re-
covery from the disease, when it has once
obtained a foothold in the system, is al-
most as rare. A malady which destroys
from one fifth to one seventh of all that
•die is a veritable plague of the most stu-
pendous proportions ; so that how to re-
strict or restrain this disease, is one of the
gravest problems with which the sanitari-
ans of the present day are called upon to
deal. J. H. K.
^ — • m
A Higher Standard of Medical Edu-
cation.— It is gratifying to note in many
different quarters the growing sentiment
in favor of a higher standard in medical
education. The University of Michigan
has, in this respect, set a worthy example
for the large number of medical schools
in the West, and it is interesting to note
that although the standard requirements
for entrance at this excellent school have
been gradually raised from year to year
for a number of years back, the attend-
ance has not fallen off. This fact points
to an appreciation on the part of the pro-
fession, of the importance of the advances
made. The Legislature of the State of
New York has recently created a law
requiring a State examination of all
graduates in medicine. It is rather hu-
miliating to learn that a bill has recently
been brought before the Legislature, ex-
empting from all the requirements of the
previous bill relating to examinations, all
medical students who have entered upon
their studies within a year from the pas-
sage of the bill. It is certainly to be
hoped that this exemption bill will not
become a law. The too rapid increase
of medical men in this country gives rise
to the employment of unfair and often
disgraceful means of competition among
them, and leads to the adoption of com-
mercial methods which are a disgrace to
a noble profession. Any and every meas-
ure looking toward the lessening of the an-
nual output of doctors by medical schools,
and improvement in the quality of instruc-
tion imparted, and the raising of the stand-
ard both for admittance and graduation,
should be welcomed by all who have the
interests of the profession at heart.
J. H. K.
• • m
Metchnikoff on Vaccination. — The
interesting work recently done by Metch-
nikoff in relation to the subject of im-
munity, and described by himself in this
journal, lays the foundation for a broad
field of research in relation to this most
important question, and offers a hope for
most remarkable results. The question
of immunity has been one of the most
puzzling with which physiologists and
biologists have had to deal. To Metch-
nikoff is properly attributable the honor
of having been the first to throw any real
light upon this important question. His
profound and exact researches have de-
veloped original facts of the most in-
tensely interesting character, and which
thus far seem to have well stood the test
of the most severe criticism to which
they could possibly be subjected. It is
to be hoped that this savant will be
able to continue his researches until this
knotty question is fully elucidated, and
until the means have been acquired by
which many of the maladies which now
make such havoc with human life may be
brought under control by the prophylac-
tical measure of artificial immunity.
J. H. K.
REVIEWS,
345
Reviews.
*' Original Researches Concerning
Tri-Methyl-Xanthine and its Deriva-
tives."— By Moses Gomberg, M. S.,
University of Michigan.
Through 'the kindness of the author,
we have received an abstract of a paper
prepared by him, giving the results of an
extended series of chemical studies hav-
ing for their object the determination of
a constitutional formula of caffeine. The
results obtained seem to confirm those
obtained by E. Fisher.
The original observation made by
Lehmann respecting the close resem-
blance of caffeine to creatinin, one of
the excrementitious products of tissue-
work, seems to be confirmed by later
studies of this substance, although this
fact is not referred to by the author,
whose sole purpose was to determine the
chemical constitution of this interesting
substance. Mr. Gomberg certainly de-
serves great credit for the painstaking, in-
vestigation which he has made, which not
■only confirms the observations of other
eminent chemists, but add something to
what was previously known respecting
caffeine and its compound.
"Parasites and Parasitic Diseases
of the Domesticated Animals." — By
L. G. Neumann, Professor at the Na-
tional Veterinary School of Toulouse.
Translated and edited by George Flem-
ing, C. B., LL. D., F. R. C. V. S. 8vo,
•cloth, 873 pages, 365 illustrations, $8.
William R. Jenkins, 851 and 853 Sixth
Avenue, New York. In 1876, realizing
the need, in the English language, of a
work to which the student of human
or veterinary medicine, the sanitarian,
agriculturist, or breeder or rearer of ani-
mals, could refer for full information,
with regard to the external and internal
parasites — vegetable and animal — which
attack the various species of creatures
man has domesticated. Dr. Fleming com-
menced a work to meet the want, but,
owing to a pressure of other duties, was
compelled, temporarily, to relinquish this
task. In 1888 Neumann's treatise was
issued, and that being the most complete
and comprehensive of any which had yet
appeared, and the arrangement somewhat
on the plan Dr. Fleming adopted. Dr.
Fleming resolved to venture on its trans-
lation instead of proceeding with an inde-
pendent attempt.
The result of his efforts is this book.
With it, no work in English is to be com-
pared so far as veterinary medicine is
concerned ; and even in human medicine
— English or foreign — there is none so
comprehensive and complete.
The damage done to health — the para-
sitic diseases — the author had particu-
larly in view, and so deemed it useful to
establish the order to be followed accord-
ing to the nature of the organs invaded,
and this has been the predominant idea
throughout the work.
In order to facilitate diagnosis, the
study of the commensals, which are so
frequently met with, has been added to
the study of parasites. All the living
forms observed on the surface or in the
texture of organs, whether common or
rare, frequent or exceptional, have been
included. The work is divided into
eight sections, as follows : Parasites of
the Skin, Parasites of the Digestive
Apparatus, Parasites of the Serous Mem-
branes, Parasites of the Respiratory
Apparatus, Parasites of the Circulatory
Apparatus, Parasites of the Muscles, Con-
necting Tissue, and Bones, Parasites of
the Nerve Centers and Organs of Sense,
Parasites of the Genito-Urinary Organs.
"The Successful Treatment of
Chronic Diseases ; a Plea for Their
More Methodical Management." — By
Simon Baruch, M.D., Physician to the
Manhattan General Hospital, New York
Juvenile Asylum, and Montefiore Home
for Chronic Invalids.
346
REVIEWS,
This excellent paper, read at the last an-
nual meeting of the Medical Society of the
State of New York, contains much food
for thought, especially by those who have
allowed to pass, without some notice, the
many progressive steps which have been
made within the last twenty years, in the
rational treatment of chronic disorders.
The following interesting description of
the Dettweiler treatment of consumption
at Falkenstein, well illustrates the author's
idea respecting the regulation of the en-
tire life of the chronic invalid : —
''Dr. Dettweiler looks with disfavor
upon medicinal remedies, and pins his
faith chiefly to the curative influence of
pure air, to which he exposes his patients,
without regard to the rigorous climate in
winter even, at all seasons. The disci-
pline of this institution is rigid, and al-
most military in exacting obedience. At
8 A. M. the patients are expected to be
down stairs under penalty of a fine.
Then each one stretches himself upon a
reclining chair, of which there are a very
large number in the large halls, which
he leaves five or six times during the
morning to take a ten or fifteen min-
utes' walk. ' Patients are advised to
walk slowly, on a gentle slope, with
shoulders erect, and every fifteen minutes
to fill their lungs to their full capacity by
inhaling through the nose.' Breakfast is
served, consisting largely of milk, after
which the patient returns to his reclining
chair, and the rest of the day is passed in
the same manner as the morning. Dett-
weiler is most autocratic among his pa-
tients, and teaches them to cough only
three times a day. Hence each cough is
followed by expectoration, and he never
allows them to cough uselessly. At lo
p. M. each one returns to his bedroom,
which has remained open the entire day ;
the window is left partly open the entire
night, covered by a light blind.
''No drugs whatever are used at Fal-
kenstein, and still the results are most
satisfactory, thirty-seven per cent, includ-
ing all grades, recovering completely."^
A considerable part of the paper is de-
voted to a description of hydro-therapeu-
tic methods in the treatment of chronic
disorders. This paper cannot but be of
service to all who are not familiar with
the rational employment of hydro-ther-
apy, and suggestive even to those who
have had years of experience in the em-
ployment- of this valuable remedy.
"The Wife and Mother. A Med-
ical Guide to the Care of Her Health
and the Management of Her Chil-
dren."— By Albert Westland, M.A.M.,
M.D., C.N. P. Blakiston, Son & Co.,
Philadelphia.
This little work of 282 pages, written
by an able English physician, is brimful
of interest, wxll condensed and simplified
for the use of the lay reader. It is a
work which any physician can with per-
fect propriety place in the hands of his
intelligent lady patients, and in so doing
feel assured that the suggestions obtained
from it will be of service to him as well
as to his patients. The medical educa-
tion of the laity is a work which has been
much neglected by physicians, but which
much needs to be done. Quackery and
patent medicines will hold their place in
public esteem, and charlatans will con-
tinue to fatten upon the credulity of the
ignorant public until physicians do their
duty in enlightening the public mind re-
specting the functions of the body and the
laws by which their activities are regulated.
Ignorance is the mother of superstition ;
superstition is the friend of quackery.
In order that men and women shall be
able to distinguish between the intelligent
and skillful physician and the pretentious
charlatan, it is necessary that individuals
should possess a sufficient degree of med-
ical knowledge to be enabled to form a
correct opinion respecting the merits of
the two classes of candidates for public
favor and patronage. This little book
will contribute to the diffusion of just the
kind of information which people need.
•5^
jjr T this Season of the Year,
jAs thousands of Invalids are
seriously considering the
question, —
WHERE
SPEND THE
SUMMER
Where Can I Spend the Months of
July and August, and part of September,
with the Greatest Profit and Satisfaction ?
HE ANSWER
to this question depends
on what the individual
wishes to accomplish by a
summer vacation. If
change and recreation
only are desired, these can be found in a thousand places — at
health and other resorts which abound in almost every State in
the Union, none of which, how^ever, excel the delightful re-
sorts of northern Michigan.
If, in addition to rest and recuperation, the invalid needs a careful study of
his diseased conditions, and an intelligent regulation of diet, exercise, and all other
health conditions, — in other words, scientific health culture, efficiently carried out
by the aid of the best known medical means and appliances, thoroughly trained
nurses and attendants, and competent physicians, — then the choice between the most
desirable places becomes very much restricted. -^ There are certainly few institutions
in this country where the needs and desires of an earnest health-seeking invalid can
be satisfactorily met. Such places can be counted on the fingers of one hand, and
are. perhaps, little known because of the fact that the managers of such institutions
are conducting them in a scientific, and in some instances a philanthropic spirit, and
consequently do not employ as a means of winning patronage, the emblazoned ad-
vertisements, the truth-sacrificing circulars, and other advertising methods com-
monly resorted to by the proprietors of mineral springs establishments, bogus
sanitariums, and other so-called * * health institutions ' ' and quasi-medical establish-
ments, with which the country abounds.
The advertisements of these establishments do not appear in public prints or
popular magazines because such advertising is closely akin to quackery, and brings
those who employ it into bad company.
The managers of the Sanitarium at Battle Creek, Michigan, many years ago
undertook to organize a thoroughly scientific institution which would represent
rational medicine in its most advanced form, and would be exactly what it professed
to be — an institution where patients are honestly and fairly dealt with, treated at
reasonable rates, given kind attention and comfort, and opportunity for the recovery
of health under the most favorable conditions. The majority of patients treated in
this institution are sent to it by physicians who by personal acquaintance, or
through the reports of their patients, have become thoroughly familiar with the
character of the institution and its management.
BRIEF DESCRIPTION
OF THE
5ANITARIUM.
▼ ▼ T ▼ T T
^ ATTLB CREEK, one of the most beautiful and prosperous cities of Michi-
^ gan, is centrally located in the salubrious Peninsular State. Its population
is 20,000, while its death rate is but seven per thousand. Battle Creek is
situated on two great thoroughfares of railway travel between the East and
the West, being at the junction of the Grand Trunk and the Michigan Central lines ;
and two other railways make it easy of access from the South.
The city has an electric railway and is lighted by electric lights. A great
number of pleasant drives are afforded by its well-kept and shaded streets.
The Buildings are lighted by a 700-light plant, Edison incandescent system.
Safety Hydraulic Elevators. Outside stairways for fire escapes accessible from
every window.
The Institution aflfords facilities for baths of every description : Turkish, Rus-
sian, vapor, electric, water baths of all kinds, and the electric light bath. In-
dependent accommodations for ladies and gentlemen, sufficient for 80 persons
at one time. More than 800 feet of glass for sun-baths.
A General Parlor, 40 x 50 feet, is luxuriously furnished with Dhagistan rugs,
easy chairs, etc. The Dining-Room has a seating capacity of 400, is beauti-
fully lighted and ventilated, and always cheerful. No kitchen smells. Cui-
sine unsurpassed ; table service excellent. Everything an invalid needs, and
special dietaries prepared as directed.
VIEW OF GOGUAC LAKE FROM SANITARIUM LAKESIDE GROUNDS.
The Gymnasium, 85 x 45 feet, is supplied with every appliance for exercise, and
furnishes special instruction and class drills in Delsarte and Swedish gymnas-
tics, under a trained director. Exercise by prescription.
The Si^edish Movement Department, both manual and mechanical, is the
most extensive in the United States. Vibrating bars and seats, kneaders, rub-
bers, beaters, shakers, and manipulating appliances of all sorts.
The Electrical Department contains every improved appliance for medical ap-
plications of electricity. Galvanic, Faradic, Dynamic, and Static electrical
apparatus and appliances for electrolysis, electro-cauter}^ etc.
An Aseptic Maternity on the cottage plan ( steam heat and thorough ventila-
tion), provides the best possible conditions for lying-in patients, with expe-
rienced professional attendance and rigorous aseptic management.
Special Departments for surgical cases, eye, ear, throat, and lung diseases,
nervous diseases, genito-urinary diseases of men (non-specific), opium and
alcohol habits, and diseases of women. A kindergarten and nurser3^, to keep
the children happy and out of mischief.
Three Fine Greenhouses, maintaining a
magnificent collection of palms and va-
rious tropical flowers and plants, keep the
house filled with bloom during the win-
ter season. Flowers are everywhere in-
doors during the winter season. Patients
can visit the greenhouse at any time
without going out of doors.
Glass=Inclosed Sun-Parlors and Veran=
das for winter sunning and promenad-
ing.
SUMMER HOUSE AND FRESH-AIR INLET.
Pure Water from sandstone rock.
There are from 250 to 300 Employes in the Sanitarium service the year
round, of whom from 90 to 100 are medical attendants and nurses. Also seven
thoroughly trained physicians, and a large corps of manipulators skilled in
massage and the Ling system of Swedish movements.
The Sanitarium Training=School, in which our nurses are trained, is the
largest and most popular in the United States. Its course of training is
the most complete and
thorough of any school.
Tri=Weekly Lectures on pop-
ular medical subjects by
the physicians.
Ahundant Means for Rec=
reation indoors during
inclement weather. Facil-
ities for walking, driving,
and horseback riding at all
seasons.
The Sanitarium is Not a
Pleasure Resort nor a
fashionable hotel, but an
ideal place for invalids
needing good nursing, the
benefits of regular habits
and scientific professional
care and treatment, and who desire to get permanently well.
The Sanitarium Nursery and Kindergarten. This enables mothers to bring^
little ones with them without being burdened with their care and supervision.
The children have the advantages of kind and experienced teachers and am-
ple playgrounds.
For Further Particulars, see large circular and card of rates.
J. H. KELLOGG, M. D., Supt.,
Sanitarium, BATTLE CREEK, MiCH,
,,,>*• '^"
^=^^^^Hrt«^Wt'
ON THE LAWN.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
N10NTHL.Y BXJI.L.ETriN.
Battle Creek, Mich., August, 1892,
JIELATIYE INFLUENCE OF GERMS AND THEIR
PRODUCTS IN THE PRODUCTION OF
DISEASE.
Theorists indulge in speculation in regard
to the etiology of disease, and some even try
to destroy the bacterian doctrine by deduc-
tions from more or less misunderstood phe-
nomena. One very prolific source of attack
on the germ theory is the supposition that it
cannot be told whether the germ itself or some
of its products causes the disease, or whether
it is the "perverted" field in which it grows,
which produces disturbances. The arguments
•of the ^' chemico-physical theory,'^ the ^'per-
verted force theory,^' and others, are derived
from various misunderstood phenomena of
b^terial and animal life which a. few well-
directed experiments may shatter.
The Director of the Laboratory had occasion
some time ago to make direct experiments to
^demonstrate the part that germs of certain
diseases, their products, and the material of
their field of growth or culture, play in produc-
ing pathological lesions and phenomena. The
bacillus anthracis was the first used.
Experiment A. — Cultures on potato, made
with charbonous blood from a mule which died
from the disease.
Rabbits were inoculated as follows : —
Series 1. Two with a particle of culture virus
diluted in ten drops of water.
Series 2. Two with another particle washed
in a pint of water and filtered once through a
new and clean Chamberland filter bougie, using
the germs retained on the filter; and two with
thirty drops each of the liquid itself.
Series 3. Two with the germs of a similar
particle washed in a pint of water, as above,
twice in succession, filtered each time, using the
germs on the bougie after second wash ; and
two with thirty drops of the liquid of this last
wash.
Results: Rabbits of series 1 both contracted
anthrax and died.
Rabbits of series 2, which were inoculated
with the germs retained by the bougie, de-
veloped charbon, and died from it, while the
rabbits inoculated with the water that served
as a wash for them and retained their poison-
ous products, only produced a mild, temporary
illness, with a momentary elevation of tem-
perature— no anthrax.
The rabbits of series 3, which received the
germs of charbon from the bougie, after second
washing, both developed the malady; one died,
the other made a slow recovery. The two rab-
bits inoculated with sixty drops of the liquid of
the last wash failed to develop any disease or
fever.
Conclusions: 1. It is the germ of anthrax
that produces the disease, not its products.
2. The products are poisonous, and may
cause disease in the manner of other chemical
poisons, but do not produce the typical and
characteristic symptoms of anthrax within the
period of inoculation.
3. The assertion that one cannot separate
the germ from the products, even by culture,
and then establish the action of each, is not
well founded; it can be done.
4. What is true of this malady must be true
of numerous others, and the facts support the
bacterian doctrine of specific disease.
Experiments with blood serum of animals
having died from anthrax, made on the same
principle and by the same methods, give the
same general results as do cultures. In the
animal organism the germ acts first, and then
this action and its resultant transformations
and the generated chemical poisons are the
factors in producing anthrax.
LIVER FLUKES IN CATTLE.
(Concluded.)
"The cercari^ escape from the snail and en-
cyst on the herbage which is devoured by ani-
mals, or they may be taken in the drinking
water. They find their way to the liver, where
they develop into mature^ flukes, and thus
the cycle of life is completed.
(351)
352
LABORATORY OF HYGIENE.
"These changes, or stages, take place mostly
during tlie summer months when mollusks are
abundant and other conditions are favorable.
^''Effects of the Parasite. — The invasion of
the liver by the cercariae is not manifested by
unfavorable symptoms. Some observers assert
that there is a marked tendency to fatten for
about two months. Probably the first thing
to attract attention is the death of a few weak
lambs early in the fall. The general havoc
makes it appearance later, especially during
the late winter or early spring. If present in
limited numbers no marked deviations from
health are noticed. So common are these
parasites that it is exceptional to find a liver
entirely free from them at any time of the year,
and especially so during the spring. Even
cattle slaughtered for beef, and in good con-
dition, harbor a few during the entire year.
"If the flukes are present in large numbers,
serious damage results. Their presence in the
bile ducts in sufficient numbers, obstructs the
free passage of that fluid, and therefore in-
creases the tension on the liver cells that secrete
the bile; this causes a considerable quantity of
the bile to enter the blood, and therefore the
animals appear jaundiced.
** The walls of the bile ducts become thickened
and are often coated with hard, grit-like crusts.
The bile becomes ropy and of a peculiar slimy
appearance. These conditions existing, the cir-
culation of the blood is retarded, the animals
become pale (anaemic), weak, poor in flesh, and
dropsical. The dropsy of the abdomen is con-
siderable and this gives the animal a 'pot-
bellied' appearance. Dropsy appears, also,
between the lower jaws on account of the
position of the head when grazing. This con-
dition is called ' water-jaw.' As the disease
progresses, sheep lose portions of their wool.
Extreme emaciation and debility follow, and
frequently a profuse watery diarrhea sets in,
which is usually fatal.
"The symptoms just stated are so conspicu-
ous that stockmen call the disease 'water-
jaw,' and 'scours.' In the localities I visited,
I received the impression that heifers coming
two years old suffered more than those of any
other age. Many of these cattle and sheep die,
and many of those that recover do not thrive
the following summer, but remain poor and
weak, and fail to breed.
"On post-mortem examination an enormous
quantity of fluid (dropsy) is found in the ab-
domen, some of which is partly organized.
The liver is literally rotten, and in its bile
ducts great numbers of mature flukes are
found. These, on exposure, extend and retract
their bodies like a leech, and eject the dark
contents of their digestive tract per mouths
They curl and soon die. Their eggs are seen
in the gall and gall-bladder in great numbers.
Frequently a few adult flukes are found in the
small intestine.
" 2 reaimeni. — Medicinal treatmentis of little
value. Some improvement follow^s the use of
tonics, but very little is accomplished. There
can be no doubt as to the value of a liberal use
of salt. This is suggested by the fact that
stock that have access to salt marshes are
comparatively free from flukes.
^'■Preventive Treatment. — As the develop-
ment of the parasite in its various stages de-
pends on the presence of water and water
animals, the disease can only occur when stock
have access to such stagnant ponds of water
as contain the cercariae, or to grass or herb-
age that has grown in damp, wet places; iti*
evident that when these conditions do not ex-
ist, the disease cannot occur, that is, the para-
site will fail to complete the cycle of life.
" Theconclusion is obvious. Cattle and sheep
must not have access to infected water holes,
but must be furnished pure water.
"a new liver fluke (distomum texanicum.)
"It is now three years since I saw this ani-
mal for the first time. My attention was called
to it by a butcher who regarded them as
leeches, and desired an explanation of their
nature. ♦
^'Description of the Parasite. — Body flat,
liver colored, elliptical or oval, some wider be-
hind than in front, adults 30 to 35 m.m. long,
and 20 to 30 m.m. wide. Some very large ones
73 m.m. long, smallest ones 8 m.m. long and 4
m.m. wide. The average specimens about 30
m.m. long. Skin of small and medium sized
ones armed with numerous spines or points di-
rected backward. Mature specimens destitute
of spines except in patches or scattering ones,
especially on ventral surface of body near the
outer margin, and then generally large. Mouth
terminal, sessile, not on a well defined neck.
Ventral sucker large, muscular, 4 to 5 m.m.
from preceding. Genital pore midway between
the preceding. Penis not always protruding,
but when so, curved slightly. Excretory pore
small, at opposite extremity from mouth and
slightly dorsal. The margin here is sometimes
curved from both sides, making it slightly ob-
cordate. Eggs brown, oval, or a little larger
at one end, on which there is a cap. Length
from 0.14 to 0.16 m.m. Width 0.09 to 0.10
m.m. The.digestive tractconsistsof themouth,
which is made up of circular and radiating
muscular fibers in which are situated, in each
section, 4 or 5 large nucleated cells. From the
mouth proceeds a muscular pharynx, which
LABORATORY OF HYGIENE.
35a
suddenly divides, a little anterior to the geni-
tal pore, into two main trunks which extend
the entire length of the body. These give off
from 12 to 16 branches, which give oft' sec-
ondary ones, which terminate in blind pouches,
or caeca. The lining of the digestive tract is
disposed in finger-like points or projections,
somewhat similar to the villi of mammals.
''This parasite is found in the liver tissue of
cattle. I have found as many as 27 in one
liver; the average number is from 10 to 15.
These parasites are found in channels that they
have j)roduced. They seem to be wandering
aimlessly about in any direction. I think the
majority are near the convex or outer surface
of the liver. The channels they produce admit
the little finger, and these seem to heal or fill
up soon after, leaving a red scar. Sometimes
they perforate the surface of the liver, then
suddenly turn back into the liver again. I
think that they sometimes leave the liver and
bore into adjoining tissues or organs, but I
have not found them in other places than the
liver. Having wandered about for some time,
Fig. 1.
Fig. 2.
they come to rest and encyst themselves. Fre-
quently two have encysted together. Those
that are wandering have their bodies covered
with spines, while those at rest seem to have
lost their spines— their organs of locomotion.
When encysted they are always sexually ma-
ture. The wall of the cyst becomes dense and
tough and is usually coated with a grit-like
substance; butchers call such livers 'shelly.' I
think they die in these cysts. These cysts con-
tain a very dark, almost black, muddy liquid,
which contains myriads of eggs. The gall and
gall bladder of such livers are usually normal,
and in several instances in which I examined
the entire quantity of bile, a very few eggs
were found. I think the greatest number was
5 in the entire quantity of bile; but 1 was
not positive that these were the eggs of this
animal.
"The life history of this species is unknown.
"From the anatomical peculiarities of this
animal one readily recognizes it as belonging
to the Distomidfe.
"In February, 1891, I sent specimens to
Dr. Joseph Leidy, the distinguished scientist,
for identification. He did not recognize them
as any known species. I have also submitted
them to other experts with the same result.
On the suggestion of one expert, I have decided
to propose the name of Distomum Texanicum,
as a suitable one."
Z54:
LABORATORY OF HYGIENE,
Analysis of Stomach Fluids. — At the present
time the work of the Laboratory of Hygiene is
chiefly devoted to an investig:ation of stomach
fluids. Nearly 200 analyses have been made
within the last month, the elaborate and exact
method of Hayem and Winter being employed
for the determination of the total chlorine, and
the different conditions upon which the chlorine
exists in the stomach fluid, which is obtained
by means of a siphon one hour after a test
breakfast.
Technique.
How to Extract Griffith's Leucomaine from
the Urine of Epileptics. — Take a considerable
quantity of urine, produce alkalinity by the
addition of soda carbonate stirred in it, and
with the further addition of half its weight of
ether. After deposit and filtration, the ether
is stirred with a solution of tartaric acid, which
causes the leucomaine to form a soluble tar-
trate. The liquid is again alkalinized with
soda carbonate, and agitated with half its vol-
ume of ether. The etherized solution is allowed
to evaporate spontaneously; the leucomaine
remains as residue.
This substance is a white matter crystallized
in oblique prisms; it is soluble in water; gives
a slightly alkaline reaction. It forms a chlor-
hydrateand chloraurate crystallized. Chloride
of mercury forms with it a greenish white pre-
cipitate; nitrate of silver, a yellowish pre-
cipitate. It gives a white precipitate with
phosphotungstic acid; brownish white with
phosphomolybdic acid; yellowish with tannic
acid. Analyses ascribe to this new leucomaine
the following formula: C^^ H^*^ Az.^
Method of Rapid Staining for Tubercle Bacilli
in Specimens Preserved in Miiller's fluid. — The
method devised hy M. Letulle, published in
the Bulletin de la Societie Anatomique, is as
follows : The specimen having been preserved
in Miiller's fluid and afterward sufficiently
hardened in alcohol, may, if necessary, be im-
bedded in celloidine in the usual manner for
making sections. It should then be treated as
follows: —
1. The sections taken from the water are
treated by haematoxylin, which colors the
nuclei. Wash thoroughly with water, then
pass to —
2. Allow them to remain at least fifteen min-
utes in a carbolated solution of rubin, which
consists of a saturated solution of rubin in a
2 per cent solution of carbolic acid.
8. Rapid washing with water for one minute.
4. One half minute in absolute alcohol.
5. Allow it to remain five minutes in the fol-
lowing solution : 2 per cent solution of carbolic
acid, 100 parts; iodine green, one part.
6. Wash with alcohol until the color desired
is obtained.
7. Immerse in essence of bergamot.
8. Immerse in xylol.
9. Mount in balsam of xylol.
This methoQ requires less than half an hour,
and always succeeds. It shows the nuclei in
violet, the hyaline bodies as cherry red,
and the tubercle bacilli carmine red upon a
field of gray lilac tint.
JkNTISERTIC.
PROPHYLACTIC
DEODORANT.
LISTERINE
NON-TOXIC.
NON-IRRITANT.
NON-ESCHAROTIO.
F'OK^il^dCXJIyiV* — Listerine is the essentfal antiseptic constituent of Thyme, Eucalyptus
Baptisia, Gaultheria, and Mentha, Arvensis, in combination. Each fluid drachm also contains
Iwo grains of refined and purified Benzo-boracic Acid.
I>OiSE^. — Internai^IvY : One teaspoonful three or more times a day (as indicated), either
full strength or diluted, as necessary for varied conditions.
LISTERINE is a well-proven antiseptic agent — an antizymotic — especially useful in the
management of catarrhal conditions of the mucous membrane ; adapted to internal use, and to
make and maintain surgical cleanliness — asepsis — in the treatment of all parts of the human body,
whether by spray, irrigation, atomization, or simple local application, and therefore characterized
by its particular adaptability to the field of
PREVENTIVE MEDICINE— INDIVIDUAL PROPHYLAXIS.
LiSTE;E.i]srE;
Destroys promptly all odors emanating from diseased gums and teeth, and will be found of great
value when taken internally, in teaspoonful doses, to control the fermentative eructations of
dyspepsia, and to disinfect the mouth, throat, and stomach. It is a perfect tooth and mouth wash,
indispensable for the dental toilet.
Descriptive Literature upon Request.
LAMBERT RHARMAOAL CO., ST. LOUIS, MO.
AGENCIES.-
S MAW SON & THOMPSON,
LONDON, E. C.
ROBERTS A CO.,
PARIS.
S. PAPPENHEIM,
BERLIN, W.
VILANOVA HOS. Y CIA.
BARCELONA.
RENAL CALCULUS (Natural Size), Weight 137 Gms. (2109.8 Grains.) Removed by
J. H. Kellogg, M. D., Sept. 12, 1892. (See page 357.)
TH
• •
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH., U. S. A., SEPTEMBER, 1892. NO. 11.
Original Articles.
STUDY OF IMMUNITY.
BY M. METCHNIKOFF.
IV. PREVENTIVE PROPERTY OF THE SERUM
OF VACCINATED RABBITS.
We have already shown that the serum
of vaccinated rabbits protects rabbits
against hog cholera. This result is very-
constant, and may be obtained not only
by injecting serum at the same point as
the virulent blood, but also by introduc-
ing it at points very remote from the
place of inoculation. The rabbits re-
ceiving under the skin a quantity of
most virulent blood sufficient to kill wit-
ness rabbits, and likewise the serum of
vaccinated rabbits, manifest only a local
suppuration, and surely recover. The
serum injected into the veins preserves
equally rabbits to which a mortal dose of
virus has been inoculated under the skin.
The serum may be injected at the same
time or before the introduction of the
virus. A rabbit which received thus in
the auricular vein, 4, 5, c. c. of serum of
a vaccinated rabbit, resisted perfectly an
inoculation of 0,33 c. c. of virulent
blood (a mortal dose for a witness), in-
jected in the subcutaneous tissue.
While the serum of vaccinated rabbits
is a very efficacious preventive against
subcutaneous inoculation, it only re-
tards death if the virus be introduced
into the veins. In an experiment in
which the virulent blood was injected
into the auricular vein, the rabbit which
had received 3, 5 c. c. of vaccinal serum,
died in forty-two hours, while the witness
which had not been treated with the
serum died in five hours and twenty
minutes. The injection of a stronger
iose of serum would, perhaps, have
acted in a more efficacious manner.
The minimum dose of serum necessary
to prevent death (after the subcutaneous
injection of virus) is 0,5 c. c. In an
experiment in which I used only 0,25
c. c, death was not prevented, but it oc-
curred five days after that of the witness.
All the rabbits vaccinated against hog
cholera furnished vaccinal serum. The
serum obtained from blood withdrawn a
short time (five days) after the proof in-
oculation, is itself as active as that with-
drawn at more advanced periods.
The vaccinating property of the serum
depends more on the quantity of toxines
injected into the vaccinated rabbits than
the really refractory state of the lat-
ter. I deduct this conclusion from a
few observations which I have been able
to make in the course of my researches.
I have seen rabbits vaccinated with doses
more than sufficient (4 c. c. of toxic
blood), which had resisted the proof in-
oculation, die finally with evident signs
of general infection of the microbe of hog
cholera, and still their serum, withdrawn
a few days before death, was so active
that 0,5 c. c. sufficed to preserve a rab-
bit against mortal infection with virulent
blood injected subcutaneously.
On the other hand, rabbits cured of
hog cholera by treatment with serum of
vaccinated rabbits, furnish themselves a
serum which does not interfere with the
mortal malady in other rabbits. Not-
withstanding this, the cured rabbits
above mentioned have acquired immu-
nity against other virulent virus.
The efficacy of the serum of vaccinated
rabbits not totally refractory against hog
cholera, is evidently due to previous in-
jections of sufficient quantities of toxic
blood.
The attempts at treatment with preven-
tive serum of rabbits inoculated pr^vi-
356
ORIGINAL ARTICLES.
ously with virus have not been numerous.
They have not given me, as yet, any
positive results, probably because of the
rapidity with which hog cholera evolves
in rabbits.
In multiplying these researches, we
might perhaps obtain better success, but
the study of this problem did not enter
into the plan of this work ; it has been
reserved for later efforts.
The experiments for the prevention of
the malady by means of serum sufficed,
of themselves, to demonstrate the efficacy
of this liquid when coming from the or-
ganism of vaccinated rabbits.
But as the serum is a very complicated
mixture, which cannot be identified with
the blood plasma, it would be interesting
to have a more precise idea of the pre-
ventive role of each of its constituting
parts. Unfortunately, it is impossible to
separate the diverse elements of the blood
of rabbits, so the problem cannot be
solved under the present scientific meth-
ods. We cannot, then, know whether
the preventive substances of the serum
come from the plasma or the cellular
elements. Concerning the latter, I will
mention that the blood of vaccinated
rabbits is richer in leucocytes than the
normal blood.
With the object of contributing to the
enlightening of the problem, I have made
a few experiments with the liquid of
oedema provoked by stopping the circu-
lation. At the base of the ear of three
vaccinated rabbits (the serum of which
had plainly manifested its preventive
properties) a rubber ring was placed.
The following day the ear was found
hanging, swelled by the oedema. The
oedematous liquid was easily gathered in
sterilized pipettes. It was absolutely
transparent, colorless, and contained
only an insufficient number of leucocytes.
By the same processes, I have been able
to extract oedematous liquid from three
witness rabbits not vaccinated.
The oedematous liquid of the two kinds
inoculated with a trace of virulent blood
gave cultures abundant enough of the
microbes of hog cholera. But while in
the liquid of the vaccinated, this microbe
presented itself chiefly under the form of
a chain composed of oval bacilli or
cocci, the liquid of the witness rabbits
contained only forms of mono-bacilli
or diplo-bacilli. The difference in the
growth of the cocco-bacilli in the two
kinds of oedematous liquid is, conse-
quently, very striking, while in the serum
it is almost null.
Inoculated in the veins of the eye, or
under the skin of rabbits, the cultures in
the liquid of the oedema of the vaccinated
appeared just as active as in those of
control. The slight differences observed
had no value, and are explained by the
variations in weight and other individual
characteristics of inoculated rabbits.
These experiments demonstrate that
there is a very considerable difference
between the influence of the liquid of the
oedema and the complete serum of vac-
cinated rabbits. These prove, besides,
that the variations in the form and growth
of the bacteria (strepto-bacilli instead of
diplo-bacilli) have no relation to the
virulence.
The striking difference between the
serum obtained out of the animal organ-
ism and the liquid of the oedema drawn
directly from it, indicates to what point
it would be imprudent to conclude, from
the particularities of the serum, the phe-
nomena to be due, which occur in the
vaccinated organism. It is necessary,
therefore, to study the properties of the
latter.
This same postulate arises from the
consideration that the preventive activity
of the serum cannot be explained by the
bactericide property, anti-toxic property,
nor by the attenuative power of this
humor. If the preventive serum does
not act on the bacteria and its toxines, it
is because it must exert its influence on
the organism subjected to the treatment.
(To be continued.)
A RENAL CALCULUS OF UNUSUAL SIZE-
NEPHRECTOMY — RECOVERY.
BY J. H. KELLOGG, M. D.
Superintendent Sanitarium, Battle Creek, Mich.
A PATIENT, Mrs. W., aged — years, was
brought to me for examination, September
— ,by Dr. Darby, of Waterloo, Ind. She
had suffered for a long time from pain in
the right side, and some time previously
the doctor had discovered a hard mass,
which upon investigation proved to be an
enlarged and prolapsed kidney. The
mass was so large that it filled almost the
entire right side, reaching from the lower
ribs to considerably below the crest of the
ilium, and extended inward nearly to the
OBIGINAL ARTICLES.
35T
median line. The patient suffered so
much pain, and was evidently losing
ground so rapidly, through the immense
quantities of pus discharged with the urine
daily, that I thought it best to advise the
removal of the diseased organ, and after
proper preparation of the patient, pro-
ceeded to operate.
My first intention was to operate by
the abdominal method, on account of the
great size of the mass, but at the last mo-
ment I concluded to undertake the opera-
tion by the lumbar method, fearing that
some condition might be encountered
which would render nephrectomy impos-
sible or imprudent, so that the operation
might be terminated as a nephrotomy, re-
calling a remark made by Mr. Lawson
Tait, in conversation with the writer when
a student assistant with him, in which
the operation of nephrectomy was totally
condemned, nephrotomy being consid-
ered by Mr. Tait the only justifiable
operation upon the kidney. Mr. Tait's
argument was, that any condition of the
kidney likely to be benefited by an opera-
tion requires nothing more than nephrot-
omy, the cases in which nephrectomy
would be of any service being in his
opinion hopeless, even with a radical
operation.
The operation was begun by a vertical
incision reaching from the last rib to the
crest of the ilium. When the kidney was
reached, it was found to be closely ad-
herent to its capsule, as the result of re-
peated inflammatory attacks which had
also consolidated the fat lying outside of
the capsule, making it even more difficult
to separate the capsule from the adjacent
tissues than to break up the adhesions
between the kidney and the capsule. It
was evident that a large opening would
be required for the removal of the mass,
and a transverse incision four inches in
length, starting from the middle of the
first incision, and running toward the
linea alba, was accordingly made. This
extension of the incision enabled me to
introduce the whole hand, and by patient
effort, the adhesion between the kidney
and its capsule was finally completely
broken up. It was, however, found im-
possible to extricate the enormous mass,
although the opening was made as large
as possible without entering the peritoneal
cavity, by further extension of the trans-
verse incision. I accordingly laid bare
and amputated the anterior two thirds of
the last rib, and by a conside-rable effort
was then able to pull and push the kidney
out of its bed. The central portion of the
mass presented a stony hardness, which,
taken together with a nodular appearance
and feeling of the organ, suggested the
probability of a malignant disease. The
organ also presented several cyst-like
masses, one of which was the size of a
large orange.
After ligating the pedicle, excluding
the ureter and inclosing the vessels in a
separate ligature, I proceeded to ampu-
tate the mass, when I at once discovered,
from the gritty sensation imparted to my
knife, that the central hardness was due
to an immense renal calculus which filled
the whole interior of the organ. As
soon as the pelvis and the kidney were laid
open, a great quantity of mingled pus,
mucus, and urine which had been dammed
back by the calculus, producing the cystic
condition before referred to, rushed out.
Precaution had been taken to protect
the wound, as far as possible, from in-
fection from this source, and the tissues
exposed were thoroughly disinfected ; the
operation was quickly terminated, two
drainage tubes being introduced into
the deeper parts of the wound, which
was closed by deep sutures, which,
when tied, obliterated almost entirely
the cavity left by the removal of the
kidney. The upper portion of the ure-
ter, which was enormously dilated and
thickened, was stitched to the skin.
The ligatures were left long so as to
facilitate removal, absolute aseptic man-
agement of the wound being evidently
impossible. Considerable hemorrhage
occurred during the operation, as the
tissues lying about the kidney were ex-
ceedingly vascular. This was well con-
trolled, however, by stuffing the wound
from time to time with sterilized gauze
and by application of sponges wet in hot
water.
The calculus was found to weigh 137
grams, the largest of the kind removed
during life of which I have found any rec-
ord. A photo-reproduction of the cal-
culus, natural size, is presented as the
frontispiece of this number.
The patient made a rapid and excellent
recovery. The temperature subsequent
to the operation, did not at any time ex-
ceed 101.4°. Only the very slightest
suppuration occurred, so that the tubes
were removed in a few days. On the
358
ORIGINAL ARTICLES.
tenth day all the sutures were removed.
Within a few days subsequent to the
operation, the condition of the patient
was found to be decidedly better than be-
fore the operation. The pus, which
before the operation had been so great in
quantity as to render the urine very thick
and its filtration very slow, had disap-
peared almost entirely. Before the opera-
tion, the quantity of urine passed in
twenty-four hours was 850 c. c. ; the
specific gravity, 1018 ; urea, 18.7 grams;
total solids, 30. 6 grams. The pus was so
great as apparently to constitute fully one
half of the total amount of liquid ; and
boiling, after the addition of nitric acid,
showed a quantity of albumen 1-3 2nd of
the volume of the urine tested.
The toxicity of the urine, as determined
by the method of Bouchard, which con-
sists of an injection of the urine into the
veins of a rabbit in quantities sufficient
to produce death, was as follows : The
amount required to kill a rabbit weighing
1.4 kilos, 40 c. c, making a urotoxic, or
the amount required to kill one kilogram
of rabbit, 28.6 c. c; the total number of
urotoxies produced in twenty-four hours,
or the possible amount of living being
killed by the urine of twenty-four hours,
29.7 kilos; the urotoxic coefficient, or
possible amount of living being killed by
the urine produced by each kilogram of
patient in twenty-four hours, .6. The
rabbit died in two minutes from the be-
ginning of the injection, with slight spasm,
the pupil being first contracted, then di-
lated ; the temperature rose .4 of one
degree C. In three days after the opera-
tion, the amount of urine was found to be
900 c. c. The reaction, formerly ex-
tremely alkaline, had become normally
acid, 10 c. c. of the urine requiring 1.5
c. c. of the decinormal solution of sodium
hydrate to neutralize it. The specific
gravity was 1030 ; the urea, 48.6 grams ;
there was a bare trace of albumen, and
only a few pus corpuscles to be found in
each field. One half minute after the
beginning of the injection, the rabbit's
pupils began to contract, and a powerful
tetanic spasm occurred, which continued
until death, one minute after the injection
began. The pupils were extremely con-
tracted, and there was pronounced ex-
ophthalmus, but no change in tempera-
ture.
The toxicity was found to be as follows :
Amount required to kill a rabbit, the
weight of which was 1.8 kilos, 16 c.c. ;
urotoxic, 8.6; number of daily urotoxies,
104.6; the urotoxic coefficient, 2. 113.
The amount of urea produced by the
one kidney subsequent to the operation
was more than two and one half times
that produced before the operation.
The amount of total solids was more
than double, and the toxicity was two
and one half times as great, being nearly
five times greater than normal, indicating
an abnormal increase of toxic matters in
the system subsequent to the operation,
perhaps in part the result of absorption
from the extensive wound, although sep-
sis in the wound was almost entirely
absent.
October 2, three weeks after the opera-
tion, an examination of the urine gave
the following results : Quantity for 24
hours, 142 1 c.c. ; specific gravity, 1016 ;
urea, 21.3 ; total solids, 55.47 grams.
A very slight sediment, consisting of
urates, phosphates, and oxulates ; no pus ;
no albumen ; reaction natural.
These observations are of interest, as
showing the ability of a kidney to assume
double duty at once, when called upon to
do so, and even to do an amount of work
considerably greater than that ordinarily
performed by two sound kidneys. The
patient's suffering the night following the
operation, was so slight that considerable
sleep was obtained. She has already re-
covered from the operation, and, with
the exception of being somewhat weak
from confinement in bed, is in every way
in a better physical condition than before
the operation was performed.
-»■ — • — •*-
THE NEW CHEMISTRY OF THE STOMACH.
Illustrative Cases — A New Classifi-
cation.^
BY J. H. KELLOGG, M. D.
Before presenting a series of cases
illustrative of the different types and
varieties of stomach disorders as relates
to the disturbance of the normal chem-
ical processes of digestion, it may be
well to recall briefly the significance of
the different quantities which furnish the
basis of classification. Each of the quan-
tities represented by the symbols (A),
(A'), {a), (T), (H), and (C), teaches an
1 The matter contained in this article was presented at the
Cincinnati meeting in a paper by the author, entitled " Meth-
ods of Precision in the Investigation of the Disorders fo-
Digestion, or The New Chemistry of the Stomach."
ORIOmAL ARTICLES.
359
important fact in relation to the work
done by the stomach.
(A) represents the total acidity which
is normally due almost wholly to free
HCl and the combined chlorine or
chloro-organic combinations present in
the gastric juice, only a very small
percentage of acidity being normally
attributable to lactic acid and acid phos-
phates. In normal conditions, the total
acidity is not less than .180 grams, nor
more than .200 grams in 100 c. c. of
stomach liquid, the acidity being rep-
resented as anhydrous HCL
(A'). When the total acidity is greatly
increased by the products of acid fer-
mentation, it is important to know what
portion of the acidity is due to nor-
mal elements, and how much must be
attributed to lactic acid or to other mem-
bers of the series of fatty acids. A' is
found by multiplying the quantity C by
,2>6, the normal coefficient, and adding
H ; obtained from the formula A' = (« X
G) + H.
(a). This quantity, obtained from the
, A— H , , .
formula — -^ — = a, has for its normal
value, .86. A higher figure represents
the presence of abnormal acids resulting
from fermentation. A lower value shows
the presence in the quantity C of neutral
chloro-organic combinations having a
resemblance to normal digestive products,
but without nutritive value, and which
contribute nothing to the acidity of the
stomach fluid. Both of these facts are
of great importance, and as the informa-
tion conveyed by them can be obtained
in no other way, the value of <2 as a
means of determining the quality of the
chemical work done by the stomach will
be readily appreciated. When below the
normal figure, it indicates with cer-
tainty that the value C is depreciated by
neutral chloro-organic compounds ; but
the amount of this depreciation is not so
clearly indicated by the lowered value
of a as is the amount of acid fermenta-
tion by its increased value, since the
neutral compounds in C may be, to a
greater or less extent, neutralized by the
products of acid fermentation. Thus,
while we are able to say that acid fer-
mentation is present whenever we find
a above the normal figure, we cannot
with equal certainty say that acid fer-
mentation is not present when a is less
than the normal figure.
This fact is clearly shown by one or
two remarkable cases, the details of
which will be given later in this paper, in
which the value of a is 00, being represented
by a fraction with a whole number for a
numerator, and zero for a denominator,
X \
o/"
Here x represents the amount of
acidity due to the products of acid fer-
mentation. It is evident that C might in
a given case possess such a value, al-
though wholly composed of neutral com-
pounds, as to mask completely the value
X, thus hiding the presence of the abnor-
mal acids. The amount of acidity due
to the products of fermentation which
can be hidden in this way, is, however,
comparatively so small that this fact
does not materially lessen the value of a
as an index to the quality of the chem-
ical work done in the digestive process,
and it may properly be regarded as
the coefficient of digestive work. It
should be remembered that a represents,
not a definite quantity, but simply the
proportion which exists on the one hand
between the acidity normally due to the
chloro-organic compounds, or C, and
the increased acidity due to the pres-
ence of the products of the acid fer-
mentation, or the diminished acidity due
to the presence of neutral compounds
in C. When a is found to be zero, as we
have observed in a number of instances,
the indication is positive both that acid fer-
mentation is wholly absent, and that C is
wholly composed of neutral and worthless
compounds, a becomes 00 when C is o,
and when A exceeds H, the result ob-
tained by subtracting H from A in this
case representing exactly the amount of
acidity due to acid fermentation. The
significance of a when found to be o or
00, is readily shown by the following
formulae : —
Recalling the formula A = H -}- C -{- Jf »
in which x represents the products of acid
fermentation, and the formula derived
^ H C X
from the foregoing — - — = — +— , it
is clear that in any case in which C = o,
;. 11 1. A— H _ X
we shall have , or 00.
o o
(T) represents the total chlorine, mak-
ing allowance for the amount of chlo-
ride of sodium taken in the test-meal,
and indicates the total amount of gland
work done in the stomach in the secre-
360
OBIGIJSrAL ARTICLES
tion of fixed chlorine, that is, chlorine
combined with bases.
(H) represents the amount of chlorine
which has been set free under the vital
influence of the stomach work, and is
ready to enter into the digestive process
proper, by combining with albumen.
(C) represents the amount of chlorine
which, after having been set free from
the bases, has entered into combination
with albumen, and thus has taken part
in the digestive process. When C has
its proper acid value, it represents the
useful chemical work done by the stom-
ach. The sum of H and C represents
the total amount of chlorine set free from
the bases, or what might be termed the
preliminary chemical work done by the
stomach.
In considering from a therapeutic
point of view the results obtained by
the chemical analysis of stomach fluids,
it is necessary especially to keep in mind
the four possible kinds of work done in
the stomach : —
1. Gland work, represented by T.
2. Preliminary chemical work, repre-
sented by H -{- C.
3. Useful chemical work, represented
by C taken in connection with a.
4. Vicious chemical work, or fermenta-
tion, indicated by the increased value of a.
Illustrative Cases. — Within the last six
months, nearly 400 analyses of stomach
fluids have been made under the writer's
supervision in the Sanitarium Laboratory
of Hygiene, the fluids analyzed having
been obtained from nearly 300 different
cases. The cases studied in this paper
number 240, and the number of analyses
340. Careful study has been made of
the results obtained by each analysis,
together with a careful comparison with
the symptoms presented by the patient.
It is not intended to present in this ar-
ticle even a brief summary of all the
interesting facts which have been noted,
but merely to give a sufficient number of
cases to illustrate each one of the lead-
ing forms of disturbance in the digestive
process, which have been observed.
Before presenting these illustrative
cases, it must be stated that the study
of this large number of cases has brought
to light a considerable number of forms
which were not noted by Hayem and
Winter in their investigation, which in-^
volved only 200 analyses, and a consider-
ably smaller number of cases. As the
work progressed, the increasing number
of new forms finally became so great as to
compel me to undertake a new classifi-
cation. The necessity for a new classifica-
tion has been more and more impressed
upon the mind of the writer, in noting
the marked difference as regards thera-
peutic requirements existing between
cases grouped by Hayem and Winter, in
the same class. The classification here-
with presented is certainly not above
criticism, and whether or not it is any
improvement upon classifications pre-
viously presented, will appear only after
it has been subjected to the ordeal of
criticism by those competent to estimate
its value, and the test of a longer expe-
rience. It is offered simply as the best
attempt the writer can make at the pres-
ent time toward grouping the various
forms of disturbance in the chemical
processes of the stomach in such a man-
ner as to show at a glance both the
therapeutic indications and the relation
of each individual form to dissimilar or
cognate forms.
The classification offered ought not
perhaps to be termed a new one, as it
is in fact only a re-arrangement and an
extension of that made by Hayem and
Winter.
The term hyperpepsia is used to indi-
cate an excess of stomach work ; hypo-
pepsia, a deficiency of stomach work ;
hyper hydrochloric, an excess of free HCl ;
hypohydrochlorie, a deficiency of free HCl.
The terms hyperacidity and hypoacidity
are self-explanatory. The principles
upon which the classification is based
are as follows : —
Three great classes are recognized, —
I. Hyperpepsia, in which an exces-
sive amount of both glandular work and
chemical work are done.
II. Hypopepsia, in which there is a
notable diminution in the stomach work ;
if not always in the glandular work, in
the chemical work.
HI. Simple dyspepsia.
Each of these classes is again subdi-
vided.
Hyperpepsia is divided into three
groups, the characteristics of which are, —
(a.) H -|-, free hydrochloric acid in
excess. Hyperpepsia with hyperhydro-
chlorie.
(b.) H — , free hydrochloric acid de-
ficient. Hyperpepsia with hypohydro-
chlorie.
ORIGINAL ARTICLES.
361
0)
0.
u
DC
u
Q.
>•
z
<
(0
0.
u i
Q.
O
Q.
>-
Z
(Free HCI in excess)
H—
(Free HCI deficient)
C—
(Combined CI deficient)
1ST DEGREE
A^— T but above
.100 gms.
2ND DEGREE
A^ — , and below
.100 gms.
(hyper-acidity) 1
f-a.f
-{
A-
(hypo-acidity)
+a.f.
—a. f.
+a f,
-a f.
A+
(hyper-acidity) ) ^^ f .
A- l--^-
(hypo-acidity)
J^+a. f.
f A+, —a. f
A'+, -ha. f
j A-,-a. f
I A-,+a. f
f A4- (pseudo- \ x^ f
hyper-acidity) f ' ' " '
—a. f
A-
-|-a. f.
f A+ (pseudo- \ |.a, f . .
hyper-acidity) \
r-a. f .
+a.f.
3RD DEGREE A =0— Apepsia
Without acid fermentation . .
With acid fermentation.
C4- ;=
c— .
A-]- a—
A+ o^
A— a—
A— a-\-
A-Y «— ,
A+ a^
A — a —
A-;==. .+
A-f- a~
A-f r/-f
A— a—
A'— «-f
A'— ^^-f-
A— .^—
A— a-\-
A+ ..+
A— a—
A— r^-{-
i^ 0 rt 0
A= a=
A=:;+ ..-
A= rr-{-
A=;-\-a-\-
=T+;=
=:T=.,--,-f
C+
H+
C+
^+
H-h
c+
H—
c+
4--"-
T=;+
T
T+
T+
T+
T+
T-
T-
T—
'r-
T—
T-
T=:
T=
T-.
H
c+
— c+
H+
C—
_._ii+;
_, ^_
_ H+;
C—
-4- "-
_ I^—
— C—
_ H—
— C—
_ H-;
— C—
-'+C-;
H 0
C—
H—
" C+
., H=
"~'+C+
H =
C—
1+
+
+
\-
'i
1+
= f
[-
+
(c.) C — , a deficiency of useful chem-
ical work.
We always find C -j- in groups (a) and
(b), and H -|- in group (c).
Groups (a), (b), and (c) are each
divided into sub-groups, in which we
find, respectively, A-f-? and A — , or hy-
peracidity and hypoacidity.
We have a still further division of each
sub-group into two types, as acid fer-
mentation is present or absent, as indi-
cated by coefficient a.
In group (c), characterized by C — ,
the sub-groups A -\- and A — combine with
the two types into which they are respect-
ively divided, and present each a second-
ary variety. A'-}- and A' — , making four
groups each with one type, acid fermenta-
tions occurring with both A'-j- and A — ,
while A-f- and A' — occur only in cases
without fermentation.
Hypopepsia. — The basis chosen by
Hayem and Winter for the classification
of hypopepsia is followed, three classes
being formed, in the first of which A' is
less than normal but above .loo, and in
the second, below .loo; in the third, or
apepsia. A' is o. A' is necessarily always
— ,in hypopepsia. In each of the first
and second degrees of hypopepsia, we
have two sub-groups, A — and A-f-, or
hypoacidity and hyperacidity. A — pre-.
sents two types, as acid fermentation
is absent or present. A-j- presents, nec-
essarily, but one type, that of acid fer-
mentation. This type is conveniently
texTCiQd psetido-hyperacidity, as the total
acidity may be high, although the value
of a due to the normal elements of gas-
tric juice, or A', may be small.
Simple Dyspepsia. — I have divided sim-
ple dyspepsia into two classes : —
362
ORIGINAL ARTICLES.
(a.) Cases in which acid fermentation
is absent.
(b.) Cases in which acid fermentation
is present.
Each of these groups is divided into
sub-groups. The basis taken for the
subdivision of group (a) is the value
of co-efficient («), which may be (i) =,
or (2) — . In group (b) the basis of
subdivision is the value of C, which is
(i) = or -\~j and (2) — .
The utility of this classification from a
therapeutical standpoint will be seen
when we consider the therapeutic in-
dications of each of the several classes,
sub-classes, and types recognized in this
class of cases. How these therapeutic
indications are to be met is a subject too
large for consideration in this paper, but
one which I have made the subject of
long and varied experimentation, extend-
ing through many years, the results of
which I shall report in another paper.
The limits of this paper will admit of no
more extended reference to this branch
of the subject than the following brief
suggestions : —
In the accompanying outline exhibiting
the classification which I have briefly de-
scribed,— a.f. means without acid fermen-
tation ; -|- a.f., with acid fermentation.
For convenience of reference, I re-
produce here, the table of normal vari-
ations given in the preceding article : —
Total acidity (A) (0.180 — .200 grns)
Coefficient (a) (.86)
Total chlorine (T) (0.300 — 0.340 gms.)
Free HCl (H) (0.025—0.050 gms) ) ^g
Organic chlorides (C)(o. 155 — o.i8ogms)p -^
Fixed chlorides (F) (o, 109 gms. )
Normal Digestion (o. 109 gms. )
Case 64.
Normal Digestion. — A lady aged 35
years had been for a few weeks under
treatment for pelvic and nervous dis-
orders, which required an application
of the rest-cure. She had been recently
allowed to take exercise, and was gain-
ing rapidly in flesh and strength ; tongue
clean, and no symptoms of disordered
digestion. The following were the quan-
tities found: (A), .175; («), .85;
(T), .322; (H), .042; (C), .156; giv-
XT .
ing the formula, A = a =^T = [. =.
= )
In this case, the chemical processes
concerned in digestion are evidently en-
tirely normal.
(C),
+•
Hyperpepsia. — The following case
illustrate the different forms of hyper-
pepsia : —
Hyperpepsia with hyperhydrochlorie and
hyperacidity — without acid fermentation.
Case 39.
The patient, a lady aged 49 years, had
suffered for many years from disorders
which had been greatly aggravated by
the frequent use of purgatives for the
relief of obstinate constipation. The
symptoms relating to the stomach were,
eructations of gas, extreme acidity, fre-
quent attacks of severe pain in the stom-
ach, good appetite, heaviness at the
stomach. Many neurasthenic symptoms
were also present, including great mental
depression, sleeplessness and vertigo,
urine scanty, with sediment of urates
and uric acid. Physical examination
showed the stomach to be moderately
dilated, great tenderness in both lumbar
ganglia of the sympathetic, abdominal
muscles very tense. The quantities given
by analysis were as follows: (A), .256;
{a), .07; (T), .560; (H), .240;
.224. H +
Formula, A+« — T+CH-
Hyperpepsia due to a great excess of free
hydrochloric acid, but without acid fer-
mentation. The eructations of gas and
other symptoms in this case would have
led to the conclusion that the patient
was suffering from simple acid dyspepsia,
and might perhaps have suggested the
employment of hydrochloric acid as a
means of suppressing abnormal fermen-
tations, or remedies of a stimulating
character to induce a greater degree of
digestive activity. The gas was evidently
the result, not of fermentation, but of
the secretion of CO2 from the blood,
which not uncommonly occurs in cases
of excessive irritability and consequent
congestion of the gastric mucous mem-
brane. On the employment of means
for suppressing the excessive amount of
glandular activity shown by the high
figure of (T), the patient rapidly im-
proved, and in a few weeks left the
Sanitarium with every evidence of perma-
nent improvement of health.
Hyperpepsia with hyperhydrochlorie and
hyperacidity — acid fermentation.
Case 226.
A young man aged 22 years, who had
been addicted to hasty eating, overeat-
ORIGINAL ARTICLES.
863
ing, excessive use of sweets, confection-
ary, meats, drinking freely of fluids at
meals, and of sedentary habits, had
employed for relief, but without benefit,
various mineral acids, hot water drinking,
etc. He complained constantly of too
abundant secretions in the mouth, burning
in the oesophagus, fullness, distension of
the stomach, eructations of great quanti-
ties of gas, regurgitation of hot, sour liq-
uid, frequent attacks of sharp pain in the
stomach soon after eating, excessive ap-
petite, inahility to digest coarse foods,
such as cabbage, green peas, etc. ; burn-
ing and heaviness at the stomach ; ex-
treme constipation, bowels moving not
more often than once in three days ;
stools hard ; gaseous distension of the
bowels ; poor memory ; inability to con-
centrate the mind ; dullness ; hesitancy in
speaking ; drowsiness after meals ; head-
ache; heaviness in the head; strained
feeling in the eyes ; pain in the scalp and
chest ; coldness of extremities, especially
of the knees ; feverishness fifteen or
twenty minutes after eating ; specks be-
fore the eyes ; occasional loss of sight ;
general feeling of weariness and exhaus-
tion ; shortness of breath. Physical ex-
amination showed a considerable degree
of dilatation of the stomach. The quan-
tity of stomach fluid removed was 125
c. c, reddish in color, and presented a
considerable quantity of mucus. The
quantities obtained were as follows : (A),
•352; {a), .95; (T), .428; (H), .140;
(C), .224.
Congo-red and methyl-violet gave
strong reactions. Uffelmann's reagent
showed lactic acid present in consider-
able amount. Biuret reaction showed
peptones present in moderate amount.
Lugol's solution gave blue violet color,
indicating but slight digestion of starch.
The chemical work done by the stomach
in this case is represented by the fol-
lowing formula :
A+«-t-T+C+ f ^•
Case 73.
A young woman of twenty-four years,
had suffered for many years from stom-
ach disorders, without finding relief, al-
though a great variety of medical means
were employed. The following quanti-
ties were obtained: (A,) .380; {a),
1-35; (T), .440; (H), .070; (C), .230.
Formula, A-fa-fT-f^ if+-
Uffelmann's reagent showed in this
case a great amount of lactic acid, and
the stomach fluid when withdrawn ex-
hibited a dark brown color, probably due
to the presence of a small quantity of
blood, the result of the intense conges-
tion of the mucous membrane present
in the case. The hyperacidity in this case
was certainly very remarkable, and the
highest I have yet encountered, being
nearly double the maximum amount pre-
sented in health. The determination of
the value of (A') in this case, shows that
the acidity due to the products of acid
fermentation was equivalent to nearly
.100 grams of anhydrous HCl for each
100 c.c. of the stomach fluid.
Hypei'pepsia with hyperhydrochlorie and
hypoacidity — without acid fermentation.
Case 51.
The patient, a lady aged 37 years, had
suffered for many years from a variety of
stomach symptoms, which had recently
led to a diagnosis of malignant disease.
She had been assured that she was suffer-
ing from cancer involving stomach, liver,
and spleen, and that her case was hope-
less. The patient suffered from constant
pain in the stomach, flatulency, throbbing
at the epigastrium, pain in the head,
general nervousness, depression, emacia-
tion, and obstinate constipation. Phys-
ical examination showed extreme sensitive-
ness of the solar plexus and of both
lumbar ganglia ; the lower border of the
stomach was three inches below the
umbilicus, the right kidney was prolapsed,
the bowels prolapsed, the abdominal
walls extremely flaccid. The figures fur-
nished by analysis of the stomach fluid
were as follows: (A), .132; («), .2^^ ;
(T), .364; (H), .048; (C), .224.
Congo-red and methyl-violet both gave
good reactions, and the biuret reaction in-
dicated the absence of albuminoids. The
formula representing the digestive work
m this case is A — a — T-|-C-{- )"'"
The figures for (H) are so near the
maximum in this case, that it is evidently
proper to class it with cases in which (H)
is -f, the case being, in all other respects,
identical with those which fall in this
group.
364
ORIGINAL ARTICLES.
Hyperpepsia with hyper hydrochloric and
hypoacidity — with acid fermentation.
Case 207.
The formula for a typical case of this
form of dyspepsia would be, A — ^ +
H A- )
T -|- p T f +• I have not yet met a
typical case of this form, but have found
cases so nearly approaching it that I ex-
pect to meet it in the study of a larger
number of cases. It is only necessary
that the value of C should be so small that
with the addition of the products of acid
fermentation present in the case, the to-
tal acidity is still below the normal figure,
a condition which is certainly not unlikely
to occur.
Hyperpepsia with hypohydrochlorie and
hyperacidity — without acid ferinentation.
Case 197.
A lady, aged 30 years, had long suf-
fered from severe headache, although she
had experienced no special symptoms
which she had herself attributed to the
stomach. She herself confessed to care-
less habits of eating, eating hastily and
sometimes to excess, especially in the
use of flesh meats and salads, of which
she was very fond. The patient was also
subject to attacks of shortness of breath
and impairment of vision. Physical ex-
amination showed foul tongue, great
tenderness of both the right and the left
ganglia and of the abdominal sympa-
thetic. Examination of the stomach fluid
gave the following results : (A), . 204 ; {a),
•76; (T), .332; (H), .000; (C), .268.
Congo - red gave a good reaction ;
methyl-violet, none. Uffelmann's rea-
gent showed lactic acid present, and the
biuret reaction indicated the presence of
peptones in moderate amount. The
above figures furnish the following for-
Ho )
mula :A-f« — T = C+)^* In this
case it will be noted that peptones were
formed, notwithstanding no free hydro-
chloric acid whatever was present in the
gastric juice. An abundance of hydro-
chloric acid was secreted, as shown by the
high figure of (T), and more than the usual
amount of useful stomach work was done,
as shown by the high figure of (C). The
diminished value of coefficient («), how-
ever, indicates the presence of an abnor-
mally large amount of neutral compounds
in (C), probably a larger amount even
than is indicated by the lessened value of
coefficient (a), since lactic acid was shown
to be present, indicating a considerable
degree of acid fermentation concealed.
When (C) is in excess, its quality is usu-
ally diminished, a very striking example
of which we have already given in case
39, in which the value of coefficient {a}
was only .07.
Case 246.
The patient, aged 43 years, had suf-
fered for many years from stomach dis-
orders as the result of hasty eating,
overeating, irregular meals, excessive use
of sweets, fats, meats, fluids at meals,
pickles, vinegar, and tea and coffee. Bad
positions in sitting, sedentary habits, and
the traction of heavy skirts upon tight
waistbands had aggravated her disorders.
Quinine, mineral waters, and various
other measures and tonics had been tried
without relief. The patient observed a
metallic taste in the mouth in the morn-
ing; which would sometimes remain dur-
ing the entire day ; a very bad breath ;
eructations of gas ; fullness in the stom-
ach; nausea, lasting from 15 to 20 min-
utes ; appetite variable ; special crav-
ing for coffee, pastry, and rich food ;
bowels constipated ; prolapse of rectum ;
extremely nervous and depressed ; occa-
sionally giddy ; constant sense of weari-
ness ; palpitation of the heart. Physical
examination showed a brown coat upon
the tongue, and extreme tenderness of the
sub-umbilical ganglion. Examination of
the stomach fluid after the usual test-
meal consisting of ij4 ounces of water
crackers with 8 ounces of water, gave the
following figures: (A), .200; {a), .71 ;
(T), .376; (H), .008; (C), .272.
Congo-red and methyl-violet both gave
good reactions. Reaction for lactic acid
was pronounced, as also the biuret re-
action. Lugol's test showed that starch
digestion had advanced only to the state
of erythro-dextrine, as indicated by the
light purple color ; rennet ferment abun-
dant. The above figures give the follow-
ing formula : A = a — T-j- C +
The acidity in this case is at the ex-
treme upper limit of normal variation,
and hence the case may be fairly classed
as one of hyperpepsia with hypohydro-
chlorie and acid fermentation, without acid
fermentation. The following is another
very interesting case of the same sort : —
OBIOINAL ARTICLES.
365
Case 236.
The patient, aged 45 years, had not
considered herself dyspeptic, and until
recently had enjoyed excellent health.
Weighed, eighteen months previously,
192 pounds ; present weight, 108 pounds ;
had been accustomed to use meat, sweets,
and coarse vegetables freely, but made
little use of fruits ; condiments, tea, and
coffee had also been freely used. The
only symptoms relating directly to
the stomach, which the patient had
noted, were, occasional vomiting when
constipated, and burning at the stomach
much of the time ; frequent attacks of
diarrhoea ; pain in the right side ; ring-
ing in the ears ; scanty urine. Physical
examination shbwed stomach and bowels
prolapsed, right and left ganglia of the
sympathetic sensitive, abdominal walls
extremely flaccid. Examination of the
stomach fluid gave the following figures :
(A), .196; {a), .80; (T), .324; (H),
004 ; (C), .240.
Methyl-violet gave a slight reaction for
free HCl. Uffelmann's reagent indicated
the presence of lactic acid. Biuret reac-
tion showed abundance of peptones ;
LugoPs solution showed imperfect diges-
tion of starch. The formula furnished by
H— )
the above figures, is A=a — T=i:C-)- j ~l" '
A case of hyperpepsia with hypoacidity
and a deficient amount of free hydrochlo-
ric acid, or hypohydrochlorie, but with-
out acid fermentations.
Many cases of this sort are met, and
show clearly that the presence of free
HCl is not a matter of so great impor-
tance as has formerly been supposed.
The diminished value of {a) in this case,
accounts in part, perhaps, for the steady
loss of flesh observed in this patient dur-
ing a series of months. The patient made
a rapid gain in flesh after being put to
bed and subjected to the treatment indi-
cated for relief of her stomach disorder,
Hyperpepsia with hypohydrochlorie and
hyperacidity — acid fermentation.
Case 254.
The patient, a young woman aged 22
years, had for two or three years been
running down in health, suffering from
a variety of nervous symptoms which
had been attributed to excessive work in
school, and other causes which probably
had little or nothing to do with her con-
dition. The patient was considerably
emaciated, very weak, and extremely
nervous. Physical examination showed
a foul tongue ; stomach dilated, the lower
border of the stomach being an inch be-
low the umbilicus ; the abdominal walls
much relaxed ; considerable degree of
ovarian irritability, which, however, prob-
ably had little to do with the general con-
dition. The amount of fluid withdrawn
from the stomach was 60 c. c, and ex-
amination gave the following results :
(A), .280; («), 1.03; (T), .312; (H),
.004 ; (C), .268.
The color reagents showed the presence
of free hydrochloric acid in abundance,
also lactic acid. The biuret reaction
showed peptones abundant. LugoPs so-
lution gave a purple reaction, indicating
imperfect starch digestion. Rennet fer-
ment abundant. The formula resulting
from the above is as follows : A-f «-|-Trz=
The young woman made rapid improve-
ment under measures directed to the re-
lief of her stomach disorder.
Hyperpepsia with hypohydrochlorie and
hypoacidity — without acid ferfnentation.
Case 151.
The patient, a lady aged 45, had long
suffered from digestive disturbance as the
result of irregular eating, the use of pick-
les, cheese, and other harmful articles of
food, waist constriction from corsets and
waist bands, and the use of coffee. Ap-
petite diminished, stools very irregular,
alternation of constipation and diarrhoea,
gaseous distension of the bowels, tenes-
mus of lower bowel, general nervous ex-
haustion, constricted feeling in the region
of the heart, tongue flabby, hyperaesthe-
sia of the lumbar ganglia of the sympa-
thetic. At the time of examination there
was impaction of the lower bowel. The
amount of fluid was 74 c. c. A .160, a
.73, T .304, H .008, C .206. Congo-red
and methyl-violet both gave slight reac-
tion. Lactic acid test negative, peptones
abundant. Formula : A — a — T=:C-|- j
Hyperpepsia ivith hypohydrochlorie and
hypoacidity — with acid fermentation.
To complete the scheme of classifica-
tion, I ought to be able to present here a
case of hyperpepsia with hypohydro-
366
OBIOmAL ARTICLES.
with acid fer-
would require
_^_|_T+;=z;—
-f-;=. As will be seen by refer-
chlorie and hypoacidity -
mentation. Such a case
the following formula : A
c+s
ence to the chart, this formula might oc-
cur also in hypopepsia of the first degree,
with hypoacidity and acid fermentation,
the only thing required being a slightly
higher value for T and for C than I have
happened to meet in any of the cases
thus far studied ; so this may be consid-
ered as the point at which hyperpepsia
and hypopepsia meet and overlap.
Hyperpepsia with deficient combined chlo-
rine (C — ) and hyperacidity — without acid
fermentation (A-|-).
Case 129.
A young woman aged 22 years, had
been accustomed to take large quantities
of fluids at meals, and had taken large
quantities of iron, which she thought to
be in part the cause of her condition ;
suffered from regurgitations of food, es-
pecially at menstrual periods ; had ex-
cessive appetite and a craving for acid
foods ; extremely nervous ; impaired
memory ; loss of energy ; mental confu-
sion ; inability to concentrate the mind ;
occipital and frontal headache ; general
pain ; distress and giddiness ; disturb-
ance of vision ; specks before the eyes ;
appearance of fire before the eyes ; gen-
eral exhaustion ; trembling of the limbs.
Physical examination showed tongue
coated white over its whole surface ; the
lower border of the stomach one inch
below the umbilicus ; solar plexus ex-
tremely sensitive ; abdominal walls flac-
cid. The amount of stomach fluid with-
drawn was 170 c.c, more than four
times the normal amount. The follow-
ing is the result of the examination of the
stomach fluid: (A), .256; {a), .80;
(T), .360; (H), .152; (C), .130.
Peptones abundant. Formula, A -}- a
~^ -|-. A case of hyperpepsia
_T + C —
with diminished amount of useful chem-
ical work, as shown by C — , and hyper-
acidity from the excessive quantity of
hydrochloric acid present, but without
acid fermentation.
Hyperpepsia with deficient combined chlo-
rine (C — ) and hyperacidity (A'-(-) — with
acid fermentation.
+•
Case 199.
Young woman of 28 years, who had
suffered from stomach disorders for a
number of years, the most prominent
symptoms being acid and flatulent dys-
pepsia; heaviness of the stomach; gen-
eral weariness and confusion of thought.
Quantity of fluid withdrawn, 150 c. c.
Result of examination of stomach fluid :
(A), .280; A^ .252; U), 1. 14; (T),
(H), .394; .166; (C), .100.
Formula derived from the above quan-
H +
tities : A-f«-fT-[-C —
This case is nearly identical with the
preceding, only differing from the fact
that acid fermentation was present.
It is important to obtain the value of
A' in these cases, so as to be able to form
a correct judgment respecting the amount
of actual stomach work done, as the value
of A in cases of acid fermentation is al-
ways more or less attributable to the acid
products of fermentation. By compari-
son of the values A' and A, one can form
at once an estimate of the amount of nor-
mal chemical work done by the stomach
as compared with the abnormal chemical
work in the form of acid fermentation.
Hyperpepsia with deficient combined chlo-
rine ( C — ) and hypoacidity — without acid
fermentation.
Case 59
A man of 57 years, Avho had for many
years been accustomed to high living and
the free use of ardent spirits. Examina-
tion of the stomach showed marked
dilatation. A chemical analysis gave the
following figures : (A), .088; («), o; (T),
.360; (H), .090; (C), .090.
Biuret reaction very slight, neither
indicating the absence of peptones nor
of albuminoids. Formula, A — a — T -f-
P ' >- =. A case of marked hyperpep-
sia, as indicated by the high figure for free
hydrochloric acid, yet with pronounced
hypoacidity, and without acid fermen-
tation. The zero value of coefficient {a)
indicates the total absence of useful work
on the part of the stomach.
Hyperpepsia with deficient combined
chlori7ie (C — ) aiid hypoacidity {A' — ) —
with acid fermentatiofi.
Case 155.
The patient, aged 25 years. The stom-
ach fluid when withdrawn was green in
ORIGINAL ARTICLES.
367
color, indicating the presence of bile.
Result of analysis: (A), .192; (AO,
.152; {a), 2.29; (T), .404; (H), .128;
(C), .028.
Formula derived from the above quan-
tities, A' — a-\-T -\- C — f " A case
of hyperpepsia with hypoacidity, and
with deficiency of useful stomach work,
and acid fermentation.
In this, as in the analogous case — 199
— it is necessary to obtain the value of A'
in order to form a correct estimate of the
amount of normal chemical work done by
the stomach, since the acid fermentation
present contributes more or less to the
value of A. In the present case, A is
normal, although A' is much below the
normal value, and this notwithstanding
the high value of H.
Hypoacidity of the first degree {A! — but
above .100) with pseudo-hyperacidity {A' -f-)
due to acid fermentation.
Case 154.
The patient, aged 37 years, had suf-
fered from stomach disorders for some
time ; had been addicted to the free use
of tea and coffee and usual errors in
diet. The stomach symptoms noted,
were, distress two or three hours after
eating; eructations of gas; sometimes
regurgitation of food with small clots
of blood ; vomited black clots of
blood one month previous ; burning
pain ; appetite variable ; bowels very
inactive ; insomnia ; general exhaustion ;
palpitation of the heart. Physical ex-
amination showed red tongue coated in
the center ; lower border of stomach
below the umbilicus ; great tenderness
of the solar plexus and the umbilical
ganglia ; general tenderness of the ab-
domen. Stomach tube withdrew 120 c. c.
of fluid. Analysis gave the following
figures: (A), .320; (AO, .140; {a). 2.14;
(T), .392; (H), .020; (C), .140.
Peptone reaction slight. Formula,
H —
A + (A^— )^ + T + C —
Hypopepsia of the first degree with hypo-
acidity — without acid fermentation.
Case 275.
A young woman, 25 years of age, had
suffered from dyspepsia and a variety
of general nervous and pelvic symptoms
for a number of years. Stomach tube
withdrew 70 c.c. of fluid. Result of ex-
amination : (A), .124; {a), .73; (T),
.288; (H), .016; (C), .148.
Peptones and rennet ferment abundant.
LugoPs solution gave purple reaction for
erythro-dextrine. Formula, A — a — T
— C — j ' A case of hypopepsia of
the first degree, with hypoacidity and
without acid fermentation.
Hypopepsia of the first degree with hypo-
acidity — with acid fermentation.
Case 117.
The patient, an unmarried lady aged -^^iy
had suffered for a number of years with
stomach disorder, the prominent symp-
toms of which were nausea in the morning,
constipation, constant occipital headache,
sensation of pressure and heaviness in the
head, and muscular twitching. The lower
border of the stomach was two inches
below the umbilicus. The right kidney
was movable, hypersesthesia of the right
lumbar ganglion of the sympathetic. The
quantities obtain by analysis were as fol-
lows : Amount of stomach fluid 300 c. c. ;
slight amount of mucus present. A
.140, a .89, T .202, H O, C .158. The
HO
formula: A — « -|- T —
Hypopepsia of the second degree (A' —
and below .106) — with pseudo-hyperacidity
(A-).
Case 61.
The patient, a lady aged 29, had suf-
fered for many years from indigestion,
the result of irregular meals, the free use
of sweet pickles and other indigestible
articles of food, waist constriction by
corset wearing and tight waist bands, and
the continuous use of purgatives. Had
also taken chloride of gold and strychnia.
The prominent symptoms were chok-
ing, sensation of soreness, in the oesopha-
gus, fullness in the stomach, eructations
of gas, nausea almost continuous, brief sen-
sation of hunger a few hours after eating
constipation, hemorrhoids, gaseous dis-
tension of the bowels, many neurasthenic
symptoms, especially distress of mind and
insomnia, occipital headaches, burning
and pressure in head, giddiness, vertigo,
sensations of chilliness, trembling, espe-
cially of the legs, muscular twitching,
and palpitation of the heart. The phys-
368
ORIGINAL ARTICLES.
ical examination showed the stomach to
be dilated, the lower border being i^^
inches below the umbilicus. Analysis of
the stomach fluid showed the following
quantities: A .248, A' .087, a 2.72, T
.190, H .014, C .086. Congo-red and
methyl-violet both gave good reactions.
Peptones abundant. Formula : A — a -\-
H-)
T — V — . A very marked case of
hypopepsia of the second degree, with
pseudo-hyperacidity.
Hypopepsia of the second degree with
hypoacidity — without acid fermentation.
Case 265.
The patient, a woman aged 48 years,
had suffered from digestive troubles for
many years ; had been addicted to hasty
eating and over-eating, and to the exces-
sive use of sweets, fats, and fluids, espe-
cially at meals, overwork at sewing late at
night. Symptoms : bitter taste in the
mouth in the morning, tender surface
upon the tongue, scanty secretion in
the mouth, eructations of gas, regurgi-
tations of fluid frequently after eating,
occasional vomiting of bile and mucus
without nausea, sometimes vomiting the
entire amount eaten ; the vomited matter
bitter ; cramps in the stomach ; faint-
ness ; faint sensation in the stomach ;
good appetite ; the patient has observed
that vegetables, fermented bread, and
strong acids disagree with her ; bowels
very inactive ; stools whitish, mixed with
opaque mucus, at times bloody and large
in amount ; pain at and after stools ; fre-
quent ineffectual effort to relieve bowels ;
gaseous distension of bowels, with odor-
less flatus ; drowsiness after meals, also
at other times ; heaviness in the head,
bowels, and knees ; pain in back and lower
part of the shoulders, also in ribs and
right side ; sciatica, giddiness, vertigo ;
noise in the head, dreams of falling, cold-
ness between the shoulders, also of the
extremities ; specks before the eyes ; ap-
pearance of fire ; twitching of the muscles.
Physical examination showed moderate
dilatation of the stomach, and prolapse
of the bowels. Amount of fluid with-
drawn from the stomach, 100 c. c. Re-
sult of examination of stomach fluid : (A),
.012; {a), o ; (T), .156; (H), .012; (C),
.028.
Peptone slight. LugoFs solution gave
no reaction, showing complete digestion
of starch. Rennet ferment absent.
Formula, A — ^ — T— C— ) " A
case of hypopepsia of the second degree,
without acid fermentation.
Hyperpepsia of the second degree with
hypoacidity — with acid fermentation.
Case 13.
The patient, a physician aged 35 years,
had recently suffered from an attack of
la grippe which had left him with greatly
disordered digestion. Physical examina-
tion showed marked dilatation of the
stomach. Stomach tube withdrew, after
the test-breakfast, 55 c. c. Analysis
gave the following figures: (A), .010;
(AO, .0017; («), 5.00; (T), .100; (H),
.000 ; (C), .002.
HO)
Formula, A — a-^-T — C — \ ' A
most pronounced case of hypopepsia of
the second degree without acid fermenta-
tion, but was exceeded in another case,
the details of which will be given at an-
other time.
Case 62.
A lady, aged 65 years, had suffered for
years from frequent attacks of great pain
in the stomach, which occurred at such
short intervals that the pain was nearly
continuous, the pain burning in character ;
also suffering from pain in the region of
the liver and in the left side and from
morbid taste. The stomach fluid con-
tained a considerable amount of mucus.
The following quantities were obtained
by analysis : A, .175 ; A', .096 ; a, 2.11 ;
T, .260; H, .040; C, .064. Formula:
H ==r
A' — (A—) a -f T— C —
In this case the free HCl (H) is normal
in amount, but the case is nevertheless
one of hypopepsia of a very pronounced
type. Such cases are rare, but do exist,
and emphasize the importance of a
method of investigation which gives
exact rather than presumptive data.
Hypopepsia of the Third Degree — Apep-
sia. — I havei observed two cases of this
sort, the most typical one of the two
being herewith presented.
The analysis of the patient's stomach
fluid easily explained the anaemic and
emaciated condition which existed, and
ORIGINAL ARTICLES.
369
the extreme exhaustion which had baffled
all attempts to afford relief by the aid of
tonics or other palliative measures.
Simple Dyspepsia. — The following cases,
which for lack of space we will present as
briefly as possible, represent the four
forms of simple dyspepsia which are
recognized in our classification.
Under appropriate treatment the pa-
tients showed marked improvement in
nutrition.
Case 247.
A young lady, aged 23 years. Amount
of stomach fluid, 175 c. c. (A), .228 ; {a),
.85 ; (T), .312; (H), .032 ', (C), .232.
Peptones abundant ; starch digestion
moderate ; rennet zymogen abundant.
Formula, A-[-rt;=T=^C + f ' The
deviation from the normal chemism of
the stomach is not sufficient in this case
to relegate it to any of the classes of mor-
bid digestion. It is simple dyspepsia
without acid fermentation. The high
value of {a) which is practically normal,
indicates the good quality of the chloro-
organic compounds represented by (C).
There was moderate dilatation of the
stomach as shown by examination, as
well as by the large quantity of liquid
present at the end of the hour, which
does not exceed, in healthy stomachs,
40 e.c.
Case 119.
A man aged 26 years. Amount of
stomach fluid withdrawn, 135 c. c. (A),
.140; {a), .57; (T), .302; (H), .032;
(C), .190.
Peptones abundant. Formula, A — a
_T = C+j^' The small value of
{a) in this case indicates the depreciated
value of (C), due to the presence of a
large quantity of ntutral chloro-organic
compounds, which also diminished the
total acidity. The value of (C), if
wholly made up of normal elements,
would produce with (H) an acidity rep-
resented by (A'), .195.
Case 116.
A lady aged 24 years had spent a
number of years in boarding-school, suf-
fering from severe constipation of the
bowels, hemorrhoids, inability to concen-
trate the mind, and extreme nervous irri-
tability, with giddiness, sudden loss of
strength, and general exhaustion, with
general muscular weakness and debility.
Her condition had usually been attributed
to overwork in school. The patient had
not considered herself a dyspeptic, but
the physical examination showed a badly
coated tongue and a relaxed condition of
the abdominal muscles, the right kidney
was movable and sensitive. By means of
the stomach tube, 113 c.c. of fluid was
withdrawn after the usual test-breakfast,
an examination of which furnished the
following data : (A), .200 ; (a), .^^ ; (T),
.286; (H), .002 ; (C), .224.
Lactic acid was present, and the biuret
reaction showed a considerable amount
of peptone. The following formula
represents the chemical work of the stom-
ach in this case : K=z a ^ T — C-j- j '
A case of simple dyspepsia without hyper-
acidity ; and deficiency of hydrochloric
acid and slight acid fermentation.
Case 89.
The patient aged 42 years. Amount of
stomach fluid, 165 c.c. (A), .200 ; {a) .89 ;
(T), .284; (H), .020; (C), .202.
Formula, K = a ^T — C -\- \ ^' In
this case also the amount of disturbance
of the stomach process is so slight that it
may be classed as a simple dyspepsia with
acid fermentation, probably due to the
delay of the stomach in emptying itself
of its contents.
Case 94.
A man, aged 55 years. Amount of
stomach fluids no c. c. (A), .168; (^),
.87; (T), .310; (H), .050; (C), .136.
Uffelmann's reagent showed lactic acid
present. Peptones abundant. Formula,
A — ^-|-T = C — j * A case of sim-
ple dyspepsia with C — , and acid fer-
mentation. The diminished amount of
useful stomach work through the failure
of chlorine to combine with albumen,
and the acid fermentation which may
have been greater than that shown in the
value of {a) as indicated by the amount of
lactic acid present, were doubtless the
result of the dilated condition of the
stomach which prevented the complete
and prompt emptying of the organ, and
so gave rise to a slight degree of disturb-
ance of the normal chemical process of
digestion, and occasioned the setting up
of a vicious chemical process in the form
of acid fermentatign.
370
TRANSLATIONS AND ABSTRACTS.
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE LIVER AS A BILE-MAKING ORGAN.
BY DUJARDIN-BEAUMETZ.
Member of the Academy of Medicine, Physician to the
Cochin Hospital, Paris.
Translated by J. H. Kellogg, M. D.
Therapeutic Considerations.
I SHALL not undertake to deal with all
the numerous problems which arise in re-
lation to the therapeutics of the biliary
passages. I shall deal with only three
• important points relating to this subject.
1. The treatment of biliary calculi.
2. New considerations in relation to
icterus, and particularly infectious icterus.
3. Urticaria of hepatic origin.
The question of the treatment of biliary
calculi was the subject of several very in-
teresting and important communications
made to the Congress held at Wiesbaden,
in April, 1891. We have introduced into
the therapeutics of this disease a new
medicament, olive oil ; and surgery, the
methods of which have recently been per-
fected, undertakes to deal more success-
fully with this affection.
In his remarkable report to the Con-
gress of German physicians, Naunyn, of
Strasburg, has shown upon what a fragile
basis repose all the chemical theories
which have been invoked for the expla-
nation of the precipitation of cholesterin
in the bile. It has been claimed that if
cholesterin, which constitutes the basis
of biliary calculi, is precipitated in the
bile, this form is due to an increase in
the proportion of this substance. This
explanation is shown to be of no value,
since the experiments of Thomas have
demonstrated that cholesterin neither in-
creases nor diminishes in the bile, and is
maintained at a nearly constant percent-
age in spite of variations in the dietary.
Since cholesterin belongs to the fatty
series, the majority of physicians have
held that an increase of cholesterin is
due to a dietary too rich in hydro-car-
bons, or to an incomplete combustion of
these hydro-carbons ; hence, in accor-
dance with this idea, they have sup-
pressed fats and other hydro-carbon-
aceous elements in the dietary of persons
suffering from hepatic gravel. To-day,
it is necessary to abandon this view, and
we find that if there is any special dietetic
hygiene to be required of persons suffer-
ing from biliary calculi, it must be es-
tablished upon some other basis. Others
have sought to explain the precipitation
of cholesterin by modifications occurring
in the character of the bile. It is thus
that Thudichum has maintained that
the decomposition of glyco-cholic into
choliac acid explains the liberation of
cholesterin. Authors have sought to ex-
plain this phenomenon by the presence
of calcareous salts. None of these ideas
have been verified by experience.
The same is true respecting the view
which saw in an exaggerated activity of
the central nervous system the origin of
the excessive amount of cholesterin. We
must renounce all these theories and hence-
forth rely upon clinical investigations.
These investigations show us two' great
facts, one of which has been clearly pre-
sented by Naunyn. It is, that there is
always to be found in biliary calculi a
nucleus of epithelial debris furnished by
the mucous membrane of the diseased
biliary passages. Another fact which I
think has not been sufficiently emphasized
by Naunyn, is the stasis of bile in the gall
bladder.
Let us examine each of these facts.
The presence of epithelial debris as a
nucleus of biliary calculi, is an evident
proof that the calculi are nearly always
formed after an inflammation of the
biliary ducts, including the gall bladder,
a form of inflammation to which Naunyn
gives the characteristic name of desquam-
ative angiocholetis.
What is the origin of this angiochole-
tis ? It results fromrthe extension of the
gastro-duodenal inflammation to the bil-
iary passages, or, as we may add, an in-
fection of the bile ducts. What is the
source of this gastro-duotienal inflamma-
tion ? It is the result of excessive alimen-
tation or irritating foods, or the insuffi-
cient mastication of food.
The stasis of the bile in the gall bladder
is as important a cause of biliary calculi
as desquamative angiocholetis. One is
the complement of the other. At first,
inflammation hinders the outflow of the
bile, and consequently occasions its ac-
cumulation in the gall bladder ; deficient
TRANSI^ATIONS AND ABSTRACTS.
371
exercise, and especially corset wearing,
by interfering with the normal mobility
of the liver, explains why biliary calculi
are so frequently encountered in women.
Finally, irregularity in eating plays also
a role in the retention of bile. We should
not forget that in the physiological state
each inspiratory movement depresses the
liver upon the intestinal mass, and that
by this means a more or less energetic
pressure is exerted upon the gall bladder.
As the mode of respiration in man is
diaphragmatic and inferio-costal, while
in women the type of respiration is
superio-costal, and, adding to this mode
of respiration the effect of the corset, it
will easily be comprehended why biliary
calculi are so frequent in women. As to
eating, physiology show us that two hours
after eating, the gall bladder tends to
empty itself. It is, then, upon these two
great facts, a proper dietetic regimen and
proper exercise, that the hygiene of
invalids suffering from biliary calculi
must henceforth rest.
As regards dietetic regimen, we have
to examine successively the choice of
foods and the interval between meals.
As I have just said respecting the choice
of foods, we must absolutely abandon the
proscription heretofore made, of car-
bonaceous and hydro-carbonaceous foods
in cases of biliary calculi. These foods
may be permitted, avoiding, however, an
excess ; but all irritating foods must be
absolutely prohibited, and as the gastro-
duodenitis always precedes the desquama-
tive angiocholetis which is the immediate
cause of the calculi, it is important to
combat the first symptoms of this gastro-
duodenitis by a dietary as simple as pos-
sible.
The basis of this dietary is to be found
in the vegetarian regimen. Let us not
forget, in fact, that this duodenal inflam-
mation follows an exaggerated acidity of
the gastric juice, and that this acidity is
itself produced by an excess of proteid
foods. You will then absolutely pro-
scribe meats, and will require your patient
to follow a regimen composed of eggs,
grains, fresh vegetables, and fruits.
To inflammation as a cause of this des-
quamative angiocholetis, it is necessary
to add infection ; that is to say, the pene-
tration of microbes from the intestine
into the biliary passages. Putrescent
meats, such as game, fish, shellfish (oys_
ters, clams, etc.), lobsters, and crabs
being among the causes of this infection
of the biliary passages, must be absolutely
proscribed.
As regards the internal cause, it is
necessary to be equally rigorous. Alcohol
being one of the most frequent causes of
gastro-duodenitis, it is necessary to for-
bid all alcoholic drinks, and to insist
upon the use of soda water or milk. We
have seen that alkaline waters are not
cholagoguic in their action. It is not,
then, by an increase of biliary secretion
that their curative action can be ex-
plained. To my idea, their therapeutic
effects must be attributed especially to
the power which they possess of dimin-
ishing the gastro-enteritis by lessening
the acidity of the gastric juice. Further,
their general action upon the nutrition of
the body also explains their favorable
effects. It is not sufficient simply to
prescribe a vegetarian regimen, abstin-
ence from alcoholic drinks, and the use
of alkaline waters. It is still necessary
to require of the patient that he give to
his meals sufficient time to secure the
complete mastication of his food. Mialhe
maintained, many years ago, that all
dyspepsia is the result of insufficient
mastication. Without going so far as
this, one may say, however, that the pres-
ence of badly masticated foods is one of
the most frequent causes of gastro-duode-
nitis. Such foods really act as foreign
bodies which irritate the pyloric region
of the stomach and the mucous membrane
of the duodenum. The same is true of
an excessive quantity of foods. Great
eaters are very subject to gastritis. It is
necessary, then, to eat rationally and to
masticate slowly. As to the interval be-
tween the meals, it is necessary that it
should not be too long, since we know
that each meal aids the gall bladder in
emptying itself. The invalid will be per-
mitted to take, in addition to his break-
fast and dinner, a little food on rising, and
then at about three o'clock in the after-
noon, so as to make four meals a day, —
two large meals and two small ones. It
should be well understood that this pre-
scription applies only to patients whose
stomachs are not dilated, who constitute,
It is important to observe, the exception
among those suffering from biliary calculi.
The presence of biliary calculi in per-
sons suffering from dilatation of the
stomach, is easily explained, because
there is often in such cases an irritation
372
TRANSLATIONS AND ABSTRACTS.
of the duodenum and an infection of the
biliary passages, circumstances favorable
to the development of desquamative an-
giocholetis.
The stasis of the bile in the gall blad-
der may be combated by different means,
some of which belong to the domain of
pharmacy proper, others, to that of
hygiene. Of the first class may be men-
tioned cholagogues, of which I especially
recommend two drugs, evonymin and
salicylate of soda. I was one of the first
to make known the favorable action of
evonymin, my first researches concern-
ing which will be found in the thesis of
one of my students. Dr. Davet. The
following is the formula which I em-
ploy : ^ Evonymin, medicinal soap a a,
grains, 3.
Make into two pills, which are suffi-
cient for one dose.
Salicylate of soda is also a good chola-
gogue. I often administer to men suf-
fering from biliary calculi a dessertspoon-
ful of the following solution after each
meal : I^ Soda salicylate, 15 grams, aqua
250 grams.
Salol with salicylate of bismuth is also
a powerful cholagogue. A formula of
my intestinal antiseptic powders may also
be utilized. It is as follows : ^ Salol,
salicylate of bismuth, bicarbonate of
soda a a, 10 grams. Divide into 30
powders.
You may employ podophyllon, cas-
caria, or the purgative mineral waters
containing sulphate of soda, such as
rubinat, villacabras, and carabana.
Finally, let us not forget that large
rectal enemata act as cholagogues.
This is the method of Kriill. Solutions of
naphthol may be used for this purpose,
as mentioned in the preceding lesson.
We have learned that respiration
favors the flow of bile, by depressing the
liver upon the intestinal mass, and thus
compressing the gall bladder. It is nec-
essary, then, to direct our patients to
make full, deep inspirations by the em-
ployment of respiratory gymnastics.
One of the most simple of these gymnas-
tic exercises consists in making the pa-
tient count in a high key without taking
breath.
It should be well understood that
women must be required to wear their
corsets loose, a thing often difficult to
accomplish. In men, the wearing of
belts must be forbidden, and they must
be required to wear braces. Walking,',
and all bodily exercises, by increasing
respiratory movements, become power-
ful adjuvants in the treatment of this dis-
order.
In such exercise, a true massage of the
gall bladder is produced, but a direct
pressure may be made upon the base of
the gall bladder by means of abdominal
massage administered by the methods of
massotherapy. Finally, hydrotherapy,
by improving the muscular tone, may
also be advised in these cases.
These are the principal lines which
should be followed in the treatment of
biliary calculi. But two great indica-
tions must be met, to secure a cure:
first, prevent the production of calculi ;
then combat, not the discharge of the
calculi, but the painful symptoms which
accompany the discharge, which are de-
scribed under the name of hepatic colic.
One of the best means of combating
the reflex spasm which originates in the
irritation of the mucous membrane of
the biliary passages, is the injection of
morphia. It is in these cases that you
would use morphia and atropia associated
as in the following formula : 1^ Hydro-
chlorate of morphia, grams o.io, sul-
phate of atropia, grams o.oi, aqua,
sterilized, grams 20.00.
Inject with a hypodermic syringe in
usual doses, repeating until pain is re-
lieved.
(To be Concluded.)
Detection of Alkaloids in the Urine.
— In an interesting series of articles in
Les Noveau Remedes, for June 24, 1892,
Dr. Bardet, of the Cochin Hospital, gives
the following as the best reagents for de-
tecting alkaloids or glucocides in the
urine : —
Phospho-molybdate of soda. This salt
in an acid solution (usually nitric) gives
precipitates of greenish or bluish tur-
bidity in liquids containing vegetable
principles of a basic character, or of
glucocides. This reagent is extremely
sensitive.
Double iodide of mercury and f)otash.
This test is generally known as Mayer's
reagent. It is extremely sensitive. Nearly
all solutions of alkaloids may be detected
by this reagent. Glucocides are rarely
precipitated by it. The following is the-
formula : —
TRANSLATIONS AND ABSTRACTS.
373
Mercuric chloride gms. 13.446, Po s
sium-iodide, gms. 49.800, Distilled water,
I litre.
Morphia may be detected by this re-
agent, in a solution containing 4 parts in
10,000; Atropia, 15 parts in 100,000;
Nicotine, 4 parts in 100,000 ; Strychnia,
66 parts in 10,000,000.
Mayer's reagent may also be used as a
means of quantitative estimation, ic.c.
of the reagent corresponds to the follow-
ing quantities of active principles : —
Strychnia .0167, Atropia .0195, Mor-
phia .02,' Nicotine .00405.
The quantities indicated are fractions
of a gram. In use, it is only necessary
to multiply the figures above given by the
number of cubic centimeters required to
precipitate all the alkaloid, in order to
obtain the weight of the active substance
contained in the solution.
Double iodide of cadmium and potash.
This reagent, though less sensitive than
the preceding, has the advantage of pre-
cipitating only the true alkaloids ; it
does not precipitate either the glucocides
or the xanthic bases.
To detect an active principle in the
urine, proceed as follows : Obtain all
the urine passed for twenty-four hours.
Reduce by evaporation to one tenth the
original volume. Agitate with ether,
then with chloroform. After filtration,
evaporate these two liquids. Dissolve
the residue in acidulated water, and ap-
ply the reagent.
The Toxic Properties of Bases Ex-
tracted from Muscular Tissue. — M.
M. Gautier and Landi recently reported
to the Academy of Science, Paris (June
20, 1892), the results of studies which
they have conducted for the purpose of
determining the physiological effects of
the bases contained in muscular tissue.
They divide these bases into four groups,
as follows : I. Xanthic bases ; 2. Carbo-
pyridic bases and their analogues; 3.
Neurinic bases, hydro-pirroric bases, etc;
4. Creatinic bases.
The effects of these several classes of
excrementitious agents are shown to be
as follows : —
1. Xanthic bases are found in flesh
only in very small proportions, and can-
not be properly said to be poisons.
2. The carbo-pyridic bases and their
liquids produce slight stupefaction of
animals when administered in sufficient
doses (i}^ gms of chloro-hydrate per kilo-
gramme of animal). They are not other-
wise dangerous.
3. The neurinic, hydro-pirroric, and
allied bases, whether extracted from flesh
of muscular tissue or from preserved meat,
are the most venomous of those which
are precipitated by mercuric chloride.
Injected in the mouse in dose of one cen-
tigramme of the chloro-hydrate, it causes
death in two hours, after having produced
dyspnoea and other symptoms of inter-
ference with respiration, spasmodic move-
ments of the limbs, and alternations of
paralysis and tetanic convulsion. ,
4. The creatinic bases injected under
the skin, as the preceding, produced with
the same doses, first, vomiting and diar-
rhoea, then tetanic siiocks, and at the end
of thirty minutes, paralysis of the limbs,
and finally death at the end of an hour.
The effects are the same, whether the
bases are obtained from fresh meat or
from preserved meat.
These effects are of the greatest impor-
tance, both from a hygienic and a thera-
peutic point of view, and furnish scien-
tific foundation for the practice long ago
established empirically by observing
physicians, of withholding flesh food
from patients suffering from acute febrile
disorders.
The researches of modern bacteriology
have shown that in most if not all acute
disorders accompanied by febrile action,
the system is laboring under the influence
of poison generated within the body, as
the result of the growth of microbes of
varied character, the intensity of the fe-
brile action depending upon the degree
of accumulation of poison within the
system. Most of these poisons are
eliminated chiefly by the kidneys. It is
only by the elimination of these poisons
that the febrile action can be efficiently
controlled, hence it is important that all
possible means should be employed to
aid the system in ridding itself of all dis-
turbing poisons ; and it is equally im-
portant that poisons of an allied character
should not be introduced into the system
either dietetically or otherwise.
Dr. Austin Flint some years ago called
attention to the fact that fever patients
were often starved to death by feeding
upon excrementitious products, the effect
of which, as a food, is practically nothing.
These recent researches of Gautier and
374
TRANSLATIONS AND ABSTRACTS.
I^andi show that the extractives of meat
are not only useless as foods, but are
positively injurious as toxic agents.
It is scarcely necessary to emphasize
further the importance of these observa-
tions and their practical bearing upon the
hygiene and therapeutics of dietetics.
There can be no question but that the
vegetable kingdom furnishes, in fruits
and grains and a few wholesome vegeta-
bles, the purest and most healthful nour-
ishment.
In taking flesh food, one is only taking
the products of the earth at second hand,
and, as is now clearly shown by modern
researches, a second-hand diet in the
form of flesh food is deteriorative to a
very marked degree. This view is quite
contrary to the popular notion that food
elements are somehow improved by trans-
formation into animal substance, never-
theless it is based upon scientific facts of
the most authoritative character, and
must be accepted.
Thoracic Deformities in Young
Men. — The Revue d^ Hygiene in the June
number, 1892, gives an abstract from La
Normandie, of a very interesting paper
upon thoracic deformities in young men,
observed by comparing measurements
taken by the tailors of Caen, of fifty in-
dividuals between the ages of eighteen
and twenty-two years, thirty years ago,
with those of the same number of per-
sons recently measured.
In the style of coats worn thirty years
ago in France, the anterior thoracic line
corresponding to the opening of the coat
was at a greater distance from the axillary
seam than the recent patterns, which in-
dicates a diminished convexity of the an-
terior thoracic wall, and a diminution of
the capacity of the thorax. Each side
of the anterior median line, and espe-
cially upon the extension of the mammary
line, in men's coats, a piece was cut out
to adapt the garment to the form, by
diminishing the inferior diameter of the
waist of the coat. At the present time,
this piece must be replaced by an ellip-
tical piece, because the thorax of young
men tends to take the same diameter
above and below.
•Zi The posterior thoracic line of the mod-
ern style of coat, that which corresponds
to the middle back and seam of the gar-
ment, instead of being a vertical line, as
in the style of garment worn thirty years
ago, is curved with an anterior concavity
in its upper part. This form is neces-
sary, in order that the coat should not
wrinkle, and should fit the back, which
tends to roundness. Upon the individ-
ual orders of their patrons, the tailors
were found to have written eighty times in
one hundred the words, ^^Back round."
The deformities to which this change
in the style of coat is due, may be
summed up as follows : The chest is
flattened, that is, the anterior thoracic
wall no longer has its normal convexity ;
the back is round, that is to say, its line
is convex when it should be straight.
Finally, the superior and inferior diame-
ters of the thorax tend to become equal,
that is to say, while the inferior diameter
has remained normal, or nearly so, the
superior diameter has diminished, and
equally, the capacity of the thorax has
also diminished. These modifications
are met with in about 80 per cent of
young men. The normal type with the
back straight or slightly concave, the
chest prominent, and the waist curved, is
now rarely seen.
Normal shoulders, that is to say, high
shoulders, to employ a technical term of
the tailor, are met with only about three
times in one hundred. The neck is for-
ward, the chest flattened, and the back
rounded. This appearance of the aver-
age young men of eighteen or twenty
years of age, of the present time, is recog-
nized in every day observations ; the hips
are preeminent, and the bust short. This
feminine characteristic becomes very fre-
quent in France, accompanied with a
development of the mammae which in-
creases in appearance the thoracic cir-
cumference without really increasing the
capacity of the thorax.
It is further noticed that the difference
which should normally exist, and which
is found in the ancient measurement, be-
tween the thoracic circumference taken
at the nipple, and the abdominal circum-
ference taken at the umbilicus, tends to
diminish the latter ; for example, in i860,
in a man of twenty years, the thoracic
circumference was forty inches, and the
abdominal, thirty-two inches. To-day
the thoracic measurement is only thirty-
five and one fifth inches, while the ab-
dominal is thirty-two and four fifths
inches.
These very important facts are of great
TRANSLATIONS AND ABSTRACTS.
375
interest as showing the tendency to phys-
ical degeneration which results from our
modern habits of life, neglect of physical
culture, and too sedentary habits. The
increase of the abdominal measurement is
but a natural result of the depression of
the thorax due to forward flexion of the
body by sitting positions. Bad positions
in standing and walking are the principal
cause of this deformity. Posterior cur-
vature of the spine, such as is described
in the abstract above quoted, is the most
common of all forms of deformity,
though, curiously, it is the one least
frequently mentioned, and has now for
the most part been altogether overlooked
by those who have made a special study
• of the deformities of this portion of
the body.
-* — • — ■*-
New Views Respecting Alkaloidal
Antagonism. — The researches of Noth-
nagel and Rossbach respecting the action
of alkaloids, the potency of which is
often so great that very energetic action
follows a dose consisting of a few frac-
tions of a milligramme, have shown that
notwithstanding the action of these drugs
in such small quantities, their activity is
wholly the result of contact with the
tissues. Each tissue-element possesses
its own sensibility. The muscular and
cellular tissues possess comparatively lit-
tle sensibility, while the nervous system
is almost infinitely sensitive. Any for-
eign body, when brought in contact with
the elements of the nervous system, pro-
duces an extremely energetic reaction,
even in most minute quantities, when of
a chemical composition differing from
that of the elements. This, of course,
refers to bodies in solution. It is not
the foreign substance which acts upon
the nervous elements, but rather these
are the living tissues which react upon or
toward the foreign body.
Many substances when introduced into
the body, quickly lose their peculiar
characteristics by contact with the oxy-
gen and other active elements found in
the tissues. The poisonous alkaloids,
however, are substances which preserve
their identity, undergoing no essential
change, so that they reach the nervous
elements, and by their contact induce the
characteristic reactions.
These recently established facts re-
specting the action of alkaloids are of
practical importance, as they have a
direct bearing upon the use of alkaloids
of a supposed antagonistic character,
either together, with a view of securing a
modified physiological action, or in suc-
cession, with the purpose of antidoting
the effect of an overdose. The idea
that an alkaloid, the introduction of
which into the system is followed by a
physiological reaction opposite in char-
acter to that resulting from the use of
another alkaloid is, consequently, an
antidote for it, and may be safely utilized
to combat a toxic action, has been shown
by Rossbach and Frohlich, who have es-
tablished the following laws : —
1. There is no regular antagonism be-
tween the effects of two poisons.
2. The real action of alkaloid poisons
can be only paralyzing or exciting.
3. The paralyzing action takes prece-
dence, always, of the exciting action.
As an illustration of the above, it is
well known that strychnia excites while
alcohol paralyzes. If these two poisons
were administered together, the alcohol
prevents the strychnia from acting so long
as its paralyzing action is exerted. If the
strychnia is administered first, unless the
dose be one sufficiently large to be im-
mediately fatal in its effects, alcohol ad-
ministered afterward may prevent the
toxic effects of the strychnia from ap-
pearing.
4. After a paralyzing poison has been
administered, the characteristic action of
an exciting poison cannot be produced.
5. On the contrary, a paralyzing poison
may always act when an exciting poison
has been administered.
6. This antagonism can rarely ever be
of use therapeutically, for it can be em-
ployed only in cases of poisoning by ex-
citing agents, and then the administration
of the paralyzing agent adds a new toxic
action of a very dangerous character.
The Formation of Sugar from Pep-
tones.— Mr. R. Lepine, in a recent note
to the French Academy of Sciences, states
that peptones coming in contact with the
blood under certain conditions give rise
to sugar. This may point to the origin
of a portion of the sugar which is pro-
duced in vitro at 58^ C. in the blood of
a dog during digestion, or after having
been bled. Until now this was thought by
many writers to come exclusively from the
glycogen of the blood.
376
BACTERIOLOGICAL NOTES.
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Medicine, from original sources.]
The Treatment of Tuberculosis by
Antiseptic Vaporizers. — Dr. Marche,
in th^ Journal de Medicine et de Chirurgie
Pratiques,, describes a method of treat-
ment of pulmonary phthisis in which he
keeps his patients supplied with creosote
much more thoroughly than is possible
with the various modes of ingestion and
inhalation. He keeps his patients in a
room where vapors of creosote are con-
tinually produced. The success attend-
ing this treatment, is, to say the least,
very remarkable. If this report is true,
as we have every reason to hope, it would
seem that this simple method of treat-
ment would become popular and would
be generalized.
> • *
Different Modes of Contagion in
Tuberculosis. — M. Arthaud, in the
Revue Inter7iatio?iale de Bibliographie,
gives the result of a study of the origin of
the different modes of inoculation in this
disease. He studied minutely the method
of contamination in loo typical cases. In
17 of these he failed to find a plausible
explanation of their inoculation. In the
80 remaining cases he established that
the inoculations seem to have been in-
duced by a long sojourn in lodgings con-
taminated by some preceding occupant,
who had suffered from marked tuberculo-
sis and had inhabited the same rooms for
a long period, or had died therein. In
all cases, with some variations, the primi-
tive signs of invasion appeared after a
sojourn in such lodgings, varying from one
to four months. Dwelling places are not
the only factors in contagion. The Arch-
ives Medicates Beiges, in notes on M. Art-
haud's investigations, justly says that the
places of habitual reunions, the work-
shops, offices, etc., are so many very dan-
gerous centers. The author indeed cites
many striking examples. The balneary
and other resorts frequented by consump-
tives are not exempt from reproach on this
subject. M. Arthaud ends his communi-
cation in the following language : '' ist, the
most frequent mode of transmission of
tuberculosis is contamination from the in-
habited locality (rooms, etc.), and its rela-
tive frequency is about 80 per cent; 2nd,
the excessive frequency depends on the
negligence of all prophylactic measures ;
3d, in instituting by legal means some very
praictical hygienic measures, it is reason-
able to hope that tuberculosis will dimin-
ish in frequency and even die out as
leprosy did among our ancestors."
A Mode of Infection of Milk Little
Known. — Prof. Gaffky, in Deut. Med.
Woch., describes three cases of infectious
enteritis having attacked simultaneously
three employees of the Institute of Hy-
giene, of Giessen. Inquiry made on the
subject demonstrated that the disease was
produced by the ingestion of milk con-
taminated by means little suspected or at
least little known, namely, the direct
contamination of the milk by the dejec-
tions of a sick cow.
The disease began on the same day in
all three cases, the symptoms, though of
varying intensity, presented the same
character ; at the beginning cephalalgia,
repeated chills, malaise. In the most
severe case, there appeared afterward a
high fever accompanied with some degree
of stupor and profound andynamy ; the
tongue was coated, the abdomen dis-
tended and tender to pressure, the faeces
frequent, scant, and of a dark brown
color, partly liquid and holding in sus-
pension particles and granules ; on the
nth day an intestinal hemorrhage oc-
curred. The uriiie was albuminous and
contained, at the beginning, granular
cylinders and white globules but no red
corpuscles ; these bodies disappeared rap-
idly, but the urine remained albuminous
until convalescence. The fever began to
fall the twelfth day, and about the nine-
teenth day the temperature regained its
normal point. The most striking and
persistent symptom of all was extreme
weakness.
M. Gaffky concludes that these three
patients were affected by milk of which
all three had partaken on the eve of the
appearance of the symptoms. The three
parties had the day iDefore brought to
the laboratory a closed bottle of milk ; the
one most violently attacked drank the
greatest quantity, the second drank but
one cup, and the last the remainder. The
milk had not been boiled, and having
been ingested immediately on opening the
bottle, could not have been contami-
nated by the air. Some conscientious
BACTERIOLOGICAL NOTES.
377
researches were made to discover the
source of infection of the milk, and it was
found that a cow was suffering from hem-
orrhagic enteritis, and still gave a little
milk, which had been sent to the labora-
tory. Bacterial investigations of the de-
jections of the three patients and the sick
cow, revealed a bacillus of small dimen-
sions, very mobile, and susceptible of
culture. Inoculation of these cultures in
mice and guinea pigs proved extremely
virulent and fatal in most cases ; the same
bacilli were found in sections of fragments
of the mucous intestinal wall of the cow.
The blood and milk withdrawn with the
greatest asep.tic care were examined and
did not reveal any microbe of this kind.
There is no question, we are too careless
about this mode of infection.
The Bacillus of Cholera. — The
Archives de Medicine Experimentale pub-
lishes the researches of M. A. F. Guyon,
Interne of the Hospitals of Paris, which
demonstrate to what degree such inves-
tigations may assist in the application
of prophylactic measures against this
disease.
Koch admitted at the beginning of his
studies, that the bacillus of cholera re-
sists desiccation but a few hours. He
reasoned that this was due to the absence
of spores, and that it would be impossi-
ble to disseminate the disease through the
air, because the desiccated microbes that
could thus be transferred would be dead.
It was thought, therefore, that the viru-
lence of the cholera bacillus existed only
in a certain stage of moisture incom-
patible with their dispersion in the air.
Later researches demonstrated great dif-
ferences in this matter according to the
cases. M. Guyon has attempted to elu-
cidate these differences in a series of ex-
periments in the laboratory of M. Strauss.
One fact of general application was
demonstrated by these experiments ; viz,
that on the one hand rapid death of the
cultures dried in ordinary air takes place,
and on the other hand they resist when
they are dried in dry air. Furthermore,
other deeper experiments demonstrated
that it is because of dryness of the medium
that the bacilli survive, and that the hin-
dering influence of ordinary air is evi-
dently due to vapors of water which it
contains. The oxidation which destroys
the bacillus occurs more easily in the pres-
ence of humidity than in dry air, in which
dry cultures are protected against the ac-
tion of oxygen. This is in harmony with
demonstrated facts in reference to other
microbes. We know that dryness is one
of the conditions of latent life.. Desicca-
tion, then, does not always signify harm-
lessness. The method and conditions of
desiccation are to be considered in the
destruction of virulence of any microbe,
on the medium in which desiccation
takes place.
* % m
The Penetration of Walls by
Germs. — Dr. A. Serafini, Assistant at
the Institute for Experimental Hygiene,
Rome, has recently published the results
of a very interesting series of experiments,
the purpose of which was to determine
the hygienic value of various sorts of
building materials, in which are recorded
observations which indicate that some
species of germs have a remarkable pene-
trating power. Dr. Sanfelice, a colleague
of the author, perforated the wall of the
ancient hospital San Gallicano, at Rome,
taking great care to collect only the dust
which was obtained from the central por-
tion of the wall. On planting some of
this dust in nutritive gelatine, he observed
the production of a number of micro-
organisms, the bacillus subtilis predom-
inating. Other observers have reported
similar results. Bonome found the ba-
cillus of tetanus in the walls of an old
church. Emmerich found the pneumo-
bacillus of Friedlander in the walls of a
prison. Uptadil produced an acute in-
fection resembling malignant oedema by
injecting guinea pigs with cultures ob-
tained from the wall of one of the wards
of the old hospital at Augsburg, a ward in
which there had been cases of typhoid
fever and septicsemia.
A question of interest which has not
yet been fully settled by experiment, is
whether organisms contained in the ma-
terial of walls or which penetrate them
from ihe outside, can emerge upon the
surface and thus become a source of in-
fection. Layet, in his interesting work
upon this subject, answers the question
in the affirmative, but no experimental
evidence has been furnished. In experi-
ments made by Serafini, it was found
that germs diffused through water pene-
trated, without the aid of pressure, into
handmade brick to a depth of four inches
in twelve days.
378
EDITORIAL.
The Bacteriological World
AND
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Battle Creek, Mich., September, 1892.
TUBERCULOSIS CONTRACTED AT HEALTH
RESORTS.
A PATIENT who came under the ob-
servation of the writer not long since, con-
firmed an idea that he has had for some
time ; namely, that the flocking of people
to unscientific health resorts is often at-
tended with much danger. The patient
in question was suffering only from
overwork ; his family history was clear,
and there was no tuberculosis to be traced
in his immediate kin or among his an-
cestors. He went to a health resort at a
high altitude to recuperate. He boarded
at a hotel in which numerous consump-
tives were coughing and expectorating ;
four months afterward, he developed tu-
berculosis and has now a typical case
of pulmonary phthisis. The unfortunate
condition of these resorts is, that there is,
as a rule, no system, of disinfection of
the rooms, verandas, hallways, etc. The
patients are allowed, in most hotels, to
expectorate where they choose without
restriction ; the result is, germs are scat-
tered broadcast in the buildings and out-
side on the grounds ; they become dry and
are scattered in the air, and are inhaled
by those exposed. Thus a health resort
which in the beginning may have been ex-
ceedingly effective in combating consump-
tion, becomes, after a time, a veritable
center of infection.
It is claimed that the air is in itself,
under all circumstances in high altitudes
sufficient to destroy the germs of con-
sumption. It is not so ; tuberculosis
cultures may be carried on in Colorado
as in Michigan. One of the chief reasons
why a high altitude is beneficial to con-
sumptives in certain stages is because it
gives to the system in various ways, more
strength, more vitality, more fighting
power, I may say, to resist the deadly
microbes, and it renders the field (body)
less fertile and less susceptible.
Doubtless the germs scattered outdoors
at such a high altitude, particularly if
moisture exists occasionally, will live but
a short period, because, as pointed
out by M. Arthaud and others, the des-
iccation of germs is fatal to them, when
"it occurs in a moist atmosphere such as
is produced by dew, for instance. If
desiccation occurs in dry air protected
from moisture, as in a room, it seems
that it is somewhat of a protection to the
spores. Theoretically, then, the spores
of tuberculosis expelled in dry air of a
high altitude would, if inhaled by the
proper subject, be liable to take root,
and if that subject should descend to a
lower altitude, might develop.
This history of the case which I have
mentioned is clearly one of contagion in
a polluted atmosphere. The beginning
of the disease was noted slightly, or at
least suspected while still in the infec-
tious center; he left it, to go to a lower
atmosphere, and at once began to sink
under the dreadful ravages of tubercu-
losis. Again he had to return to a high
altitude, to a place less inhabited by the
sick, and where hygienic measures were
carefully carried out by himself, and be-
gan to improve.
The point which I wish to draw atten-
tion to is, that persons who select resorts
harboring patients suffering from tuber-
culosis, should be strictly on their guard,
and that every hotel-keeper should regu-
larly disinfect his premises. The establish-
ments where no care is taken to disinfect
the buildings, rooms, grounds, etc., are
dangerous places for patients, even when
EDITORIAL.
379
already suffering from the malady ; for a
tuberculous patient exposed to an air im-
pregnated more or less with consumption
germs, cannot do so well as in a clear,
pure atmosphere. p. p.
CURETTING BEFORE LAPAROTOMY.
All gynecologists who have frequently
performed the operation of removal of
the uterine appendages have noted oc-
casional cases in which the menstrual
period continued after the operation, if
only at irregular intervals, and this fact
has given rise to a certain degree of skep-
ticism as to the influence of the removal
of the appendages in controlling menstru-
ation. Several gynecologists of some
note have given expression to the thought
that the effect of the removal of the ap-
pendages upon the menstrual function is
uncertain. A number of cases have
occurred in the writer's practice, in which
the catamenial flow continued for some
months after the operation, and in several
cases there was very pronounced menor-
rhagia. In two of the cases, uterine hem-
orrhage occurred at irregular intervals,
apparently independent of any catamenial
influence. A careful investigation of
these cases developed the fact that, in
every case in which profuse menorrhaghia
existed, vegetations of the endometrium
were present, and by removal of these,
the hemorrhage ceased and the meno-
pause was promptly established.
The writer agrees with the views of Dr.
W. R. Pryor, who advocates in an article
in the February number of the Journal of
Gynecology and Obstetrics, thorough cur-
etting of the uterus before laparotomy for
removal of the appendages. It may not
be best to do this in every case, particu-
larly in cases of pyosalpinx. The most
careful aseptic percautions might be in-
sufficient to prevent the setting up of
active inflammatory symptoms. By the
employment of careful asepsis, the opera-
tion can be preformed in proper cases
without setting up any inflammatory mis-
chief in the pelvis and thus complicating
the nature of the operation. It should be
performed, as a rule, at least a week prior
to the abdominal operation, but if neces-
sary, may be performed at the same time,
as but a few moments are required for its
completion. In preparation for the op-
eration, the vagina should be thoroughly
washed and scrubbed with soapsuds made
from good laundry soap, then irrigated
with a 1-6000 solution of bichloride of
mercury and packed with gauze soaked
with 1-10,000 solution, and wrung dry as
possible. The gauze packing should be
placed the day before the operation.
A good method of cleansing the vagina
is to wrap around the extremity of an
ordinary douche tube a strip of gauze,
making a mass as large as will easily enter
the vaginal orifice. During the irrigation
of the vagina with the soapsuds, the
douche-tube thus prepared, may be used
as a scrubbing-brush. Care should be
taken to reach every portion of the vagi-
nal surface, particular pains being taken
to reach the area behind the cervix in the
posterior cul de sac.
In every case of operation for control of
hemorrhage, as in casesof bleeding fibroids,
the operation should be preceded by a
thorough curetting, and also before laparot-
omy for removal of the appendages in cases
in which there has previously existed a so-
called chronic endometritis or cervical
catarrh. I have occasionally seen profuse
hemorrhage occurring at irregular intervals
in these cases after removal of the tubes and
ovaries, although this symptom had not
been present before the operation. The
hemorrhage was controlled by curetting,
which revealed the presence of a luxuri-
ant growth of vegetations. It is probable
that in these cases, the vegetations had
existed before the operation, or, at least,
a condition favorable to their develop-
ment had previously existed. In two or
three cases, irregular hemorrhages ap-
peared several months after the operation,
380
EDITORIAL,
and when the menopause had seemed to
be fully established. It seemed clear, in
these cases, that the vegetations had
grown after the operation. The writer
has several times found an abundant
growth of vegetations in the uterus when
the menstrual flow had not been more
than usual in quantity, and one instance
in which the menstrual flow had been
scanty. These cases were encountered
in following, as a routine, the practice of
curetting the cavity of the uterus before
closing up a lacerated cervix, this prac-
tice having been found of marked service
in stimulating the process of involution
in cases of sub-involution, and in sup-
pressing a catarrhal discharge when pres-
ent.
In the writer's opinion, many of the
unpleasant symptoms of which the patient
expects to be relieved by a laparotomy,
but which often persist for many months
subsequently, and sometimes bring the
operation into discredit in consequnce
of its apparent failure to accomplish
what was expected of it, may be dissi-
pated by a preliminary curetting.
J. H. K.
The Abuse of Mercury. — That mer-
cury is a valuable remedy in some forms
of disease cannot be disputed. That it is
a most effective germicide is well known,
and doubtless this property is what gives
it its chief value as a remedial agent.
The ancient notion that mercury is a
cholagogue was long ago exploded by
Bennett, in his experiments upon dogs,
which were afterward confirmed by the
elaborate researches of Rutherford.
Doubtless the supposed cholagogic action
of mercury is due to the germicidal projt-
erties of the drug, which, by lessening
morbid fermentations and putrefactive
processes in the intestine diminishes the
amount of ptomaines which the liver is
compelled to destroy, and hence enables
this organ to do more efficient work in
the performance of its bile-making and
glycogenic functions.
The fact that mercury has sometimes
proved so efficient a remedy, has led to
its enormous abuse. The writer has
endeavored to call attention to this fact
in various ways and on various occasions
during the last twenty years, and is now
encouraged to see that so excellent an
authority as Landolt is raising a vigorous
protest against the abuse of mercury, es-
pecially in affections of the eye. As this
acute observer remarks in the Archive
d'' Ophthalmologie, for February, 1892 :
''The doctor as well as the patient may
sometimes be the victim of a species of
auto-suggestion. The physician somehow
becomes convinced of the great value of a
remedy, without any scientific ground for
his opinion, and yet he considers it a
great fault if he does not administer it.
This belief does not injure the patient,
and may even assist in his recovery if he
has faith in the remedy, provided the
substances employed are of an inoffensive
character. When so powerful and ener-
getic a remedy as mercury is employed,
however, the possible beneficial effect of
the suggestion is purchased at too dear a
price, since the mercurial treatment, by
its deleterious effect upon the system,
may deprive the physician of a most
powerful ally in the curative action of a
good constitution."
There is great wisdom in the last re-
mark. The wise physician will ever keep
in mind the fact that the curative action
of the system itself, or the vis niedicatrix
fiaturce, is of far greater value than any
single remedy which could be employed
in a majority of cases of disease.
J. H. K.
The Influence of Tobacco upon Di-
gestion. — J. Ydan-Pouchkine recently
reports in Wratch, the results of experi-
ments upon seven healthy persons not
addicted to smoking, for the purpose of
determining the effects of tobacco upon
digestion. He made careful examina-
tions of the gastric juice for three days,
EDITORIAL,
381
during which no tobacco was taken. At
the end of that time, each of the seven
persons experimented upon were allowed
to smoke twenty-five cigarettes daily.
The gastric juice was examined each day
as "before. The observations were also
continued for an additional period of
three days, after which the use of to-
l)acco was discontinued. The results ob-
served were as follows : —
1. Tobacco increases the quantity of
gastric juice, but diminishes its acidity,
a significant fact, when it is recalled that
the degree of acidity of the gastric juice
is the measure of its activity in the ab-
sence of abnormal acid fermentations.
2. The quantity of free hydrochloric
acid in the gastric juice is diminished
under the influence of tobacco.
3. Just in proportion as the free hydro-
chloric acid is diminished, the digestive
power of the gastric juice is diminished.
4. Tobacco also diminished the ac-
tivity of the rennet ferment contained
in the gastric juice.
These facts should be carefully con-
sidered by those physicians who have
been in the habit of recommending to-
bacco chewing to their dyspeptic patients
as an aid to digestion. We have con-
stantly noted the remarkable fact that
tobacco smoking and chewing, though
not infrequently recommended as an
•excellent remedy for certain dyspeptic
conditions in men, are never prescribed
for women suffering from identical con-
ditions. There has never been the
slightest scientific basis for such a recom-
mendation, and the results of careful
scientific experiment now presented by
the authority above quoted furnish a
most excellent reason for prohibiting
tobacco, not only to those suffering
from feeble digestion, but also to those
who wish to keep their digestive organs
in a healthy condition.
The tobacco habit is one of the most
•conspicuous blemishes upon our modern
civilization. No apology can be offered
for it which is not equally good, or better,
for the alcohol habit, the opium habit,
the cocaine habit, or the hasheesh habit.
It is to be hoped that the time is not far
distant when medical men as a class, will
set their faces earnestly against poison
habits of every description. Then, and
not until then, can we hope for the be-
ginning of a general reformation on the
part of the laity. j. h. k.
The Infection of Milk. — A bacterio-
logical note in this issue, on the subject
of the infection of milk, suggests possi-
bilities of infection of a varied character
from this source. The case mentioned
by Prof. Gaffky, in which infectious en-
teritis was produced by the ingestion of
milk contaminated by the dejections of
a sick cow, presents a more striking ex-
ample of the transmission of a disease
from a lower animal to man than is
usually observed. There are numerous
other affections, many of them much
more dangerous, which may likewise be
transmitted, as affections of the alimentary
canal, and diseases affecting other most
important organs. It has long been be-
lieved by some high authorities that the
germs of typhoidfever are sometimes trans-
mitted through milk to persons using it.
There are many cases on record in which
it seems as if the malady could have been
produced in no other way. Not only the
germs of diseases affecting animals may
be transmitted to human beings, but
also various poisonous germs existing in
stables, on the bodies of the animals, in
the dejections, etc.
Furthermore, such affections as tuber-
culosis, as has been so often shown, may
be communicated directly to human be-
ings through the milk of diseased cows.
Thus it would seem that too much care
could not be taken in milking cows and
preparing the milk for human consump-
tion. It has been the duty of the writer,
during his career in public office as a
sanitarian, to inspect closely many dairies
382
EDITORIAL,
supplying milk to cities, and he has sel-
dom failed to find more or less contami-
nation of some sort.
It is very seldom that milking is done
in a very cleanly manner in large estab-
lishments, and what is called clean by
most milkers is in reality only relatively
so, and in fact often more or less filthy.
The inspection of dairies in most cities
where it exists at all, consists of chemical
analyses having for their object the deter-
mination of the quality of the milk, so
far as constituents are concerned. The
germs that it may contain are seldom if
ever inquired into. The question is not
considered at all in most cases ; in fact
the inspectors are seldom competent to
make bacteriological analyses.
There is need of a radical change in this
department of hygiene, but it never will
coVne until the public realizes the dangers
of polluted milk and filthy dairies, and
places inspection on a scientific basis,
free from political influence. p. p.
Toxicity of the Urine in Epilepsy. —
The remarkable researches of Bouchard
and his student Rogers, which have been
published from time to time within the
last few years, have attached to the study
of the toxicity of the urine, by means of
intravenous injections of this secretion in
rabbits and other animals, an importance
which is apparently quite too little known
and appreciated.
Bouchard has shown that the killing
power of urine varies greatly in different
pathological states, and his studies have
clearly demonstrated the fact that there is
an important relation between these va-
riations and the systemic manifestations
in various forms of the disease, — for ex-
ample, in pneumonia it has been shown
that the toxicity of the urine is greatly
lessened during the early period of
the disease ; but when the period of reso-
lution begins, the toxicity of the urine
is increased several fold. From which
the conclusion must be drawn, that in the
early part of the disease, the toxines pro-
duced by the pnenmococcus are retained
in the system, and that the ability of the
kidneys to eliminate the poisons ordina-
rily produced in the body, is lessened.
When the period of resolution arrives,
however, and the vital forces begin to gain
th^ ascendency, the accumulated poisons
are rapidly eliminated, giving to the
urine an abnormal degree of toxicity.
M. Fere has recently been pursuing the
same line of studies in relation to epi-
lepsy, and has discovered that there is a
great increase in the toxicity of the urine
before the convulsive paroxysm charac-
teristic of this disease, and during the
period of physical excitation.
The researches of Bouchard show that
the urine naturally contains a toxic agent
capable of producing convulsions, since
in many cases rabbits experimented upon,
die in convulsions.
It would seem that these experiments
would throw some light upon the etiology
of the disease, as it seems quite possible
that epileptic seizures may be in part due
to excessive accumulation within the body
of the particular toxine capable of pro-
ducing the symptoms present in this
malady.
Another hypothesis is, of course, pos-
sible ; viz., that the disease may be due to
an abnormal susceptibility developed in
the spasm-center of the brain, so that a
slight increase within the body of toxic
agents eliminated through the kidneys,
may have the effect of producing the,
explosion of energy which manifests itself
as an epileptic seizure. J. h. k.
^ • ^
The Comparative Vital Resistance
of Carnivorous and Vegetable -Eating^
Animals. — Bonnejoy, a French physi-
cian of some eminence, pointed out, a
year or two ago, the interesting fact that
the poison-destroying ability of animals,
a property which resides chiefly in the
blood corpuscles, the phagocytes, and the
liver, differs in animals with their habits
as regards diet, being greater in vegetable-
REVIEWS.
383
eating animals than in the carnivorous.
This important and interesting observa-
tion has recently been confirmed by ex-
periments conducted by Dr. W. Siebel,
of Elberfeld, for the purpose of investi-
gating the toxic properties of salophen.
Dr. Siebel found that a rabbit showed no
symptoms whatever after a dose of salo-
phen equivalent to four grams per kilo,
while a dog showed poisonous symptoms
after ten grains of salophen per kilo ad-
ministered in divided doses in the space
of six hours.
These experiments do not indicate high
toxic properties for salophen, but do show
a far greater susceptibility to the action
of blood poisons on the part of the dog.
The writer has undertaken some ex-
periments for the further elucidation of
this interesting physiological fact. A
ready explanation of the susceptibility of
the dog to poison is the fact that the blood
corpuscles and the phagocytes as well as
the liver are compelled to expend the
greater part of their energy in the de-
struction of ptomaines and other poisons-
introduced with the food of the animal, a
task not required of the vegetable-eating
rabbit or other creatures which do not
feed upon the flesh of animals. j. h. k.
Reviews.
'*The Principles and Practice of
Medicine. Designed for the Use of
Practitioners and Students of Medi-
cine."—By William Osier, M. D., Fel-
low of the Royal College of Physicians,
Professor of Clinical Medicine in the Uni-
versity of Pennsylvania, Philadelphia, etc.
D. Appleton & Co., New York.
This work of a little more than looo
pages, is the latest American contribution
to the already considerable list of text-
books upon the practice of medicine which
have been published in this country, and
we think it not too much to say that it is
one of the best. One can scarcely read a
page without being impressed with the
great care which has been taken to bring
the work up to the very latest date in the
inclusion of the results of scientific re-,
search, and in the exclusion of exploded
theories and obsolete practices. In
this respect, the work seems to us to be
far ahead of any similar one which has
appeared within the last dozen years.
The author gives the fullest assent to
the germ theory of disease, and con-
tinually makes practical applications of
the theory in his prescriptions for treat-
ment. We are especially glad to note
the very thorough and practical treat-
ment of the subject of typhoid fever,
which forms the introductory chapter of
the work. The treatment of nervous
diseases is also worthy of the highest
commendation. The author seems to
have found the happy mean between the
extremely technical mode of treating the
subject required for the specialist, and
the concise, comprehensive, and practical
manner of presentation required for the
average -practitioner.
In a work so complete in other re-
spects, we are surprised to find no men-
tion made of the remarkable work done
by Bouchard and his pupil Rogers, in
the study of the toxicity of the urine.
In view of the facts presented by these
authors, it seems impossible to ignore
the importance of this line of inves-
tigation. The kidneys are the avenues
through which the great majority of
toxic substances, including the toxines
formed by microbes in the alimentary
canal, find their exit from the body,
and the light which has been thrown
upon a great variety of toxic symptoms,
particularly the various infectious dis-
orders, but also some chronic diseases,
by a study of the toxic properties of the
urine, after the intra-venous injection
method of Bouchard, gives to the sub-
ject an importance which certainly en-
titles it to mention if not to complete
elucidation in every modern treatise on
the practice of medicine.
384
REVIEWS,
We should like, also, to have seen in
this excellent work a mention of the
methods of examination of gastric fluids
perfected within the last year or two by
Hayem and Winter, of Paris. The meth-
ods given by the author, which are essen-
tially those of Boas, have been clearly
shown by Hayem and Winter to be quite
unreliable. It is true, as stated by the
author, that the determination of the total
acidity by acidimetry estimates ''not only
the free HCl, but that in combination ; "
but it is not true that shaking the gastric
contents with ether will remove all the
organic acids present. Each acid has its
own coefficient of solution, when taken in
an aqueous solution and shaken with ether,
but a sufficient amount is left behind to
constitute a serious source of error. It
is also incorrect to employ this method
as a means of determining the amount of
free HCl, since the chlorine in combina-
tion with albumen possesses the same
degree of acidifying function as does free
HCl ; so that, with a given total acidity,
the chlorine present might be entirely in
the form of free HCl, or free HCl
might be absent, and chlorine present only
in combined form. It is a matter of great
practical importance to know whether the
chlorine is in a free state, or whether it is
combined with albumen, and whether the
relation of the combined chlorine and free
HCl is the normal one. The method of
Hayem and Winter determines with abso-
lute exactness the total amount of chlo-
rine present, and the different conditions
in which chlorine is found present,
whether fixed with bases, combined with
albumen, or in the state of free hydro-
chloric acid. It is thus possible to make
a scientific classification of disorders in
the chemical processes of the stomach,
and to found thereon a rational mode of
treatment for the relief of these disorders.
We also note that the author omits the
mention of methyl-violet as a test for free
hydrochloric acid. We have found this
test to be one of the most delicate and
reliable of the many which have been
proposed, besides being very convenient
in application.
On the whole, however, the work is, as
we have before stated, the best of its kind
which has recently appeared, and will
doubtless soon find its way into the lab-
oratory of every progressive physician.
J. H. K.
P. Blakiston, Son & Co., Philadel-
phia, Announce as in Press, ''Mate-
ria Medica, Pharmacy, Pharmacol-
ogy, and Therapeutics," by Wm. Hale
White, M.D., F.R.C.P., etc.. Physician
to, and Lecturer on Materia Medica, at
Guy's Hospital ; Examiner in Materia
Medica, Royal College of Physicians and
Royal College of Surgeons, etc. Ameri-
can Copyright Edition, edited by Rey-
nold W. Wilcox, M. A., M.D., Professor
of Clinical Medicine at the New York
Post-Graduate Medical School and Hos-
pital, Assistant Visiting Physician Belle-
vue Hospital, etc. Printed in one com-
pact, handy volume.
" Nursing in Abdominal Surgery
and Diseases of Women," by Anna M.
Fullerton, M. D., Physican in charge,
and Obstetrician and Gynecologist to the
Women's Hospital in Philadelphia. Pub-
lished by P. Blakiston, Son & Co., Phil-
adelphia.
This little work of 284 pages contains
the best summary of the views generally
held upon the subject treated, which has
yet appeared. In fact, so far as we know,
it is the only treatise of the sort which
has yet been published. The work is
eminently practical in its character, and
the author has evidently taken great pains
in its compilation. Abdominal surgery is
so new and progressive a department of
medicine, it will not be matter of surprise
if few surgeons are found who agree ex-
actly with many of the methods outlined
and the specific directions given, as each
successful operator has methods of his
own to which he has been led by his own
personal experience, which are, in his
hands, most successful, and to which he
naturally feels inclined to trust in prefer-
ence to others. But certainly, every
candid abdominal surgeon who peruses
this work will find something which he
will be glad to utilize. It would be too
much to say that we indorse everything
the work contains ; but it is certainly too
valuable a treatise to be omitted from the
library of any nurse or physician who
wishes to be thoroughly posted in this
branch of surgical work.
HERE TO
SPEND THE
INTER!
At this Seasox of the Year Thousands of
Invalids are Seriously Considering
THE Question, —
Where can I Spend
THE Months of
Nouember, December,
Janiiary, Pebrdary, ►*'> March,
With the GREATEST PROFIT?
THE ANSWER
to this question will depend
upon what the individual
wishes to accomplish by a
sojourn away from home. If rest and recuperation are the chief requirement, the
Southern and Pacific Coast States offer numerous attractions which draw throngs of
semi-invalids and valetudinarians every year.
If, in addition to rest and recuperation, the invalid needs a careful study of his
diseased conditions, and an intelligent regulation of diet, exercise, and all other
health conditions, — in other words, scientific health culture, efficiently carried out
by the aid of the best known medical means and appliances, thoroughl)^ trained
nurses and attendants, and competent physicians, — then the choice between the most
desirable places becomes very much restricted. There are certainly few institutions
in this country where the needs and desires of an earnest, health-seeking invalid can
be satisfactorily met. Such places can be counted on the fingers of one hand, and
are, perhaps, little known because of the fact that the managers of such institutions
are conducting them in a scientific, and in some instances a philanthropic spirit, and
consequently do not employ as a means of winning patronage, the emblazoned ad-
vertisements, the truth-sacrificing circulars, and other advertising methods com-
monly resorted to by the proprietors of mineral springs establishments, bogus
sanitariums, and other so-called ' ' health institutions ' ' and quasi-medical establish-
ments, with which the country abounds.
The advertisements of these establishments do not appear in public prints or
popular magazines because such advertising is closely akin to quackery, and brings
those who employ it into bad company.
The managers of the Sanitarium at Battle Creek, Michigan, many years ago
undertook to organize a thoroughly scientific institution which would represent
rational medicine in its most advanced form, and would be exactly what it professed
to be — an institution where patients are honestly and fairly dealt with, treated at
reasonable rates, given kind attention and comfort, and opportunity for the recovery
of health under the most favorable conditions. The majority of patients treated in
this institution are sent to it by physicians who by personal acquaintance, or
through the reports of their patients, have become thoroughly familiar with the
character of the institution and its management.
DESCR/PTION
OF" THE
"^ ATTlyB CREEK, one of the most beautiful and prosperous cities of Michi-
^ gan, is centrally located in the salubrious Peninsular State. Its population
is 20,000, while its death rate is but seven per thousand. Battle Creek is
situated on two great thoroughfares of railway travel between the East and
the West, being at the junction of the Grand Trunk and the Michigan Central lines ;
and two other railways make it easy of access from the South.
The city has an electric railway and is lighted by electric lights. A great
number of pleasant drives are afforded by its well-kept and shaded streets.
The Buildings are lighted by a 700-light plant, Edison incandescent system.
Safety Hydraulic Elevators. Outside stairways for fire escapes accessible
from every window.
The Institution affords facilities for baths of every description : Turkish, Rus-
sian, vapor, electric, water baths of all kinds, and the electric light bath. In-
dependent accommodations for ladies and gentlemen, sufl&cient for 80 persons
at one time. More than 800 feet of glass for sun baths.
A General Parlor, 40 x 50 feet, is luxuriously furnished with Dhagistan rugs,
easy chairs, etc. The Dining- Room has a seating capacity of 400, is beauti-
fully lighted and ventilated, and always cheerful. No kitchen smells. Cui-
sine unsurpassed ; table service excellent. Everything an invalid needs, and
special dietaries prepared as directed.
THE GYMNASIUM.
The Gymnasium, 85 x 45 feet, is supplied with every appliance for exercise, and
furnishes special instruction and class drills in Delsarte and Swedish gymnas-
tics, under a trained director. Exercise by prescription.
The S^vedish Movement Department, both manual and mechanical, is the
most extensive in the United States. Vibrating bars and seats, kneaders, rub-
bers, beaters, shakers, and manipulating appliances of all sorts.
The Electrical Department contains every improved appliance for medical ap-
plications of electricity. Galvanic, Faradic, Dynamic, and Static electrical
apparatus and appliances for electrolysis, electro-cautery, etc.
An Aseptic Maternity on the cottage plan ( steam heat and thorough ventila-
tion ), provides the best possible conditions for lying-in patients, with expe-
rienced professional attendance and rigorous aseptic management.
Special Departments for surgical cases, eye, ear, throat, and lung diseases,
nervous diseases, genito-urinary diseases of men (non-specific), opium and
alcohol habits, and diseases of women. A kindergarten and nursery, to keep
the children happy and out of mischief.
Three Fine Greenhouses, maintaining a
magnificent collection of palms and va-
rious tropical flowers and plants, keep the
house filled with bloom during the win-
ter season. Flowers are everywhere in-
doors during the winter season. Patients
can visit the greenhouse at any time
without going out of doors.
Glass=Inclosed Sun^Parlors and Veran=
das for winter sunning and promenad-
ing.
SUMMER HOUSE AND FRESH-AIR INLET.
Pure Water from sandstone rock.
There are from 250 to 300 Employes in the Sanitarium service the year
round, of whom from 90 to 100 are medical attendants and nurses. Also seven
thoroughly trained physicians, and a large corps of manipulators skilled in
massage and the lying system of Swedish movements.
The Sanitarium Training=School, in which our nurses are trained, is the
largest and most popular in the United States. Its course of training is
the most complete and
thorough of any school.
Tri=Weekly Lectures on pop-
ular medical subjects by
the physicians.
Ahundant Means for Rec=
reation indoors during
inclement weather. Facil-
ities for walking, driving,
and horseback riding at all
seasons. ^^^
The Sanitarium is Not a
Pleasure Resort nor a
fashionable hotel, but an
ideal place for invalids needing good nursing, the benefits of regular habits,
and scientific professional care and treatment, and who desire to become per-
manently well.
The Sanitarium Nursery and Kindergarten. This enables mothers to bring
little ones with them without being burdened with their care and supervision.
The children have the advantages of kind and experienced teachers and am-
ple playgrounds.
For Further Particulars, see large circular and card of rates.
J. H. KELLOGG, M. D,, Supt.,
Sanitarium, BATTLE CREEK, MiCH.
MAIN ENTRANCE.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
IMONTTHI^Y BULIvETTIN.
Battle Creek, Mich., September, 1892.
CLINICAL AND EXPERIMENTAL TUBERCULOSIS.
In our investigations on the relative action
of microbes and their products in the produc -
tion of disease, we have made numerous ex-
periments and observations on the relative
effects of the bacillus of tuberculosis and the
poisons which it generates. Inoculated sepa-
rately, it is possible to observe the differences
in effect, and the role which each of them plays
individually; and then, by mixed inoculations,
to show the action of the two together as oc-
curs in accidental disease, or by inoculation
of cultures or of sputum. Generally speaking,
the effect of the germs of pure cultures, when
inoculated in a healthy tissue, or in the pleural
cavity, or in the lungs, or the peritoneum, dif-
fers somewhat from the inoculations made with
infectious sputum.
Pure cultures produce a well-defined, clean-
cut, usually uncomplicated tubercle, free from
foreign micro-organisms. Inoculations with
sputum usually cause the production of com-
plicated pustules, abscesses, and occasionally
irregular and non-typical tubercles contami-
nated by other germs and other productions.
By separating from the culture media the sub-
stance which has been known for some time
under the name of tuberculine, it is possible
to inoculate the two separately, that is, the
plant and its chemical poisonous product.
Thus separated, the plant can still produce tu-
bercles in which new chemical products arise;
the tuberculine only causes a more or less pro-
nounced disturbance of the circulation and
nervous system, with more or less fever, with-
out the formation of tubercles. The acute or
the chronic form of the disease may be pro-
duced by the inoculation of pure or impure
tuberculous cultures.
In observing the symptoms and fever of tu-
berculosis produced thus with pure cultures,
and the tuberculosis which occurs accidentally,
we observe parallel development. In both in-
stances we observe acute and chronic forms.
In the acute case, the disease more or less rap-
idly runs its course; tubercles do not gather in
masses, but the germs seem rather to take
a whole organ or several organs by storm, as
it were, the germs developing with wonderful
rapidity, and scattering through the blood
and lymphatic circulations. In chronic cases,
the germs localize and develop localized tuber-
cles. They usually become, for a time at least,
wholly surrounded by walls, through the efforts
of nature. These cases may end in acute tu-
berculosis at a given time.
If now we consider the effects of the inocula-
tion of tuberculine alone, we may observe, ac-
cording to the dose administered, more or less
symptoms of poisoning, with febrile reaction
more or less intense. But in this, as in other
kinds of poisoning, there is no period of in-
cubation, no spreading of the disease in the
organism, no generation of new poison ; it is
a pure, simple case of poisoning, in which
the blood and nervous system are the most
deeply interested. When these symptoms sub-
side, either by death or recovery, no tubercles
or true tuberculous lesions exist.
It is then possible to separate the germs of
tuberculosis and their products, inoculate them
separately, and watch the results of each, not-
withstanding that so many antagonists of the
bacterian theory claim that it cannot be done
satisfactorily. The separation is possible by
means of washing and filtering, as wasexplained
in the article on the " Relative Role of Germs
and Their Products," in Laboratory of Hy-
giene department, August number pf this
journal.
Recently MM. Drayfus-Brisac and Bruhl have
published a most interesting work on the study
of the different clinical forms of tuberculosis.
They are divided into, —
A. Acute miliary tuberculosis with pyrexia,
under which heading they have the following
subheads : First, a typhoid form ; and second,
an attenuated form of pyrexia.
B. Miliary acute thoracic tuberculosis, under
which heading they count: First, the suffocat-
ing form ; second, a bronchial or broncho-pneu-
monic form ; and third, a pleural form.
mJn this very complete work the authors dem-
(389)
390
LABORATORY OF HYGIENE.
onstrate very clearly that there exist two very
distinct forms of acute tuberculosis, one in
which the infection is general, and the morbid
poison of which reaches various portions of the
body through the blood and lymph ; another
in which the acute symptoms are localized in the
chest — it is a local affection of the lung, in fact,
where the microbes have penetrated by means of
the bronchials.
We might likewise subdivide the chronic forms
of consumption according to their localization
and pathological nature.
Thus, to sum up, tuberculosis is a disease
which is essentially due to the bacillus of Koch,
and the poisons generated are only a part of
the factors in causing illness and death. The
symptoms and course of the malady, taking
all complications into account, are of vast
importance in therapeutics.
In the treatment of tuberculosis, therefore, it
is well to remember these facts, for whereas
the chronic affection or the local acute affec-
tion might yield to certain forms of treatment,
generalized tuberculosis and most other forms
of localized acute tuberculosis are not thus
amenable to treatment. These facts should
play a very important role in the deliberations
of the physician, in determining whether or not
to send a patient away, and to what distant
climate this or that consumptive should go
for health.
Acute cases, local or general, do not do well
at a high altitude; in fact, a majority of them
would be and really are injured, or are some-
times killed outright by the production o f
hemorrhages, etc. p. p.
ANALYSIS OF STOMACH FLUIDS.
The recent work of Hayem and Winter, two
of the leading physiological chemists of Paris,
has thrown wonderful light upon the chemistry
of digestion. Their plan of investigating
stomach fluids was quite fully presented in an
article by the writer in the August number of
this journal . An extended investigation of the
relation of various foods, medicines, and hy-
gienic conditions to the chemical process of the
stomach, is being carried on in the Sanitarium
Laboratory of Hygiene at the present time,
the full results of which will be reported in a
future number. Nearly four hundred analy-
ses of stomach fluid have been made in the
Laboratory up to present date. We trans-
late the following description of the method
from the work entitled, "Du Chimisme Stoma-
cal," by Hayem and Winter: —
"Place in three capsules designated respect-
ively as a, h, and c, 5 c. c. each of the stomach
liquid previously well filtered.
"To capsule a, add an excess of carbonate of
soda; then evaporate all the capsules to dry-
ness on the water-bath, after which proceed as
follows: —
"Carry capsule a progressively and cau-
tiously to a red heat, avoiding a higher tem-
perature. To h asten destruction of the organic
matters, and to diminish the action of the
heat, the dried residue should be broken and
stirred frequently with a glass rod.
"The capsule should be withdrawn from the
heat when the points of ignition are no longer
visible, and when the mass becomes pasty by
the beginning of the fusion of the carbonate of
soda.
"The calcination should be just sufficient to
produce a colorless solution. After cooling,
add distilled water and a slight excess of pure
nitric acid boiled, to drive off the excess of car-
bolic acid. Then neutralize the solution, or
even render it slightly alkaline by the addition
of pure carbonate of lime or soda. In employ-
ing carbonate of soda, the limit of alka-
linity is indicated by an abundant precipitation
of calcareous salts which carry down all the
carbon.
" After filtration with Berzelius's filter paper,
and washing the residue with boiling water,
the amount of chlorine present is determined
by a decinormal solution of nitrate of silver in
presence of neutral chromate of potash.
" The addition, as stated above, of a slight
excess of nitric acid, favors the separation of
the carbon. The final addition of the carbon-
ate of soda in very slight excess, increases the
sensibility of the indicator without interfering
with the reaction.
" Proceeding in the manner above described,
and taking all the necessary precautions,
absolutely constant results may be obtained
with the same liquid. The sensitiveness of the
method with the chromate of silver is great.
"The figures furnished by a, and expressed in
HCl, represent the total amount of chlorine
contained in the stomach liquid.
"(fo.) After prolonged evaporation at 100°
C, for an hour after the disappearance of all
liquid, add an excess of carbonate of soda
again; evaporate again, and proceed as before
for the determination of the amount of chlorine
present.
"The figures furnished by capsule b represent
the total chlorine less that which has been
driven off by prolonged evaporation on the
water-bath, that is to say, less the free hydro-
chloric acid; a— 6 = free HCl.
" By evaporation on the water-bath at 100°,
LAEORATORY OF HYGIENE.
391
ized gelatine. 10. A number of test-tubes with
sterilized nutrient bouillon. 11. A few Erley-
the same results are obtained as in an oven at
110°; but if the last temperature in exceeded
even very slightly, the mass gives off white
fumes, and the results are vitiated. So, for
constant results, it is better to employ pro-
longed evaporation on the water-bath.
'•(c.) After drying, capsule c is calcined with
care, without the addition of soda. By break-
ing the residue, the calcination is hastened,
and requires but a short time. Here, espe-
cially, excessive elevation of temperature must
be avoided. The heat is arrested when the car-
bon becomes well dried and friable. The cap-
sule should be quite deep, and only the bottom
should be touched by flame, the upper portion
being protected by wire cloth. After cooling,
proceed as before.
"The figures obtained from b represent the
amount of fixed chlorides, consequently b — c
will give the amount of chlorine lost during
the calcination of the residue of capsule c, that
is to say, the combined chlorine."
The following cases in actual practice will
illustrate the mode of utilizing the data ob-
tained by the method above described. The
stomach fluid tested by the color reagents
gave a Congo-red, very slight reaction with
methyl-violet. For capsule a, .320 gms. For
capsule b, .264 gms. For capsule c, .056 gms.
From this data we obtain the amount of HCl
and combined chlorine, expressed as hydro-
chloric acid. 320 (a) — 264 (b)=56 (H), the
amount of free hydrochloric acid. .264 (b) —
.056 (c) = .208, the amount of chlorine com-
bined with albumen, represented by (C). The
total acidity was found to be .128. Substitut-
ing these figures for the symbols in the foUow-
A — H
mg formula — ^ — = a (for explanation of
which see article in August number, entitled,
" The New Chemistry of the Stomach " ) , we have
.128— .056
208 ' '^(^)» which, worked out, gives us
as the value of (a) .34.
We now have for examination the following
quantities: The total acidity (A) .128; coef-
ficient (a) .34; total chlorine (T) expressed as
HCl, .320; free HCl, .056; organic chlorides
or combined albumen (C) .208. Comparing
these quantities with the table of normal va-
riations found on page 327 of the August
number, and writing out the corresponding
XT _|_ J
formula,wehave,A— a— T = -Yrx C "^"' ^l^^ch
will be recognized at once by the great excess
of free hydrochloric acid and combined chlorine
as a case of hyperpepsia, notwithstanding the
absence of hyper-acidity.
From the formula, A
ing .86 for coefficient, the normal "alue of (a),
and introducing the figures o'" med and mul-
tiplying, we have .128 astht alue of A', which
represents the acidity which the amount of free
and combined hydrochloric acid would produce
if the chloro-albumen compounds were nor-
mal, .208 X .86 = .178 + .056 = .234. The dif-
ference between .128 and the actual acidity
(A — A'), is .10106, a deficiency which is ex-
pressed in the figures shown for coefficient (a),
.34, which expresses the quality of the useful
work done by the stomach. In this particular
case the amount of work done by the stomach
is ample in all respects, but the quality of the
work done is poor. After an analysis of this
sort there need be no hesitancy in deciding
what needs to be done for a patient.
As the Sanitarium Laboratory is the only
institution of the kind in this country at the
present time which is carrying on investigations
of this sort, the managers have decided to place
their facilities at the disposal of the medical
profession for analysis of stomach fluids, when
the fluid can be received at the Laboratory
without too great lapse of time after removal
from the patient. One such examination will be
made without charge for any physician who is a
subscriber to this journal. In other cases, the
sum of $2 will be charged for the examina-
tion, which requires several hours of pains-
taking work in each individual case. Those
who wish to -avail themselves of this offer
should write for directions for obtaining and
sending the stomach fluid.
Technique.
The Test for the Comma Bacillus. — In view
of an impending epidemic of cholera in this
city, and probably in the greater portion of the
other cities this side of the Atlantic, I desire to
give your readers the usual method of exami-
nation of dejecta of suspected patients, as prac-
ticed in the Bacteriological Institute at Berlin.
The articles necessary for the examination
are: 1. A microscope with Abbe's condenser
and the oil-immersion system. 2. A solution
of fuchsin 1 gm. (Rubin) in 90 c. c. distilled
water and 10 c. c. alcohol. 3. A few pipettes,
glass rods, object-glasses or cover-glasses, and
slides. 4. A few platinum wires melted or sold-
ered to the end of glass rods. 5. A few hollow
slides. 6. Ten to twelve glass plates or glass
panes about 12 ctm. long and 9 ctm. wide. 7.
About a dozen ordinary flat plates. 8. An alco-
hol lamp, or gas being preferable, a Bunsen
burner. 9. A number of test-tubes with steril-
392
LABORATORY OF HYGIENE.
mer's glasses, about one third filled with 1 per
cent peptone solution : 1 gm. peptone, 0,5 gm.
chloride of sodium, 100 gras. distilled water.
12. Concentrated sulphuric acid.
The dejecta of suspected patients are scat-
tered in as thin a film as possible on a plate,
and this is carefully examined with the aid of a
platinum wire for a mucous flake, " Schleim-
flocke," which is laid on the edge of the plate
and isolated.
From this we take a piece the size of a pin-
head, and sterilize a platinum loop (by draw-
ing it through a. Bunsen burner), and then rub
it on a cover-glass until it is evenly divided;
then remove all superfluous material by press-
ing another cover-glass over it, an|d allow it to
get air-dry.
Then draw it three times through a Bunsen
burner in the same manner as we proceed in the
examination of sputa for the tubercle bacillus,
and by means of a pipette add a few drops of
the fuchsin solution for about one to two min-
utes to the cover-glass, and then wash it off in
distilled water. Then add a drop of water to
the cover-glass, lay it on a slide, and examine it
with the oil-immersion system.
If we wish to preserve the specimen, we could,
after staining with the fuchsin solution, wash
off the excess of stain with distilled water, and
allow it to get thoroughly air-dry, then add
some Canada balsam.
In some cases, called "foudroyant," where
the intestinal contents have a colorless or pale
red color, with slimy (mucous) flakes or with a
flour-soup mass, we will frequently find, espe-
cially, however, in the reaction period with
cases running a slow course, no mucous flakes,
but large quantities of blood. Here there are,
besides cholera bacilli, large quantities of
other micro-organisms, and sometimes only
the cholera bacilli sparingly, so it is advisable,
to render a diagnosis absolutely positive, to
add to microscopical examination the exami-
nation by the aid of "cultures."
. Cultures can best be made in "hollow slides"
by smearing the border with vaseline, then
bringing a small drop (from a platinum loop)
of sterilized bouillon into this hollowed groove
of the slide, and inoculating this latter bouillon
with the smallest possible particle of the sus-
pected mucous flake. The cover-glass is care-
fully laid on the vaseline, which serves to ren-
der the groove air-tight, and also prevents the
evaporation of this drop of sterilized bouillon,
which is then laid aside in a temperature of 20°
to22°C. The room can be heated if the tempera-
ture of the air is below this. It takes about
twenty hours to have the bouillon turbid, and
this slide (hollowed, containing the infected
bouillon) can be examined with the oil-immer-
sion without disturbing the culture. The best
place to examine is the border line, and even if
but few cholera bacilli were formerly present,
they grow so rapidly that they will be easily
recognized by their curved shape.
Culture Method by Schottelius.—Take 100 to
200 c. c. of the suspected dejecta from intesti-
nal contents, and place them in a beaker glass
containing 250 to 500 c.c. of mild alkaline meat
bouillon, and mix thoroughly; then let this
mass stand twelve to twenty-four hours at a
temperature of 30° to 40° C. After this time
the cholera bacilli have usually increased in
numbers, and are found on the upper layer of
the fluid. Introducing at the upper layer a
platinum loop, and taking out a small drop
(about the size of a lenten seed) and rubbing it
on a clean cover-glass, we allow it to dry thor-
oughly (air dry) ; then draw it three times
through a flame to flx it, and finally stain, as
previously described, with the fuchsin solution.
Post-mortem Tests. — To examine suspected
intestinal contents, I open the abdominal cavity
carefuUj^ and ligate, with the aid of two stout
cords or twine, a piece of the ileum (about three
to four centimeters in length), well filled with
fecal contents, near the caBcum. It is well to
apply a ligature close to the upper ligature,
and another below the lower ligature, and cut
between the two ligatures, so that the intesti-
nal contents will not be spilled in the abdomi-
nal cavity and prevent the completion of the
autopsy. It is well to cut out a piece of the
intestine, about three to four centimeters in
length, from the upper portion of the ileum,
and to lay its excised portions in ordinary
water until ready for use, i. e., examination of
contents. The method is the same as has been
described, i. e., take a small piece of floculent
mucus, about the size of a pin-head, and exam-
ine it. Gelatine stroke and stick cultures, and
also potato cultures, can be made for examina-
tion. They also grow on blood serum and
agar.
Human beings are usually infected through
the mouth, i. e., through food, etc.; but it is
found that if the stomach is partly fllled and
has sour reaction (gastric juice), the latter acts
as a barrier to the infectious material.
Cholera bacilli require for their growth a mild
alkaline nutrient medium, and are very sensi-
tive regarding mineral acids.
By adding 0.07 to 0.08 per cent of muriatic
or nitric acid to a neutral nutrient solution,
the growth of the bacilli was stopped. This
statement is found in Gunther's "Bakteriolo-
gie," p. 210, and is made by Kitaseta. — Louis
Fischer, M. D., in N. Y. Med. Record.
PUBLISHERS' DEPARTMENT.
Salophen in Acute Rheumatism.— From re-
•cent reports it appears evident tliat the new
organic compound, acetylpara-amidosalol, or
salophen, is to take a very high place in
therapeutics; not only in acute rheumatoid
maladies, but in those in which a principal ob-
ject of treatment is to secure an undisturbed and
•continuous intestinal antisepsis without risk of
injury to the patient.
The New York Medical Journal of July 30,
1892, contains an article on salophen, written
by William H. Flint, M. D., of the Presbyterian
Hospital, which foreshadows some of the excel-
lent effects which may now be expected from
this extraordinary new remedy.
Dr. Flint says that during his summer hospi-
tal service, he caused salophen to be adminis-
tered to all cases of rheumatism, and that he
was so well pleased with its action that he
"desires to make known to his confrei'es the
advantages of salophen treatment, hoping their
results may be as happy as his own."
The author presents detailed reports of six
cases of acute rheumatism treated with salo-
phen in 15-grain doses, given dry upon the
tongue, and swallowed with cool water, every
three hours, and with sodium bicarbonate, in
10-grain doses, administered in the same way,
thrice daily.
Dr. Flint's conclusions concerning the results
obtained are stated by him as follows : —
"From the above given histories it willbe
seen that in all the cases except the last, the
pains were quite relieved, the redness dispelled,
and the temperature reduced to the normal
point on the second or third day of treatment.
In the exceptional case the patient may have
exaggerated theintensity of her pain to prolong
her stay in the hospital ; but no objective symp-
tom persisted, after the seventh day of treat-
ment. It is probable that a speedier result
may be safely obtained by the use of larger
doses, or of the same doses at shorter inter-
vals. In none of the cases was the heart's action
at all weakened, nor was the digestion impaired
by the remedy. The urine was unaffected by
the treatment."
The writer concludes that: "We possess in
salophen a remedy equally potent as the other
salicylates to control the symptoms of acute
rheumatic arthrites, but devoid of their tend-
ency to weaken the heart's action, to disturb
the stomach, and to produce albuminuria and
smoky urine."
It will be observed, as hinted by Dr. Flint,
that he might, had he so desired, have used
larger doses of salophen, as, indeed, others
have done; but many will agree that our best
and most lasting results are often obtained
with medium or small doses.
Dr. Flint adds : " It is the writer's purpose to
conduct a series of experiments with a view of
ascertaining whether salophen may be made
available for securing intestinal antisepsis."
We are glad to learn of this intention, not only
on account of the authors well-known reputa-
tion in the treatment of gastro-intestinal mala-
dies, but because other observers have already
spoken of the value of salophen in such formid.
able affections as gastrectasis and other severe
conditions of which abnormal fermentations
constitute a symptom.
Bouchard's experiments, reported a few years
ago in an interesting and excellent work en-
titled "Auto-Intoxications," show very clearly
an important relation between intestinal sepsis
and rheumatism. A large proportion of the
cases of rheumatism investigated, were suffering
from dilatation of the stomach, one of the most
potent of all causes of abnormal fermentation
and decomposition in the alimentary eanal. It
seems very probable, although we have no per-
sonal experience on which to base the sugges-
tion, that salophen is beneficial to rheumatism,
as shown by Dr. Flint's observations, through
its activity' as an antiseptic agent. We shall
await with interest the report of Dr. Flint's
further investigations.
A View of the World's Fair Buildings in
the iorrn of a large-sized lithograph, in eight
colors, with key to same, can be had by sending
your address with twenty cents in postage
stamps, to Geo. H. Heaftbrd, G. P. A., Chicago,
Milwaukee & St. Paul R'y, Chicago, 111. As the
supply is limited, applications must be made
early. Should the supply become exhausted,
the postage stamps will be returned to appli-
cant.
North Star Points is the title of a book of
reference for all points between Chicago and
Lake Superior on the line of the Milwaukee &
Northern R. R., and is a valuable publication
for business men and tourists who may be in-
terested in the development of the agriculjbural,
mineral, and timber resources of Northern Wis-
consin and the upper peninsula of Michigan.
This book, together with an illustrated pam-
phlet telling " Where the Trout Hide," willbe
sent free upon application to Geo. H. Heafford,
General Passenger Agent "North Star Route,"
Chicago, 111., or to Harry Mercer, Michigan
Pass. Agent, 82 Griswold St., Detroit, Mich.
The Mississippi Valley Medical Associa-
tion will hold its eighteenth annual session at
Cincinnati, Wednesday, Thursday, and Friday,
Oct., 12, 13, and 14, 1892. The program is a
valuable one, containing many of the most
prominent names in the profession. It covers
every department in medicine. The attendance
will he unusually large, as Cincinnati is the cen-
ter of population of the United States. Not
only the scientific, but also the social part of
the meeting will be of the highest order. The
interest of the convention will be augmented
by the meeting of the officers of the Pan-Ameri-
can Medical Congress, also other bodies of
medical men. Dr. Benjamin Ward Richardson
has written his earnest desire to be present. The
Association will be just in time and just in line
forthoseenrouteto the American Public Health
Association in the City of Mexico. Among the
many prominent gentlemen who are expected
to read are the following: Dr. Hunter McGuire,
Richmond, Va., President of the American Med-
ical Association, the address on Surgery; Dr.
Hobart Amory Hare, professor of Materia Med-
PUBLISHERS' DEPARTMENT.
ica Jefferson Medical College, Philadelphia, the
address on Medicine. Papers are expected by
Drs. Reed, Ricketts, Hall, Dowiing, Ayres, Con-
nor, Ransohoff, Hoffe, Dandridge, Comegys,
Whittaker, Zenner, Ziuke, Cincinnati; Cook,
Woodburn, Thompson, Indianapolis; Owen,
"Walker, Evansville; Lydston, Moyer, Belfield,
Hamilton, Chicago; Mathews, Wathen, Larra-
bee, Reynolds, Renner, Louisyille; Savage,
Nashville; McGahan, Chattanooga; Dixon,
Henderson; Hughes, Love, Loeb, Dalton, Borck,
Bond, Hulbert, Mclntyre, Ohmann-Dumesnil,
Lewis, St. Louis; Lanphear, Kansas City;
Smith, Montreal; Sutton, Murdock, Daly, Pitts-
burgh; Early, Ridgway, Potter, Thornbury,
Buffalo; Baker, Cleveland, Thorn, North, To-
ledo; Walker, Detroit; Jones, Eaton, Baldwin,
Columbus; Bond, Richmond. C. A. L. Reed,
M. D., Pj-esident, Cincinnati; E.S.McKee, M.D.,
Secretary, Cincinnati.
"Ne;w Facts about the DAKOTAs"isthe title
of the latest illustrated pamphlet issued by the
Chicago, Milwaukee & St. Paul Ry., regarding
those growing States, whose wonderful crops
the past season have attracted the attention of
the whole country. It is full of facts of special
interest for all not satisfied with their present
location. Send to Harry Mercer, Michigan
Pass. Agent, 82 Griswold St., Detroit, Mich.,
for a copy free of expense.
Many physicians are recommending the use
of Horlick's Malted Milk as a table drink in
place of tea, coffee, cocoa, etc. The evil effects
of the long-continued use of tea or coffee are
well known, but the difficulty has been to pro-
vide a pleasant and satisfactory substitute.
Malted milk, served either hot or iced, makes
one of the most pleasant, refreshing, and nutri-
tious drinks imaginable, little if any more ex-
pensive than the ordinary drinks, and of course
far more healthy and nutritious. Does not
stimulate but aids digestion. Prepared by sim-
ply adding water. Address the Malted Milk Co.,
Racine, Wis., for samples.
Contents of Lippincott's Magazine for
October.— "The Kiss of Gold" (illustrated),
Kate Jordan; "Hearing my Requiem" (Jour-
nalist series), George Alfred Townsend; "The
Prayer-Cure in the Pines" (poem), Clarence H.
Pearson; "At the Stage Door" (illustrated),
Robert N. Stephens; "The Carnival at St.
Louis" (illustrated), James Cox; "Unconscious
Service" (poem), Margaret J. Preston; "Mus-
cle-Building" (Athletic series), Edwin Checkley ;
"Old Paris" (illustrated), Sigmund J. Cauff-
man; "Under the Harvest-Moon" (poem),
Helen Marion Burnside; "James Russell Lowr
ell," Richard Henry Stoddard; "Christopher
Columbus" (poem), John B. Tabb; "Men of
the Day," M. Crafton ; "As it Seems; " «' W^ith
the Wits" (illustrated by leading artists).
ANTISEPTIC.
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DEODORANT.
LISTERINE
NON-TOXIC.
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NON-ESCH ARCTIC.
r^OI^lM[U"IvA.« — Listerine is the essential antiseptic constituent of Thyme, Eucalyptus
Baptisia, Gaultheria, and Mentha, Arvensis, in combination. Bach fluid drachm also contains
two grains of refined and purified Benzo-boracic Acid.
I>OJSE^» — iNTERNAi^iyY : One teaspoonful three or more times a day (as indicated), either
full strength or diluted, as necessary for varied conditions.
IvISTBRINE is a well-proven antiseptic agent — an antizymotic — especially useful in the
management of catarrhal conditions of the mucous membrane ; adapted to internal use, and to
make and maintain surgical cleanliness — asepsis — in the treatment of all parts of the human body,
whether by spray, irrigation, atomization, or simple local application, and therefore characterized
by its particular adaptability to the field of
PREVENTIVE MEDICINE— INDIVIDUAL PROPHYLAXIS.
liste:e.i]^^:e;
Destroys promptly all odors emanating from diseased gums and teeth, and will be found of great
value when taken internally, in teaspoonful doses, to control the fermentative eructations of
dyspepsia, and to disinfect the mouth, throat, and stomach. It is a perfect tooth and mouth wash,
indispensable for the dental toilet.
Descriptive Literature upon Request.
LAMBERT PHARMACAL CO., ST. LOUIS, MO.
AGENCIES
S MAW SON & THOMPSON,
LONDON, E. C.
ROBERTS & CO.,
PARIS.
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VILANOVA HOS. Y CIA.
BARCELONA.
Fig .2. — Early stage of progressive muscular atrophy, showing atrophy of deltoid,
supraspinatus, and infraspinatus muscles of right shoulder.
Fig. 1. — Atrophy of lumbricales and interosseous muscles, with con-
traction of long flexors of fingers, producing the " Claw-like hand."
XH
Bacteriological World
AND MODERN MEDICINE.
VOL I. BATTLE CREEK, MICH., U. S. A., OCTOBER, 1892. NO. 12.
THE STUDY OF IMMUNITY.
BY M. METCHNIKOFF.
V. THE PROPERTY OF THE MICROBE OF HOG
CHOLERA IN THE ORGANISM OF A RABBIT.
We could never believe that the cocco-
bacillus of hog cholera, with its thin en-
velope and its poor aspect, should be in
a condition to live long in a body abso-
lutely refractory to this microbe. And
yet, inoculated in the skin of these rabbits,
it provokes a protective suppuration, and
maintains its life about three weeks.
The pus withdrawn after a few days or
more from the subcutaneous abscesses of
the rabbit, presents, under the micro-
scope, quite a mass of living and dead
leucocytes, in which there are no mi-
crobes to be found. But it suffices to sow
a little of this pus in broth to obtain an
abundant culture of Coccobacillus suinu7n,
— culture always very virulent.
The microbes end, however, by perish-
ing in the pus, and, if it is withdrawn in
about three weeks after the inoculation
of the virus, the inoculated broth remains
perfectly clear and sterile.
Often enough, the subcutaneous ab-
scesses end by opening at the exterior,
by which the animal is relieved of a
quantity of pus ; in other cases the ab-
scesses remain closed and absorb slowly.
Two months after the inoculation, the
abscess is still voluminous enough, and
contains a very thick white pus. Later,
it diminishes and is transformed into a
brownish mass diminished in thickness.
In all these cases, the pus is sterile, and
we find in it no remains of destroyed
microbes. The bacteria capable of re-
sisting so long in the refractory organism
finally end in death : their death occurs,
not in the liquid, but in the interior of
the phagocytes. If the pus is withdrawn
forty-eight hours after the subcutaneous
inoculation of the rabbit, the microscope
already fails to reveal the microbes. But
if a little of this pus is placed in the in-
cubator at 38° C, it is easy to observe
that the leucocytes contain masses of
bacteria of hog cholera which take on
coloring in a most normal manner. These
bacteria appear in the form of small oval
bacilli, diplobacteria,^and also of beads.
They develop in the interior of the pus
globules and invade the liquid, in which
they produce a perfect culture.
These facts demonstrate that the mi-
crobes are englobed alive by the pus leu-
cocytes, 'but that some of the bacteria
resist, and when transported to condi-
tions unfavorable to the phagocytes, in-
vade the pus.
The long resistance of the englobed
bacteria, gives us to understand that in
a few unfavorable circumstances for the
organism of the rabbit, the microbe suc-
ceeds in developing and killing its host.
It is thus that we may explain more
easily, the case in which a vaccinated
rabbit, tested with vital virus, succumbed
at last to pyemia. This disease was pro-
voked by the microbe of hog cholera,
and occurred nearly a month after the last
inoculation of the virus.
The observation that I have just cited,
renders it probable that the microbe, able
to resist a long time in the vaccinated
rabbit, may end by adapting itself to the
medium, and in a favorable moment in-
vade the organism. This should demon-
strate that the englobed coccobacilli
preserve, not only their vitality, but their
virulence in the interior of the phago-
cytes. The last proposition may be
easily studied, because very minute doses
suffice to provoke a deadly form of the
disease in rabbits.
The pus of the refractory rabbits in
which hog cholera bacteria exist in the
interior of the leucocytes, is virulent. I
394
ORIGINAL ARTICLES.
have observed this important fact many
times. The pus withdrawn forty-eight
hours after inoculation of the vaccinated
and refractory rabbit, killed the rabbit
(in which it had been injected in the
auricular vein) in forty hours. In other
experiments the virulence was still more
marked. A drop of pus from an inocu-
lated rabbit, withdrawn four days after
the inoculation of the virus, and injected
in the vein of another rabbit, produced
hog cholera with fatal termination in less
than twenty-one hours. On preparation
of this pus, no microbes were to be
observed.
From another vaccinated rabbit, which
had resisted several virulent inoculations,
the pus injected in the auricular vein of
a new rabbit caused death in twenty-nine
hours and twenty minutes. This pus had
been withdrawn seventeen days after in-
oculation of the vaccinated rabbit with
toxic blood. While the pus formed at
the point of inoculation proved so viru-
lent, the serum of the same vaccinated
rabbit manifested a very marked prevent-
ive property. One cubic centimeter of
a very rich culture in this serum,'injected
in the vein of a rabbit, produced its death
only after seventy-eight hours, notwith-
standing the enormous difference between
the immense quantity of microbes con-
tained in an abundant culture and the
few that this pus contained, — so few
in number that they were not revealed
with the microscope.
We see, according to these experiments,
that the pus which has bee7i formed at the
spot where the afiimal was attacked by the
7nicrobe, does not at all possess the prevent-
ive property which is so remarkable in the
serum of the same vaccinated animals.
In cases where the organism contains
microbes which during a long time remain
alive and preserve their virulence, and
where, notwithstanding this, the organ-
ism is not invaded, we are always tempted
to admit the existence of the antitoxic
power. The microbe, though virulent,
does not hinder, because its toxines are
destroyed at the moment of their produc-
tion. The absence of an antitoxic prop-
erty from the blood serum, demonstrated
in the second chapter, could not furnish
sufficient evidence, because we know that
often the phenomena which occur in the
living organism are very different from
those observed in the serum obtained
outside of the organism.
Let us examine the behavior of vac-
cinated rabbits with regard to the tox-
ines. This question has already been
approached by Mr. Selander, who arrived
at the conclusion that ''immunity against
the microbe may be acquired without
immunity against the toxines being estab-
lished." This result has been established
by the fact that the rabbits, while vacci-
nated against the very virulent virus, die
when they receive minimum doses of toxic
blood. Of the three vaccinated rabbits
poisoned by Mr. Selander, one suffered
with toxic injection eighteen days after
testing with the mortal virus ; a second,
nineteen, and a third, twenty-seven days
after the test. These rabbits had re-
gained their natural weight, appeared in
good health, and yet they all died under
the same conditions, and at the same
time as the witnesses. Mr. Selander was
kind enough to let me witness this ex-
periment, the exactitude of which I can
confirm.
Though the fact of the sensitiveness of
the vaccinated rabbits to the toxines had
already been observed by Mr. Selander
I have sought to ascertain them by my
own experiments. To that end I injected
minimum mortal doses of toxic blood in
the veins of three vaccinated rabbits.
Intoxication was practiced twenty-one,
sixty-two, and one hundred and nine days,
after the date of the last test with the
virulent virus. The first rabbit, tested
four times with the living virus, had be-
come visibly impoverished ; but the other
two rabbits were completely recovered
from the inoculation and considerably
increased in weight. Well, the three
rabbits manifested a great deal of sus-
ceptibility to the toxic blood, and died
before their non-vaccinated witnesses.
The toxines injected in the blood of vacci-
nated rabbits had consequently not been
neutralized, nor had they destroyed their
structure.
The vaccinated rabbits are equally sen-
sitive to the doses of the non-fatal tox-
ines. Injected in the auricular veins,
these doses provoke a general uneasiness
and an elevation of temperature, as in
the witnesses not vaccinated. Even the
toxic blood heated to 60° C. produces
the same effect on the rabbits refractory
to the living virus and on the witnesses.
The toxines injected under the skin
act in the same manner on vaccinated
rabbits and other witnesses.
ORIGINAL ARTICLES
395
This accumulation of facts demon-
strated that the acquired immunity against
hog cholera is not at all due to an anti-
toxic property of the vaccinated organism.
The resistance of the vaccinated rab-
bits which have some virulent microbes
in their phagocytes, is not truly due to
the antitoxic power of their bodies.
As there is no destruction of toxines in
the organism of vaccinated rabbits, they
rid themselves of the toxic substances by
the aid of exaggerated diuresis. The dif-
ficulties that we encounter in securing
pure urines in sufficient quantities to
study in precise manner their toxic power,
are such that I have contented myself at
this stage with examining the quantity of
urine emitted.
In the course of a slow or acute dis-
ease, there is no retention of urine, and
it is only in exceptional cases that we
find the bladder full at autopsies. The
quantity of urine emitted demonstrates,
rather, the augmentation of diuresis dur-
ing hog cholera in the rabbits.
I have made a comparative observation
on two rabbits, inoculated under the skin
with virulent virus, one of which was
vaccinated and the other was utilized as
a witness. It is in the last that the
greatest quantity of urine was passed,
both before the inoculation of the virus
and during the disease.
There is only one conclusion to draw
from these experiments, and that is that
the inoculation is not connected with the
retention of urine in the rabbits.
Of all the differences which may have
been found between the vaccinated rab-
bits and the witnesses, the most con-
siderable is undoubtedly that which con-
cerns the system of phagocytary defense.
When we inoculate a very virulent mor-
tal virus in the rabbit not vaccinated
in the subcutaneous tissue, a hyperemia
of all the neighboring vessels is produced,
the diapedesis is feeble, and phagocytosis
rare. At the point of inoculation there
appears a slight soft tumor. In the vac-
cinated, the tumor is, on the contrary, hard
and larger : the diapedesis is considerable
and phagocytosis extremely developed.
When the inoculated virus is less active.
a progressive tumor is produced in the
non-vaccinated rabbits, which also con-
tains a quantity of leucocytes. In case
of cure, there is developed at the point
of inoculation, a thick pus, formed by
the masses of leucocytes.
Mr. Massart has observed that virulent
virus of hog cholera contained in glass
tubes, and introduced into the abdominal
cavity of the rabbits, produces only a
feeble attraction for leucocytes, but in
the vaccinated rabbits, on the contrary,
attracts them very strongly.
There exists then, a parallelism manifest
bettveen the resistance of the animal and the
activity of the phagocytes.
The subcutaneous injection of toxic
blood heated to 58° or 60° C, provokes
equally a leucocytory reaction, very dif-
ferent in the vaccinated rabbits and wit-
nesses. While in the former the tumor
contains masses of migrated leucocytes
produced from the beginning, in the
latter the tumor is soft, and contains
only a few leucocytes. It is only later,
when the witness rabbit enters the stage
of cure, that the number of leucocytes
augment, and the tumor becomes firmer.
These facts are in perfect accord with
the phenomena of the leucocytes in rab-
bits infected by the microbe, but intoxi-
cated by the toxine of hog cholera. In
vaccinated rabbits, the number of leuco-
cytes is materially augmented, while in
the witnesses it diminishes in a notable
way. Mr. Werigo observed the latter
fact for the first time in investigations
executed in my laboratory, and he will
speak on the subject in his writings.
We see, then, from all that precedes in
this chapter, that in the resistance of
vaccinated rabbits against hog cholera,
the phagocytes which direct themselves^^
toward the microbes, which englobe them
in a living and virulent state, and which
end in destroying them in their pro-
toplasma, exert a function of the highest
importance. This role is the more con-
siderable because the phagocytes are
not seconded by any property whatever
capable of destroying the toxic products
of the microbes of hog cholera.
(To be continued.)
396
ORlOmAL ARTICLES.
THE NEW CHEMISTRY OF THE STOMACfl.
BY J. H. KELLOGG, M. D.
(Continued.)
As the work upon which this paper is
based includes, so far as the writer knows,
the largest number of cases which have
been studied by so exact methods of in-
vestigation, I think it important to pre-
sent a brief summary of the results ob-
tained, which will show at a glance the
relative frequency of the pathological
conditions which are recognized by this
mode of investigation, and as will appear,
indicate that some of the current notions
upon this subject are quite erroneous.
With reference to the three general
classes, hyperpepsia, hypopepsia, and
simple dyspepsia, the cases were divided
as follows : —
Hyperpepsia 170
Hypopepsia 116
Simple dyspepsia 35
In considering these figures, it should
be remembered that hyperpepsia and hy-
peracidity are by no means coincident
■conditions ; and that each of the three
groups included in hyperpepsia has a
sub-group in which the acidity is below
normal. The old method of analysis
would place all of these cases in hypo-
pepsia ; but as the cases given show, and
as will appear still more clearly from the
summary of the particular conditions ob-
served for each group, many cases of
hypoacidity are really cases in which
there is an excess of stomach work rather
than a deficiency, and hence belong to
the class of hyperpepsia rather than
hypopepsia.
The accompanying tables present at a
glance the particular facts observed as
regards the relative frequency of excess,
deficiency, and equality, in the figures
found by analysis in relation to the total
acidity (T), the coefficient of digestive
work {a), the total chlorine (T), the free
HCl (H), the combined chlorine (C),
and the sum of free HCl and combined
chlorine (H-f-C), representing the amount
of chlorine set free from the bases and
j)repared to enter into the work of di-
gestion.
The tables also show the relative fre-
quency of the different forms of hyper-
pepsia, hypopesia, and simple dyspepsia.
and the dominant characteristics of each
group. The following facts presented
by the tables are especially worthy of
note : —
Hyperpepsia. — The 170 cases found in
this class constitute 52.9^ of the total
number of cases studied.
I. Hyperpepsia with Hyperhydrochlorie
{H-{-). — The first group of this class,
hyperpepsia, with hyperhydrochlorie, or
free HCl in excess, presents sixty-three
cases, which is 19.6^ of the entire num-
ber of cases studied, or 37 ^ of all the
cases of hyperpepsia. This is by far the
largest single group found. In this
group, A is of course nearly always -f-,
yet we find A — in six cases, although,
as will be noticed, free HCl (H), and
combined chlorine (C), are -\- in all
the cases of this group. It is evident,
then, that these six cases could not be
properly classed as cases of hypopepsia,
although in a single one of them the total
chlorine (T) was slightly deficient. The
total chlorine is found in excess in 50 of
the 54 cases.
An interesting fact especially worthy of
note in relation to this group is the fre-
quency with which a — occurs. Since
the figures represented by a are an in-
dex to the quality of the digestive work
done, or, at any rate, to the chemical
quality of C, indicating, when deficient,
the presence of neutral chloro-organic
compounds, which are as much greater
in proportion as a is less than normal,
it is evident that in this group of hyper-
pepsia, in which we find both H-f and
C-j- and with rare exceptions A-j- and
T-j-, or hyperacidity and excessive se-
cretion of chlorine, the digestive product
is, if not in the majority of cases, in at
least a large minority (42.8^), inferior
in quality, a fact which accounts for the
remark often made by this class of pa-
tients, '* Doctor, I have a ravenous appe-
tite ; I eat more than I ought to eat, and
I seem to digest my food without diffi-
culty ; nevertheless, I lose in weight con-
tinually, and cannot gain an ounce of
flesh."
2. Hyperpepsia with Hypo hydrochloric
{H — ). — In this group, characterized by
a deficiency of free HCl, we find seventy-
four cases, 23^ of the total number of
cases studied, or 43.5% of the cases of
hyperpepsia. This group is only ex-
ceeded by the preceding in the number
of cases which it presents.
ORIGINAL ARTICLES.
397
TABLE I.- SUMMARY OF THE RESULTS OF CHEMICAL ANALYSIS OF STOMACH FLUID IN 321 CASES OF DISORDERED
DIGESTION, CLASSIFIED IN RELATION TO NORMAL QUANTITIES.
Group.
Sub-Gboup.
fHyperhydrochlorie
(H+)
63 caf^es
Dypohydrochlorie
(H-)
14 cases.
Hypochlorhydrie
(C-)
Usefal Work Defi-
cient. 33 cases.
Ist Degree. (A —
but above .100
gms.) 58 cases.
2d Degree. (A—
and below . 100
gms). 57 cases.
3dDegree — Apepsia
(AO). 2 Cases.
[Without Permenta-
j tion. 19 cases.
1 With Fermentation.
Hyperacidity (A-|-) without a .f. ....
" with a. f.
Hypoacidity. (A — ) without a. f
Hyperacidity (A-|-) without a. f
" with a. f.
Hypoacidity (A — ) without a. f. . . . .
Hyperacidity (A-f ) without a. f.
with a. f
Hypoacidity (A — ) without a. f. . . . .
" with a f
Pseudo-hyperacidity ( A-f A' — ) with a f.
Hypoacidity (A — ) without a. f
" with a. f
Pseudo-hyperacidity (A-j-A — ) with a. f.
Hypoacidity (A — ) without a. f.
" with a. f
Pseudo-hyperacidity (A-j-A — ) with a. f.
o
r.
29
29
5
29
37
8
1
9
12
8
3
29
18
11
3.5
19
3
Coefficient
+
29
37
Neutral (AO) ,
Typical (a=) . .
(Qualitative (a — )
I
15 cases.
I Hyperchlorhydrie (C-|-)
[ Hypochlorhydrie (C — )
23
29
14
14 14
1
32
Total CI
(T)
+ =
14
1
24
9
6
33
13
2
2
3 1
7 6
4
1
FreeHCl(H)
+ = - 0
+
37
Combined
CKC)
— 0
(H+C)
+ =
29
6
4
2
21
17
7
35
19
3
2
TABLE II.— GENERAL SUMMARY OF THE RESULTS OF CHEMICAL ANALYSIS OF STOMACH FLUIDS I.N 32! CASES,
CLASSIFIED IN RELATION TO NORMAL QUANTITIES.
Group.
ill
1)
-yj
S3
o
6
63
74
33
170
58
57
2
117
19
15
34
321
Acidity (A)
Coefficient (a)
Total CI (T)
Free HCl (H)
Combined C1(C)
(H+C)
<
+
58
66
13
137
11
3
—
5
8
20
33
47
54
0
2
2
2
+
29
37
20
86
29
22
6
7
13
28
30
13
71
29
32
0
3
2
5
+
60
33
26
119
8
3
11
2
4
6
136
3
30
4
37
11
6
17
10
5
11
3
14
39
48
2
89
7
6
+
63
33
96
74
0
+
63
74
0
+
63
73
6
142
_
10
5
15
1
16
13
13
8
10
—
riyperhydrochlorie
(H4-)
v-^-^ 1 /
Hypohydrochlorie
(H— )
Hypochlorhydrie
(c-).
Total
1st Degree (A — ,
but above .100 gms.)
2d Degree (A — and
below .100 gms ) . . .
3d Degree — Apep-
sia (A 0)
Total
Without Acid Fer-
mentation
With Acid Fer-
mentation
Total
Grand Total. .
33
33
30
55
2
87
1
2
2
1^
ypopepsia H;
17 Cases. 1
10
9
74
44
41
4
7
2
13
137
12
16
13
45
57
2
Dyspepsia H
Cases. 1
14
4
5
9
160
S
9
17
17
101
7
1
8
142
51
15
15
152
5
61
14
1
19
10
10
85
8
5
12
15
10
16
4
4
104
1
5
18
14
146
5
a
15
69
13
116
1
97
20
39
13
172
13
25
174
8
24
1
121
2
15
157
18
47
1
117
398
OBIGmAL ARTICLES.
It is noticeable that the total chlorine
is in excess much less frequently in this
group (44.6%), as compared with the
preceding (95.2^). The less frequency
with which hyperacidity occurs in this
group, and the smaller proportion of
cases in which the total chlorine is in ex-
cess, indicate distinctly that in this group
the hyperpepsia is less pronounced than
in the preceding. A careful study of the
cases in this and the preceding group
show a gradually descending scale reach-
ing from the most pronounced hyper-
pepsia down to hopopepsia. The most
attenuated cases, in fact, seem to overlap
the first group of hypopepsia, so that the
fourth division of hyperpepsia withhypo-
hydrochlorie (H — A' — , -|- a. f.) would
coincide with the first division of hypo-
pepsia of the first degree.
Hyperacidity is the dominant condi-
tion as in the preceding class, although
likewise not absolutely constant ; for we
find A — in four cases, notwithstanding
that the amount of combined chlorine is
present in so great excess as to more than
compensate for the deficiency of free
HCl in every case, so that we find in all
the cases of this group (H -f- C) in ex-
cess. Evidently there is a sufitcient
amount of chlorine set free from the
bases to give a figure for A in excess of
the normal in every case. The hypo-
acidity is then due in these cases to the
presence of neutral chloro-organic com-
pounds, shown by the diminution of a.
It will be noted, however, that A — oc-
curs less frequently in this group (6.7^),
than in the preceding (7.9%)- The same
is true of a — .
3. Hyperpepsia with HypochlorJiydrie or
Combined Chlorine. — The value of the
method of chemical investigation of
stomach fluids, to which it is the purpose
of this paper to call attention, is espe-
cially apparent in the study of this group
of cases of hyperpepsia. In fact it is
only by the aid of this method that it is
possible to discover these cases, and form
of them a distinct group. The older
methods give their characteristic reac-
tions in the presence of both free HCl
and combined chlorine, and hence afford
no means of distinguishing between these
two important conditions of the chlorine
participating in the digestive act : and
yet a recognition of these conditions and
a careful determination of the quantity
of chlorine in each state in a given case.
affords our only means of determining
how much of the chlorine set free from
the bases with which it is combined when
secreted by the stomach, really enters into
the digestive process by combining with
albumen for the conversion of the latter
into peptone.
The 7,T, cases comprised in this group
constitute 10.2^ of the entire number of
cases studied, or 19.4% of the cases of
hyperpepsia. It will be noted that A —
occurs in nearly two thirds of the entire
number of cases, showing at once the
fact that the combined chlorine (C) is
a more important element in the produc-
tion of the normal acidity of the gastric
juice than is free HCl (H).
The total chlorine is in excess in
78.9^ of the cases, a much larger pro-
portion than in the preceding group.
Free HCl is in excess in all the cases,
although the total amount of chlorine set
free, shown by the sum of H and C
(H -|- C) is deficient in 36.3^ of the
total number of cases, being in excess in
only six cases, or less than one fifth of
the entire number of cases in this group.
The quality of the digestive product is
also poor, however, in a large proportion
of cases, as shown by the low value of
{a), which is below normal in thirteen
cases, or 39.4% of the total number,
and also by the absence of peptones from
the stomach fluid.
This class, notwithstanding the large
proportion of cases of hypoacidity
(60.6^), is evidently allied to the pre-
ceding groups, although the general for-
mula furnished by the cases of this group
with hypoacidity is also very closely al-
lied to the formula found in the first
group of hypopepsia. One characteris-
tic peculiarity alone distinguishes the
formulae of this group from those of hy-
popepsia of the first degree ; namely,
the excess of free HCl, or H -j-, which
is always present in this group, associ-
ated with C — , but is never found in
hypopepsia. It will also be noticed that
in all the sub-groups of this class of hy-
perpepsia, T -f (total chlorine in ex-
cess) takes the precedence, T= and
T — only occurring in the third and
fifth subdivisions of the group, its most
attenuated forms, which approach very
closely to hypopepsia, as does the third
form in each of the preceding groups.
Both the ' groups may be said to
touch the line of hypopepsia, which is
ORIGIN'AL ARTICLES.
899
actually overlapped by the preceding
group, as already remarked.
4. In the total summary of the char-
acteristics exhibited by hyperpepsia in
its different forms, we find A -[- in 80.6%
of the cases of hyperpepsia; A — in a
little less than one fifth of the cases,
while A= is absent. It should be
mentioned, however, that A -|- includes
a few cases in which the total acidity was
close to the extreme upper limit of nor-
mal variation, and A^ — two or three
cases in which A was close to the lower
limit. A=: is a characteristic of sim-
ple dyspepsia.
The coefficient a is below normal in
71 (41.7^) of the cases. a=i occurs
in only 13 cases, being one of the charac-
teristics of simple dyspepsia. The total
chlorine is equal, or in excess, in 119
cases (70%), being found deficient in
only 14 (8.2^ ) of the cases.
H -f" occurs in 96 (56.5^) of the
cases, and H — in 74 (43.5%) of the
cases. We find C (combined chlorine)
in excess in 137 (80.5^-) of the cases,
and deficient in 33 (19.4^) of the cases.
(H -|- C) is in excess in 142 (83.5%) of
the cases, equal in 16 (9.4^) of the
cases, and deficient in 12 (7%) of the
cases.
Hypopepsia. — The total number of
cases of hypopepsia was found to be 117,
36.4^ of all the cases examined, a much
smaller number than would be supposed
by the frequency with which hydrochloric
acid is administered to patients by phy-
sicians and the great quantities of pepsin
and other digestive agents, and digested
or partially digested food substances an-
nually swallowed by dyspeptics. A care-
ful study of the chemistry of digestion
in pathological cases shows that deficient
digestive work is not the chief fault in
the majority of cases of disordered diges-
gestion, but abnormal or vicious chemical
work. My statistics show unmistakably
that in a great proportion of cases of indi-
gestion, the stomach is even doing an ex-
cess of work ; but the quality of the work
done is inferior or takes a wrong direc-
tion, so that notwithstanding the great
amount of labor performed by the stom-
ach, the blood is not supplied with the
proper amount of well-elaborated food
substances, but instead receives a great
amount of material which has been par-
tially digested only, or has been sub-
jected to deteriorating changes through
the action of microbes and other fer-
ments, and which must be destroyed by
the liver and eliminated by the kidneys
and other emunctories, along with the
normal waste and excrementitious prod-
ucts of the tissues. It is this semi-
starvation and auto-intoxication which
gives rise to a great share of the morbid
symptoms presented in various forms of
functional stomach disorder.
In hypopepsia we find a still greater de-
ficiency of well elaborated food elements
than in hyperpepsia, and yet it is not un-
common to find persons suffering from a
very extreme degree of hypopepsia who
are not by any means so much emaciated
as we should expect to find them, and
sometimes even enjoying fair health, ow-
ing to the fact that the stomach is not the
chief digestive organ of the body, but only
a sort of antechamber in which the pre-
liminary digestive work is done. So it is
possible for very good health to be en-
joyed coincident with hypopepsia, pro-
vided a suitable dietetic regimen is
followed, and even though the stomach
may be almost wholly inactive in the di-
gestive process.
As before stated, I have followed the
plan of Hayem and Winter in grouping
cases of hypopepsia, since their method,
although wholly artificial, is as good as
any that has occurred to me. The study
of a still larger number of cases will per-
haps enable me to find a natural and bet-
ter basis of classification.
I. Hypopepsia of the First Degree
{A — or A' — , but above .100 gms.'). —
The total number of cases in this class is
58 or 49.4^ of all the cases of hypopep-
sia. We find here, as in hyperpepsia, a
few deceptive cases, although of the op-
posite character. The total acidity
which is usually less than normal (47
cases, 8i. i ^) was found to be in excess in
II cases (18.9^). As hydrochloric acid
was also present in all but three of the
cases, although diminished in quantity,
these cases examined by the older methods
would have been pronounced cases of hy-
perpepsia ; but that they belong to the
class of hypopepsia is evidenced by the
fact of the deficiency in the total chlorine
(T), and also in the diminished combined
value of H and C (H -f- C), as well
as the low value of H. These cases af-
ford another interesting illustration of the
importance and value of the ingenious
method of investigating stomach fluids
400
ORIGINAL ARTICLES,
devised and perfected by Hayem and
Winter.
A — appears in 47 (81%) of the cases,
much more frequently than in hyper-
pepsia.
The total chlorine is in excess in but
eight cases (13.8^), being deficient in
39 (67.2%) of the cases. Free HCl (H)
was deficient in 44 (75.8^) of the cases,
and entirely absent in four cases (6.8%).
A few cases in which it was found
equal were classified as hypopepsia be-
cause of the low values of T and C,
showing an evident and marked diminu-
tion in both the secreting and chemical
work of the stomach. The combined
chlorine (C) was deficient in 30 (51.7%)
of the cases, equal in 16 (27.6%), and in
excess in 12 (20.7%) ; and (H -\- C) was
minus in 45 (77.6%) and equal in 13
(22.4) of the cases, never in excess.
2. Hypopepsia of the Second Degree {A
or A' — , and below .100 gms.'). — Total
number of cases, 57, or 48.5% of the
cases of hypopepsia. * Here, as in the pre-
ceding group, we find a few cases (three,
or 5.2%) of pseudo - hyperacidity. In
each of these cases, as in the similar cases
of the preceding group, an abnormal de-
gree of acidity was present, due to acid
fermentation and the formation of a great
quantity of lactic acid and perhaps other
members of the fatty acid series. That
these cases belong properly to the class
hypopepsia, is easily ascertained by ob-
taining the value of A' by the method
previously described. This value was, in
the three cases of hyperacidity found in
this group, determined to be less than
.100 gms., although the acidity was in
one instance found to be .413 gms., or
more than double the normal amount,
the value of A' in this instance being
only .86 or about one fifth the total
acidity.
In this case we find A less than nor-
mal in 54 (94.7%) of the cases, a much
larger proportion than in the preceding
group. T -f- occurs in this group in
but three cases, the total chlorine falling
below normal in 48 (84.2%) of the cases
and equal in only six (10.5%). The
free hydrochloric acid was normal in only
nine (15.8%) of the cases, below normal
in 41 (71.9%) of the cases, and o in
seven cases. C was o in two cases,
and below normal in 55 (96.5%) of the
cases. The advanced state of hypo-
pepsia in this group is shown by the fact
that the combined value of H and C
(H -\- C) is below normal in every case,
while in the preceding group this value
is normal in 22.4% of the cases.
3. Hypopepsia of the Third Degree {A
o, or Apepsid). — In the two cases of this
sort which I have met, A and a were
minus in both. In one of these cases the
reaction of the stomach fluid was slightly
alkaline, and the value of A — was .20. T
was minus in both cases. Free HCl was
wholly absent in one case, and present in
a small quantity in the other. Combined
chlorine (C) was present in slight quan-
tity in both cases.
In this group, the stomach work
reaches the vanishing point, a condition
which not infrequently co-exists with ma-
lignant disease, although not invariably
present. When present in connection with
a perceptible thickening in the epigastric
region, it becomes, however, a very im-
portant aid to diagnosis, as hyperpepsia
would not be likely to co-exist with such
a condition except in the case of gastric
ulcer accompanied by fibrous thickening.
We thus have a very important means of
differential diagnosis in a class of cases in
which it is sometimes difficult to deter-
mine by other means whether an exist-
ing disease of the stomach is simple
ulceration which may be cured, or a
disease of a malignant and incurable
character.
Summarized, the facts relating to hy-
popepsia are as follows: A — in loi
{2>6.T,%) of the cases; A -j- in* only 14
(11.9%); total chlorine in excess (T -f)
in only 11 (9.4%) of the cases, and de-
ficient in 89 (76%) of the cases. Free
HCl was found deficient in 85 (72.6%)
of the cases, and normal in only 19
(16.2%). Free HCl was entirely absent
in 13 (11.1%) of the cases. The com-
bined chlorine was diminished in 87
(74-3%) of the cases, equal in 16
(13.6%), and in slight excess in only
12 (10.2%) of the cases. The combined
value of free HCl and combined chlorine
was also deficient in 104 (88.8%) of the
cases, and equal in only 13 (11.1%).
Simple Dyspepsia. — This class includes
34 cases, 10.6% of the entire number
studied. The cases included in this class
are those in which there was no serious
disturbance of the chemical work of di-
gestion. The smallness of the propor-
tion of cases is at once an indication of
the importance of a careful chemical
ORIOINAL ARTICLES.
401
study of the stomach fluid in all cases
of dyspepsia, to obtain a basis for a
rational plan of treatment.
Of the cases of simple dyspepsia the
total acidity (A) was found to be in slight
excess in nine (26.4^) of the cases, equal
in 17 (50^), and slightly deficient in only
eight (23.5%) of the cases. The coeffi-
cient a was found in excess in 15
(44.1^) of the cases, as the result of
acid fermentation, which fs the principal
chemical disturbance met with in simple
dyspepsia, there being neither a defi-
ciency nor an excess of chemical work
of any considerable degree, but rather
a vicious chemical action added to the
normal work of the stomach. That this
vicious action may ultimately lead to a
disturbance of the normal chemical work
of the stomach, I have many times seen
demonstrated by the readiness with which
the normal chemical work of the stomach
is resumed when acid fermentation is sup-
pressed by lavage and the employment of
intestinal antisepsis through the aid of
proper diet, and when necessary, anti-
septic , medication.
We find a — in 14 (41.1%) of the
cases, and evidence that a deterioration
in the quality of the work done by the
stomach may occur without either an in-
crease or a diminution of the amount of
work done ; in other words, without either
hyperpepsia or hypopepsia. T = was
found in 15 (44.1%), T+ in 6 (17.6%),
T — in 13 (38.2%) of the cases. Free
HCl was normal in quantity in 20
(58.8%), and deficient in 13 (38.2%) of
the cases. Combined chlorine (C) was
in excess in 25 (73.5%) of the cases.
This deviation is not sufficiently serious
in itself to characterize the case as ab-
normal, since an increase of combined
chlorine is, according to my observation,
a condition commonly present in cases
in which a patient is rapidly gaining in
flesh. The combined value of H and
C (H -j- C) was slightly in excess or
equal in nearly all the cases (33, or
97%).
General Summary. — A brief glance at
the grand total of the chemical facts con-
tained in the table shows hyperacidity to
be present in 170 (52.9%) of the cases;
hypoacidity was found in 117 (36.4%) of
the cases. The acidity was normal or
equal, in 17 (5.3%) of the cases, and
wholly absent in two (.6%) of the cases.
The coefficient of chemical stomach
work, shown by the value of a, was in
excess in 152 (47.3%) of the cases, de-
ficient in 146 (45.4% ) of the cases, equal
in 18 (5.6%) of the cases, and o in five
cases.
The total chlorine was in excess in 136
(42.3%) of the cases, deficient in 116
(36.1%) and equal in 69 (21.4%) of the
cases.
Free HCl was in excess in 97 (30.2% ),
deficient in 169 (52.6%), equal in 12^
of the cases, and entirely absent in 13
{4%) of the cases. Combined chlorine
(C) in excess in 174 (54. i %), deficient in
121 (37.6^) cases, equal in 24 (7.4^)
cases, and totally absent in two cases.
The combined value of H and C
(H -f- C) appeared in excess in 157 cases
(48.9%), deficient in 117 (36.4^) cases,
and equal in 47 (14.6%) cases.
Acid Fermentation. — It is interesting to
note the relation of acid fermentation to
the several classes described. As indi-
cated by the value of a, fermentation
was present in 87 (51.1%) of the cases
of hyperpepsia, in 5 1 (43. 5 %) of the cases
of hypopepsia, and 15 (44.1%) of the
cases of simple dyspepsia; from which it
appears that acid dyspepsia is a more
frequent accompaniment of hyperpepsia
than of hypopepsia. This fact would
seem at first sight to oppose the opinion
generally held that the free HCl of the
gastric juice is a natural antiseptic, and
of great use in inhibiting abnormal fer-
mentations. It seems probable, however,
that in many cases, the hyperpepsia may
be the result of glandular irritation and
hyperactivity produced by the contact with
the gastric membrane of lactic and other
acids produced in excess by abnormal
fermentations. That free hydrochloric
acid lessens the tendency to acid fermen-
tation in the stomach is clearly shown by
a comparison of the frequency of the
occurrence of fermentation in the differ-
ent groups of hyperpepsia. In the first
group, hyperpepsia with hyperhydro-
chlorie, acid fermentation was found in
29 cases (46%); in the second group,
free hydrochloric acid was deficient, al-
though (H -j- C) was in excess, and acid
fermentation was found present in 37
cases (50%); while in the third group,
hyperpepsia with hypochlorhydrie, acid
fermentation was found present in 20
cases (60.6% ).
Just why acid fermentation occurs less
frequently in hypopepsia than in hyper-
402
OBIOINAL ARTTCLES.
pepsia, is somewhat difificult to under-
stand. A remarkable concurrent fact,
and one which I believe is new to the
study of this subject, is the very com-
plete digestion of starch in cases of
pronounced hypopepsia, which I have
observed in a very considerable number
of cases. In fact, I have found the state
of the starch digestion to be a very good
index to the degree of total acidity. When
A is large, LugoFs .solution gives a blue,
bluish purple, or purple color, show-
ing that the starch is unchanged or is
partially or completely converted into
erythro-dextrine. In well-marked cases
of hypopepsia with hypoacidity, Lu-
gol's solution gives no reaction what-
ever, showing complete conversion of the
starch into sugar, an observation which
is confirmed by the strong reaction for
sugar given by Fehling's solution.
Through the more prompt conversion of
starch into sugar in the stomach in hypo-
pepsia, the digested starch may disap-
pear by absorption so rapidly that the
conditions become less favorable for the
development of acid fermentation than in
the presence of a large quantity of par-
tially digested starch. This point is of
sufficient interest to be worthy of more
complete study, and I hope to be able to
elucidate it more fully in some future
paper.
(To be Continued.)
-*—•—*-
CONTRIBUTION TO THE STUDY OF PROGRES-
SIVE MUSCULAR ATROPHY.
BY W. H. RILEY, M. D. , BATTLE CREEK, MICH.,
Member ofothe American Neurological Association.
During several years back there have
come under my observation a large num-
ber of cases of the above named disease.
The following paper is based largely on a
personal study and treatment of these
cases, as seen in hospitals and institu-
tions especially adapted to the treatment
of similar diseases. I hardly deem it prof-
itable in this connection to enter into
the history of the disease or the theories
and teachings of the older investigators,
many of which have no value to us, ex-
cept as a matter of history, in the de-
velopment of our present knowledge of
the subject.
The many improved methods of study
and investigation, especially the very
satisfactory methods of staining nerv-
ous tissue, which science has recently
placed in our hands, have cleared away
many of the uncertain theories of the
older pathologists, and established our
knowledge on a more sure founda-
tion. But while taking a brief retro-
spective view of the development of the
knowledge of the subject under consider-
ation, and congratulating science for the
advancement she has made in a better
understanding of this particular disease,
we are still far from the goal of com-
plete and ])erfect knowledge and absolute
control.
Causes. — Heredity undoubtedly has
some influence in the causation of this
disease ; not that we frequently see a
transmission from parent to offspring of
this particular malady, but of a peculiar
neuropathic condition, which makes the
individual peculiarly susceptible to other
more active causes which may be suffi-
cient to develop the disease. Frequently
there is in the families of these cases,
epilepsy, pulmonary consumption, and
other chronic diseases, indicative of a
neuropathic state. Rarely is there a
direct inheritance of this disease. Gow-
ers reports two cases of this kind. Males
are more susceptible to the disease than
females. According to Friedreich's sta-
tistics, females constitute only eighteen
per cent of the whole number of cases.
The per cent of cases in females coming
under my own observation has been even
smaller than this. It is doubtful if this
large difference is due simply to sex.
It is more reasonable to ascribe the larger
per cent in males to their greater ex-
posure to noxious influences.
Progressive muscular atrophy most
frequently manifests itself between the
ages of thirty and fifty years. Rarely
does the disease find its victims outside of
these limits. Most of the cases coming
under my observation have been above
forty-five years of age. I have seen the
disease well advanced in one case at
twenty years, but it is probable that most
cases of muscular atrophy occurring in
early life are due to inflammatory and
not to degenerative processes of the
spinal cord, or else are idiopathic in their
nature.
Among the more direct and exciting
causes may be mentioned syphilis, ex-
posure to wet and cold, excessive venery,
injuries, mental distress and anxiety, and
ORIGINAL ARTICLES.
403
possibly excessive use of certain muscles.
In those cases which succeed syphilis, an
interval of several years usually inter-
venes between the primary disease and
the degenerative changes in the nervous
system. A large number of cases com-
ing under my observation have been sub-
jects of exposure to wet and cold. A
goodly number of these have been travel-
ing men, and men engaged in railroad
service. So large has been the percent-
age of this class that it has suggested to
me that possibly railroad traveling itself,
continued for a long time, may act as a
factor in producing some disturbance in
the nutrition of the spinal cord, which
ultimately might result in this disease.
Traveling men and men in railroad serv-
ice are frequently exposed to the inclem-
ency of the atmosphere, and it may be
that this and other causes, which we may
be unable to elicit in the history of the
case, are also active factors. In one
case the disease developed after a single
exposure by bathing late in the fall of the
year, when the water was extremely cold.
More frequently several exposures are nec-
essary to develop the disease. Frequently
the deleterious effects of the exposure
first manifest themselves by neuralgic
pains, to be followed later on by the more
serious and more permanent symptoms
which characterize the disease. By some
authorities, mental distress, especially
fright, is said to be one of the most fre-
quent causes. It is a well-established fact
that the mental state has a wonderful in-
fluence upon the nutritive processes of
the body, and it may be possible that this
condition, long continued, together with
some other cause or causes, may be suffi-
cient to establish the disease.
The disease finds its victims in all
classes of society, quite as large a per
cent of the cases coming under my ob-
servation having been among the rich and
middle classes as among the poor, and
those whose circumstances in life have
been less favorable.
The disease is frequently seen among
those whose occupation demands an ex-
cessive use of certain muscles of the body.
It is true that an excessive use of muscles
may cause them to atrophy ; but it is
quite doubtful if excessive exercise of any
particular set of muscles is sufficient to
bring about a disease so wide in extent
and so extreme in degree as that of pro-
gressive muscular atrophy. More often
the cause in these cases will be found
elsewhere.
There are certain well-marked diseases
of the nervous system which seem at times
to follow injuries in some part of the
body. Very frequently the disease makes
its onset at the seat of the injury. Paraly-
sis agitans, locomotor ataxia, and pro-
gressive muscular atrophy are examples
of these. Frequently cases present them-
selves in which no apparent cause can be
found. Again, two or more of the causes
mentioned above may be active in any
given case. Sometimes there is a weak-
ness and wasting of certain muscles fol-
lowing an infectious disease, as measles,
typhoid fever, or diphtheria, but the cause
of the atrophy of the muscles in these
cases is usually a neuritis, and is not due
to any disease of the spinal cord.
Symptoms. — The symptoms of this
disease are confined almost entirely to
the motor system. The weakness and
wasting of the muscles are so distinctly
prominent and so universally present as
to be characteristic of the disease. The
weakness and atrophy usually occur simul-
taneously ; sometimes, however, there is
a weakness before any wasting is noticed.
Very soon, the wasting shows itself in the
muscles first paralyzed. The disease usu-
ally begins in the muscles of the upper
extremities, manifesting itself with about
equal frequency in the muscles of the
shoulder and the smaller muscles of the
hand. When the disease begins in the mus-
cles of the hand, the attention of the pa-
tient is frequently directed to the weak-
ness by the difficulty experienced in per-
forming some delicate movement, such as
writing or buttoning the clothing. This
weakness is usually soon accompanied by
a wasting of the parts affected. In the
hand, the thenar and interossei muscles
are usually the first to be affected, and
their wasting, together with contraction
of the long flexors and extensors, causes
a peculiar appearance of the hand (the
''claw-like hand"). The thenar emi-
nence is flattened, sometimes depressed,
or in an advanced stage of the disease
there may be an entire absence of mus-
cular tissue, so that the first metacarpal
bone can be distinctly felt beneath
the skin. The skin over the formerly
rounded eminence, on account of the
wasting of the muscles beneath, becomes
relaxed, wrinkled, and superfluous. On
account of the wasting of the interossei
404
ORIOINAL ARTICLES.
and lumbricales, depressions form be-
tween the metacarpal bones on the back
of the hand, and the flexor tendons in
front. (See Fig. i, frontispiece.)
From the hand the disease may next
attack the muscles of the forearm, par-
ticularly the extensors ; or the muscles of
the shoulder on the same side may be
next affected, while the muscles of the
forearm and arm remain intact until later
in the history of the disease, or may es-
cape entirely. Sooner or later the disease
shows itself in the corresponding muscles
of the hand of the opposite side of the
body, and here again affects in turn the
muscles of the shoulder, arm, and back,
and may then travel downward and affect
the muscles of the lower limb. When the
disease begins in the shoulder, the deltoid
usually suffers first, and frequently with
it the supra and infra-spinati are in-
volved. (See Fig. 2, frontispiece.) These
three muscles have to do with raising the
arm and rotating it outward. When they
are the seat of paralysis, the movements
which they are accustomed to perform in
health are either diminished or absent.
In such a case we find the patient unable
to raise the arm to a horizontal position
(principally from paralysis of the deltoid),
and the arm is usually carried with the
palmar surface looking backward (paraly-
sis of the supra and infra-spinati), in-
stead of facing inward toward the body,
as is the case normally. In a very early
stage of the disease, this rotating of the
arm inward may not be present ; but
when the spinati are involved to any ex-
tent, it is noticeable, and not infrequently
if the patient is asked to raise his arm to
a horizontal position, it will be noticed
that it is done only with great difficulty,
or a horizontal plane may not be reached
at all, and with the progress of the dis-
ease this symptom becomes more and
more marked.
From these two above points in the
upper extremity, namely, the deltoid
muscle of the shoulder and the smaller
muscles of the hand, the disease gradually
spreads to other adjacent parts, until it is
quite universal in its extent and extreme
in degree. The trapezius, serratus mag-
nus, latissimus dorsi, and pectoralis major
are among the muscles of the shoulder
and back that are frequently affected in
the earlier stages of the disease. The
muscles that extend the head on the
spine are frequently affected to such a
degree that it is with difficulty that the
patient can carry the head in an upright
position. To compensate for this loss of
power, and to prevent the head from
dropping forward upon the chest, it is
thrown backward sufficiently to bring its
center of gravity directly over the spine
and habitually carried in this position.
It is not without difficulty that the patient
is able to bring the head into this posi-
tion, but when once gained, the work of
the weak muscles at the back of the neck
is much lessened. If the head is moved
slightly forward, it is apt to drop so that
the chin touches the chest, and can only
be moved back to its former position with
a great effort. In some cases the disease
begins in the muscles of the forearm,
usually the extensors, and from here ex-
tends to the muscles of the shoulder of
the same side, and soon reaches to cor-
responding muscles on the other side of
the body. Again, there is rather a small
per cent of cases where the disease begins
in the lower limbs, usually in the anterior
muscles of the leg below the knee, and
from there travels upward to other mus-
cles, affecting in turn other muscles of the
legs, hands, arms, shoulders, etc.
In a majority of cases the muscles of
respiration suffer sooner or later, and
their impairment constitutes a great
source of danger to life, and not in-
frequently their complete paralysis is
the immediate cause of death.
In those cases where the disease begins
in the hand or the lower limbs, the re-
spiratory muscles are not usually inter-
fered with until late in the progress of the
disease. There are other cases, however,
where the respiratory movements are in-
terfered with early in the history of the
disease, and where, from loss of power,
they may cause death before the disease
has had opportunity to invade less im-
portant parts. This is particularly true
in those cases in which the disease begins
in the muscles of the arm or shoulder on
one side (usually the right), and is at-
tended with considerable rheumatic pain
at the beginning. In these cases the dis-
ease very soon affects the thoracic mus-
cles ; and their almost total paralysis,
together with the general weakened con-
dition of the body, is sufficient in many
cases to cause death. In those cases in
which the thoracic muscles are affected,
the respiratory movements are carried on
wholly by the action o^ the diaphragm.
ORIGINAL ARTICLES.
405
CHART, illustrating the absolute and comparative strength of the different groups of muscles of the
body, in a case of progressive muscular atrophy. The absolute strength is expressed in pounds
avoirdupois by the figures at the angles, or points in the zigzag line. These figures should be com-
pared with those between the two heavy horizontal li>nes in the middle of the chart, which repre^
sent the strength of the average adult male.
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406
ORIGINAL ARTICLES.
Respiration is then purely abdominal,
and the walls of the chest may be almost
motionless, or there may be merely a
slight movement in the upper part of the
chest. The wasting of the muscles of the
chest, together with the unopposed at-
mospheric pressure, produces in these
cases a flatness of the chest in front, and
a narrowing of the chest from before
backward.
In many cases, on the other hand, the
diaphragm is the first of the respiratory
muscles to suffer. The respiration is then
carried on by the intercostal arid thoracic
muscles. These, however, sooner or later
give way to the disease, and become
weaker and weaker. The respiratory
movements increase in frequency, and the
breathing becomes more and more shal-
low. In the vain attempt to retain the
breath of life, the muscles of '^ extra-
ordinary inspiration " are called into
play : the sterno-cleido-mastoid and sca-
leni muscles stand out like whip-cords ;
every muscular fiber that is not already
degenerated, is taxed to its utmost, and
the struggle for life goes on till death
ends the scene.
The disease may confine itself to cer-
tain muscles first attacked until they are
almost entirely deprived of any power of
contraction, or until they are entirely
wasted away, before new muscles are in-
vaded, and the almost total absence of
muscular fiber in some parts makes a
striking contrast when compared with the
apparently healthy and well-formed mus-
cle closely adjacent. Again, several
muscles may be involved apparently at
the same time, and very soon again
others, and so on until all the muscles of
the body are involved, but not to such an
extent as totally to deprive any of its
function ; that is, the disease seems to
attack nearly all the muscles simultane-
ously, and the paralysis and wasting are
quite as prominent in one part of the
body as in another ; there is quite as
much difficulty in performing one move-
ment as another, and this frequently be-
fore the disease is well advanced.
One sometimes sees a case in which
the patient is able to perform all the
movements of the body in health, but if
tested, these movements will be found to
be extremely weak. In such cases there
will be a few muscles, such as the thenar
muscles of the hand and some of die
muscles of the shoulder, that may be
slightly more wasted and weakened than
others, and at the same time there may
be a general shrinkage of nearly all the
muscles of the body.
Between these two extremes, one in
which a few muscles only are much af-
fected at the onset, and that of a wasting
and weakness of all the muscles of the
body simultaneously, we may have all
shades of variation and differences as to
the severity and extent of muscles in-
volved. Before the disease has progressed
very far, the muscles of the trunk are in-
volved, and this particularly manifests
itself in attempts on the part of the
patient to rise from a horizontal to an
upright position.
The weakness of the muscles so ap-
parent in performing ordinary movements
becomes even more conspicuous when
subjected to a careful comparative test.
On the accompanying chart, which has
been arranged under the direction of Dr.
J. H. Kellogg, from the strength measure-
ment of loo adult men, we have (by ex-
tending the chart to meet the needs of
the case) a graphic representation of the
absolute and comparative strength of the
diiferent muscles of a case in which there
was paralysis and atrophy of the muscles
of the upper extremity, and paralysis and
increased myotalic irritability without
atrophy of the muscles of the lower
extremity.
It will be seen at a glance, by referring
to the chart, that with one or two excep-
tions the strength of all the muscles is
below the average, and that the strength
of the arms is much less than that of the
lower limbs. Many of the muscles, in
fact, are absolutely powerless, as is indi-
cated by the zero marks on the chart,
while the loss of power of other muscles
varies, as is shown by the different fig-
ures in the chart indicating their abso-
lute strength.
The total strength of the arms is
represented by the number 235, while the
total strength of the arms of the average
individual is represented by the number
1 132, showing a loss in the arms of about
80 per cent. Other comparisons may be
readily made by referring to the figures
in the chart.
(To be continued, i
TRANSLATIONS AND ABSTRACTS.
407
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE LIVER AS A BILE-MAKING ORGAN.
BY DUJARDIN-BEAUMETZ.
Member of the Academy of Medicine, Physician to the
Cochin Hospital, Paris.
Translated by J. H. Kellogg, M. D.
I WISH to speak especially of a new
remedy, olive oil. The homoeopaths, to
whom we owe our knowledge of some
new medicines, were the first to devise,
nearly twenty years ago, the use of olive
oil in large doses in the treatment of
hepatic colic. They were, in this, in
part faithful to their doctrine, since they
combat hepatic calculi composed essen-
tially of cholesterin, a fat body, by an-
other fat body, similia si?mlibus. We
note, however, that they employ it in
high doses, which is far from being a
Hahnemannian doctrine. From the
United States the method passed to
England, where it was employed by regu-
lar physicians. In France, it was only
after the work of Touatre, in 1887, that
this preparation began to be used ; and
Chauffard and Dupret, in 1888, and Mar-
tial Durand, in 1889, Huchard, Germaine
S6e, and Marciguey, have successively re-
ported the good effects from this method.
All these cases have been collected in
an excellent work by one of my students.
Dr. Willemin, of Vichy, from whom I
borrow some of the most important points
of this study. To-day the cases are suf-
ficiently numerous to enable us to assert
that olive oil in large doses is one of the
best modes of treatment of the pain pro-
duced by biliary calculi. It arrests the
acute pain almost instantly, and consid-
erably diminishes the period during which
the patients suffer from heavy pains,
weakness, and malaise.
Failures are the exception, and, strange
as it may appear, the large quantity of
oil is generally well supported by the pa-
tient, and is not vomited. It is necessary
to give, at a single time, 200 grams (6 to 7
ounces) of pure olive oil. To remove
this disagreeable taste, it is only neces-
sary to have the patient rinse his mouth
with water containing a little brandy or
orange juice. For my service, I add to
the oil 20 grams of beef bile for each 200
grams of oil. This mixture is slightly
bitter, but it is well supported by the
patients, and the results have been the
same as with oil. I have been led to em-
ploy bile by the researches of Prevot
and Binet, who have shown that this sub-
stance is a powerful cholagogue.
We are still ignorant of the true method
of the therapeutic action of this oil.
Touatre held that the oil always brought
away the calculi. We now know the
cause of this error. Touatre confounded
with calculi the oil concretion resulting
from incomplete digestion of the oil.
It can scarcely be admitted that the
oil acts directly upon the calculi, for the
oil cannot pass into the biliary passages.
Stewart maintained that the oil is de-
composed into a fatty acid and glycerine,
the latter producing in the intestine re-
flex movements favoring a discharge of
the calculus. Others, particularly Rosen-
berg, consider bile as a powerful chola-
gogue, and that it is this cholagogic
action which explains the favorable ef-
fects of the oil.
Finally, it may be mentioned that the
direct action of the oil upon the orifice
of the common duct, and especially upon
the adjacent region of the duodenum,
tends to diminish the reflex spasm which
is the first cause of the colic. For my-
self, I am ready to adopt the opinion of
Willemin, who thinks that oil in large
doses acts in several different ways ;
first, as a cholagogue, then by diminish-
ing reflex action, and finally, by favoring
the descent of the calculus in the intes-
tine by its laxative action. Whatever
may be the mode of its action, the num-
ber of successful cases is to-day so large
that before resorting to the injection of
morphia, we should always make our
patients suffering from hepatic colic take
the single dose of 200 grams of olive oil,
either with or without the addition of beef
bile.
It remains for me to say a few words
respecting surgical intervention in cases
of biliary calculi. The surgery of the
abdomen has made great progress in re-
cent years, and the liver has participated
in this surgical progress. Large abscesses
of the liver have been opened, portions
of the liver have been resected, the liver
has even been sutured in its normal posi-
408
TRANSLATIONS AND ABSTRACTS.
tion, but especially worthy of mention
are operations upon the gall bladder,
which is sometimes simply opened (chole-
cystotomy), and sometimes completely
removed (cholecystectomy). The first
attempts made by Lawson Tait and
Langenbuch, have been rapidly imitated
in different countries, and in France the
cases of Terrillon, of Terrier, of Routier,
and of Perier, are a sufficient demonstra-
sion that these operations upon the bili-
ary passages have entered into the domain
of current surgery.
Whenever an insurmountable obstacle
exists to the outflow of bile, so that the
gall bladder becomes distended so greatly
that it may even be confounded with a
hydatid cyst, whether the cause is a cal-
culus or an alteration of the biliary pas-
sages, it is the duty of the physician to
employ surgical measures to secure the
cure of the patient, and in a great ma-
jority of cases these will be followed by
success.
To the already quite extended category
of different forms of icterus, there has
been added, recently, a new variety, that
of infectious icterus. Guided by the new
methods of investigation instituted by Pas-
teur, investigators have sought to deter-
mine whether or not the bile contained
micro-organisms, and by what means
these organisms could gain entrance to
the bile. The clinical symptomatology
of this hepatic infection has been estab-
lished, and conclusions have been reached
which are interesting, both from a clin-
ical and from a therapeutic standpoint.
All these facts are fully presented in a
very remarkable thesis by D.r. Ernest
Dupret.^
Bile is, in the normal state, free from
microbes, and that, in spite of the pres-
ence of the numerous pathogenic micro-
organisms constantly present in the
duodenum, and even in the ampule of
Vater ; but in the pathological condition
the barrier is overleaped, and the bile is
then infected by numerous pathogenic
microbes.
This infection may occur, as remarked
by Dupret, by five different channels, — the
lymphatic, the arterial, the two venous
(portal and hepatic), and the biliary.
Infection by the hepatic channel is
very rare. As to infection through the
arterial circulation, this occurs only as
1 E. Dupret, Les Infections Biliaires ; Etude BactSriolo-
gie et Clinique. Paris, rSgi .
the result of general pysemic infection.
This is the cause of abscess of the liver,
so frequent in purulent infection.
Infection by the portal vein is the
cause of dysenteric abscess. Infection
by the hepatic vein is very rare ; however,
Widal, Achalme, and Claisse have ob-
served several cases of this sort.
Infection by the biliary way is much
the most interesting, and will alone oc-
cupy our attention. Dupret has classified
biliary infections as primitive and sec-
ondary, and the following table is a good
resume of the division which he has
adopted : —
r
Primary,
0)
1-1
Acute
Chronic
f Spontaneous. (Series of
attacks of infectious
I icterus.)
Induced. (Biliary infec-
tions compli eating
\ general affections.)
Chronic icterus.
Secondary
f Foreign bodies (inert or
Intrinsic ob- J living),
structions by j Calculus.
Cancer.
Extrinsic ob-
structions by
f Tumors of the duode-
-j num, pancreas, liver,
[ etc.
Whether primary or secondary, biliary
infection shows itself by a group of symp-
toms of which fever is one of the most
constant characters. This fever is some-
times remittent, sometimes clearly inter-
mittent, and it offers then the three stages
of intermittent fever. These attacks may
even assume a grave and pernicious form,
and the patient may succumb during an
attack.
Against infectious icterus of whatever
form, the science of therapeutics is not
without the means of defense. Antiseptic
medication is especially indicated, and
here is the triumph of salol, of salicylate
of bismuth, of intestinal lavage with solu-
tions of naphthol, and appropriate die-
tetic regimen, of which milk should con-
stitute almost the exclusive basis.
Let us not forget that a favorable prog-
nosis in these cases is to be drawn from
the abundance of urine. The greater the
quantity of urine produced in twenty-four
hours, the greater are the chances of
cure, and this diuretic action will be ob-
tained by the exclusive use of milk. It
is not necessary to enter further intq the
details of this antiseptic medication, as
it is precisely the same as that which I
have so often described.
However, there is one remedy which
must take an important place in the treat-
ment of these cases of infectious icterus.
TRANSLATIONS AND ABSTRACTS.
409
This is calomel. In a preceding lesson I
have shown you that, upon experimental
grounds, calomel is not a cholagogic
medicine, and the experiments of Prevot
and Binet confirm entirely those of Ruth-
erford and Vinal. The last-named ex-
perimenters proposed to substitute the
bichloride of mercury for the proto-chlo-
ride ; but, according to the experiments
of Prevot and Binet, these two salts of
mercury cannot be considered as chola-
gogic medicines.
However, clinical experience has shown
the great benefit that may be derived
from calomel in certain hepatic affections,
and in some countries, in England, for ex-
ample, this drug is in current use. I be-
lieve that we may explain the good effects
of calomel in the treatment of hepatic
affections by its antiseptic properties.
It is a powerful microbicide, and we can
understand that in infectious hepatic af-
fections secondary to intestinal disease,
this drug may render great service. Dr.
Sacharjin has very highly recommended
the employment of calomel in these cases.
He employs it in fractional doses, giving
one centigramme (one sixth grain) seven
times a day. However, I use calomel
with extreme moderation, and that be-
cause I have seen many patients experi-
ence the phenomenon of salivation after
its administration.
You know that it is demonstrated to-
day, and in a positive manner, that the
transformation of calomel into bichloride
of mercury under the influence of foods
containing chloride of sodium, is much
more difficult than has formerly been be-
lieved. It is necessary to cease the
remedy when the symptoms of gingivitis
appear.
It remains for me to terminate this
lesson by a few words respecting the
urticaria of hepatic origin. You are
familiar with the urticarias of dietetic
origin, of which the most intense type is
that which has been observed after eating
certain shellfish or oysters. In these
cases it has been maintained that icterus
is produced by a toxic substance con-
tained in the liver of these moUusks, a
toxine which Brieger has isolated, and
which he has given the name of mitylo-
toxine. These same phenomena of poi-
son are often seen to follow the puncture
of hydatid cysts, and it is probable that
there is another toxine not yet isolated
which produces this urticaria.
The same phenomenon occurs at the
period of convalescence from infectious
icterus, in particular from the icterus due
to retention resulting in infection. When
the bile is again thrown into the intestine,
eruptions of urticaria of great intensity
occur. These urticaria last for a certain
time, then diminish, and finally disappear
completely when the individual recovers
his health.
I explain these particular forms of
icterus as follows : It is probable that the
bile retained in the infected liver is the
point of departure. This bile contains a
great number of microbes and toxines anal-
ogous to those which are developed in
the liver of the mollusks. This bile, which
is thrown in upon the surface of the in-
testine, when the obstruction is removed,
is absorbed, and then produces the phe-
nomena of intoxication, of which the
nettle rash is only one manifestation.
Here also the only therapeutic means
applicable is intestinal antisepsis, which
is a prompt remedy, not only in urticaria
following infectious icterus, but in the
majority of urticarias, which are usually
pathogenic eruptions, as remarked by
Bazin, some being due to poisoning by
medicinal agents, the majority, however,
being due to poisons derived from the
food. At the present time, physicians of
the medical school of the Hospital St.
Louis prescribe an exclusive milk regimen
in the most intense urticarias, whatever
may be their origin.
AUTO-INTOXICATION OF INTESTINAL ORIGIN.^
Internal strangulation and constipa-
tion present two extremes, the maximum
and minimum of intoxication of intesti-
nal origin, and that morbid condition yet
little known, which is termed embarras
gastrique. The origin of the disease is
obscure and complex. We are ignorant
as to what is the first cause, but we know
that there exists at a certain moment in
this affection, a diminution of the saliva,
from which comes a clammy condition of
the mouth ; of the gastric juice, in con-
sequence of which the peptogenic power
of the stomach is lessened ; of the in-
testinal glands, which results in constipa-
1 Translated by J. H. Kellogg, M. D., from M. Bouchard's,
work entitled " Leqvns sur les Auto-Intoxicatio7is dans les
Maladies.'"
410
TRANSLATIONS AND ABSTRACTS.
tion. The appetite is diminished, a fact
which is advantageous, since the diges-
tive power is lessened, and consequently
the quantity of food usually taken would
give to the parasitic ferments a larger
amount of putrescible matter. In these
conditions of defective digestive secretion
I see the possibility of a development of
abnormal fermentations.
It is certain that the subjective troubles
experienced by patients cannot be ex-
plained by the deficiency of food for so
short a period. On the contrary, the
production of putrid fermentations ex-
plains the bitterness of the mouth, the
headache, and the prostration. If, then,
I can give you any instruction ^respecting
the first cause of the disease, I have some
reason for supposing that intoxication
must play a part in the pathogeny of
some of the symptoms.
In certain persons, who, suffering habit-
ually from diarrhoea, have only a single
liquid and fetid stool each day, we observe
nearly always headache, vertigo, rigors;
they complain of bitterness of the mouth;
their breath and skin have a disagreeable
odor; now all these inconveniences may
be made to disappear at once by evacuat-
ing the large intestine of its contents. A
person who awakes with a sensation of
exhaustion may be relieved at once by a
simple enema. These facts constitute
not a demonstration, but one more evi-
dence to add to the probabilities in favor
of the role played by intoxication in the
genesis of nervous symptoms.
One may even see symptoms much
more grave disappear after the simple
evacuation of the digestive tube. Wash-
ing the stomach is not, properly speaking,
a curative measure, but it removes ma-
laise, headache, and migraine. In some
patients suffering from dilatation of the
stomach, washing the stomach causes a
disappearance not only of the pain, the
pyrosis, the acidity, but of all the other
symptoms called reflex. Certainly lav-
age does not cure dilatation of the stom-
ach, but it renders great service in palli-
ating the most distressing symptoms, a
service which is very manifest, but un-
happily, at the same time also transitory.
In my service is to be found a woman
whose stomach was dilated. She suffered
constantly from supra-orbital headache.
Washing the stomach was always immedi-
ately followed by a disappearance of the
headache.
When the stomach contains still more
toxic matters, such, for example, as are
found in intestinal obstruction, lavage has
a utility not less manifest. Senator has
already formulated this indication. M.
Chantmess has also been able to verify
it in a patient of my service suffering from
intestinal obstruction from a cause un-
known. The faecal vomiting attested the
accumulation of toxic matters in the
stomach, and explained the general
symptoms which accompany internal
strangulation : small pulse, coldness from
paralysis of the cutaneous vessels, etc.
Four liters of the horribly fetid liquid
were evacuated by the stomach tube, and
the symptoms of peritonitis, which so
closely resemble those of intestinal in-
toxication, quickly disappeared. A new
accumulation of faecal matters in the
stomach was followed by the return of
grave symptoms which another washing
of the stomach caused to disappear, and
the patient made a good recovery. He
was cured, not by lavage, but the lavage
gave him a respite by arresting the intoxi-
cation, thus giving, I suppose, time for
nature to remove the strangulation.
There are other circumstances in which
one may suppose that the stagnation of
intestinal matters produces fever. After
laparotomy the fever may be explained in
many cases by a septic state of the peri-
toneum, and we see it disappear after the
relief of the constipation. (Kiistner.)
Obstetricians are well acquainted with
the fact that certain febrile symptoms
which follow confinement disappear after
the evacuation of the bowels, either spon-
taneously, or as a result of the adminis-
tration of a mild purgative.
The injurious influence of intestinal
stagnation after operation explains the
ancient forgotten opinions in surgical
practice. It was the rule to prepare a
patient for operation by administering
successively an emetic one day, then a
purgative the next, and thus repeat two
or three times. We do not to-day carry
this preventive measure so far, but after
the operation is performed, at least in
cases of operations upon the abdomen,
one may with advantage it appears, ac-
cording to the testimony of M. Verneuil,
induce movement of the bowels. These
are clinical facts which agree with theory.
There are some cases in which it has
been demonstrated that the grave symp-
toms of true indigestion were of toxic
TRANSLATIONS AND ABSTRACTS.
411
character. Senator has observed in one
of his friends a fact of this sort, in
which the intoxication resulted from sul-
phureted hydrogen produced in the in-
testines of the patient. There were
vomiting and eructations of gas, as well
as gas emitted by the anus, with an odor
of rotten eggs. The symptoms consist
of faintings, anxiety, etc. But the poi-
son may be revealed by the emunctories.
The gas emitted blackened .paper impreg-
nated with acetate of lead. The stools
and urine also contained hydrogen sul-
phide. We find, then, in this case, cer-
tain symptoms which form a part of the
classic picture of poisoning by sulphu-
reted hydrogen, from certain indigestions.
The presence of this poison in the in-
testine was demonstrated also in the
urine. It is certain, then, that it had
traversed the blood.
In some persons special foods, though
neither toxic nor putrid, produce regu-
larly indigestion and grave symptoms.
In each case if there is poisoning, it is
due not to the food but to the non-diges-
tion. The digestive juices fail to trans-
form food which is repugnant to the
stomach. The nervous system occasions
some disturbance of the secretion. The
gastric juice does not flow into the
stomach, or the hydrochloric acid is
absent at the moment of the conflict be-
tween the foods and the microbes. But
hydrochloric acid serves not only to
soften and to hydrate the alimentary
mass, it must also protect it against the
action of the parasitic ferments. The
action of these ferments not being pre-
vented, anomalous fermentations occur in
the stomach and in the intestine. The
products of these fermentations are ab-
sorbed, and as a result poisoning occurs,
which happily is not grave, since the
kidneys protect the organisms by elimina-
tion of the poisonous substances.
In 1882, I made the following observa-
tion : A man disliked cold fish, which
had been cooked the day before. One
day when he had made use of this food
which was repugnant to his nervous sys-
tem, digestion ceased and he experienced
the ordinary symptoms of indigestion,
first in the stomach and then in the intes-
tine. The diarrhoea continued not only
until the last part of food eaten had been
eliminated, but still longer. It was at-
tended by great prostration and distress.
The first symptoms appeared only after a
regular period of incubation of eight
hours, during which, without doubt, the
microbes had manufactured a quantity of,
poison which caused such a prolonged
intoxication. And in order that so great
an abundance of poison should be manu-
factured, it is evident that there must
have been a great multiplication of the
normal bacteria of the digestive canal.
In fact, I estimate the quantity of mi-
crobes in this case to be one third, of the
faecal mass. There was also an increase
of the intestinal alkaloids, since from
twelve grams of faecal matter I obtained
enough of the alkaloids to estimate the
proportion to be fifteen milligrams to a
kilogram of faecal matter. There also
appeared in the urine a great quantity of
alkaloids, the amount being fifty times
the normal quantity. In this case we see
that without the introduction into the di-
gestive tube of meat in a state of decom-
position, and without the intervention
of specific microbes, by the multiplication
of normal bacteria only, there was pro-
duced a great increase of one, at least, of
the toxic substances ordinarily to be
found in ,the intestine.
I once observed three persons who
were taken simultaneously with symp-
toms of the same sort. Breakfasting
together, they had eaten some fish with
some disrelish about ten or eleven o'clock
in the forenoon. At seven o'clock in the
evening, one of the three felt indisposed.
The others sat down to dinner, but found
themselves affected with identical symp-
toms before the meal was concluded.
The symptoms of the disease were ver-
tigo, prostration, vomiting, and diar-
rhoea. These symptoms were not the
result of poisoning, since they appeared
only after an incubation of eight hours.
The diarrhoea was not that which follows
indigestion, and which ceases at once
after the elimination of the undigested
foods ; it continued night and day during
eight days, with from eight to fifteen
evacuations daily. The patient remained
all this time in a half conscious condi-
tion. The three persons recovered, the
duration of the disease being the same
in each. This disease may be legiti-
mately attributed to the putrefaction
which occurred in the digestive tube,
and to the multiplication of the mi-
crobes which manufactured the poisonous
substances.
(To be continued.)
412
BACTERIOLOGICAL NOTES
Bacteriological Notes.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological
World and Modern Medicine, from original sources.]
Bacterial Complications in Chol-
era.— Mr. L. Renon, of the Necker
Hospital, describes four cases of cholera
in which the symptoms presented were
those of true cholera, but were not in all
cases due entirely to the comma bacillus.
Two of them were due to the bacterium
coli communis ; the~"other two were pure
cases of cholera, in which the cholera
germ was associated with the bacterium
coli communis. It would seem that
these facts have some practical impor-
tance from a diagnostic and pathogenic
standpoint.
^ — • — 4
The Action of Tobacco Smoke on
Pathogenic Micro-organisms. — Dr.
Tassinari, of the University of Rome,
has made numerous experiments on the
action of tobacco smoke on bacteria.
The last experiments he made confirmed
his former reports, to the end that to-
bacco smoke is clearly bactericide. He
concludes that cigar and pipe tobacco
smoke possess very clear bactericidal
power in general, and suggests that par-
ticularly on cholera bacilli tobacco smoke
should be taken into serious considera-
tion, as a prophylactic measure against
affections of a specific character in the
mouth. It seems to us that less objec-
tionable antiseptics would be decidedly
preferable.
Certainly the fact that tobacco will kill
cholera microbes is no apology for the
continued use of this drug, any more
than does the fact that quarantine will
hold cholera germs at bay argue for the
perpetual maintenance of quarantine.
The fact that tobacco smoke is germi-
cidal, proves it to be a toxic agent.
Immunity and Cure of Experiment
Animals in Diphtheria and Tetanus.
— Messrs. Behring and Wernick and Mr.
Kitasato have made very interesting and
useful 'researches on these questions.
Messrs. Behring and Kitasato have dis-
covered a very important fact in their
researches on diphtheria and tetanus.
They discovered, in fact, that these af-
fections could be cured by application of
chemicals, such as tri-chloride of iodine,
without destruction to the bacteria, and
by the same means immunity could be
conferred on them. In this case it would
seem that these remedies do not act by
their germicidal power, but by their neu-
tralizing action, being free from destruc-
tive power with regard to the poison
produced by the bacteria. Furthermore,
in studying closely the properties of the
serum of the blood of the animals vac-
cinated, it was found that this serum
occasionally destroyed the poison itself.
These eminent bacteriologists are still
at work on these interesting subjects, and
we hope that they will contribute to the
solution of questions so important.
Preventive Vaccination of Animals
against the Cholera Microbe. — A good
many experiments have been made of late
with the object of preventing cholera, and
some very interesting and probably very
useful results have been obtained. Brie-
ger and Wassermann cultivated the bacil-
lus of cholera by using virulent germs
from Massaouah. These germs were cul-
tivated 24 hours in extract of thymus of
a calf or peptonized broth, heated 15
minutes at 65° C. or 10 minutes at 80° C,
and finally allowed to remain 24 hours
in an ice chest.
Guinea-pigs received in four days 4 c. c.
of this liquid in injection in the perito-
neum. After a short malaise the animals
recovered, and after the last injection be-
came absolutely refractory to the comma
bacillus. Two months after the inocula-
tion immunity still exists, and it is prob-
able that it will continue longer.
Simple culture in the extract of thymus,
followed by a few days on ice without
heating the culture at all, gave just as
active vaccinal liquid. This fact con-
firms the specific action ,of the thymus
on the cultures, a fact which had been
recognized by Kitasato and the above
named authors themselves.
Klemperer was able to render animals
immune against cholera intoxication by
different processes. First, by a process
analogous to the preceding ; that is, by
inoculation of i c.c. daily for five days,
with a culture maintained during three
days at a temperature of 40.5° C. The
animals thus treated supported very well
a dose of cholera poison fatal for those
not thus protected.
BACTERIOLOGICAL NOTES.
413
The simple heating of the culture at
7o°C. during 2 hours produces a vaccinal
liquid so active that in 17 hours after a
single injection in the peritoneum of 2.5
c. c. of this liquid, tolerance was ac-
quired for the usually fatal dose.
The action of the constant current of
20 milliamperes on a culture of one day,
kills th» bacilli completely, and produces
an attenuation of the poison and a very
acceptable inoculation vaccine.
Finally, Klemperer, has been able to
confer immunity to guinea-pigs by means
of blood serum of rabbits rendered re-
fractory by injection of cultures attenu-
ated by heat.
According to Gamaleia, the dog is more
sensitive to cholera than most other ani-
mals serving for experiments in the labo-
ratory.
Preventive Inoculation of Hog
Cholera in Man. — Haffkine has dem-
onstrated the possibility of vaccinating
against hog cholera in human beings.
He attempted the inoculation on himself
first, and then on other persons. He
used an attenuated choleric virus. 'The
disorder provoked by this attenuation
lasted scarcely 24 hours, and consisted
only in a slight elevation of tempera-
ture with some fever (headache, dry
mouth, high colored urine) without any
derangement of the intestines. There
was a local alteration consisting of a
little pain at the point of inoculation,
with swelling of the skin in the neighbor-
ing ganglia. All these symptoms dis-
appeared before the fourth day after
inoculation.
The injection in these same persons of
virus increased in virulence by successive
passages from the organism of the guinea-
pig, in order to get a fixed virus, and
killing guinea-pigs and pigeons surely,
produced in man no more serious symp-
toms than those just described.
Haffkine concludes from these trials
that inoculations may be practiced on
man with the greatest safety, and he
thinks that the human organism would
have acquired very certain immunity
against choleric infection six days after
vaccination.
Ferran, of Barcelona, who, as every-
body knows, began to inoculate against
cholera as far back as 1885, has ad-
dressed a note of priority to the Society
of Biology in France. This investigator
claims that the culture of the comma ba-
cillus of Koch in broth loses its viru-
lence very rapidly, to such a degree, in
fact, that the cultures may be drunk in
small quantities with impunity, and inocu-
lated at a dose of 2 c. c. in the connec-
tive tissue. He claims that in order to
sustain and re-inforce immunity created
in himself and patients, he has recourse
to the very simple process of drinking a
few drops of the culture from time to
time.
-^ — • — »-
Bacteriological Diagnosis of
Cholera. — Laser published a note in
Berl. Klin. Woch. No. 32, in which a
very simple method of bacteriological
diagnosis of cholera is explained. It is
as follows : —
Inoculate a series of tubes containing
peptonized broth or gelatine peptone with
the suspected foeces to be examined ;
an equal number is inoculuted with the
foeces of a person in good health. The
whole is placed in an incubator and in
24 hours the diagnosis can be made by
the odor, the tubes containing the culture
of the choleric microbe emitting a charac-
teristic repulsive odor which cannot be
mistaken, as it can be compared with the
result of the cultures made from the
healthy subjects. The slightest quan-
tities of faecal matter (mere particles)
should be used.
The diagnosis will be confirmed after
a thin scum is formed on the surface of
the culture, and after 48 hours the action
of the '' cholera-roth " (rose-violet by the
action of strong acid) is obtained. Ex-
amination is completed by microscopical
analysis of the faeces and the scum of the
culture.
A New Leucomaine. — It was in 1881
that M. Armand Gautier discovered a
new class of alkaloids derived from pro-
teid matters, to which he gave the name
of leucomaines. They are bases formed
in the living cells and partly eliminated
by the urines. Mr. A. B. Griffiths, on
the same basis, succeeded in obtaining a
curious alkaloid from the urine of epilep-
tics. This poisonous leucomaine pro-
duces trembling, intestinal and urinal
evacuation, dilation of the pupil, con-
vulsions, and death.
414
EDITORIAL
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THE
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
$2.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., October, 1892.
MICROBES IN BREAST MILK.
Inflammation in the mammary gland,
followed often by abscesses, is not al-
ways regarded with the importance that
the case demands. The writer has had
occasion to study such cases clinically
and microscopically, and is in a position,
at this early stage of his observations and
researches, to state that such inflamma-
tions are sometimes at least of a specific
character, and are consequently danger-
ous to the nursing child.
It is not uncommon to find mothers
insisting on nursing a child even after
the inflammation is pro-nounced, and oc-
casionally until the ripening of an ab-
scess.
A case of recent occurrence in which
inflammatory spots appeared here and
there in the glands, was successfully
treated for a time ; all the swelled and
hardened spots disappeared. Nursing
had been continued during the treatment.
The child from the beginning of the
trouble until its decline did very well.
At this point it seemed to digest miser-
ably. Soon a small nodule was felt deep
in the left breast of the mother, beneath
the areola of the nipple. It became very
painful and hard. At the same time the
child became ill. The food fermented
rapidly in the bowels, and evidently pro-
duced toxines which caused stupor. The
alimentary canal bloated with gas ; the
faeces were full of mucus, and emitted a
putrid odor.
The milk was examined microscopic-
ally, and was found to contain pus and
cocci. Having no culture media at hand,
it was impossible to make cultures. The
breast milk was discontinued, and pep-
tonized cow's milk, sterilized, was used
instead, and the child rallied (after, of
course, a proper disinfecting treatment
of the alimentary canal).
This is only one instance of several
observations pointing in the same direc-
tion. It seems to the writer that in such
cases the fermentation in the alimentary
canal is set in by microbes in the mother's
milk — germs similar, perhaps, to those
found in the exterior in healthy cow's
milk, and probably often in diseased
cow's milk ; for mammitis in milch cows
is not uncommon, and this milk is often
sold to the unsuspecting public.
p. p.
-• — ♦ — ♦-
REST-HOUR.
Few chronic invalids appreciate the
value of an hour's rest in the middle of
the day. Many persons condemn them-
selves to confinement for a whole day in
bed, sometimes, indeed, for two or three
weeks of this sort of penance, by neglect-
ing to employ the ounce of prevention
which is so readily afforded by a little
rest before a complete breakdown.
Chronic nervous invalids are not infre-
quently in the condition of the man whose
bank account is completely exhausted,
and who must now eke out a parsimonious
existence by practicing the greatest econ-
omy in his expenditures, since his outlays
of means cannot exceed his daily income
unless by extraordinary economy or the
cutting off of unnecessary expenditure, he
succeeds in accumulating again a small
reserve fund.
The man who has exhausted his stores
of nervous energy until he finds himself a
nervous bankrupt, suffering from the well-
recognized symptoms of neurasthenia or
nervous exhaustion, cannot expect ever
again to be able to indulge in the lavish
EDITORIAL.
415
expenditures of nervous energy which
were the original cause of his breakdown.
It is often necessary, indeed, that such a
nervous invalid should reduce his expen-
ditures of energy to the lowest possible
point, so as to allow of an accumulation
.of strength to a sufficient extent to enable
him even to engage in the ordinary duties
of life. For many such invalids, an hour's
rest in the middle of the day would be a
most valuable means of '* keeping up."
An invalid who cannot endure the strain
of continuous effort for from eight to
twelve or fourteen hours, may be able to
maintain efficient activity for three, four,
or five hours without difficulty ; and after
resting an hour or two, he may find his
forces replenished so that he can renew
his labor for the same length of time as
before ; and yet the same invalid might
find himself so broken down by prolong-
ing his effort an hour or two beyond the
proper limit, as to require two or three
days, or even as many weeks, for recu-
peration.
There are many nervously broken down
men and women who are still struggling
on with the active duties of life, who
would be marvelously helped and relieved
of the great burden of mental and nerve
distresses of various sorts, by taking a
whole day's rest in bed now and then ;
even half a day once a week, if a whole
day cannot be spared from the active
duties of life, may prove in many cases
of invaluable service, and will greatly in-
crease the invalid's efficiency.
Many chronic nervous invalids, whose
cases are too chronic, and whose break-
down has been too complete for a perfect
cure to be effected, have been made to
live for years very comfortably, practi-
cally free from serious inconvenience, by
adopting this plan at the suggestion of the
writer, and have expressed themselves as
grateful for the relief from brain-fag,
nerve-strain, and a variety of accompany-
ing ills, which is thus afforded.
The exercise cure is doubtless needed
in a far greater proportion of cases than
the rest-cure, and yet there are now and
then cases in which rest in bed for a few-
hours, or even for a whole day, will prove
of greater benefit even than an excursion
into the country or a tramp in the woods.
HEREDITY.
The question is constantly asked, " To
what degree is heredity responsible for
the moral and physical infirmities from
which human beings suffer ? According
to Galton we inherit one tenth of our
original nature from our grandparents,
and one fourth from our parents. The
fact of heredity is well recognized in
the common expression, '<achip of the
old block." The influence of heredity is
well shown in India, where a caste exists
for every trade. Fathers consider it a
waste of effort to undertake to teach their
sons a trade different from their own,
recognizing the advantage of hereditary
aptness in the children for their father's
trade or profession.
India also affords another illustration of
the national deterioration which has re-
sulted from the practice of secluding the
women, and condemning them to a life
of ignorance and comparative idleness,
which has existed for many generations.
Fathers and mothers sharing equally in
the transmission of hereditary qualities,
male as well as female children suffer from
this deteriorating influence, and thus the
race has steadily retrograded, from the
golden age of Hindu civilization, when the
masterpieces of Sanscrit literature were
produced, to the present time. An In-
dian writer recently concluded an address
with this remark: *'I feel justified in
concluding my address as Milton's Satan
concluded his speech to his followers ly-
ing at his feet in the oblivious pool of
Lethe, with the words, —
"'Awake! arise! or be forever fallen.'"
Unquestionably, heredity accounts for
much of the nervous weakness and other
416
EDITORIAL.
functional disorders from which so large
a proportion of the natives of civilized
countries suffer at the present day.
Bacillus Coli and Eberth's Bacil-
lus.— Great interest has been aroused
in the bacteriological world by the studies
which have been made within the last year
or two upon the relation between the
bacillus coli communis and various in-
flammatory and septic conditions of the
body. Of especial interest have been the
studies which have been undertaken to
show the relation between this common mi-
crobe, which is always present in the intes-
tine, and the bacillus of Eberth, which has
been supposed to be the specific cause of
typhoid fever. Attention was first called
to the possible relation between the bacil-
lus coli and typhoid fever by Rodet and
Roux, who found the pure culture of the
baqillus in the pus furnished by the lo-
calized peritonitis occurring in typhoid
fever, and also observed it in abscesses
of the liver occurring as a complication
in this disease. In an epidemic of ty-
phoid fever, they found great quantities
of the bacillus coli in an almost pure
state in the stools of the patients, but
were unable to find Eberth's bacillus in a
single instance. In one case they dem-
onstrated the presence of Eberth's bacil-
lus in the spleen by means of puncture,
although this bacillus was present in the
stools, which contained, however, the ba-
cillus coli in an almost pure state. Val-
lethas more recently taken up the study of
the subject, and has likewise found that
Eberth's bacillus is absent in many cases
of typhoid fever, while the bacillus coli is
invariably present. These observers hold
that the peculiar conditions present in ty-
phoid fever are the cause of biological
changes in the bacillus coli, which give
it the characters heretofore recognized as
peculiar to Eberth's bacillus, from which
it appears that Eberth's bacillus is only a
transformed bacillus coli.
From these and other studies, it ap-
pears that the bacillus coli is capable of
being transformed, under special con-
ditions, into a variety of forms, and is
capable of producing various pathological
conditions. Its presence having been
demonstrated in cases of abscess, pleurisy,
peritonitis, dysentery, and cholera nostras,
as well as in typhoid fever. It has also
been learned that the bacillus coli may
undergo the changes by which it becomes
a virulent microbe outside of the body,
as in water-closets and cesspools, as well
as in the body. The evidence is, in fact,
that the bacillus, when obtained from
cesspools and water-closets has more
virulent properties than when derived
from human intestines, and that its vir-
ulence is even greater than that of Eberth's
bacillus.
The important sanitary bearing of
these discoveries is evident.
J. H. K.
The Sinusoidal Current. — One of
the editors of this journal read a paper
upon this subject at the annual meeting
of the American Electro-Therapeutic As-
sociation, held at the Academy of Medi-
cine in New York City, Oct. 4 to 6,
1892, the following brief abstract of which
appeared in the Electrical Engineer: —
''Dr. J. H. Kellogg, of Battle Creek,
Mich., read a paper on 'The Physiolog-
ical Effects of Magneto-Electricity of
Regular Variations ' or sinusoidal current.
The author began by referring to M. D'Ar-
sonval's studies upon the physiological
effects of the alternating magneto-electric
current, and quoted his statement that
' The intensity of the motor, or sensory,
reaction is proportionate to the variation
of the potential at the point excited.' The
author some years ago experimented with
a small magneto-electrical apparatus, or
telegraph generator, and found that this
machine produced powerful but painless
muscular contractions. He then made
an apparatus for graphically representing
currents, from which many tracings from
EDITORIAL.
417
the machine referred to and also various
forms of faradic machines were made. A
number of these curves were shown. That
due to the faradic current was uneven with
respect to the zero line, while that of the
magneto-electric machine corresponded
exactly with those obtained by D'Arsonval.
The comparative painlessness and great
penetrating power of the sinusoidal cur-
rent were especially emphasized. An
induced current capable of producing
equally strong contraction is so painful
as to be almost intolerable, and the same
is true with current from a static machine.
Experiments upon the effect of this cur-
rent on the sense of taste, the olfactory
sense, and the auditory sense, are now in
progress. The effect upon the optic
nerve is attributed to its remarkable
power of diffusion or penetration. Dr
Kellogg's device for the graphic repre-
sentation of the curves, consists of an
electro-magnet arranged to form an an-
nular field in which a delicate solenoid is
made to move by an alternating current.
This solenoid acting on the short arm of
a delicate lever, compels the long arm to
scribe its movements upon a rotating
cylinder covered with smoked paper."
Scientific Exposure of Magnetism
Frauds. — At the meeting of the Ameri-
can Electro-Therapeutic Association, held
at the Academy of Medicine, New York
City, October 4 to 6, which we had the
pleasure of attending, Dr. Frederick Peter-
son and Mr. A. E. Kennelly, of the Edison
Laboratory, reported the ''results of some
physiological experiments with magnets,"
which they had conducted at the Edison
Laboratory, employing for the purpose
magnets of great power, and of sufficient
size to require two men to lift them. The
magnets were arranged in such a manner
as to secure the greatest possible amount
of magnetic energy in action. Frogs'
blood and other fluids, as well as human
beings, were subjected to the influence of
the magnet. We quote the following brief
abstract of the paper read by these gentle-
men, from the Electrical Engineer for
October, 1892 : —
"After a few words in regard to the
effect of magnetism upon certain forms of
hysteria, etc., and quoting Profs. Bene-
dikt, Roberts, Bartholow, and Dr. Vansant
on the subject, the authors described ex-
periments made by them with magnets of
great power at the Edison Laboratory at
Orange. The pole-faces of the magnet,
which two men were required to lift, were
1.2 cm. apart, and between these poles
objects were placed for observation. The
intensity of the field was about 5000
c. G. s. lines per square cm. A drop of
water on a glass slide in this field was
visibly distorted. Experiments were made
on blood, which was found to be unaf-
fected in any way. Experiments upon
frogs failed to give any result. Then the
effect of a continuous current was noted,
and circulation was found to cease.
Benedikt's statement that magnetism will
produce paralysis was then tested. A set
of idle field magnets converging into a
cylinder two feet in diameter and seven
inches deep was employed. In this cyl-
inder a dog was placed for five hours
without the slightest visible effect. Ex-
periments were next tried upon the brain.
The armature and one journal were re-
moved from a dynamo converting about
70 h. p. at full load, and in the space
between the pole-pieces the subject placed
his head. The intensity of the magnetic
field produced was about 2500 c. G. s.
lines per square cm. A switch was ar-
ranged to open and close the exciting
circuit. Sphygmographic tracings, taken
continuously, showed no change in regu-
larity.
"The respirations were not changed in
the least, and there were no sensations
that could be attributed to magnetic in-
fluence. Experiments in connection with
reversed magnetism also failed to show
any effect upon the subject. From these
experiments, the authors conclude that
418
EDITORIAL
the human organism is unaffected by the
most powerful magnets known to modern
science ; that neither direct nor reversed
magnetism exerts any perceptible in-
fluence upon the iron in the blood, upon
the circulation, upon ciliary or proto-
plasmic movement, upon sensory or
motor nerves, or upon the brain."
The experiments above described seem
to settle in the most positive manner, the
question as to whether the magnet is pos-
sessed of any therapeutic virtues. If
experiments with a magnet with an elec-
trical current capable of doing work equal
to a twenty-horse power produces no effect
whatever upon the nerves, the heart, or
the blood, it is evident that the toy
magnets which are peddled about the
country in the form of magnetic insoles,
magnetic garments, etc., can have no
possible influence upon the human body.
These contrivances are simply mind-
cures, so far as magnetism is concerned ;
all that is possible is that in some in-
stances some benefit may be derived from
the abdominal supporters, insoles, and
other appliances in which the magnets
are concealed.
THE TEA AND COFFEE HABIT.
The facility with which intelligent
human beings acquire poison habits is
one of the anomalous physiological prob-
lems presented by modern civilization.
Wherever the human race is found, if
there is to be found in the same portion
of the earth a drug capable of producing
artificial felicity, it is certain to have
votaries more or less numerous, each of
whom will be loud in the praise of the
marvelous virtues and the innocuous
properties of the particular drug to which
he is attached. The Chinaman finds his
soporific heaven in smoking the inspis-
sated juice of the poppy. The native of
the Orient undertakes to lift himself to a
higher level of artificial bliss by means of
Indian hemp. The Siberian chews his
mushroom, while the North American
and his imitators in almost every land,
in the mystic rites of smoking, chewing,
snuffing, and dipping, figuratively bow
down to the god nicotiana tabacum.
Every leaf, bark, root, and seed equal
to producing a temporary nerve-tickle,
has been hunted out, experimented with,
and utilized as a source of artificial ex-
hilaration. So universal is this disposi-
tion, that some have even been led to
suppose it a physiological demand, the
gratification of which is as necessary as
eating and drinking, or the supply of any
natural want. The untruth of this popu-
lar notion is clearly shown, however, by
the fact that the gratification of a physio-
logical appetite is not attended by the
production of disease, while a narcotic or
stimulated appetite brings in its train a
multitude of maladies and miseries, each
peculiar to the special drug by which it
has been produced. Healthful foods
taken in quantities sufficient to satisfy the
normal appetite, are never productive of
disease. This cannot be said of a single
one of the felicity-producing drugs, to the
use of which the human race, or any por-
tion of it, is addicted.
But the purpose of this article is not to
portray the evils arising from the long
category of poison habits which human
beings cultivate in different portions of
the world, nor even to treat exhaustively
mischiefs arising from a single one of the
deceptive drugs which hold and enslave
so many millions of the human race, but
rather to call attention to the fact that
some commonly used and little suspected
drugs, notwithstanding their apparant
harmlessness, carry, under the cloak of a
brain-soothing, a nerve-tickling power, a
poison laden draft, which strikes deep
into the vitals of those who seek to hide
behind the care-effacing, nerve-exciting
agent.
It is a fact which is pressing itself more
and more emphatically upon observing
physicians in all civilized countries, that
EDITORIAL.
419
the undeniable disease called '* nervous-
ness " is increasing in prevalence at a
most alarming rate. This is a matter of
common observation and remark. There
is a decreasing number of physicians who
do not believe that the apparently harm-
less practice of tea and coffee drinking,
is, in part at least, responsible for this
growing depravity of nerve-cell and fiber.
To prove this beyond any possibility of
cavil, to the satisfaction of every man, is
a task which not one will attempt to un-
dertake, since the complexity of the
forces in operation which tend to modify
or to deteriorate the human constitution
under the artificial conditions of civiliza-
tion, renders every problem relating to the
physiological or pathological influence of
habits most difficult of solution.
That tea and coffee have a decided in-
fluence in the direction suggested, will
not, we think, be disputed by any intelli-
gent, observing medical man, since evi-
dence of a very positive character is af-
forded in the fact that while the influence
of moderate doses, even though long con-
tinued, may be inappreciable or undis-
coverable in the midst of a multitude of
other possible causes, and without any
morbid manifestation, it requires only a
slight excess to develop the- toxic proper-
ties of theine or caffeine ? And further-
more, it is well enough known that what
might have been, for one person, a mod-
erate dose, that is, a dose so small in
quantity that its effects are not imme-
diately observable, may be for another per-
son sufficient to produce toxic effects.
The toxic effects of the ''cup that
cheers, but not inebriates," are familiar to
every one as the sleep-banishing property
of a strong cup of tea. Not one would
dispute for a moment, that a drug capa-
ble of producing drowsiness or sleep in a
person who is not fatigued or in a condi-
tion to require sleep, must be possessed
of a toxic property. Is it not quite clear
that a drug capable of producing, tem-
porarily, the most obstinate insomnia,
even in a person whose physiological state
is such as to demand recuperation or
sleep, must be possessed of poisonous
properties of a very positive kind ?
Lehman, the eminent German physio-
logical chemist, unhesitatingly pronounced
caffeine to be a poison, notwithstanding
the claim that he, even at that day, had
made it apparent, as an apology for the
use of a mild narcotic, that it was a food ;
and the evidence that he was right, which
was based upon the results of experiments
upon himself and others as well, in stud-
ies of the close relation between the
chemical constituents of caffeine and
those of the well-known alkaloidal poison,
is constantly affirmed by evidence accu-
mulated by the experimental researches of
physiologists and physiological chemists.
Reviews.
Drinking Water and Ice Supplies. —
By T. Mitchell Prudden, G. P. Putnam's
Sons, Pubs., New York and London.
Like all the works of Dr. Prudden, this
is an excellent and exceedingh^ practical
work, full of sound suggestions and un-
questionable demonstrations tending to
educate the masses on the necessity of
pure water and pure ice. The book is
divided into seventeen chapters, covering
the ground fully and tersely, so that any
one may gain the most valuable informa-
tion on the subject of water.
It is undoubtedly true that water con-
tains, in many quarters, the elements of
disease, and causes sporadic and epidemic
affections often of a most fatal character.
Unfortunately, the world does not see it,
and seems indifferent to the scientific
teachings which are sent forth in public
print. Dr. Prudden's book is a little
volume of 139 pages, well illustrated, and
is the first short, concise English work
on water, under the light of to-day, writ-
ten in a manner attractive and free from
technicalities. Everybody should pos-
sess a copy.
HERE TO
SPEND THE
INTER!
At this Season of thk Ykar Thousands of
Invalids are Seriously Considering
THE Question, —
Where can I Spend
THE Months of
NouerRbep, Decembep,
Janiiapy, Febriiary, ,.^^ March,
With the GREATEST PROFIT?
THE ANSWER
to this question will depend
upon what the individual
wishes to accomplish by a
sojourn away from home. If rest and recuperation are the chief requirement, the
Southern and Pacific Coast States offer numerous attractions which draw throngs of
semi- invalids and valetudinarians every year.
If, in addition to rest and recuperation, the invalid needs a careful study of his
diseased conditions, and an intelligent regulation of diet, exercise, and all other
health conditions, — in other words, scientific health culture, efficiently carried out
by the aid of the best known medical means and appliances, thoroughly trained
nurses and attendants, and competent physicians, — then the choice between the most
desirable places becomes very much restricted. There are certainly few institutions
in this country where the needs and desires of an earnest, health-seeking invalid can
be satisfactorily met. Such places can be counted on the fingerjs of one hand, and
are. perhaps, little known because of the fact that the managers of such institutions
are conducting them in a scientific, and in some instances a philanthropic spirit, and
consequently do not employ as a means of winning patronage, the emblazoned ad-
vertisements, the truth-sacrificing circulars, and other advertising methods com-
monly resorted to by the proprietors of mineral springs establishments, bogus
sanitariums, and other so-called ' ' health institutions ' ' and quasi-medical establish-
ments, with which the country abounds.
The advertisements of these establishments do not appear in public prints or
popular magazines because such advertising is closely akin to quackery, and brings
those who employ it into bad company.
The managers of the- Sanitarium at Battle Creek, Michigan, many years ago
undertook to organize a thoroughly scientific institution which would represent
rational medicine in its most advanced form, and would be exactly what it professed
to be — an institution where patients are honestly and fairly dealt with, treated at
reasonable rates, given kind attention and comfort, and opportunity for the recovery
of health under the most favorable conditions. The majority of patients treated in
this institution are sent to it by physicians who by personal acquaintance, or
through the reports of their patients, have become thoroughly familiar with the
character of the institution and its management.
DESORIRTION
or THE
^ ATTlyK CREEK, one of the most beautiful and prosperous cities of Michi-
^ gan, is centrally located in the salubrious Peninsular State. Its population
is 20,000, while its death rate is but seven per thousand. Battle Creek is
situated on two great thoroughfares of railway travel between the East and
the West, being at the junction of the Grand Trunk and the Michigan Central lines ;
and two other railways make it easy of access from the South.
The city has an electric railway and is lighted by electric lights. A great
number of pleasant drives are afforded by its well-kept and shaded streets.
The Buildings are lighted by a 700-light plant, Edison incandescent system.
Safety Hydraulic Elevators. Outside stairways for fire escapes accessible
from every window.
The Institution affords facilities for baths of every description : Turkish, Rus-
sian, vapor, electric, water baths of all kinds, and the electric light bath. In-
dependent accommodations for ladies and gentlemen, sufficient for 80 persons
at one time. More than 800 feet of glass for sun baths.
A General Parlor, 40 x 50 feet, is luxuriously furnished with Dhagistan rugs,
easy chairs, etc. The Dining- Room has a seating capacity of 400, is beauti-
fully lighted and ventilated, and always cheerful. No kitchen smells. Cui-
sine unsurpassed ; table service excellent. Everything an invalid needs, and
special dietaries prepared as directed.
THE CONSERVATORY.
The Gymnasium, 85 x 45 feet, is supplied with every appliance for exercise, and
furnishes special instruction and class drills in Delsarte and Swedish gymnas-
tics, under a trained director. Exercise by prescription.
The S^wedish Movement Department, both manual and mechanical, is the
most extensive in the United States. Vibrating bars and seats, kneaders, rub-
bers, beaters, shakers, and manipulating appliances of all sorts.
The Electrical Department contains every improved appliance for medical ap-
plications of electricity. Galvanic, Faradic, Dynamic, and Static electrical
apparatus and appliances for electrolysis, electro-cautery, etc.
An Aseptic Maternity on the cottage plan ( steam heat and thorough ventila-
tion), provides the best possible conditions for lying-in patients, with expe-
rienced professional attendance and rigorous aseptic management.
Special Departments for surgical cases, eye, ear, throat, and lung diseases,
nervous diseases, genito-urinary diseases of men (non-specific), opium and
alcohol habits, and diseases of women. A kindergarten and nursery, to keep
the children happy and out of mischief.
Three Fine Greenhouses, maintaining a
magnificent collection of palms and va-
rious tropical flowers and plants, keep the
house filled with bloom during the win-
ter season. Flowers are everywhere in-
doors during the winter season. Patients
can visit the greenhouse at any time
without going out of doors.
Glass=Inclosed Sun^Parlors and Veran=
das for winter sunning and promenad-
ing.
SUMMER HOUSE AND FRESH-AIR INLET.
Pure Water from sandstone rock.
There are from 250 to 300 Employes in the Sanitarium service the year
round, of whom from 90 to 100 are medical attendants and nurses. Also seven
thoroughly trained physicians, and a large corps of manipulators skilled in
massage and the lying system of Swedish movements.
The Sanitarium Training=School, in which our nurses are trained, is the
largest and most popular in the United States. Its course of training is
the most complete and
thorough of any school.
Tri=Weekly Lectures on pop-
ular medical subjects by
the physicians.
Ahundant Means for Rec=
reation indoors during
inclement weather. Facil-
ities for walking, driving,
and horseback riding at all
seasons.
The Sanitarium is Not a
Pleasure Resort nor a
fashionable hotel, but an
ideal place for invalids needing good nursing, the benefits of regular habits,
and scientific professional care and treatment, and who desire to become per-
manently well.
The Sanitarium Nursery and Kindergarten. This enables mothers to bring
little ones wdth them without being burdened with their care and supervision.
The children have the advantages of kind and experienced teachers and am-
ple playgrounds.
For Further Particulars, see large circular and card of rates.
J. H. KELLOGG, M. D., Supt.,
Sanitarium, BATTLE CREEK, MiCH.
MAIN ENTRANCE.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
MONTHLY BUI^LETIN.
Battle Creek, Mich., October, 1892.
THE ACID OF THE GASTRIC JUICE.
There has been an almost endless discussion
amonj;' physiologists respecting' the nature of
the acid of the gastric juice. Quite a consider-
able number of eminent chemists have main-
tained that the normal acid of the gastric juice
is lactic acid, and there have been physiolog-
ical chemists of repute who have regarded the
acidity of the gastric juice to be dne, in consid-
erable part, to acid phosphates. The majority
of authorities have given their adhesion, how-
ever, to the views of Bidder and Schmidt, who
regard the acidity of the gastric juice to be due
to the presence of free hydrochloric acid. The
experiments of Richet and others have thrown
considerable doubt upon this theory, however,
and consequently, much confusion has existed
among physiologists upon a point which it
would seem ought by this time to have been
authoritatively settled. That lactic acid is
normally present, in small amounts at least, in
the early stages of digestion, is a fact which
cannot be disputed; and that it plays a part
of some importance in the digestive process,
the writer has demonstrated to his own satis-
faction, although just what part it acts in the
normal chemical process of digestion cannot
yet be fully exi)lained by the data which physi-
ological and therapeutic experiments have
placed in our hands. The facts which the
writer desires to present in this brief articlf», it
is believed will be found of interest in this con-
nection, and will contribute something toward
the settlement of this important physiological
question. The facts to be presented are as fol-
lows:—
1. The results observed respecting the con-
stancy of free HCI in the quantitative analysis
of 413 different stomacli fluids.
2. The results noted as regards the presence
of lactic acid in the examination of stomach
fluids.
3. Experimental observations respecting the
effect of the addition of free hydrochloric acid
to meat juice and other albuminous fluids.
4. Therapeutic observations respecting the
influence of lactic acid upon the digestive
process.
In this note, attention will be called only to
the flrst two classes of facts, the third and
fourth observations being reserved for a suc-
ceeding article.
1. The Results of the Quantitktive Analrsis
of 413 Stomach Fluids. — The stomach fluids
analyzed in this series of observations were
furnished by 321 different individuals. The
fluid was withdrawn from the stomach one
hour after taking a test breakfast, neither food
nor fluid having been taken since rising. The
presence of hydrochloric acid was determined
qualitatively by the use of the usual color rea-
gen ts, Congo-red, methyl-violet, Giinzburg's rea-
gent, and the resorcin and sugar reaction.
Each fluid was also carefully exa?nined quanti-
tatively by substantially the same method
suggested by Bidder and Schmidt, which con-
sists in first determining the total amount of
chlorine present in the gastricflnid, then mak-
ing a second determination, after evaporating
the liquid to dryness without the addition of
carbonate of soda, and drying the residue for
an hour so as to drive off all free HCI. Sub-
tracting the figures obtained in the second an-
alysis from those obtained in the first, the
difference will represent, of course, the exact
amount of HCI existing in a free state in the
fluid examined. No method of determining the
amount of HCI present in the gastric juice more
accurate than this has ever been devised, and
indeed this method seems to offer all the ad-
vantages as regards accuracy that could be
desired. It is evident that the only chance for
error, if any exist, would be in the represen-
tation of too small a quantity of free HCI,
since in the fli-st determination the free HCI is
wholly fixed by the carbonate of soda added,
so that the only source of error likely to arise,
will be found in neglecting to continue the
evaporation of the dried residue in the second
determination for a sufR(nent length of time to
completely dissipate the free HCI present.
The results obtained were as follows: —
(a.) The presence of free HCI was indicated
(424)
LABORATORY OF HYGIENE.
425
l>y color reactions in 362 cases, or 87.6 per
cent of the total number examined.
(b.) The presence of HCl was determined by
the quantitative method, and in amount suffi-
cient to be measured, in 307 cases, or 96.1 per
cent of the total number of fluids examined.
It is interesting- to note that free hydrochlo-
ric acid was found and the amount determined
by the quantitative method, in every single
instance in which its presence was indicated by
color reactions, although the color reagents
failed to indicate the presence of free HCl in
quite a number of instances in which it was
present in very appreciable quantit3% as de-
termined by quantitative analysis. In one
instance the color reagents totally failed to
indicate the presence of free HCl, although this
acid was present to the amount of .020 grams
of anhydrous acid in each 100 c.c. of stomach
liquid.
It appears from these results that hydrochlo-
ric acid is a very constant constituent of the
gastric juice, even under unfavorable circum-
stances, for nearly all the cases examined were
persons who were suifering more or less from
stomach disorders. The sixteen cases in which
no hydrochloric acid was found by quantitative
analysis, were all cases of hypopepsia of a very
pronounced degree. Hj^poacidity existed in
all the cases, and lactic acid was present in
only three of the sixteen cases.
2. Observations Relating to Lactic Acid in
the Analysis of 328 Stomach Fluids.— The
stomach fluids examined were furnished bj'^ 232
difl'erent persons, nearly all of whom were suf-
fering more or less from disordered digestion.
For obvious reasons, no quantitative estima-
tion of the amount of lactic acid present was
undertaken. Uflfelmann's reagent was em-
ployed with all possible precautions. A
watery solution of the residue obtained by
washing the liquid several times with ether,
then evaporating the ethereal extract, was
used, but the presence of lactic acid was in-
dicated in only 180 cases, or 54.9 per cent of
the total number of fluids examined.
The evidence respecting the degree of con-
stancy of lactic acid as a constituent of gastric
juice aff"orded by this fact, cannot be said to
be absolutely conclusive, on account of the
want of a thoroughly reliable color indicator
for this acid; but such evidence'as exists, leads
to the conclusion that this acid is much less
constant as a constituent of gastric juice than
is free HCl, and this observation still remains
good, even if we consider lactic acid present in
€very case which presents any evidence of acid
fermentation, since the addition to the figures
above given of the 59 cases of acid fermenta-
tion in which the presence of lactic acid was not
noted, making 259 cases in all, would still give
21 per cent of the total number of cases ex-
amined in which lactic acid was observed to be
absent.
I do not know whether or not a study of this
sort, including so large a number of cases, has
ever before been made, and hence am not able
to make a comparison of my results with those
obtained by other observers. T ought to add,
however, that every ])recaution was taken to
avoid the ingestion of lactic acid with the food,
and to exclude lactic -acid -forming ferments.
To this end I discarded the use of the white
raised bread commonly employed for the test
breakfast, and used, instead, unleavened water-
bread composed of whole-wheat meal with the
addition of common salt to the amount of
three fifths of one per cent of the bread taken.
Admitting the correctness of the above ob-
servations, it seems quite clearly established
that free HCl is the normal acid of the human
gastric juice, and that lactic acid, except in
very small amount, plays only a subordinate
part.
If it be suggested that the observations are
inconclusive, because the digestion was dis-
ordered more or less in the majority of cases
from which the fluids were obtained, this ob-
jection is negatived by a comparison of the
results obtained in cases of hyperpepsia and
hypopepsia respectively. Of the total number
of cases examined with reference to lactic acid,
182 belonged to the class hyperpepsia, and 123
were cases of hypopepsia. Lactic acid was
found present in 97 cases, or 53.3 per cent, of
the cases of hyperpepsia, and in 63, or 51.2 per
cent, of the cases of hypopepsia. If lactic acid
is normall^'^ a prominent constituent of the
gastric juice, we should expect to find it in-
creased in quantity in cases in which the other
elements of the gastric juice were found in
excessive proportion; but, ns shown by the
above figures, this is not the case; instead, we
find lactic acid occurring with equal frequency
in cases of hypopepsia, in which also it was
present the most frequently in excessive amount.
J. H. K,
(To be continued.)
CONVENIENT METHODS FOR DETERMINING CO..
The writer's interest in sanitary subjects led
him some years ago to give attention to the
subject of CO2 analysis.
The need of some simple and accurate means
of determining the quantity of CO2 found in at-
mospheric air was especialh-^ felt. After experi-
ments with different forms of apparatus for
426
LABORATORY OF HYGIENE.
making an estimate of COg, the apparatus
shown in Fig. 1 was finally perfected. This ap-
paratus consists essentially of two graduated
glass bottles holding one liter each, connected
by tubing in such a way that one liter of watei-
can be made to siphon from one bottle to the
Fig. 1.
other; and a glass tube about sixteen inches in
height, in the bottom of which is fixed a tube
with a small aperture, is connected with the
two bottles in such a manner that as the water
siphons from one bottle to the other, the air
contained in the empty bottle, as the bottle
fills, will be forced through the small opening,
and made to pass upward through the vertical
tube, which is supported againslTthe standard,
which also serves to support the bottle from
which syphonage is taking place. By replacing
the bottle and replacing the pinch cocks, the
passage of air through the solution is con tinned
as long as may be required. If the air of a room
is to be examirred, the air is collected in one
bottle and is passed through the apparatus to
the other. If the air to be examined is con-
tained in the rubber bag or a gasometer, it is
only connected with the short-tubed bottle and
admitted as required.
In using the apparatus, the vertical tube is
partly filled with lime or baryta water, which
absorbs the CO2 contained |in the air, which|[is
made to bubble up through it from the aper-
ture at the bottom. The lime or baryta water
is colored by a solution of phenol-phthaleiu.
Thepurple color produced by thephenol-phtha-
lein disappears instantly as soon as the limeor
baryta water contained in the solution is
wholly neutralized by the CO2, and is thus a
most delicate means of determining when a
sufficient quantity of air has been passed
through the apparatus. It will be evident to
any one at all familiar with chemical estima-
tions that it is only necessary to know the
amount of lime or baryta contained in the
solution, to determine the proportion of CO,
contained in the air examined.
To determine the amount of CO^ in the
breath is an operation in which extreme ac-
curacy is required, as a physiological investiga-
tion and a most accurate method is required-
M. Gomberg, M. S., who is at present in charge
of the chemical work of the Laboratory, has
perfected the method which he has employed in
physiological researches which are being car-
ried on in the Laboratory, and which will be
recorded at a later date. The method which is,
we think, in some respects unique, is thus de-
scribed by M. Gomberg: —
The method that we employ for estimat-
ing CO2 in breath is based upon a well-known
principle, namely, absorption of the CO2 in a
standard solution of Ba (OH).,, and titrating
the excess of the baryta solution with standard
oxalic acid. The mechanical devices for apply-
ing this principle are numerous. 8ome of them
require special, somewhat expensive appara-
tus; others are cumbersome and involve in-
accuracies due to change of temperature of the
gas while handling the receptacle. The most
accurate method, of course, is to pass a meas-
ured quantity of the gas through a drying
apparatus, and then absorb the CO2 in a
Liebig's or a Geissler's potash-bulb. But this
method requires a very considerable expendi-
ture of time, and for this reason could not be
employed in this Laboratory, where a com-
paratively large number of estimations are to
be made in a day.
71w method is as follows: (Fig. 2.) A
Shiff's azotmeter (x) is filled with distilled
water. It is then connected at its upper end
with the rubber bag or gasometer containing
the sample of breath to be analyzed, and is
thus filled by downward displacement of the
water. The fluid in bulb (b) is brought to a
level with the fluid in the upright tube of the
azotmeter. If none is at hand, an ordinary
100 c.c. burette will answer. Graduate it from
the top, invert, insert a rubber stopper, and
LABORATORY OF HYGIENE.
42T
connect the latter by means of rubber tubiug-
with a fuiiDel. From the surface of the water
in the burette, the exact readiug- is taken,
and temperature and barometric pressure are
noticed.
Now a small Erlcmeyer's flask of about 60
c. c. capacity, containing a measured quantity
of standard Ba (OH)., and acouple of drops of
piienal-phtlialein solution, 2percentin alcohol,
is connected with the azotmeter, as shown in
the figure. All the connections, are made with
thick wall capillarj'^ tubing such as is used in
gas analysis. By raising the bulb (b) and open-
ing the stop-cock, the gas is slowly forced
through the Ba (OH)^ solution in very minute
Fig. •>.
babbles, thus exposing a large surface for ab-
sorption, to insure which theeudof the delivery
tube is pressed against the end of the flask.
After all the gas is forced from the burette, the
flask is disconjiected, and the excess of Ba
(0H)2 is rapidly titrated with oxalic acid.
It is found by repeated trials that by careful
management and occasional shaking of flask d
no CO2 escapes into a second bottle, e also
containing an exact amount of Ba (OH) 2.
The advantages in employing this apparatus
are evident: 1. The volume and the tempera-
ture of the gas employed can be determined
very accurately; 2. The absorption of COv
by the water on the burette is practically noth-
ing, as the surface of the water exposed is very
small, and can be made absolutely nothing by
using a saturated solution of common salt;
3. The rapidity of passing the gas can be regu-
lated at will.
We employ a solution of oxalic acid contain-
ing 1.4081 gms. of the acid in a liter of water.
1 c. c. of this solution represents 0.25 c. c.
of CO2 at 760 mm. pressure and 0°C. The
Ba (OH) 2 solution is made of approximately
the same strength.
By taking the precautions usually employed
in such work (as potash guards over the Ba
(OH 2 reservoir and over the burette, etc.),
very concordant results can be obtained, as is
seen from the following: —
-u
a^
CD
'A
p
2 6
i^'?^"
f^^
«
> 0
IN r-
62.
^^
!=! 0
330'3
. ft
^
O^-M
(IhO >
0
99
PM
Eh
2.5°C
Eiq
744.5mra.
86
4.53
Sample 1.
95
744.5
24
83
4.70
97
744.5
25
84.3
4., 51
99.5
744.5
25
86.5
4.22
Sample 2.
98.5
744.5
25
85.6
4.. 38
97.5
744.5
25
84.5
4.31
101
751.8
26
88.2
3.85
Sample 3.
98.2
7.51.8
26
85.7
3.81
96.5
751.8
26
81.2
3.72
The Coloring Matter of the Micrococcus
Prodigiosus. — This microbe, which is so com-
mon in the air, and produces a red color in the
medium in which it grows, is capable, says M.
Prillieux and Mr. Griffiths, of producing an al-
teration of the grain of wheat; it is thecauseof
the corrosion of wheat, and can be destroj'^ed
with a solution of sulphate of iron. Mr. Grif-
fiths has examined the pigment which produces
the red color in 500 potato cultures. It is
soluble in alcohol and gives a red solution.
This alcoholic solution is precipitated by the
addition of water. The precipitated pigment,
after filtration, is redissolved in the alcohol,
and the alcoholic solution is evaporated at
40° C. The chemical formula of the substances
is the following: C38 H56 AzO,.
The alcoholic solution gives with the spectro-
scope two bands of absorption, one in the blue
and one in the green; acids bring the solution
to a carmine color; alkalies render it yellow.
PUBLISHERS' DEPARTMENT.
It May be iNTEJiESTme to Know that vvheu
excursion rates are made to Chicago for people
who live in the East, to enable them to attend
the World's Fair next year, it is contemplated
by the Western roads to also make excursion
rates from Chicago to all principal business and
tourist points in the West, Northwest, and
Southwest, so that those who desire to spend a
few weeks among their friends in the Great
West may have an opportunity of so doing
without incurring much additional expense. It
may be well to consider this subject in advance
of actual time of starting, and the Chicago,
Milwaukee & St. Paul Railway Co. lias issued
maps and time tables and other instructive
reading matter, which it will be glad to furnish
free of expense upon application by postal card
addressed to Harry Mercer, Michigan Passen-
ger Agent, 82 Grisvvold St., Detroit, Mich., or
to Geo. H. Heafford, General Passenger Agent,
Chicago, 111.
Home-Seekers, Attention! The United
States Government has decided to open, Nov.
22, 1892, for settlement under the homestead
law, the unearned lands of the Marquette &
Little Bay Du Noquet Railroad, heretofore re-
served from entry, in Northern Michigan. At
the same time the right of the Ontonagon &
Brule River Railroad has been denied to a large
tract of land in the Upper Peninsula of Michi-
gan. This gives an unprecedented chance to
locate valuable timber and mineral lands,
which are among the best in the Upper Penin-
sula, and are reached only over the North Star
Route (Milwaukee & Northern Railroad) be-
tween Chicago and Lake Superior.
For further particulars address C. E. Rollins,
Land and Immigration agent, 161 La Salle
Street, Chicago.
The Diet for WastingI)i.seases.— In typhoid
fever, phthisis, pneumonia, nervous prostra-
tion, etc., where the vitality is low and the di-
gestive organs weak, theuse of Horlick'sMa.lted
Milk as a diet has proven very beneficial, often
sustaining the strength of the patient and pre-
venting excessive emaciation and assisting in
rapid recovery where recovery is possible.
This preparation is composed of rich cow's
milk and an extract of malted grain, containing
all the elements of nutrition in a form most
easily digested. At the same time it forms a
delicious drink and one acceptable to the weak-
est stomach. Prepared for use by simply add-
ing water.
A Modern Method of Medication.— Among
the many methods of administering medica-
ments, the soluble elastic gelatin capsule is
growing to be one of the most popular.
There are many efficient but unpalatable
medicaments which may be readily exhibited in
this way, without offending the palate of the
most sensitive patients, and capsules are much
easier to swallow and morf» soluble than pills.
Few physicians are aware of the many medic-
aments that are now administered in this way.
Among these one need only mention the follow-
ing to indicate the wide application of this
method of giving numerous drugs; —
Apiol, balsam fir, balsam Peru, cascara sag-
rada, castor oil, castor oil and podophyllin,
chaulmoogra oil, cod-liver oil, cod-liver oil and
creasote, cod-liver oil and iodine, cod-liver oil
and iodoform, cod-liver oil and iron, cod-liver
oil and phosphorus, copaiba, copaiba and cu-
beb ; copaiba, cubeb, and buchu ; copaiba, cubeb,
and iron; copaiba, cubeb, and matico; copaiba,
cubeb, matico, and sandal; copaiba, cubeb, and
sandal; copaiba, cubeb, and sarsaparilla; co-
paiba and iron ; copaiba, cubeb, and turpentine ;
copaiba and sandal; creasote (beechwood), 1
minim; eucalyptus oil ; gurjun balsam; linseed
oil; liquor sedans; male fern and kamala; ni-
troglycerine, 1-100 grain; oil of pennyroyal;
pichi extract; salol; tar, purified; valerian oil;
Warburg's tinctnre; wintergreeu oil; wormseed
oil ; quinine muriate and sulphate.
Of extra sized elastic-filled gelatine capsules,
there are castor oil, 2J^ to 15 gram ; cod-liver
oil, 2% to 15 gram; male fern and castor oil;
santonin and castor oil.
Messrs. Parke, Davis & Co. were among the
first to make this method popular, and will be
pleased to afford physicians interested all de-
sired information concerning this agreeable
method of medication.
Aristol. — Nearly all drugs, whether or not
originally intended for external use, have been
applied at one time or another to local, exterior
traumatisms, in the once current belief that
" remedies that are good within should be good
without.'' Theconspicuousfaihire of the many
attempts to obtain a perfect dressing for sup-
purative conditions which should be equally
good for accidental or operative injuries, con-
stitutes an interesting section in the history of
surgery. The promptness, for instance, with
which aristol was adopted by practitioners
demonstrated the great existing need of an ad-
herent, stimulating, safe, and effective cicatri-
sant. The evidence thus far appears to demon-
strate that aristol has not disappointed the
profession in any of these particulars.
Malted Milk. — We have made extensive
use of the malted milk manufactured by the
Malted Milk Co., of Racine, Wis., for a number
of years, and consider it a valuable addition to
the medical armamentarium of a medical hos-
pital or sanitarium. It is often more valuable,
if possible, for the physician in private practice,
as it places in his hands a remedy which is at
the same time food and medicine, and combines
properties of peculiar excellence in the class of
cases to which it is adapted. Many patients
who cannot take milk in any other form can
take it in this form, and with great benefit ; in
fact, now and then physicians take malted milk
themselves, on account of the ease with which
it is digested, and its consequent value as a re-
storative. The observation that doctors never
take their own medicines, does not apply in
this case, at least.
REAWNO BOOH
\ /
>1
Bacteriological World
AND MODERN MEDICINE.
VOL. I. BATTLE CREEK, MICH., U. S. A., NOV. AND DEC, 1892.
NO. 13.
Original Articles.
STUDY OF IMMUNITY.
BY M. METCHNIKOFF.
VI. THE RESISTANCE OF RABBITS TREATED
WITH SERUM.
It remains for us to examine the
phenomena taking place in the organism
of the nonvaccinated rabbits which resist
the virulent infection, by treatment with
the serum of vaccinated rabbits.
Let us inject 0.25 c. c. of very virulent
blood under the skin of the ear of a
rabbit, having just received in a vein
3 c. c. of preventive serum, and let us
make an injection of the same virulent
blood under the skin of the ear of a
witness rabbit, not treated by the serum.
A few hours later a little exudate is with-
drawn from the point of inoculation of
the two rabbits ; this exudate contains very
few leucocytes, but contains an enormous
mass of microbes of hog cholera ; the
witness dies 9 hours and 25 minutes after
the injection. The vessels of the ear are
greatly congested ; a drop of exudate
withdrawn is troubled, but there are in it
no leucocytes, only an enormous mass of
microbes.
As in this case the action of the mi-
crobe has been very rapid (after sub-
cutaneous injections the rabbits usually
die only after 24 hours or later), the
treated rabbit is injected with 4 c. c.
more of the same serum in the vein of
the sound ear. The rabbit becomes
manifestly sick ; the congested ear be-
comes oedematous. The liquid exudate
contains masses of the bacteria of hog
cholera and a certain number of leuco-
cytes, all of which are full of microbes.
The next day the rabbit begins to im-
prove. The oedema of the ear contains
a troubled exudate in which you will find
besides a mass of bacteria of hog chol-
era, many leucocytes, a large number of
which contain microbes easily stained by
methyl-blue. In order to know in what
state the bacteria are at the beginning of
the healing, the exudate containing al-
ready numerous phagocytes, I have in-
jected three drops of this liquid under the
skin of the ear of the new rabbit. This
rabbit died in 15 hours ; this proves
that the bacteria, a number of which are
already englobed (but the majority of
which we find free in the exudate) were
very virulent.
Forty-eight hours after the beginning of
the experiment, the ear of the rabbit
contained a thick exudate, voluminous
enough, composed of a mass of leu-
cocytes, but in which no bacteria were
found with the microscope, neither in
the exterior nor the interior of the phag-
octyes. But still this pus contained
some virulent microbes. Injected under
the skin of the ear of the new rabbit,
they cause death in 51 hours and 30
minutes, with typical symptoms, and the
blood contained an abundance of bacilli
of hog cholera.
This experiment demonstrates clearly
that the cure was produced, not by bac-
tericide or attenuating humors, but really
as a result of the intervention of the
phagocytes having englobed the bacteria,
and thereby preventing their normal
action.
The bacteria of hog cholera treated
with preventive serum, provokes a local
suppuration, which persists a long time,
just as in vaccinated rabbits.
This pus contains equally, during a
long time, bacteria, in which a viru-
lence can be easily demonstrated.
An emulsion in a physiological solution
of NaCl, of the sub-cutaneous pus of the
rabbits which escaped death, owing to the
treatment by preventive serum, provoked
430
OBIOIJSfAL ARTICLES.
in new rabbits fatal hog cholera, even
when taken 13 days after the inocu-
lation of the virus ; the pus injected in
the vein of the new rabbit produced death
in 20 hours, with all the signs of hog
cholera.
The rabbits treated by preventive serum
contain, then, for a long time, in the phag-
ocytes of their pus, microbes still viru-
lent, which condition does not prevent
them from keeping a normal temperature
and of feeling perfectly well. It is not
therefore owing to the bactericide or the
attenuating property of the humors that
this result may be obtained. We can the
less invoke an antitoxic property ; for as
we have seen in Chapter IV, the serum of
the rabbits preserved by the serum of the
vaccinated cases does not even exert a
preventive influence. Furthermore, we
have seen that the antitoxic property is
wanting even in rabbits vaccinated with
toxines and possessing a very high degree
of preventive power in the serum. // is
not, therefore, the microbe which is modi-
fied by the action of the preventive seruin,
but it is the treated organism. From all the
facts exposed we can draw the conclusion
that the preservation of the rabbits not
vaccinated or treated with serum is due
to the superior activity of the phago-
cytary defense. We may therefore ex-
press the supposition that the preventive
serum, as in the example of hog cholera in
rabbits, acts as a stimulant to the phago-
cytes, in rendering them less sensible to tox-
ines, and exciting them in their fight against
bacteria.
VII, CONCLUSIONS.
First, The serum of rabbits vaccinated
against hog cholera does not present bac-
tericide or antitoxic properties.
Second, This same serum does not
possess the power of attenuating the
virulence of the microbe of hog cholera.
Third, Notwithstanding the absence of
these three properties, the serum of the
vaccinated rabbits protects the new rabbits
against mortal infection by the bacteria
of hog cholera.
Fourth, This preventive property is
not found again in the liquid of the
cedema provoked by the stopping of the
circulation.
Fifth, The bactericide property of the
organism of the vaccinated rabbits re-
sides in the phagocytes.
Sixth, The pus of vaccinated rabbits
retains during a long time some virulent
microbes.
Seventh, The organism of vaccinated
rabbits is very sensible to the toxines of
hog cholera, and does not present any
antitoxic property.
Eighth, The phagocytes play a very
important role in the resistance of vac-
cinated rabbits.
Ninth, The phagocytes play equally a
very important role in the resistance of
nonvaccinated rabbits or those treated
with preservative serum. It is probable
that these exert, in these conditions, a
stimulating influence on the phagocytes.
THE NEW CHEMISTRY OF THE STOMACH
BY J. H. KELLOGG, M. D.
(Concluded.)
In my studies of digestive fluids, I do
not confine myself to a determination of
the quantity of chlorine present in its
different forms, but also employ the vari-
ous color reagents, and also the well-
known tests for peptones, propeptones,
and albuminoids, the coagulation test for
rennet ferment and for the rennet zymo-
gen, and also determine the state of the
starch digestion by means of LugoPs
solution. Tests are also made for lactic
acid, as well as for acetic and butyric
acids, and for bile and alcohol when the
presence of these substances is suspected,
important facts are also ascertained
from an ocular examination of the stom-
ach fluid, from a determination of its
quantity and the amount and appearance
of the residue left on the filter. On the
next page is a reproduction of the blank
form which I have prepared for use in
my own laboratory, and which I find
very convenient, as it shows at a glance
all the more important things relating to
the work of the stomach which it is possi-
ble to know.
I also sometimes employ salol for de-
termining the state of the motor function
of the stomach, and iodide of potash for
ascertaining the rate of absorption ; but I
find so great a discrepancy in the results
obtained by these methods that I cannot
but consider them as of less value than
the information derived by other means,
especially clapotement and the stomach-
tube.
ORIGIN- A L ARTICLES.
431
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D
As regards the treatment of the various
conditions with which we are made ac-
quainted by a careful chemical investiga-
tion of the products of digestive work
obtained from the stomach when in full
activity, I have scarcely space in this
paper to do more than simply call atten-
tion to the fact that the requirements of
each individual case are by this method
so clearly defined, and so explicitly indi-
cated that there can be no doubt as to
what needs to be done. After obtaining
the data furnished by the cJiemical inves-
tigation, noting also the quantity of the
fluid withdrawn, one has but to make a
formula to be enabled to see at a glance
what are the therapeutic indications in
the particular case. For example, if in a
given case the formula found is A -|- ^ +
rj, , P j[ [■-[-, the fact is discovered in-
stantly that the case in hand is one
of hyperpepsia with hyperhydrochlorie,
hyperacidity, and acid fermentation.
Whether or not the hyperacidity is or
is not due to acid fermentations alone,
can be ascertained by determining the
value of A', which should always be done
whenever we find a -{-. If A' is above nor-
mal, then we have hyperacidity due to hy-
perhydrochlorie, and to this is superadded
the acidity resulting from acid fermen-
tation. If the acidity resulting from
acid fermentation is very considerable
in amount, and especially if the quantity
of fluid drawn from the stomach is large,
we know at once that the first measure to
be employed in the case, unless strongly
contrary-indicated by some other patho-
logical condition, is lavage. It is sur-
prising indeed how quickly acid fermen-
tations may be suppressed by simply
washing out the stomach, at the same
time so ordering the patient's dietary
as to avoid the introduction of a new
supply of microbes, in other words,
employing an antiseptic diet.
The superiority of a method which de-
termines, quantitatively, the amount of
chlorine present in the stomach fluid, and
the exact amount of chlorine present
under the several conditions in which this
element is found in the stomach fluid, is
well shown by the following case : —
The patient (Case 68), a married lady
about fifty years of age, had suffered for
many years from stomach disorders more
or less pronounced. The quantities ob-
tained after the test breakfast were as
432
ORIGINAL ARTICLES.
follows: (A), .272; (AO, .251; («), .96;
(T), .384; (H), .058; (C), .224.
The color reactions were as follows :
Congo-red indicated the presence of free
acid. Methyl-violet gave only a very
slight reaction, indicating a very small
amount of hydrochloric acid in a free
state, notwithstanding the fact that it was
present in excess. Uifelmann's reagent
gave a very slight reaction, indicating the
presence of lactic acid in only a very
small amount.
It is evident that without the quantita-
tive chemical analysis in this case, the
real nature of the case could not have
been understood. The slight indication
of the methyl-violet reaction would sug-
gest that the excessive acidity was due to
the fermentation, which would be consid-
ered as confirmed by the reaction for
lactic acid, as this reaction is known to
be more or less uncertain, and not at all
reliable as an indication of quantity. The
determination of the actual quantities of
chlorine present, however, shows us that
the amount of fermentation is very slight,
a being normal at .86, and that the quan-
tities of free HCl (H) and combined
chlorine (C) present, are sufficient to give
an acidity of .251, the significance of
which is readily seen by comparing these
figures with the normal limits, .180 and
.200.
In the following case, the same point
is illustrated, and an additional one of
fully equal importance : —
The patient, a married lady of 35, was
a chronic dyspeptic. Sixty-nine c. c. of
stomach fluid were obtained after a test
meal, in which a considerable amount of
mucus and residue were found. Analysis
gave the following quantities : (A), .320 ;
(«). 1-35 ; (T), .340: (H), .074; (C),
.182.
Congo-red indicated the presence of free
acid, but methyl-violet gave only a very
slight reaction. Uffelmann's reagent gave
a slight reaction for lactic acid. If the
color reagents had been relied upon with-
out the quantitative analysis, this case,
as the other, might have been regarded
as a case of excessive acidity due to fer-
mentation alone, whereas there is not
only fermentation but also hyperpepsia
of a very considerable degree, as is
readily seen by comparing the figures
given with the normal, both the combined
chlorine and the free HCl being .025-
.050, and the Value of A' being found
considerably above normal, namely .231.
A great amount of fermentation is also
shown to be present, as indicated by the
high value of a. This is a case of hyper-
pepsia with acid fermentation. By no
other known means could the exact
conditions present in this case have been
accurately ascertained.
In the cases mentioned above, the
fermentation was quickly suppressed by
lavage, aseptic diet, and antiseptic medi-
cation, and the patient made rapid and
marked improvement.
The following summary relating to
other data than that pertaining to the
chlorine of the gastric fluid may be of
interest : —
Sex. — Of the whole number of cases
examined, 30^ were men and 70%
women. The proportion of males to
females found in each of the three great
classes of dyspepsia is as follows : —
In hyperpepsia the proportion was
found to be, for males, 34.6^ ; females,
65.4: in hypopepsia, for males, 24.8^ ;
females, 75.2^ : in simple dyspepsia, for
males, 26.5%; females, 73.5%. It thus
appears that men are more susceptible to
hyperpepsia than are women, while hypo-
pepsia is the most common form of stom-
ach disorder in women.
Digestion of Proteids. — Out of 261
cases, peptones were abundant in 183 ;
reaction for peptones was feeble in 32
cases, and absent in 44 cases. The test
for albuminoids was also absent in 11
cases.
The rennet ferment was present in
abundance in 77.1% ; was entirely absent
in 13.8^ ; was present in the form of
zymogen in two cases in which it could
not be detected in the form of rennet ;
and was entirely absent as rennet or
zymogen in 7.6% of the cases.
Starch Digestion. — In 149 cases in
which starch digestion was especially
studied, the purple color of acrodextrine
was found in 67.8% ; the digestion of
starch shown by the blue color was pres-
ent in 2% ; good digestion of starch,
shown by brown coloration, in 17.4%,
and complete digestion, indicated by no
reaction, in 2% of the cases.
Quantity of Fluid Obtained. — The nor-
mal quantity of fluid is 40 c.c. Eighty to
100 c.c. was found in 32.3% of the cases,
and more than 100 c.c. in 67.7^.
Residue. — Residue was found to be
less than one fourth of the entire quantity
OBIOINAL ARTICLES.
433
of fluid withdrawn in 20.7%, more than
one fourth and less than one half in
62.9%, and more than one half in 16.4%
of the cases.
Mucus. — Mucus was present in con-
siderable quantity in 45.1^, in very
small quantity in 46.3^, and absent in
only 8.6^, indicating very clearly the
the relation of stomach catarrh, or ex-
cessive secretion of stomach mucus, to
cases of dyspepsia, so-called.
Lactic Acid. — Lactic acid was in ex-
cess in 34.2^, diminished in 23.5^, and
absent in 46.5^.
Dilatation of the Stomach. — Dilatation
of the stomach was observed in 42^ of
the cases.
Hypercesthesia of the Sympathetic Gan-
glia.— Hypersesthesia of the solar plexus
of the lumbar ganglia of the sympathetic
was present in 29.6^ of the cases.
Kidney Displacement. — Mobility or dis-
placement of one or both kidneys was
found in 14.6^ of the cases.
It would also be of interest to study
the relation of the various data presented
to the several classes, groups, and sub-
groups of dyspepsia, but this study must
be deferred for a future paper.
The excess of free hydrochloric acid,
and of the total chlorine, indicates
usually a glandular irritation resulting in
excessive secretion. Not uncommonly
there will be found great hyperaesthesia
of the solar plexus, the lumbar ganglia,
and sometimes other portions of the ab-
dominal sympathetic, the relation of which
to functional disorders of the stomach is
a matter of great interest, but of too
large proportions to be considered in this
paper. This glandular and nervous
hyperaesthesia or irritability must be
lessened by the employment of an ap-
propriate dietary, soothing remedies,
*uch as subcarbonate or subnitrate of bis-
muth, galvanism, and the various re-
sources of hydrotherapy adapted to such
cases. By the aid of massage, skillfully
administered, the relaxed stomach may
be emptied of its contents before fermen-
tation has become far advanced. By
these and other means the return of the
stomach process to a normal channel
may be facilitated, and generally the vis
medicatrix natures is competent to restore
to a normal state the vital activity of the
stomach when favorable conditions are
applied, so that the patient quickly ex-
periences wonderful relief ; and the satis-
faction afforded to the doctor by the
gratitude of his patient is ample com-
pensation for the painstaking investiga-
tion required to put him upon the right
track.
The chart which I present with this
paper exhibits a classification of all the
different forms and types of dyspepsia
which I have encountered in a careful
study of 340 analyses, and shows at a
glance the therapeutic indication of each
form. The best means of meeting these
indications may not be in all cases known
to us at present, although the results
which I have obtained are such that I do
not feel any hesitancy in saying to any
patient whose stomach disorders are
clearly functional, that he may confi-
dently expect relief within a reasonable
length of time by the employment of the
rational measures with which we are ac-
quainted, and which the precise knowl-
edge afforded by the accurate means of
investigation enable us to employ with
far greater satisfaction and success than
heretofore. We have long been pos-
sessed of abundance of artillery and
ammunition with which to fight the hydra-
headed disease, dyspepsia, which is per-
haps responsible for more human ills and
woes than any other malady ; but our ef-
forts have been often fruitless because we
were obliged to aim our artillery without
precision, like firing at an enemy con-
cealed in a fog-bank.
The new light which has come to us
through the brilliant results of the labors
of the eminent French physiologists,
who have given to us the new method of
analysis described in this paper, illumi-
nates this subject with the light of a noon-
day sun, and renders interesting — I may
even say fascinating — the study and
treatment of a class of disorders which
have been heretofore so disappointing,
and so baffling as to render to many
physicians the very sight of a chronic
dyspeptic, obnoxious and repulsive. Al-
though for twenty years my professional
work has been done under such circum-
stances as to bring me in contact con-
stantly with a very large number of obsti-
nately chronic cases belonging to this
class of sufferers, I confess I have fully
shared the sentiments above expressed,
with my medical brethren, and have only
really experienced genuine satisfaction —
I may almost say delight — in meeting an*
old dyspeptic, since I have based my
434
ORIGINAL ARTICLES.
treatment of these cases upon positive
facts furnished by a rigid chemical in-
vestigation, instead of trusting to hypo-
thetical theories, intuition, or even ex-
perience, which is a dear school to learn
in, — at least for our patients, — and un-
fortunately teaches wrongly almost as
often as rightly. No therapeutic experi-
ence could be more interesting than to
watch a bad type of indigestion gradually
rising from the lowest depths of hypo-
pepsia through the various degrees of
this morbid state, by and by reaching
simple dyspepsia, or some attenuated
form of hyperpepsia, and finally assum-
ing those normal characters which indi-
cate a restoration to perfect health. The
only possible objections that can be
raised to this investigation of stomach
disorders is the fact that it is inconven-
ient for both patient and physician. I
have found, however, without a single
exception, that patients who have long
suffered the pangs of chronic dyspepsia,
are very ready to submit to the slight
inconvenience accompanying the skillful
passage of a small stomach tube, and
many patients find the operation so little
disagreeable that they are inclined, from
.curiosity to learn what progress they are
making, to desire the passage of the tube
too frequently. By a general and skillful
use of the tube, it is possible to employ
it without serious difficulty on the most
delicate patients, and even children.
As regards the inconvenience to the
physician, I cannot speak so encourag-
ingly, for nothing short of a very thor-
ough, painstaking, and most exact chem-
ical investigation is of the slightest value.
Indeed, the information afforded by a
careless investigation might be most un-
fortunate and damaging by giving a
wrong direction to the treatment. The
most precise chemical methods and the
most exact and dexterous manipulation
will alone give satisfactory results. A
mere qualitative analysis is of no value
whatever, as has already been shown.
An exact quantitative determination of
the chlorine in its several states must be
made. For this, a properly equipped
laboratory and a skilled chemist, or at
least one who is skilled in the particular
methods required in quantitative analysis,
are requisite. The time required for the
careful examination of a single specimen
of the stomach fluid is from three to five
hours. Much of this time must be con-
sumed in filtration and evaporation, and
so three or four specimens can be ex-
amined at once without much increasing
the time spent. It must not be imagined,
however, that when an analysis has been
made and the diagnosis and therapeutic
indications worked out, all has been ac-
complished that a stubborn case requires.
It is often necessary to make repeated
analyses, varying the character of the
test meal and the time of the digestion.
Above all it is necessary that a careful
dietetic prescription shall be made, and
that the patient shall be made to carry it
out. The difficulties in the way of in-
ducing the patient to take the dietetic
part of his prescription, are sometimes
very great, but the thing must be accom-
plished, even if it becomes necessary to.
send the patient away from home to some
place where his dietetic needs may be
supplied, or to hire a special cook or
nurse to supervise his dietary. At what-
ever cost, the thing must be done, and
not in a half-hearted way, but most
thoroughly, or the effort will be fruitless.
I find that patients are always deeply
interested in the results of the chemical
investigation of the stomach fluid, and a
careful physical examination of the stom-
ach by clapotement and other means.
Patients who have long suffered from
stomach disorders recognize at once the
value of this mode of investigation, and
are very ready to bear uncomplainingly
the slight inconvenience of the method,
feeling that an effort is being made to*
reach the root of the difficulty which has,
occasioned them so much discomfort and
suffering. The ability to represent graph-
ically by a formula the exact condition of
the digestive process in a given case, and
to determine mathematically the extent of
deviation from the normal condition, re-
lieves the subject of functional disorders*
of the stomach from the mystic vague-
ness with which it has been surrounded
heretofore, and illuminates every case
thus investigated with a light which ren-
ders the study really a fascinating one to
both patient and physician. The graphic
character of the method and its exact-
ness have suggested that it might be
termed the ''algebra of the stomach."'
Certainly no algebraic problem could be
more interesting than are the problems in
the digestion which this method enables
one to solve readily, and with a high do
gree of precision.
ORIGINAL ARTICLES.
435
In my own experience, 1 think I have
demonstrated that most of the therapeu-
tic indications encountered in functional
disorders of the stomach may be fully
met by careful and intelligent regulation
of the diet with the aid of the informa-
tion afforded by the chemical investiga-
tion of stomach fluids. There is still,
however, a great dearth of knowledge re-
specting the dietetic properties of various
food substances and preparations. The
observations of Beaumont upon the stom-
ach of Alexis St. Martin afford about the
only reliable information possessed by
the profession at the present time ; but
unfortunately, this ingenious investigator
was unacquainted with the facts which
have been developed by modern physiol-
ogy, and especially by bacteriology, and
hence his observations were necessarily
crude and his results conflicting and un-
certain. As a matter of fact, we know
almost nothing about the digestibility of
foods or the special therapeutic values of
different food substances. • I am now en-
gaged in an extensive series of experi-
ments upon healthy persons, which I
trust will afford definite and positive in-
formation, since the exact chemical meth-
ods which we now possess enable us to
study the digestive process in all its stages
with nearly the same precision that the
assayer studies the handful of crude ore
brought him by the prospector, and with
results as brilliant as those which some-
times reward the mine hunter among the
mountains of the West.
The results of my studies, together
with an outline of the methods of treat-
ment which I have found successful in
the management of functional disorders
of the stomach, I shall make the subject
of other papers.
CONTRIBUTION TO THE STUDY OF PROGRES-
SIVE MUSCULAR ATROPHY.
BY W. H. RILEY, BATTLE CREEK, MICH.
Member of the American Neurological Association.
(Continued.)
In the onward progress of the dis-
ease, parts first affected become more
and more wasted until there may be a total
absence of muscular tissue, while new ter-
ritory is being constantly invaded by the
morbid process. Bony prominences are
made bare. Joirits become relaxed and
loose, and in some cases dislocations
occur. On account of the unequal affec-
tion of antagonistic muscles, deformities
not infrequently result. The claw-like
hand has already been referred to. There
may also be deformities about the hip
and shoulder joints.
When the arms are the seat of much
wasting, the lower limbs may be normal,
or the muscles may be soft, flabby, and
slightly wasted. As the disease pro-
gresses, the changes in the lower limbs
are soon as great as those in the upper,
and in extreme cases, the wasting is quite
as great in one part of the body as
another.
There is another class of cases in which
the appearance of the lower limbs is quite
different from the above. These have
frequently been classed by themselves as
a separate disease, under the head of
amyothrophic lateral sclerosis ; but as we
shall presently see, from a pathological
standpoint, there is not enough that is
different in these cases to require a de-
scription under a separate head. In these
cases the disease usually affects the cerv-
ical region of the spinal cord, producing
a decided paralysis and wasting of the
muscles of the upper extremity, especially
about the shoulders, while in the lower
limbs the appearance is quite different ;
the legs are weak; the muscles are some-
what hard and spastic; the reflexes, deep
and superficial, are increased; the patient
has a stiff, awkward gait, steps short,
with a tendency to scrape toes, and does
not raise his feet far from the ground.
This spastic condition of the muscles,
while well marked, does not reach that
extreme degree that is commonly seen in
spastic paraplegia. In this class of cases
there are not the usual electrical changes
in the muscles of the legs that we find
where wasting is present. There may be
some slight diminution of irritability to
faradic and voltaic currents, or the elec-
trical irritability may be normal. The
comparative strength of the muscles of
the upper and lower extremities in these
cases is illustrated by the chart.
The normal irritability of the muscles,
and nerves to electrical stimuli is usually
changed. These changes differ accord-
ing to the nature, extent, and rapidity of
pathological changes in nerve and muscle.
There is no one rule of electrical reaction
that will apply in all cases. In order to
appreciate and rightly interpret whatever
436
ORIGINAL ARTICLES
deviation there may be from the normal,
one must keep clearly in mind the action
of the motor nerve and muscle when stim-
ulated by a faradic or voltaic electrical
current in a healthy condition, and the
necessary pathological changes in nerve
or muscle, or both, to bring about any
particular change in their electrical irri-
tability. Both nerve and muscle in a
healthy condition respond when stimu-
lated by the faradic or voltaic current.
When a healthy motor nerve is stimulated
with a secondary current of the faradic
machine, it produces a continuous or te-
tanic contraction of the muscles supplied
by the nerve. If single isolated shocks
are sent into a nerve, a single contraction
of the nerve results. When a voltaic cur-
rent of ordinary strength passes through
the nerve, there is no contraction during
its passage, except at the ''make" and
''break*' of the current. A contraction
may result, if the current strength is sud-
denly increased or decreased during its
flow without an actual "make" or
"break."
When the faradic or voltaic currents
are applied directly to a muscle in a
healthy condition, a contraction of the
muscle results, but the contraction is not
as great as when applied directly to the
motor nerve which governs the muscle.
In either case the muscle is brought into
activity by the electric stimulus acting
through the nerve. The contractions are
greater in one case than the other, be-
cause the nerve is more directly stimu-
lated. It is a fact, however, that the
muscles themselves are irritable to electri-
cal stimuli without the intervention of the
nerve.
If the nerve be destroyed by the action
of curare, or by section, or by disease
such as inflammation, so that its influence
is entirely removed from the muscle and
the muscle itself directly stimulated by
the faradic current, a contraction is the
result ; but the contractions under these
circumstances are not as great as when
the same strength of current reaches the
muscle by acting through the nerve, and
in a short time, a few days at most, no
contractions at all can be produced with
the faradic current.
If the muscle under similar circum-
stances be stimulated with the voltaic
current, it will be found to contract as
readily or more readily than when the
nerve is intact. At first, when the influence
of the nerve is removed from the muscle,
the response is about the same as under
normal conditions, except that the contrac-
tions are somewhat slower ; but very soon
the irritability of the muscle to the voltaic
current increases so that the contractions
are produced with a much weaker current
than normally. This absence of faradic
irritability with increased voltaic irrita-
bility is due to certain nutritive changes
taking place in the muscle.
Now with the disease under considera-
tion, there is, as we shall presently see, a
degeneration of motor nerves as well as
wasting of muscles, and with this degen-
eration there is a diminution of irritability
of nerve to both faradic and galvanic cur-
rents. If the changes in the nerve are
slight, there may be scarcely any devia-
tion from the normal in the electrical
reactions ; but if the nerve is entirely de-
stroyed, there will be no response on the
part of the muscle when the nerve is
stimulated.
The reaction of the muscles varies with
the nutritive changes taking place in
them, and these in turn depend on the
extent of degeneration in the nerve.
When the degenerative changes in the
nerve occur rapidly, there may be a total
absence of irritability of the nerve to the
voltaic and faradic currents, while the ir-
ritability of the muscle to the voltaic
current may be normal or even increased.
The quality of the voltaic irritability may
also be normal, but sometimes the anodal
closure contraction occurs as readily as
the cathodal closure contraction, A. CI.
C.^C.Cl.C.
When the wasting is slow, there is usu-
ally diminution of irritability to both
faradic and galvanic currents. As the
muscular nutrition fails, so does their irri-
tability ; and in cases where the wasting
is great, only slight contractions may be
obtained. When the wasting is extreme,
no contractions can be produced at all
with either current. At one end of a
series of electrical charges there may be
a total absence of faradic irritability in
both nerve and muscle, with increased
voltaic irritability, and qualitative changes
in the muscle ; at the other end, simply a
diminution of both faradic and galvanic
irritability in nerve and muscle ; and be-
tween these two extremes there may be
many shades of variation.
Fibrillary contractions are frequently a
prominent symptom throughout the dis-
ORIGINAL ARTICLES.
437
ease. They occur as a contraction of a
bundle, or more often a few muscular
fibers, now here, now there, each contrac-
tion being momentary in its duration, to
be quickly followed by a similar manifes-
tation in some other part. These usually
occur spontaneously, but may be easily
provoked by a slight tap, by exposure to
air, by passive and active movements of
the muscles, or by slight electrical stimu-
lation. They may frequently be seen in
a part which is later the seat of the more
serious symptoms of wasting and paraly-
sis. Usually they are present throughout
the disease ; and when once present in
any particular part, usually remain until
the total atrophy of the muscles causes
their disappearance. While this symptom
has a prominent place in forming the pict-
ure of the disease, it by no means belongs
to this disease alone.
In those parts that are the seat of the
characteristic wasting, all reflex action is
abolished, and this on account of the
damage done to the motor cells and motor
fibers which constitute the efferent portion
of the reflex arc. The afferent portion
of the reflex arc is unaffected. We shall
presently call attention to the normal
condition of the posterior root fibers and
the posterior columns of the spinal cord,
and as we shall see, there is no loss of
sensation.
The tendon reflex action is lost in those
parts that are later the seat of wasting,
even before the wasting is apparent. In
these cases where there is paralysis of the
lower limbs without wasting, the reflexes
may be present, in fact are usually exag-
gerated, but in these cases the paralysis
is caused by damage to motor fibers for
the legs in the upper segment of motor
path, while the lower segment, which
forms the efferent part of the reflex arc, is
little damaged or remains unaffected.
The sensory symptoms are usually
slight, and may be entirely absent. Usu-
ally there is no pain. Sometimes, how-
ever, especially at the beginning, there
may be neuralgic pains in the part that is
later the seat of wasting and weakness.
There may be rheumatic pains, more or
less severe, felt in the limb and joint, usu-
ally where the disease is most severe.
Feelings of ''numbness" and ''dead-
ness " are sometimes complained of, but
cutaneous sensibility as a rule is not im-
paired. The patient is able to recognize
impressions of touch, pain, and temper-
ature, when applied to the skin, quite as
readily as in health. The sensibility of
the muscles is also retained. The patient
is able to recognize changes in posture.
Occasionally one sees cases where the
disease begins in the muscles of the
shoulder and upper arm, where severe
pain in the early history of the disease is
a prominent symptom. The weakness of
the muscles that follows in a very short
time is extreme in degree. The disease
runs a rapid course, and in a few months,
or a year at most, death is the result.
Along with the wasting of the muscle
there is, usually, a loss of adipose tissue
and a slow but gradual loss of weight.
At the close of the disease, in these cases
where less important parts are affected,
the emaciation is so great that very little
muscular tissue is left on the bony skele-
ton. The atrophied limb is cold, and
may be pale or livid, but usually there is
no acute vaso-motor disturbance.
The sympathetic is, as a rule, not in-
volved. Dilatation or contraction of the
pupil has been observed chiefly in cases
where the cervical cord was involved, and
no doubt was due to disease of the spinal
cord and not the sympathetic. The vis-
ceral functions are usually not disturbed.
There may be some slight digestive dis-
turbance, with constipated bowels. The
sphincters rarely suffer. Occasionally
they do, more especially in those cases
where the wasting is extreme in the lower
limbs. There are certain changes in the
composition of the urine. My own ob-
servations have been that the amount of
urea gradually decreases during the prog-
ress of the disease, and in one case was
one half the quantity at death that it was
a few months before. On the other hand,
phosphates and oxalates of lime were in-
creased. These observations seem to
agree quite closely with those of Gowers
and Fromman.
As a rule, the temperature remains
normal during the progress of the disease.
In the later stages of the disease, where the
muscles are breaking down rapidly, the
temperature may rise to ioo° or ioi°,
but it will seldom remain here.
The heart, as a rule, is not involved in
the early history of the disease; but in
the later stage, when the patient becomes
much emaciated, the pulse may be very
rapid and weak, and may reach 120 beats
per minute.
(To be continued.)
438
TBANISLATIONS AND AB8TBAGTS.
Translations and Abstracts
[The articles in this department are prepared expressly for
this journal.]
THE GLYCOGENIC FUNCTION OF THE LIVER.
BY DUJARDIN-BEAUMETZ.
Member of the Academy of Medicine, Physician to the
Cochin Hospital, Paris.
Translated by J. H. Kellogg, l\r. D.
In 1848, Claude Bernard published his
first experiments, which he continued
during many years. Claude Bernard es-
tablished the glycogenic function of the
liver by means of many demonstrative
experiments. He began by analyzing the
hepatic tissue, and finding in it the pres-
ence of sugar in the proportion of one to
two per cent. Then he analyzed the
blood which entered into the liver, and
that which escaped from it, and he found
that while the blood in the portal vein
contained no glucose, that in the hepatic
vein always contained it. He showed,
then, that there is a special body con-
tained in the liver which furnishes this
sugar, and that this substance persists
after death, of which he obtained posi-
tive proof by passing a current of water
through the liver and finding it to be
charged with glucose. Claude Bernard
gave to this substance which he had iso-
lated, the name of glycogen. Glycogen
is isomeric with starch ; it has for its
formula (CgHioOj) -fHoO. This formula
is that of inuline and amylo-dextrine.
This analogy led Bernard to give to gly-
cogen the name of animal starch. It has
also been called hepatine and Bernardine.
It can be isolated as a white powder,
which swells in contact with water, like
starch. These bodies, in the presence of
diastase, are transformed into achroo-dex-
trine and starch.
The quantity of glycogen in the he-
patic tissue is variable. It has been
found in so great a proportion as 13
to 17 per cent. It is also found in the
muscles, in the white globules, and in
embryonical tissues.
But this animal starch requires a fer-
ment which is found in the hepatic cells.
These, Claude Bernard has also isolated
by means of alcohol.
The production of sugar in the liver
may be thus divided into two acts : —
1. The manufacture of glycogen from
the glucose and peptone absorbed ; and —
2. The transformation of the starch
into glucose.
These two acts have for their object
the maintenance in the blood of a given
quantity of sugar which may be fixed at
one or two parts to 1000. This sugar is
burned in the different vital acts of the
body, and by its combustion serves to
maintain animal heat.
The liver thus acts as a regulator by
means of its glycogenic function. It
stores the glucose under the form of
glycogen, ready to throw it into the
blood at any moment when it may be
deficient in quantity. When the quan-
tity of sugar in the blood becomes too
great, as when the proportion becomes
two and one half parts per 1000, it es-
capes in the urine, and glycosuria apr
pears.
Where do these two physiological act^
occur? — In the hepatic cell itself; and
when this is destroyed, the double func-
tion disappears, from which fact impor-
tant conclusions maybe drawn relating to
the pathology of diabetes.
It was not sufficient for Claude Bernard
to have shown the glycogenic role of the
liver. He, studied also the influences
which modified this glycogenic function.
It is upon this that I shall particularly
dwell, as of the first importance from a
clinical point of view. As the glycogenic
functions of the liver are increased, or
combustion of the glucose thrown into
the blood diminished, the proportion of
two and one half parts of sugar per 1000
parts of blood is exceeded, and glyco-
suria appears. That is a pathological
condition which must be combated.
One of the most important influences
which affects the glycogenic function of
the liver, is the nervous system. Claude
Bernard showed that there existed upon
the floor of the fourth ventricle, a point
which controls the glycogenic function,
and that an experimental diabetes may be
produced in animals by the puncture of
the fourth ventricle. Before we had ac-
quired a knowledge of pancreatic diabetes,
this was the only method employed in
the laboratory for the experimental pro-
duction of glycosuria in animals. Unhap-
pily this experiment gives no information
of therapeutic value, because the glycosu-
TMANSLATIONS AND ABSTRACTS.
489
ria thus produced in animals is temporary
in character, the animal recovering at the
end of a few days.
We have no very clear explanation of
this action of lesions of the floor of the
fourth ventricle upon the glycogenic func-
tions of the liver ; but that this action is
real, has been demonstrated by an ex-
periment of Winogradoff, who showed
that in frogs deprived of the liver, this
nervous lesion did not produce glycosu-
ria. It is probable that these lesions of
the nervous system act in producing
glycosuria by modifying the hepatic cell
itself, and the nutritive conditions which
control them.
The same is true of diabetes resulting
from injuries of the brain, so that there
is a distinct group of glycosurias of nerv-
ous origin. It is due to the physiolog-
ical action of the liver as a regulator, that
a percentage of glucose in the blood is
maintained at the constant point of two
parts to looo. Two circumstances may
modify this equilibrium : —
1. The liver may produce too much
sugar.
2. The amount of sugar consumed by
the system may be insufficient.
In the first group are to be found those
cases which have been described under
the name of dietetic glycosuria : The
man or the animal takes too great quan-
tities of glucose, resulting in an excess of
sugar in the blood, of alimentary origin.
I should remark that it is exceedingly
difficult to increase the amount of sugar
in the blood of a perfectly healthy animal.
In the experiments which I have made
with respect to the diuretic properties of
glucose, which you will find described in
the thesis of one of my students, Mme.
Sophie Meilach, I have found it neces-
sary to give rabbits 70 grams (2^ ounces)
of sugar per kilogram of body weight, to
obtain alimentary glycosuria.
Dietetic glycosuria occurs under the
influence of various predisposing causes;
and very frequently, by submitting the
animal to special diet for a long period,
the glycogenic function of the liver will
be suppressed.
Diabetes is sometimes due to the fact
that sugar is not burned in the system.
Asphyxia produces this condition. Dia-
betes due to poisoning is explained in the
same manner as is that due to the ad-
ministration of ether, chloroform, and
certain drugs, such as mercury, morphia,
chloral, etc. These substances modify
the blood in such a manner as to prevent
the destruction of sugar, and thus occa-
sion its accumulation.
Among the drugs which produce this
toxic glycosuria, should be mentioned
phloridzin. This drug, introduced by
subcutaneous injections, or by the stom-
ach, produces in animals an intense gly-
cosuria, which continues as long as the
drug is administered. However, it should
be remembered that this is an experi-
mental form of diabetes, which may be
produced without any modification of the
liver, since a frog deprived of its liver
becomes diabetic under the influence of
this drug. It is probable that phloridzin,
which is a glucocide obtained from the
roots of certain trees, the pear, the apple,
and the cherry, is transformed in the sys-
tem directly into glucose without the in-
tervention of the liver or of the pancreas.
This question of toxic hyper-glyc3emia
brings us to the study of pancreatic dia-
betes. I have shown you that the liver
throws into the blood a given quantity of
glucose. This quantity, according to the
figures of Bouchard, is very great, amount-
ing to nearly two kilograms, or 1850
grams (a little more than four pounds), in
twenty-four hours.
This quantity of glucose is burned by
respiration and muscular activity, but a
portion is also destroyed by the blood!
The sugar-destroying property of the
blood, has been termed its glycolitic
power. Lepine and his pupils have made
the glycolitic power of the blood the sub-
ject of a series of communications, since
1889, which have clearly shown the power
of the blood to destroy sugar. They have
shown that this glycolitic power of the
blood is due to a ferment which is pres-
ent in the blood corpuscles, and which is
produced in the pancreas, which explains
so-called pancreatic diabetes.
In 1877, our colleague and friend Lan-
cereaux showed that the grave forms of
diabetes, to which the name diabetes
maigres (diabetes accompanied by ema-
ciation) has been given, are accompanied
by more or less pronounced lesions of
the pancreas. The frequency of these
alterations in cases of grave diabetes is
such that the x\2,viiQ pancreatic diabetes has
been given to them.
In his communication, Lancereaux calls
attention to known facts respecting altera-
tions in the pancreas, accompanying gly-
440
TRANSLATIONS AND ABSTRACTS
cosuria, and he showed that the first of
these observations dated as far back as
1789, having been made by Cowley.
This fact of pathological anatomy was
verified by further investigation, the re-
sults of which we find presented in the
thesis of a student of Lancereaux, Dr.
Lapierre, which appeared in 1879. In
1881, Baumel, of Montpellier, published
some observations upon diabetes accom-
panied by emaciation, and even by dia-
betes without emaciation, with lesions of
the pancreas. This pancreatic diabetes,
which had been established by clinical
observation, was confirmed by the experi-
ments made in 1889 by Von Mehring and
Minkowski, who, in studying the functions
of the pancreas, showed for the first time
that total extirpation of the pancreas
produced in animals a sugar diabetes of a
most severe type; but this experimental
diabetes, in place of being temporary, as
that produced by lesion of the nervous
system, was permanent, and ended in the
death of the animals.
Some years before, experiments upon
the pancreas had been attempted, but
these experiments had given very contra-
dictory results, in consequence of the
difficulty of the operation and the disor-
ders produced by it, which rapidly killed
the animals operated upon.
The experiments of Von Mehring and
Minkowski showed the experimental fact
without seeking an explanation. Since
that time, these experiments have been
often renewed. Hedon, of Montpellier,
practiced total extirpation of the pan-
creas twenty-three times. In the first
ten attempts, the animals died as the
result of the operation ; but by making
first a partial operation, then complet-
ing it eight days later, removing, first
thfe head of the pancreas, then the re-
mainder, the animals survived the opera-
tion. In all these cases in which perma-
nent diabetes was established, the animals
became voracious, and lost flesh rapidly.
Partial extirpation of the pancreas does
not produce diabetes, which was claimed
by Reali and Renzi, and confirmed by
recent experiments.
It remains now to explain these re-
sults. To-day, relying upon the experi-
ments of Lepine, and then of Gley and
H6don, we are led to think that the
pancreas is a blood-gland, and that it
throws into the bloodvessels, though not
into the pancreatic canal, a special fer-
ment which gives to the blood the power
of destroying the sugar which it contains.
This view is still a hypothesis ; for it may
be asked whether the diabetes may not be
the result of injuries to the solar plexus
which surrounds the pancreas, or perhaps
the disturbances of nutrition produced by
the suppression of the pancreatic juice,
in consequence of which very rapid ema-
ciation occurs.
However this may be, we must add to
disturbances of the liver as a cause of
diabetes, lesions of the pancreas. While
the liver throws into the blood the glucose
necessary to maintain the sugar of the
blood at a constant proportion, the pan-
creas, by the ferment which it throws
into the blood, destroys a certain quan-
tity of this glucose ; and when this fer-
ment is no longer secreted, there results
from this suppression, a hyper-glycaemia
which induces glycosuria. In a word,
the glycogenic functions of the liver are
complemented by the sugar-destroying
power of the pancreas.
Neither is the liver the only sugar-
producing organ in the body. Other
organs, as the muscles, and, according
to Rouget, Pavy, and others, many other
tissues contain glycogen.
Finally, in the physiological state dur-
ing lactation, the females of mammals
secrete a particular sugar (lactose), which
constitutes the mammary lactose which is
furnished by a special glycogen fabricated
by the epithelium of the mammary glands
acted upon by the albumenoid principles
of the blood.
Thus, then, there exist, from a physio-
logical point of view, three sources of
glycogen in the body : Embryonal tissue,
the mammary glands, and the liver, the
sugar production by the liver being in part
controlled by the pancreas.
The first two are temporary ; one exists
during embryonic life, before the forma-
tion of the liver ; the other, in the fe-
males of mammals during lactation.
It is to the glycogenic function of the
liver, however, that the sugar of the blood
is due, and which enables us to explain
the hyper-glycsemia which induces a more
or less persistent glycosuria.
The terms diabetes and glycosuria are
used interchangeably, for the reason that
it is very difficult to separate the diabetes
from the glycosuria. It has been asserted
that glycosuria is only a passing symptom,
which may be present even in a state of
TRANSLATIONS AND AB STB ACTS.
441
the system which is physiological ; while,
on the contrary, the term diabetes is ap-
plied to a pathological condition which is
a general malady. I consider this discus-
sion as scholastic and theoretical rather
than clinical.
We will first study the theories of dia-
betes, beginning with the form termed
pancreatic diabetes. This form of dia-
betes is still imperfectly known ; for, while
it is not true that pancreatic diabetes is
always a grave disease, one cannot equally
affirm that grave diabetes is always due
to disease of the pancreas ; for fatal dia-
betes accompanied by great emaciation
sometimes occurs without disease of the
pancreas. There are also some cases of
diabetes accompanied by disease of the
pancreas, in which the patients are not
always emaciated, but obese.
In the autopsy of cases of diabetes due
to disease of the pancreas, we find more
or less complete atrophy, cysts, deteriora-
tions of the canal of Wirsung, sclerosis,
and other changes, which, however, rarely
change the gland ; while, on the contrary,
in experimental diabetes, it is only the
total destruction of the gland which pro-
duces the disease.
Notwithstanding this fact, Lepine has
shown that in diabetes there exists a
diminution of the glycolitic power ; that
it is this diminution which explains the
hyper-glycsemia which induces glycosuria.
This diminution in the power of the blood
to burn the sugar, may result from the
diminution, in the secretion, of the spe-
cial ferment formed by the pancreas ; but
this diminution in the power of the sys-
tem to destroy sugar is also found in
hepatic diabetes. Lepine observes the
paradoxical fact that the glycolitic power
of the blood was sometimes increased,
although it was excessively rich in sugar.
Finally, from the experimental point
of view, Gaglio has maintained that if,
after removal of the pancreas, the tho-
racic canal is ligated, the experimental
glycosuria disappears.
Equally numerous are the theories re-
specting diabetes of exclusively hepatic
origin; Bouchard counted thirty in 1880.
This figure is to-day far surpassed. We
will not stop to consider all these theo-
ries, for they have, from the point of
view which concerns us, only a second-
ary interest. Taken together, the theo-
ries of diabetes may be divided into two
principal types, the one regards the cause
of the disease to be an exaggeration of
the glycogenic function of the liver, which
throws into the blood more glucose than
is necessary to maintain the vital func-
tions ; according to the other type of
theories, however, on the contrary, the
quantity of glucose secreted by the liver
remains the same, but there is no com-
plete combustion of the sugar thrown
into the blood.
Let us rapidly examine these two theo-
ries. The first is the one which was
originally maintained by Claude Ber-
nard. Lecorche, and more recently Al-
bert Robin, have presented this view in
a new form, maintaining that diabetes
results from excessive activity of the
tissue metamorphoses, and in his com-
munication to the Academy, Robin, rely-
ing upon the analysis of urine, affirmed
that in the diabetic there is always an in-
crease of oxidations.
The other doctrine, on the contrary,
has been defended by Bouchard, who
asserts that diabetes results from the fact
that the system cannot burn the sugar
thrown into the blood by the liver, and
that this default in combustion is itself
produced by a diminution in the nutritive
functions. So he classed diabetes among
the results of lowered nutrition. I should
remark that recent theories of pancreatic
diabetes approach this view, since Lepine
affirms that the cause of diabetes results
from a diminution in the power of the
blood to destroy glucose.
It is very difficult to pronounce to-day
between these two theories, because both
of them may be true, for diabetes is not
a single disease, it is multiple ; and if,
in fact, as is true in a great majority of
cases when the vitality is lowered or the
general functions of the system enfeebled
or nutrition impaired, diabetes is seen to
make its appearance, it is not less true
that other cases are observed in which
the disease appears during the period of
the development of the body at the age
of from fifteen to thirty years. It thus
appears to me to be difficult to attribute
a common etiology to these two affections
so different in their course.
There exist, then, many different forms
of diabetes, each of which may have a dif-
ferent etiology, and I am glad to see Le-
pine, the author of the theory of pancreatic
diabetes, adopt this view. ''Diabetes,"
says he, ''results from an excess of pro-
duction of supply of sugar relatively to
442
TRANSLATIONS AND ABSTRACTS.
its destruction. The disturbance of the
equilibrium between the sugar produced
(or introduced from the outside) and the
sugar destroyed, may be induced in dif-
ferent ways; consequently, there are many
species of diabetes."
But that upon which I desire especially
to insist, is the necessity of the integrity
of the functions of the liver to maintain
glycosuria. I have seen many diabetics,
and have observed, many times, the fol-
lowing fact : When, in a case of diabetes
of moderate intensity accompanied by
obesity, thanks to a careful regimen scru-
pulously followed, the daily production
of sugar is lowered below ten grams, a
hepatic affection supervenes (infectious
icterus, cancer of the liver, cirrhosis), the
sugar disappears from the urine, even
though the patient no longer follows his
dietetic rules. I have made two very
close observations upon this point. In
one case, an angio-cholitis succeeded by
an infectious icterus followed gastro-duo-
denitis, the patient was subjected to a
dietetic regimen consisting exclusively of
milk and vegetable foods, in which green
vegetables predominated, and the sugar
disappeared from the urine. At the mo-
ment the obstacle disappeared, that is to
say, when the bile re-entered the intestine
and the phenomena of icterus disappeared,
the same dietary was followed by a repro-
duction of glycosuria.
In another observation, a fact nearly
analogous was observed : the sugar dis-
appeared during a hepatic affection, and
reappeared when the patient recovered
from the hepatic disorder. It appears to
me that we may explain, upon physiolog-
ical grounds, these observations. In
hepatic affections, the glycogenic func-
tion of the liver disappears, and with it,
the original cause of the diabetes. This
also occurs in other affections, even in
incurable ones, as cancer and cirrhosis.
Cirrhosis has been known to follow dia-
betes, and the observation has often been
made that the immediate use of alcohol,
which is quite frequent with diabetics,
causes the sugar to disappear from the
urine.
I believe that the liver must remain in-
tact in order to maintain the pathological
glycosuria in diabetes. It may be ob-
jected to this view that lesions of the
liver are sometimes found in diabetics,
and in numerous autopsies which have
been made, hypertrophic cirrhosis and
true cirrhosis have been observed. True
cirrhosis may be easily explained by the
excessive use of alcohol, which is in-
dulged in by most diabetics, who, thanks
to the activity of the elimination of the
alcohol through the kidneys, are able to
take it in large quantities without becom-
ing intoxicated.
Cirrhosis, furthermore, is curative for
diabetes, at least in part; for the cir-
rhotic liver ceases to be glycogenic, and
the choking of the hepatic cells by cellu-
lous cirrhosis destroys not only the gly-
cogenic but also the antiseptic and biliary
functions of the liver. I have never seen,
among a great number of cases of hepatic
disease, a single one in which diabetes
occurred in the course of a hepatic affec-
tion, and I believe it is to-day generally
admitted by pathologists that affections
of the liver do not produce diabetes.
On the other hand, intercurrent affec-
tions of the liver tend to cause the disap-
pearance of sugar in the urine.
-^ — • — *-
Influenza in Russia. — According
to the Medicinische Wochenschrift, of
St. Petersburg, la grippe is much more
severe in St. Petersburg than in this
country. Last year the influenza raged
with such severity among the Kalmuck
Tartars, that whole villages were extermi-
nated. These semi-civilized people dread
the scourge as much as they do small-
pox ; and when a person is stricken
down with it, he is usually abandoned to
his fate.
New Method of Establishing an
Artificial Anus. — M. Chaput, of Paris,
has suggested a valuable improvement in
the method of operating the established
artificial anus. It consists in the use of
the haemostatic forceps to connect the
intestines and the peritoneum before in-
cising the bowels. The lips of the intes-
tinal wound, the intestine being incised
to the extent of half an inch, are stitched
to the skin.
» • ^
A New Method of Anaesthesia. —
Dr. Wiesendenger describes a new method
of employing cold as an anaesthetic. The
essential feature of the method is the
application to the part which it is desired
to freeze, of a brass tube or other suitable
appliance containing liquid carbonic acid
gas.
TRANSLATIONS AND ABSTRACTS.
443
Electrical Anaesthesia. — La Medi-
iine Moderne for Jan. 7, 1892, contains
the following description of a method
of extracting teeth without pain, which is
in use at the electrical medical institute
of London. We translate as follows : —
''The apparatus consists of a small
Rhumkorff coil wound with very fine wire
and provided with an interrupter which
gives 452 vibrations per second, and con-
stitutes the most important part of the
apparatus. The patient places himself in
an ordinary dental chair, takes the neg-
ative electrode in his left hand, and the
positive in iiis right. The current is grad-
ually increased to the limit which the pa-
tient is able to endure. Then the forceps,
which are connected with the positive
electrode, are placed upon the tooth, and
it is immediately extracted and the cur-
rent interrupted. The patient experi-
ences no other sensation than the prickling
produced in the hands and forearm by
the passage of the current. The secret
of the anaesthetic effect produced by the
electrical current obtained from this ap-
paratus, seems to reside in the extreme
rapidity of the interruption. A similar
apparatus was exhibited by a member of
the American Electro-Therapeutic Asso-
ciation, at its recent meeting in New York
City. "
Hygiene and Regimen of Rheu-
matism.— H. Cazalis, according to La
Aledicine Moderne, holds that the rheu-
matic diathesis is not wholly attributable
to general hyperacidity or hyponutri-
tion, but that another factor is required,
namely, a special predisposition to ir-
ritability existing in the connective tis-
sues, which consequently are the point of
least resistance in the system, and become
the seat of the disease when certain poi-
sons are introduced into the system or
are formed in abnormal quantities. It is
held by numerous authors that the con-
nective tissue is the origin of uric acid,
— a theory which seems to accord with
that of M. Cazalis, since this acid is
usually found present in excessive quanti-
ties in rheumatics, possibly as the result,
as well as a cause, of the irritation exist-
ing in the connective tissue. Basing his
argument upon the facts and figures pre-
sented by the most eminent chemists and
physicians, M. Cazalis lays down rules and
principles for the government of the diet,
a general regimen of the rheumatic, the
essential facts of which are as follows : —
1. As regards diet, the author insists
that a person with the rheumatic diathesis
shall take into his system as little as pos-
sible of organic poisons, especially such
as irritate the connective tissue. These
poisons, it is well known, are particularly
abundant in flesh foods, it having been
long ago discovered by observing physi-
cians that the cause of the prevalence of
rheumatism and gout in England is due,
not to wine, as formerly supposed, but to
the excessive consumption of flesh food.
2. M. Cazalis believes that a predispo-
sition to irritability existing in the con-
nective tissue may be overcome by the
judicious employment of baths, gymnas-
tics, massage, and other hygienic means.
A New Symptom of Bright's Dis-
ease.— M. Dieulafoy indicates the exist-
ence, in Bright's disease, of various dis-
turbances of the auditory nerve, deafness,
roaring in the ears, tingling, sounds of
various sorts. It now appears from the
observations of M. Bonnier that the ear
symptoms of Bright's disease may be
manifested not only through the auditory
nerve, that is to say, by disturbances
of the cochlea, but also through disturb-
ances of the labyrinth, such as vertigo,
nausea, vomiting, syncope, apoplecti-
form phenomena, gyratory movements,
and irresistible falling. The symptoms
are paroxysmal in character, being gen-
erally induced by vaso-motor disturb-
ances of the ear under the influence of
uraemia, such as congestion, oedema, etc.
These symptoms may be the initial phe-
nomenon of Bright's disease, or may
appear later in the affection. When the
symptoms are due to renal disease, it
resists the usual treatment by quinine,
but disappears rapidly under the milk
resrimen.
-» — • — ^-
For Cracked Nipples. — A. Oehren,
an eminent German physician, offers the
following as an excellent remedy for
cracked nipples : —
Ichthyol, I gram, lanoline, 5 grams,
olive oil, or oil of sweet almonds, i gram.
This ointment immediately diminishes
the intolerable pain of nursing. The in-
fant can continue to nurse without injury,
as the ointment contains no poisonous
substance, and the ointment may be
easily washed off with simple water.*
444
BACTERIOLOOIGAL MOTES.
A New Dietetic Regimen. — M.
Germaine See, of Paris, one of the most
eminent of French physicians, has re-
cently called attention to the fact that
modern investigations have considerably
changed the views of physiologists re-
specting the proportion of nitrogenous
and carbonaceous food elements required
for the sustenance of the body. The old
theory required 4 ounces of albumen, i^
ounces of fat, and 12 to 15 ounces of
carbo-hydrates, for sugar and starch,
making, in all, 17 to 30 ounces of water-
free food. According to M. Germaine
See, ''these figures are to-day completely
changed, as the result of observation
upon different races and physiological
experiments ; the amount of albumen re-
quired, has been reduced one half."
The proportion now recognized as neces-
sary for the maintenance of health is :
Albumen, 2 to 2 J^ oz. ; fat, 2 oz. ; starch
and sugar, 16% oz. ; or about 21 ounces
of water-free food elements.
In reply to the question, What are
nourishing substances ? M. Gemaine See
remarks as follows: "A substance to
be nourishing must furnish, in relation
to its weight and volume, the greatest
possible quantity of nutritive principles.
Nutritive principles, as is well known,
are themogenic elements. The second
condition which must be met by a food
is that it shall satisfy taste and hunger
without producing too quickly the sensa-
tion of satiety. In addition to their nu-
tritive and sensory qualities, foods must
possess two other properties, viz., ease
of digestion in the stomach, and readi-
ness of absorption in the intestines."
Bacteriological Notes.
-* — • — *-
It occurs sometimes that surgeons fail
to find the local lesions sought for in
trephining for partial epilepsy. The
examination of the urine in such cases
would have proved the error. It is clin-
ically impossible to distinguish between
partial hysterical epilepsy and partial true
epilepsy due to the presence of neoplasms.
A chemical formula has been used in the
service of Mr. Charcot, by which differ-
entiation can be made. In a case of
epilepsy due to neoplasms, there is no
notable augmentation of the urea and the
phosphates in the fixed residues in the
urine at the moment of the crisis ; in par-
tial hysterical epilepsy, on the contrary,
there is a marked diminution of these
elements.
[The notes appearing in this department are abstracts or
translations prepared expressly for the Bacteriological,
World and Modern Medicine, from original sources.]
Treatment of Osteitis and Tuber-
culous Arthritis by a Solution of
Iodoform in Oil. — Dr. Bbhni discov-
ered by accident that iodoform is
completely soluble in the oil of sweet
almonds, and supposing that the solution
of iodoform must be superior to an emul-
sion for injections, made tests in this
line which confirmed his views. Iodo-
form oil, says the Archives Medicate
Beiges^ is clear, and of a yellowish
amber color ; it can be easily injected
with the Pravas syringe without the
necessity of employing strong canules,
and without the use of anaesthetics, even
when the articulations are very sensitive ;
the pain is insignificant and disappears
in one half hour. The results are as
good as with the emulsion at least.
The preparation must be made aseptic-
ally. For this, prepare the powder of
iodoform by washing in distilled water,
gather in a filter, and dry in absorbent
paper. The sweet almond oil is placed
in a sterile dish and heated in an oil bath
until it boils ; then it is allowed to cool
to 100 C., at which time the iodoform,
previously weighed, is mixed with it. If
the oil is too hot, it will decompose the
iodoform. The solution thus obtained
will last months if kept in the dark.
After the disinfection of the affected
portion, the injection is made at the point
where the greatest pain exists on press-
ure. One syringeful is sufficient, the
needle should be inserted quickly and
deeply, and the liquid emitted here and
there in small quantities in the tubercu-
lous seat ; no attention is paid to fistula.
The seat of the injection is then covered
with sublimated cotton, and cold applica-
tions are made upon the articulation.
After eight days, the second injection
may already be made in the neighbor-
hood of the first, and eight days later,
the third, and so on.
If there is an abscess, it should be as-
perated and the injection made in the ab-
cess itself.
In addition to this treatment the author
recommends salt baths with progressive
doses of salt. After the bath, massage.
BACTEBIOLOaiCAL NOTES.
4i5
first light and then more energetic, prac-
ticed with passive movements. Immedi-
ately after these manipulations the artic-
ulation is placed in a strong compressive
bandage, and the patient is placed in
bed for an hour or so. After the sec-
ond injection the patient begins to try
to walk.
Bohni condemns completely the method
of tenderness in the treatment of fun-
gosities and arthritis. He says that the
more gentle the treatment, the more im-
mobilizing the bandage, the more damag-
ing is the result, and more rapid is the
progress of the disease.
According to the author, his method
of treatment applies to all ages, the prog-
nosis being more favorable in children.
The articulations of the foot and the
metatarsal are those which yield more
readily to this kind of treatment. Those
of the wrist, the metacarpal, also give
very good results. Less favorable is
the prognosis of the knee in adults.
As to white tumors on the hip, the au-
thor has treated but one which ended
favorably.
Of twenty-eight cases treated by the
author, seventeen were completely cured,
and ten greatly improved.
phine, which would perhaps prevent the
absorption of the toxines and prolong the
action of lactic acid in opposing its too
rapid elimination.
A Ne^v Chemical Function of the
Cholera Bacillus. — M. Ferran has dis-
covered that the comma bacillus, like
many others, for instance the bacillus of
diarrhoea, the streptococcus scarlatina,
and the bacillus coli communis, has the
property of producing the fermentation
of milk, and causing by this action on
the lactose the production of paralactic
acid.
The attention of the clinicians is di-
rected to the fact that the bacillus
communis which possesses pathogenic
functions sometimes very much resem-
bling those of cholera, produces also
paralactic acid, and to the fact that para-
lactic acid paralyzes the chemical effect
of both the germ of cholera and of the
bacillus coli communis. Inasmuch as
this acid is a precious remedy against
these diarrhoeas, would it not be equally
efficacious against the diarrhoeas caused
by the con^ma bacillus?
It seems rational to use, in cholera,
lactic acid in lemonade, assisting its
action by the anexosmotic power of mor-
Laparotomy in Tuberculous Peri-
tonitis of Children. — Dr. Aldibert, says
the Archives Medicate Beiges^ concludes
an article on the above subject as fol-
lows : *'If we except the intestinal occlu-
sions which must be considered separately,
we find that of forty-six cases of infantile
peritoneal tuberculosis there were four
deaths and forty-two cures, two of which
persisted after one year, and two after
two years : this gives a death rate of
eight and six tenths per cent against
ninety-one and four tenths per cent of
cures, a quarter of which are definite.
The operation caused no death by itself,
an improvement always followed laparot-
omy even in fatal cases. The operative
mortality was nil. If we consider the
cases of peritonitis recognized as tuber-
culous by histological and bacteriological
tests, we have eighteen cures, of which
two continued after one year, three after
one and one half years, and one after
two years, /. '<?., one third are assured
cures. These figures demonstrate the
curability of tuberculous peritonitis by
laparotomy.
The Treatment of Actinomycosis.
— The treatment recommended by Prof.
Thomassen, of the Veterinary School of
Utrecht, against actinomycosis is the ad-
ministration of from six to eight grams
(one and one half to two drams) of aque-
ous solution of iodide of potassium. The
treatment has been tried in France, says
M. Nocard ; M. Godbille, a student of his,
has radically cured five patients in less
than fifteen days. M. Thomassen counts
eighty successful treatments without a
single failure. Actinomycosis is very
frequent in America ; why not try this
faithfully?
This, truly, would consist of a specific
treatment of actinomycosis in cattle at
least ; its simplicity and rapidity of ac-
tion and constant efficacy was the more
remarkable that the disease is serious,
progressive, and prevents nourishment
of the animal. It may be well to try
this treatment in human actinomycosis
also.
44()'
EDITORIAL
The Bacteriological World
AND
MODERN MEDICINE.
PUBLISHED MONTHLY BY THK
MODERN MEDICINE PUBLISHING CO.
Subscription Price :
$2.00 per Annum. Single Copy, 25 Cents.
Battle Creek, Mich., Nov. and Dec, i892.
MEETING OF THE AMERICAN PUBLIC HEALTH
ASSOCIATION IN THE CITY OF MEXICO.
The American Public Health Associa-
tion held its annual session, according
to appointment, Nov. 28, 1892, in the
CMty of Mexico. This is the first time the
Association has met within the territory
of our sister Republic, although a meet-
ing was held several .years ago in the city
of Toronto, Canada. The visit to Mexico
was made in response to an urgent invita-
tion from the government, conveyed by a
delegation of twelve of the leading physi-
cians of Mexico, who were present at the
meeting of the Association held last year
in Kansas City.
The meeting was pronounced by all
the old members present to be one of
the most successful which has ever been
held. The recognition and support ac-
corded by the government of Mexico,
doubtless contributed very largely to the
success of the meeting, as did also the
generous rates of transportation granted
by several of the leading railroad lines in
selling round-trip tickets at the rate of
one fare. The kindly feeling of the gov-
ernment toward the Association became
more and more apparent the moment
one found himself across the border and
within Mexican territory. Instead of
being confronted by Custom House offi-
cials eager to explore one's trunks and
satchels for contraband articles, the dele-
gates were met by representative Mexican
physicians who fairly overwhelmed them
with amiable courtesies, conveying a '
hearty welcome from the President, and '
the information that the Custom House
officers had been instructed to make no
inspection of the baggage of the members
of the American Public Health Associa-
tion. This treatment was so different
from what most of us had been led to ex-
pect by the newspaper accounts, and the
statements of some travelers concerning
the treatment which foreigners received
in Mexico, that all prejudices were at once
removed, and the visiting members found
themselves prepared for a thorough enjoy-
ment of Mexican hospitality, as well as
the scientific program prepared by the
officers of the Association. On reaching
the city, the members from the United
States were met by a large delegation of
Mexican physicians, by whom they were
divided into parties of three each, with a
native physician as a conductor, and es-
corted to the several hotels where quar-
ters had previously been secured.
The interest of the government in the
work of the Association is indicated by
the fact that President Diaz was present
at the formal opening, and that he invited
the members of the Association to be 1
present at his own inauguration, which
occurred on the morning of the second '
(lay of the meeting, even giving the mem-
bers precedence before his highest officers
in the congratulatory reception which fol- :
fowed immediately after the inauguration
ceremony. Every moment of time not
required by the regular sessions of the As-
sociation, from 8 o'clock in the morning
until a late hour at night, was occupied
by a regular program of excursions, visits
to hospitals and other public institutions,
formal and informal receptions, and po-
lite attentions quite too numerous to men-
tion. It is safe to say that no scientific
body of men was ever more enthusias-
tically and more generously' received
than were the. members of the American
Public Health Association by the govern-
ment and the people of Mexico.
EDITORIAL. N
BEA'HtlVTrT -ROOM
i H.
Numerous scientific' papers, some of
which were of great vahie as contributions
t'o sanitary science, were read before the
Association, although the number of pa-
pers contributed was so large that many
could not find a place upon the program.
Seventy-five papers were contributed by
Mexican physicians alone.' The great
number of papers presented certainly
indicates a lively interest in sanitary
science, a considerable part of which is
due to the excellent work which has been
done by the American Public Health As-
sociation. The proceedings of the Asso-
ciation for 1892 will be published in both
Spanish and English. It is to be hoped
that the pleasant aifiliation formed be-
tween the profession of this country and
that of Mexico at this meeting in the City
of Mexico, and the discussion of interna-
tional sanitary questions of great prac-
tical interest to both countries, will result
in mutual benefit.
Our Mexican neighbors are afflicted
with certain endemic maladies, which,
golden^3^oi^tiiAity for' the inception^/
great enterprizes of varied character,
which will be not only a source of wealth
to our citizens, but an untold blessing to
the unprogressive and poverty-stricken
millions of Mexico. We shall take oc-
casion at some future time to lay before
our readers some interesting facts re-
specting the therapeutic value of the
climatic conditions afforded by the great
Mexican tableland. j. h. k.
AN EPIDEMIC OF TYPHO-DIARRH(EAL DISEASE.
A MOST remarkable epidemic is now
raging in the city of St. Louis, Mo.,
among both young and old, and in all
classes of society. The manifestations
are decidedly of a character to indicate
local intestinal disturbances. The symp-
toms last for several days, and even
weeks, during which time symptoms of a
typhoid character appear, and become
more or less pronounced.
1.1 1 • , , ^^^ object of this notice of the eoi-
wh,le produang less disturbance and demic is not to discuss the pathology of
less fatahty, than typho.d fever and even the disease, but rather to point to the
pulmonary tuberculosis, are likely to ex- condition which produces it. Various
tend across the border .nto the southern hypotheses have been advanced as to the
sect on of th,s country, where they may cause, one of which is that the milk sup
create general consternation by their plied to the city is the chief facto if Zt
fatahty and by necessitattng a most rigid the only one, in the production of the
quarantme resulting ,n a complete sus- malady ; another is, that the germs ex.s
pension of commercial intercourse and a in the air ; and still another is tha h v
consequent enormous pecuniary loss, exist in the water in certain loca it s
Yellow fever, or '.Yellow Jack," as the The first opinion is undoubtedly at
disease is familiarly known in the South, fault. The disease is general in the dtv
IS unquestionably the greatest barrier and not confined to places receiving mfk
which stands in the way of intimate from a particular dairy. It cannot be rr
intercourse between us and the people of sible that all the dairies of St I ouis are
our neighbor Republic. If by the study in the same condition, and that most of "
of practical sanitary questions which espe- the milch cows therein could be unde the
cially relate to t,s disorder, yellow fever same influence so that the milk f,l
can be shorn of its terrors, so that our these sources could be affected in th^
cit,.ens may be led to enter into as inti- same way, unless, perhaps the watr and
mate commercial relations with Mexico food supply for all of them wasTdentir,
as IS the case with Canada, the people of which is not the case Tt Ts auil '
the United States will find in this great sible, however, thirthe bad'waL' o^f
country of undeveloped resources a which we will have something to say
448
EDITORIAL.
farther* on, may have an influence in the
production of the milk, and cause it to
be inferior, if not injurious.
The idea that the cause exists in the
air is untenable, as towns and cities in
the same altitude and latitude, within a
short distance of St. Louis, do not suffer
from the same disease.
There remains, then, the opinion that
the water is actually the cause of the
epidemic. This is undoubtedly true, and
one might arrive at this conclusion with-
out making any special investigation. It
is only necessary to examine into the
general condition of the water supply of
St. Louis, to realize that bacteriologically
it is most impure.
I am well aware that the chemical con-
dition of this water indicates that it is
perfectly wholesome, but in truth it is
polluted, and is carried to the homes in
this condition. The inhabitants have
the idea that its muddy appearance and
all its organic and inorganic admixtures
constitute a healthful condition, and
drink the water without filtration or
boiling.
The supply of water for the city, com-
ing from the river, is always a subject of
more or less importance. There have
existed, this year, however, circumstances
which render it much more than ordi-
narily dangerous. The overflow of the
Mississippi River for hundreds of miles
each side, extending up almost to its
source, and then its gradual receding to
the natural channel, have washed the filth
of thousands of square miles of land into
a common course, whence the city of St.
Louis derives its drinking water.
The slow disappearance of the overflow^
the long stagnation of the water on the
banks of the river, have presented a most
efficient medium for the growth of all
kinds of micro-organisms, including some
capable of producing disease with typhoid
and malarial symptoms.
There is no question that the people of
St. Louis are suffering now from the re-
sult of poisoning by microbes existing in
this water, and that many of them have
complications from the effect of malarial
effluvia which has developed in the neigh-
borhood. It is singular that these facts,
so plainly visible, do not alter the routine
practice of certain doctors, and change
the mind of numerous persons, who still
insist that the water is safe ; and of cer-
tain officials of the city, who, in order to
counteract the effect of any admission
that St. Louis is not healthy, insist that
the drinking water is absolutely pure and
wholesome. It would be much wiser and
more humane to acknowledge the truth,
and use every means to remedy the evil.
As a rule, St. Louis water is very health-
ful, but now a rare condition exists, which
renders it dangerous.
The citizens of that city pay for the
water they get, and are entitled to the
pure article. There is no justification
whatever in supplying a beverage which is
actually poisonous, and produces whole-
sale distress and fatalities reaching a
high percentage, when it could be pre-
vented.
The condition of this city is one that
may arise, and perhaps does exist, in
many other cities on the banks of the
Mississippi. It is more extensive here,
because the whole city population is af-
fected. J', p.
BROWN-SEQUARD'S ELIXIR.
A FEW years ago* the general press of
the country, and even the medical press
(chiefly the unscientific medical journals,
however), used in mockery and buffoon-
ery the respected name of Brown-Sequard,
the famous physiologist of the College
de France, when he announced the dis-
covery of the stimulating, tonic, and re-
storative properties of testicular juice.
No discovery was ever attacked with such
deprecating and unworthy language. Prof.
Brown-Sequard, however, fired with en-
thusiasm to perfect his discovery, as
only a scientist may be, never noticed
EDITORIAL.
449
the scurrilous comments on his name,
reputation, and learning. Calm as an
enthusiastic scientist can remain under
the stimulus of grand achievements, he
continued his labor with sublime indiffer-
ence to the ridicule of his enemies. He
seemed bent upon only one thing; viz.,
to prove the truth of his assertions. The
insults thrown in his face only added to
his zeal in his work.
Now, Dr. Brown-Sequard is avenged.
The truth of his position is proven. The
testicular juice is as valuable a therapeu-
tic agent as the discoverer claims. I)rs.
Lemoine, of Lille, d'Arsonval, of Paris,
A.. Poehl, of Paris, and numerous other
investigators of equal standing and merit
in France, Russia, and other countries,
have demonstrated the truth of Brown-
Sequard's position. Not only that, but
following the route indicated by this
famous scientist, several other physiolog-
ical animal substances have been used
in injection since, by various ex})erimen-
talists, with a view to determine their
effects as therapeutic agents. Brain mat-
ter is among these, and it has been found
useful in various forms of neurasthenia,
etc. More still, certain chemists, believ-
ing the active principle of testicular juice
to be spermine, have prescribed the hy-
drochlorate of spermine in lieu of- the
animal fluid, and this, too, with remark-
ably useful therapeutic effects.
Dr. Dupouy, editor of the Moniteur
d'Hygicne Publique, than whom no more
conscientious and independent physician
exists in France, uses the following lan-
guage in defense of Brown-Sequard's
discovery : —
''In locomotor ataxia, the efficacy of
this medication has also been considerable.
Brown-Sequard, in fact, cites the case of
an ex-fencing master of a regiment, ataxic
and retired from the army as such, who
was radically cured after a short treat-
ment. ']'o-day, adds our great physiolo-
gist, this man gives fencing lessons, and
is able to go through with a score of bouts
a day. According to the facts verified
by himself and by Dr. d'Arsonval, it is
possible to-day scientifically to formulate
the following conclusions upon the ther-
apeutical action of the testicular juice
matter. The latter, injected in cases of
enfeebled old people, rapidly gives them
back their strength in durable and definite
proportions. In locomotor ataxia, tuber-
culosis, anaemia, and other analogous
morbid states, this agent tones up the
general state of the health, strongly aids
resistance to disease, and brings on a
fine convalescence.
'^Moreover, Brown-Sequard, in order
to demonstrate, by an argument ad hom-
inem, the value of his liquid, tries his
strength before his colleagues on a dyna-
mometer, and the instrument records a
muscular strength of 45 kilogrammes. It
must be well borne in mind that our
learned physiologist is over seventy-five
years of age, and that very strong and
very vigorous men only succeed in re-
cording on the dynamometer a force of
from 40 to 41 kilogrammes [?]. This is,
now, the answer given, for the second
time, to the skeptics and the guardians
of the capital of the academies, ever con-
tem^ptuous of everything which does not
come from the laboratories of their mas-
ters, and refusing to test the experiments
of the College de France.
•'The Brown-Sequard injections may
at present be considered as constituting
one of the most brilliant discoveries of
modern therapeutics."
p. p.
Four years ago the writer had the
pleasure of spending a little time by
special invitation with Dr. Brown-Sequard
in his private laboratory in Paris. His
statements respecting his wonderful im-
provement in strength, freshness, and
vigor were confirmed by his assistant, Dr.
Henrocque and by his appearance. He
is certainly a man of keen perception and
undoubted veracity. His mother was an
American woman. j. h. k.
450
EDITORIAL.
IS ASEPTIC SURGERY POSSIBLE ?
BuDiNGER has recently made some
experiments in Billroth's clinic for the
purpose of determining the relative value
of various methods of wound treatment,
and the author concludes, as the result of
his observation, that it is impossible to
treat wounds in such a manner as to keep
them absolutely free from microbes. He
says, ''No method has been devised to
prevent the fall of microbes upon the
wound during the operation, or to kill
them and prevent' them from develop-
ing." The author's experiments were,
made with staphylococci albus, aureus,
and citreus, all of which were found to
be virulent.
These views of the author seem to be
somewhat extreme, as we think it just as
possible to open the skin without inocu-
lating the tissues underneath it, as to open
the test tube containing sterilized culture
media without inoculating the same. Op-
erating in an atmosphere free from mi-
crobes, with sterilized instruments, and
with hands, clothes, and everything about
the person made absolutely free from
microbes by sterilization, it certainly
seems to me to be possible that an opera-
tion wound might be made and closed
without infecting the tissues with air
germs. That conditions sufficiently per-
fect to insure absolute Asepsis are rarely
secured, must be admitted. Certainly^
surgeons are indebted to the germicidal
properties of the living tissues for most
of their cases of wound union without
suppuration.
The observations made by Budinger,
even if his conclusions be admitted, do
not in the slightest degree lessen the im-
portance of the aseptic methods which
are the special characteristics of modern
surgery ; for it will be readily admitted
that the tissues are better able to defend
themselves against a small number of
germs than against a multitude. But in
the opinion of the writer, the effects of
these observations should be, not to dis-
courage attempts to secure absolute asep-
sis, but to emphasize the importance of
devising a more effective and thorough-
goi-ng means for excluding aseptic mi-
crobes from operation wounds.-.
A method employed by the writer for
a number of years, and, as he believes,
with good results, has been the use of an
air filter connected with a fan run by an
electric motor, by means of which a cur-
rent of germ-free air is passed over the
field of operation during the entire op-
eration. The same apparatus is used to
free the air of the operating room from
dust. The effectiveness of the apparatus
has been very well shown by the accumu-
lation of dust on the' inside of the filter,
and by the fact that potato cultures can
be readily exposed for a long time in the
current of air which is passed through
the filter, without becoming infected.
J. H. K. ,
Papoid in Dyspepsia. — A. J. Park,
M. D., of Chicago, has recently published
a small series of cases which are illustra-
tive of the good effects derived from the
use of carica papaya in functional dis-
orders of the stomach. The three cases
described were all manifestly benefited
by the use of the remedy, although other
rational means were used at the same
time. Most of these patients had tried a
great \'ariety of remedies before, how-
ever, without benefit, so that Dr. Par'k
felt justified in giving papoid credit for
the remarkable improvement observed.
No analysis of the stomach fluid was
made in these cases, and so it is not pos-
sible to state exactly what was accom-
plished by the papoid, which would cer-
tainly be very desirable ; but its empirical
use seems to have been attended by good
results. There are doubtless cases in
which this remedy is valuable, although
the number of cases in which the nature
of the stomach disorder is a deficiency of
pepsin is very small indeed, compared
EDITORIAL.
451
with the number in which the disturb-
ance is due to an excess or deficiency of
some of the other elements of the digest-
ive fluid. In a careful study of 261 cases
by exact chemical methods, a deficiency
of pepsin action was found in only 44
cases, or 16.8 per cent of the total num-
ber of cases studied. The writer has
given elsewhere a careful analysis of the
results found in the analvsis of several
hundred stomach fluids, as regards varia-
tion in the proportion of normal ele-
ments and the presence of abnormal
elements. Nearly all observers who
have studied stomach liquids by modern
chemical methods, agree that a deficiency
of pepsin is not the most common of the
morbid conditions present in functional
disturbances of the stomach ; neverthe-
less, there is a certain proportion of cases
in which this deficiency does exist, and
for such cases papoid seems to be a most
valuable remedy. It is absolutely free
from foreign ferments, being of vegetable
origin, and does not produce the toxic
substances which are sometimes found
accompanying peptic digestion, — prob-
ably in cases in which the pepsin employed
is impure, and hence sets up putrefactive
processes in addition to peptic digestion.
J. H. K.
How Cholera Attacks the Human
Body, and How to Prevent It. — The
comma bacillus is the cause of Asiatic
cholera ; all other germs found with it in
cases of cholera are merely associates,
which may or may not be harmful. The
bacillus coli communis, as well as other
microbes sometimes found associated with
the comma bacillus, or which produce by
themselves some diarrhoeal or choleraic
symptoms, are individually and collect-
ively incapable of producing Asiatic
cholera, although it must be admitted
that they sometimes produce fatal disease,
either by their individual or combined
action, or in complicating the effect of
the true germ of cholera.
From this basis, it must be apparent
to all that the essential point in the pre-
vention of cholera is to prevent the germs,
from entering their feeding grounds in
the system. The comma bacillus is never
found in the blood, the glands, nor in
any part of the organism, except the
alimentary canal. Preventive measures,
then, must be directed against the intro-
duction of this parasite by the mouth
(and perhaps the nose), through which it
must travel to reach the bowels before it
can do any pernicious work.
The germs of this fatal malady travel
from place to place by means of the body,
particularly the dejecta. No atmospheric
influence nor combination of atmos-
pheric or telluric conditions, could spread
the malady. When transported from its
home in Asiatic lands, it follows commer-
cial channels, being carried in the body,
in the clothing, or by means of various
things to which the germs may be at-
tached or with which they may be mixed.
It spreads from individual to individual
in a community, by means of the inges-
tion of germs in water, milk, and other
articles of diet.
It follows, then, that, first, general
sanitary measures must be enforced against
the introduction of the disease from for-
eign lands by means of persons traveling
and by commercial intercourse ; secondly,
every home should exercise prudence and
institute means to prevent the access of
dangerous food, clothing, etc., into their
families ; thirdly, and most important of
all, every one should follow rules for self-
protection, — a sort of sanitary system to
insure against the invasion of the alimen-
tary tract by the comma bacillus.
It would be interesting to map out the
various practicable methods of general
and special sanitation, but this would
carry me too far in this article.
The chief question for each individual
to consider, in this matter as in all dis-
eases, is '* self-defense." To succeed in
this, one need only eat nothing raw, but
452
EDITORIAL.
have all his food cooked«; water, milk,
fruits, and every article of diet should be
thoroughly cooked. Besides this, the
body, and particularly the mouth, nose,
and hands, should be thoroughly disin-
fected with some antiseptic wash (car-
bolic acid, boracic acid, and thymol, for
instance). As in all intestinal germs ca-
pable of disturbing the food and the de-
jecta in the bowels, the comma bacillus
thrives best in overloaded stomachs and
bowels, in intestines replete with rich and
indigestible foods, and in organisms in
which nature's own powers of fighting
germ life and resisting disease have been
weakened by wrong living, dissipation,
etc. Temperance in all things, regular
habits, absolute cleanliness, and disin-
fection are the necessary conditions to
save individuals from cholera in an in-
fected district. p. p. .
abbreviated and condensed text-book.
Dr. Davis, Jr., has already made a name
for himself, and his works are worth the
most careful consideration.
Reviews.
Diseases of the Lungs, Heart,
and Kidneys. — By N. S. Davis, Jr.,
A. M., M. D., Professor of Principles and
Practice of Medicine, Chicago Medical
College ; Physician to Mercy Hospital ;
Member of the American Medical Associ-
ation, Illinois State Medical Society, Chi-
cago Medical Society, Chicago Academy
of Sciences, Illinois State Microscopical
Society ; Fellow of the American Acad-
emy of Medicine j Author of "Consump-
tion, How to Prevent It, and How to Live
with It," etc. No. 14 in the Physicians'
and Students' Ready-Reference Series. In
one neat 12 mo volume of 359 pages,
extra cloth, $1.25 net. The F. A. Davis
Co., 1 23 1 Filbert St., Philadelphia, Pa.
This is a most valuable addition to the
Ready- Reference series of medical works
at the command of the medical profes-
sion. Being the essentials of lectures
delivered by the author at the Chicago
Medical College, they constitute a more
useful book of reference than the usual
-*• — •— *-
Tuberculosis of Bones and Joints.
— By N. Senn, M. D., Ph., D., Profes-
sor of Surgery in Rush Medical College,
Chicago, III. The F. A. Davis Co., Pub-
lishers, 1 23 1 Filbert St., Philadelphia, Pa.
Like all that Dr. Senn writes, this work
is concise, clear, and practical. It is an
admirable resum of modern ideas on
tubercular disease of the bones and joints,
and the most approved and recent of sur-
gical treatments. Much of this very de-
sirable treatise consists of the experiences
of the author himself, whose surgical skill
and medical knowledge are surpassed no-
where in this or foreign countries. The
book is a large 500-page volume, and con-
tains 107 practical illustrations. No prac-
titioner can well afford to be without this
splendid collection of authoritative surg-
ical and medical ideas on the subject of
which it treats.
The Physician's Visiting List. —
Lindsay & Blakiston, Philadelphia ; P.
Blakiston, Son & Co., Philadelphia, pub-
lishers, ;^i to ^3.
No better recommendation of this ex-
ceedingly useful little volume can be given
than that it has been published yearly for
forty-two years. It is a neat little pocket
memorandum book of the greatest practi-
cal value to the medical practitioner. It
has a visiting list for every day in the
year, want memoranda, record of obstet-
rical cases, record of deaths, etc. , all things
of every-day necessity. When we con-
sider in addition to this the many excel-
lent suggestions in cases of emergency,
such as poisoning, drowning, and also the
list of new remedies, the metric system,
the rule for examining urine, etc., it is
apparent that Blakiston's visiting list is a
requisite for the doctor's outfit for the
practice of medicine.
HERE TO
SPEND THE
INTER!
At this Season of the Year 1>housands of
Invalids are Seriously Considering
THE Question, —
Where can I Spend
THE Months of
NoverRber, Decennbep,
January, Pebriiary, ^^^ March,
With the GREATEST PROFIT?
THE ANSWER
to this question will depend
upon what the individual
mmm^m^mmmmmmmmmBma^m^mmm^m^mmmmmm^mtm^mm wishes to accomplish by a
sojourn away from home. If rest and recuperation are the chief requirement, the
Southern and Pacific Coast States offer numerous attractions which draw throngs of
semi-invalids and valetudinarians every year.
If, in addition to rest and recuperation, the invalid needs a careful study of his
diseased conditions, and an intelligent regulation of diet, exercise, and all other
health conditions, — in other words, scientific health culture, efiiciently carried out
by the aid of the best known medical means and appliances, thoroughly trained
nurses and attendants, and competent physicians, — then the choice between the most
desirable places becomes very much restricted. There are certainly few institutions
in this country where the needs and desires of an earnest, health-seeking invalid can
be satisfactorily met. Such places can be counted on the fingers of one hand, and
are, perhaps, little known because of the fact that the managers of such institutions
are conducting them in a scientific, and in some instances a philanthropic spirit, and
consequently do not employ as a means of winning patronage, the emblazoned ad-
vertisements, the truth-sacrificing circulars, and other advertising methods com-
monly resorted to by the proprietors of mineral springs establishments, bogus
sanitariums, and other so-called "health institutions" and quasi-medical establish-
ments, with which the country abounds.
The advertisements of these establishments do not appear in public prints or
popular magazines because such advertising is clOvSel}^ akin to quackery, and brings
those who employ it into bad company.
The managers of the Sanitarium at Battle Creek, Michigan, many years ago
undertook to organize a thoroughly scientific institution which would represent
rational medicine in its most advanced form, and would be exactly what it professed
to be — an institution where patients are honestly and fairl}^ dealt with, treated at
reasonable rates, given kind attention and comfort, and opportunity for the recovery
of health under the most favorable conditions. The majority of patients treated in
this institution are sent to it by physicians who by personal acquaintance, or
through the reports, of their patients, have become thoroughly familiar with the
character of the institution and its management.
DESCRIRTION
OF THE
*^\^ ATTlvK' CRKKK, one of the most beautiful and prosperous cities of Michi-
*)^£ gan, is centrally located in the salubrious Peninsular State. Its population
v(^K^ is 20,000, while its death rate is but seven per thousand. Battle Creek is
situated on two great thoroughfares of railway travel between the Bast and
the West, being at the junction of the Grand Trunk and the Michigan Central lines ;
and two other railways make it easy of access from the South.
The city has an electric railway and is lighted b}^ electric lights. A great
number of pleasant drives are afforded by its well-kept and shaded streets.
The Buildings are lighted by a 700-light plant, Edison incandescent system.
Safely Hydraulic Elevators. Outside stairways for fire escapes acce:^sible
from every window.
The Institution affords facilities for baths of every description : Turkish, Rus-
sian, vapor, electric, water baths of all kinds, and the electric light bath. In-
dependent accommodations for ladies and gentlemen, sufficient for 80 persons
at one time. More than 800 feet of glass for sun baths.
A General Parlor, 40 x 50 feet, is luxuriously furnished with Dhagistan rugs,
easy chairs, etc. The Dining- Room has a seating capacity of 400, is beauti-
fully lighted and ventilated, and always cheerful. No kitchen smells. Cui-
sine unsurpassed ; table service excellent. Everything an invalid needs, and
special dietaries prepared as directed.
THE CONSERVATORY.
The Gymnasium, 85 x 45 feet, is supplied with every appliance for exercise, and
furnishes special instruction and class drills in Delsarte and Swedish gymnas-
tics, under a trained director. Exercise by prescription.
The S^vedish Movement Department, both manual and mechanical, is the
most extensive in the United States. Vibrating bars and seats, kneaders, rub-
bers, beaters, shakers, and manipulating appliances of all sorts.
The Electrical Department contains every improved appliance for medical ap-
plications of electricity. Galvanic, Faradic, Dynamic, and Static electrical
apparatus and appliances for electrolysis, electro-cautery, etc.
An Aseptic Maternity on the cottage plan ( steam heat and thorough ventila-
tion), provides the best possible conditions for lying-in patients, with expe-
rienced professional attendance and rigorous aseptic management.
Special Departments for surgical cases, eye, ear, throat, and lung diseases,
nervous diseases, genito-urinary diseases of men (non-specific), opium and
alcohol habits, and diseases of women. A kindergarten and nursery, to keep
the children happy and out of mischief.
Three Fine Greenhouses, maintaining a
magnificent collection of palms and va-
rious tropical flowers and plants, keep the
house filled with bloom during the win-
ter season. Flowers are everywhere in-
doors during the winter season. Patients
can visit the greenhouse at any time
without going out of doors.
GlassJnclosed Sun-Parlors and Veran=
das for winter sunning and promenad-
ing.
SUMMER HOUSE AND FRESH-AIR INLET.
Pure Water from sandstone rock.
There are from 250 to 300 Employes in the Sanitarium service the year
round, of whom from 90 to 100 are medical attendants and nurses. Also seven
thoroughly trained physicians, and a large corps of manipulators skilled in
massage and the lying system of Swedish movements.
The Sanitarium Training=School, in which our nurses are trained, is the
largest and most popular in the United States. Its course of training is
the most complete and
thorough of any school.
Tri=Weekly Lectures on pop-
ular medical subjects by
the physicians.
Abundant Means for Rec=
reation indoors during
inclement weather. Facil-
ities for walking, driving,
and horseback riding at all
seasons.
The Sanitarium is Not a
Pleasure Resort nor a
fashionable hotel, but an
ideal place for invalids needing good nursing, the benefits of regular habits,
and scientific professional care and treatment, and who desire to become per-
manently well.
The Sanitarium Nursery and Kindergarten. This enables mothers to bring
little ones with them without being burdened with their care and supervision.
The children have the advantages of kind and experienced teachers and am-
ple playgrounds.
For Further Particulars, see large circular and card of rates.
J. H. KELLOGG, M, D., Supt.,
Sanitarium, BATTLE CREEK, MiCH.
MAIN ENTRANCE.
The Laboratory of Hygiene.
(SANITARIUM.)
J. H. Kellogg, M. D., Supt. Paul Paquin, M. D., Director.
1VIONTHL.Y BULLETIN.
Battle Creek, Mich., Nqv. and Dec, 1892.
THE ACID OF THE GASTRIC JUICE.
(Concluded.)
Last month the writer presented the results
of the quantitative analysis of 413 stomach
fluids as regards the presence or non-presence
of hydrochloric acid, and the presence or non-
presence of lactic acid in 328 stomach fluids.
Some further observations respecting the rela-
tion of free hydrochloric acid to digestion,
which seem to be worthy of record, have been
made and are here given : —
3. Observations Respecting the Effect of the
Addition of Free HCl to Meat Juice.— The fact
that free hydrochloric acid is not found in the
gastric juice of dogs that have been fed upon
meat, has been used as an argument against
the theory which regards this acid as an essen-
tial constituent ol healthy gastric juice. Hay-
em and Winter some time ago suggested that
this fact might be due to the combination of
free hydrochloric acid with the albuminous ele-
ments of meat, thus causing the disappearance
of HCl in a free state from the gastric fluid ob-
tained from the stomach of a dog during the
digestion of flesh food. The following experi-
ment, a modification of an experiment made
by the authors above referred to, seems to
demonstrate this hypothesis to be correct: —
A quantity of meat juice was expressed from
fresh beef, and titrating with a decinormal so-
lution of hydrate of potash, its acidity was
found to be equivalent to .021 grams of anhy-
drous HCl. A solution of hydrochloric acid
was then added drop by drop to an equal
quantity of the same preparation of meat
juice, testing frequently for the presence of
free HCl. No indication whatever was ob-
tained until after .015 grams of anhydrous
HCl had been added. A faint indication of
the presence of free acid was then obtained
with Congo-red paper. The solution was then
titrated with a decinormal solution of KHO,
and its acidity was found to be an equivalent
of .035 gfams of anhydrous HCl, showing
that the HCl added had not been neutralized
by any alkaline substance in the meat juice,
but that it had been simply fixed by the albu
men with which it had formed an acid combi-
nation, it still retaining its acid function to the
full degree.
This experiment explains very completely the
absence of free HCl from the gastric juice of the
dog during the digestion of meat, and of course
answers completely the argument based upon
this fact.
4. Therapeutic Observations Respecting the
Influence of Lactic Acid upon the Digestive Proc-
ess.— I have made a very considerable number
of observations respecting tiie influence of lactic
acid upon stomach digestion. Having noted the
frequent absence of lactic acid in cases of hypo-
chlorhydrie, lactic acid being noted as absent
n 25 (61 per cent) of the 41 cases of hypo-
chlorhydrie, — cases in which free HCl is present
in the gastric juice in abundant quantity, but'
fails to combine with albumen to the usual ex-
tent, or, in other words, in which there is a
deficient amount of useful work done by the
stomach, — it occurred to me to be possible
that the qualitative change in the character of
the chemical woi-k done by the stomach might
be due to this notable deficiency of lactic acid,
which previous experience had taught me to be
useful in certain cases of dyspepsia, although I
had not before been able to predict in ad-
vance just which cases would be benefited by
the remedy. I accordingly began the adminis-
tration of the lactic acid in doses of 5-15
minims of pure acid in cases of this class, and
with most excellent results, as will be seen by
the following case, which is a fair example of
tnany others which might be cited : —
A young man aged 30, a student, had suf-
fered for eight or ten years from stomach dis-
orders which had been but partially relieved
by the various remedial measures which he had
employed. Was emaciated, and sufi'ered much
from sour stomach. Appetite was good, but
the nutritive processes were evidently very de-
fective, for he was continually emaciated and
weak, and unable to pursue his studies except
under great difficulty.
(457)
458
LABORATORY OF HYGIENE.
Analysis of tlie stomach fluid gave the follow-
ii)g quantities: (A) .217; (a) 1.00; (T) .354:
H.090; (C) .120.
Formula: —
A + a + T+^, +|_
The above figures indicate hyperpepsia with
hyperchlorliydrie, hyperacidity, and acid fer-
mentation. The amount of free hydrochloric
acid is notably large — nearly double the maxi-
mum quantity found in health; but fermen-
tation existed notwithstanding the presence
of this large quantity of free HCl, a circum-
stance which I have observed in many other
cases. The patient had occasionally found re-
lief by the use of lacto-peptine. At my sugges-
tion, he discontinued the use of this remedy,
and used lactic acid instead — 5 to 10 drops im-
mediately.after each meal, sometimes repeating
the dose one half hour to one hour after the
meal. September 7, 1892, a month after the
first analysis, another test breakfast was taken,
and the following figures were obtained: (A)
.188; {a) .81; (T) .284; (H) .020 ; (C) .204:
Formula: —
H —
INVESTIGATION OF CONTAMINATED DRINKING
WATER.
A = ^i = T —
C +
Uffelmann's test for lactic acid gave no reac-
tion. Peptones abundant. This formula in-
dicates simple dyspepsia with slight deficiency
of free HCl, without acid fermentation. It is
interesting to note that under the influence of
the lactic acid the excessive secretion of chlo-
rine had disappeared, the fermentation ceased,
and the large quantity of free HCl which re-
mained in the stomach unused, was made to
combine with the albumen, and thus enter into
the useful chemical work of the stomach. The
excess of the combined albumen (C) cannot be
considered a pathological condition in this
€ase, as it only indicates the effort of nature to
supply the extra quantity of nutritive mate-
rial needed for promoting a gain in flesh.
Under the influence of this simple remedy alone,
having made no change whatever in his diet,
the patient had gained several pounds in flesh,
and was so greatly improved that he consid-
ered himself practically well.
Similar observations respecting the thera-
peutic value of lactic acid have been made in a.
large numberof cases, with equally good results.
1 consider myself justified in asserting with
confidence that lactic acid may be depended
upon as a remedy that would favorably in-
fluence the chemical processes of digestion,
certainly in improving the quantity of the
chloro-organic combinations, and possibly
also in influencing the combination of chlorine
with albumen, and perhaps the setting free of
chlorine from the bases.
DuifiNG the last month, considerable atten-
tion has been given to the examination of
drinking water, as the result of an outbreak
of typhoid fever involving a number of persons
in the same family. The work has been done
by Mr. F. E. Braucht, one of the assistants in
the laboi-atory. A sanitary inspection of the
premises on which the outbreak occurred was
made, with the following results: —
The well is situated on a ridge, the surface
soil of which is sand and gravel. It is driven
to a depth of nearly a hundred feet, and in
its course passes through nearly fifteen feet of
hardpan and solid rock. One would naturally
think that such a well would contain the purest
of water, but not so with this. Within a dis-
tance of twenty to forty-five yards are five
deep privy vaults, and near by a hencoop con-
tributes its portion of bad hygiene. The slops
from the house are also thrown out immedi-
ately around the well.
With the sample of water brought me, I in-
jected two rats hypodermically, at the root of
the tail, one with 3 c. c, and the other with
6 c. c. After two days, both rats showed signs
of illness, and on the third day refused to take
food. On the ninth day after inoculation, the
rat inoculated with 6 c. e.of the water died;
the other was sick for some time, but finally "
recovered.
Post-mortem examination showed the liver,,
kidneys, and spleen to be congested. The
spleen was dark colored. The small intestine
showed signs of inflammation, and dropped
to pieces upon the slightest pressure.
Culture made upon gelatine showed a whitish
growth upon the second day, Yery much the
same as.Eberth's germ. Microscopical exami-
nation showed a small bacillus, a little smaller
than Eberth's bacilli, and a few micrococci.
Culture upon potato grew with an invisible
growth, except a few colonies of white mold.
Culture in sterile milk after a week's time
turned the bacillus a greenish yellow, and
thoroughly digested it.
Three cubic centimeters of a thirty-six hour
culture of bouillon, injected hypodermicallj^ at
the root of a rat's tail, killed him in less than
twenty-four hours. The same culture left to
stand a few days, had almost the same appear-
ance as sterile bouillon, but upon the slightest
agitation turned a dark gi-een, which disap-
peared again upon standing. The odor from
this culture was very disagreeable.
LAUORATOTIY OF HYGIENE.
459
Chemical examination of the water was as
follows: —
Hardness, before boiling, 8°.
Hardness, after boiling, 5J^°.
Odorless and tasteless at a temperature of
30°-40°C.
Chlorine, 32 parts per 1,000,000.
Free ammonia, 80 yjarts per 1,000,000.
The physician who sent in the sample of
water, informed me that in the latter part of
July a young lady who had been away, re-
turned home, and in a few days was taken
with typhoid fever. She lived near the well,
and used the vault forty yards away from it.
This was the first case that occurred ; but from
that time until the water was brought for ex-
amination, there had been six or more cases
of typhoid fever among those using the water
from that well. The use of the water was
stopped, and no more cases have developed.
Technique.
The Absence of Hydrochloric Acid. — Ewald
claims, in his work on Diseases of the Stom-
ach, that in "menstruation, no free hydro-
chloric acid, or only a very small quantity, is
secreted," supporting his statement by the
authority of Kretschy, Fleischer, and Boas.
He also claims to have found complete and
permanent absence of fi-ee hydrochloric acid in
a number of persons who had no stomach
complaints, from which he concludes that "no
poRitivediagnosticvalue"shou'ld be attributed
to an increase or diminution in acidity which
is referred to free hydrochloric acid, in which we
suppose he also includes thecorapound chlorine
or chloro-organic substances, which, in the de-
termination of acid by acidimetry, behave pre-
cisely as does free hydrochloric.
F'rom the observations which we have made
upon stomach liquids, and the resultsof experi-
ments which we now have in progress, we are
inclined Ito the opinion that these conclusions
of Dr. Ewald are not well grounded, or, at any
rate, that thenumber of healthy persons whose
gastric fluid does not contain free hydrochloric
acid, is much smaller than he supposes.
(To be continued.)
k — • — *
A New Mode of Staining Spores. — Moller rec-
ommends the following method for staining
spores, which is excellent in its results: —
The preparation on the cover-glass is passed
three times through the blaze, or placed two
minutes in absolute alcohol, then two minutes
in chloroform, and washed in water. It is then
plunged from one half to two minutes in chro-
mic acid of 5 percent, washed again thoroughly,
covering the glass with a drop of solution of
phenicfuchsin, and is then carried to ebullition
in the flame during sixty seconds. Once the
fuchsin is evaporated, the cover-glass is decol-
orized ill a sulphuric acid solution of 5 per cent
and again washed in water. It is at last left for
thirty seconds in an aqueous solution of methyl-
blue or of malachite green, and washed. The
spores then appear a dark red, while the body
of the bacteria is colored a beautiful green.
-♦—•—*-
Anisa Oil as an Imbedding Material for the
Freezing Microtome. — Good imbedding ma-
terial is one of the most difficult things to ob-
tain in microscopy, and it is always interesting
to the microtomist to find some new methods
promising one more satisfaction than what has
been tried. The following, from the Interna-
tiona,! Medical Magazine, abstracted from the
Centralblatt. f. Bakteriol. u. Parasitenk., will
be read with pleasure: —
"Kiihne, of Wiesbaden, after commenting
upon the fact that in using the freezing
microtome, if the tissue be frozen completely,
the knife is very apt to ride over it and cut a
section of uneven thickness, and that when the
freezing is of the degree most favorable for cut-
ting, the tissue is apt to become separated from
the freezing plate; suggests that this difficulty
may be obviated by substituting anise oil for
water, the former becoming solid at from 6° to
18° R. (45.5° to 72.5° F.). In course of time,
from exposure to the oxygen of the atmos-
phere, lower temperatures may be required to
solidify the oil; but when it is fresh and pure, it
congeals almost at the ordinary temperature
of the room. A small bit of the tissue, about
an eighth or a twelfth of an inch in thickness,
is placed in the oil, after careful hardening in
alcohol. In about twelve or twenty-four hours
it is thoroughly impregnated with the oil, the
clearness of the specimen being regarded as the
test. The plate of the microtome is carefully
cleaned and wiped off with a rag wet with
alcohol, and dried ; a few drops of the oil are
placed upon it, and upon this the bit of tissue
to be frozen. A few pumps upon the ether-
spray apparatus suffice to solidify the mass,
and sections maybe made. From the knife the
frozen sections should be placed in a dish con-
taining alcohol, to remove the oil, <?are being
taken to prevent contact of alcohol with the
imbedded mass on the microtome, as it would
thus be dissolved and the tissue loosened from
the freezing-plate. The further preparation of
the specimen rests with the operator, excellent
results in staining of both tissues and bacteria
being possible, with ordinary care."
460
adve:rtisenie:nx3.
Pharmaceutical Specialties of
the Farbenfabriken vorm
Friedr Bayer & Co
Aristol
Europhen
Saloph^^n
Sulfonal*
Phenac<?tine
For Pamphlets Apply to
W H Schieffelin & Co
New York
Sole Agents and Sole Licensees for
the United States
7\RIST0L is now widely used as an
^ *" agreeable and effective dressing in all
of the operations of major and minor
surgery and in dentistry. It is invaluable
in ulcerations of all kinds, and in burns,
blisters and bed-sores. It adheres closely
to mucous membranes and wound sur-
faces. {Aristol and '' Europhen- Aristol'
a combination of both remedies, are sup^
plied in ounces,)
pUROPHEN is a complete substitute
^ for iodoform and is a cicatrisant, of
special value in specific lesions, catarrhal
and ulcerative diseases and all surgical
conditions formerly treated by the latter
preparation. It has five times the cover-
ing power of iodoform and forms an im-
pervious coating over denuded tissues.
Europhen has a faint, agreeable odor
resembling that of saffron. {Supplied in
ounces. )
C^ALOPHEN is a new salicylo-phenolic
*^ derivative said to be so combined,
chemically, as to constitute a safer and
more effective remedy than either of its
components, or any analagous prepara-
tion. The reports refer in the highest
terms to its value in acute articular
rheumatism and allied affections. Com-
petent observers recommend it for trial.
{Supplied in ounces, taJjlets and pills,)
ClULFONAL induces physiological
^ sleep, free from narcosis, and with-
out sequelae. It acts purely as a hypnotic
and claims no analgic powers. Sulfonal
is also of the highest value in the neuroses
and is largely employed by neurologists.
It is a perfectly safe and reliable remedy
and its continuous use does not give rise
to a drug habit. Sulfonal must be admin-
istered according to directions. {Supplied
in ounces, tablets and pills.)
pHENACETINE continues to justify the
^ high commendations of physicians,
and it may properly be considered as
the best of the modern antipyretics and
anodynes. In la grippe, rheumatism,
migraine, neuralgia and allied maladies
it is a prompt, safe and effective remedy.
Phenacetine, unlike the secret mixtures
announced as analgesics and antipyretics,
is a true organic derivative. {Supplied
in ounces, tal:)lets and pills.)
iflCl^i
3 2044 103 041 026
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