« ForrigeFortsæt »
found a new Surgery—already begun by a celebrated English surgeon, Dr. Lister, who was among the first to understand its fertility. With no professional authority, but with the conviction of a trained experimenter, I venture here to repeat the words of an eminent confrère.
8 See Lord Lister's paper in the present volume.--Ed.
ON THE EXTENSION OF
THE GERM THEORY
"HEN I began the studies now occupying my atten
tion, I was attempting to extend the germ theory
to certain common diseases. I do not know when I can return to that work. Therefore in my desire to see it carried on by others, I take the liberty of presenting it to the public in its present condition.
I. Furuncles. In May, 1879, one of the workers in my laboratory had a number of furuncles, appearing at short intervals, sometimes on one part of the body and sometimes on another. Constantly impressed with the thought of the immense part played by microscopic organisms in Nature, I queried whether the pus in the furuncles might not contain one of these organisms whose presence, development, and chance transportation here and there in the tissues after entrance would produce a local inflammation, and pus formation, and might explain the recurrence of the illness during a longer or shorter time. It was easy enough to subject this thought to the test of experiment.
First observation.-On June second, a puncture was made at the base of the small cone of pus at the apex of a furuncle on the nape of the neck. The Auid obtained was at once sowed in the presence of pure air-of course with the precautions necessary to exclude any foreign germs, either at the moment of puncture, at the moment of sowing in the culture Auid, or during the stay in the oven, which was kept at the constant temperature of about 35° C. The next day, the culture fluid had become cloudy and contained a single organism, consisting of small spherical points arranged in pairs, sometimes in fours, but often in irregular masses. Two fluids were preferred in these experiments chicken and yeast bouillon. According as one or the other was used, appearances varied a little. These should be described. With the yeast water, the pairs of minute granules are distributed throughout the liquid, which is uniformly clouded. But with the chicken bouillon, the granules are collected in little masses which line the walls and bottom of the flasks while the body of the fluid remains clear, unless it be shaken: in this case it becomes uniformly clouded by the breaking up of the small masses from the walls of the flasks.
2 Read before the French Academy of Sciences, May 3, 1880. Published in Comptes rendus de l'Académie des Sciences, xc., pp. 1033-44.
2 In 1880. Especially engaged in the study of chicken cholera and the attenuation of virulence.-Translator.
Second observation. On the tenth of June a new furuncle made its appearance on the right thigh of the same person. Pus could not yet be seen under the skin, but this was already thickened and red over a surface the size of a franc. The inflamed part was washed with alcohol, and dried with blotting paper passed through the flame of an alcohol lamp. A puncture at the thickened portion enabled us to secure a small amount of lymph mixed with blood, which was sowed at the same time as some blood taken from the finger of the hand. The following days, the blood from the finger remained absolutely sterile: but that obtained from the center of the forming furuncle gave an abundant growth of the same small organism as before.
Third observation.—The fourteenth of June, a new furuncle appeared on the neck of the same person. The same examination, the same result, that is to say the development of the microscopic organism previously described and complete sterility of the blood of the general circulation, taken this time at the base of the furuncle outside of the inflamed area.
At the time of making these observations I spoke of them to Dr. Maurice Reynaud, who was good enough to send me a patient who had had furuncles for more than three months. On June thirteenth I made cultures of the pus from a furuncle of this man. The next day there was a general cloudiness of the culture fluids, consisting entirely of the preceding parasite, and of this alone.
Fourth observation.- June fourteenth, the same individual showed me a newly forming furuncle in the left axilla: there was wide-spread thickening and redness of the skin, but no pus was yet apparent. An incision at the center of the thickening showed a small quantity of pus mixed with blood. Sowing, rapid growth for twenty-four hours and the appearance of the same organism. Blood from the arm at a distance from the furuncle remained completely sterile.
June 17, the examination of a fresh furuncle on the same individual gave the same result, the development of a pure culture of the same organism.
Fifth observation.-- July twenty-first, Dr. Maurice Reynaud informed me that there was a woman at the Lariboisière hospital with multiple furuncles. As a matter of fact her back was covered with them, some in active suppuration, others in the ulcerating stage. I took pus from all of these furuncles that had not opened. After a few hours, this pus gave an abundant growth in cultures. The same organism, without admixture, was found. Blood from the inflamed base of the furuncle remained sterile.
In brief, it appears certain that every furuncle contains an aërobic microscopic parasite, to which is due the local inflammation and the pus formation that follows.
Culture fluids containing the minute organism inoculated under the skin of rabbits and guinea-pigs produce abscesses generally small in size and that promptly heal. As long as healing is not complete the pus of the abscesses contains the microscopic organism which produced them. It is therefore living and developing, but its propagation at a distance does not occur. These cultures of which I speak, when injected in small quantities in the jugular vein of guineapigs show that the minute organism does not grow in the blood. The day after the injection they cannot be recovered even in cultures. I seem to have observed as a general principle, that, provided the blood corpuscles are in good physiological condition it is difficult for aërobic parasites to develop in the blood. I have always thought that this is to be explained by a kind of struggle between the affinity of the blood corpuscles for oxygen and that belonging to the parasite in cultures. Whilst the blood corpuscles carry off, that is, take possesston of all the oxygen, the life and development of the parasite become extremely difficult or impossible. It is therefore easily eliminated, digested, if one may use the phrase. I have seen these facts many times in anthrax and chicken-cholera, diseases both of which are due to the presence of an aerobic parasite.
Blood cultures from the general circulation being always sterile in these experiments, it would seem that under the conditions of the furuncular diathesis, the minute parasite does not exist in the blood. That it cannot be cultivated for the reason given, and that it is not abundant is evident; but, from the sterility of the cultures reported (five only) it should not be definitely concluded that the little parasite may not, at some time, be taken up by the blood and transplanted from a furuncle when it is developing to another part of the body, where it may be accidentally lodged, may develop and produce a new furuncle. I am convinced that if, in cases of furuncular diathesis, not merely a few drops but several grams of blood from the general circulation could be placed under cultivation frequent successful growths would be obtained.' In the many experiments I have made on the blood in chicken-cholera, I have frequently demonstrated that repeated cultures from droplets of blood do not show an even development even where taken from the same organ, the heart for example, and at the moment when the parasite begins its existence in the blood, which can easily be understood. Once even, it happened that only three out of ten chickens died after inoculation with infectious blood in which the parasite had just began to appear, the remaining seven showed no symptoms whatever. In fact, the microbe, at the moment of beginning its entrance into the blood may exist singly or in minute numbers in one droplet and not at all in its immediate neighbor. I believe therefore that it would be extremely instructive in furunculosis, to find a patient willing to submit to a number of punctures in dif
* This prediction is fully carried out in the present day successful use of considerable
amounts of blood in cultures and the resultant frequent demon. strations of bacteria present in the circulation in many infections. Translator.