« ForrigeFortsæt »
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 aerobic 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 possession 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 demonstrations of bacteria present in the circulation in many infections.— Translator.
ferent parts of the body away from formed or forming furuncles, and thus secure many cultures, simultaneous of otherwise, of the blood of the general circulation. I am convinced that among them would be found growths of the micro-organism of furuncles.
II. On Osteomyelitis. Single observation. I have but one observation relating to this severe disease, and in this Dr. Lannelongue took the initiative. The monograph on osteomyelitis published by this learned practitioner is well known, with his suggestion of the possibility of a cure by trephining the bone and the use of antiseptic washes and dressings. On the fourteenth of February, at the request of Dr. Lannelongue I went to the Sainte-Eugènie hospital, where this skillful surgeon was to operate on a little girl of about twelve years of age. The right knee was much swollen, as well as the whole leg below the calf and a part of the thigh above the knee. There was no external opening. Under chloroform, Dr. Lannelongue made a long incision below the knee which let out a large amount of pus; the tibia was found denuded for a long distance. Three places in the bone were trephined. From each of these, quantities of pus flowed. Pus from inside and outside the bone was collected with all possible precautions and was carefully examined and cultivated later. The direct microscopic study of the pus, both internal and external, was of extreme interest. It was seen that both contained large numbers of the organism similar to that of furuncles, arranged in pairs, in fours and in packets, some with sharp clear contour, others only faintly visible and with very pale outlines. The external pus contained many pus corpuscles, the internal had none at all. It was like a fatty paste of the furuncular organism. Also, it may be noted, that growth of the small organism had begun in less than six hours after the cultures were started. Thus I saw, that it corresponded exactly with the organism of furuncles. The diameter of the individuals was found to be one one-thousandth of a millimeter. If I ventured to express myself so I might say that in this case at least the osteomyelitis was really a furuncle of the bone marrow. It is undoubtedly easy to induce osteomyelitis artificially in living animals.
III. On puerperal fever.-First observation. On the twelfth of March, 1878, Dr. Hervieux was good enough to admit me to his service in the Maternity to visit a woman delivered some days before and seriously ill with puerperal fever. The lochia were extremely fetid. I found them full of micro-organisms of many kinds. A small amount of blood was obtained from a puncture on the index finger of the left hand, (the finger being first properly washed and dried with a sterile towel,) and then sowed in chicken bouillon. The culture remained sterile during the following days.
The thirteenth, more blood was taken from a puncture in the finger and this time growth occurred. As death took place on the sixteenth of March at six in the morning, it seems that the blood contained a microscopic parasite at least three days before.
The fifteenth of March, eighteen hours before death, blood from a needle-prick in the left foot was used. This culture also was fertile.
The first culture, of March thirteenth, contained only the organism of furuncles; the next one, that of the fifteenth, contained an organism resembling that of furunculosis, but which always differed enough to make it easy usually to distinguish it. In this way; whilst the parasite of furuncles is arranged in pairs, very rarely in chains of three or four elements, the new one, that of the culture of the fifteenth, occurs in long chains, the number of cells in each being indefinite. The chains are flexible and often appear as little tangled packets like tangled strings of pearls.
The autopsy was performed on the seventeenth at two o'clock. There was a large amount of pus in the peritoneum. It was sowed with all possible precautions. Blood from the basilic and femoral veins was also sowed. So also was pus from the mucous surface of the uterus, from the tubes, and finally that from a lymphatic in the uterine wall. These are the results of these cultures: in all there were the long chains of cells just spoken of above, and nowhere any mixture of other organisms, except in the culture from the peritoneal pus, which, in addition to the long This has been demonstrated, as is well known.-Translator.
chains, also contained the small pyogenic vibrio which I describe under the name organism of pus in the Note I published with Messrs. Joubert and Chamberland on the thirtieth of April, 1878.
Interpretation of the disease and of the death.-After confinement, the pus that always naturally forms in the injured parts of the uterus instead of remaining pure becomes contaminated with microscopic organisms from outside, notably the organism in long chains and the pyogenic vibrio. These organisms pass into the peritoneal cavity through the tubes or by other channels, and some of them into the blood, probably by the lymphatics. The resorption of the pus, always extremely easy and prompt when it is pure, becomes impossible through the presence of the parasites, whose entrance must be prevented by all possible means from the moment of confinement.
Second observation.-The fourteenth of March, a woman died of puerperal fever at the Lariboisière hospital; the abdomen was distended before death.
Pus was found in abundance by a peritoneal puncture and was sowed; so also was blood from a vein in the arm. The culture of pus yielded the long chains noted in the preceding observation and also the small pyogenic vibrio. The culture from the blood contained only the long chains.
Third observation.-The seventeenth of May, 1879, a woman, three days past confinement, was ill, as well as the child she was nursing. The lochia were full of the pyogenic vibrio and of the organism of furuncles, although there was but a small proportion of the latter. The milk and the lochia were sowed. The milk gave the organism in long chains of granules, and the lochia only the pus organism. The mother died, and there was no autopsy.
On May twenty-eighth, a rabbit was inoculated under the skin of the abdomen with five drops of the preceding culture of the pyogenic vibrio. The days following an enormous abscess formed which opened spontaneously on the fourth of June. An abundantly cheesy pus came from it. About the abscess there was extensive induration. On the eighth of June, the opening of the abscess was larger, the suppuration See preceding paper.