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A Weekly Journal of Medicine and Surgery.


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By William T. W. Dickeson, M. D.,

Media, Pa.

THE presence of microbic parasites, ferments and microscopic fungi and the relation they bear to the cause of disease, both in animals and plants, has led to their thorough investigation. So that now most of the forms of bacterial life are known as to their harmless or injurious effects on living tissue. Their influence upon many substances entering our bodies as food and drink is important to know, whether they may or may not be deleterious to health. Whether it be on fish, flesh, or vegetable matter, microbic fungi can always be found in greater or less numbers.


The commonest source of microbes and animalculae is from water; a drop may appear as clear as a diamond, yet under the microscope it may teem with millions of animated beings.

The microbe of impure water is the bacterium termo; when water is left to stand for several days, they are generated in great numbers, and are easily obtained for examination; no spring or pond water is free from microbes and diatomes; luckily they are not injurious to health by themselves, if the larvae of other parasites be not present among them. Well and spring water that is still or stagnant contains more living organisms than running waters, because it is found that swiftly running

water is comparatively free from germs; so also, the free circulation of air interferes with the growth of fungi. It is stagnant water that becomes the vehicle of microbic parasites, and carries infectious diseases. Wells and springs in near proximity to barn yards, sewers, or cess-pools, carry through the soil organic matter which contain germs of a deleterious character, and should not be used for drinking without purification, so organic matter in solution is the common nourishment for all microbes; it supplies the oxygen necessary for their life and growth; without it they do not propagate and soon die.

A prolific source of infantile disorders originates from the fungoids that often exist in milk. Cow's milk often contains colonies of microbes that engender serious disorders in children; when any ropiness is detected in this fluid, it should not be used until well sterilized at a temperature of 200° Fahrenheit.

Thus we find that the spores of dangerous diseases are carried into the body by a neglect of these precautions and if the patients' condition be too weak to throw them off, they are carried into the circulation, causing fever and blood degeneration, by the extraction of oxygen from this fluid. This is the action of the septic vibrio in most malignant and

pernicious fever cases. Other methods also of conveying these dangerous spores besides food and water exist; it is often a mystery how the spores of malignant diseases are communicated to persons. It is claimed that besides fomites, which is the common carrier, that flies and mosquitoes have spread both splenic and yellow fever.

That fevers are due to parasitic origin there seems to be no doubt; this is made evident by an examination of the blood corpuscles in acute septicemia, where the vitality of the blood has been destroyed by the septic vibrio and the elastic stroma eaten through. Fevers and intestinal affections usually prevail after a heated term, or during a long, hot and moist season, as shown by all our epidemics, and the increased growth of parasitic germs at that time distributed through the air and water. As the weather approaches frost the germ growths are arrested, cold stops microbic development and the epidemic as a result abates.

The animal economy is not the only sufferer from attacks of parasitic fungi; their deleterious effects are also very decided upon vegetation, upon grains, fruits and flowers; for instance, the molinia fungus attacks our fruit and causes it to rot even before it is ripe.

The fungus mucor muceda destroys our canned goods and preserves and causes them to mould and putrefy.

The ascophora mucedo. fills our bread with mould, and reduces it to a poisonous product of trimethylin.

The mucor herbarium destroys the dried plants of the botanist.

The actinispora mildews books and papers when near a damp wall.

So the souring of beer and wine is the work of a microbic fungus also.

Tyrotoxin, a very poisonous excretion from microbes, exists in butter, cheese and milk, and is not destroyed even at a freezing temperature.

Some years ago a fatal malady entered many of the breeding houses of the European silk-worm and spread disease and death so alarmingly among the silkworms, that the silk industry seemed likely to come to an end. Pasteur was

applied to for a remedy. He found that the silk-worm disease was due to a microbe of the fungus family of omycetes, prapagated by spores falling on the silkworms, then penetrating their bodies, killing the animal and spreading the infection to the whole colony of worms, both young and old. The local name for the disease was Pebrine. The successful remedy was cremation and starting new breeding houses.

Pasteur and Koch also investigated the infectious disease known as anthrax or splenic fever, which destroyed so many of the domestic animals of Europe. They found the cause to be due to microbe, a bacillus, an anaerobic parasite swarming in the blood of the infected cattle, abstracting from the bloodcorpuscles the oxygen required for health; the result of this abstraction was asphyxia, coma and death.

In malignant cholera, the same result occurs, from the introduction and propagation of anaerobic microbes, or what seems more probable, where death takes place in a few hours, from absorption of the poisonous ptomaines from this bacillus.

Ptomaines are effete organic matter, sometimes very poisonous, resembling the venom of poisonous snakes. In their action they closely resemble strychnine and some other of the poisonous vegetable alkaloids; they are supposed to be the excretions of microbes of putrefaction.

Penam extracted poisonous ptomaines from the putrid organic ferments, from a man who had died of typhus fever. It was an alkali similar to strychnia in its therapeutical action; with less than one grain he caused the death of a dog in two hours. This virulent inoculated ptomaine he called septine; since then, other ptomines have been extracted, principally with a view to immunize against infectious diseases. Even after the removal of all bacteria from a fluid, the septic matter if it be sufficiently concentrated will produce by injection into the circulation, fever, rigors, spasms, collapse and finally death.

Poisonous ptomaines, the result of putrid fermentation, may form in bread,

meat, fish and milk; the latter often generates tyrotoxin, which has poisoned many people who have eaten ice cream in which it existed.

Microbes of putrefaction also produce carbuncles, boils, whitlows, phlegmon and malignant sores containing pus or putrid matter.

According to Cornell, the microbe of malignant cholera dies in pure cold water in a few hours but will live in warm drinking water or in broth for days or even weeks and retain its activity of infection. A few of such spores, under favorable conditions, will multiply in a few hours into millions, and contain all the virulence of the parent germ. Injections of these toxic cultures into the veins of rabbits and guinea pigs caused their death within a very few hours. He states: "From the fact that the fatal attack did not assume a dysenteric type it was thought that the toxic agent of cholera was due, not to the bacillus comma, but to an embolism caused by the poisonous serum of these bacilli."

Septic organisms inducing disease are now pretty well understood; they can be separated from the diseased fluids of the body, propagated by cultures, prevented from growing or producing spores and readily destroyed by antiseptics when in or out of the body. But we have to exercise great care when we introduce a foreign substance into the circulation, for death has followed closely after the .injection of serum derived from bacterial cultures not properly diluted, even when considered a fit and safe immunizing agent.

It has been asserted that the introduction into the circulation of serums from the attenuated cultures of microbes derived from any infectious or malignant disease will overpower any and all other active microbes that may be present and prove destructive to the life of the blood or the blood corpuscles.

It has been shown that the life history of these microbes exists in two conditions, both requiring organic matter and an oxygenated fluid to live in, one deriving its food from the surface (aerobic) the other from the interior fluids (anae


We find this exhausted fluid in which they once lived is now unfit for continuing their lives and that it is poisonous to both, at the same time innocuous or comparatively harmless when injected into the human circulation. This is what takes place when an immunizing serum is injected to prevent or destroy the disease-causing germs already there.

The vigor of the blood in building up animal tissues depends upon the protoplasm furnished by the chylificrous and lymphatic systems and that what are known as leucocytes play a very important part in this direction in maintaining a healthy status of the body. If therefore the cytoblastic power inherent in the blood be interfered with by the growth of parasites the result is a derangement of the circulation and disease follows, the violence of the disorder depending upon the vitality of the patient to resist the morbid action of such parasites. The production of leucocytes, therefore, is dependent on this effort to resist disease and not the cause of it, as was formerly supposed. By some it is believed that they are ultimately converted into the red discs of healthy blood besides being tissue build. ers. The direct introduction of germ serum into the circulation is said to have the same effect of increasing the leucocytes as when produced by the thoracic fluids (protoplasm or nuclein). By their increase they envelop the toxic parasite and either prevent its growth or destroy it altogether.

It is now claimed that leucocytes may be readily increased in the blood of enfeebled individuals through the direct digestive channel by administering peptonized phosphatic tissue substances of a complex chemical formula and such substances have been distributed throughout the country as prophylactics for malignant diseases and anemia.

The direct introduction of serum into the circulation is held to have the same effect of increasing the leucocytes, which by this increase envelop the toxic parasite and either prevent its growth or destroys it altogether. This is proved by the ameboid power inherent in all

white corpuscles of the blood to incorporate or lodge particles of matter in their own substance and as the leucocyte is simply an animal cell, by osmosis, they readily penetrate the vascular spaces and are converted into tissue. Under a depressed physical condition the lodgment of microbes is more certain than where the vital forces are in full vigor, and it is to this end that leucocytosis is desired in the weak individual as it is known that resistance to disease is due to such presence.

From the effectiveness of this and the splenic serum in arresting malignant anthrax disease, there is a probability that ultimately a serum will be obtained that will neutralize both germs of cholera and tuberculosis, that is, if these scourges result from sporadic introduction. At the time of the discovery of



By Randolph Winslow, A. M., M. D.,

Professor of Anatomy and Clinical Surgery, University of Maryland.

CASE I. Compound comminuted fracture of right frontal and parietal bones. Concussion of brain, paralysis, recovery.

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the antitoxine of anthrax, Pasteur and others were experimenting upon the cholera bacillus and it was announced that an immunizing serum was found, and about the same time Dr. Koch also announced his discovery of a serum or ptomaine for the extinction of the bacillus of phthisis, but unfortunately both these remedies utterly failed, after the most thorough trials, not only in hospitals but in the private practice of physicians in different parts of the country. It is to be hoped that the diphtheric serum of Professor Roux may not follow in the groove of these failures, but verify the reports published that by its use the mortality of diphtheria has fallen from 50 to 21 per cent., that in 62 cases only one death occurred and this case was hopelessly ill at the time of the injection.

R. F., white, aged 19 years, was admitted to University Hospital on July 10, 1892. On this date he was stealing a ride on an express train on the Baltimore and Ohio Railroad. When near Relay Station, the conductor came upon the platform, which frightened F. to such an extent that he jumped from the train while running at a high speed. His head struck against a post and he fell to the ground, sustaining a compound comminuted fracture of the right frontal and parietal bones, with extensive laceration of the scalp and face. The opening into the cranial cavity was two and a half inches in diameter, exposing the uninjured membranes of the brain. Dirt and pebbles had gained entrance into the cranial cavity, the orbit was extensively fractured and the zygoma and malar bone broken and detached, and the orbital plate could be plainly seen.

There was an extensive laceration of the scalp, extending from above the nose to beyond the right ear, and another almost at right angles downwards, detaching the cheek from the face. There was hemorrhage from the right ear and the pupils responded to light. He was profoundly unconscious, but was in no great shock. He had been drinking previous to injury. The parts around the wound were thoroughly cleaned, face and scalp shaved, dirt and pebbles removed from the cranial cavity and the wound and exposed cranial cavity irrigated with a weak bichloride solution. The face and scalp were loosely sutured with four sutures to hold the parts somewhat together and a voluminous antiseptic dressing applied. septic dressing applied. For some days he remained unconscious, was partially paralyzed on the left side, and had high temperatures, but in about a week his temperature fell to normal, pulse became slower and stronger and consciousness returned. He was assiduously watched by relays of students for a week and

stimulants and food administered at frequent intervals. As he convalesced, his appetite became ravenous and he became a phenomenal glutton. The scalp receded, leaving a large portion of bone exposed, a portion of which necrosed and was removed. The edges of the skin were freshened and sutured and eventually healed, and he left the hospital well, but with much scarring, and with a large defect in the skull.

CASE II.-Fracture of right parietal bone, compression of brain, paralysis, trephining, recovery.

Chas. M., white, aged 31, admitted July 22, 1892. Discharged August 29. He was brought to the Hospital in a comatose condition after falling from a second story window to the ground. There was no scalp wound, except a contusion, with much edema, also an abrasion on left shoulder and right hip. The nasal and abdominal reflexes were abolished, but the conjunctival was present. No priapism, urine and feces retained, pulse good, respiration abdominal. He had been drinking. The unconsciousness continued and twitching of face muscles and sterno-cleido-mastoid occurred. Both upper and lower extremities became paralyzed on left side. As his symptoms passed from those of concussion to those of compression, operation was undertaken July 30. Trephine was applied over the motor area, and, after removing the button of bone and incising the dura mater, a quantity of liquid blood escaped in a spurt as if under pressure. The middle meningeal artery was cut and ligated, a drainage tube was inserted and the scalp sutured; the button of bone was not replaced. Within an hour after operation there was some improvement in his condition and pinching his toe was followed by reflex or voluntary motions. He improved rapidly and on August 12 was walking about and talking rationally. He was discharged on August 29 with a clear mind but some wrist drop, which was thought to be due to a local nerve injury. I have seen this man frequently and he is following his old occupation of furniture mover. He has had some epileptic seizures, which were much bet

ter when I last asked him about it. The right parietal bone was fissured but not depressed.

CASE III.-Simple fracture of skull. Mental aberration and hemiplegia. Trephining. Improvement.

H. S., colored, aged 53 years, was admitted on August 20, 1892. He was struck by a train on the Annapolis Short Line Railroad whilst crossing a trestle and fell with the car a distance of twenty feet. He was in an unconscious condition when brought to the Hospital and was much shocked. He was put to bed and whiskey given hypodermically every twenty minutes and grain strychnine sulphate, alternating with grain nitro-glycerine administered subcutaneously every two hours. Upon examination a scalp wound and a non-depressed fracture of the skull was found, besides a few minor wounds about the face. The right eyelid was swollen and the nose bleeding. The wounds were dressed antiseptically. The patient lay in one position for two days, the bowels and urine passed involuntarily. He remained unconscious for seven days and then began to take some notice. Hemiplegia was now observed and on Septemter 3 I trephined and removed a large button of bone from over the motor area without discovering any pathological condition, except a rather free flow of cerebro-spinal fluid. Within five days his mind was nearly clear and he could soon walk around the ward. He was discharged on October 30 with his mind much improved and his hemiplegic symptoms nearly gone.

CASE IV.- Compound, comminuted depressed fracture of skull with partial paralysis of leg. Trephining. Cure.

E. D., German, aged 44 years, fireman on a steamship, was admitted November 15, 1893. On November 3 he was struck by an iron ash bucket on the top and left side of the head, causing a large scalp wound. large scalp wound. He fell to the deck and on attempting to rise found that his right leg dragged and he was unable to raise the right foot. His surgeon made light of the injury and the man was not sent to the Hospital until the lapse of twelve days. As he did not improve,

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