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

Media, Pa. THE presence of microbic parasites, water is comparatively free from germs; ferments and microscopic fungi and the so also, the free circulation of air interrelation they bear to the cause of disease, feres with the growth of fungi. It is both in animals and plants, has led to stagnant water that becomes the vehicle their thorough investigation. So that of microbic parasites, and carries infecnow most of the forms of bacterial life tious diseases. Wells and springs in are known as to their harmless or inju near proximity to barn yards, sewers, rious effects on living tissue. Their or cess-pools, carry through the soil orinfluence upon many substances enter ganic matter which contain germs of a ing our bodies as food and drink is im deleterious character, and should not be portant to know, whether they may or used for drinking without purification, may not be deleterious to health. so organic matter in solution is the Whether it be on fish, flesh, or vege common nourishment for all microbes; table matter, microbic fungi can always it supplies the oxygen necessary for be found in greater or less numbers. their life and growth; without it they

The commonest source of microbes do not propagate and soon die. and animalculae is from water; a drop A prolific source of infantile disorders may appear as clear as a diamond, yet originates from the fungoids that often under the microscope it may teem with exist in milk. Cow's milk often conmillions of animated beings.

tains colonies of microbes that engender The microbe of impure water is the serious disorders in children; when any bacterium termo ; when water is left to ropiness is detected in this fluid, it stand for several days, they are gener. should not be used until well sterilized ated in great numbers, and are easily at a temperature of 200° Fahrenheit. obtained for examination; no spring or Thus we find that the spores of danpond water is free from microbes and gerous diseases are carried into the body diatomes; luckily they are not injurious by a neglect of these precautions and if to health by themselves, if the larvae the patients' condition be too weak to of other parasites be not present among throw them off, they are carried into the them. Well and spring water that is circulation, causing fever and blood destill or stagnant contains more living generation, by the extraction of oxygen organisms than running waters, be from this fluid. This is the action of cause it is found that swiftly running the septic vibrio in most malignant and

pernicious fever cases. Other methods applied to for a remedy. He found that also of conveying these dangerous spores the silk-worm disease was due to a mi. besides food and water exist; it is often crobe of the fungus family of omycetes, a mystery how the spores of malignant prapagated by spores falling on the silkdiseases are communicated to persons. worms, then penetrating their bodies, It is claimed that besides fomites, which killing the animal and spreading the inis the common carrier, that flies and fection to the whole colony of worms, mosquitoes have spread both splenic both young and old. The local name and yellow fever.

for the disease was Pebrine. The sucThat fevers are due to parasitic origin cessful remedy was cremation and startthere seems to be no doubt; this is made ing new breeding houses. evident by an examination of the blood Pasteur and Koch also investigated corpuscles in acute septicemia, where the infectious disease known as anthrax the vitality of the blood has been de or splenic fever, which destroyed so stroyed by the septic vibrio and the many of the domestic animals of Europe. elastic stroma eaten through. Fevers They found the cause to be due to a and intestinal affections usually prevail microbe, a bacillus, an anaerobic paraafter a heated term, or during a long site swarming in the blood of the inhot and moist season, as shown by all fected cattle, abstracting from the bloodour epidemics, and the increased growth corpuscles the oxygen required for of parasitic germs at that time dis health ; the result of this abstraction tributed through the air and water. As was asphyxia, coma and death. the weather approaches frost the germ In malignant cholera, the same result growths are arrested, cold stops micro occurs, from the introduction and propbic development and the epidemic as agation of anaerobic microbes, or what result abates.

seems more probable, where death takes The animal economy is not the only place in a few hours, from absorption sufferer from attacks of parasitic fungi; of the poisonous ptomaines from this their deleterious effects are also very bacillus. decided upon vegetation, upon grains, Ptomaines are effete organic matter, fruits and fowers ; for instance, the sometimes very poisonous, resembling molinia fungus attacks our fruit and the venom of poisonous snakes. In their causes it to rot even before it is ripe. action they closely resemble strychnine

The fungus mucor muceda destroys and some other of the poisonous vegeour canned goods and preserves and table alkaloids; they are supposed to be causes them to mould and putrefy. the excretions of microbes of putrefac

The ascophora mucedo fills our tion. bread with mould, and reduces it to Penam extracted poisonous ptomaines a poisonous product of trimethylin. from the putrid organic ferments, from

The mucor herbarium destroys the a man who had died of typhus fever. It dried plants of the botanist.

was an alkali similar to strychnia in its The actinispora mildews books and therapeutical action ; with less than one papers when near a damp wall.

grain he caused the death of a dog in So the souring of beer and wine is the two hours. This virulent inoculated work of a microbic fungus also.

ptomaine he called septine; since then, Tyrotoxin, a very poisonous excretion other ptomines have been extracted, from microbes, exists in butter, cheese principally with a view to immunize and milk, and is not destroyed even at against infectious diseases. Even after a freezing temperature.

the removal of all bacteria from a fluid, Some years ago a fatal malady entered the septic matter if it be sufficiently conmany of the breeding houses of the centrated will produce by injection into European silk-worm and spread disease the circulation, fever, rigors, spasms, and death so alarmingly among the silk- collapse and finally death. worms, that the silk industry seemed Poisonous ptomaines, the result of likely to come to an end.

Pasteur was putrid fermentation, may form in bread,

meat, fish and milk; the latter often robic). We find this exhausted Auid generates tyrotoxin, which has poisoned in which they once lived is now unfit many people who have eaten ice cream for continuing their lives and that it is in which it existed.

poisonous to both, at the same time inMicrobes of putrefaction also produce nocuous or comparatively harmless carbuncles, boils, whitlows, phlegmon when injected into the human circulaand malignant sores containing pus or tion. This is what takes place when an putrid matter.

immunizing serum is injected to prevent According to Cornell, the microbe of or destroy the disease-causing germs almalignant cholera dies in pure cold ready there. water in a few hours but will live in The vigor of the blood in building up warm drinking water or in broth for animal tissues depends upon the protodays or even weeks and retain its plasm furnished by the chylificrous and activity of infection. A few of such lymphatic systems and that what are spores, under favorable conditions, will known as leucocytes play a very immultiply in a few hours into millions, portant part in this direction in mainand contain all the virulence of the par- taining a healthy status of the body. ent germ. Injections of these toxic cul If therefore the cytoblastic power inhertures into the veins of rabbits and guinea ent in the blood be interfered with by pigs caused their death within a very the growth of parasites the result is a few hours. He states : “From the fact derangement of the circulation and disthat the fatal attack did not assume a ease follows, the violence of the disdysenteric type it was thought that the order depending upon the vitality of the toxic agent of cholera was due, not to patient to resist the morbid action of the bacillus comma, but to an embolism such parasites. The production of leucaused by the poisonous serum of these cocytes, therefore, is dependent on this bacilli."

effort to resist disease and not the cause Septic organisms inducing disease are of it, as was formerly supposed. By now pretty well understood; they can be some it is believed that they are ultiseparated from the diseased fluids of the mately converted into the red discs of body, propagated by cultures, prevented healthy blood besides being tissue build. from growing or producing spores and ers. The direct introduction of germ readily destroyed by antiseptics when in serum into the circulation is said to have or out of the body. But we have to ex the same effect of increasing the leucoercise great care when we introduce a cytes as when produced by the thoracic foreign substance into the circulation, fluids (protoplasm or nuclein). By their for death has followed closely after the increase they envelop the toxic parasite .injection of serum derived from bacterial and either prevent its growth or destroy cultures not properly diluted, even when it altogether. considered a fit and safe immunizing It is now claimed that leucocytes may agent.

be readily increased in the blood of enIt has been asserted that the intro feebled individuals through the direct duction into the circulation of serums digestive channel by administering pepfrom the attenuated cultures of microbes tonized phosphatic tissue substances of derived from any infectious or malignant a complex chemical formula and such disease will overpower any and all other substances have been distributed active microbes that may be present and throughout the country as prophylactics prove destructive to the life of the blood for malignant diseases and anemia. or tiłe blood corpuscles.

The direct introduction of serum into It has been shown that the life history the circulation is held to have the same of these microbes exists in two condi effect of increasing the leucocytes, which tions, both requiring organic matter and by this increase envelop the toxic paraan oxygenated fluid to live in, one de site and either prevent its growth or riving its food from the surface (aerobic) destroys it altogether. This is proved the other from the interior fluids (anae- by the ameboid power inherent in all

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white corpuscles of the blood to incor- the antitoxine of anthrax, Pasteur and porate or lodge particles of matter in their others were experimenting upon the own substance and as the leucocyte is cholera bacillus and it was announced simply an animal cell, by osmosis, they that an immunizing serum was jound, readily penetrate the vascular spaces and about the same time Dr. Koch also and are converted into tissue. Under a announced his discovery of a serum or depressed physical condition the lodg. ptomaine for the extinction of the bacilment of microbes is more certain than lus of phthisis, but unfortunately both where the vital forces are in full vigor, these remedies utterly failed, after the and it is to this end that leucocytosis is most thorough trials, not only in hospidesired in the weak individual as it is tals but in the private practice of physiknown that resistance to disease is due cians in different parts of the country. to such presence.

It is to be hoped that the diphtheric seFrom the effectiveness of this and the rum of Professor Roux may not follow splenic serum in arresting malignant in the groove of these failures, but verify anthrax disease, there is a probability the reports published that by its use the that ultimately a serum will be obtained mortality of diphtheria has fallen from that will neutralize both germs of chol- 50 to 21 per cent., that in 62 cases only era and tuberculosis, that is, if these one death occurred and this case was scourges result from sporadic introduc hopelessly ill at the time of the injection. At the time of the discovery of tion.


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

Professor of Anatomy and Clinical Surgery, University of Maryland. CASE I. - Compound comminuted There was an extensive laceration of fracture of right frontal and parietal the scalp, extending from above the bones. Concussion of brain, paralysis, nose to beyond the right ear, and another recovery.

almost at right angles downwards, deR. F., white, aged 19 years, was admit- taching the cheek from the face. There ted to University Hospital on July 10, was hemorrhage from the right ear and 1892. On this date he was stealing a the pupils responded to light.

He was ride on an express train on the Baltimore profoundly unconscious, but was in no and Ohio Railroad. When near Relay great shock. He had been drinking Station, the conductor came upon the previous to injury. The parts around platform, which frightened F. to such the wound were thoroughly cleaned, an extent that he jumped from the train face and scalp shaved, dirt and pebbles while running at a high speed. His removed from the cranial cavity and the head struck against a post and he fell to wound and exposed cranial cavity irrithe ground, sustaining a compound com gated with a weak bichloride solution. minuted fracture of the right frontal The face and scalp were loosely sutured and parietal bones, with extensive lacer with four sutures to hold the parts someation of the scalp and face. The open what together and a voluminous antiing into the cranial cavity was two and septic dressing applied. For some days a half inches in diameter, exposing the he remained unconscious, was partially uninjured membranes of the brain. Dirt paralyzed on the left side, and had high and pebbles had gained entrance into temperatures, but in about a week his the cranial cavity, the orbit was exten temperature fell to normal, pulse became sively fractured and the zygoma and slower and stronger and consciousness malar bone broken and detached, and returned. He was assiduously watched the orbital plate could be plainly seen. by relays of students for a week and



stimulants and food administered at fre ter when I last asked him about it. The quent intervals. As he convalesced, his right parietal bone was fissured but not appetite became ravenous and he be- depressed. came a phenomenal glutton. The scalp CASE III.-Simple fracture of skull. receded, leaving a large portion of bone Mental aberration and hemiplegia. Treexposed, a portion of which necrosed phining. Improvement. and was removed. The edges of the H. S., colored, aged 53 years, was skin were freshened and sutured and admitted on August 20, 1892.

He was eventually healed, and he left the hos struck by a train on the Annapolis Short pital well, but with much scarring, and Line Railroad whilst crossing a trestle with a large defect in the skull.

and fell with the car a distance of twenty CASE II.-Fracture of right parietal feet. He was in an unconscious condibone, compression of brain, paralysis, tion when brought to the Hospital and trephining, recovery.

was much shocked. He was put to bed Chas. M., white, aged 31, admitted and whiskey given hypodermically every July 22, 1892. Discharged August 29. twenty minutes and grain to strychHe was brought to the Hospital in a nine sulphate, alternating with grain ito comatose condition after falling from a nitro-glycerine administered subcutanesecond story window to the ground. ously every two hours. Upon examinaThere was no scalp wound, except a con tion a scalp wound and a non-depressed tusion, with much edema, also an abra fracture of the skull was found, besides sion on left shoulder and right hip. The a few minor wounds about the face. nasal and abdominal reflexes were abol. The right eyelid was swollen and the ished, but the conjunctival was present.

bleeding The wounds No priapism, urine and feces retained, dressed antiseptically. The patient lay pulse good, respiration abdominal. He in one position for two days, the bowels had been drinking. The unconscious and urine passed involuntarily. He reness continued and twitching of face mained unconscious for seven days and muscles and sterno-cleido-mastoid oc then began to take some notice. Hemicurred. Both upper and lower extremi- plegia was now observed and on Septemties became paralyzed on left side. As ter 3 I trephined and removed a large his symptoms passed from those of con button of bone from over the motor area cussion to those of compression, opera without discovering any pathological tion was undertaken July 30. Trephine condition, except a rather free flow of was applied over the motor area, and, cerebro-spinal fluid. Within five days after removing the button of bone and his mind was nearly clear and he could incising the dura mater, a quantity of soon walk around the ward. He was liquid blood escaped in a spurt as if un discharged on October 30 with his mind der pressure. The middle meningeal much improved and his hemiplegic artery was cut and ligated, a drainage symptoms nearly gone. tube was inserted and the scalp sutured; CASE IV.- Compound, coinminuted the button of bone was not replaced. depressed fracture of skull with partial Within an hour after operation there paralysis of leg. Trephining. Cure. was some improvement in his condition E. D., German, aged 44 years, fireand pinching his toe was followed by re man on a steamship, was admitted Noflex or voluntary motions. He improved vember 15, 1893. On November 3 he rapidly and on August 12 was walking was struck by an iron ash bucket on the about and talking rationally. He was top and left side of the head, causing a discharged on August 29 with a clear large scalp wound. He fell to the deck mind but some wrist drop, which was and on attempting to rise found that his thought to be due to a local nerve in- right leg dragged and he was unable to jury. I have seen this man frequently raise the right foot. His surgeon made and he is following his old occupation light of the injury and the man was not of furniture mover. He has had some sent to the Hospital until the lapse of epileptic seizures, which were much bet. twelve days. As he did not improve,

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