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Showing papers in "Journal of Experimental Medicine in 1899"


Journal ArticleDOI
TL;DR: From a case of acute endocarditis of the aortic and mitral valves with infarctions m the spleen and kidneys a micrococcus was twice isolated in pureculture from the blood during life and was demonstrated after death both microscopically and in pure culture in large numbers in the valvular vegetations, the infarications and other parts.
Abstract: From a case of acute endocarditis of the aortic and mitral valves with infarctions m the spleen and kidneys a micrococcus was twice isolated in pure culture from the blood during life and was demonstrated after death both microscopically and in pure culture in large numbers in the valvular vegetations, the infarctions and other parts. No other species of microorganism was found. This micrococcus is very small, occurs mainly in pairs, sometimes in short chains, stains by Gram's method, grows in small, pale, grayish-white colonies on gelatine and agar, at first clouds bouillon, which then becomes clear with a whitish sediment, does not produce gas in glucose media, liquefies gelatine slowly and to some extent also blood serum, and is especially characterized by its behavior in milk, which it acidifies, coagulates and subsequently liquefies. It produces a milk-curdling ferment and also a proteolytic ferment, each of which is separable from the bacterial cells. It remains viable for months in old cultures and is tolerably resistant to the action of heat and antiseptics. The micrococcus is pathogenic for mice and rabbits, causing either abscesses or general infections. Typical acute vegetative endocarditis was experimentally produced by intravenous inoculation of the organism in a rabbit and a dog, and the cocci were demonstrated in pure culture in the vegetations and other parts of these animals after death. Although the micrococcus here described has some points of resemblance to the pneumococcus and Streptococcus pyogenes on the one hand and to the pyogenic staphylococci on the other, it is readily distinguished from each of these species by cultural features which have been described and which are so obvious that the differentiation of these species from our micrococcus need not be discussed in detail. We have searched through the records concerning microorganisms described in association with endocarditis and other diseases, as well as those isolated from water, soil and other sources, and have been unable to find a description of a micrococcus identical in all particulars with that here described. Such points as staining by Gram, liquefaction of gelatine, coagulation and peptonization of milk, served singly or in combination to distinguish our micrococcus from other forms which in some respects might resemble it. We feel justified, therefore, in recognizing this organism as a new species and from its fermentative properties propose for it the name "Micrococcus zymogenes." Micrococcus zymogenes must be added to the already considerable list of bacteria which have been found as the specific infective agents in endocarditis. That it was the cause of this affection in our case was conclusively demonstrated by its repeated isolation in pure culture from the blood during life, by its presence in pure culture and large numbers after death in the cardiac vegetations, the infarctions, and other parts of the body, and by the experimental proof of its pathogenic properties, and notably its capacity to produce vegetative endocarditis by intravenous inoculation in animals.

103 citations


Journal ArticleDOI
TL;DR: By determining the electrical conductivity a measure of the number of dissociated ions in unit volume of the solution may be obtained, and when this can be established for a particular case, it can be used to calculate the concentration.
Abstract: By dete~aining from time to time the freezing point of a liquid in which bacteria are growing it is possible to estimate the changes t h a t take place in the molecular concentration, t By determining the electrical conductivity a measure of the number of dissociated ions in unit volume of the solution may be obtained. The amount by which the freezing point is depressed below the ~reezing point of distilled water is directly proportional to the molecular concentration when the dissolved substances are incapable of hydrolytic dissociation, like cane sugar or proteids for instance. In the case of dissociable substances, like sodium chloride, the same is true when we reckon each ion as a molecule. The relation between the electrical conductivity and the concentration of the electrolytes is not so simple, since the specific conductivity of a solution depends not only on the number of dissociated molecules in a given volume, %ut also on the velocities of the ions. But there is always a relation, and when this can be established for a particular case, it can be used to calculate the concentration. For example, when only one electrolyte is present, the concentration can be at once determined from the electrical conductivity by interpolating values in a table showing the relation between the conductivity of the substance and tho amount of it in solution. I f more than one electrolyte be present, the electrolytes may be such as have approximately equal ionic veloc-

77 citations


Journal ArticleDOI
TL;DR: The phys;_ology of the mammalian healer has advanced with such rapid strides of late years, that clinical observers have apparently had difficulty in keeping pace with it, but little attempt has been made to adapt the theories of the experimental investigators to the observations made on the diseased heart.
Abstract: The phys;_ology of the mammalian healer has advanced with such rapid strides of late years, that clinical observers have apparently had diftlcu]ty in keeping pace with it, and but little attempt has been made to adapt the theories of the experimental investigators to the observations made on the diseased heart. It is true that the explanation of the undulations on the pulse-tracing and of their modifications in pathological conditions has engaged the attention of a considerable number of observers~ but until quite recently the divergences of the cardiac rhythm from the normal seem to have aroused little interest, and no attempt was made to explain the origin of the irregularities of the pulse. In the following pages I have endeavored to fill in one hiatas existing between clinical observation and physiological experiment. The ventricular systole which causes tlle radial pulsation is, in the normal heart, induced by' an impulse descending from the auricle through communicating fibres which are generally held to be formed of muscular tissue; the normal ventricle never contracts unless it is excited by the arrival of such an impulse from above. It is obvious that an irregularity in the ventricle (and consequently in the pulse-tracing) may arise (1) from file ventricle failing to respond normally to this impulse or from its contracting independently of it or (2) from the auricle failing to emit an impulse at the ordinary interval. Ye~ it is only of recent years that the work o.f Xrehl and Romberg s has led to the general recognition that an irregularity of the pulse may be due to disorder of the higher parts of the heart, which determine the normal rhythm. Nor has the importance of the auricle as a factor in

27 citations


Journal ArticleDOI
TL;DR: It is not yet clear that the variations in chromogenic power can be in any way correlated with the presence or absence of other physiological functions.
Abstract: THE PRINCIPAL CONCLUSIONS THAT SEEM TO ME JUSTIFIED ARE AS FOLLOWS: 1. The fluorescent pigment formed by some varieties of B. pyocyaneus is produced under conditions identical with those governing the production of the pigment by other "fluorescent bacteria." 2. The production of pyocyanin is not dependent upon the presence of either phosphate or sulfate in the culture medium. It is formed in non-proteid as well as in proteid media, but is not a necessary accompaniment of the metabolic activities of the organism (e. g. tartrate solution). 3. The power of producing pyocyanin under conditions of artificial cultivation is lost sooner than the fluorescigenic power. 4. There are greater natural and acquired differences in pyocyanigenic power than in fluorescigenic. 5. The fluorescent pigment may be oxidized slowly by the action of light and air as well as by reagents into a yellow pigment, and pyocyanin may be similarly oxidized into a black pigment. 6. A convenient separation of B. pyocyaneus into four varieties would be the following: var. alpha, pyocyanigenic and fluorescigenic (most common); var. beta, pyocyanigenic only (rare); var. gamma, fluorescigenic only (not uncommon, closely related to "B. fluorescens liquefaciens"); var. delta, non-chromogenic. 7. Except for the occasional loss of one or another function the different varieties are not so plastic as sometimes assumed, and cannot be readily converted into one another by subjection to varying conditions of life. 8. The signification and correlation of the almost countless physiological variations among the members of this group in respect to growth in gelatin, behavior to temperature, indol production, etc., remain to be determined. It is not yet clear that the variations in chromogenic power can be in any way correlated with the presence or absence of other physiological functions.

16 citations


Journal ArticleDOI
TL;DR: The object of this communication is to give the results of experimental observations on the behavior of various animal cells toward certain substances belonging to the aromatic type, notably phenol and indol, which were selected for use in the inquiry.
Abstract: I t is the object of this communication to give the results of experimental observations on the behavior of various animal cells toward certain substances belonging to the aromatic type, notably phenol and indol. ]:he inquiry was prompted by the interest wMch attaches to a Study of the natural defenses of the organism against various ]~inds of damage through chemical agencies. Prominent among the problems that arise in connection with such an inquiry are, first, the determination of the seat of the defensive action of the organism, whether chiefly in the blood or in the cells; second, the relative activity of the different kinds of cells in the neutralization of the toxic properties of the particular chemical agents employed; and third, the character of any chemical transformation that may take place, when these substances are acted upon by living cells. Indol and phenol were selected for use in the inquiry for two reasons. First, these substances are normal products of proteid clea~vage in the intestine, under the influence of bacteria and of the proteo~ytic ferment of the pancreatic juice, and they are often farmed in excessive amounts in the course of digestive derangements. Greater interest thus attaches to the fate of these substances in the organism than to that of wholly foreign poisons. Second, both indol and phenol are recognizable by means of delicate, color reactions, and it becomes possible by means of the procedures to. be described to make use of these color tests far the purpose of comparing the relative proportion of phenol and indol present in different solutions.

15 citations



Journal ArticleDOI
TL;DR: Wounds of the heart in man, when all other means have been tried and found wanting, can and ought to be closed by suture, and this conclusion seems justified.
Abstract: It would, of course, be incorrect to attempt to draw conclusions as to the dangers and the chances of success of suture of cardiac wounds in man from the results obtained by animal experimentation. Animals are placed in very unfavorable conditions after the operation. They are very restless and cannot be kept quiet. Ideal cleanliness is impossible and the animals may infect their wound by rubbing the external wound against the dirt on the floor of their cage. From the animal mortality in these investigations no rigid inferences applicable to human beings can therefore be made. Some conclusions of importance can, however, be drawn. Above all, my experiments seem to show that the mammalian heart will bear a much greater amount of manipulation than has hitherto been suspected. Very large wounds of the heart can heal and the healing process occurs in a manner entirely analogous to that in other muscular tissues. Even an extensive suture of the heart-wall of rabbits and dogs, although we know that thereby a large number of muscle fibres are destroyed and replaced by connective tissue, does not interfere with the function of the cardiac muscle as a whole. Can some of the results in the above recorded experiments be, with some restrictions of course, applied to the human heart? I think that this question must be answered in the affirmative. If we compare the knowledge we possess of wounds of the heart in man, with that obtained from animal experiments, and find that they agree in all essential particulars, then we are justified in reasoning by analogy that suture of wounds of the heart in man will give results similar to those obtained in the animal. In the last few decades, the advances made in all the branches of medicine-especially in pathology, bacteriology and surgery-have been due to a great extent to the generalization of the results of animal experimentation. To the careful and critical investigator, the results obtained in the animal experiment have always been of the greatest value in indicating to him the possibility of results to be obtained by similar procedures in the human body. From the study of wounds of the heart in man, and from the results obtained in my experiments, this conclusion seems therefore justified: wounds of the heart in man, when all other means have been tried and found wanting, can and ought to be closed by suture. The application itself of the suture is devoid of the one great danger that was feared in the past, i. e. of sudden arrest of the heart during the manipulations incident upon the application of the sutures. The number of sutures should be as small as possible so as to limit the amount of connective tissue which will be formed; for all the muscle fibres that are compressed by the sutures eventually atrophy and are replaced by new-formed connective tissue. It is probable that this connective tissue will not lead to degenerative changes in the heart-muscle. On the post-mortem table, fibrous plaques are often found in the otherwise normal human heart. In a number of the muscles of the body fibrous bands-tendinous intersections as they are called-are normally found. In the large number of microscopic sections of the heart-muscle that I have examined, I could find no evidence of pathological changes in the muscle fibres some distance from the scar. For similar reasons the suture should always be an interrupted one. We have shown that there are dangers and disadvantages in the continuous suture both on theoretical grounds and in practical use. The sutures should be passed through as little of the heart substance as possible; if they penetrate the epicardium and a small part of the thickness of the heart-muscle it will generally be sufficient. When the heart's action is not too rapid, each suture should be tied during a diastolic relaxation of the part under treatment. On this point we have not yet any experience in man. Cappelen, in his patient, tied the sutures during systole. Rehn tied them in his case during diastole. Only time and further experience will show how much importance is to be attached to this point. All that can be said, in the present state of our knowledge, is, that on theoretical grounds and from animal experimentation, it must be considered safest to tie the sutures during diastole. On first sight, it might appear difficult to apply sutures to an organ in such constant motion as is the heart. In practice, however, the difficulties have been proven not to be so great as might appear. The heart may be grasped with a forceps and the needle and suture easily passed. It is no more difficult to pass and tie a suture in a large dog than in a small rabbit. Hence we should infer that the difficulties of this procedure in the human heart, are not so great, a fact that has been borne out by the experience of those surgeons who have reported cases of heart-suture in man. The cases will always be few in which this extreme method of treatment-for so we must style it-is necessary. Indeed, of the patients that come under the care of the surgeon, there are some who will recover from even large heart wounds without any local treatment at all. Cases have been recently reported by Conner, Brugnoli, Hamilton and others, where after wounds as large as three centimetres, the haemorrhage ceased spontaneously and the patients recovered. One cannot say, therefore, that wounds larger than a certain size must always be sutured. Each case must be carefully considered by itself. When we examine the nine cases of suture of the human heart in man (see pages 487 to 490) we cannot but hope for considerable success from this new method of surgical procedure. Of the nine cases, four recovered entirely, and four died of complications referable to other organs-quite an encouraging record in a few cases. Finally, I may be permitted to summarize these conclusions as follows: 1. Suture of a wound of the heart as a final resort is an operation worthy of consideration in some cases and often justifiable. 2. Suture of wounds of the heart in animals, and also in man, is devoid of the danger of sudden arrest of the heart, due to the manipulation of the heart incident to the procedure, unless Kronecker's coordination centre be injured. 3. The suture should be an interrupted one of silk, applied in most cases so that the epicardium and superficial layers of the myocardium should be the only ones penetrated, and tied, when possible, during diastole. 4. No stated indications can be given as to the cases that are operable or the time when the operation should be done. Each case must be considered by itself for symptoms which would justify operative interference.

13 citations


Journal ArticleDOI
TL;DR: When chronic interstitial pancreatitis has reached a certain grade of intensity diabetes ensues and is the terminal event in the disease.
Abstract: (1) There exists a distinct morbid entity, haemochromatosis, characterized by the widespread deposition of an iron-containing pigment in certain cells and an associated formation of iron-free pigments in a variety of localities in which pigment is found in moderate amount under physiological conditions. (2) With the pigment accumulation there is degeneration and death of the containing cells and consequent interstitial inflammation, notably of the liver and pancreas, which become the seat of inflammatory changes accompanied by hypertrophy of the organ. (3) When chronic interstitial pancreatitis has reached a certain grade of intensity diabetes ensues and is the terminal event in the disease.

12 citations


Journal ArticleDOI
TL;DR: My experiments lead me to believe that complete occlusion of the small intestine at its lower end will give rise to the occurrence of cholin, neurin and perhaps other bases, provided the food taken contains any considerable quantity of lecithin, and it is not improbable that still other poisons are formed by bacterial action from other constituents of the food in cases of intestinal obstruction.
Abstract: My experiments lead me to believe that complete occlusion of the small intestine at its lower end will give rise to the occurrence of cholin, neurin and perhaps other bases, provided the food taken contains any considerable quantity of lecithin. It is not improbable that still other poisons are formed by bacterial action from other constituents of the food in cases of intestinal obstruction. While cholin would have to be absorbed in relatively large amounts to exert a marked toxic action in human beings it is otherwise with neurin, which is many times more intense in its action and must be classed with the exceedingly active poisons. It has been shown both by the experiments of Schmidt and Weiss and also by those recorded in this paper that the poisonous neurin may be formed from cholin by bacteria. In its physiological action neurin agrees closely with muscarin; especially to be noted here is the paralytic action on the heart and its power to increase the intestinal movements to such an extent that continual evacuations occur. Whether the ptomaine which was found by me is poisonous 1 cannot yet say. It must be considered proved, however, that highly toxic substances may arise in the intestinal canal during its complete occlusion. The method of treating cases of intestinal obstruction, before surgical means are resorted to, namely, washing out the stomach and as much of the gut as possible often reduces the violent paristalsis and this is due, perhaps, to the removal of substances out of which irritating and toxic products are formed by bacteria. In conclusion, I would remark that our knowledge of the fate of lecithin in the digestive canal under normal conditions is very deficient. The assumption that it is saponified by the fat-splitting enzyme of the pancreatic juice, thus yielding cholin, glycero-phosphoric acid and fatty acids, rests on the work of Bokai in 1877 and, as that investigator himself admits, without excluding bacterial action. This omission throws grave doubts on the results. If the assumption of Bokai be correct, caution must be observed in the use of some foods that have been considered most nutritious and healthful; for instance, the ingestion of a meal made up largely of eggs would hardly be without danger because of the poisonous action of the large quantity of cholin liberated from the lecithin and the probability of the formation of the highly poisonous neurin. It is my purpose in the near future to examine this question with the help of modern methods.

12 citations


Journal ArticleDOI
TL;DR: The conventional custom of bacteriologists in the past fifteen years has brought the subject of species differentiation to a position which is untenable, and it seems to the writers to be futile to speak farther of the past.
Abstract: When bacteriologists have before them the problem of differentiation and classification of bacteria from water, independent of efforts to isolate with minimum delay some specific organism of disease, they proceed in a manner which is substantially as follows: 1. There is obtained on a given laboratory medium a pure culture of a special bacterium, the environment and life history of which, prior to its isolation at the laboratory, are for the most part unknown. 2. From the pure culture there are seeded a greater or less number of conventional culture media, known to differ in composition somewhat as prepared at different times at the same laboratory, and considerably as prepared by various workers in different laboratories. 3. These cultures are subjected at the laboratory to varying temperatures and periods of development leading up to final descriptions of cultural characteristics. 4. Observations upon and descriptions of the results obtained from the growth of this special bacterium under the above stated conditions are made. 5. Upon a comparison of the records of this bacterium with the limited descriptions of more or less similar forms given by other observers, it is found that they do not coincide, and therefore a new species is recorded. Practically speaking, the above outline shows briefly and in a general way the conventional custom of bacteriologists in the past fifteen years, and whieh~ as is well known, has brought the subject of species differentiation to a position which is untenable. Owing to the wide recognition of this state of affairs it seems to the writers to be futile to speak farther of the past. It is the purpose of this paper to refer briefly to a number of points

10 citations



Journal ArticleDOI
TL;DR: Owing to the relative infrequency of agonal invasion, it is believed that in the majority of cases where the autopsy is performed promptly after death, the bacteria which are found in the organs succeeded in reaching these organs previously to the death agony, and are associated with the course of the disease.
Abstract: Our conclusions from the literature and our own experiments may be summarized as follows: I. Blood for bacteriological examination during life should be taken directly from the veins and in considerable quantity. II. Resorption of toxines is the most important feature in cases of sepsis; pyogenie bacteria invade the general circulation in a rather small proportion even of severe eases, and, as a rule, late in the course of the disease. III. A general infection by the pnenmococcus can be demonstrated occasionally in the late stages of acute lobar pneumonia. IV. The value of blood cultures as a means of diagnosis in obscure cases of sepsis is limited by the fact that invasion of the blood by the specific organism cannot be demonstrated during life in the majority of cases. Positive cultures are very valuable; negative cultures do not exclude local septic infections. V. The detection of specific bacteria in the blood of cases of sepsis and of pneumonia gives a very unfavorable prognosis in most cases. VI. General terminal infections with pyogenic cocci occasionally occur as an immediate cause of death in chronic disease. Local infections processes play this part more frequently. VII. As far as our experiments have shown, invasion of the blood by bacteria during the death agony, with subsequent distribution of the genus to the organs by the circulation, is a rather uncommon occurrence. VIII. Owing to the relative infrequency of agonal invasion, we believe that in the majority of cases where the autopsy is performed promptly after death, the bacteria which are found in the organs succeeded in reaching these organs previously to the death agony, and are associated with the course of the disease. IX. The presence of bacteria in the organs of late autopsies is due in many cases to post-mortem extension from one organ to another, and in some cases to the post-mortem growth of small numbers of genus which were distributed to the organs by means of the circulation.

Journal ArticleDOI
TL;DR: In the course of a careful study of a long series of livers, both cirrhotic and otherwise, the authors have in the specimens examined, with scarce an exception, encountered larger or smaller numbers of minute bodies, and the more they have studied them the more assured they have become that these are bacterial in nature.
Abstract: In the course of a careful study of a long series of livers, both cirrhotic and otherwise, we have in the specimens examined, with scarce an exception, encountered larger or smaller numbers of minute bodies, and the more we have studied them the more assured we have become that these are bacterial in nature. Under t h e ordinary 1/12th immersion lens and by the usual methods of staining these may easily be overlooked and, if recognized, they may easily be mistaken for minute pigment granules present in the liver cells. But by more intensive staining and by employing a good 1/18th immersion lens, their nature becomes more evident. The methods we have employed with the greatest amount of success have been by staining with carbel-fuchsin (one-half the ordinary strength) and subsequent bleaching in the sunlight in our earlier observations; and, of late, almost exclusively earl~ol-thionin, made according to the formula recommended by Muir and Ritchie,~ the sections being cleared by aniline oil. Stained by either of these methods the granules resolve themselves in the main into fine diplococci surrounded often by a fine halo as to the nature of which we shall speak later. When these diplococci are present in any numbers them may also be isolated minute spherical and ovoid bodies of the same dimensions and there may also be seen occasional strings of three or four coccus-like bodies.

Journal ArticleDOI
TL;DR: In instances of gonococcal septicæmia the diagnosis may, in some cases, be made during life by cultures taken from the circulating blood according to proper methods.
Abstract: (1) An acute gonorrhœal urethritis may be the starting point for a grave general septicaemia with all its possible complications. (2) These infections may be mixed or secondary, due to the entrance into the circulation of organisms other than the gonococcus, or they may be purely gonococcal in nature. (3) Endocarditis is an occasional complication of gonorrhœa. (4) This endocarditis may be transient, disappearing with but few apparent results, or it may leave the patient with a chronic valvular lesion, or it may pursue a rapidly fatal course with the symptoms of acute ulcerative endocarditis. (5) The endocarditis associated with gonorrhœa is commonly due to the direct action of the gonococcus, hut may be the result of a secondary or mixed infection. (6) Pericarditis may also occur as a complication of gonorrhœa, but it is less frequent than endocarditis. It may, as in the case of the latter, be the result either of a pure gonococcal or of a mixed infection. (7) Grave myocardial changes, necroses, purulent infiltration, embolic abscesses are common in the severe gonococcal septicaemias. (8) In instances of gonococcal septicaemia the diagnosis may, in some cases, be made during life by cultures taken from the circulating blood according to proper methods.

Journal ArticleDOI
TL;DR: The following general conclusions may be drawn from the preceding work: Fibrin is altered by formaldehyde and is then less easily digested by pepsin and by trypsin, and the diastase is protected against decomposition.
Abstract: The following general conclusions may be drawn from the preceding work: Fibrin is altered by formaldehyde and is then less easily digested by pepsin and by trypsin. Papain is apparently unable to digest fibrin even when this is exposed to very weak formaldehyde (1:1000) for a very short time. The casein of milk, on contact with formaldehyde, undergoes rapid alteration and is as a result not coagulated by rennet, or but very slowly. Such altered casein, like similar fibrin, is not readily digested by the proteolytic ferments. The longer the formaldehyde acts on casein and on fibrin the more marked is the result. Pepsin is not affected by a one per cent solution of formaldehyde, even when the mixture has stood for four weeks. Even a five per cent solution of formaldehyde acting for three weeks has no effect on pepsin. Contrary results obtained by others are due to an alteration of the fibrin by the formaldehyde. A putrid solution of pepsin in distilled water one month old digests fibrin as readily as a fresh solution. Rennet is not affected even by a four per cent solution of formaldehyde acting for several weeks. The absence of coagulation at times is due to the action of formaldehyde on the casein of the milk and not on the rennet ferment. Papain is very quickly altered by formaldehyde, even in very dilute solution. Moreover, it is unable to digest fibrin that has been exposed to the action of a very dilute solution of formaldehyde for a short time. Trypsin is altered by formaldehyde to such an extent that digestion of fibrin will not take place, or but very slowly. The extent to which trypsin is affected by formaldehyde depends largely upon the amount of organic matter present, as well as on the amount of ferment in the solution. Amylopsin is not destroyed by very dilute solutions of formaldehyde, but stronger solutions decrease the activity of the ferment, and if used in sufficient concentration will destroy it completely. Ptyalin, like the diastatic ferment of the pancreas, is not destroyed by dilute solutions of formaldehyde. If the latter is used in rather strong concentration and allowed to act for some time it will destroy the ferment. The action of formaldehyde is more rapid and more marked at a slightly elevated temperature than at ordinary room temperature. Malt diastase, unlike the diastatic ferments of the saliva and pancreatic solution, is not destroyed by formaldehyde when this is used in moderate amount and at ordinary temperature. Unlike pepsin, a solution of malt diastase readily undergoes decomposition on standing even for one or more days. This destruction is undoubtedly due to bacteria since it does not take place when formaldehyde is present. Consequently the favoring action which formaldehyde apparently exerts on diastase really consists in the inhibition of the growth of micro-organisms, and hence the diastase is protected against decomposition.

Journal ArticleDOI
TL;DR: The office notes were as follows: Woman, 32 years, well nourished, married, two ehildren, one ntis-carriage, mother and father and one sister living; mother well; father has ill health, of which the cause was not ascertained, previous history uneventful.
Abstract: On the morning of September 28, 1897, Mrs. L. R. presented herself for the surgical treatment of a bite of the left cheek. She stated that about 4: o'clock that morning she was awakened by a noise in the chicken coop, and hurrying on her clothing went out to investigate. As she pushed open the door of the coop an animal sprang out upon her, biting her on the left cheek. The wound bled profusely and to stop the h~emorrhage she applied some liniment and a bandage. When she presented herself for treatment, five hours after the accident , there were two sharp, deep punetures on the left cheek, one-half an inch apart, sinking deeply into the underlying tissue, from which on pressure a bloody grumous fluid exuded. The wound was scrubbed with soap and water, washed out with peroxide of hydrogen and packed with gauze. Two days following, the same treatment was repeated. At the third dressing, as the wound seemed clean, it was allowed to granulate over and the patient was dismissed. Nothing more was heard of the patient until December 3, two months and five days following the bite. On that day the patient again came complaining of severe pain and numbness over the left cheek in the region of the previous bite. The office notes were as follows: Woman, 32 years, well nourished, married, two ehildren, one ntis-carriage, mother and father and one sister living; mother well; father has ill health, of which the cause was not ascertained, previous history uneventful. Had neuralgia of right side of face some years ago. No other ailments. No history of hysteria or other neuroses. The pain of which the patient complains is localized on the left cheek in the region of the sear of the previous bite. It commenced

Journal ArticleDOI
TL;DR: Two further contributions to the subject have come to my notice, the first by Horton-Smith and the second by Petruschky, the work of which should properly have been included in the literature mentioned in the previous article.
Abstract: In a previous number of this Journal t the writer published an article \"Upon the Presence of the Typhoid Bacillus in the Urine,\" and, as the result of observations upon 38 cases of typhoid fever, drew the following conclusions: (1) Typhoid bacilli were demonstrated in 9 out of the 38 cases (about 25 per cent). (2) The bacilli, when demonstrated, were always present in large numbers, and in practically pure culture. (3) The bacilli appeared first in the later stages of the disease, and persisted, in the great majority of cases, far into convalescence. The urine of typhoid patients should, there for , not only be rigorously disinfected during the disease, but should also be carefully sup e r ~ e d during convalescence. (4) The typhoid bacilli were practically ahvays associated with albuminuria and the presence of renal casts. On the other hand, urines containing considerable amounts of albumin and casts in large numbers often showed no typhoid bacilli. (5) Irrigation of the bladder with antiseptic solutions offers a possible means for removing permanently the bacilli from the urine. Since the publication of that article two further contributions to the subject have come to my notice, the first by Horton-Smith and the second by Petruschky. The work of Horton-Smith appeared in 1897 in the Transactions of the Medical and Surgical Society of London, and should properly have been included in the literature mentioned in my previous article. Horton-Smith examined the urines

Journal ArticleDOI
TL;DR: The rarity of leukmmic cutaneous affections may be inferred from the fact that a number of text-books on medicine and even on dermatology either do not speak of this condition at all, or simply mention it in a general way.
Abstract: Some time ago I published in the Yale Medical Journal* a preliminary report of a case of ]euk~emia cutis. I present now a more extensive study of this case. For the sake of convenience much of the matter of the previous article will be included here. The rarity of leukmmic cutaneous affections may be inferred from the fact that a number of text-books on medicine and even on dermatology either do not speak of this condition at all, or simply mention it in a general way. In Unna's book t on the pathology of skin diseases there may be found a critical summary of 9 cases, and while perhaps a few may have escaped detection, probably scarcely more than a dozen cases are on record. Kaposi's ease (1885) is the most frequently cited, and has directed especial attention to these lesions; the first observation, however, goes back to Biesiadecki's report in 1876, whose article is often quoted also with reference to the theory of leuk~mia. The l eukmmic affections of the skin which have hitherto been observed may be grouped into three classes.~: The first class is represented by cases in which there are circumscribed, multiple, pinhead to hazelnut-sized, rapidly growing, pale or faintly red to brownish-colored tumors, irregularly distributed over the body, with little tendency to retrograde metamorphosis or ulceration. To this group belong the cases of Biesiadecki, ttochsinger and Schiff, Oliver, and Phi]ippert. ttoehsinger and Schiff found in their

Journal ArticleDOI
TL;DR: The normal adult heart muscle of the human subject is made up of irregular rhomboidal cells, which are usually considerably branched, and each cell consists of darkly staining columns, which run longitudinally and are separated by unstained substance.
Abstract: The normal adult heart muscle of the human subject is made up of irregular rhomboidal cells, which are usually considerably branched. Each cell consists of darkly staining columns, which run longitudinally and are separated by unstained substance. These columns are commonly spoken of as fibril bundles, and correspond with what v. KSlliker has called \"3luskelsi~ulchen.\" The unstained substance between is generally known as sarcoplasm. Careful observation and certain methods of special staining reveal a definite relation between these two parts of the cell. The fibril bundles are striated like voluntary muscle, showing a narrow disc called Krause's membrane, and a broader disc or Briicke's line of doubly refractive substance between each two narrow striations. Krause's membrane corresponds with the \"Zwischensche ibe\" o f Ge.rman writers, and Briicke's line is identical with the \" Querscheibe.\

Journal ArticleDOI
TL;DR: This method of procedure is of importance, because there is reason to think that the composition of the blood undergoes alterations in certain respects by contact post mortem with the tissues.
Abstract: Although the alterations in the composition of the blood which follow uncomplicated experimental double nephrectomy are of much interest in relation to the pathology of hlunan ureemic states, the literature relating to the subject is exceedingly limited, and it is certain that investigators have not given it the attention of which it is worthy. I t is the aim of this paper to present concisely the results of experimental work relating chiefly to the chemical changes that occur in the blood as the result of double nephrectemy. In most instances dogs were employed as the subjects of these observations, and both kidneys were removed at one operation. The chief symptoms following the removal of both kidneys in dogs are as follows: lowering of the temperature, loss of appetite, drowsiness, vomiting, diarrhea. In a few instances the second kidney was removed several days after the removal 9f the first. In a smaller series of cases studies were made of the blood after both ureters had been tied just below the pelves of the kidneys. In almost all cases the animals were carefully watched, and were bled to death as soon as there were indications tha* life was not likely to be prolonged for many hours. This method of procedure is of importance, because there is reason to think that the composition of the blood undergoes alterations in certain respects by contact post mortem with the tissues.* Thus v. Limbeck obtained the follo~ving results:


Journal ArticleDOI
TL;DR: The only conclusion which can be drawn from these experiments is that no fat was formed as the result of phosphorus poisoning, and the fatty degenerations so-called which occurred in these frogs did not comprehend any formation of fat at all, but simply the deposition of fat.
Abstract: 588.780 grm. of frogs, all of the same sex, of the same comparative approximate weights, taken from the ground about the same time, kept awake and without food for nearly the same time, were divided into equal groups; the one group was poisoned with phosphorus, the other group held as a control. The frogs in the poisoned group lost in dried residue 8.821 grm. or 16.5 per cent of the dried residue of the control group; 1.182 grm. of nitrogen, corresponding to 7.388 of proteid, or 18.45 per cent of the nitrogen and protein in the control frogs; 1.026 grm. of fat, or 22.64 per cent of the fat in the control animals; and 0.261 grm. glycogen, or 13.3 + per cent of the glycogen in the control frogs. I believe that it is obvious that in these experiments no fats were produced from protein. Mathematically, it is possible to conceive that fats could have been formed but entirely burned up. As previously stated, the carbon in the proteid lost during the poisoning was equivalent to 4.600 grm. of fat, and it is conceivable that these 4.600 grm. of fat were formed, but that they, together with the 1.026 grm. of fat actually lost during the experiments, were burned. In brief, the fat combustion might have been tremendously increased, and masked an actual fat formation. This however is unsupported by evidence, and is highly improbable. It is hard to conceive that in an organism whose katabolic functions were greatly augmented as the result of phosphorus poisoning, in which protein, fat, and glycogen were being burned in excess, the carbon of the protein would first have been converted into fat and then the fat burned as such. I believe the only conclusion which can be drawn from these experiments is that no fat was formed as the result of phosphorus poisoning. Thus the fatty degenerations so-called which occurred in these frogs did not comprehend any formation of fat at all, but simply the deposition of fat. These results are directly opposite to those of Polimanti. Polimanti apparently did not weigh his animals before the beginning of the experiment, and based his calculations upon the relation of the fat to the dried residue. Obviously his calculation was based upon the assumption that the dried residue of a frog was unaffected by phosphorus poisoning. Polimanti, in declining to base his calculations upon the weight of the animals when dead, states that as water is often increased, such a calculation would be misleading. But since the dried residue may and does vary, calculations based upon it are also misleading, and thus the only proper basis of calculation is the original weight of the frogs before the experimentation. Calculated upon the basis of the dried residue, in my material the percentage of fat in the control animals was 8.48 per cent, in the poisoned animals 7.86 per cent, so that, even upon the basis of Polimanti's incorrect calculation, in my experiments fat was lost in notable quantity. Just before this study was completed, the publication of Athanasiu, (8) from Pflueger's laboratory, appeared. Operating with a large number of frogs, and under varying conditions, with careful methods and rigid controls, Athanasiu reached the conclusions: that phosphorus poisoning has no effect upon the total quantity of fat in frogs; that it has little effect upon the nitrogen; that it produces a diminution in the quantity of glycogen; and that the fatty degenerations are really fatty infiltrations. While my results agree with those of Athanasiu in the essential point, that no fat was produced by phosphorus poisoning, they differ in that the poisoned frogs, in my experiments, lost fat and protein as well as glycogen, while his frogs lost only glycogen. Since our methods were almost the same, the differences must have resided either in the conditions surrounding the experiments, or in the animals. I do not believe that such differences exist between the Rana fusca and esculenta of Europe and the Rana palustris of America as to explain the differences in our results. These differences I believe may be explained by varying conditions. My animals were kept in a warm cellar, at a temperature of from 18 to 20 degrees C. The period of poisoning with Athanasiu's frogs varied from one to six days; all of my frogs lived over six days, most of them ten or twelve days. Since we know that the katabolic actions of most poisons are greater in prolonged intoxications, it is fair to assume that the time element was the factor in the production of my results. While it would be unscientific and illogical to state that fat cannot be formed from protein, the fact stands that it has never been shown, either in physiology or pathology, that fats are formed from protein. On the contrary, nearly all of the careful work upon the question has yielded negative results. Not. only has it never been shown that, in fatty degeneration so-called, fat is formed from the cellular protein, but it has never been demonstrated that fat is then formed at all, even from glucosides, etc., substances from which fats may be readily formed.

Journal ArticleDOI
TL;DR: There is a transitory glycosuria in diphtheria, which is found frequently in the severe cases and is usually present in the fatal ones and is often associated with albuminuria.
Abstract: (1) There is a transitory glycosuria in diphtheria, which is found frequently in the severe cases and is usually present in the fatal ones. (2) This glycosuria is often associated with albuminuria. (3) Injections of diphtheria antitoxin are occasionally followed for a few days by a slight glycosuria.

Journal ArticleDOI
TL;DR: The old observation of Gerlaeh, that the nerve cells anastomose with each other, has been discarded, and the more modern neurone theory substituted.
Abstract: The opinion is now widely accepted, that the nerve cells throughout the central nervous system are independent structures. The cell processes, it is thought, invariably run out to end free, and one nerve cell has no further connection with any other than that of mere contact. This, in brief, constitutes the neurone theory which is so vigor~ ously maintained by yon Lenhoss6k, Golgi, Ram5n _y Cajal and others. The claim for the independence of the nerve cells is based almost entirely upon the use of Golgi's silver impregnatio.n method, and the embryological researches of His. The investigations of the latter may indeed show that all the dendrites of a nerve cell develop from the neurocyte, and that they do not anastomose with each other; but when in mature cells such anastomoses are demonstrated anatomically, the observations of His lose some of their significance. :But notwithstanding the fact that Golgi's method demonstrates only individual elements, and these for the most part only imperfectly; and notwithstanding the fact that the pictures presented are so crowded with artefacts as to cause every statement concerning the histology of the cells to be made with the greatest reserve, still as a result of its use, the old observation of Gerlaeh (1), that the nerve cells anastomose with each other, has been discarded, and the more modern neurone theory substituted. Held (2) does not believe in the neurone conception and maintains that anastomoses between nerve cells are demonstrable by Golgi's method. 5'ly own observations have led to a similar conclusion.

Journal ArticleDOI
TL;DR: It is probable that lesions of the peripheral nerves in typhoid fever in human beings are common and that the post-typhoid hyper sthesias and paralyses are due to this cause.
Abstract: (1) The application of the Nissl method to the study of the motor cells of the spinal cord, and the nerve cells of the dorsal root ganglia in typhoid fever, shows that these cells regularly suffer pathological changes in the course of the infection. (2) The alterations in the motor cells are more constant and of a severer grade than are those in the cells of the sensory ganglia. The more characteristic changes consist of disintegration, solution and destruction of the chromatic substance of the cell starting from the axone hillock and proceeding toward the nucleus. Coincidently the nuclei of the affected cells seek the periphery. Alterations are also suffered by the nucleus and nucleolus. (3) While this central form of ehromatolysis is the prevailing type of pathological change, disintegration, etc., of the Nissl bodies situated in the periphery of the cell and in the dendrites is also observed (peripheral chromatolysis). (4) In experimental infection with typhoid bacilli in rabbits a similar series of lesions in the corresponding nerve cells in the spinal cord and ganglia is encountered. (5) The main or central type of lesions discovered is identical with that found in man and animals after section, destruction, or even slight injury of the peripheral nerves. (6) The examination of the peripheral nerves arising from the lumbar segment of the cord (the site in man and rabbit of the most profound changes) in rabbits inoculated with typhoid bacilli showed well-marked evidences of parenchymatous degeneration. (7> It is probable that lesions of the peripheral nerves in typhoid fever in human beings are common and that the post-typhoid hyper sthesias and paralyses are due to this cause. (8) Restitution of the chromatic granules may take place in the affected nerve cells, the new formation beginning about the nucleus and extending through the protoplasm.

Journal ArticleDOI
Carlin Philips1
TL;DR: The histological examination of the comparatively early phases of the atrophic lesions in the present case possesses considerable interest, for the subject has received but little investigation.
Abstract: The study of simple atrophy of the adrenal bodies in Addison's disease may prove of considerable importance in explaining more thoroughly the process underlying this group of symptoms. The lesions in simple atrophy o~ the adrenals afford a much better opportunity of investigating the gradual death of the parenchyma than the gross destructive changes in tuberculosis of the glands, most commonly associated with the disease. The histological examination of the comparatively early phases of the atrophic lesions in the present case possesses considerable interest, for the subject has received but little investigation. Very few cases of simple atrophy of the adrenals in Addison's disease are recorded, and of these hardly a single one has been given thorough histological study.


Journal ArticleDOI
TL;DR: A careful examination of the literature on the subject forces the conviction that the majority of tumors which have been classed as fibrosarcomata were in reality gliomata unusually rich in fibres.
Abstract: Fibrosarcoma of the brain, though described with relative frequency by earlier writers, scarcely finds mention in later textbooks of pathology , and though individual cases are still recorded in the current literature, they almost invariably come from observers who base their diagnosis chiefly upon the gross appearances, and whose description of the microscopic findings is far from satisfactory. A careful examination of the literature on the subject forces the conviction that the majority of tumors which have been classed as fibrosarcomata were in reality gliomata unusually rich in fibres. Indeed, the tendency of pathologists now is to regard as gliomata all tumors of the nervous system, which cannot be proven to have taken their origin either in the meninges or in the walls of the blood-vessels, in the latter case usually in the endothelium. It is, therefore, with some hesitation that I venture to give the name of fibrosarcoma to a primary growth in the cerebrum, a growth which cannot have originated in the meninges nor in the endothelium of the vessels. It seems, however, impossible to class it otherwise than as a connective-tissue tumor of a very peculiar type, originating probably in the outer coats of the blood-vessels. The specimen was given me for examination by Dr. L. L. Skelton, of Chicago, to whom I am indebted for the following brief notes of the clinical history and autopsy. The patient was a married woman, twenty years of age. When seen by Dr. Skelton in consultation she was suffering from \" terrific\" headaches, and gradual impairment of vision. There were slight incoSrdination, hysteria, psychic changes

Journal ArticleDOI
TL;DR: The Pasteur method being entirely free from the element of danger which pertains to the glycerine dilution method and resting upon a sounder experimental basis is the one to be preferred.
Abstract: 1. I have simplified the dilution method by using a stock glycerine emulsion of the virulent cord, from which the desired dilutions can be readily prepared. The proportion of glycerine should not exceed ⅕ part, if it is desired to retain the full virulence of the emulsion. 2. There is some danger of giving rabies to animals in the dilution immunization treatment, a danger which is not present in the Pasteur method. 3. The dried-cord method does not rest solely upon the principle of dilution, but is based also upon attenuation of the virus. 4. The Pasteur method being entirely free from the element of danger which pertains to the glycerine dilution method and resting upon a sounder experimental basis is the one to be preferred.

Journal ArticleDOI
TL;DR: The object of the researches here described was to determine whether there is or is not, within the cord, regeneration of the fibres of the dorsal roots of the spinal nerves following the degeneration caused by injury to the roots between the spinal ganglion and the cord.
Abstract: The object of the researches here described was to determine whether there is or is not, within the cord, regeneration of the fibres of the dorsal roots of the spinal nerves following the degeneration caused by injury to the roots between the spinal ganglion and the cord, and also to show the amount of this regeneration, if any should Occur. With this object in view experiments were conducted upon the second cervical nerve in the dog. The selection of this nerve was suggested by the following considerations: In the first place, the posterior root ganglion of the second cervical nerve in the dog lies normally outside the intervertebral foramen, so that experiments upon the roots are much easier and the risk of injuring the cord is much less than it wonld be were it necessary to open the vertebral canal. ]~[oreover, the second cervical nerve in the dog is connected with the sympathetic system, not by a mixed ramus communieans, but by a gray ramus alone; a fact of some importance, as will be shown later. Evidences of regeneration were sought for both by physiological and by histological methods. The present article deals with the physiological methods and the,results obtained by them, while a discussion of the subject from a histological standpoint will appear later. The literature of this subject is not extensive, and most of it dates from a period when the ideas concerning the relations of the nerve fibres and cells were less complete than at the present day. In the very brief summary of this literature that is here presented no especial attempt is made to criticise the older results in the light of newer