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4-6
35 CORNELL UNIVERSITY

(910 THE
lower Veterinary Likeary
FOUNDED BY ‘
ROSWELL P. FLOWER
for the use of the

N. Y: STATE VETERINARY COLLEGE
1897 -

 

 

 

This Volume is the Gift of
Dr. V. A. Moore

 

 

 

 
Bacteriology in a Nutshell

- A Primer for Nurses

COMPILED AND ARRANGED BY
MARY EE. REITD.
GRADUATE NURSE,

Superintendent Thomas Hospital Training School for Nurses,
Charleston, W. Va., 1898-02; Assistant Instructor in General
Nursing, Woman’s Branch of the German Hospital
Cincinnati, O., 1904; Principal of the Training
School and Superintendent of Nurses,

Charleston General Hospital,

Charleston, W. Va., 1905-07.

 

First Epirion, 1904.
Seconp Epirion, ReEvIsED AND ENLARGED, 1907.
Tuirp Epition, 1908.—FourtH EpItIon, 1909.
Fourts Epirion, RevisEp AND ENLARGED, I910.

DEDICATION.

To Charlotte A. Aikens, Author of Hospital Housekeeping;
Training School Methods and The Head Nurse and Primary
Studies for Nurses, to whose suggestion this booklet owes its
origin; to my dear friend and old Superintendent, Sister Emilié
Koch, of the German Hospital, Cincinnati, Ohio; and to my sister
nurses throughout the world, “Bacteriology in a Nutshell” is most .
affectionately dedicated.

{

CINCINNATI, OHIO.
JULY, 1904.
CHARLESTON-ON-KANAWHA, W. VA,
1907-1908-1909-1910.
QR
4-6 | :
e 33 COPYRIGHT 1904.

19 lo BY MARY E. REID,

COPYRIGHT I907,
BY MARY E. REID.

COPYRIGHT 1909.
BY MARY E, REID.

COPYRIGHT IQIO.
BY MARY E, REID.

Me G87
CONTENTS.

INTRODUCTORY

Cuapter I.—Brier History or BACTERIOLOGY.
Earliest days.—Perfection of the single lens.—
The “Dutch Microscopist.”—His discoveries —The
compound microscope.—First account of the germ
theory of disease—A problem of ancient bacterio-
logy.—Men who have made valuable contributions
to the science—Their discoveries........... II-27

Cuapter I].—TuHer Retation or BactertA To DISEASE.
BAcTERIA IN Processes OF NATURE.
Mysteries revealed by the microscope. Cell forma-
tion—The organs and systems of the body.—
Health dependence.—Cell functions.—Cell derange-
ment.—The term bacteria—Bacteria as friends.—
Bacteria as enemies.—The first use of the term
bacteria.—Relative size of saprophytic and parasitic
families ........ ee ee 27-37

Cuapter III.—Description or THE Most ImporTANT
BacteriaA.—MEtTHops oF MULTIPLICATION, ETc.
Morphology. — Spore-forming bacteria. — Non-
spore-forming bacteria—Development.—Multipli-
cation. — Dimensions. — Coloring bacteria.—Pha-
gocytes. — Phagocytosis. — Opsonins. — Resistive
power of spores—Parent bacillus after spore
formation; its life or death................. 37-47
Cuapter JV.—BactertaL Invasion.—How Bacteria
GAIN AN ENTRANCE TO THE SYSTEM.
Parke’s list of communicable diseases.—Period of
incubation.—Invasion.—Channels of Entrance.—
Development of symptoms.—How infection is
thrown off.—Sources whereby bacteria die within
the body.—Immunity, natural, acquired, artifical —
Antitoxins—their preparation and uses.—Koch’s
Circuit——The Opsonic Theory.............. 47-68

pagd
‘CONTENTS.

Cuapter V.—ComMoN CoMMUNICABLE DISEASES.

Why the term communicable has taken the place of
the terms contagious and infectious.—The bacteria
found present in some of the diseases mentioned.—
Transmission of diseases.—Seat of invasion or
attack—Effects of invasion—Multiplication or
extermination of germs.—Fresh air and ventilation
in communicable diseases.—Bacteria in water, milk
and so forth.—Duties of the nurse in communicable
GiSeaSeS decwhag tastes Beteean ees 69-107

Caapter VI.—BacTERIA IN SURGERY.—SEPSIS.—ASEPSIS.
—ANTISEPSIS.

Bacteria most frequently found in surgery; cases
in which they occur.—Sepsis. Asepsis. Antisepsis.
Causes of sepsis——Why sepsis should not occur in
the present age——Why surgeons and nurses dread
sepsis.—The debt the world owes to Lord Lister.—
The vigilant nurse.—Sterilization.—Disin fection.
—Antiseptics—Germicides.— Deodorants. — Heat
as a germicide.—Intermittent sterilization. —

Aseptic surgery.— Hand disinfection.— Disin-
fection of instruments, rooms, furniture, beds,
beddinig: etésses se car aaniedah ncaa o Vagmecacs 108-127

CHAPTER VII.—Sotutions, THEIR PREPARATION AND
UsEs.—Fu MIGATION.

Some of the drugs in common use for the prepar-
ation of solutions, how prepared, how used.—
Normal salt solution, when and how used.—Sterile
water.—Filtered water.—Distilled water—Alcohol.
—Ether—Sulphur fumigation —Formaldehyde.—
Formalin.—“Hospital Formulary” giving number
of grains used in preparation of solutions of various
strength—A common rule for the preparation of
solutions from drugs in liquid form where absolute
accuracy is not required.................. 128-144

Iv
CONTENTS.

Cuapter VIII.—Hycientc PrecauTIONS AGAINST
BacTerIAL INVASION.
The result of neglected hygienic laws.—Civiliza-
tion, fashion, and hygiene——Social restrictions no
longer a menace to hygienic laws.—Out of door
recreation.—Average length of days of the con-
scientious nurse-——How this period may be pro-
longed.—The successful nurse—Her duty toward
her neighbor.—Her duty toward herself—Muscu-
lar exercise.—Hygienic dress——Uniform should
not be worn on the street.—The reason why.—
Obedience to Nature’s calls—Diet—Water sup-
ply. Sunshine—Fresh air.—Rest—Sleep—The
nurse with “a Southern exposure”....... 145—I161

salva cogignotaas cn mea es ey Ne Aci SANS 204-211

SUPPLEMENT.

Cuarter I.—
Ehrlich’s Hypothesis of Immunity.—Relation to
physiological Metabolism.—Relation to pathological
Metabolism.—Comparison with Theory of Metch-
TKO, cove ixencarersg ese eenawuae kei 162—169

Cuapter I]_—Strum THERAPY—
Definition.—Direct and indirect Serum Therapy.—
Principles Of —Antitoxins Treatment of Tetanus
and Diphtheria.—Antibacterial Serums.—Vaccina-
tion—Curative and prophylactic treatment—A
few of the products now in use.—Antimeningitis
Serum.—Staphylococcic Vaccine.—Gonococcic Vac-
cine (Bacterin of Neisser)—Koch’s Tuber-
GUN iT: eGancn ye ers e teenies pene Heed sacs a emenGiewaNe 170-202
BACTERIOLOGY IN A NUTSHELL.

cases in the maternity wards, with little
thought, apparently as to the condition of
their hands. Semmelweis immediately began
to scrub and disinfect his own hands before ap-
proaching the beds of his maternity cases, and
soon found his efforts crowned with success.
Then he insisted upon his fellow-students
practicing the same routine. The mortality
rate in the students’ clinic thereafter became
much less than that of the midwives. The dis-
: infectant used by Semmelweis and his co-
Sone workers was chlorine solution. In spite of the
success of this conscientious worker, there was
much skepticism with regard to his theory, and
he died in an insane asylum, his malady the re-
sult of worry over unfriendly criticism.

In 1849 the germ which causes anthrax was
discovered by Pollender, of Germany, but it
was not until the year 1863 that *Casimir
Joseph Devaine, a Frenchman, by the process
of inoculation proved that Pollender’s germ
really produced anthrax.

In 1862 fLouis Pasteur, of France, the fame

Pasteur’s of whose work at ‘“‘Pasteur Institute,”’ Paris, is
Experiments. : x ‘
world wide, first began his experiments to
prove that living organisms are in the air we
breathe, in the food we eat, upon the clothing

 

*Casimir Joseph Devaine, born at St. Armand-les-
Eaux, France, in 1812; died in 1882.
_T Pasteur was born at Déle, Jura, France, in 1822;
died in 1895.
6
BRIEF HISTORY OF BACTERIOLOGY.

we wear,in the dust we tread beneath our feet,
and that they may be found any place where
dust settles. It had long been contended that
the processes of fermentation and putrefaction
were purely chemical processes and not the
work of micro-organisms. It was proven also
through the experiments of Pasteur that the
reproduction of bacteria takes place by pro-
cesses similar to those which cause the repro-
duction of larger vegetable or plant life and not
by spontaneous generation. Many other im-
portant discoveries are credited to the experi-
ments of Pasteur. In fact, some scientific men
of the present day go so far as to say that the
real history of bacteriology dates no farther
back than to the experiments and discoveries of
Pasteur; that while it was not he who first dis-
covered the existence of germ life, nor who first
studied bacteria, nor who first suggested their
connection with fermentative processes and
with diseases, yet it is to his experiments we
- owe the placing of bacteriological study upon a
firm basis, and that all the history of micro-
organisms which antedates the experiments and
discoveries of Pasteur is merely theoretical,
more likely to be erroneous than otherwise.

In 1872 Klebs began to teach that general
sepsis is caused by bacteria invading the blood.
Klebs is of German birth; he was born in

17

Errors
Lessened by
Pasteur,
Dawn of
Antisepsis.

BACTERIOLOGY IN A NUTSHELL.

Koenigsberg ;- he was educated at Berlin, and
later in life (1882-92) was professor at Zurich.

In 1873 the micro-organism of relapsing
fever was discovered. To Obermeier, of Ger-
many, belongs the credit for this discovery.

In 1875 the germ theory of disease was
pretty generally accepted, at least by the scien-
tific world. In that year Lord Lister, an
English surgeon, who later (1877) was pro-
fessor in King’s College, London, began the
use of antiseptics in surgery. He based his
experiments upon the discoveries of Pasteur.
Carbolic acid solution was the first substance
used by Lister in his surgical operations, and
thus was ushered in the era of antiseptic surg-
ery. Only thirty-five years have passed, and
yet to what gigantic proportions has grown the
use of substances to either destroy germs or to
prevent their doing mischief by stopping their
growth! Carbolic acid solutions still remain
in common use.

The bacillus of leprosy,* the bacillus leprae,
was discovered by a German scientist, Hanson,
in 1879, and in the same year the micro-coccus
of gonorrhoea by Neisser. (Neisser is also of

*In July, 1904, Rost, of the medical staff in India,
reported that he had succeeded in cultivating the bacillus
of leprosy and from the cultures had made a substance
he called “leprolin,” which, when injected into the tissues
of lepers, had a marked beneficial effect.

18
BRIEF HISTORY OF BACTERIOLOGY.

German birth, probably located at Munich at
this time. )

The bacillus typhosus, the germ of typhoid
fever, was discovered by Eberth and Koch, of
Germany, in 1880.

And in that year (1880) came also the dis-
covery of the germ of pneumonia. Some
writers give the credit (or discredit) for caus-
ing this disease to the micro-organism observed
by General Sternberg* of the United States
Army; others to the diplococcus lanceolatus,
discovered by tFrenkel, of Berlin, who was
professor at Halle. Recent investigation has
shown that the diplococcus discovered by
Frenkel is probably the sole cause of genuine
acute, lobar pneumonia, although other germs,
one of which is the “pneumo-bacillus of Fried-
lander,” are said to be sometimes found asso-
ciated with this form of the disease. Several
germs are believed to be capable of causing
broncho-pneumonia.

In 1882 the name of Robert Koch* sprang
into fame when he made the greatest of his

 

* Authorities assert that the germ observed by Stern-
berg and the diplococcus lanceolatus are probably iden-
tical. Fraenkel associated the germ with pneumonia
causation; Sternberg apparently did not.

+ Koch, born at Klausthal, Germany, in 1843. Led the
German expedition which in 1883 went to Egypt and
India to investigate cholera. In 1890 announced a cure
for tuberculosis, the power of which experience did not
at that time demonstrate. Died at Baden-Baden, Germany,
May 28, 1910.

19

Later
Discoveries.

Koch’s
Discoveries.
Progress
of Other
Scientists.

BACTERIOLOGY IN A NUTSHELL.

many discoveries—the germ which is the cause
of all forms of‘tuberculosis. This discovery is
not only to be considered the greatest of Koch's.
discoveries, but one of the greatest discoveries
of the age, as to tuberculosis, in one or anothei
of its forms, is due at least one-sixth of all the
deaths which occur yearly in the human family.
Had the remedy for this disease, prepared by
Koch,* proven a success, he would have im-
mortalized his name in very deed.

In 1884 Koch made another discovery,
namely, the comma bacillus of cholera; so-
called because’of its peculiar shape. (Pasteur
discovered the germ of chicken cholera in
1880.) In 1884, also, the germ of diphtheria,
called the bacillus diphtheriz, was discovered
by Leeffler, and the bacillus of tetanus, called
the bacillus tetani, by Nicolaier.

The germ which causes “la grippe” was dis-
covered in 1892 by Pfeiffer. Leeffler, Nico-
laier, Pfeiffer, are all of German nationality.
(Leudwig Pfeiffer, born at Eisenach in 1842,
lives at Weimar. ) .

In 1894 came the discovery of the bacillus
pestis, the germ of the Eastern bubonic plague
by Yersin, of France, who was at this time pur-
suing his scientific investigations in China.

Kitasato, a Japanese, working independently

 

* See Supplement Chap. II, for recent return to con:
fidence in tuberculin.
20
BRIEF HISTORY OF BACTERIOLOGY.

of Yersin, during an epidemic of bubonic
plague in Hongkong in 1893-4, discovered the
same germ and the result of their researches
was proclaimed to the world almost simultan-
eously.

In 1897, the discovery of the bacillus of yel-
low fever was reported by Sanarelli, a
Spaniard. This germ was not accepted be-
cause it failed to comply with certain requisite
scientific tests. | (Koch’s circuit, spoken of in
chapter IV, was not proven.) The same is
said of the germ found in carcinomatous speci-
mens, and of the germ of small-pox reported
by Dr. William T. Councilman, of Harvard
College, in the spring of 1904.

It is now definitely known that the *spiroch-
etae pallidae, discovered by Hoffman and

 

* For years Professor Paul Ehrlich, of the Royal
Prussian Institute, has been experimenting with various
drugs in order to discover something which shall have
the power to destroy the parasitic spirochetes within
man and the lower animals without injuring the organic
cells of the body. Recently it has been the good fortune
of Ehrlich to discover a drug, or combination of drugs,
which authorities believe possesses the power to destroy
the parasite, spirochetae pallidae, the germ of syphilis.
This drug is known: ag arsenobenzol, or “606.” Ehrlich
discovered while pursuing his investigations that the
attempt to destroy animal parasites by small doses of
an injurious drug was unsafe, owing to the fact that the
parasites frequently develop a toleration for the drug

 

* See Supplement, page 162.
21

Koch’s
Circuit
Not
Traced.
BACTERIOLOGY IN A NUTSHELL.

Schaudinn, of Germany, in 1905, is the germ’
of syphilis. New methods of staining cultures

which they transmit to their offspring. He therefore
sought to discover and perfect a drug, the action of
which should destroy the parasites by the administration
of a single large dose, at the same time leaving the subject
uninjured. This result he has achieved in his wonderful
“606,” which is being used with marvelous results in
both Europe and America. The active principle of the
drug “606” is arsenic. Other parts of the drug are
chemical groups used for the purpose of fixing the
arsenic to the parasites. The chemical name of “606”
is paradiamidodioxy-arsenobenzole dihydrochlorid, In
appearance it is a yellowish powder. It rapidly oxydizes
on exposure to air and is for this reasom preserved in
vacuum tubes. It does not dissolve very readily in
water, and when thus dissolved is strongly acid. As this
acid solution causes great pain, it is administered either
as a neutral base or as an alkiline salt. It is given by
hypodermic injection either deep into the muscles or
into the veins, or subcutaneously. The concensus of
opinion seems to favor the subcutaneous method. “606”
is dissolved in a mortar in one (1) to two (2) cc. of
ordinary solution of sodium hydrate. To this is added
acetic acid by the drop method until a fine yellowish
suspension is percipitated. This percipitale is then col-
lected in from one (1) to two (2) cc. of sterile dis-
tilled water. To this is added 1-10 normal sodium
hydrate, or one per cent acetic acid. The suspension. is
drawn into a suitable syringe and injected below the
shoulder blade underneath the skin. The area used
must be thoroughly cleansed and disinfected in the usual
way. Slight pain sometimes follows the subcutaneous
injections. Also there may be some elevation of tem-
perature, a rash resembling urticaria, and sometimes a
slight swelling about the site of operation is. observed
on the second or third day, but no untoward results occur.

22
BRIEF HISTORY OF BACTERIOLOGY.

used in 1906-07 by these and other scientists
working independently have brought to light
the true relationship which this germ (hitherto
considered doubtful), bears to the loathsome
disease, syphilis, the micro-organism of which
has for so many years remained a mystery to
the medical profession and to other scientific
workers. Authorities in both Europe and the
United States are now satisfied as to the
authenticity of the spirochetae pallidae:

The germs which cause many of our most
common communicable diseases still continue
to be undiscovered. We are in the dark as to
what parasite is responsible for small-pox,
scarlet fever, measles, chicken-pox, etc. Rheu-
matism and arthritis deformans are believed by
some authorities to be germ diseases, but as yet
this theory has not been proven, although an
antistreptoccic serum is in use in some parts of
the United States which is said to be helpful in
both of these incurable diseases.

SUMMARY OF CHAPTER I.

1

The earliest days of bacteriology said to be
traceable to the time of Caesar, in whose day a
Roman writer hinted at the invasion of the
human structure by “creatures” invisible to the

23

Many Germs
Still Baffle
Scientists,
BACTERIOLOGY IN A NUTSHELL.

naked eye and of their power to produce dis-
eases.

The perfection of the single lens. Nation-
ality of the perfector. Discoveries of this
scientist during the seventeenth century under
the single lens and by means of the compound
microscope. The presentation of the results
of his researches together with appropriate en-
gravings to the Royal Society of London,
England, of which society he was afterward
Fellow.

Power to produce the so-called infectious
diseases ascribed to micro-organisms by a
scientist of Vienna. Theories advanced by this
scientist. Non-acceptance of his theories:

The germ theory of disease again advanced
about sixty years later and its successful demon-
stration.

A short account of one of the subjects which
caused much discussion during the century and
a half between the discoveries of the Hollander
and the acceptance of the theory of the scientist
of Vienna.

The man who first threw light upon the
mystery surrounding this vexed question and
the manner in which he carried on his experi-
ments. Work and its results along the same
lines by other scientific men of that period.

24
REVIEW.

Errors of some of the early students of bac-
teriology.

Slow progress in discovering a special germ
for each infectious disease.

Men who are considered to have made the
most valuable contributions to bacteriology and
their discoveries.

QUESTIONS FOR REVIEW.

I.—Who perfected the “single lens” and
what were the first discoveries made by its per-
fector? In what year did he announce his
discoveries? Are these the earliest discoveries
of which we have any account?

IIJ.—In what year were later discoveries an-
nounced by this scientist? How were these
discoveries made? To whom were the results
of his researches presented ?

III.—What attempts were made to classify,
separate and identify the germs discovered, and
were they believed to be in any way connected
with pathological changes in any particular part
of the body?

IV.—Who was the first physician to ascribe
to micro-organisms the power to produce the
so-called infectious diseases? In what year
was the announcement made? Was the theory
accepted ?

25
BACTERIOLOGY IN A NUTSHELL.

V.—Who is said to have been the first to suc-
cessfully demonstrate that the germs discovered
in the seventeenth century could produce dis-
eases ?

ViI.—Describe in detail one of the chief
points of discussion during the years that
elapsed between the discoveries mentioned and
their acceptance as disease germs. Tell of the
man who first threw a gleam of light on the
vexed question, of the means used, of others
who followed the same method of research, the
results gained. af

VII.—Mention some of the errors of early
students of bacteriology with regard to the
germ theory of disease. To whom do some
bacteriologists ascribe most credit for the firm
basis of this theory in the present day?

_ VIIL—By whom and in what years were
antiseptics first used? In what class of cases
were they used? What were the first sub-
stances used? Are they still in use and are
they now considered valuable antiseptics?

IX.—By whom and in what year was it first
taught that bacterial invasion is the cause of
puerperal sepsis? What became of this
scientist? Who first taught the theory of
general sepsis?

X.—By whom was the germ of typhoid fever
discovered? In what year was the discovery

26
REVIEW.

made? Mention other discoveries made by one
of these men? Which is considered to be the
most important of his discoveries and why?

XI—Name some of the important dis-
coveries made during later years and their dis-
coverers.

XII.—Mention some diseases now consid-
ered to be caused by bacteria and explain why
the germs discovered in one or two instances
have not been accepted as the originators of
the trouble.
Revelations
of the

Microscope.

Cell
Formation,

Organs and
Systems.

CHAPTER II.

THE RELATION OF BACTERIA TO DISEASE—BAC-
TERIA IN PROCESSES OF NATURE.

Mysteries concerning the origin of numerous
diseases, which must otherwise have remained
mysteries forever, have been made more or less
clear since the perfecting of the microscope
Prior to the revelations made by the use of this
instrument, very little was positively known
concerning the formation of the various ele
ments of which the machinery of the human
structure is made up and by which it is kept
in running order. Now scientists are able tc
trace the human body back to the time when it
was but a single cell, from this single cell tc
watch its growth and development into in-
numerable single cells, to see the single cells
fold into layers, these in their turn to form the
groups of cells out of which the various bones
and muscles and nerves and tubes and tissues
of the body are composed. These groups we
call the organs and systems of the body. Each
has its own work to perform, and each exists
to a certain extent independently of the other.
Yet all are so intimately related and connected
in their efforts to maintain life and health that

when disease comes to one group of cells com
28
SALLERIA AND DISEASE,

posing a system, other groups composing other
systems suffer also.

The group of cells from which the muscular
system is made up, by its united action, called
into play by nerves, produce our movements.
Another group of cells forms the liver and har-
monious action of this group is necessary in
order that impurities be removed from the
blood. Certain fluids which are esseritial to the
welfare of the body are also manufactured by
this group. The brain is composed of another
group of cells of a different type; from this
group thought and intelligence emanate, and
‘from still another group is composed the nerves
which convey messages to and fro between the
brain and the outer world and so on. When
these various groups are all “in tune” then the
human body is in a state of health, when they
are “out of tune,” we speak of the body as in a
state of disease. Ina state of disease our work
is no longer a pleasure to us; our hours of
recreation are no longer a joy. Our days are
filled with discomfort and our nights are robbed
of rest and sweet sleep.

As nurses, then, let us grasp this thought that
“disease is a derangement of the structures or
functions of the body,” and in order that the
human structure remain healthy, there must be
harmonious action between separate types or
groups of cells. If one group fails to work

29

Action of
Various Cells.

Brain and
Nerve Cells.

Definition of
Disease.
Bacteria a
Cause of
Disease.

BACTERIOLOGY IN A NUTSHELL.

harmoniously, then comes a disturbance of the
harmony of the other groups, and because of
this disturbance there comes disease. For ex-
ample: If there is trouble in the nervous system,
then, too, we find the digestive system is
affected, and vice versa. So we may go on
through the other systems and find them all
more or less dependent one upon another.

The causes of disease are many and varied.
One of the most serious causes, as revealed by
scientific research, is the invasion of the differ-
ent organs and systems of the human structure
by a species of bacteria; these it has been
proven produce many of the so-called infectious
diseases. Bacteriological research tends to the
belief that certain forms of moulds and pro-
tozoa—the latter being the simplest form of
animal life, and one which is distinguished from
all other animal groups because each protozoon
consists of but a single cell—are also causes of
some of the “infectious diseases.” So much has
been said and written on “the relation of bac-
teria to disease” that many people fail to dis-
criminate between the bacteria which are our
friends and those which are our enemies.

As pupils in the study of bacteriology we
learn that the term bacteria is applied by
scientists to the large group of minute vegetable
micro-organisms, commonly called “germs” or
“microbes.” This name was first given to

30
BACTERIA AND DISEASE.

them about the year 1869, after *Hoffman had
demonstrated that these tiny mysteries occu-
pied a class by themselves, quite distinct from
yeast plants and moulds with which they had
been confused in earlier days of bacteriological
research. For years scientists had been unable
to decide as to whether bacteria were members
of the plant family, or whether they were the
offspring of animal life, for the reason that
they were found to possess characteristics of
both families or kingdoms. When it was dis-
covered under the microscope that some of the
bacteria are spore-forming, their classification
as members of the plant or vegetable kingdom
was determined. Absence of chlorophyl, the
name given to the green coloring matter of
plants, caused doubt to arise in the minds of
many; chlorophyl is the property in plant life,
which enables them to cause decomposition of
carbon dioxide and ammonia and to consume
as food their products. Bacteria, lacking this
property, feed upon the same forms of food as
the higher animals consume.

All forms of bacteria may be divided into
two great classes in order to simplify for study.
These two classes are called the saprophytes,
and the parasites. The saprophytes, which are
the friends of all animal life, are many times

 

*Hoffman was a German botanist. Born at Roe
delsheim, 1819; died at Giessen, 1891,
3t

Bacteria
Explained.

Animals or
Plants.

Saprophytic
Bacteria.
Parasitic
Bacteria

Our Foes.

Good
Bacteria.

BACTERIOLOGY IN A NUTSHELL.

more numerous than the parasites. Of the num-
berless species of bacteria only about forty (40)
are known to cause disease in man. Parasites
are enemies to animal life; they are the so-
called disease germs” or “microbes”; they
exist only at the expense of other living bodies.
They invade various parts of the living body
and under favorable conditions they weaken
and sometimes destroy the parts they invade.
They take away from us substances on which
our health is dependent, and deposit in their
place that which poisons and frequently com-
pletely destroys. Because of their power to
produce pathological changes in animal bodies,
parasitic bacteria are also called pathogenic
bacteria.

Saprophytic bacteria not only are our friends,
but they are of such benefit to mankind that we
could not live without them. They live upon
dead organic matter, and by their activities de--
composition, fermentation and putrefaction are
produced. Nourishment necessary to the sus-
tenance of vegetable life is derived from car-

-bonic acid gas, ammonia and water, which are

all produced by the action of saprophytic

bacteria on dead animals and vegetables. Veg-

etable and plant life would cease to exist if the

carbon and nitrogen to which they owe their

growth and development could not be obtained

from this source. Animal life is sustained. by
32
BACTERIA IN PROCESS OF NATURE.

the oxygen thrown off by trees and plants and
to a certain extent by the food obtained from
the vegetable world; therefore, the work of the
saprophytes is necessary to the existence of all
forms of life.

With regard to the work of saprophytes as
our friends in the processes of Nature, let us
look a little farther into this phase as explained
to us by scientists. Let us see why it is that
they play so important a part in these processes,

Bacteria in
Natural
Processes,

and how it is that they are so completely inter- ,

woven with the vital powers of nature, that life
in all its forms would vanish from the earth
should their activities cease. _

When as children we explored the woods and
perched ourselves upon fallen tree trunks and
saw them dropping into decay, how many of us
now studying bacteria in regard to their con-
nection with our work as nurses ever associated
the process of decay with the activities of
germs? Today we are taught that bacteria
play an important part in this process after the
hard, woody substance of the tree has been
softened and prepared for their work by
moulds. Then, after the tree has been attacked
by bacteria, it drops to pieces as a yellowish
brown deposit, to mix with dead leaves and
sink into the soil as a fertilizer. to promote the
growth of healthy plants and trees that inhabit

the forest.
33

Decay of Trees
and Plants.
Decay of
Animals,

Where
Oxygen is
Obtained.

4

BACTERIOLOGY IN A NUTSHELL.

The same thing happens in decay of dead

‘plants and animals. In decomposition of ani-

mals saprophytes play a still more important
part, as it is by their agency alone that the work
on every part of such bodies is accomplished
and the preparation made for mixing with the
soil and the atmosphere. Whatever of the de-
cayed substance of tree and plant and animal
is not of use as a fertilizer is disseminated in
the form of gases to be taken up by the air, to
be returned to the elements from which it
came, again to be used in the formation of
something else in the various processes of
Nature. So plant and vegetable and animal
life is renewed and sustained in a great
measure through the fertilization of the soil
by decomposition of dead plants and vegetables
and animals, and by the gases they disseminate,
none of which would come to pass without the
activities of bacteria.

We inhale from the atmosphere oxygen,
which is absolutely necessary for the sustenance
of animal life, and which is thrown off for our
use from growing plants and trees and other
forms of vegetable life. We exhale carbonic
acid gas, or “carbon dioxide,” which, together
with the influences of the sun and the rain, is
necessary for the growth and sustenance of
trees and plants and vegetables. This is one
way, among others, in which the animal king-

34
SUMMARY AND REVIEW.

dom is necessary to the vegetable kingdom and
vice versa, the plant and vegetable world giving
off oxygen for use of the animal world, and the
animal world in its turn supplying the plant
and vegetable world with carbon dioxide in a
ceaseless round. All other foods used to sus-
tain animal and plant life are so arranged by
the processes of Nature as to be used again and
again in a continuous circle, first by plants and
then by animals, and then over again by plants,
the circle to endure so long as the sun shines
and the rain falls to promote its continuance.
Many of these processes require much thought
in order to understand the intricate workings
of Nature. Those who undertake the study in
earnest find it of special interest. Not the least
interesting phase is the way in which nitro-

genous foods, so necessary to animal life, take

their place in the continuous circle, and how,
through the assistance of bacteria they are
prepared to return to take part in the main-
tenance of plant and vegetable life.

Bacteria which assist in the sprouting of
seeds and in other processes of Nature in farm
and garden, form an interesting study, also.

SUMMARY OF CHAPTER II.

Mysteries with regard to diseases revealed by

the microscope.
ms)

Nature in
Food Supply.
BACTERIOLOGY IN A NUTSHELL.

Cell formation and the formation of the or-
gans and systems.

Health of the various organs and systems of
the body dependent one upon another.

Functions of some of the groups of cells.

Derangement of the structure and its func-
tions the cause of diseases.

Bacteria as friends and as enemies.

Application of the term bacteria.

Length of time the term has been in use
and the scientist who first distinguished the
group from yeasts and moulds. His nationality.

Difference in size of the saprophytic and
parasitic families.

What we understand by the term pathogenic
bacteria.

Saprophytic bacteria and the benefits derived
from them by the animal and the vegetable
kingdoms.

QUESTIONS FOR REVIEW.—CHAPTER II.

I.—How has the perfecting of the microscope
been of benefit to mankind in a special way?

Il.—Give in detail some of the mysteries
with regard to the human structure as revealed
by the microscope since its perfection.

III.—Are the different systems of the body
in any sense independent systems? Give one

reason why they are not entirely independent.
36
SUMMARY AND REVIEW.

IV.—Mention the functions of the groups of
cells spoken of in this chapter.

V.—Explain what you understand by the
term “disease” and give the cause of one serious
form of disease.

ViI.—Into how many classes may bacteria be
divided in order to simplify for study?

VII.—Define bacteria, pathogenic bacteria,
saprophytic bacteria.

VIII.—Prove that pathogenic bacteria are
foes to health.

IX.—In what way do saprophytes benefit
mankind?

X.—Explain what would happen to plant
and vegetable and animal life if saprophytic
bacteria should be destroyed or become inac-
tive? Give reasons for your answer?
Morphology
Defined.

Micro-cocci.

Bacilli.

CHAPTER III.

DESCRIPTION OF THE MOST IMPORTANT BAC-
TERIA, METHODS OF MULTIPLICATION, ETC.

MorpPHotoey is that branch of science which
treats of the classification of bacteria with re-
gard to their shape, outline, structure and their
methods of grouping. Placed in broth,
bouillon or other substance they are cultivated,
and much useful information has been gained
with regard to the habits, etc., of these tiny
specimens of vegetable life.

It has been found by studying them under
the microscope, that all bacteria of any import-
ance are either “sphere,” “rod,” or “spiral”
shaped, and so they are divided into these three
classes. &

The spherical may be perfectly

& round like a ball or marble, or they
@ = may be oval or egg-like; they vary
? in size and many are imperfect in

shape. The name given to all bac-
teria of this formation is “cocci” or “mi-
crococci.”’

Spheres,

The rod-shaped may be long or
Sg short, square or round at the ends,
am, - _ thick or thin, but all bear the com-
mon name of “bacilli.” The
largest number of disease germs
are of this class,

Rods,

8
MORPHOLOGY.

The spiral-shaped somewhat

corkscrew, and whether they have

few or many curves, whether
wh loosely or tightly twisted, the one
~ws name, ‘‘spirilla,” covers all of this

Spirals. variety.

Modifications or subdivisions of the cocci
have also been determined by watching their
manner of forming into groups as seen in grow-
ing cultures.

Staphylococci is the term used to describe
those which group in masses like grape-
clusters.

Streptococci, to describe those with method
of grouping into chain-like sections.

Other forms of the micrococci are found to
group in pairs, and to describe these the term
diplococci is used.

Those which form into groups of four are
called tetrads.

Still another form is seen to make up groups
of eight and sixteen, and to describe these we
use the term sarcine.

There are two main subdivisions of the bacilli,
namely; bacilli which are spore-forming, and
bacilli, which are non-spore-forming. By the
term spores we mean seeds or eggs of the bacilli.

All forms of bacteria are dependent upon
certain conditions for their development; these
39

   

Spirilla,

resemble the twisted part of a"

Staphylococci,

Streptococci.

Diplococci.

Tetrads.

Sarcinae.

Oxygen.
a

BACTERIOLOGY IN A NUTSHELL.

conditions are a certain temperature and food
proper soil, and in some instances oxygen as
found in the air.

Bacteria that require oxygen are given the
name of aerobes. Those that do not require
oxygen are called the anaerobes.

Pathogenic bacteria require organic matter

Food. to feed upon. Vegetable or animal matter,
fluid or solid, fresh or decayed, all kinds are
adapted to their use as food, but the blood and
juices of the animal body tissues are specially
favorable material for their growth and de.
velopment.

The temperature of the human body, viz.,

Temperature. 98.6° F., is the most favorable for the multi-
plication of pathogenic bacteria, although they
will also multiply quite rapidly in a lower
temperature; 70° F. (ordinary summer heat)
is sufficiently high. Below 70° F. their growth
is slower and has been found to cease at 60‘
F. A temperature of 110° F. is believed by
many to prevent their growth.

Size of bacteria is a part of their description
difficult to determine. So tiny are they that it
is only under the highest power of the micro-
scope that scientists are able to study them at

eiusicg all. One of the largest of the bacilli is said to

Bacteria. be about 1-12,000 of an inch in length, and
I-50,000 of an inch in thickness. We are told

that it would take six thousand billions of-the
40
MORPHOLOGY.

average sized bacilli to weigh one grain, and
that fifteen hundred of the largest bacilli if
placed end to end would not reach across a
small pin head. Bacteria are single cell plants
(unicellular), but this single cell is capable of
producing innumerable other cells under favor-
able circumstances. Some forms of bacteria
move about quickly, through flagella, an
appendage which is lash-like in appearance and
by means of which they are made to resemble
a form of animal life. Other bacteria are very
slow in their movements.

Weigert* in the year 1877 discovered that
micro-organisms could be colored by the use of
aniline dyes, so as to be distinguished from the
media in which they are cultivated. Up to that
time great difficulties stood in the way of thei1
successful study, because of their transparency
as well as their minuteness. Since Weigert’s
discovery that they can be colored, many of the
peculiarities by which their varieties are deter-
mined have been pointed out.

We have said that one condition necessary tc
the growth and development of bacteria is
proper soil. A perfectly healthy body with
normal resistive power is not favorable soil for
the development of disease germs. In such a
body certain cells exist which are foes to these

 

* Professor Carl Weigert, anatomist at Frankfort,
. Germany.
41

Power of
Motion.

Weigert’s
Discovery.
Phagocytes,

Function of
Phagocytes

BACTERIOLOGY IN A NUTSHELL.

germs; they have the power either to absorb or
destroy disease-producing bacteria. Some of
these cells are found in the white corpuscles of
the blood, the leucocytes, and are called phago-
cytes; the process of destruction or absorption
is known as phagocytosis. The name phago-
cytes (from the Gk. phago “I eat”) was given
to these cells by the man who discovered their
province, the scientist, *Elié Metchnikoff, a
Russian, one of the most distinguished bac-
teriologists of the present day and who is car-.
rying on his work at Pasteur Institute, Paris,
France, as successor to Pasteur. While scien-
tists differ as to the method of warfare as waged
between the cells of the body, termed phago-
cytes, and the germs of disease, most of them
agree that the healthy body has the power to
overcome and exterminate such foes by their
means. Scientists who are not associated with
the school of Metchnikoff, teach us that there
are properties contained in the serum of the
blood known as opsonins, discovered by Sir
Almoth E. Wright, of England, which assist
the phagocytes very materially in their work.
They prepare the pathogenic bacteria in some
unexplained manner, making them more readily
digested and absorbed and then attract them
toward the phagocytes.

The body which is not healthy, and in which

* Metchnikoff was born in the government of Kharkoff
in 1845. Was professor at Odessa in 1870.
42
MORPHOLOGY.

normal resistive power is absent, on the othe1
hand is not able successfully to fight disease-
producing germs which invade it at one point
or another, they overcome weakened resistive
forces, increase and multiply within the body,
and we become victims of the disease the special
form of bacteria present produces.

There are two methods of multiplication in the
bacterial world—fission and spore formation.

The method by which micro-cocci and
spirilla multiply is termed fission; fission ir.
common everyday language means simply di-
vision. They rapidly separate or divide intc
a number of sections, each of which soon leaves
the parent cell, and in turn divides into other
sections or parts. The micro-cocci before
fission takes place elongate or lengthen out,
they then divide in the center, each half again
divides and these new sections also repeat the
process again, and again. In many instances
they divide at right angles to the first division
‘and again at right angles, forming in this man.
ner the groups of two, four, eight and sixteen,
which have been mentioned as the “diplococci’
“tetrads” and “‘sarcine’”’. Those which upon
division do not immediately become detached
one from the other, but which form into chain.
like sections have also been described as bear
ing the name of “streptococci.” Others again
that remain grouped in clusters, we have

43

‘

Fission.
Bacilli
Method of

Multiplication.

Spore
Forming
Bacilli.

BACTERIOLOGY IN A NUTSHELL.

learned are called the “staphylo-cocci.” The
process of division and subdivision is kept up
as long as the germs have proper soil to exist
upon, provided, also, the food, temperature,
air and moisture are such as they require.
Bacilli multiply in much the same way and
under conditions similar to those required by
the micro-cocci and spirilla. This is especially
true of the bacilli which are non-spore-forming.
With regard to the spore-forming bacilli,
when they can no longer obtain sufficient or
proper food or surroundings, they shrivel or
dry up and appear to be dead. They may keep
up this semblance for months, but let conditions
once more become favorable for their develop-
ment and we soon find they not only are not
dead, but are not even sleeping merely resting.
Place them in suitable culture media, for in-
stance, and immediately they begin to germi-
nate and produce innumerable micro-organisms
of the same variety as those from which they
sprang. They do not reproduce other spores -
at once, but never fail to reproduce that char-
acteristic variety of bacillus which is Spore-
forming. Fortunately for the human family
the number of spore-forming bacteria is small,
and not one is known to be instrumental in
producing a pestilential, epidemic disease.
There are certain changes which take place
in the bacilli when the process of seed or spore
44
MORPHOLOGY.

development is about to begin. Spores, or Protoplasin
seeds, are made up of tiny particles of the Defined.
protoplasm or active, life-giving substance of
which bacilli are composed. They form some- Spore
times at one end of the rod, sometimes at the Formation,
other end, and again they may form in the
center of the rod. They at first appear to be
just tiny spots, or dots in the protoplasm, or
life-giving matter, of the parent bacillus, but
very soon they begin to divide off and are easily
distinguished under the microscope as tiny seeds
or eggs which scientists call “spores.” They
rapidly increase in size and break through the
framework of the bacillus, the non-essential part
of which usually dies and the seeds or spores are
left behind in a protecting cover or capsule.
This cover or capsule is said to enable spores to
resist influences that would very quickly destroy
other forms of bacteria. The power possessed
by spores to resist heat and drying is found to Radintex
be almost incredible. Bacteriologists assert that Power of
some forms of spores live on after they have Spores:
been exposed for a brief period to a tempera-
ture of 360° F. Other forms have been treated
to a bath of boiling water for a longer period,
and yet both have come through these processes
alive and have again germinated.

While the parent bacillus, as a rule, is sup-
posed to die during spore formation, because the
spores use up the protoplasm of the parent cell

45
BACTERIOLOGY IN A NUTSHELL.

for their own sustenance, this is believed not to
be true in every instance. The functions of the
parent cell are said sometimes to go on in the
usual way during the process of spore-forma-
tion, sufficient of its protoplasm being retained
to sustain life and again to renew its activities
after the spores have broken through its walls.
SUMMARY OF CHAPTER III.

Classification with regard to shape, out-
line, etc.

Definitions of various names descriptive of
bacteria. ;

Methods of grouping as seen in growing
cultures.

Terms used to designate methods of grouping.

Bacteria which form spores and those which
do not.

Development of bacteria dependent upon
certain conditions.

Why it is difficult to determine dimensions
of bacteria.

Discovery of Weigert.

Power of phagocytes and opsonins.

The discoverers of phagocytes and opsonins.

Why bacteria sometimes conquer the phago-
cytes.

Methods whereby bacteria multiply.

Process of spore-formation.

Definition of protoplasm.

Wonderful resistive power of spores,

46
SUMMARY AND REVIEW.

Parent bacillus after the process of spore-
formation. .

QUESTIONS FOR REVIEW ON CHAPTER III

I.—Why is the study of morphology im-
portant, and how is it best facilitated?

II.—Describe each of the three forms of bac-
teria. Which of these is most common?

III.—Is the process of multiplication of bac-
teria rapid? If so, in what manner and under
what conditions are they propagated?

IV.—Are pure blood and healthy tissues con-
ducive to the development of the various kinds
of bacteria?

V.—Which method of antagonizing disease
germs appeals to you—resistance by a vigorous
healthy body, or their destruction by the use of
powerful drugs?

VI.—What is the meaning of spore-forming
as applied to bacteria?

VIL—Are all varieties of bacteria spore-
forming? About what is the size of the lar-
gest known bacillus?

VIII.—In what manner do micro-cocci and
spirilla multiply? Give term applied and its
meaning.

IX.—Are spores easily exterminated? What
can you say of their peculiar resistive powers?

‘What is protoplasm?

X.—Does the parent bacillus remain vigor-

ous after propagating its kind?
47
CHAPTER IV.

DISEASES CAUSED BY BACTERIAL INVASION.
HOW BACTERIA GAIN AN ENTRANCE
TO THE SYSTEM.

Parkes, in his “Manual of Hygiene and Pub-
lic Health,” gives the following table of dis-
eases due to the invasion of the human struc-
ture by bacteria. He divides these diseases
into five classes, viz.:

CLASS I.
Smallpox, Influenza,
Scarlet Fever, Relapsing Fever,
Measles, Diphtheria,
Mumps, Erysipelas,
Chicken-pox, Typhus, :
Whooping Cough, Epidemic Pneumonia.
CLASS II,
Yellow Fever, Dysentery,
Cholera, Diarrheea.

Enteric (Typhoid) Fever,

CLASS III.

Anthrax or Malignant Pustule, Vaccinia,
Foot and Mouth Disease, Ophthalmia,

Leprosy, Syphilis,
Glanders, Gonorrhea,
Rabies, ; Tetanus,
CLASS IV.
Erysipelas, : Hospital Gangrene,
Septiczemia, Puerperal Fever.
CLASS V.

Tuberculosis, including Lupus and Scrofula.

I.—Diseases placed in class one are desig-
nated as air-borne, in other words, diseases
48
PARKE’S LIST, ETC.

which may be carried and communicated by
floating dust.

II.—It is claimed that diseases placed in class
two may be carried and communicated by float-
ing dust or taken into the system in water. The
“air or water borne’ diseases, so-called.

III.—*Inoculation as a rule, is the means of
communication of diseases mentioned in class
three.

IV.—A surface lesion is said to be necessary
for the communication of diseases in class four.
When this lesion is present the disease is com-
municable by direct inoculation or may be
transmitted through the air. (By “lesion” we
mean a wound, hurt, or other local alteration
of tissue from a higher to a lower condition.)

V.—In class five a surface lesion is not neces-
sary and the disease is communicable either by
direct inoculation or through the air.

It must be borne in mind, however, that
authorities differ as to the mode of entrance
of some of the bacteria and that theories change
as new light is thrown on the subject. The
science of bacteriology is still rapidly pro-
pressing.

The alimentary canal, the respiratory tract,
the genital tract, the mucous membranes,

 

* By inoculation we mean the introduction of a specific
virus into the system.
49

Inoculation.

Lesion. |

Authorities
Differ.
Channels of
Entrance.

Period of
Incubation.

Period of
Invasion.

Why
Multiplication
Ceases,

BACTERIOLOGY IN A NUTSHELL.

wounds and the skin, all form channels where-
by infection is conveyed to the various parts
of the body which are seats of attack for
pathogenic bacteria.

An incubation period, which varies in dura-
tion, is common to all forms of disease caused
by the invasion of bacteria. During the incu-
bation period there are no symptoms of the
disease. The germs have gained admission
to the body by one or other channel of entrance
and a war is being waged between the invaders
and the antagonistic cells of the body already
spoken of as phagocytes and opsonins. Under
favorable circumstances the invaders do no
harm, they are destroyed by their foes and are
thrown off from the body in the excretions. If
the powers of resistance are weakened in any
way, by the presence of any other disease, for
instance, the influence of the phagocytes is lost
and the period of incubation ends in another
period wherein the power of the invading
bacteria is made manifest and symptoms arise
followed by more or less serious results.

_ In each specific disease the infection is
thrown off from that part of the body which is
the seat of the invasion.

During the course of a communicable or
specific disease there comes a time when there
is no longer any suitable nourishment for the
growth and development of the micro-organ-

50.

X
NATURAL IMMUNITY.

isms and then the disease is starved out.
Sometimes the action of the germs upon the
cells of the body produces a condition which is
poisonous to the germs themselves and thus
they are destroyed by the products of their own
wital activities. In either case the tissues are
. left in a state of immunity from that particular
disease for a longer or shorter period, some-
times for life. We are told of three forms of
immunity.

I.—Natural immunity, which is the natural
and constant resistance of the antagonistic cells
or. phogacytes to the development within the
body of pathogenic bacteria.

II.—Acquired immunity, which is that im-
munity given to the body, or which the body
gains, by a single attack of a certain com
municable disease.

III.—Artificial immuity, which is that im-

munity given to, or gained by the body, through
the use of antitoxins.

NATURAL IMMUNITY.

Let us look into the subject of natural im:
munity and the part played therein by several
allies to the phagocytes.

First, let us consider the protection afforded

the healthy human body by its inner and outei-

surfaces.
51

Immunity.

Natural
Immunity,

Acquired
Immunity.

Artificial
Immunity.
Cleanliness.

The
Skin.

Its

Fortifications.

BACTERIOLOGY IN A NUTSHELL.

We have said in another chapter that bac-
teria exist everywhere. Our skin, finger-nails.
hair follicles, etc., all harbor them. Their
numbers are limited only by the cleanliness of
the individual and even on the surface of the
bodies of the most cleanly the existence of some
pathogenic bacteria is a normal condition.

It has long been an open question whether
or not micro-organisms found upon the skin
can gain admission, find their harmful camping
ground and bring about diseases unless the skin
has a broken surface, or is in some way injured.
In some instances it has been proven that in-
jury or abrasion is not always necessary in
order that germs of disease penetrate the skin
and do us harm. Entrance through an abso-
lutely unbroken skin is a rare occurrence, how-
ever, and then it is believed that the portal of
entry is either through the openings of the
sweat glands or the hair follicles. When in-
vasion takes place, we find as a result that such
troubles as pustules, boils, carbuncles, etc.,
caused by pus-forming bacteria arise. As a
rule, while the sebaceous glands, which are the
appendages of the hair follicles, do not secrete
germicides, the perspiration is of an acid
nature, believed to be slightly germicidal and
it also contains salts which cause it to be an
enemy not easily overcome by certain forms of

52
NATURAL IMMUNITY.

disease germs. The unbroken skin does not
absorb bacterial toxins.

Subcutaneous connective tissue sometimes
forms a formidable barrier to the entrance of
pathogenic or disease germs even after they
penetrate the skin, although there are excep-
tions to this rule, also, as there are exceptions
to all general rules.

The mucous membranes by reason of their
moist condition favor the growth and develop-
ment of a number of bacteria; yet, by a certain
mechanical process, these are constantly ex-
creted and removed without causing the per-
fectly healthy any harmful result.

Certain conditions of the conjunctiva favor
the entrance of harmful germs, yet the con-
stant mechanical action of the eyebrows, the
eyelids, the eyelashes, the tear irrigation of the
surface of the conjunctiva and the germicidal
power of the tear salts; the rapidity with which
the conjunctival epithelium is found to bring
about the process of repair, all of these agents
tend to protect this surface from infection,
healthful conditions being equal.

While it is true that the cavity of the nose
is a common ground for the camping of such
germs as the staphylococci, the streptococci,
the bacillus of diphtheria, etc., they are for the
most part held in abeyance owing to the filter-
ing action of the small hairs on the inner sur-

53

Subcutaneous
Connective
Tissue.

Mucous
Membranes.

The
Conjunctiva.

The
Nose.
The
Mouth.

The
Lungs.

BACTERIOLOGY IN A NUTSHELL.

face of the nose which are kept in motion as
we breath in the bacteria-laden air. The
curves in the nasal cavity also catch dust laden
with bacteria and deposit it in the moist sur-
face of its walls where it is imbedded in mucous
and thrown off by the nose blowing process, if
our bodies are in a normal condition.

Thirty or more different micro-organisms
are said to be normally present in the mouth;
among these are found some that are patho-
genic. The diplococcus pneumonia and the
diphtheria bacillus are among the number.
Yet in a condition of healthfulness these are
expelled through the action of the saliva and
the desquamating of the epidermis due to the
process of mastication. While saliva is not a
germicide, we are taught that it exerts some
influence over disease-producing germs where.
by their growth and virulence are lessened.

In the passage of disease germs to the vital
portions of the lungs, we have seen that the
surfaces of the nose and mouth play an im-
portant part in reducing their harmfulness
The surfaces of the walls of the bronchi also
serve as an impediment to their progress.
Here they are imbedded in a coating of mucous
to be, as a general rule, coughed up and ex:
pectorated unless the system is in a condition
to favor the development of bronchitis, pneu-

54
NATURAL IMMUNITY.

monia, tuberculosis, etc. A neglected cold
often induces such conditions.

The hydrochloric acid which the gastric juice
contains is said to be able to deal a death-blow
to the germs of typhoid fever, tuberculosis,
cholera, dysentery, and some other pathogenic
micro-organisms, when they reach the stomach
in food or water. The gastric juice is believed
by some authorities to render many disease-
producing germs harmless by digesting their
poisons. As nurses, we have learned by ex-
perience that such germs are not by any means
always destroyed by the juices which the sur-
face of the stomach secretes and expels. They
reach the intestines when such powers of re-
sistance are weakened through our failure to
take care of our health, and typhoid fever,
cholera, dysentery, etc., flourish because of our
negligence. Bacteria and their toxins are often
thrown off from the stomach in the process of
vomiting. .

The protective power possessed by the secre-
tions of the intestina: surfaces is limited. Bile
is slightly germicidal; it also neutralizes some
of the toxins. The pancreatic juice has the
power to destroy some of the products of
pathogenic bacteria. In a state of health, harm-
ful germs are eliminated in fecal matter.

The protection against disease germs afforded
the healthy human body by the surface of the

55

Stomach.

The

Intestines.
Phagocytosis.

BACTERIOLOGY IN A NUTSHELL.

genito-urinary tract, is due to the acids thrown
off from the vaginal walls and the irrigation
due to voiding of urine.

The discovery of the province of the phago-
cytes we have already stated is due to the
researches of Metchnikoff of the Pasteur
Institute, Paris. The phagocytes are in reality
contained in the leucocytes or white corpuscles
of the blood. Metchnikoff was the first to dis-
cover and demonstrate and announce that these
cells of the body have the power not only to
devour pathogenic bacteria, but also to destroy
and digest them after they are devoured. Metch-
nikoff also asserts that the leucocytes have
the power to excrete germicidal substances
into the plasma and serum of the blood giving
to the serum greater power as a germicide than
it is known to possess normally. Metchnikoff
also believes that the phagocytes, the name he
has given to the leucocytes, may also absorb
the poisons or toxins of pathogenic bacteria,
and in some manner cause these to be harmless.

Other theories concerning substances said
to be contained in the healthy human body,
which by their action render us immune or
protected from the inroads of disease germs,
present difficulties too great for students just
beginning to look into the science of bacte-
riology, and are really of more benefit to

physicians than to nurses. In our work, we
56
NATURAL IMMUNITY.

only need such knowledge as will serve to help
us to keep healthy ourselves and to aid us in
our profession as care-takers of the sick.

With regard to acquired immunity which
comes to us as a result of one attack of a com-
municable disease. It has already been stated
that in some instances our recovery is due to
the death from starvation of the germs of that
disease, for the reason that they have consumed
all the suitable nourishment that existed within
us. We not only recover, but are left pro-
tected (immune), for a time from a recurrence
of that particular disease. Or, instead of death
arising from starvation, sometimes the germs
have over-reached themselves in their work of
destruction and have produced within us a
toxin or poison which proves to be a source of
death to themselves and of protection or im-
munity to us. In some diseases we are im-
mune for years, sometimes for life. In other
diseases the state of being immune may be only
short lived. Lasting immunity is usually af-
forded by one attack of such diseases as small-
pox, scarlet fever, measles, typhoid fever or
plague. While in pneumonia, diphtheria,
cholera, etc., the protection afforded us by one
attack is often very brief, and seems rather to
predispose to other attacks.

In artificial immunity, Metchnikoff teaches
that when antitoxins are injected into a subject,

57

Acquired,
Immunity.

Artificial
Immunity.
Opsonins.

Nature Is
Jealous.

BACTERIOLOGY IN A NUTSHELL.

they stimulate the phagocytes into greater ac-
tivity and also lend to them greater power for
destruction and absorption of pathogenic bac-
teria and of their toxins. The substance
opsonin, is said by some authorities to act as
an ally to the phagocytes by rendering them
easier of digestion and of absorption. While
opsonin is always normally present in the blood,
it is now believed by many scientists to be
increased in both acquired and artificial im-
munity and is of great assistance to the action
of the phagocytes, not only by rendering them
easier to destroy, but by attracting them toward |
their destroyers, the phagocytes.

THE Opsonic THEORY.

_ The following article, by L. B. Newell, M.
D., copied from the May (1907) number of
the North Carolina Medical Journal, gives a
very clear explanation of the “Opsonic
Theory.”

“The immortal Pasteur realizing the im-
mensity of the subject of the causation of
disease by germs and seeing the effect of the
use of vaccine upon smallpox, uttered the
prophecy that the day would come when we
would treat all bacterial disease by vaccination.

Nature takes ample care that we find out
her secrets only after an infinity of work, yet

as the years go by we begin to realize more and
58
THE OPSONIC THEORY.

more how prophetic were the words of
Pasteur. Step. by step biologists, bacteriolo-
gists, pathologists and therapeutists have been
drawing nearer the goal, each investigator
profiting by the errors of his predecessors—
each coming a step nearer the truth.

Years ago Metchnikoff promulgated his
theory of Phagocytosis. Since his time it has
been known that when bacteria enter the
tissues of the body the system at once en-
deavors to combat their invasion by sending
vast numbers of white blood cells to meet the
enemy. To that mysterious power of attrac-
tion which exists between the invading bac-
teria and the leucocytes, or phagocytes, we
have applied the term chemiotaxis. The pha-
gocytes have the power under certain circum-
stances of picking up the microbes, ingesting
them and killing them. Metchnikoff, believ-
ing that the leucocytes were the only active
elements in the process of phagdcytosis, held
that the fluid portion of the blood was merely
an indifferent medium. Others taking up the
work found that the serum is far from being
inactive or indifferent. They found that the
invading bacteria are in many cases victorious
and overcome the defensive leucocytes. And
this led to the question why either the bacteria
on the one hand or the white blood corpuscles

on the other hand are not always victorious,’

59

Pasteur the
Prophet.

Chemiotaxis. ©
Wright’s

Answer Final.

Derivation
of Opsonin.

BACTERIOLOGY IN A NUTSHELL.

Attempts to answer this have given rise to many
theories and much theorizing. Over in one of
the great English* hospitals there is a man,
Sir A. E. Wright, who has asked this ques-
tion and has answered it with such finality that
the scientific world has almost accepted it as
proved. He has found that there are in the
blood serum or plasma certain substances which
act upon bacteria in such a way as to prepare
them to be ingested and destroyed by the
leucocytes. Without this substance or these
substances the leucocytes are powerless. To
this power, substance or property of the blood
has been applied the term Opsonic derived
from the Greek word Opsono, meaning “TI pre-
pare food for” or “I prepare for dinner.” For
our purposes it matters little what the proper-
ties and characteristics of opsonins are. Ap-
parently there is a different opsonin in the blood
for each form of bacteria. It is a fact readily
observed that an individual often succumbs to
one infection’ more readily than to another;
likewise the same individual at one time seems
immune to a certain bacterial disease, at an-
other he quickly falls a victim to the same
affection. According to our opsonic theory
we would explain these facts by the varying
degree of opsonic power of the blood. Instead

—* St, Mary’s Hospital, Paddington District, London,
England, where Wright established a department of
scientific research in 1005.
 

THE OPSONIC THEORY.

of saying that the infection is more virulent or
that his vital resistance has been reduced we
say the opsonic index is low.

It is claimed by the discoverer that there
actually is a variation at different times in the
opsonic content of the blood. In other words
the blood of an individual will be stronger or
weaker in opsonic power, or the blood of the
same individual will be at different times
stronger or weaker in opsonic power as regards
each disease germ.

That the leucocytes are powerless to fulfill
their function as phagocytes without the help
of opsonins is according to the advocates of
the theory entirely established. Without de-
scribing in detail the methods by which this
is proved it is sufficient to say that the
leucocytes isolated by appropriate methods and
mixed with living germs in a liquid saline
medium do not attack bacteria; but if blood
serum be added to the mixture of leucocytes
and bacteria the phagocytic activity begins at
once. This undoubtedly proves that the serum
contains some substance which enables the leu-
cocytes to attack and destroy the micro-organ-
isms.

Wright has originated a very ingenious

method of determining the opsonic power of.

the blood by comparing the opsonic potency of

_the blood of the individual under observation
61 :

Variation in
Opsonic Content
of the Blood.

Power Contained
in Serum.
Test for
Opsonic
Index.

BACTERIOLOGY IN A NUTSHELL.

with that of the mixed blood of a number of
normal persons. The degree of opsonic power
as determined by this method has been termed
the opsonic index.

Suppose a patient is suffering with an in-
fectious disease like tuberculosis, acne, or ulcer-
ative endocarditis. In such conditions why
are the leucocytes unable to prevail in their
battle with the invading germs? It is because
the opsonic index is below normal or those sub-
stances which enable the leucocytes to fight the
germs are diminished. The problem therefore
naturally presents itself: increase the opsonins,
raise the opsonic index to normal or above
normal and the defenders will prevail!

For obvious reasons any description of
laboratory processes in a paper of this kind is
entirely out of place, but the practical applica-
tion of this theory is about as follows:

An individual is about to undergo treatment
for infection by a certain germ. His blood is
tested for its opsonic index, which indicates
whether or not his vital resisting powers are
above or below normal. If below normal he

is given a hypodermic injection of a specially

prepared culture of the germ which caused his
disease—the micro-organisms having previ-
ously been rendered harmless by heat. As a
result the opsonic power is at first diminished,

but this is invariably followed by a positive
62
IMMUNITY—ANTITOXINS.

increase; this is repeated at suitable intervals
as indicated by frequent blood examinations,
the object being to keep the blood serum in a
condition to prepare the bacteria for destruc-
tion by the white blood cells, that is, in as high
a state of opsonic power as possible.

This principle is being put to very successful
practical application in staphylococcic infection
of the skin such as acne and boils; in tuber-
culosis of the joints, glands and even in con-
sumption; empyema due to presence of the
pneumococcus, ulcerative endocarditis caused
by the streptococcus and in various other forms
of specific bacterial diseases. It is not ap-
plicable except to those diseases of which the
specific causative germ is known.

In other words Opsonin treatment is an
attempt to increase the power of resistance of
the body to attacks by pathogenic organisms.
The results of bacterial invasion are in part,
impairment of digestion and assimilative func-
tion, normal metabolism is interfered with, so
that tissue waste must be repaired, nutrition
fostered and strength conserved.”

ANTITOXINS are antidotes to bacterial
poisons. These substances are obtained by in-
jecting into the body of one of the lower ani-
mals, found subject to the disease, poisons

produced by pathogenic bacteria while develop-
63

Practical
Application.

Antitoxins.
Animals
Experimented
Upon.

Protection.

Testing.

BACTERIOLOGY IN A NUTSHELL.

ing in broth, bouillon or other culture media.
After the bacteria have remained in the culture
media for a stated period their poison per-
meates it. Some of the bouillon is then taken
and injected into the chosen animal (horses,
goats, guinea pigs, rabbits, etc., are all experi-
mented upon. The horse is preferred for the
development of diphtheria antitoxin), with a
special syringe, in very small doses at first
which are gradually increased until the animal
ceases to exhibit any symptoms of the disease,
the poison of which has been used for the in-
jections. Then he is said to be immune or
protected from that particular disease. Some
of the blood of this immunized animal is then
procured and allowedtocoagulate and the serum
or fluid part is injected into other animals or
into members of the human family, in the same
way in which it was used in the first instance,
until they too become immune from that specific
disease for a longer or shorter period.

Before using the blood serum of an im-
munized animal on the human subject it is
tested in another of the lower animals for the
purpose of ascertaining its protecting power.
If it stands the test, it is put up in small tubes
sterilized and tighty sealed until required for
use. Diphtheria, tuberculosis, tetanus, septicemia,
and other diseases are treated by antitoxin
inoculations, The mortality rate in diphtheria,

64
IMMUNITY—ANTITOXINS,

which, until the use of antitoxin used to be fifty
per cent and over, has through the instru-
mentality of this agent been reduced to three
per cent when used sufficiently early in the case.
Antitoxins are said to have the power to render
inert bacteria that may already be present in
the subject treated, or to bring about such alter-
ations in the tissues of the body as will prevent
their development and a cure is the result.

There are four steps necessary in the prepar-
tion of antitoxins:

I.—The germs are obtained and grown ina
proper substance under suitable conditions until
the toxin or poison is produced.

II.—The poison is introduced in gradually
increased doses until protection is obtained.
(A dose, we are taught, can be borne toward
the last of the treatment which if given at first
would have caused instant death.) Some
authorities tell us the process takes from three
to six months. Others give the period as from
six months to two years.

IIJ.—Some of the blood of the immune ani-
mal is next obtained; aseptic precautions are
observed during its removal. After coagula-
tion the serum is taken and its protecting
power tested in other lower animals.

IV.—It is put up in tubes, sterilized, and care-
fully and aseptically sealed, ready for the use

of the human subject.
65

Power of
Antitoxins.
Vaccination.

Koch’s
Circuit.

BACTERIOLOGY IN A NUTSHELL.

The antitoxin treatment is somewhat similar
in its effects to vaccination as a protection
against small-pox. The theory has been ad-
vanced that vaccination against diphtheria and
other communicable diseases may come to be
an established method during epidemics.

It is claimed by Koch that in order to prove
that a certain germ or micro-organism is the
cause of a specific disease it must produce cer-
tain effects. Briefly, these are as follows:

I.—Where the disease is present there the
specified germ must always be found.

I].—The germ found in the diseased body
must again grow and multiply in proper culture
media outside of the body.

III.—The same disease must be reproduced
in a healthy animal by using the poison or
toxin obtained from the culture media in which
the germ has multiplied.

IV.—The same germ must again be found in
the serum of the blood of the animal thus in-
oculated as a result of the process.

Koch further states that it must be proven
that no other germ is capable of producing the
disease under consideration and that if the
original micro-organism is not found all
through the process the suspected disease does
not exist.
SUMMARY AND REVIEW.
SUMMARY OF CHAPTER IV.

Parkes’ list of diseases due to bacterial in-
vasion. How they are communicable.

Authorities have different opinions on this
point.

Manner in which bacteria gain an entrance
to the human structure.

The periods of incubation, invasion and de-
velopment of disease if the bacteria are .not
overcome by the phagocytes.

How infection is thrown off from the healthy
body.

Death of bacteria through lack of nourish-
ment and other causes.

Immunity: Natural, acquired, artificial and
definitions.

The opsonic theory.

Antitoxins: Where they are obtained and
how they are prepared.

Koch’s Circuit.

QUESTIONS FOR REVIEW.—CHAPTER IV.

I.—How are diseases designated in the
classes mentioned?

II.—Define inoculation. Surface lesion.
Air-borne.

III.—Mention channels through which in-
fection is communicated: to the body.

67
BACTERIOLOGY IN A NUTSHELL.

IV.—What do you understand by “period of
incubation?” “Seat of invasion?”

V.—Explain the conditions under whicn
symptoms of diseases due to bacteria arise?

ViI.—What becomes of the invading germs
if overcome by the phagocytes?

VII.—How do bacteria work out their own
destruction?

VIII.—In what other way may their multi-
plication within the body be arrested, and their
death result? Who discovered the province
of the opsonins?

IX.—Describe antitoxins in detail, their de-
velopment and use? What effects should be
expected to follow the antitoxin treatment?

X.—What is Koch’s germ theory? De-
scribe the complete circuit in detail.
CHAPTER V.
COMMON COMMUNICABLE DISEASES.

In former years communicable diseases were
spoken of as either contagious or infectious
diseases. The term contagious was applied to
those diseases which are transmitted by direct
contact or inoculation; infectious to those
which are either air or water borne. It has
been developed by experience that many of
the diseases which were called infectious can
also be transmitted by contact or inoculation
and also that those diseases termed contagious
are sometimes air or water borne, hence the
apparent necessity for the change to the term
communicable which is used to cover all dis-
eases that may be transmitted or communicated
from a sick to a well person without refer-
ence to the method of transmission or com-
munication.

Among the communicable diseasescommonly
met with by the nurse we will first mention

TypHorp Fever. The invading micro-
organism in this disease is the bacillustyphosus,
discovered by Eberth and Koch and sometimes
called Eberth’s bacillus in honor of one of its
discoverers.* The seat of invasion in typhoid
fever is the small intestine in the lower part of

* See history, Chapt. I, page 19.
69

Contagious
and
Infectious,

Communicable
Diseases,

Bacillus
Typhosus.
The Peyerian
Glands.

Changes
Produced.

Hemorrhage.

Perforation
and
Peritonitis.

Absorption
of Poison,

BACTERIOLOGY IN A NUTSHELL.

what is known as the iliem, situated near the
ileo-caecal valve. The bacillus first attacks cer-
tain structures termed the Peyerian glands
(also termed ‘“Peyer’s patches,” after the an-
atomist who first discovered or described
them). These glands are small white look-
ing patches, or groups of lymph follicles, (tiny
sacs containing great numbers of small.
round cells and some fluid) in the mucous and
submucous layers of the lower part of the small
and the beginning of the large intestine. As a
result of the attack, the Peyerian glands in-
flame, swell, thicken and frequently ulcerate
When ulceration occurs sloughing or casting

_ off of dead particles of tissue follows and an

open sore is left behind. Sometimes a blood
vessel is punctured by an ulcer, when a hem-
orrhage more or less severe in its effect takes
place. An ulcer may, and frequently does.
extend through the entire wall of the intestine,
when perforation and the escape of the in-
testinal contents into the abdominal cavity
causes peritonitis and death, unless the perfora-
tion is stich as can be repaired and the patient
is in a condition to warrant such a measure.
While the small intestine is said to be the
chief seat of the bacterial invasion, the various
systems of the human structure are also
affected. There is elevation of temperature,
due to absorption of poison produced by the
70
COMMON COMMUNICABLE DISEASES.

bacillus typhosus, and the patient frequently
suffers from thirst.

A disordered condition of the nervous system
exists, manifested by headache, insomnia, and
in severe cases by delirium, unconsciousness
and other very grave symptoms, described by
authorities as “the typhoid state.”

The digestive system is affected and in con-
sequence we observe loss of appetite, a furred
tongue and sometimes nausea and vomiting.
At times there is a severe diarrhoea present, at
other times constipation may exist.

There are disturbances, too, of the circula-
tory and respiratory systems. The heart beats
more rapidly and there is a corresponding in-
crease in the pulse rate. There are character-
istic changes in the respiration, also, very often.

Changes in the skin are apparent, and it is
usually found to be hot and dry during the
height of the fever.

The changes in the muscular system are
shown by their thin, flabby condition, which is
especially noticeable if the disease runs a pro-
longed course.

Changes are observed in the urine owing to
an increase of the solids contained therein. It
is highly colored and diminished in quantity
usually.

The germs of typhoid fever are thrown off
in the evacuations from the bowels, in the urine,

7 ;

The Nervous
System.

The Digestive
System.

The Circula-
tory and
Respiratory
Systems.

The Skin.

The Muscular
System.

The Urine.

Excretion of
Germs.
Common
Methods of
Communication.

Contaminated
Milk,

BACTERIOLOGY IN A NUTSHELL.

in vomited matter, in the desquamating skin, in
the rose spots, in pus from suppurative com-
plications, and are sometimes found in the
sputum and sordes (foul substance which col-
lects on the teeth and gums of fever patients).
Flies are known to distribute the infection. The
common method of communication is through
contaminated drinking water and food sup-
plies. Milk has been found to contain the
germs and they are said to multiply rapidly
therein. *Milk may be contaminated (1), be-
cause the cows are not kept clean; (2), because
milk pails, cans or other vessels in which milk
is kept are not thoroughly cleansed and boil-
ing water poured into and over them before
using; (3), because the dairy is not kept pure
or persons handling the milk are not careful;
(4), because water, which some dishonest
dealers are said to put in the milk they sell, may
contain the germs. Epidemics of the disease
are common and are often traced to a contam-
inated water supply. Hence the necessity for

*In the best dairies and creameries now-a-days the
milk is Pasteurized in sterile receptacles. Water used to
wash the butter is boiled in covered apparatus, and then
cooled to the proper temperature in specially constructed
refrigerators. Special care is taken to sterilize all cans,
pails, etc., used for the milk and butter. The cows are
kept clean, and the milkers’ hands and clothing also, both
in milking and in handling the milk afterward. Butter
made in these dairies and creameries, according to agri. ’
cultural journals, keeps months longer than when made
and taken care of in the old-fashioned way,

72
COMMON COMMUNICABLE DISEASES.

filtering and boiling the water used for drink-
ing and in preparing food, especially during
epidemics. We cook our foodstuffs to make
them safe, and use sterile water to cleanse fruits
and vegetables which come to the table un-
cooked. We keep milk* and meats, unless
already contaminated when purchased, un-
harmed by placing them on ice. An epidemic
of typhoid fever occurred in Butler, Pennsyl-
vania, in 1903, the horrors of which are still
fresh in our memories. The death rate was
enormous. Many nurses lost their lives. An
infected water supply was the cause.
Great care is necessary on the part of the
nurse who attends typhoid fever patients to
guard all sources of infection under her im-
mediate control. Separate dishes must be used
for such patients, and these must be kept iso-
lated and cleansed by themselves. They must
be disinfected each time after using by pouring
over them boiling water, and they must be
boiled for at least ten minutes once daily, also.
Stools and urine and vomited matter must be
thoroughly disinfected before they are emptied.
Use a sufficient quantity of good disinfectant
solution, boiling water, milk of lime, carbolic
acid, etc. (See Chapter VII for disinfectants),

*It is now considered much the safer plan to use
pasteurized milk for all purposes. The difference in
price between this and the raw product is very small.

73

Sterile
Drinking
Water.

The Butler
Epidemic.

Prophylaxis.
BACTERIOLOGY IN A NUTSHELL.

to completely saturate the mass. Cover the
vessel and allow it to stand for an hour before
disposing of its contents. Thoroughly cleanse
and disinfect the vessel and its cover each time
after using and as a matter of precaution keep
a small quantity of a disinfectant solution in
all vessels preparatory to using again. If you
are using carbolic acid for this purpose, be very
sure to thoroughly wash it out before giving
the vessel to your patient. Severe burns have
been caused by failure to perform this most
important duty. All such vessels should be
boiled once a week, at least. Use a separate
thermometer for typhoid fever patients and also
separate bed-pans, urinals, syringes and rectal
tubes. Keep the thermometer in a bichloride
solution, I-1,000, renewed daily. Be very partic-
ular to cleanse the rectal tubes and syringes and
boil them every day. Bed-pans and urinals
should be boiled in a soda solution at least
once a week. Never turn syringe nozzles
imside of syringes after using. This is a com-
mon error. Infected fecal matter is carried by
the nozzle to the inside of the syringe,—where
it is difficult to reach. Remove the nozzles;
scrub well with soap and hot water before boil-
ing. They should be kept in a carbolic acid solu-
tion, I-40, with the rectal tubes. This solution
must also be prepared anew once in twenty-four
hours. See that bed and body linen and towels
74
COMMON COMMUNICABLE DISEASES.

are disinfected before placing in the laundry
with the ordinary wash; these should be soaked
for at least two hours in a hot 1-20 carbolic acid
solution. Burn all pieces of old linen or ab-
sorbent cotton used to cleanse the mouth and
teeth and lips. Use listerine, borolyptol or other
good solution for this purpose. Give particular
attention to cleansing and disinfection of the
sick room at the close of the case and of every-
thing it contains.

In nursing private cases outside the hospital
when preparing your patient’s room ask per-
mission to remove all unnecessary furniture and
draperies, etc., which may serve as lurking
places for germs. Explain when you ask per-
mission why you would like to have the room
as nearly on the hospital order as possible. If
you are allowed a choice of rooms, one with
plenty of windows for ventilation and on the
south side of the house is preferable and as far
removed from noise and disturbance as you
can get it.

TAKE CARE OF YOUR OWN HEALTH. Be
very careful to thoroughly wash and scrub your
hands (particularly your nails, beneath which
are favorite hiding places for germs), and dis-
infect them each time you attend to the evacua-
tions. Never touch your face with your hands
after such work until they have been carefully
cleansed and disinfected. A tiny speck of any

75

The Patient’s
Room,

Personal
Hygiene.
General
Precautions.

Fresh Air and
Sunshine.

BACTERIOLOGY IN A NUTSHELL.

one of the discharges may be deposited upon
the face or lips and gain an entrance to the
body with disastrous consequences to you. Be

watchful of like dangers when giving baths,

enemas and in cleansing the lips, the teeth, the
mouth and the finger-nails of your patient.
Pay strict attention to personal disinfection be-
fore going from a communicable disease to an-
other case.

Keep your patient’s person, bed, bedding
and room absolutely neat and clean. Pay
special attention to cleansing the mouth and
teeth and lips between the hours for feeding
and before administering food or stimulant or
medicine, as well as after the bath, particularly
in severe cases where sordes collects so rapidly
on the teeth and lips. Dust all woodwork and
furniture with a cloth wrung out of a hot disin-
fectant solution. Floors also should be washed
every day with a hot disinfectant solution.
Pay strict attention to ventilation. Remember
that neatness and cleanliness are necessities, and
that an abundance of fresh air and sunshine are
Nature’s own disinfectants. Two to three thou-
sand cubic feet of fresh air are required in all
sick rooms; the latter amount is obtainable in a
room fifteen feet wide by twenty long, with a
ceiling elevation of ten feet, but the current must
be changed every hour in order to keep the at-
mosphere pure. Your patient can be protected

76
COMMON COMMUNICABLE DISEASES,

by a screen from her possible fear of “catching
cold” while you open up the windows from the
bottom. They should be kept open a few inches
at the top all the time. All “disease germs”
multiply rapidly in a room kept dark, dingy and
badly ventilated, and where papers, books, and
rubbish are allowed to accumulate. The sick
one takes these germs into the system again and
the disease is both aggravated and lengthened.
*Study to acquire right methods of bathing in
this disease. Do not forget the importance of
the cleansing bath using warm water and good
soap every morning, followed by an “alcohol
tub” and careful powdering of the back and
other parts of the body where pressure is ob-
served or friction is noted due to contact with
the mattress. Change your patient’s position

* While it is not the purpose of the writer to speak
of methods of treatment given in diseases caused by
bacterial invasion, several years experience in training
nurses has revealed the fact that many pupils fail to
grasp the proper methods of applying hydrotherapeutics
when nursing typhoid fever. If the physician orders tub
baths, they seem to fail to recognize the necessity for
using friction systematically in order to bring about the
requisite reaction. When they do use friction, they go
about it in such a haphazard fashion that frequently there
is an increased elevation of temperature instead of a
decreased, and the nervous symptoms at the end of the
treatment are more pronounced than before beginning it
(This does not refer to patients whose peculiarities of
constitution are such as to contra-indicate “tubbing,” but
to those who, when properly handled, respond admirably)
In giving sponge baths, also, very often the right method
of sponging is not observed. It seems to be necessary
for nurses who are training pupils to pay particulai
attention to practical teaching in this direction,

7

Alcohol
Rub,

Change
Patient’s
Position.
Ice Caps.

BACTERIOLOGY IN A NUTSHELL.

frequently from side to side unless the
physician in charge instructs you otherwise.
This will not only be a comfort to the sick one,
but will in conjunction with the warm cleansing
bath and alcohol rub, which should be fre-
quently repeated, aid in the prevention of bed
sores, the occurrence of which in almost all
cases is due to lack of care and watchfulness
on the part of the nurse. Turn your patient’s
pillows often and shake them up thoroughly be-
forereplacing them under the head. If the physi-
cian orders ice caps on the head and abdomen,
see that they are kept filled with ice and noi
with hot water. To allow the ice to melt and
become hot water does more harm than good.
When the physician says “ice caps” he means
ice caps and not hot water bottles. Do not
forget to keep the finger-nails clean and the
hair neat, if the physician does not order the
hair clipped.

The care and watchfulness necessary in
nursing typhoid fever holds good in nursing all
germ diseases. It will therefore be unneces.
sary to speak of these at length when dealing
with other communicable diseases.

A Bioop Test. If there is reasonable doubt
as to the disease from which a patient is suffer-
ing being typhoid fever, a test discovered by
Widal, of the University of eee ee is
sometimes resorted to.

7
COMMON COMMUNICABLE DISEASES.

Wipav’s TEsT is based upon the fact that the
blood serum of a person who has typhoid fever
is antagonistic to the bacillus typhosus. A
drop of blood is obtained from the suspected
patient by pricking the lobe of his ear. This
drop is placed on a clean glass slide and covered
with another slide immediately to prevent other
germs which may be lurking about from getting
into it, and it is then allowed to dry. A little of
the bouillon, or other substance, in which the
bacillus typhosus is being cultivated is then
placed on another clean glass slide and covered.
The dried blood of the suspected patient is made
into a watery solution and added to the culture.
From this mixture of dried blood and typhoid
bacillus, what is known as a “hanging drop”
preparation is made under the microscope.
If the patient has typhoid fever the bacilli will
be seen rapidly to lose their power of motion
and to form into tangled clumps, or masses,
and so get away from the blood serum of the
patient. If typhoid fever does not exist, this
clumping and entanglement of the bacilli and
arrest of their movements does not occur.
There is said to be an exception to this rule in
cases where the patient has had the disease

 

* German authorities spell this scientist’s name Vidal,
and assert that he is French and that the American
spelling, “Widal,” has arisen because of the German
pronunciation of the letter V. The French alphabet does
not contain the letter W.

79

“Widal’s
Test.”

Exception to
*Widal’s Test.
Cholera and
Dysentery.

Sources of
Infection.

BACTERIOLOGY IN A NUTSHELL.

recently, under which circumstance the reac-
tion may occur without such evidence of the
onset of a new attack.

CHOLERA is caused by Koch’s comma bacil-
lus. Dysentery, a somewhat similar disease, is
caused by the bacillus dysenteriae—both of
these diseases are contracted through the same
sources as typhoid fever is contracted, and the
same watchfulness against its spread must be
rigidly carried out; also the same precautions
as to personal cleanliness and neatness with
regard to the nurse, patient, and patient’s room.
Be especially careful to let the pure air and
sunshine have free access at all times, and
remember the danger from impure water.
Epidemics of cholera from that source are not ©
common here. An epidemic occurred in Ham-
burg, Germany, in the months of August and
September, 1892, when nearly nine thousand
deaths were reported during the two months.
The epidemic was believed to be due to the
infection of the river from which that city ob-
tains its water supply. Gipsies had camped on
the river banks, and as they had a case of
cholera in their midst, the trouble was thought
to have arisen from that source.

DipHtHeErRtaA. The bacillus diphtheriz, the
micro-organism of diphtheria, can be taken into
the system in food. It may also be communi-

cated from the sick to the well directly from the
80
COMMON COMMUNICABLE DISEASES.

mouth, indirectly through articles used in the

sick room, such as infected dishes, books, toys,
spoons, or other similar articles, or the infection
may be breathed in. The germs are found in
the discharges from the nose and throat. The
nurse must be careful to avoid having the
patient cough in her face, as particles of mem-
brane dislodged from the throat are a fruitful
source of danger, especially so to both physi-
cians and nurses during operations on the
throat (tracheotomy and intubation of the
larynx), for the relief of patients suffering
from this dread disease.

While the seat of invasion in diphtheria is
usually the throat, other parts of the body
suffer also, which is always the state of affairs
in severe germ diseases. A common sore
throat forms a good camping ground for the
diphtheria bacillus and the deadly work is
accomplished very rapidly in many instances.
Patients sometimes die before their danger is
realized by the uninitiated. Suffocation, heart
failure and exhaustion are immediate causes
of sudden death. The nurse must be ever on
the alert for symptoms of approaching danger
from any of these sources.

Disinfect all discharges from the throat and
nose; all bed linen, towels, handkerchiefs,
spoons, dishes and all sick-room appliances with

boiling water, or with hot carbolic acid solution
81

Intubation
and
‘Tracheotomy.

Disinfect and
Ventilate.
Fumigate.

Membranous
Croup and
Whooping
Cough.

Various
Forms.

BACTERIOLOGY IN A NUTSHELL.

1-20. Wash all woodwork, floors and walls
with bichloride of mercury solution 1-1,000
during the case. Observe carefully the precau-
tions with regard to patient and room, sunshine,
ventilation, cleansing and disinfection at the
close of case. Fumigate with formaldehyde
or sulphur. Be careful to protect your patients
from any possibility of drafts striking them.
Use a screen about the bed. No patient’s bed
should be so placed as to be in a current of air.
A room properly ventilated is not “drafty” of
necessity.

Membranous croup and whooping cough are
contracted in the same way as diphtheria, and
are spread by the same means. Moist air is
necessary in the patient’s room in most cases of
diphtheria, whooping cough and croup to re-
lieve the throat symptoms.

INFLUENZA OR LA GRIPPE.

The bacillus influenzae, the germ of this
disease finds an entrance to the system through
the respiratory tract. Sources of infection are
the discharges from the throat and nose, which
should always be disinfected.

There are several forms of “la grippe”,
notably the catarrhal, bronchial and intestinal
forms. In the intestinal form, some physicians
advise disinfection of the evacuations also,
This is one of the few germ diseases which one

82
COMMON COMMUNICABLE DISEASES.

is apt to contract very frequently. No num-
ber of attacks will afford immunity. Epi-
demics are common.

SCARLET FEVER, MEASLES, GERMAN MEASLES,
CHICKEN POX.

The germs causing scarlet fever, measles,
German measles (Roseola) and chicken pox
are found in the secretions from the nose and
throat and in the desquamating (peeling or
flaking) skin. The disease can be contracted
through direct contact with the afflicted person,
articles used in the sick room, such as books,
toys, clothing, food or dishes, and also from
dust and sweepings of the ward or room. This
is especially true of scarlet fever and measles,
and the nurse needs to be more than ordinarily
cautious, as the disease can be communicated
to the well just as long as any desquamating
skin remains. Disinfection before desquama-
tion ceases is practically a waste of time. Cats
and dogs are believed to carry the germs in
their coats and should be kept out of the sick
room. Use carbolized oil as an inunction in
all of these diseases to prevent or lessen the
danger from floating particles of skin. Gowns
and bed linen, which are full of these particles,
should be removed carefully and placed at
once in a disinfectant solution. Do not shake

them about the room. Wash all furniture,
83

Methods of
Communica-
tion. °

Domestic
Animals,
BACTERIOLOGY IN A NUTSHELL.

woodwork, window-sashes and floors with a
cloth wrung out of a disinfectant solution
during the case. Destroy all toys, books, etc.,
used by a scarlet fever patient, by fre
preferably, at the close of the case. When nurs-'
ing scarlet fever in a private home, if at all pos-
sible, obtain two well ventilated, sunny com-
municating rooms in the top story of the dwell-
ing. Have everything you may need for the
care of your patient and yourself in the room
adjoining the sick room, in order.to avoid the
danger of carrying infection to other parts of
the home. If others must frequent the corridor
outside the rooms you have chosen, keep a sheet
wrung out of carbolic acid solution (1-20)
spread over the outside of doors that commu-
nicate with that hallway or corridor. Place over
/ any opening that may be at the bottom of the
doors a towel or cloth saturated with the same
solution. Keep in the closet of the adjoining
room a change of attire to be worn on the street
if you are allowed to go out for an airing, and
be careful not to place in this closet anything
you have worn or used in the sick room. Keep
in this room disinfectants for your own and the
physician’s hands and for disinfecting articles
used in the sick room. The physician will
also probably leave with you his gown, which
he wears to protect his street garb when he
makes his daily visits. This you must also
84
COMMON COMMUNICABLE DISEASES.

keep in the adjoining room where the phy-
sician dons it before seeing his patient.
If your meals are sent up to you from the
general kitchen, be sure to disinfect the
dishes, the tray and everything on the tray
before placing it in the corridor to be carried
down stairs. A small ice chest in which to keep
articles of food, such as pasteurized milk, eggs,
etc., is a great convenience, in fact almost a
necessity, and should of course be placed in
the room adjoining the sick room. After
desquamation ceases your patient must be
treated to several baths containing a disinfec-
ant before mingling with other members of the
family. Nothing worn in the sick room may
be placed on your patient after his bath. Use
the same routine in all diseases in which there
is desquamation. Be very thorough in fumigat-
ing and cleansing, also in personal disinfection
before going to another case.

Mumps. In mumps it is deemed wise to dis-
infect discharges from the throat and nose.
Although it has not yet been proven how the
disease is contracted, it is conceded by all to be
a communicable disease.

TETANUS, commonly called “lockjaw,” is
caused from the invasion of wounds by a germ
known as bacillus tetani, usually found in the
soil near the surface The poisonous matter is

thrown off through the pus ennee from the
85

Sources of
Communication
Unknown.

Bacillus
Tetani.
Fourth of
July Toy
Pistols.

Symptoms.

BACTERIOLOGY IN A NUTSHELL.

wounds. We frequently meet with cases of
tetanus caused by the patients having stepped
on a nail protruding from a board lying in
their pathway. The nail has penetrated the
shoe, entered the foot and carried with ‘t
particles of soil containing the germs. The
bacillus tetani is said to possess the power to
do its deadly work in as short a period as
twenty-four hours, and but rarely to cause
mischief later than the tenth day after the
accident.

In the past few years numbers of cases of
tetanus have occurred after Fourth of July cele-
brations, arising in wounds caused by toy pis-
tols. Blank cartridges of these toys are said to
contain the germs, although authorities are of
the opinion that the germs are probably upon
the soiled hands of the child before the accident
and that they cause trouble in the wound after-
ward just as they do in other gunshot accidents
in which tetanus arises. A law was passed in
1903 in many of the large cities of the United
States prohibiting the sale of these pistols.

The throat and jaws seem to be the parts
most affected when the symptoms first appear.
A feeling of stiffness and sometimes of pain in
these parts is complained of. Rapidly the
stiffening of the jaws increases. Severe
muscular spasms develop, at first in the muscles

of the jaw, but soon to spread over the entire
86
COMMON COMMUNICABLE DISEASES.

muscular system. The spasms increase in
rapidity and severity until they are kept up
almost continuously. (The spasms seen in
tetanus are somewhat similar to the spasms
from strychnia poisoning.) Eventually the
jaws become tightly clenched, the back is bowed
and the patient is frequently found to rest only
on the back of his head and his heels, the rest
of the body arching upward from the bed.
Death commonly occurs from exhaustion. The
majority of cases prove fatal.

Medicines seem to have no effect in arresting
the progress of tetanus. Chloroform and
opiates are used by many physicians for the
temporary relief they give from the violence of
the spasms. In recent years the antitoxin
treatment has saved some lives. In order to
be of any marked value it must be administered
early in the case.

The nurse is instructed to keep the patient’s
room darkened and to guard him from all dis-
turbances. Noises are said to aggravate the
spasms, and she is cautioned to keep him quiet.
He should be watched very closely and must
not be left alone a minute. Strenuous efforts
to give him nourishment must be made. As
the jaws are tightly clenched, recourse is had to
nutrient enemata. “Nose feeding” is not
recommended by the best authorities, as it is

87

Arching of
the Back.

Effect of
Medicines.

Management
of Tetanus,
Preventive
Measures.

Cause of
Erysipelas.

BACTERIOLOGY IN A NUTSHELL.

believed to aggravate the spasms. Opiates are
sometimes given by rectal injection also.

The best authorities now recommend open-
ing up accidental wounds as quickly as possible
after they occur. A thorough irrigation of
the wound with an antiseptic solution then
follows, such irrigation to be kept up at
frequent intervals until all danger of the in-
vasion of the bacillus tetani is over. Between
the irrigations, the wound is protected by an
aseptic dressing held in place by a bandage.

- Some advocate leaving the wound open to

the air after irrigation, claiming that the
bacillus tetani will not live in the presence
of air. Even more than strict regard must be
paid to disinfection and cleansing during the
case and at its close.

ERYSIPELAS, at one time regarded as an
acute inflammation of the skin, is now attrib-
uted to the invasion of the system by the strep-
tococcus pyogenes* which gains an entrance
through wounds, and sometimes through

" scratches or punctures of the skin so tiny as to

be almost imperceptible to the naked eye. The
disease is spread by means of small particles
of desquamating skin from the affected part
floating in the air and by pus from the wound

 

*When the streptococcus pyogenes invades the skin we
have erysipelas; when it invades the blood, we have
septicemia or “sepsis,” and other inflammations in which
suppuration occurs.

88
COMMON COMMUNICABLE DISEASES.

in some cases. It is carried from one person Channels
to another by actual contact, clothing, or other of Outlet.
infected articles, such .as dishes, bedding,
towels, dressings, and anything used by-
patients. It may also be communicated by the
hands of the physician or nurse or by instru-
ments used in treating the case. All such out-
lets and inlets of this most mischievous germ
must be well guarded by the nurse. Burn all
old dressings immediately and use disinfect-
_ants rigidly throughout the case and at the
close of the case. All cases must be isolated
and given to the care of a special nurse. The
“eternal vigilance” ordered in the nursing of
scarlet fever and other desquamating diseases
must be rigidly adhered to in erysipelas.

While the erysipelas germ is liable to attack
wounds, the disease frequently appears where
there is no perceptible wound. A _ rose-red
blush of the skin is seen. The edges of the
affected area are clearly distinct from the
healthy surroundings. There is usually a
swollen condition and the sick one complains
of a tightness and stiffness in the diseased
region. Erysipelas spreads rapidly when it at-
tacks loose tissues, such as those of the face,
and preventive applications have to be made
early in the case. It is a very severe disease in Alcoholic
some instances, particularly so in persons ad- Subjects.
dicted to the habit of using alcoholics to excess.

89
Methods of
Entrance.

Predisposing
Causes.

BACTERIOLOGY IN A NUTSHELL.

Various parts of the system are affected as
shown by elevation of temperature, nausea, and
frequently vomiting, headache, rapid pulse, and
after the disease is well advanced in bad cases
there may be delirium and exhaustion. The
disease sometimes proves fatal. Cleanse, dis-
infect and fumigate rigidly.

Tusercutosis. All forms of this sieeage.
which attacks various parts of the human struc-
ture, are caused by the bacillus tuberculosis.
Tuberculosis of the lungs is called phthisis or
consumption. When the germs attack the
lymphatic glands the disease is spoken of as
scrofula. Tuberculosis of the skin is termed
lupus. The nurse meets with tubercular joint
disease, tubercular disease of the kidneys,
tubercular meningitis, tubercular peritonitis
and so forth.

The germ which is responsible for the de-
velopment of tuberculosis generally gains ad-
mission to the system through breathing in air
in which they are circulating, but it may be
taken in through other sources; for instance, by
drinking milk containing the germs. Jersey
cows are said to be subject to tuberculosis and
their milk apt to contain the germs. Wounds
also admit the germs.

Persons predisposed to tuberculosis are those
whose chests are not well developed, whose cir-
culation is poor and whose vitality is low, par-

90
COMMON COMMUNICABLE DISEASES.

ticularly if their surroundings and occupations
are unhealthy. Those who have to work in
dusty, overheated, badly ventilated rooms, for
example. Insufficient or poor food is given as
another cause favoring the development of the
disease. When one of these causes, or several
of them, weaken the structure, power of re-
sistance is lessened, and when the germs gain
an entrance we fall an easy prey to the ravages
of the disease, if they are not sought after and
driven out at an early stage.

The duties of the nurse when caring for a
tubercular patient are to thoroughly disinfect
all sputa, cleanse and disinfect all sputa cups,
and to destroy by fire all dressings used on
tubercular wounds. Many physicians demand
that sputa be burned also, and special sputa
cups are now in use with a detachable water-
proof lining made of a sort of pasteboard.
These linings are put up in packages which
come with each sputa cup. They are easily
slipped in and out and are changed several
times a day. They are burned immediately on
removal from the cup. Bed and personal
clothing (particularly handkerchiefs) must be
treated to a bath of boiling water or well

soaked in a good disinfectant solution before

placing in the general wash. Boil all dishes and

vessels used for feeding and other purposes in a

2% sal soda solution at least once daily for ten
QI

Early
Precautions.
Fresh Air
Treatment.

The Mosquito
Anopheles.

BACTERIOLOGY IN A NUTSHELL.

minutes. While tubercular patients are not
isolated in the same sense in which scarlet fever
or diphtheria patients are, they should occupy
separate bedrooms and the use by others of a
tubercular patient’s dishes should be FoR-
BIDDEN.

Keep your patient out of doors in the fresh
air and sunshine as much as possible. “Out of
doors all the time, and sleep and eat in the open
air in a proper climate” is getting more and
more to be the prescribed treatment. To
which is added as indepensable, plenty of
nourishing, easily-digested food, especially an
abundance of milk and eggs, perfect cleanliness
and neatness of person and surroundings and
a cheerful atmosphere at all times. The nurse
who pays strict attention to all of these re-
quisites is a valuable and valued assistant to
the physician fighting this disease.

Matarta. Malaria is due to the ravages of
the germ plasmodium malaria, discovered by
Laveran, of France, in 1880. The plasmodium
malaria is an animal parasite; a protozoa, quite
as minute as the vegetable bacteria to which
most germ diseases owe their origin, but much
more complex in structure. It is a single cell
parasite, as all protozoa are, and is believed to
be carried from the sick to the well by a species
of mosquito—the anopheles. Those who live
in low, damp localities or near “swampy”

92
COMMON COMMUNICABLE DISEASES.

regions are more apt to be attacked, as these
are favorite haunts of the mosquito. In such
places window screens and doors with a very
close mesh should be used to prevent the in-
vasion of the anopheles. The germs get into
the red corpuscles of the blood through the
agency of the mosquito, live upon them, and
destroy them. We are taught that there are
three varieties of the malaria germ (as there
are also three forms of the disease), one of
which lives in the human structure seventy-two
hours, and the other two forty-eight and
twenty-four hours, respectively.* Their death,
sad to say, does not mean the end of the
mischief they accomplish, as when they cease
to exist themselves they divide up into a
number of tiny particles or segments each of
which means a new life or germ. These new
germs attack other red corpuscles and live upon
them until they, too, die, but in dying they
form new parasites, as their parent germs did
before them. Each fresh set of germs de-
stroys a large number of the red corpuscles.
Koch, and other scientists, who teach that
the germ is carried by mosquitoes, believe they
* The names given to the three forms or species of
the plasmodium are, (1) plasmodium praecox, found in
aestivo-autumnal malaria, living twenty-four hours; (2)
the plasmodium vivax of the tertian form of malaria,
the life of which is forty-eight hours; (3) the plasmodium
nialariae, found in the quartan form of malaria, which

has a seventy-two hour life.
93

Plasmodium
Malariae.

Length of
Days and
Multiplication.

Mode of |
Communica-
tion,
BACTERIOLOGY IN A NUTSHELL.

slake their thirst in infected pools in swamps
and then alighting on healthy bodies they com-
municate to them the disease-producers by
inoculation. Grassi, Bignami and other Italian
workers have proven by their experiments that
the theory of Koch of Germany and of other in-
vestigators in Europe and America in this
regard is based upon fact. They also teach that
these mosquitoes carry the poison in the same
way from the sick to the well. Prevention of
malaria is only possible by destroying the
mosquitoes.

UNCINARIASIS, another disease caused by an
animal parasite, the uncinaria duodenalis, is
quite common in the United States as well as
in other parts of the world, and is often
diagnosed as malaria, some of the symptoms
being similar. The seat of invasion in un-
cinariasis is the duodenum, the jejunum and
less frequently the colon. Other names given
to uncinariasis are hook-worm disease, anchylo-
ostomiasis, Egyptian chlorosis, etc. Hook-
worm disease is its common title. This
name has probably arisen because of the
peculiar bending backward upon itself of the
anterior portion of the parasite, giving to it a
hook-like appearance when observed under the
microscope. The germs of uncinariasis are
blood devourers and by means of peculiar tooth-
like and suction appendages they cling to the

94
COMMON COMMUNICABLE DISEASES,

mucous membrane that lines the intestine. In
this position they suck the bloodof their victims.
A pronounced anaemia, of course, follows.
This is one symptom found also in malaria. The
plasmodium malariae causes anaemia by its
power to destroy the red corpuscles of the
blood. The germs of the uncinaria duodenalis
enter the body in drinking water or from hands

that have become soiled with dust containing |

the parasites. They are also said to be able
to gain an entrance through the skin from
whence they are carried by the blood into the
right side of the heart and to the lungs.
From the pulmonary blood-vessels they are
thrown into the air spaces and carried upward
to the bronchial tubes, larynx and into the
oesophageal tract; then they are swallowed and
finally pass into the stomach and gain their
camping ground, the intestine. | The disease
this micro-organism produces is frequently
fatal. Diagnosis is made by examining a small
particle of feces under the microscope.
CEREBRO-SPINAL MENINGITIS is caused by
the diplococcus intracellularis meningitidis.
It. is not communicated from the sick to the
well in the same manner in which most com-
municable diseases are, and the germs are not
found in the excretions unless there are lesions
formed either of the brain or spinal cord. The
exact method by which the germs enter and
95

The Germ a
Diplococcus.
Seat of
Attack.

BACTERIOLOGY IN A NUTSHELL.

leave the structure has not been fully decided
upon by scientists, but nurses are instructed
that it is safest to disinfect all discharges from
the body, all personal clothing and bed linen;
also to fumigate and thoroughly cleanse the
room at the close of the case.

The seat of invasion in cerebro-spinal men-
ingitis is in the membranes which cover and
enclose the brain and spinal cord. The germs
set up an inflammation of these membranes,
which are known as the meninges, but the
poison is also distributed to other parts of the
body. Inflammation of the meninges is a
characteristic symptom by which the disease is
made manifest. Sometimes only a small por-
tion is affected, at other times the greater part
of the cerebral surfaces are involved. This is
one of the very few diseases in which the nurse
is told that lack of strict personal cleanliness,
so far as the patient is concerned, must some-
times be permitted because of the necessity for
absolute rest and freedom from all movement.

About one-half of the number of cases of
cerebro-spinal meningitis end in death,* and
about three-fourths of its victims are children
under ten years of age. There have been
epidemics of the disease in the United States,

 

_ * Statistics of the year 1909 show a marked diminu-
tion in the number of deaths where anti-meningococcic
serum was used sufficiently early in the case, :

96
COMMON COMMUNICABLE DISEASES.

One of the most appalling occurred in a small
town in Pennsylvania (population 6,000) in
1864, when it is said that some four hundred
children lost their lives. The very best med-
ical attention and most careful nursing are
necessary to bring about recovery.

PNEUMONIA. Pneumonia is one of the
most serious of all diseases due to the invasion
of the human structure by bacteria. The
special germ to which this disease owes its
origin is the diplococcus pneumonia, or
“Fraenkel’s diplococcus lanceolatus,’”’ which is
also said to produce meningitis, pleurisy and
ulcerative endocarditis. The disease produced
in all cases is an inflammation, the manifesta-
tion of which is modified by the portion of the
body invaded. Pneumonia is an inflammation
of the lungs, sometimes of one or more of the
lobes of one lung, sometimes of the lobes of
_ both lungs, or it may be an inflammation of all
of both lungs. Endocarditis is an inflammation
of the endocardium or membrane lining the
heart. Meningitis is an inflammation of the
meninges or membranes which. enclose and
cover the brain and spinal cord. These various
organs have various functions; this function is
interfered with when the organ becomes in-
flamed and the symptoms are different, while
the cause may be the same. The germ was
- discovered first in the lungs in pneumonia and
97

The Germ of
the Disease.
Why Named

for Pneumonia.

Predisposing
Influences,

Entrance and
Excretion,

Importance of
Nursing.

Immediate
Causes of
Death.

BACTERIOLOGY IN A NUTSHELL.

took its name from that disease. As was men-
tioned in Chapter I, broncho-pneumonia is
often caused by other germs, but authorities are
of the opinion that in genuine, acute, lobar
pneumonia the diplococcus pneumonia is
always present. The germ is a very common
one. It is found in the dust and sweepings of
rooms and is frequently present in the mouths
of the healthy. Exposure to severe weather or
dampness which has produced a heavy cold
acts as a predisposing cause. The system is
invaded, resistive power weakened, and an at-
tack of pneumonia follows. The germs enter
the lungs through the respiratory tract often
causing disastrous changes in these organs.
The poison is eliminated from the system
through the secretions from the seat of the
disease, usually the sputum, which should he
disinfected or burned as in tuberculosis.
Pneumonia has been called the “Captain of
the Men of Death,” because it carries off annu-
ally more victims than any other disease. In
few other forms of illness is such constant care
and watchfulness on the part of the nurse de-
manded as in pneumonia. The disease usually
ends by crisis, when collapse or great prostra-
tion of all the vital forces may occur. Or the
patient may die during the course of a severe
form of the disease from suffocation or heart

failure. Such patients must not be left alone
98
COMMON COMMUNICABLE DISEASES.

under any consideration. Heart failure, is
perhaps, a point especially to be impressed upon
the nurse, as any sudden exertion or excitement
on the part of the patient may bring about the
dread calamity. One attack of pneumonia in-
stead of affording immunity, seems to predis-
pose to other attacks.

RELAPSING FEVER. The micro-organisin
which causes relapsing fever, discovered by
Obermeier in 1873, is termed Spirocheta
Obermeieri. Scientists are of the opinion that
the disease is carried from the sick to the well
by the bite of insects, although the actual
method has not been fully determined. An
epidemic of relapsing fever occurred in New
York and Philadelphia in 1869. It is not a
common disease in recent years, and epidemics
unheard of, owing to improved sanitary con-
ditions.

Friartasis is a disease due to the filiaria san-
guinis hominis, a small worm-like parasite. It
is admitted to the body, usually, through the
alimentary canal in impure drinking water.
Mosquitoes are believed by some authorities to
cause a spread of the disease by the inoculation
of their victims with the blood of diseased per-
sons. The seat of the disease is the deeper
lympathics. Prominent symptoms are chyle
in the urine, cedema of the skin (swelling due
to effusion into connective tissue), and hyper-

99

Obermeier’s
Germ.

Method of
Communication
Uncertain.

Impure
Water and
Mosquitoes.
Prevention.

Yellow
Fever
Commission.

Cause.

BACTERIOLOGY IN A NUTSHELL.

‘trophy (morbid enlargement) of the cellular

tissues, known as “elephantiasis.”’
Prevention consists in removing the sources
whereby drinking water is contaminated and in

_ destroying the mosquito.

YeLtow Fever. The seat of invasion in
yellow fever is the blood. While yellow fever
is not a disease commonly met with by the nurse
in this part of the country, we will speak of it
briefly in this connection. It is a disease which
is very rapidly spread by means of a species of
mosquito, the stegomyia fasciata. Dr. Carlos
Finlay, of Cuba, in the year 1881, first pro-
claimed positively that this species of mosquito
carries the yellow fever germ, which as yet
temains undiscovered; but the connection of
the mosquito with yellow fever announced by
Finlay waited until 1900 for its experimental
demonstration at the hands of the yellow fever
commission consisting of Drs. Reed, Carroll,
Lazear and Agramonte. Two members of this
commission acquired the disease, one of whom,
Lazear, lost his life from its effects. A number
of American physicians had been suspicious of
the mosquito years prior to Finlay’s time, hav-
ing observed their prevalence during yellow
fever epidemics. Dr. Rush, in 1793; Dr.
Weightman, in 1839; Drs. Wood and Barton,
in 1853, all had given voice to this opinion.

These insects transmit the germs by direct
: 100
COMMON COMMUNICABLE DISEASES,

inoculation of blood from the sick to the well.
The disease is not air borne, nor is it carried in
clothing, books or other such articles. The
mosquitoes must be destroyed in order to pre-
vent the spread of the disease. To return to the
work of the yellow fever commission: The
experiments of the American workers, Reed
and Carroll, and their assistants Agramonte
and Lazear, brought to light positive proof of
the part the mosquito, stegomyia fasciata,
plays in the rise and spread of yellow fever.
The yellow fever commission was appointed by
the Surgeon General of the United States Army
to carry on a work of investigation at Havana,
Cuba, in the year 1900. It has been proven
through the efforts of this commission that the
unknown germ of yellow fever is transmitted
from the sick to the well through the bite of
just this one type of mosquito and has also made
clear the utter futility of attempts at circum-
scribing the disease by means of disinfectants.
These men have successfully demonstrated that
the blood is the only avenue of escape of the
germ and that in no other way than through the
agency of stegomyia fasciata can the infected
blood be carried and transmitted. Therefore,
use of disinfectants must be valueless and
destruction of the mosquito, stegomyia fasciata,
the only solution of the yellow fever problem.

With regard to Carroll and Lazear, authorities
Jor

How
Transmitted.

The Blood
Only Avenue
of Escape.
Experiment of
Carroll.

Death of
Lazear.

Preventive
Measures.

BACTERIOLOGY IN A NUTSHELL.

tell us that on August 27, 1900, Carroll allowed
himself to be bitten by stegomyia fasciata that
twelve days before (on the second day of the
disease) had bitten a typical case of yellow
fever. After an incubation period of three days,
Carroll developed a very severe form of the
disease. He made an uneventful recovery.
Lazear also allowed himself to be bitten by the
same species of mosquito, but was not so
fortunate as his co-worker, Carroll. Lazear died
in a hospital at Washington, D. C., from the
effects of yellow fever; a martyr to scientific
research.

In the Southern States and in Mexico, where
epidemics of yellow fever occur every year,
physicians surround the beds of patients sus-
pected to be developing the disease with a net-
ting to prevent the onslaughts of the mos-
quitoes. Dr. Walter Wyman, surgeon of the
U. S. Marine Hospital, in speaking of the
disease in Texas and in Mexico, says that it is
necessary to screen the beds of “‘suspects” be-
cause it is not possible to tell until the fifth
day whether or not the disease is the “dread
yellow variety” which is communicable only
“during the first three days.’  Strenuous
efforts are being made by the health officers in
all parts of Texas and Mexico to exterminate
the pestilence-breeding and disease-carrying

mosquitoes. Water barrels, which are much
102
COMMON COMMUNICABLE DISEASES.

used in these places and which form favorite
haunts for the mosquitoes, are screened also.
All pools and swamps are treated with oil and
in some places drained and filled in.

Busonic PLaGueE is caused by the bacillus
pestis. The seat of invasion of this germ is
the skin and subcutaneous tissues, the lym-
phatics, the lungs and the intestinal tract.
Authorities teach us that the pneumonic form
is the most dangerous and the most readily
communicable. All the discharges, clothing,

etc., must be treated to a hot carbolic acid solu-

tion bath, strength 1-20. Floors and wood-
work must be washed daily with a solution of
bichloride of mercury 1-1,000. Patients must
be rigidly isolated and dead bodies cremated.
While this disease is one commonly confined to
Eastern countries, it may be carried into our
ports on ships infested with rats, mice and
other vermin. This germ has the power
to enter the body through wounds, the alimen-
tary canal, or the respiratory tract. The in-
fection is thrown off in the pus from wounds,
in sputum and in discharges from the body.
When a wound is invaded by the germs, a
severe local inflammation results and quickly
spreads to the lymphatic glands. Flies and
other insects transmit the disease. Adhere
rigidly to personal disinfection at the close of

the case, and all through the case.
103

The Bacillus
Pestis.
Discovery of
the Germ.

Koch’s Circuit
Not Proven.

An Air-borne
Disease.

BACTERIOLOGY IN A NUTSHELL.

SMALLPox. The micro-organism which
causes smallpox was reported as discovered by
Dr. Wm. T. Councilman, of Harvard College,
Boston, Mass., in the early spring of 1904.
He made known his discovery during the
course of a lecture given in that city on “The
Aetiology of Smallpox.” He described the
germ of smallpox as a.“‘protozoon,” represent-
ing the very lowest order of animal life and
therefore quite different from the vegetable
micro-organisms common to the majority of
communicable diseases. Dr. Councilman is
said to have proven that his germ will pro-
duce smallpox by his experiments on rabbits

- and monkeys, but as it is not produced by cul-

tures Koch’s circuit is not traced. The small-
pox infection is general. It invades the skin,
the conjunctiva, the mouth, the oesophageal
tract, the rectum, and the blood.

Smallpox is one of the air-borne diseases and
enters the system through the respiratory tract
and may also be introduced through the skin.
The disease is so readily communicable that all
discharges must at once be disinfected or
burned. The chief factors in the spread of the
disease are the secretions from the nose and
throat and the desquamating skin, all of which
‘contain the poison. Flies which alight on
patients spread the disease. Patients must be

protected by screens about their beds. Great
104
SUMMARY AND REVIEW.

care should be observed to prevent particles of
peeling skin from being carried by the air as
floating dust. In giving baths the water should
contain a disinfectant. Antiseptic washes are
used and also inunctions of antiseptic ointments
or oils to lessen the danger from desquama-
tion. “Everlasting and eternal vigilance” must
be observed in all diseases where there is
desquamation. Formaldehyde vapor is recom-
mended for fumigation after disinfection and
cleansing at the close of the case.

A lecturer* on “Specific Fevers” when speak-
ing in the writer’s presence on the subject of
smallpox a few years ago, advised a class of pupil
nurses as a matter of precaution to “burn every-
thing but the patient at the close of the case.”

Preventive treatment in smallpox epidemics
consists in the rigid carrying out of vaccina-
tion. It is not considered that a nurse who
has been recently vaccinated incurs the slightest
risk in nursing small pox.

SUMMARY OF CHAPTER V.

The terms contagious and infectious as
formerly used have given place to the more
- accurate term “communicable.”

The specific invading micro-organism of
some of the communicable diseases.

Means of transmission—methods of entrance.

*Dr. Robert Saunders Henry, lecturer on_ Specific
Fevers, Thomas Hospital, Charleston, West Virginia,

‘98 to ’o2. 105

A Matter of
Precaution.

The Nurse’s
Danger.
BACTERIOLOGY IN A NUTSHELL.

Seat of invasion.

Effects—constitutional or local.

Multiplication or extermination of germs.

Cleanliness and fresh air as preventives of
diseases termed communicable.

The points demanding most careful atten-
tion on the part of the nurse in all communi-
cable diseases. Disinfection, etc.

QUESTIONS FOR REVIEW CHAPTER V.

I—Give the nurse’s duties, especially as
applied to the severe forms of communicable
diseases.

II.—Give methods of entrance and means of
communication in the diseases designated;
typhoid fever, diphtheria, scarlet fever, tetanus,
tuberculosis, smallpox.

IIJ.—What location is named as the seat of
invasion in typhoid fever? Describe the pro-
gress of the disease resulting in hemorrhage
and perforation.

IV.—In which of the communicable diseases
do you consider most rigid disinfectant and
antiseptic precautions necessary?

V.—Name some communicable diseases be-
lieved to be due to impure water. .

VI.—Describe symptoms of tetanus. State
the usual cause of the disease. How long after
injury may danger of the attack exist? What
treatment is recommended as preventive?

VII.—What conditions are conducive to the
106
SUMMARY AND REVIEW.

development of tuberculosis? Give method
adopted as preventive of its spread. Name
treatment most in favor and state the nurse’s
duties.

VIII.—How is the mosquito responsible for
the spread of malaria? What effect has the
disease upon the blood of its victims? Are the
parasites long lived? In what manner do they
multiply ?

IX.—Which are most susceptible to menin-
gitis, old or young people? Why are the
methods of cleanliness so rigidly carried out in
other infectious diseases not recognized in
meningitis ?

X.—What conditions favor the development
of pneumonia? Show why constant vigilance in
caring for a pneumonia patient is so necessary.

XI.—To what means of communication is
yellow fever confined? What preventive meas-
ures are used?

XII.—How does the germ discovered by
Councilman differ from those of most other
communicable diseases? What essential part
of Koch’s circuit is not carried out?

XIII.—Why should a strenuous use of dis-
infectants be maintained in nursing smallpox?
Name the principal preventive treatment.

XIV.—Does the nurse incur greater risk in
nursing smallpox than in nursing other severe
forms of communicable diseases?

107
Germs
Commonly
Encountered.

BACTERIA IN SURGERY.
CHAPTER VI.

SEPSIS, ASEPSIS AND ANTISEPSIS.

In surgical practice the bacteria met with
most frequently are the following:

Tue STAPHYLOCOccUS PYoGENES AUREUS,
the streptococcus pyogenes, the bacilli coli
communis, the bacillus tuberculosis and the
bacillus tetani.

Tue StapHyLococcus *PYoGENES AUREUS.
Water, dust and air are all means by which this
micro-organism is distributed. It is found,
also, in the mouth, under the finger-nails, and
in superficial layers of skin. This is the germ
most frequently found to be concerned in

‘severe forms of inflammation confined to small

areas in which pus is found, described as
“acute, suppurative circumscribed inflamma-
tion.” While the staphylococcus pyogenes
aureus does not form spores, it is very difficult
to destroy, resisting to a remarkable degree all
means used for its extermination.

Tur SrapHyLococcus PyoceNes *ALBuUS
AND *CITREUS. These germs are found in the

 

* Pyogenes signifies pus-forming; Aureus, golden-
yellow.

* Albus means white.

* Citreus, citron-yellow. These colors are assumed
when seen in growing cultures.

108
SEPSIS—-ASEPSIS—-ANTISEPSIS.

pus from acute abscesses, but are less virulent
than the staphylococcus pyogenes aureus.

STREPTOCoccuS PyoGENEs. One of the
most frequent causes of peritonitis after sur-
gical operations (post operative peritonitis) is
said to be the germ streptococcus pyogenes. It
is found also in puerperal endometritis (inflam-
mation of the mucous membrane lining the
uterus after a child is born) ; in ulcerative en-
docarditis (inflammation of the membrane
lining the heart accompanied by ulceration),
and is also believed to be the cause of general
septicemia (general poisoning of the system
due to bacteria in the blood).

DipLococcus Pneumonia. This micro-
organism,. or germ, is found in empyema
(formation of pus in a cavity), and in acute
abscesses.

. Bactttus TETaANr. Surgeons always fear
the bacillus of tetanus in accidental wounds,
particularly those which have been exposed to
danger of infection from the dust of streets,
stables, or cellars.

Sepsis, ASEPSIS AND ANTISEPSIS. Sepsis is
the result of the gathering of bacteria into the
blood. Bacteria, as we have already said in a
previous chapter, is the name given by
scientists to the large field or group of vege-
table micro-organisms we commonly hear
spoken of as “germs” or “microbes,”

tog

The Cause
of Sepsis.
BACTERIOLOGY IN A NUTSHELL.

We have also said that there are special
bacteria for special diseases, as for example the
“bacillus typhosus” in typhoid fever. In tu-
berculosis the “bacillus tuberculosis,” etc. The
shape of the bacteria in many instances giving
to it its name, viz.: bacillus, “rod-shaped or
pencil-like,” spirilla, “twisted or curved,” cocci
or micro-cocci, “sphere-shaped,” or like a ball
or marble, with modifications or subdivisions of
these shapes as for experimental purposes they
are cultivated in gelatinized broth or other
liquids, and their varied methods of forming
into groups is seen under the miscroscope.
These varied groups are spoken of as “clusters,”
“chains,” “twos,” “fours,” “eights,” and so
forth. Sometimes the disease in which the
germ is first found gives to it its name. The
bacteria found in sepsis when seen under cul-
tivation are grouped in “chains,” and the name
given to them is streptococcus pyogenes.

Sepsis SEPSIS means poisonous or putrid. Asepsis,
Defined. free from poison or putrefaction. Antisepsis,
against poison or putrefaction. Sepsis is found
in general surgery, in gynecological surgery
and in obstetrics. But it ought not to be
found in any one of them. In these days of
aseptic surgery when so much time and thought
and expense are given to the preparation
of the patient, operating-room, dressings,

surgeon’s gowns, caps, instruments, etc., so as
IIa

99 66
SEPSIS—-ASEPSIS—ANTISEPSIS.

to render all these, and surgeons, assistants and
nurses as well, absolutely free from poison
(aseptic) by means of sterilization and anti- Sepsis Should
septics no one should suffer from so terrible a Nop Occur
condition, a condition dreaded by all physicians
and nurses.
Following the preparation of dressings, ban-
dages, gauze, sponges, etc., the utmost possible
vigilance is necessary in order to be sure that
all are kept aseptic after they have been made
aseptic. Of what avail is the special process.
they undergo if the packages containing them
are opened and the dressings passed to the
surgeon by a nurse or assistant who has not
been properly prepared by the free use of soap,
hot water, scrub-brush and the after thorough
use of antiseptics, especially in “hand cleans- ae
ing.” Of what use is it to use an aseptic Operations,
brush, antiseptic solutions and so forth in pre-
paring the area to be operated upon if the nurse
who uses the solutions has been opening and
closing windows and doors, or touching other
things not aseptic, and then comes to take part
in the work mentioned without first thoroughly
scrubbing and sterilizing her arms and hands?
It is after just such blunders as these in operat-
ing rooms, or in private homes, that trouble
with the patient often arises. There is great
reason to wonder why trouble does not arise in pesutt of

every case carelessly handled. Frequently the Blunders,
IIl
Symptoms.

A Fight for
Human Life,

BACTERIOLOGY IN A NUTSHELL.

patient comes through the operation well, and
for:a day or two seems to be doing nicely,
then comes a chill, a sudden rise of tempera-
ture, an increased pulse rate, the patient is rest-
less and uneasy, and has a worn, anxious ex-
pression; other symptoms more or less alarm-
ing appear. The physician is hastily sum-
mond, and with a grave face, which he vainly
tries to brighten in the patient’s presence, he
examines the chart, then mutters beneath his
breath “sepsis;” always a dread word even to
physicians and nurses grown old in the work.
He removes the bandages and dressings to find
abscesses formed about the stitches he had put
in with such care, or, worse still, pus oozing

from between the stitches. Then comes a

hand to hand fight to overcome the effects of
the poison and to save human life, which, sad
to say, cannot always be accomplished, no
matter how closely the physician’s orders are
carried out.

In place of a surgical case we may have a
case of *obstetrics, perhaps a case in which it

 

*In some of the best Maternity Hospitals of the
present day all personal clothing, as well as bed linen,
used for both mother and infant during the first week
are sterilized, just as for a surgical case. This applies
especially to the gowns, abdominal bandages, perineal
pads, diapers, etc. These are put up in packages, sep-
arate from those containing gauze for the cord, silk, etc.
Each package contains sufficient clothing for one day.

_After sterilization they are not handled until needed.

Infants so cared for are said to be less troubled with skin
112
STERILIZATION AND DISINFECTION.

has been necessary to use instruments. The
nurse in preparing them for the physician’s use
has not been sufficiently careful, or in some
other way something containing the germs of
disease has been carried into the puerperal
genital tract. Again we have the character-
istic symptoms observed in the surgical case,
and again the dread word “sepsis,” rings in our
ears. Glad we are to be able to say that such
cases are more rarely encountered as the years
go by. A conscientious, well-trained nurse
will watch every corner, and will let no source
of infection escape her keen eye. She will use
all aseptic and antiseptic precautions herself,
and she will also guard well her work against
any such disasters (or worse) as have already
been alluded to.

Surgeons, themselves, as a rule, realize very
fully the grave responsibility of a life at stake;
but seldom do we meet a careless one. They,

-as well as the world at large, owe a debt of
gratitude to Semmelweis* and Lord Lister* for
the discovery of the possibility of the overthrow
of the power of sepsis through the use of anti-
septics.

STERILIZATION AND DISINFECTION. We
often hear the terms sterilization and disinfec-

eruptions, and there are no infections of the cord. Sterili-
zation of articles used for the mother serves as a further

protection against sepsis.
* See history, Chapter I.
113

How Did
It Occur?

Sepsis Cases
Becoming
Rare.

The Debt We
Owe Lister.

Sterilization.
Disinfection.

Antiseptics.

Germicides.

Deodorants.

BACTERIOLOGY IN A NUTSHELL.

tion used interchangeably as expressive of the
same meaning, which, strictly speaking, is not
accurate. When we sterilize anything we are
supposed completely to destroy the vitality of
all bacteria present, either within, or upon the
substance sterilized. The process of steriliza-
tion is accomplished by the proper application
for a stated period of either chemical agents or
heat.

In order to disinfect anything we do not
necessarily destroy all the bacteria present, but
only those that are harmful, because of their
power to create disease—power to infect—in
other words.

Certain substances used to prevent the
growth of bacteria, but which may not neces-
sarily destroy them are called antiseptics. An
antiseptic does not always possess the power to
disinfect, but a disinfectant is always an anti-
septic.

Germicides and disinfectants are inter-
changeable terms because they both possess the
power to destroy disease-producing germs.

Deodorants are substances or agents used to
destroy offensive odors; they are not of neces-
sity disinfectants, but they may be. Creolin,
lysol, formalin and carbolic acid are all both
deodorants and disinfectants, while such de-
odorants as Eau de Cologne and violet extract

have no power to disinfect.
114
DISINFECTANTS—-HOW MOST EFFECTIVE.

VARIOUS CONDITIONS MODIFY THE POWER OF
DISINFECTANTS.

I.—The kind of bacteria we wish to destroy.
Some are more difficult to kill or to render
powerless to do mischief than others. Spores
are found much harder to deal with, as was
spoken of in describing their formation, than
the bacteria from which they spring.

II.—The number of bacteria to be destroyed.
If a large number are present more of the solu-
tion is necessary than for a small number.
Completely saturate the mass always, for what-
ever number.

III.—The temperature and strength of the
solution. Hot disinfectants are more effective
than warm or cold disinfectants; in fact, all
disinfectants should be used hot.

IV.—Material with which a solution may
come in contact. If some disinfectants come
in contact with organic matter, they are rend-
ered of little or no value thereby. The writer
remembers seeing a pupil nurse sent three times
to empty out and prepare anew a disinfectant
solution because an assistant put his soiled
finger into the first two, in order to test the
temperature, and was about to make the same
blunder a third time when prevented by the

Conditions
Modifying the
Power of
Disinfectants.

An Assistant’s
Mistake.

whispered admonition of the head nurse. The —

lesson is plain.
115
Definition.

BACTERIOLOGY IN A NUTSHELL.

V.—LencTH oF TIME GIVEN THE DIs-
INFECTANT TO DO Goop Work. As a rule, too
little attention is paid to the matter of teaching
pupil nurses the necessity for allowing articles
to be disinfected to remain in the solution, or
to be exposed to heat, etc., for a sufficient length
of time to obtain good, safe results. Give
definite instruction with regard to time required
to disinfect hands, clothing, instruments, and
so forth. Such instruction will save trouble
many times.

Hot air, steam or boiling water, are all dis-
infectants or germicides. The value of hot air -
or dry heat as a disinfectant is limited, as there
are so many things which cannot be disinfected
by either without being injured. Moist heat
(steam), is more penetrating than hot air, and
mattresses, clothing, and surgical instruments
can all be treated by moist heat without sustain-
ing injury. Clothing stained with pus, or fecal
matter, should not be disinfected with steam
heat, as the stains will be found difficult, if not
impossible, to remove afterward.

Boiling water is warranted to destroy all
KNOWN BACTERIA OR THEIR SPORES if exposed
to its power for a sufficient period, and provided,
also, that a sufficient quantity is used to saturate
the mass.

INTERMITTENT STERILIZATION. By  inter-

mittent sterilization we mean the exposure of
116
AsEPTIC MEASURES.

erticles to be sterilized to the action of live
steam for one hour on three successive days.
Certain spores have been known to retain ger-
minating powers after being treated to a bath of
boiling water, and the end sought in intermit-
tent sterilization is to destroy all bacteria which
may develop from spores after the first or sec-
ond sterilization. The process is not always
necessary, because exposure to live steam for
one hour usually kills both bacteria and spores.

In aseptic surgery many consider the use of
both heat and chemicals necessary in order to
insure freedom from all pathogenic bacteria
and their spores. This applies only to the
preparation of dressings, sponges and the skin,
except in diseased conditions. “Clean healthy
tissue contains no bacteria.” “Wounds in
healthy tissue tend to heal spontaneously.”

“Antiseptics being all more or less irritant
tend to interfere with the healing process.”’

If a healthy wound is properly protected
from possible invasion of micro-organisms, the
use of antiseptics is unnecessary and may be
injurious. Infection may reach the wound in
several ways:

I.—Because the room in which the operation
is performed is not properly prepared, or if
sweeping or dusting is done just when the
wound is to be uncovered for dressing. Dust

must always be wiped up in sick-rooms where
II7

Healthy
Tissue
Aseptic.

Infection of
Healthy
Wounds.

Never Dust
With a Dry
Cloth.
Responsibility
of the Nurse.

BACTERIOLOGY IN A NUTSHELL.

wounds are to be dressed with a cloth wrung
out of a disinfectant solution.

II.—Use of water not sterilized in its con-
tainer, or not kept closed after sterilization,
when it again becomes filled with micro-
organisms.

III.—If the skin of the patient has not been
made aseptic prior to the operation. No mat-
ter how cleanly a person may be, the skin, the
hair follicles, and sweat glands all harbor bac-
teria, and if not properly attended to these may
invade the wound. (Ordinary cleanliness is
not “surgical cleanliness.” )

IV.—The hands of the surgeon or nurse may
cause the trouble.

V.—Instruments, drainage, the clothing of
patient, or operator, or nurse, ligatures, sutures,
sponges, dressings, towels, any of which may
be infected. The nurse’s duty is to guard
against danger of infection from whatever
source. After careful cleansing, drainage tubes
must be boiled for an hour on three successive
days and kept between times and until needed
for use in a 75% solution of alcohol. Boil
again for ten minutes just prior to using. Dis-
infect your hands and insert the sterile gauze
packing required by many surgeons and fold
the tubing in a sterile towel ready for use when
called for. Gauze sponges, dressings, towels,

gowns, etc., should be placed in separate
118
ASEPTIC MEASURES,

packages, plainly marked and exposed to the
influence of live steam in a high pressure
sterilizer for thirty minutes on three successive
days. They must not be opened until they are
required for use. Ligatures and sutures should
be loosely wound on glass spools and placed in
test tubes plugged with sterile cotton before
placing in the sterlizer. The cotton plugs, un-
less made too firm, will permit the entrance
of sufficient heat to sterilize the material,
Always keep sutures and ligatures in sterile
tubes closely plugged when not in use, and place
these in tightly closed sterile glass jars. Gauze
sponges should have no raw edgés exposed

When properly made they are folded upor —

themselves and all raw edges turned in.

A careful nurse never makes a mistake in
the number of abdominal sponges she has in
use during an operation.

Catgut requires much preparation in order
to make it safe. Many surgeons prefer to use
catgut which is scientifically prepared in large
laboratories; this is put up in specially con-
structed tubes, which are not opened until re
quired for use. Even these would better be
sterilized again prior to the operation.

DISINFECTION AND DISINFECTANTS.

No. 1. Hanp DisinFectTion.—First, cleanse

the hands (including the arms above the

elbows) with plenty of antiseptic soap and
119

Be Sure of
Your Sponge ,
Count.

Special
Catgut.

Precautions
Used.
Soak Hands
and Arms.

Alcohol and
Bichloride
Preferred.

BACTERIOLOGY IN A NUTSHELL.

hot water, using a sterile brush vigorously for
ten minutes, especially for the nails, beneath
which germs lurk. Second, clean the nails
thoroughly with a nail knife or file, to remove
any bacteria the nail brush may have left be-
hind, Third, scrub the hands again, as the
nail cleaning process will have deposited par-
ticles of dirt containing germs on the hands.
Fourth, soak the hands and arms for several
minutes (3 to 5) in a solution containing about
twenty grains potassium permanganate to each
pint of water, and then in another solution of
oxalic acid (saturated solution), soaking the
hands for the same length of time. The po-
tassium permanganate is a good germicide, un-
less it comes in contact with organic matter,
and oxalic acid is a still better one; it also
removes from the hands the brown stain of the
potassium permanganate. Fifth, soak the hands
and arms in alcohol, and again in hot sterile
water. Dipping the hands and arms in the solu-
tions is of no avail. The alcohol is a further
precaution against bacteria, and the sterile
water relieves the irritation caused by the
vigorous scrubbing and use of strong solutions.
During operation use alcohol, bichloride of
mercury solution, 1-8,000, and sterile water if
necessary for further protection.
No. 2. Hanp Distnrection.—Some sur-
geons use alcohol, followed by bichloride solu-
120
HANDS AND INSTRUMENTS, ETC.

tion and hot sterile water, applied in the same
way as the permanganate and oxalic acid are
used after the vigorous scrubbing with brush,
soap and water and use of nail knife recom-
mended in No. 1. There are various other
methods of hand disinfection.

~ No. 3. Hann Distnrection.—This method
has given uniformly good results.

I.—Five to ten minutes thorough washing
and scrubbing with green soap and hot water,
using a sterile nail brush vigorously, especially
about the finger nails, and drying with a sterile
towel. ;

II.—Careful cleaning and clipping of nails
with nail file and knife.

III.—A second washing of hands with soap
and hot water for further cleansing from nail
deposits.

IV.—Chloride of lime paste is next well
rubbed into hands and nails, and well rinsed off
in a soda carbonate solution.

V.—Soaking of hands three to five (3 to 5)
minutes in a bichloride of mercury solution
1-4,000, followed by hot sterile water.

During operation use frequently for the
hands a bichloride of mercury solution I-4,000,
if necessary, followed by sterile water, as a pre-
cautionary measure. In the most up-to-date
hospitals, surgeons and their assistants and the

nurses who have charge of the instruments and
121
Face Masks
and

Rubber Gloves.

Thorough
Cleansing
Required,

Watch Your
Scalpels,

Cover
Instruments
Quickly.

BACTERIOLOGY IN A NUTSHELL.

dressings during surgical operations, are now-
a-days using face masks as well as rubber
gloves. Those who as yet have not adopted the
face mask tie several folds of gauze over the
mouth; the saliva, even of the most healthy, has
been proven to contain pathogenic bacteria. A
slight cough may eject the saliva upon the field
of operation with disastrous consequences to
the patient.

To DisinFEcT SURGEONS’ SCALPELS AND
INSTRUMENTS :—First, cleanse instruments and
scalpels thoroughly, paying particular atten-
tion to all crevices and hollow parts. Wrap
the blades of the scalpels in cotton and place in
a separate tray above the tray in which you
place the other instruments, as scalpels must
only be boiled two minutes, to prevent dulling
their edges. Place both trays in the sterilizer
in which water is boiling (the water should
contain a small quantity—2%—of carbonate |
of soda). Boil all instruments except scalpels
or bistouries twenty minutes. Remove from
the sterilizer and place immediately in a five per
cent (5%) solution of carbolic acid, covering
the receptacle with a sterile towel, unless the
surgeon prefers to use his instruments dry,
which many do; in this case they are kept in
the sterile receptacle in which they are boiled
and covered as quickly as possible. The same

process of cleansing and sterilizing should be
122
SPUTA, CLOTHING, BEDS, BEDDING, ETC.

adopted after an operation; they must be wiped
dry with a sterile instrument cloth before
returning to the instrument closet.

The method of sterilizing instruments
adopted by some hospitals is to wrap the in-
struments in a sterile towel after cleansing
thoroughly, and then to expose them to the in-
fluence of live steam for a stated period; about
thirty minutes.

To Disinrect SPuTA AND Sputa Cups :—
Pour into the cups sufficient hot five per cent
(5%) carbolic acid solution to saturate the
contents of the cup. Add a small quantity of
carbonate of soda, 5% solution (common wash-
ing soda),to loosen the sputa from the sides and
‘bottom of the cup; cover and allow to stand
until cold before emptying, then cleanse thor-
oughly. The cups should be well scrubbed and
boiled once a day in a soda-carbonate solution,
5%, particularly the sputa cups of tuberculosis
patients.

To Disinrect CLoTHING, BEpDs, BEDDING
AND FuRNITURE:—Personal clothing, towels
and bed linen used in the care of communicable
diseases must be soaked for two or more hours
in a proper disinfectant solution (carbolic acid,
sol. five per cent (5%) is good), and then
thoroughly washed. Dry in the outdoor air
and sunshine. Mattresses and pillows should
be exposed to the influence of live steam for a

123

Use of Soda
Carbonate.

Boil Sputa .
Cups.
Outdoor Air

in Disinfection.

Exposure
from all Sides.

Leave Bureau
and Other

Drawers Open.

Removal
of Odors.

BACTERIOLOGY IN A NUTSHELL.

- sufficient length of time to do good work.

When there is no apparatus for the steaming
process, wash the surfaces of pillows and
mattresses with the disinfectant solution, turn
over the foot-boards of the beds in rooms or
wards to be fumigated, so that the substance
used for futnigation may reach them from ail
sides. To complete the process, put them out
in the fresh air and sunshine for twenty-four
to forty-eight hours. Mattresses stained with
typhoid fever defecations would better be
burned.

Beds, windows, walls, floors, woodwork and
all pieces of furniture first must be cleansed
with brush, soap and hot water and then washed.
with the disinfectant solution. Bureau and
stand drawers, closets and closet shelves should
be treated in a similar way, and left open for
fumigation. The thorough cleansing with soap
and water must be again repeated after fumiga-
tion. If floor rugs are used they should be
washed off with the solution, and both sides
exposed to the fumes of formaldehyde or other
substance just as recommended for mattresses.
Then they should be hung up and well beaten
in the open air, and left there for twenty-four
to forty-eight hours also.

To Distinrect RusBerR SHEETS :—First,
wash clean in hot water with soap and brush,

rinse in clear water and soak one hour in
124
SUMMARY AND REVIEW.

carbolic acid five per cent (5%) solution, or
other good solution. Wipe dry and hang out
in the fresh air and sunlight to remove any
odor than that of rubber. Sheeting with the
rubber preparation on either side (reversible),
is the best and safest in nursing communicable
diseases. The disinfecting can be more
thoroughly accomplished, and the sheets look
safe. This sheeting makes a good covering
for all vessels used for evacuations, etc., to be
disinfected.

SUMMARY OF CHAPTER VI.

Bacteria in surgery. Cases in which they
are found.

Sepsis, its cause, the germ found in sepsis.
Why there should be no cases of sepsis in the
present age. Why sepsis is so much to be
dreaded.

The “everlasting and eternal vigilance”
necessary in surgical work and nursing. The
dangers to be guarded against. What may
come of blunders in surgery and in obstetrics.

Responsibility recognized by most surgeons
as too great to be trifled with.

The nurse’s responsibility should be ever
uppermost in her thoughts.

Sterilization. Disinfection. Antiseptics.

Germicides. Deodorants.
125

Reversible
Rubber
Sheeting.
BACTERIOLOGY IN A NUTSHELL.

Conditions which may lessen the power of
disinfectants.

Heat as a germicide. Intermittent steriliza-
tion.

Aseptic surgery. The precautions necessary
to prevent infection from reaching healthy
tissues.

QUESTIONS FOR REVIEW—CHAPTER VI.

I.—What germs are most commonly met
with in surgery? What cases are they most
likely to attack ?

II.—What germ do physicians most fear in
a certain class of accidental wounds?

III.—Define sepsis, asepsis, antisepsis. What
germ is said to be responsible for the disease
sepsis? How does it gain an entrance to the
human structure? Is it easily overcome? De-
scribe the symptoms of sepsis. Seat of in-
vasion in sepsis.

IV.—Describe in detail the work of the nurse
in guarding sources of infection before, during
and after operations and in obstetrics.

V.—Define sterilization and disinfection.
Antiseptics. Germicides. Deodorants. Are
germicides and disinfectants interchangeable
terms?

VI.—Give an accurate explanation of the
conditions modifying the power of disinfect-
ants. ,

126
SUMMARY AND REVIEW.

VII.—What do you know of intermittent
sterilization? Explain where its use is ad-
vised.

VIII.—Define aseptic surgery. What do
many surgeons consider necessary adjuncts to
safety in the practice of aseptic surgery. De-
scribe in detail the precautions you would
observe in protecting healthy wounds from in-
fection.

127
Cases in
Which It
Is Unreliable.

CHAPTER VII.
SOLUTIONS, THEIR USES AND PREPARATION.

IopinE Sotution :—Harrington’s solution
of iodine is an antiseptic rapidly growing in
popular favor. Strength used, 1-100 and
1-500. ‘This solution is believed by many to
be the best antiseptic now in use for any pur-
pose.

Cargotic Acip SOLUTION AS A DISINFECT-
ANT :—Carbolic acid solution may be safely
used for the disinfection of personal clothing,
bedding, excreta, surgical instruments and
appliances. It cannot be relied upon to de-
stroy spores, and thereforé should not be used
as a disinfectant in tetanus, anthrax, malignant

. eedema, or in any disease due to invasion of

spore-forming bacteria. A one per cent strength
solution is said to be sufficiently strong to
destroy the germs of cholera, typhoid fever,
diphtheria and erysipelas if used hot in suf-
ficient quantity, and allowed to stand an hour,
so as to completely saturate the material to be
disinfected. It will not injure furniture o1
woodwork if used in this strength.

A fe per cent (1-20) solution is necessary
in surgical practice, in order to be reliable.
Fifty-one drams of liquid carbolic acid dis-
solved in each gallon of water makes a five per
cent solution. Pour boiling water over the

carbolic acid and mix thoroughly. To make a
128
SOLUTIONS—USES AND PREPARATION OF,

small quantity of a five per cent (5%) sol.
carbolic acid (1-20) add one dram of the liquid
to nineteen drams of water. (See table at
close of Chapter VII. for number of grains tc
each pint. )

BICHLORIDE OF MERcury solution will de
stroy all forms of bacteria and their spores.
Strength 1-500 required for spores—exposure
one hour. Bichloride of mercury is not re-
liable for the disinfection of excreta, sputum or
pus, because of its power to unite with albumin-
ous matter, which protects the substance Where It
and prevents the solution from penetrating the Fails:
mass. It is a good disinfectant for linen, etc.,
strength, 1-1,000, used hot. It is also used in
hand disinfection and as a wet pack or dressing
in various forms of inflammation. It ruins in-
struments or anything in the shape of metals
and is injurious to fine woodwork or polished
surfaces.

In making up bichloride of mercury solu-
tions, tablets containing seven and a half grains
are often used. One of these tablets added tc
one pint of water makes a I-1,000 solution.
One to a quart a 1-2,000 solution; I-1,000 is
the strongest solution used for almost any pur-
pose. Water is added to obtain the weaker
solutions generally used. For example, if you
have a quart of 1-1,000 solution prepared and

the doctor asks for three quarts of I-4,000 so-
129
Keep in
a Cool
Dark Place.

BACTERIOLOGY IN A NUTSHELL.

lution, add three quarts of warm sterile water
to your quart of 1-1,000 solution, and you will
have the desired strength. If only a small
quantity, say one pint of the solution I-4,000
is needed, take four ounces of the 1-1,000 solu-
tion and add to it twelve ounces of water of
the required temperature. In using the bi-
chloride of mercury powder (corrosive subli-
mate), dissolve seven and one-fourth grains
(grs. 7%4) in each pint of water. Nurses must
not forget that it is a strong corrosive poison.

Sublimine, which is another preparation of
mercury, called ethylenediamin-sulphate of
mercury, is used for all purposes in which
bichloride of mercury solutions are used. It
is considered by some to be less irritating than
bichloride of mercury and alcohol to remove .
oily substances from the skin prior to its use as
2 disinfectant is unnecessary. Strength of so-
lutions from I-10,000 up to I-300.

PEROXIDE OF Hyprocen (Hydrogen Diox-
ide), also called “dioxygen,” is considered by
many surgeons to have no equal either for
safety or efficiency in treating cavities or sur-
faces secreting pus. This preparation must be
kept tightly corked, as it will otherwise dete-
riorate in value very rapidly, and in a cool, dark
place; heat and light spoil the preparation.

INTESTINAL EvacuaTIONs may be safely

disinfected by pouring upon them three times
130
SOLUTIONS—USES AND PREPARATION OF.

their quantity of boiling water. Cover for
one hour before disposing of them. Milk of
lume made from freshly slaked lime is also
a safe, cheap disinfectant for excreta. It
should remain in contact with the evacuation
for two hours. Freshly slaked lime must
be used in preparing this solution. To slake
the lime, pour one pint of water over two
pounds of lime. When dissolved mix thor-
oughly. This preparation is also called
“hydrate of lime.” To make the “milk of
lime” solution, use one pound of hydrate of
lime to eight pints of water. Contact with the
air spoils this solution, renders it inert, and for
this reason it should be made anew every two
days.

Lyso is a good antiseptic, especially so as it
is non-irritant. It can be used to disinfect
almost everything in the sick-room.

It is used also for irrigation purposes; for
disinfection of skin prior to operations; for
hand disinfection, etc. Usually a two per cent
solution is required. When using the liquid
lysol a two per cent solution can be made by
dissolving two and one-half fluid ounces of the
drug in one gallon of water. For dressings
prior to operation, one-half per cent solution
is used. (For number of grains required in
making up solutions, see table.) Tricresol,
solutol and solveol are among the most valuable

I31

Keep Your
Solutions Fresh.

Give Time for
Good Work.

Prepare
Frequently.

Wide Range of
Usefulness,
Strength of
Solution.

Usefulness
Limited.

Weak
Points.

‘

BACTERIOLOGY IN A NUTSHELL.

disinfectants of the present day. They all de-
stroy spores and are not open to the objection
raised against bichloride of mercury with re-
gard to albuminous substances. They belong to
the same family as lysol and are known as the
creosols. Tricresol is accounted as the best dis-
infectant of the group, solutol, solveol and lysol
following in value in the order named. 1 to 5%

' solutions are required in order to be effectual.

CREOLIN is another antiseptic used as a dis-
infectant for the hands, and also for the pur-
pose of irrigation. A five per cent solution is
sufficiently strong, as a rule.

PotassiIuM PERMANGANATE is a fairly good
disinfectant, but its application is limited, be-
cause its action is so quickly rendered inert by
contact with organic matter. It also stains a
yellowish brown any object which it touches,
and the stain requires the application of an acid
to remove. It is used quite extensively as a
deodorant in offensive wounds, for hand dis-
infection and to irrigate cavities. Sixteen to
twenty grains of the potassium permanganate
crystals to each pint of water is the strength of
the solution generally used. Oxalic acid (a
saturated solution) is frequently used to re-
move the stain of potassium permanganate. It
is considered to be a more powerful germicide
than permanganate of potassium, but it is de-
cidedly irritant in its effects.

132
SOLUTIONS—USES AND PREPARATION OF.

NorMAL SALT SOLUTION is a very valuable
antiseptic. As a douche and enema it is well
known. It is also used in intravenous, subcu-
taneous and rectal injections, for its stimulat-
ing’ effects after hemorrhage in various dis-
eases; in shock during or after surgical opera-
tions; in toxemia from any cause. A pint of
the solution is frequently given by rectal in-
jection an hour or two before a surgical opera-
tion, as its use serves to lessen the possibility of
shock, and also assists in preventing the thirst
from which patients so often suffer after surg-
ical operations. 0.6 per cent is the strength
used. The solution is made by dissolving one
dram of pure salt in each pint of hot water.
Sterilize in its container before using, except
where used as a rectal injection, when steriliza-
tion is not necessary. When used intravenously,
or subcutaneously, it must, of course, always
be sterilized.* The intravenous injections are
never given by the nurse, as it is a method con-
fined to the physician alone. It is used during
operations very often, or immediately after
operations, when there has been much loss of
blood, or where the patient is suffering from
shock, in order to “furnish sufficient fluid to

* Sterilize the syringe, canula, suture, thermometer for
testing the temperature of the solution (which should be
115° to 120° F.), scissors, and everything in the shape of
instruments by boiling in soda carbonate solution. For
the intravenous injections, thoroughly scrub and sterilize
the area to be used.

133

Wide Range of
Usefulness.
BACTERIOLOGY IN A NUTSHELL.

suspend the remaining red blood cells for cir-
culation through the system, and to restore a
normal amount of circulating fluid for the
heart and arteries to act upon.” For wet dress-
ings, packs, purposes of irrigation and’ for
soaking of wounds or incisions after surgical
operation in septic and other cases, no better
solution than normal saline has yet been dis-

covered. In point of fact, it has few equals.
WHEN PREPARING FOR AN OPERATION the
nurse can make up a salt solution containing
two ounces of common salt to one pint of hot
water ; sterilize the solution by boiling fifteen to
twenty minutes, after filtering, in a tightly-
closed sterile jar. One dram of this solution
added to each pint of sterile water is the
strength required for all injections necessary
when the patient is suffering from shock,
exhaustion, or other causes in which normal
salt is called for. It should be made anew for
each operation. Or, small tubes containing two
drams of pure table salt may be sterilized by the
intermittent method (one hour each day on
three successive days). The contents of one
tube dissolved in one quart of boiling filtered
water gives the physiological or normal
strength solution. Cool to proper temperature.
The saturated solution contains eleven and
one-half (1114) ounces of salt dissolved in one
quart of boiling water. Sterilize in its container.
134
SOLUTIONS—-USES AND PREPARATION OF.

Use one ounce to a pint of water for “Normal”
strength.

ForMALin So.ution. <A four per cent
solution of formalin is considered to be as effec- |
tive as bichloride of mercury solution 1-1,000,
or as carbolic acid solution 1-20 (5%).
Formalin contains formaldehyde forty per cent
and wood-alcohol ten per cent. Unlike bi-
chloride of mercury it does not unite with
albuminous substances in solution, but it Strong
destroys tron, steel or other metal quite as ace
effectually. The four per cent solution is pre-
pared by adding forty-one-drams to each gallon
of water. It destroys spores and can be used
safely, also, to disinfect excreta, urine, pus, etc.
(For number of grains to use for each pint of
solution see table at close of Chapter VII.)

Boracic Acip is a mild, non-irritating anti-
septic used freely in irrigation and in surgery
of the eye and ear. Many surgeons use a sat-
urated solution; others prefer a solution of one
dram to each pint of water. It is dissolved by
pouring boiling water over the acid powder.
It does not dissolve readily in warm water. In eee
fact it would better be boiled. In making the
saturated solution, it has been found that only
about eighteen grains of the powder to each
ounce of water is soluble in water alone. j

THe AMERICAN STANDARD. A soluticie+, siiability.
known as the “American Standard” is made’

135
BACTERIOLOGY IN A NUTSHELL.

by dissolving six ounces of chloride of lime in
one gallon of water. It is said to be valuable
in the disinfection of excreta. Chloride of lime
in order to be reliable must be purchased of a
reliable manufacturer.

THIERSCH’s SoLuTion. In the preparation
of this solution, which is often used as an anti-
septic for purposes of irrigation, add one and a
half ounces of boracic acid and two drams of
salicylic acid to one gallon of water. Dissolve
the acids in hot water and sterilize before using.

BaLsaM OF PERv. A five to ten per cent solu-
tion of balsam of Peru is an antiseptic solution
frequently used in dressing burns and other
wounds. The balsam is combined with castor
oil or glycerine as a base. Balsam of Peru,
five per cent, and castor oil ninety-five per cent,
is the common formula.

These are a few of the best drugs for anti-
septic and disinfectant purposes now in use.
New drugs for the same uses are being discov-
ered every year.

STERILE WatTER. As sterile water alone is
so frequently used in aseptic surgery, its prep-
aration should be understood even by nurses
just entering the work. The water should first

be filtered and then boiled in vessels* which

{ ~Ve also been made thoroughly clean by wash-
So

‘

~ .
* Filtered water and salt solutions are preferably
sterilized in their containers and kept therein tightly

closed until used.
136
SULPHUR—FORMALDEH YDE—FORMALIN.

ing and soaking in an antiseptic solution, or
better still, by boiling. Distilled water ought
to be aseptic, but as those who distill it are apt
to handle it carelessly, nurses are advised to
boul even distilled water before using it for
aseptic surgery.

FILTERED WATER.

FILTERED WATER is not considered safe to
use for drinking or surgical purposes without
sterilizing. The parasitic bacteria filter through
any ordinary filtering apparatus, the process of
filtration only ridding the water of other im-
purities and making it transparent. A system
of sand filtration is in use in some cities. By
means of the sand the parasitic bacteria are
held in abeyance until destroyed by the sapro-
phytic.

AxcoHoz is used in skin sterilization for the
purpose of removing oily substances, which
prevent the penetration of some other disin-
fectants. Ether is used for the same reason.

SULPHUR DIOXIDE FUMIGATION.

To use sulphur for fumigation, take (4)
four pounds of rock sulphur (brimstone) for
each one thousand cubic feet of air space. All
apertures and crevices about transoms, doors
or windows, etc., must be well packed with
_ damp absorbent cotton, or batting, or strips of
137

Sand
Filtration
Only Safe
Method.

ToF
Witt
Danger from

Inhaling.

BACTERIOLOGY IN A NUTSHELL

old muslin, to prevent the escape of the gas.
Paste paper over openings of grates or regis-
ters, key holes and speaking tubes. Place an
agate-ware, or other metal basin or tub, half-
filled with boiling water upon a firm foundation
made of several bricks built near the center of
the apartment. Moisture is always necessary
during the process of fumigation when using
sulphur dioxide. Have the required amount of
sulphur on top of some paper in an iron kettle
sitting in the basin or tub of water. Pour over
the sulphur a few ounces of alcohol. Set fire
to the outer edge of the paper and leave the
room quickly, as the fumes of gas from sulphur
are dangerous to inspire.* Close and lock
the door, and place a thick rug over any
crevice that may be at the bottom. Keep the
room closed for twenty-four hours, then open
up the doors and windows and _ ventilate
thoroughly. Floors, woodwork, etc., should
then be cleansed thoroughly with soap and
water and all dust wiped up with a cloth wrung
out of carbolic acid solution (5% ) five per cent.

FORMALDEHYDE FUMIGATION.

FORMALDEHYDE is more reliable for fumiga-
tion than sulphur. It is a gas made by burning

 

* The writer remembers an instance in which a nurse
was almost suffocated by inhaling sulphur gas. She
thoughtlessly stepped back into the room for a forgotten
article, and was almost ove cous when rescued.

13
SULPHUR—FORMALDEHYDE—FORMALIN.

methyl alcohol, commonly called wood-alcohol,
in a specially constructed lamp. One and a half
pints of alcohol are required for each one
thousand cubic feet of air space. The process
of converting this amount of alcohol into
formaldehyde gas or vapor takes less than two
hours, and the rooms or wards are ready for
free ventilation at the expiration of eight hours.
Observe the same method of packing crevices
of doors, windows, transoms, etc., and of clos-
ing grate openings and key holes as described
in sulphur fumigation.

_ In some hospitals, potassium permanganate
crystals are combined with formaldehyde solu-
tion in order to liberate gas more readily and
rapidly. The liquid formaldehyde is poured
over the crystals.* It is also said to increase
the germicidal properties of the formaldehyde.
Formaldehyde and sulphur dioxide tapers are
used with good result also. A wet sheet or
other moisture must be present in the room or
ward to be disinfected when using these tapers.
Solidified formaldehyde is a preparation recom-
mended by many. A very simple, specially
constructed lamp is used for generating the
_ gas which is liberated very rapidly. Moisture _
in the room or ward during its use is believed
to be unnecessary; the preparation itself being

*For a room fifteen feet square, five ounces of
permanganate crystals and twenty ounces of formalde-
hyde solution are used.

139
be bg

Some Lamps
Unsatisfactory.

_ Ammonia
*” -Will Remove

‘dor.

BACTERIOLOGY IN A NUTSHELL.

moist. It sometimes dries out, however, and
then water must be added.

As so many formaldehyde lamps are unre-
liable, some have found it more satisfactory to
use formalin solution, which contains forty per
cent of formaldehyde. The formalin is boiled
in a special apparatus and the gas passed into
the room to be fumigated by means of a tube
inserted through a key-hole or other small
opening. One gallon of the preparation will
supply sufficient gas to purify about twelve
hundred cubic feet of air space.

THE SHEET METHOD OF FORMALDEHYDE

FUMIGATION.

After packing all crevices in the room or
ward to be fumigated, and opening up all closet
doors, stand drawers, etc., place a dry sheet in a
pail and over it ._pour one pint of liquid
formaldehyde for every one thousand (1,000)
cubic feet of air space. Quickly spread the
sheet over a line previously stretched across the
room. Close and pack the crevices around
door frames and transoms. It is asserted that
the liberation of the fumes all at once accom-
plishes the work of disinfection more thor-
oughly than when they are liberated slowly
and diluted with air. Liquid commercial
ammonia sprinkled about a room after formal-
dehyde fumigation will remove or neutralize

the odor remaining in the room.
140
SOLUTIONS.

TABLE FOR PREPARATION OF SOLUTIONS,

Using as a basis 7800 grains to the pint.

From “Hospital Formulary.”

To Prepare One Pint of a Solution.

Required to contain of a certain substance.

Per cent,

1/100 per cent....
1/50 per cent....
1/40 per cent....
1/30 per cent....
1/25 per cent....
1/20 per cent....
1/15 per cent....
1/10 per cent....

1/5 per cent....
1/4 per cent....
1/3 per cent....
1/2 per cent...
I per cent...

I 1/3 per cent....
2 per cent....
24 per cent....
3 per cent....

4 per cent....

5 per cent....
Io per cent....
20 per cent....
25 per cent....
50 per cent....

BAH RHR RR HR RR RRR RRR RRR

in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in

Or

10,000...
5,000...
4,000...
3,000...
2,500...
2,000...
1,500...
1,000...
500...
300...
200...
100...
TE as
50...

40
33
25

20...
10...
Baia

4...
Dinas

Take of the substance the
below stated amount in
-grains with enough water

to make one pint.
.grains
. grains
.grains
.grains
.grains
.grains
-grains
.grains
.grains
.grains
. grains
.grains
.grains
.grains
.grains

Ys.

grains
grains

.grains
.grains
.grains
.grains
.grains
.grains

9.73
1.46

1.83,

2.44
2.92
3.65
4.87
7.30

14.60
18.25
24.33
30.50
73-00
97-33
146.00
182.50
219.00
292.00
305.00
730.00

1460.00

1825.00

3650.00

The following simple method of computing
the amount of a liquid drug to be used may be
found useful when preparing solutions for pur-
poses in which absolute accuracy is not neces-

sary.

One pint, liquid measure, contains seventy-
six hundred and eighty (7,680) minims—(3)
36 X (3) 8 X (m) 60= (m) 7,680—.
I4I
BACTERIOLOGY IN A NUTSHELL.

Multiply the number of minims by the per
cent solution required and the result gained
will be the amount of drug in minims for each
pint of solution. Divide this sum by sixty
(60), the number of minims in a dram, and
you will have the quantity to be used in drams.

Example—To make one pint (OI) of a five
per cent solution:

7680 X .05==384.00-+-60==6.40, or about
six and a quarter (634) drams of the drug to
each pint of water.

For a two per cent solution proceed as’ be-
fore: 7680 .02==153.60-60—=2.56, or about
two and a half (24%) drams to each pint of
water.

SUMMARY OF CHAPTER VII.

Harrington’s Solution—Strength used.

Carbolic Acid Solution—its value as a dis-
infectant. Its preparation and uses. Its un-
certainty in destroying spores.

Bichloride of Mercury Solution—prepara-
tion and uses. Its power to unite with albu-
minous substances.

Use and care of Peroxide of Hydrogen.

Safe method of disinfecting excreta. The
preparation of lime for such purposes.

Lysol and Creolin as safe antiseptics.

Advantages and disadvantages of Potassium
142
SUMMARY AND REVIEW.

Permanganate as a disinfectant. Oxalic Acid
in comparison.

Value of Normal Salt Solution. Its prepa-
ration, when and how used.

How Formalin may be as effective as bichlo-
ride of mercury, or carbolic acid.

Boracic Acid, mild, non-irritating, much
used for the purpose of irrigation.

American Standard and Thiersch’s Solution
—their composition and uses.

Balsam of Peru combined with an oil one of
the best dressings for burns.

Sterile Water—process of sterilization.
Distilled water. Filtered water not used with-
out sterilizing in aseptic surgery.

QUESTIONS FOR REVIEW.

I.—lIs carbolic acid a complete germicide?
In what class of diseases is it safest to employ
other disinfectants rather than carbolic acid?

State accurately how to prepare a carbolic
acid solution suitable for use in surgical prac-
tice.

II.—Why is bichloride of mercury unsafe to
use for disinfecting excreta, pus, etc.? Surgical
instruments? How would you prepare one pint
of bichloride of mercury solution 1-4,000 from
a solution I-1,000 as a base?

III.—What can you say of the efficiency of

143
BACTERIOLOGY IN A NUTSHELL.

peroxide of hydrogen? What precautions
should be taken to prevent its becoming inert?

TV.—What can you say of the value of lime
as a disinfectant? How would you prepare 't
for use?

V.—Name several points in favor of the use
of lysol as an antiseptic. Also mention one or
two disadvantages of potassium permanganate.

VI.—In what ways does the use of normal
salt solution benefit the patient when used dur-
ing or after operation? :

VII.—What advantage has formalin solu-
tion over bichloride of mercury for disinfecting
excreta?

VIII.—Why is the free use of boracic acid
safe?

IX.—How is the “American Standard” solu-
tion prepared? Also “Thiersch’s Solution?”
What per cent solutions of the balsam of Peru
are used? Mention a common base. |

X.—Describe the method of sterilizing water,
Is it safe to sterilize water without filtering?
And is distilled water safe to use in aseptic
surgery without sterilizing? ,

XI.—Describe the process of sulphur fumi-
gation. What are its disadvantages?

XII.—What is formaldehyde? State why
it is a more reliable substance to use for fumi-
gation than sulphur. Has its use any disad-
vantages?

144
CHAPTER VIII.

Hycrenic PRECAUTIONS AGAINST BACTERIAL
INVASION.

Neglect of the laws of hygiene frequently
. brings upon the human structure troubles which

so weaken its various organs and systems that
access of bacteria and development of their
poisons therein becomes an easy matter. It
seems opportune, therefore, to add a few
thoughts along hygienic lines.

Nurses, perhaps more than any other class
of women, should not only understand but obey
the laws of Nature as revealed to us in the
study of hygiene. We are so often questioned
by sick ones entrusted to our care as to why
certain ills have come into their lives. Too
often they suffer from diseases of bacterial
origin brought upon themselves through
neglect or ignorance of hygienic laws. While
it is not within the province of the nurse to
take the place of the physician, whose duty it is
to explain this painful truth to his patient, she
can very often afterward help the sufferer by
suggestion, advice and example, to guard
against future troubles.

In the first place, then, what do we mean by
hygiene? Hygiene is that branch of science
which teaches us how to keep healthy. In by-

145

Result of
Neglected
Hygienic Laws.

Hygiene
Defined.
Dame Fashion
and Hygiene.

Society’s
Restrictions.

Outdoor
Games No
Longer
Tabooed.

BACTERIOLOGY IN A NUTSHELL.

gone years, so-called civilization and the ac-
companying customs of the day laid so many
restrictions upon women that it was impossible
to follow fashion’s dictates and be healthy at
one and the same time. Young girls were put
into tight corsets, French-heeled shoes, etc.,
when scarcely beyond babyhood; at any rate,
before they were fairly in their teens and while
they should still have been at play, a thing quite
out of the question for the poor little martyrs
arrayed in such outlandish costumes. In fact,
at the time when foolish mothers allowed them-
selves to follow fashion’s whims and so torture
their young daughters, for half-grown girls to
romp and play games was considered a social
outrage and if young women were to attempt
to join in outdoor sports the offense was rated
as about next door neighbor to criminal. While
there may be, and probably are, many who still
cling to such erroneous and silly notions, the
day has pretty well gone by when established
fashions are so directly opposed to the laws of
health. Woman now-a-days has just as good
opportunities to be healthy as has her brother
man. In this age young girls and young women
may join with members of the “‘sterner sex’’ in
games of tennis, golf and croquet without
being considered “Tom boys” or unladylike.
They learn to swim and to row, to climb to the

hilltops, to ride horseback, to take calisthenic
146
HYGIENIC PROTECTIVE SUGGESTIONS.

exercises, to go corsetless if they want to, and
to wear skirts whose trains are not an impedi-
ment to long, brisk walks in God’s pure air
and sunshine, all without danger of being
called or thought of as either immodest or
ahead of the age, and therefore objects for
contempt.

In our work as nurses so much of our every-
day duty.lies within doors and quite often
caring for those suffering from communicable
diseases, that we are apt to become care-
less or forgetful of the laws which keep us
healthy, the principal and most important
ones of which are the daily bath, fresh out-
of-door air and sunshine and exercise, also
sufficient rest and sleep and proper food taken
at regular intervals. Without obedience to
these laws at the right time and in the right
way the nurse cannot satisfactorily fulfill her
duty to those the physician entrusts to her care.
If she attempts it she soon becomes a physical
or mental wreck; sometimes both. The aver-
age length of time the conscientious nurse is

God’s
World.

Hygiene and
Length of Days.

able to remain in active service as care-taker of ©

the sick is said to be ten to fifteen years. The

time must of necessity be much shorter if her

health is neglected. This does not by any

means signify that we may ever shirk duty.

Oh, no! There are frequently times of emerg-

ency when the nurse, especially the nurse in
147

Duty Toward
Our Neighbor.
BACTERIOLOGY IN A NUTSHELL.

private work, finds it impossible to have her
hours “off duty.” So often there is no one in
the home who is sufficiently experienced in the"
care of the sick to be trusted to relieve her
even for a few hours of much needed rest. If
the expense of a second trained nurse cannot be
afforded, then the path of duty is obvious.

These hours of danger, as a rule, do not last
through many days. Then we must again
take up our “sponge” and “plunge” baths, our
brisk walks in the fresh air and sunshine more
rigorously than ever, and so regain our lost
tone.

Let us decide right in the beginning as we
enter nursing ranks to divide our time of recre-
ation in cultivating all the aids to health and
usefulness (not neglecting the mind), and so
prolong the “length of days” we shall spend
in pursuit of our high and noble calling. High
and noble indeed to those who enter the work
‘in the right spirit. Not for the sake alone of
the money in it,* although the financial side of
the question is important, ‘“‘surely the laborer
is worthy of his hire,’ and be assured that to

* The writer once had the misfortune to hear a pupil
nurse, who had been rebuked for neglect of duty, make
this remark: “I don’t care how I get through my work
in training school. What I am thinking of is the $25 a
week I am going to make when I am out for myself.”
Girls, do not enter the field in such a spirit! The place
for such nurses is outside the ranks with the nurses
who cannot control temper.

148
HYGIENIC PROTECTIVE SUGGESTIONS.

the “worthy” are always given the fruits of
their labor with all kindly appreciation. But
let us remember, also, that there is an inborn
love of the work paramount in the heart of
every nurse who ever becomes in any true sense
of the word worthy and a success. Such
nurses enter the training-school with heart and
soul and mind aglow, with hands ready and
willing accurately to perform the most trivial
or the most difficult tasks with equal care and
promptness. Physicians’ orders are carried out
promptly and accurately and are “charted”
neatly and concisely. At the expiration of the
case while in hospital service each chart is filed

away with other hospital records. In private.

practice these charts are the property of the
physician in charge, and are given to him at the
close of the case. These nurses never forget that
the patient’s chart is a history of the case to
which at some future time the physician may
need to refer; therefore, every symptom is ob-
served carefully and is recorded faithfully.
Their patients always look well cared for; their
hair, teeth, tongue, finger-nails and all parts of
the body are immaculate; their beds dainty and
sweet, and every square inch of the sick rooms
or wards over which they have charge is as
neat and clean and trim as human hands and
observant eyes can make them. Use of solu-
tions in communicable diseases is never forgot-
149

The Successful
Nurses.
Our Duty

to Ourselves.

Nature’s
Gifts.

Results of
Inactivity.

\

BACTERIOLOGY IN A NUTSHELL.

ten. These are the nurses who despise gossip,
scorn deceit and all petty meanness, and who
realize that personal responsibility is attached
as a primary link in the chain of ‘qualifications
of the good nurse.” This realization keeps
them ever on the alert to add to this primary

_ link all the others necessary to make them not

only good nurses, but the best nurses possible.

While realizing our duty towards others, do
not let us forget that we owe a duty to our-
selves also; that we are responsible to God for
our own health. There are broken-down
nurses in the world today who ought still to be
in active service, but whose condition, through
mistaken ideas of duty, renders them a burden
to themselves and to others. Unselfishness is a
virtue, but remember also that “self-preserva-
tion is the first law of Nature.”

A Heattuy Muscutar SysteEM.—We are
taught when studying the muscular system that
Nature gives to each individual about the same
kind and amount of muscle; that the difference
in strength as seen in different people is due in
part to the manner in which they are taken care
of, used, disused or abused. All of our organs
must have proper exercise in order to be kept
healthy, and in order also that we get from
them that service for which they were intended.

If we do not use our brains in study while

we are young they become inactive and we
150
HYGIENIC PRUTECTIVE SUGGESTIONS.

grow dull and stupid. In later life we awaken
to the fact that there are a great many things
we would like to know which we do not know,
and we find it a much more difficult task to
get our brains to act as we desire them to than
it used to be. Study then becomes a burden
rather than a pleasure. In the same way, if we
do not exercise the voluntary muscles (those
muscles which our will controls) sufficiently,
they become wasted and soft and flabby, and
we feel the effects of their disuse in the in-
volutary muscles (those muscles over which
our will has not control). The heart does not
do its best work, the organs of respiration and
of digestion and of excretion are impaired, and
the whole structure is apt to suffer.

On the other hand, if the voluntary muscles
are abused by over-exercise and insufficient
rest we have other evils to contend against.
They wear out faster than Nature can supply
the new material with which to rebuild them,
and we have again the weak, flabby voluntary
muscles, and suffering to endure also from a
weakened condition of the involuntary. All of
these things increase our chances for bacterial
invasion.

Exercise.—Proper muscular exercise then
is necessary if we preserve our health. Mus-
cular development of the arms is often very

noticeable in nurses who give massage treat-
ISI .

Results of
Overwork.

Walking
Develops the
Muscles.
How to Walk.

How to
Dress.

Keep the
Uniform
Sacred.

BACTERIOLOGY IN A NUTSHELL.

ment. Good, brisk walks in the open air are
conducive to the development of all the muscles
of the human structure. When walking do
not drag along as if not quite sure what your
limbs were given you for. It is necessary to
walk briskly in order to keep the circulation
just right. Keep your head erect; your
shoulders well thrown back to give the inspired
air a chance to expand the lungs and keep
them in good working trim. Narrowchested
people become such very often because they
neglect to carry themselves erect and “square
their shoulders’ when they stand or walk.
Narrow-chested people court tuberculosis. To
walk several miles a day is necessary for those
whose occupations keep them indoors most of
the time. ,

Dress.—There is nothing more hygienic in
the way of dress than the nurses’ uniform, but
it was never designed for street wear. It was
designed to protect the sick from bacteria so
frequently carried to them im the woolen
dresses, as well as by the soiled hands, of those
who used to care for them, and who knew noth-
ing of the laws of hygiene as trained nurses
understand them today.

In some cities nurses seem to be given to the

habit of going about the streets and on street _

cars in their uniforms when out for a “con-
stitutional.” This practice, if they but stop to
~ 152
HYGIENIC PROTECTIVE SUGGESTIONS.

think about it, must impress them as all wrong.
We can never tell just where we may encounter
a communicable disease, just as likely on the
street cars as anywhere else. How dreadful to
carry its germs back to some poor sufferer with
already enough to bear! Let our uniform
then be sacred to the sick-room alone, but let
us always wear it there. When one sees a nurse
on duty wearing rings, bracelets, fancy collars
and pins, one stands aghast!

Have a street dress which is simply but taste-
fully made and quickly donned. Wear hygienic
waists, and skirts suspended from the shoulders
rather than from the hips. Wear sensible-
looking, neat hats. Nothing is much more
unprofessional than a nurse in a hat on the
“flower garden” order, or who is adorned with
neck chains, rings, “bangle” bracelets, and
so forth, whose skirts sweep the streets and
gather up dust and bacteria as they sweep.
When it comes to exercising in garments that
constrict the chest and abdominal muscles, it
is quite out of the question. How can the
abtominal or pelvic organs remain healthy
when thrown into unnatural positions by pres-
sure of tight corsets, waist bands or dragging
skirts? How can the nurse who goes out in
cold or wet weather only half clad expect to he
healthy? Any young woman is deserving of
censure who goes out in unseasonable weather

‘153

Jewelry and
Fancy Collars
Not Uniform.

Dress Sensibly.
The Various
Baths.

BACTERIOLOGY IN A NUTSHELL.

in a waist and skirt on the spider-web order
over gossamer underclothing ; who wears also
flimsy, low-cut shoes and the thinnest of
hosiery ; yet we try to excuse her on the plea of
“poor judgment” or “a lack of common sense,”
but for the nurse there should be no excuse.
In her daily avocation she comes in contact too
many times with the fruits of just such errors ©
in judgment. She sees in all their sadness the
evils brought upon the human frame by just
such indiscretions. The cold that developed
after exposure to the elements; the cough that
never got well; the development of tuber-
culosis; the wasted pain-racked frame, all
these are object lessons too familiar ever to
be lightly overlooked or forgotten. It is the
nurse’s duty to dress so as to be healthy. Her
work demands health. There is no room in the
ranks for the nurse who “enjoys poor health.”

Let us all try to be healthy.

THE Batu.—Nothing is more conducive to
good vigorous health than proper and system-
atic bathing. Few things are more restful to
the tired nurse when she comes off duty than a
good warm salt bath before retiring. A pint
of sea salt, or common salt, to each two gallons
of water is a fair proportion. Take a good
“rub” with a Turkish towel on emerging from
the bath. A cold sponge bath should be taken
in the morning when you rise. Many recom-

154
HYGIENIC PROTECTIVE SUGGESTIONS.

mend a cold “plunge” bath and find it very
healthful when taken quickly and followed by a
brisk rubbing, but it is a bath not suited to all
constitutions. Those who find a cold plunge
too severe, often enjoy getting into a tepid bath
and gradually lowering the temperature until
‘at ts cold. A good soap and water tub bath
several times a week is necessary to health-
ful conditions, in addition to “salt’’ baths,
“sponges” and “plunges.” When taking a
bath after a meal, allow two hours to elapse
before beginning operations.

THE Harr, THE TEETH, THE Nalits, Etc.—
Take care of your hair and keep it well sham-
pooed. Diseases can be communicated from
one to another by bacteria which fasten upon
the hair, as well as upon the skin, beneath the
finger nails and within the mouth. Do not for-
get these points when carrying out personal
disinfection during and at the close of nursing
a communicable disease. Be especially careful
when nursing a case where gonorrhoea or
syphilis are suspected. Many good nurses’ lives
have been sacrificed or ruined by contracting
these diseases through lack of care while nurs-
ing such patients. The toilet is never complete
until the hair, the teeth and the finger nails are
as immaculate as the dress and the rest of the
person.

Do not forget that neglect of Nature’s calls

155 .

Disinfect the
Hair.
Obey the
Calls of
Nature.

A Mixed Diet.

Water Supply.

Put the

Pitcher in the.

Refrigerator.

BACTERIOLOGY IN A NUTSHELL.

leads to habitual constipation, cystitis and other
evils allied: to these. Write this truth in cap-
itals upon your memories. It will save you
lots of trouble.

Foop AND WATER SuppLy.—In order to
keep healthy, food should not only be taken at
regular intervals and in proper quantities, but

‘it should also be of the most nutritious, easily

digested and assimilated character. Pastry
and sweets should be partaken of very moder-
ately, if at all. The heaviest meal of the day
should not come in the evening when the diges-
tive system is tired from the exertions of the
day and needs rest. A mixed diet, consisting
of meat, vegetables, fruit, bread, eggs and milk,
will be found more valuable, when planning for
a healthful diet, than the cranky idea of living
entirely upon vegetables or going to the other
extreme and cutting them out of the food list
entirely.

Do not drink cold water, particularly ice-
cold water, with your meals. It chills the
stomach and retards digestion. The human
structure requires plenty of water to keep the
wheels of its complex machinery in good run-
ning order, but this water supply should ve
taken in between meals and should be as pure
as filtering and boiling will make it. Put the
pitcher containing the water on the ice instead
of putting ice into the pitcher. Few germs, if

156
HYGIENIC PROTECTIVE SUGGESTIONS.

any, are entirely destroyed by freezing. They
usually thaw out and again renew their ac-
tivities. Typhoid fever germs live all winter
in pond ice and in the spring and following
summer are just as powerful as ever to spread
infection.

REST AND SLEEP.—Do not sleep or rest in a
stuffy, dusty, badly ventilated room. Remem-
ber to have between two and three thousand
cubic feet of fresh air in all your sleeping rooms
as well as in sick-rooms. This amount of air

we have already said, when speaking of “com-

municable diseases,” is found in a room twenty
feet long by fifteen feet wide with a ceiling ele-
vation of ten feet, provided the current of air
is changed frequently to keep it pure. The
windows should always be open at the top and
to aid in the regular changing of impure for
pure air, open them up from the bottom for a
while every day and open the doors also. Do
not open your windows several inches higher
than your window screens in hot weathet, or
remove the screens, thus admitting flies, etc.
Pick up a common house fly and examine it
under the microscope. The common house fly
has come to be called “the typhoid fly.” When
you see the numberless pathogenic bacteria on
its feet you will not make this mistake again.
Do not rest or sleep in a current of air. It is an
injurious habit for even the most vigorous.
157

Ventilate Your
Sleeping Rooms.
Remove

Day Garments.

Untidy
Nurses.

Let the
Sunshine In,

The Sunny
Nurse.

BACTERIOLOGY IN A NUTSHELL.

Do not sleep in any garment worn during the
day. Learn to relax the muscles when resting.
Do not sleep with a pile of pillows beneath the
head; use only a small pillow. Better no pil-
low at all than to be held up in almost a sitting
position all night, rounding the shoulders and
making the chest hollow.

Keep your own room clean and neat. It is
a matter quite surprising to find any number
of nurses whose rooms look as if “a cyclone had
struck them,” and yet who would not be
guilty of such negligence if they were more
thoughtful of laws of health as applied per-
sonally. Where there is dust and other lack of
cleanliness there, also, will always be found
disease germs.

SUNSHINE.—Sleeping rooms and all rooms
occupied by the delicate should be rooms with a
southern exposure, so as to have the effects of
the sun’s rays for the greater part of the day.
Not only should we live in the sunshine as
much as possible, but we should ourselves be
sunny. The only place for the gloomy nurse
is with the mercenary nurse, the bad-tempered
nurse, the untrustworthy nurse and the nurse
who “enjoys poor health’—outside the ranks.
This thought is particularly applicable to those
nurses who honestly desire to be successful.
Those with a sunny disposition are always at a
premium. What sick one can fail to love and

158
HYGIENIC PROTECTIVE SUGGESTIONS.

desire to have about her the nurse with a
“southern exposure.”’ She fairly beams as she
enters the sick-room, and no matter how plain
her face this nurse always looks beautiful in the
eyes of the sufferer, to whom she invariably
seems to communicate sunshine, the power of
which dissolves and drives away all gloomy
forebodings. She cannot fail to cure the “blues,”
for the sorriest grumbler in the “slough of de-
spond” on the sick list must needs feel ashamed
of such moods in the presence of the sunny
nurse.

Let us all learn to let the sunshine-into our
hearts as well as to let it shine upon us. “Let
the sunshine in” and it will radiate from the
eyes and the smile of the good nurse; be felt in
the touch of her gentle, kindly hand, and in the
tones of her sweet, cheerful, hope-inspiring
voice. Sunshine in the heart and in the soul
leaves no room for the germs of the disease sin,
‘which so often threatens to destroy our use-
fulness.

It is not only the blessed privilege of each
nurse to be the best nurse possible and to be all
that is truest, purest and most perfect among
women, but it is also her duty. May we each
strive to grasp this duty as Heaven-born, so

159
BACTERIOLOGY IN A NUTSHELL.

shall every nurse be beloved and in being be-
loved do her best and noblest work.

“The world may sound no trumpet, ring no bells,
The Book of Life the shining record tells.”

SUMMARY OF CHAPTER VIII.

Ills brought upon the human structure iy
neglect of hygienic laws.

Fashions of bygone days opposed to laws of
health.

Restrictions of society with regard to games,
dress, and so forth, a thing of the past.

Forgetfulness on the part of the nurse with
regard to hygiene may be the cause of a short-
ened period of usefulness. Following its pre-
cepts may lengthen the period.

How success is obtained by the good nurse.

Walking and dressing sensibly. The sensi-
ble dress the hygienic dress.

Keeping the uniform sacred to the sick-room,
_and why.

Bathing and when to bathe so as to be
healthy. The care of the hair, the teeth and
attention to Nature’s calls.

Proper diet and sufficient water supply neces-
sary to health.

Ventilation. Fresh air, sunshine and a
sunny disposition and their effects.

160
HYGIENIC PROTECTIVE SUGGESTIONS,

QUESTIONS FOR REVIEW.

I.—What is hygiene?

II.—Why is it necessary to both study and
practice the teachings of hygiene?

III.—How does manner of dress infringe
upon laws of health? Explain why uniform
should not be worn on the street.

IV.—Why should outdoor sports and ex-
ercise be encouraged ?

V.—Is the nurse responsible for the care of
her own health as well as that of her patient?

ViI—Is she often excusable for neglecting
outdoor exercise, baths, hours of sleep, Na-
ture’s calls?

VII—Why should a mixed diet which is
nutritious, easily assimilated and digested be
adhered to?

VIII.—Explain why fresh air, sunshine and
clean, well-ventilated apartments are necessary
to health.

IX.—Is the nurse who does not try to keep
healthy just as much out of place in the nursing
world as the nurse who does not try to control
her temper? Give reasons for your answer.

X.—Why should a nurse above all other
women aspire to be one of its purest, brightest
and noblest types?

161
Hypothesis
of Ehrlich.

Cellular
Activity.

BACTERIOLOGY IN A NUTSHELL.

SUPPLEMENT.

The “Side Chain Theory’ of Ehrlich.
COMPARISON WITH “THEORY OF METCHNIKOFF

 

* SERUM THERAPY.

PART IL.

Twenty-five years ago, in 1885, prior to the
discovery of toxins and antitoxins and before
scientific workers had discovered the real
nature of immunity, from far off Europe, Paul

Ehrlich, of the Royal Prussian Institute

for Experimental Research at Frankfurt, sent
forth to the world a small pamphlet, entitled
“The Oxygen Requirements of the Body.”
In the course of argument therein, he gives
the opinion that food assimilation by the

_ body cells comes to pass only after the nutrient

substances and the essential part of protoplasm
have united chemically. He does not give us to
understand that assimilation is at an end when
this union takes place. He goes on to explain
his belief that certain molecules of complex
nature must divide, or split up, into very simple
substances or particles prior to their entrance
into the composition of protoplasm. In other
words, the constituent part of the cell which
unites with the food substance acts the part of
a link to bring the food particles into intimate

* See introduction to Fourth Edition Revised, pages 5-9,

162
“SIDE CHAIN THEORY” OF EHRLICH,

‘relation with the digestive activities of the cell.
Ehrlich calls that part of the living protoplasm
which represents cellular activity the central
group of the protoplasm. The chemical groups
which link or bind the food substances, he calls
the “side-chains” of the. protoplasm. The
theory of Ehrlich assumes that the “side-
chains” of a cell consist of clearly defined
groups of atoms which are capable of uniting
chemically with other definite groups of atoms
in food particles. The side chains themselves
he calls Receptors. To the uniting or combin-
ing groups of both the “side-chains” and
the pabulin, or molecular products of food
elements, he has given the name Haptophores.
As the different foods have different chemical
elements, Ehrlich believes they also have dif-
ferent binding (or combining) groups, (hap-
tophores) and that there also must exist many
kinds of receptors, each of which is able only
to combine with that form of food substance
which has a corresponding binding or combin-
ing group of atoms. Each special cell, as nerve
or muscle, assimilates only that form of food
suited to its own peculiar growth and develop-
ment.

In a more recent announcement of Ehrlich

he summarizes as follows:
“We must assume that all substances which enter into
the structure of protoplasm are fixed chemically by the

protoplasm itself. We _~ always distinguished be-
103

Pabulin.

Food
Assimilation.
Physiological
Metabolism.

Pathological
Metabolism.

Immunity of
Some Animals
Explained.

BACTERIOLOGY IN A NUTSHELL.

tween assimilable substances which serve for nutrition
and which enter into permanent union with the proto-
plasm and those which are foreign to the body. No
one believes that quinine and similar substances are
assimilated—that is—enter into the composition of
protoplasm. On the other hand, the food substances
are bound in the cells and this union must be considered
as chemical. One cannot extract a sugar residuum from
cells with water, but must first split it off with acids in
order to set it free, but mow such a chemical union
demands the presence of two binding groups of maximal
chemical affinity which are suited one to the other. The
binding groups which reside in the cells and which bind
food substances I designate as “side-chains” or receptors,
while I have called the binding groups of the molecules
of food-stuffs the haptophores. J also assume that
protoplasm is endowed with a large series of such side-
chains or receptors, which through their chemical consti-
tution are able to bind the different food-stuffs and there-
by provide the prerequisite for cellular metabolism.”

This theory naturally applies to physiological
(constructive) metabolism. In pathological
(destructive), metabolism we have the presence
of an abnormal substance in the body juices
which forms new haptophores. According to
the “side-chain theory,” the power of these
substances to exert injurious effects within the
body depends upon their ability to attach them-
selves to the cell receptors. In this way is
explained the immunity of some animals to
certain toxins, viz.,—they lack the appropriate
receptors for the invading haptophores to com-
bine with. Should the invading haptophore
combine with a receptor, one of the following
phenomena takes place:

164
“SIDE CHAIN THEORY” OF EHRLICH.

(1.) The invading haptophore may so
closely resemble the normal haptophore as to
perform the function of the latter, and so no
harm is done. |

(2.) It may combine with neither good nor
bad result, but may deprive the cell of its nutri-
tion by reason of its having displaced ihe
normal haptophore.

(3.) It may be directly or indirectly inju-
rious or destructive by means of an associated
toxophorous (poisonous) group. It will thus be
understood that toxins are conceived to be com-
plex, composed of fixation or binding groups
(haptophores) and poisonous groups (toxo-
phores). The cells of the body Ehrlich believes
to possess and to furnish appropriate receptor
groups, haptophiles and toxophiles, through
which the respective combinations are effected.
But until the haptophore of the toxin has been
taken up by the haptophile of the cell, the toxo-
phore cannot attack the toxophile. He also
believes a bacterium to be a chemical compound
made up of two or more chemical groups, close-
ly or loosely combined. When a bacterium
enters the body and comes in contact with the
- lateral or “side-chain”.groups of the body cell,
the receptor (antitoxic), group combines
chemically with the toxic group of the invad-
ing bacterium. If the chemical affinity between

the toxic group and the receptor (antitoxic),
165

Toxophorus
Groups,

+

Haptophorus
Groups,

Chemical
Composition
of Bacteria.
Liberation
of Toxins.

Hemolysis.

Amboceptor.

Complement.

Ehrlich’s
Conception of
Antitoxin.

BACTERIOLOGY IN A NUTSHELL.

group is greater than that between the toxic
group and the remainder of the cell, it will
split off and combine with the receptor of
the body cell; thus toxins are liberated—set free
to carry on their work of destruction within the
body. The bacteria proper are disposed of by a
splitting-up action of the blood known as
“hemolysis.” Two bodies are present in the
blood. One body called the complement is
normally present in the serum, the other is an
intermediary body known as an amboceptor or
fixiator. When the affinity between this group
and a group contained in the invading micro-
organism is stronger than the affinity to the
remainder of its own cell it will split off and
join the other body, (the amboceptor), forming
an avenue for the passage of the complement
which destroys the cell. The phagocytes are
then supposed to remove the dead invaders,
and absorb or ingest them.

Antitoxin, Ehrlich explains in the following
manner: When a useless haptophore ‘attaches
itself to an important receptor, it becomes neces-
sary for the cell to form new receptors of a
similar nature. When prolonged and repeated
invasions of useless haptophores takes place an
excessive production of receptors is formed,
which finding no function detach themselves
from the cells to form in the tissue juices new

groups of molecules which have an especial
166
“SIDE CHAIN THEORY” OF EHRLICH.

affinity for the invading haptophores. These
latter groups, the detached or cast off receptors,
are the antitoxins.

When one seeks to compare the “side-chain
theory of Ehrlich” with the “theory of phago-
cytosis of Metchnikoff,” one finds but little in
common. Notwithstanding this fact, it is
rather striking that there are so few contradic-
tions. Ehrlich’s theory is one built upon chem-

Ehrlich’s
Hypothesis
Versus Theory
of Metchnikoff,

ical lines. That of Metchnikoff is founded upon '

biological principles. Each in a measure relates
to nutrition. Metchnikoff only carries food
substances into contact with the digestive
ferments contained in the cell and there he
leaves them. Ehrlich goes farther and teaches
us how nutritive matter enters into and
becomes a part of the protoplasm. Metchnikoff
does not appear to concern himself with the
structure of toxins, nor with the way in which
they injure the cell. Ehrlich points out both of
these factors. Metchnikoff believes that anti-
toxin is produced by phagocytic action on the
toxin. Ehrlich presents an opinion entirely
opposed to this. He believes antitoxins to be
produced by the cell itself.

Both believe that amboceptors (fixiators)
become extra-cellular in the blood. Metchnikoff
asserts that complements are substances which
are produced by the phagocytes and that they
are found in the plasma or serum of the blood,

167

Metchnikoff’s
Conception of
Complement
Versus that
of Ehrlich.
Work of
Antitoxin a
Chemical
Process.

Phagocytic
Power.

Bactericidal
Province of
Serum.

BACTERIOLOGY IN A NUTSHELL,

as a result of injury to the phagocytes. Ehrlich
does not take up these points to any great
extent, but some of the supporters of his theory
believe that complement exists normally in the
blood in the plasma.

With regard to the action of antitoxins,
Metchnikoff affirms that antitoxin stimulates
the phagocytes to an increased absorption and
destruction of toxins, while Ehrlich holds
the opinion that antitoxin combines with toxin
by a chemical process only. Metchnikoff
believes that all types of immunity are depend-
ent, either directly or indirectly, on the activity,
of phagocytes. Ehrlich’s “side-chain” theory
does not coincide with this view, yet it does not
overlook the importance of phagocytosis in
certain infections. /

It has been demonstrated by scientists that
recovery from some of the communicable dis-
eases (for example, those due to the staphylo-
coccus, streptococcus, and pneumococcus infec~
tions) is not accompanied by marked antitoxic
or antibacterial properties in the serum of the
blood. On the contrary, an increase in the num-
ber of circulating leucocytes is found, which are
known to be cells of bactericidal or phagocytic
power.

In certain other diseases, for example,
typhoid fever and diphtheria, just the opposite

condition is found. It would seem therefore,
168
THE TWO THEORIES COMPARED.

from these investigations, that phagocytosis is
of great importance in overcoming the invaders
in the first group of diseases and the antitoxic
and bactericidal province of the serum in the
other.

i6e
Serum Therapy
Defined.

Direct and
Indirect Serum
Therapy.

Strength of
Serums.

Purity of
Serums,

BACTERIOLOGY IN A NUTSHELL.

PART II.
SERUM THERAPY.

Serum therapy is an attempt to combat the

activity of certain pathogenic agents by the use
of injections into man or animal of specifically
antagonistic substances contained in or derived
from the cells and body juices of animals artifi-
cially immunized against such infections. This
process is known to the scientific world as “direct
serum therapy.” When in the tissues of man
or animal antibacterial or antitoxic substances
(antitoxins), are made to form, through .
vaccination or through protective inoculation,
the process is spoken of as “indirect serum
therapy.” Both methods are used for either |
preventive or curative purposes. Serums are
also used for the purpose of diagnosis in
diseases due to bacterial invasion.
_ Serums, in order to be effective, must be of a
specified strength. In the early days of treat-
ment of diphtheria by antitoxin, the low value
of the serum made it of comparatively little
effect unless used in very large doses, as the
preparation contained only about twenty (20)
antitoxin units per cubic centimeter. Many
serums now-a-days contain more than 500 units
per cubic centimeter.

Antitoxic and other serums must be free
from micro-organisms and toxins.

170
SERUM THERAPY.

The principles involved in serum therapy
may be considered under three heads namely
(a) Antitoxins, (b) Bacterial or antibacterial
serums (c) and Vaccination. The terms,
“anti-bacterial,” “bactericidal”? and ‘‘bacterio-
lytic” are frequently found to be used inter-
changeably. Strictly speaking this is inac-
curate, as in the true sense of the term they are
not synonymous. Bactericidal serums we, of
course, understand to mean those serums which
are able to destroy bacteria. If during the pro-
cess of destruction, they are able also to dis-
solve bacteria, they are truly bacteriolytic. In
either event the serum is antibacterial. In
typhoid fever the serum kills but does not dis-
solve the bacteria. In cholera the action of the
serum is both to kill and to dissolve the bacteria.
Until recent years the action of toxin and the
efficiency of an antitoxin could only be decided
upon by experiments on the living subject.
These experiments are still kept up, but not ex-
clusively, as the nature of the action of the anti-
toxin could not easily be determined by this
method alone. Since the introduction of test-
tube experiments into laboratory work, some
of the difficulties which existed have been
‘removed. There are still differences of opinion
among authorities, as to whether antitoxin
combines chemically with toxin, or whether its

protecting (immunizing) power is due to its
17I

Inaccurate
Use of Terms.

“Bactericidal,”
“Bacteriolytic”
and
“Antibacterial”
Explained,

Experiments.

a

Authorities
Not in Unison,
Behring
Sanctions
“Chemical
Union.”

Exception -
Taken by

Other Workers.

Antitoxic
Serums.

Antibacterial
Serums.

BACTERIOLOGY IN A NUTSHELL.

stimulating effect on animal tissues. Behring,
the discoverer of antitoxin, has always asserted
his firm belief in the theory of chemical union.
Other investigators, among them Metchnikoff,
the discoverer of phagocytosis, take exception
to this view. These men hold the belief that
“antitoxins stimulate the phagocytes to an in-
creased absorption and consequent destruction
of the poisons of bacteria (toxins). Each of
these theories has its own exponents among the
most learned workers of the present day. The
value of the activities of the phagocytes in
certain diseases is acknowledged by investiga-
tors along this line. As to the opsonins, it has
been developed through these investigations,
that “the work of the phagocytes as destroyers
and ingestors of bacteria is greatly increased

' by these properties (opsonins) contained in the

serum of the blood” (Wright).

(A) Curative Injections.

In passive serum therapy (passive immuniza-
tion) (1) injections are given with antitoxic
serums, namely those of diphtheria, tetanus,
plague, tuberculosis, typhoid and streptococcus
infections.

(2) With antibacterial serums; namely
typhoid, cholera, plague, dysentery, streptococ-
cus, staphylococcus and pneumococcus in-

fections.
172
SERUM THERAPY.

(B) Curative Injections.

In active serum therapy (active immuniza-
tion), injections of bacteria killed by heat are
given in small doses for the purpose of hasten-
ing the formation of the characteristic constit-
uents. of the blood and other fluids of immune
animans known as “antibodies,” or antidotes.

(A) Prophylactic (Preventive) Injections.

Active immunization consists of vaccination
and protective inoculations with the killed
organisms of typhoid fever, cholera and plague.
Depending upon the material injected, the
result gained is the formation of an antitoxin
or antimicrobic substance known as an ambo-
ceptor or “‘fixiator.”

(B) Inoculation With Virulent Organisms. —

(1) Used principally in experimental work.
Inoculations are given with a small amount of
the micro-organisms, that is to say, .“a non-
fatal dose.”

(II) Inoculation with virulent organisms in-
to a tissue which has some material resistance.
In the early days of vaccination, virus taken
directly from those suffering with smallpox
was used. The success of the method is believed
to be due, in all probability, to unfavorable con-
ditions found in the skin which prevented the
development of virulence.

173

Antibodies
Explained.

f
Vaccination.
Test Tube
Experiments.

BACTERIOLOGY IN A NUTSHELL.

(1.) INJECTIONS OF ATTENUATED
(WEAKENED) VIRUS.

Injections of attenuated virus are given in
order to establish resistance against a suspected
infection.

(1I.) INJECTIONS OF KILLED ORGANISMS.

This process is said to be the safest way to
vaccinate against typhoid fever, cholera and
plague. In the Pasteur Institute treatment of
hydrophobia, in the first treatment given, dried
spinal cord is the material used and it is believed
to contain killed virus.

Principles of Serum Therapy Considered.

For the sake of brevity and to simplify for
study, the principles of serum therapy may be
considered under three heads—namely :

1. Antitoxins.
2. Bactericidal or Antibacterial Serums.
3. Vaccination.

We have already mentioned the chemical
union of toxin and antitoxin, which is believed
by many authorities to bring about néutral-
ization.

Mixed in a test tube at a given temperature
and of a certain concentration, these authorities
tell us that union takes place rapidly and com-

174
TEST TUBE AND BODY EXPERIMENT.

pletely, provided the requisite degree of affinity
exists between the two substances used. There
is no third substance present with which one or
the other of the materials used may combine.

Within the body conditions are different, and
we are taught that one of two combinations
may occur. The toxin may unite with the anti-
toxin injected into the body, or a second com-
bination is possible, viz., the toxin may unite
with the tissue cells.

Union with cells, according to the demon-
stration of Heymens in his work with tetanus,
is often a very rapid and complete one.

“Heymens found that if all the blood were removed
from an animal a few minutes after the injection of a
single fatal dose of tetanus toxin and the blood of an-
other animal substituted, still it would be found that
the animal died of tetanus.”

All the toxin had combined with the cells in
that short time. Experiments of other workers
tend to demonstrate not only that the toxin may
combine with the tissue cells very rapidly, but
they also make clear the manner in which anti-
toxins bring about a cure. Interesting experi-
ments by scientists with regard to the disease,
tetanus, have brought to light the knowledge
that if the antitoxin is injected into the animal
body four minutes later than the toxin, a slight:
ly larger than the neutralizing dose is necessary
to prevent tetanus symptoms from developing

175

Union of

Toxin with
Antitoxin and
with Body Cells.

Experiments
of Heymens
with Tetanus.

Experiments of
Other Scientists.
Diphtheria
Toxin and
Antitoxin.

Curative and
Prophylactic
Treatment.

BACTERIOLOGY IN A NUTSHELL.

If eight minutes were allowed to elapse, six
times as much antitoxin is required. After
sixteen minutes, twelve times as much antitoxin

must be used. After the lapse of a few hours

no matter how much antitoxin is injected the
life of the animal is forfeited.

Experiments with diphtheria toxin and its
neutralization by antitoxin in the animal body

developed similar conditions. Practical exper-

ience with diphtheria in the human subject has
demonstrated that the longer the disease has
been in progress the more antitoxin is neces-
sary to effect a cure.

The curative action of an antitoxin does not
consist in the neutralization of the circulating
toxin, but rather in its being able to tear away
from the tissue cells the toxin they have taken
up, or “bound.” In course of treatment, the
circulating toxin “is neutralized. This step is
prophylactic (preventive) in nature and only
an equivalent of toxin is required. But a great
excess 1s required in order to remove toxin
from tissue cells. Authorities assert that when
no amount of antitoxin will effect a cure, some-
thing more than chemical union between the
toxins and the body cells has taken place. Pro-
cesses of a biological nature have arisen by
reason of which the toxin becomes a part of the

protoplasm and destructive action of the toxo-
176
EXPERIMENTS WITH TOXINS.

phorous (poisonous) group has probably |

begun.

It is important for students to remember that
‘It is not believed that antitoxin can repair an
injury toxin has already accomplished. Repair
is dependent upon the recuperative power of the
cells themselves. Curative properties are exer-
cised by reason of the power of antitoxin to
wrest or take away forcibly from the cell so
much of the toxin that less than a fatal dose is
left in the cell.

There are two points which are important to
remember in the study of antitoxin curative
treatment.

(1.) That the antitoxin must be admin-
istered early in the case, viz., before the toxins
have combined with tissue cells.

(2.) That a sufficient quantity of antitoxin
must be administered in order to overcome or
neutralize the toxin.

The study of the diseases tetanus and
diphtheria and their comparison have brought
to light many important facts concerning the
principles of serum therapy.

It has been found that diphtheria antitoxin
has very much greater curative properties than
tetanus antitoxin. In the test tube, the affinity
between the toxin of tetanus and its antitoxin
is weak, apparently. Ehrlich found that it
takes forty (40) minutes to bring about com-

177 :

Destruction by
Toxophores.

Cell
Recuperation.

Early
Administration
of Antitoxin.

Toxin ;
Neutralization.

Diphtheria Anti-
toxin Curative
Properties.
Tetanus
Toxin
Affinity.

BACTERIOLOGY IN A NUTSHELL.

plete neutralization in the test tube, while it
has been shown by the experiments of others
that the affinity of tetanus toxin for the nervous
tissues is very strong, all the toxin beimg
absorbed in a few minutes. These facts dem-
onstrate that the curative value of the tetanus
serum must be low. On the most vital of all
organs, the central nervous system and the
spinal cord, the tetanus toxin has proven to -
have marked selective action. For this reason
a lower grade of injury may prove fatal in this
disease than in other infections where less im-
portant organs (or those of greater recupera-
tive power) are affected. The theory that the
tetanus toxin is “taken up by the nerve endings
and reaches the ganglionic cells by way of the
axis cylinder, where it is in a manner isolated
and is scarcely accessible to the action of the
antitoxin (which remains, for the most part,

after injection, in the blood and lymphatic cir-

culation), has given place to the belief that the
reason for failure in the use of tetanus serum
is probably due to the powerful affinity of
tetanus toxin to the cells of the spinal cord. The
damage is done before the antitoxin can be
administered. In accidents in the laboratory,
where enormous quantities of pure cultures
have gotten into open wounds, the prompt
adminstration of serum has prevented develop-
ment of the toxemia.
178
TEST TUBE AND BODY EXPERIMENTS.

With regard to diphtheria: The degree of
affinity between toxin and antitoxin is much _. '
: ‘ : z . Diphtheria
stronger in this disease than is the affinity Antitoxin
between tetanus toxin and its antitoxin. Com- “fit:
plete neutralization in the test tube takes place
in fifteen minutes. Chemical tests have dem-
onstrated that the affinity of diphtheria toxin
for tissue cells is not nearly so great as is that
of tetanus. Diphtheria has been cured by the
toxin treatment on the second day, while cures
effected in tetanus cases are to say the least not
common. The toxin of diphtheria may affect
the nervous system and cause paralysis, but
this condition in diptheria does not often prove
fatal. Chemical experiments have shown that
the toxin of this disease is so situated in the
body as to be easy of access for the antitoxin.

I. IMPORTANT POINTS TO BE REMEMBERED.

in Serum Therapy are:

(1.) Strength of the antitoxin injected.

(2.) Freedom from bacteria and other
contamination.

(3.) Time of administration, (early in the
case).

(4.) Quantity injected.

(5.) Degree of affinity between toxin and
antitoxin.
, 179
Antitoxin
Preventive
Treatment.

Duration of
Immunity.

Endotoxins,

BACTERIOLOGY IN A NUTSHELL.

(6.) Degree of affinity between toxin and
tissue cells.

(7.) Amount of toxin taken in (“bound”)
by the tissue cells outside of a fatal dose.

(8.) Location of the toxin in the body and
the degree of accessability for the toxin.

The action of antitoxin as a prophylactic
treatment is much simpler than when used for
curative purposes. The conditions resemble
test tube experiments. There has been oppor-
tunity for the antitoxin to be distributed by the
blood and lymphatic circulation before the in-
vasion of bacteria and the production of their
toxins. It is able for this reason to meet and
combine with the toxin before it reaches the
receptors of important cells. The high value
which tetanus antitoxin as a prophylactic has
attained in recent years is in all probability
dependent upon this condition.

The immunity afforded by administration of
antitoxin for prophylactic purposes is short,
usually lasting only two or three months.
While some of it may be “bound” by the tissue

cells, a great deal of it is believed to be excreted

in the urine.

II. ANTIBACTERIAL, OR BACTERICIDAL SERUMS.

Investigators have found a large group of

organisms, which contain toxic products, asso-
180
ANTIBACTERIAL SERUMS.

ciated with the protoplasm of certain microbes.
These toxic substances are called endotoxins.

Some of the bacilli in which the endotoxins
are found are those which cause typhoid fever,
dysentery and cholera. The endotoxins of the

bacilli of these diseases cause strong anti-

bacterial serums to form in immunized animals.

Antibacterial or bactericidal serums do not
neutralize toxins. It has not been proven
definitely whether the opsonic or bacteriotropic
substances which stimulate phagocytosis are of
importance in order to bring about the vital
action of antibacterial serums. While experi-
ments in test tubes have demonstrated anti-
bacterial serum to be able to kill bacteria,
experiments in the animal body have shown
them to be much more reliable as preventives
of infection than they are as curative agents.
Immunity conferred by antibacterial serums is
of short duration, lasting only two or three
weeks.

“For this reason they are more useful as
prophylactics in man when used in combina-
tion with vaccination. In saving the lives of
animals which have been experimented upon,
antibacterial serums have proven efficient
provided they are injected in advance of the
bacteria, or at the same time, or within a few
‘minutes after the bacterial injection.”

181

Antibacterial
Serums
Investigated.
Immunizing
Power of

Vaccination.

Trained
Body Cells.

BACTERIOLOGY IN A NUTSHELL.

Antibacterial serums are not antitoxic. In
this connection the question naturally arises:
Why are there no antitoxic serums for some of
these infections? The answer of investigators
is: “Because of:

I. The difficulty in liberating the toxins
from the bacteria.

II. The difficulty of forming proper rela-
tions between the amboceptor and complement.

III. The inaccessability of the antitoxin to
the germ, as in cholera.”

III, VACCINATION.

Vaccination against smallpox is a preventive
treatment discovered by Dr. Edward Jenner of
England. He demonstrated successfully its
immunizing power in the year 1796, several
years after his discovery. Jenner was born in
Berkeley, Gloucestershire, England, in 1749.
He died in 18232.

We have all grown familiar with the term
vaccination as applied to the prophylactic treat-
ment of smallpox. By the vaccination process
the immunity gained extends over a protracted
period. It is taught by some authorities that in

_ consequence of vaccination the cells of the body

have been

“trained to produce the corresponding receptors and that
when subsequently micro-organisms gain an entrance to
the body antibodies form rapidly and overcome the
invaders in their incipiency.”

182
VACCINATION.

In smallpox we do not know the etiological
agent, therefore we cannot produce a specific
serum but must use the whole virus in the form
of a vaccine.

Protective inoculation, or in other words,
vaccination is now-a-days used to protect
against diseases other than smallpox and with
equal propriety. Attenuated, or killed virus of
a disease is inoculated and resistance to an in-
fection is established. Hydrophobia is treated
‘by inoculation as is also typhoid fever, plague,
cholera, dysentery, etc. Protection (im-
munity) is not established immediately. We
are familiar with the fact that in vaccination
against smallpox infection, several days elapse
before immunity is gained. This is also true of
vaccination or inoculation against other dis-
eases. Wright of “opsonic theory” fame, calls
this period between vaccination and the time
when immunity is gained “the negative phase.”
The period following the formation of protec-
tive properties in the subject treated he calls
“the positive phase.” The length of time of the
negative phase is dependent upon the nature
and the quantity of the virus injected. We do
not know the nature of all protective products.
If the micro-organism which causes the disease
is unknown it is not easy to determine what
protective products are formed by inoculation,

183

Diseases

in Which
Vaccination
Is Used.

Negative
Phase.

Positive
Phase.
Protective
Agents,

Health of
Animals.

Duration of
Treatment.

BACTERIOLOGY IN A NUTSHELL.

or vaccination. In the diseases typhoid fever,
cholera, plague and dysentery the protective

_ agents formed are known as “bactericidal

amboceptors.”’
ANTIMENINGITIS SERUM.
Method of Preparation:

“The serum used in the treatment of cerebro
spinal meningitis’ is prepared from horses
which are first carefully examined to ascertain
that they are in good health. They are then
treated by injections of killed meningococci
alternated with injections of cultures of men-
ingococci which have undergone autolysis.*
The injections are given alternately every few
days. After a few weeks the killed meningo-
cocci are replaced by living organisms the num-
ber of which is steadily increased. The injec-
tions are given as before, alternately with
autolized cultures.”

These injections are kept up for about six
months (in some cases for a greater period),
after which the serum of the horse is tested.
If it shows bacteriotropic power in a dilu-
tion of I to 5,000 it is considered to be suf-
ficiently strong to be of value, for therapeutic -

* Autolysis is obtained by pouring from ten (10)
to twenty (20) c. c. of sterile normal saline over the
surface of a twenty-four hour culture of the men-
ingococci. The flask is gently moved from side to
side until the cultures are partly separated from the
media. The flask is then returned to the thermostat
for another twenty-four hours.

184
ANTIMENINGITIS SERUM.

purposes. If the serum in this dilution does not
act, the treatments are continued until such
power is gained.

The efficacy of the serum treatment of

cerebrospinal meningitis has been proven by
the following facts gathered from statistics:
1. Diminution of mortality.
2. Influence on the symptoms in each partic-
ular case.
3. Reduction of the duration of the disease
and the rarity of after-effects.

DIMINUTION OF MORTALITY.

Statistics give the mortality from cerebro-
spinal meningitis in different epidemics at from
30 to 80 per cent.. In infants 100 per cent.

In 1909, during an epidemic in France the
mortality rate was remarkedly decreased by
serum therapy. 402 cases were reported, with
66 deaths; a mortality of 16.44 per cent. In
nineteen of these cases the patients were either
in extremis when the injections were given or
death was caused by some complication. Cases
treated during the same epidemic, without
serum, showed a mortality of 65 per cent.

Reports show that the best results were
gained by early injections of the serum.
Mortality in cases treated before the third day
was -less than one-third that of those where
treatment began after the first week.

185

The French
Epidemic.
First
Symptoms
Relieved.

Failures
Explained.

Influence on
Symptoms.

BACTERIOLOGY IN A NUTSHELL.

INFLUENCE ON THE SYMPTOMS.

All the symtoms were very markedly reduced
in from twenty-four to forty-eight hours after
the intraspinal injections of the serum, as a
general rule. First symptoms relieved are
coma, headache, delirium and insomnia; tem-
perature falls and sometimes becomes normal.
The fall of temperature and lessening of other
symptoms may come by lysis or by crisis.
Stiffness of the neck may persist longer than
the other symptoms although it is usually
relieved. Some cases are very little benefited
by the serum, others not at all.

Sometimes the treatment is undertaken when
too late. Or the disease may be of the septic
type. Cases in which the disease is confined to
the cranial region, which the serum can only
reach with difficulty, are not apt to yield to
treatment. Another type not benefited is the
chronic type. Lesions are believed to be located
in the vertex or in the ventricles of the brain
and so are not so accessible to the serum.

Stubborn cases lasting several weeks are not
so frequently found as they were before the
introduction of serum therapy. Convalescence
is shorter and less marked by listlessness, the
drawn and lifeless appearance of the face, etc.
The infrequency of after-effects is believed to
be due to the use of the serum not giving them

186
ANTIMENINGITIS SERUM.

time to develop. In many epidemics such after-
effects as deafness, blindness and paralysis have
been as high as 75 to 80 per cent. Since the
introduction of serum therapy statistics report
2.56 to 7.05 per cent. Complications have not
arisen in any case where they were not already
present before treatment began.

Introducd into the spinal canal, the serum
acts:

(1) directly on the meningeal lesions, and
(2) at a distance on the general organism.

Authorities emphasize the necessity for in-
jecting the serum into the subdural space and
of using sufficiently large doses. 30 cubic pieid of
centimeters is the maximal dose, except in very Operation.
young children (infants) and in cases where
only a very small quantity of spinal fluid can
be withdrawn and an obstacle is encountered.
Usually the serum passes readily into the spinal
canal. It is injected either by gravity using a
rubber tube with a needle attached and con-
nected with a funnel, or by the use of a syringe,
It is essential to remove as much spinal fluid Method of
as will equal the amount of serum injected, as IJection.
a rule. The patient’s head may be lowered a
little after the treatment to induce the spread
of the serum into the skull.

Four injections of the serum are given at
intervals of from twelve to twenty-four hours,

187
Number of
Treatments,

Clinical
Evidence,

BACTERIOLOGY IN A NUTSHELL.

even though the diplococci disappear from the
spinal fluid and the symptoms clear up. The
treatment is kept up longer than four days if
the diplococci have not entirely disappeared.
The injections are given slowly, not more than
three (3) cubic centimeters in thirty seconds.
General anaesthesia is prescribed during the
treatment. Shock following the treatment is
overcome by the use of strychnia and camphor,
administered hypodermically. Dose, of course,
to be prescribed by the physician in charge.
Clinical reports of cases treated with anti-
meningitis serum during epidemics cover the
years 1904-1909. The results obtained in the
United States are not so marked as those ob-
tained abroad. ‘The epidemic in the United
States had already passed the crisis when serum
treatment was introduced. In some parts of
Europe it was still raging. In Germany, as in
this country, the epidemic was about over. In
France, however, the serum was available at
the outbreak of the disease and the mortality
was less than twenty-five (25) per cent. The
Rockefeller Institute, New York, sent sup-
plies to Professors Calmette, Netter and Roux.
Good results from the serum treatment are
reported from Johns Hopkins Hospital, Balti-
more, Garfield Hospital, Washington, D. C.,
and many other places in the United States and

Canada.
188
ANTIMENINGITIS SERUM.

TUBERCULIN. (KOCH.)

Recently there has been a remarkable return
of confidence in the use of tuberculin as a cura-
tive agent in tuberculosis. Koch, its dis-
coverer, shortly before his death made the fol-
lowing statement :

“I maintain that its efficacy as a cure is completely
proved provided its application be restricted to still
curable cases; that is to those not too far advanced

and not complicated by streptococci, staphylococci,
pneumococci, etc.

“These processes are almost always accompanied by a

tise of temperature and the best way to guard against
the misapplication of tuberculin is to use it im cases in
which the temperature of the body does not exceed 37°
C. (98.6° F.). That tuberculin exercises an exceedingly
favorable influence on all such cases and even com-
pletely cures them, as a rule, is a fact of which I have
completely convinced myself. A number of medical men,
who have studied the therapeutic value of tuberculin for
years, and have either published their experience or have
communicated it to me privately, have arrived at the
same result.”

While many specialists advocate the use of
tuberculin even where the temperature runs up
to 100° F., all advise the greatest caution in
administering tuberculin to febrile cases.

Dr. Hammer, of Berlin, Germany, has em-
ployed tuberculin for six years in the treatment
of pulmonary phthisis. “The injections were
made in the suprascapular and intrascapular
spaces, alternately on the right and left side.
The skin was disinfected with alcohol, or

: 189

Temperature
Precautions.

Success
Abroad.
Aseptic
Preparation
of Field.

Care in

Administration.

Treatment in
Bone and
Joint Disease,
Etc.

BACTERIOLOGY IN A NUTSHELL.

alcohol and ether, as well as by thorough me-
chanical cleansing. Not a single abscess ot
infection was noted after any of the injections.
The site of injection was protected with sterile
cotton for twenty-four hours and the injection
was made with a sterile syringe having a glass
or metal piston.”” The dose must be carefully
chosen in each individual case. The object
Dr. Hammer has in view is just to avoid a reac-
tion. His initial dose is from I-1,000 m. g.
(miligrams) to 1-100 m. g. He increases the
dose very gradually.

Dr. Charles R. Kerley (Journal of the
American Medical, Association, 1909 Vol. II,
page 1179), in an article on vaccine and serum
therapy in children, states, in regard to the dose
of tuberculin, that the dose of crude tuberculin
administered for the purpose of immunization
in a chronic tuberculosis lesion, should be very
small—1-5,000 of a miligram gradually in-
creased to I-2,000, I-I,000 or more. The inoc-
ulations should be repeated not oftener than
every ten days at first and the temperature
taken every two hours. Should a rise of tem-
perature occur, the dose is too large and must
be reduced at the next injection. In selected
cases, Dr. Kerley has had good results from
tuberculin treatment in bone and joint disease
and in adenitis. Some advocate the “opsonic

190
TUBERCULIN TREATMENT IN TUBERCULOSIS.

index” as the best mode for determining the
proper dosage. Others say the “opsonic index”
is not valuable in this treatment.

STAPHYLO-BACTERIN.
(Staphylococcic Vaccine.)

Bacterins are suspensions, or emulsions of
killed bacteria intended for therapeutic use.

Staphylo-bacterin is a suspension of killed
staphylococci in normal saline solution, pre-
served with 144% phenol.

The bacteria are killed by heat at a tem-
perature of 60° C.

Bacterins are only of value in infections
caused by the same species and for this reason
it is absolutely necessary that accurate diagno-.
sis be made before beginning bacterin treat.
ment.

(1.) Diagnosis is made by examining the
pus or other discharge under the microscope.

(2.) By preparing cultures from the pus
or discharge.

(3.) By clinical phenomena.

In some cases a mixed infection is discovered,
when a vaccine of mixed bacterins is used. One
mixed bacterin, is that consisting of mixed
acne and staphlobacterin; another is the
staphylo-bacterin associated with tuberculin.
Still another is composed of staphylococcus
albus, atiteus and citreus. Difficulty in diagnos-

191

Necessity for
Accurate
Diagnosis.

Mixed
Infections.
Dose.

Observation of
Symptoms.

Bacterin by
Mouth.

BACTERIOLOGY IN A NUTSHELL. '

ing such cases has brought into use the mixed
bacterins. Dose varies from 25,000,000 to
250,000,000 staphylococci. It is conceded by
authorities to be wise to start treatment by ad-
ministering a small dose and to increase accord-
ing to indications. If a proper size dose has
been administered the patient feels better for
an hour or two, then follows a period of depres-
sion with increase of the local symptoms.
known as the “negative phase” (Wright). This
should last a day or two, when improvement
follows. The period of improvement runs from
four to twenty days—known as the “positive
phase.” Should no “negative phase” occur, the
dose is too small. If the “positive phase” is very
severe, or should it last longer than three days,
the dose is too large. The dose is not increased
so long as the “negative phase’ continues.

Administration of the bacterin by mouth has
been discussed, but it is thought that not enough
efficient work has been accomplished to make
this method advisable. _

The site of injection recommended is a point
from whence the lymph drains through or past
the local lesion.

Dr. Hartwell of the Massachusetts General
Hospital reports good results in that institu-
tion in the treatment of localized staphyloeoceus

infections by bacterins.
Dr. Pray in the Edinburgh Medical Journal
192
BACTERIN TREATMENT.

(1909), reports his use of the staphylococcus
bacterins as a preventive of infection in sur-
gical work. He believes that by this method he
has also prevented postroperative pneumonia.

Many gratifying results have been reported
through the medical journals and hospital bul-
letins by scientific workers who use the bacter-
ins in their practice throughout the United
States and Canada.

Other bacterins, the efficacy of which are
as yet not firmly established, are the Acne-
Bacterin and the Staphylo-Acne-Bacterin.
These bacterins have been the cause of much
interest owing to the work of Professor Flem-
ing, London, England, who is investigating
their usefulness in St. Mary’s Hospital, Pad-
dington, W.

THE NEISSER BACTERIN.
(Gonococcic Vaccine.)

The treatment of gonorrheal infections by
“bacterial vaccines” is also a recent method,
and has been attended by considerable success.
Sir Almoth E. Wright demontsrated that sub-
cutaneous injections of killed pathogenic bac-
teria produce in the blood and tissue fluids of
the individual a substance (opsonin) which
combines with the corresponding infecting
organisms and so modifies them that the phag-
ocytes readily take them up and ingest them
(phagocytosis). The preparation of bacteria

193

Bacterin in
Surgical Work,

Acne
Bacterin.
The Treatment
in Europe.

The Treatment
in the
United States.

Opsinic Index

Not Necessary.

BACTERIOLOGY IN A NUTSHELL.

used for this purpose Wright calls bacterial
vaccine.”

Dr. John Pardoe, Fellow of the Royal Col-
lege of Surgeons, London, England, in an
article written for the London Practitioner,
January, 1908, states that he has “seen the vac-
cine treatment of gonorrheal infections used
not only in the subacute and chronic forms, but
in the acute conditions, such as urethritis, and
conjunctivitis, with such marked beneficial
results as to justify a wider use of this method.

Drs. Cole and Meakins in the bulletin of the
Johns Hopkins Hospital, June-July, 1907,
state: “In no case have we seen the administra-
tion of gonococcic vaccine do harm, and we
feel that these cases offer sufficient justification
for the treatment of gonorrheal arthritis by
means of vaccine in doses of 500,000,000 to
1,000,000,000, gonococci, administered every
seven to ten days.” Other writers give similar
opinions. .

Some authorities state that it is advisable
although not absolutely necessary to control
the inoculations by the patient’s “opsonic
index”. Many others do not hold this view.

While gratifying results have been obtained
both in the United States and in Europe by the
bacterial vaccine treatment of diseases caused
by gonorrheal infections, too much must not be
expected of it in the way of cure. “With further

194
TREATMENT OF GONOCOCCUS INFECTIONS.

work the limitations as well as the advantages
of the method will appear. It should be used
rather in conjunction with other general meas-
ures such as rest, aspiration of joints distended
with fluid, massage, and other surgical and
general hygenic treatment.”

Following Wright’s method, vaccines have
been administered almost exclusively subcu-
taneously by hypodermic syringe. Wright
believes that the injections should be made near
the focus of infection and so located that the
flow of blood and lymph is directed toward the
point of infection. As Wright expresses it ‘“‘the
injection should be made “‘up-stream”’ in rela-
tion to lymph channels.” For the most part the
injections are given in the back, in the dorsal
or lumbar region and in the groin. The site
of the injection must be thoroughly cleansed
and made aseptic in the usual way, and great
care must be taken to use an absolutely sterile
syringe. Nothing positive seems to be known
about the size of dose to be administered and
we find anywhere from 5,000,000 to 45,000,-
000 gonococci spoken of as injected in cases
of children and 300,000,000 to 500,000,000
gonococci in adult cases, without ( it is claimed )
bad effect.

Dr. V. T. Churchman, Eye, Ear, Nose and
Throat Specialist, on the Staff of the Charles-

195

Wright's
Method.

Site of
Injection.

Dosage
Varies.
BACTERIOLOGY IN A NUTSHELL.

ton General Hospital, Charleston, West Vir-
ginia, reports a case of much interest. A male
patient suffering with an infected eye and
whose general condition was bad, was ad-
mitted to the Charleston General Hospital, June
7,1910. A microscopic examination of the pus
revealed the presence of the gonococcus of
Neisser. It was found necessary to remove the
eye in order to save the patient’s life. His
general condition was improved for a few days,
but on June 19 his condition became so critical
that all hope of his recovery was abandoned.
Meningitis had developed. Serum treatment
was resorted to. On June 20, staphylo-bacterin
(staphylococcic vaccine) minims xx was used
hypodermically. The patient’s temperature
prior to the injection was 100. A reactionary
temperature of 102.5 followed. On June 21,
very little, if any improvement was noted and
an injection of Neisser bacterin, 50,000,000
gonococci was ordered, followed by a slight
reactionary temperature of one-half a degree
(temperature had not dropped below 102°).
June 23, the temperature dropped to 99.2 and
the patient’s general condition was very
markedly improved. No further use of the
Bacterin was necessary. The patient made a
good recovery, was discharged from the
hospital July 4, went home to work and has
had no recurrence.
196
TREATMENT OF GONOCOCCUS INFECTIONS.

Dr. A. A. Shawkey, on the Surgical Staff of
the Barber Hospital, Charleston, W. Va.,
reports a very interesting chronic case due to
gonorrhoeal infection, in which an abdominal
operation was necessary, October 25,. 1909.
A ruptured sac precipitated a small amount
of the pus into the cavity. 100,000,000
gonococci of Neisser was injected immediately
after removal from the operating table at noon.
The next afternoon, 2 P. M., there was a rise
of temperature from normal to 103.6. At 6 P.
M. it had dropped to tor. At 10 P. M. tem-
perature was 100. Twenty-four hours later it
had dropped to 99°. Another 100,000,000
gonococci was injected, with reactionary tem-
perature of one-half a degree. Repeated the dose
of 100,000,000 for four successive days and then
at intervals of two to four days. Practically no
reactionary temperature occurred after the
third injection. Pus drained freely for eight
days. The entire number of injections (of 100,-
000,000 each) was eight. The patient made a
splendid recovery and has had no recurrence.

Among other bacterins receiving favorable
consideration are the Pneumo-bacterin; the
Typho-bacterin and the Neoformans-bacterin.
The latter is recommended in cancer to destroy
odor and to allay pain, swelling and discom-
fort. It is not curative. ‘

197
BACTERIOLOGY IN A NUTSHELL.

ANTI-TYPHOID VACCINE.

At as early a period as 1896, when Pfeiffer,
of Germany, began his work of investigation,
anti-typhoid inoculation has been advocated.
To Sir Almoth E. Wright, however, is due
the credit for placing the method on a firm
foundation. This he accomplished by his suc-
cessful demonstrations among the soldiers in
the British Army in India, and also in Africa
during the Boer War. Since that period and
up to the present year (1910) the work has
been successfully carried on in both the British
and United States Armies. The mortality rate
has been decreased from 28.3 per thousand
among the unvaccinated to 3.8 per thousand
among the vaccinated. At Peshawur, India,
Colonel Skinner, of the Royal Army Medical
Corps, reported an epidemic of typhoid fever
that was cut short by using anti-typhoid inocu-
lations in seventy (70) per cent of the com-
‘mand in connection with sanitary methods.
Statistics, also, show that in cases (which are
rare) where a patient who has been inoculated
takes the disease, it runs a brief and very mild
course.

Major Russell, of the U. S. Army, reports
that up to June 1, 1910, 8,510 persons had been
treated by anti-typhoid inoculation. Among
these very few serious reactions occurred. Not
any bad results have been reported and there

198
ANTI-TYPHOID VACCINE.

has not been a single case of typhoid fever
among the vaccinated, while among the un-
vaccinated there were some two hundred (200)
cases in the same period.

From various hospitals throughout the
United States and Canada come reports of
favorable results obtained by the use of the
method in the hospital and outside among
physicians and nurses in order to produce
immunity. “Typhoid carriers” have also been
successfully treated. There have been no bad
results and very few severe reactions; even
these have entirely disappeared within ea
eight hours or less.

The object sought in anti-typhoid vaccina-
tion is to produce within the human organism
substances which are antagonistic to the
bacillus typhosus and which will destroy it.
By this means the person treated is brought
into a condition similar to that of a patient
who has recovered from the actual disease.

The Anti-typhoid Vaccine is prepared from
a typical typhoid culture which is grown on
agar slants for twenty-four hours and is then
washed off into a small portion of saline
solution. It is tested for purity, placed in
tubes, sealed (one-fourth of one per cent of
tricresol is added as a safeguard), and the bac-
teria killed by heat at 60 centigrade for one
hour. 7

199
BACTERIOLOGY IN A NUTSHELL.

\

The Vaccine used in the U. S. Army is
tested on at least two of the lower animals
before use in man. All aseptic precautions
are strictly observed before giving the inocula-
tions. These are given subcutaneously in the
arms as a rule at the insertion of the deltord
muscle. Aseptic precautions are also observed
with regard to syringe, needle and vaccine
container used in giving the treatment. The
method most in use is to give three doses ten
days apart. The first dose five hundred million
and the second and third one thousand million
each. The treatment is given in the evening,
so as to lessen reaction. The reaction consists
of headache, malaise, and in very severe cases
(which are rare) nausea and vomiting, herpes
labialis and albuminurea. Even in these severe
reactions all such symptoms disappear in forty-
eight hours.

Local reaction is manifested by a redness
and tenderness in the area about the site of the
puncture and sometimes tenderness in the
auxiliary glands. The concensus of opinion
seems to be that anti-typhoid inoculations have
come to stay and that the success of the treat-
ment is assured. Also that the day is not far
distant when other serums and bacterins which
hitherto have not been so successful will be
perfected and their use adopted throughout the
whole civilized world.

200
ANTI-STREPTOCOCCIC SERUM.

Opinions of scientists with regard to the
value of Anti-Streptococcic Serum differ very
widely so far as its use in treating human in-
fections is concerned. Some investigators have
found it useful in lowering the temperature,
improving the general condition and shorten-
ing the course of diseases in which the strep-
toccoci are known to be either the primary
cause or in which they exist as a complication.
Scarlet fever and acute rheumatism, for ex-
ample, are among the latter diseases.

Bacteriological examination is necessary to
prove that the streptococci are either the cause
of the disease to be treated with the Anti-
Streptococcic Serum, or that they are present
as a complication.

In our medical journals, hospital bulletins
and from reports of physicians in private prac-
tice we find arguments both for and against
the use of the Anti-Streptococcic Serum as a
therapeutic measure. Like other inoculation
substances, it must be used by those who are
up-to-date in bacteriological processes before
its real value shall be satisfactorily determined.

Among the diseases in which Anti-Strep-
toccic inoculations have proven to be of great
value when used by expert practitioners are
the following: Chronic osteomyelitis, chronic
eczema, cystitis, urethritis, peurperal sep-

201
BACTERIOLOGY IN A NUTSHELL,

tecaemia, general sepsis, post-operative infec-
tions ‘and septic wounds.

The best results have been obtained in
chronic and acute localized infections.

The concensus of opinion of expert scientists
is that Anti-Streptococcic inoculation acts bene-
ficially either as a protection or as a cure by
increasing phagocytic activity and thereby
strengthening this, the body’s principal strong-
hold of resistance within the blood, against
the advances of the specific germ or micro-
organism, the streptococci, in its various forms.
INDEX.

Acid, boracic, 135.

“ carbolic, 18, 128.
oxalic, 121, 132.
Aerobes, 40.

Air, 34, 49, 76.
Aikens, Miss C, A., 2, 3.
Alcohol, 130, 137.
Alcohol “rub,” 77.
American Standard, 135, 136.
Ammonia, 32, 140.
Amboceptors, 166.
Anaerobes, 40.
Animal life, 31, 35.
Antisepsis, 109, I10.
Antibacterial, 170, 171.
Antiseptics, 114.
Anti-Streptococcic Serum, 201-202.
Antitoxins, 63, 66, 170, 106.
Arthritis deformans, 24.
Asepsis, 109, II0.
Assistant, III.

st mistake of, 115.
Autolysis, 184.

“

B.

Bacilli, definition of, 38.
Bacillus, cholera, 20.
diphtheriz, 20, 80,
of Friedlander, ai.
of leprosy, 18,
pestis, 22, 103.
tuberculosis, 22, go.
tetani, 22, 85, 88, 109.
typhiosus, 19, 69.
yellow fever, 21, 100.
Bacteria classification of, 38.

5 chemical composition of, 165.
coloring, 4I.
destruction, 42.
in the diseased, 42, 43.
ne in the healthy, 41.
in natural processes, 33, 35.
most important, 38.
movement, 4I.
multiplication, 4I.

204
BACTERIOLOGY IN A NUTSHELL.

Bacteria parasitic, 31, 32.
saprophytic, 32.

size of, 40.

transparenc I.

Bactericidal, 108

Bacterins, 191.

Bacteriolytic, 171.

Balsam of Peru, 136.

Barton, Dr., 100.

Bathing, 154.

Bichloride of mercury, 129, 130.

Brains, 150.

Bread, 156.

Bubonic, plague, 20-21, 103.

Cc.

“

“

Capsule, 45.
Caps, ice, 78.
Carbon, 32.
Carbonic acid gas, 34.
Carbon dioxide, 34.
Cells, 28, 30.
Cerebro-spinal meningitis, 95.
Cholera, 80.
Chlorine solution, 16.
Circuit, Koch’s, 66.
Cleanliness, 149, 154.
Communicable diseases, 69-107.
- - channels of entrance, 69-107.
& “methods of communication, 69-107
a “ nursing in, 69-107.
Complement, 166, 168.
Compound microscope, 12.
Contents, iti-v.
Councilman, 22-104.
Creolin, 132.
Croup, membranous, 82.
Cultures, 22, 38, 39.
Curative injections, 172.
D.

Dairy, the, 72...

Dairies (note), 72.

Decay, trees and plants, 33.
«~" animals, 34.

Deodorants, 114.

Desquamation, 83, 88, 104.

Devaine, 16.

Diet, 156.

20g
BACTERIOLOGY IN A NUTSHELL.

Dioxygen, 130.
Diphtheria, 20, 80, 176, 177.
Diplococci, 19, 97.
Diplococcus lanceolatus, 19, 97.
Disease, definition, 29.
Disinfectants, conditions modify, 115.
Disinfection, 73-76, 115-116.

of hands, etc., 119-125.
Dress, 152-154.
Dysentery, 80.

E.

Eberth, 19, 69.

Ehrlich’s Pippo tiiasté 162-169.
Endotoxins, 180.

Epidemics, 72, 80, 96, 185.
Erysipelas, 88.

Ether, 137.

Elephantiasis, 100.

F.

Fever, 19.

bathing in (note), 77.

relapsing, 99.

specific, (note), 105.

scarlet, 83, 84.

typhoid, 19, 69, 79, 157.

yellow, 100.

Filariasis, 99.

Finlay, Dr., 100.

Fission, 43.

Fixiators, 166.

Flies, 104, 157.

Flagella, 41.

Formaldehyde, 138-140.
lamps, 138-140.

Formalin, 140.

Frenkel, 19, 97.

Friedlander, 19.

Fumigation, 137-140.

G.

German measles (Roseola), 83.
Germicides, 114.

Glarids, Peyerian, 70.
Gonorrhoea, 18, 155, 193-195.
BACTERIOLOGY IN A NUTSHELL.

H.
Hanson, 18,
Haptophiles, 164, 165.
Haptophores, 164-167.
Hemolysis, 166.
Hemorrhage, 70.
Henry, Dr. R. S., 105.
Hair, the, 149, 155.
Health, 75, 145, 158.
Healthy exercise, 151.

“ games, 146.
muscle, 151.
Henle, 13.

Hoffman, 31.
Hydrogen peroxide, 130.

ee dioxide, 130.
Hygiene, 145-160.

- defined, 145.
neglected, 145.
personal, 75.
Hygienic dress, 152. .

“c

“

“

Ice caps, 78.
Ice water, 156.
Tleum, 70.
Immunity, 51-66.
Immunity, Ehrlich’s theory of, 162-169.
Incubation, 50.
Infection, 50.
Influenza, 82.
Inoculation, 14, 49.
Introductory, 1-9.
Invasion, 50, 70.
Jodine solution, 128.
K.
Kitasato, 20.
Klebs, 17.
Koch, 19, 20, 21, 69, 93, 189.
Koch, Sister Emilie, (Title page.)
L.
La Grippe, 20, 82.
Leeuwenhock, 11-13.
Lens, single, IT.
Leprosy, 18.
Lesion, 49.
Lister, Sir Joseph, 18, 113.
Loeffler, 20.
Lysol, 131.
207
BACTERIOLOGY IN A NUTSHELL.

M.
Malaria, 92, 95.
Malariae, plasmodium, 92.
Maternity, hospital (note), 112.
Measles, 83.
Meat, 73, 156.
Meningitis, 95, 184-188.
Metabolism, 164.
Metschnikoff, 42, 56, 57, 167-168.
Micrococci, 38.
Micro-organisms, 30.
Milk, 72, 156.
Milk of Lime, 131.
“Modified Oath,” to.
Morphology, 38.
Mosquitoes, 92, 99, 102.
Mumps, 85.

Nails, the, 155.
Nature’s gifts, 150.
Neisser, 18, 193.
Nicolaier, 20.
Nitrogen, 32.
Normal salt sol., 133.
“© "some uses of, 134.
Nurse the bad tempered, 148.
e “good, 148.
healthy, 154.
mercenary, 148.
neat, 153.
successful, 149.
sunny, 158-159.
some qualifications of, 10, 149.
and: gossip, 10, 149.
Nursing, 73-78.
io and gossip, 10, 150.

‘ oO.
Obermeier, 18, go.
Opsonins, 42, 58.
Opsonic Theory, 58, 63.
Oxygen, 34, 35.
P;

Pabulin, 163.
Parkes’ list, 48.

208
BACTERIOLOGY IN A NUTSHELL,

Pasteur, 16-17, 58.
Pasteurized milk, 72-73, 85.
Pastry, 156.

Perforation, 70.

Peritonitis, 70,

Peru, balsam, 136.
Pfeiffer, 20.

Phagocytes, 42, 61.

Plant life, 31, 35.

Plenciz, 13, 14.
Pneumonia, 19, 97.

Poisons, 32, 63.

Pollender, 16.

Potassium permanganate, 132.
Prophylactic injections, 173.
Protoplasm, 45.

Protozoa, 30, 92.
“Protozoon,” 30, 92, 104.

Receptors, 163.
Rest, 157.
Rheumatism, 24.
Roseola, 83.

Rowe, Dr. J. W., 2.
Rush, Dr., roo.

Sanarelli, 21.
Sarcinae, 43.
Schaudinn, 22.
Schulze, 14.
Semmelweis, 15, 16.
Serum Therapy, 162.

a ce principles of, 174-180.
Sepsis, 108-113.
Serums, 179, 185.
Smallpox, 22, 104.
Solutal, 131.
Solutions, 128, 136.

s table for preparation of, 141
Spirilla, 30.
Spirochetae pallidae, 22.
Spores, 39, 43, 44, 45.
Staphylococci, 44, 108, 191.
Sterilization, 113, I14.

“e Intermittent, 116.

209
BACTERIOLOGY IN A NUTSHELL.

Sternberg, 19.
Streptococci, 39, 43, IIo.
Sublamine, 130.

Sulphur, 137.

Surgery, bacteria in, 108.

“ antiseptic, 18.

“f aseptic, II7-119.
Sunshine, 76, 158.
Sweets, 156. -

Syphilis, 22, 155.

Tate, Dr. M. A,, 2.
Table for solutions, 141.
Teeth, the, 155.
Tetanus, 85, 175.
pas measures, 88.
Tetrads, 3
Thiersch’s ‘solution, £36.
Tricresol, 131.
Toxophiles, 165.
Toxophores, 165.
Toy pistols, 86,
Tuberculosis, go.
a predisposition to, 9o.
nursing in, oI.
Tuberculin, 20, 189-191.

“

; U.
Ulceration, 70.
Uniform, 152.
Uncinariasis, 94.
Uncinaria duodenalis, 95.

V.

Vaccination, 58, 66, 105, 173, 182.
Varro, UI.

Vegetable life, 32, 35.
Vegetables, 73, 156.

Ventilation, 76, 82.

Vidal (note), 70.

Water, distilled, 136.
“ filtered, 137.
“ ‘sterile, 136.
Weigert, 41.
Weightman, Dr., 100.
210
BACTERIOLOGY IN A NUTSHELL.

Whooping cough, 82.
“Widal’s Test,”’ 79.

Wright, Sir Almoth, 42, 60.
Wood, Dr., 100.

Wyman, Dr.,, 102.

Y.

Yellow Fever Commission, 100.
Yersin, 20-21.

Zz.
Zinke, Dr. E. Gustave, 2, 3.

2rt