The Harvard Classics Part 29

Furthermore all the vibrios, which crowded the liquid as motile threads, are destroyed and disappear. After the action of the air, only fine amorphous granules can be found, unfit for culture as well as for the transmission of any disease whatever. It might be said that the air burned the vibrios.

If it is a terrifying thought that life is at the mercy of the multiplication of these minute bodies, it is a consoling hope that Science will not always remain powerless before such enemies, since for example at the very beginning of the study we find that simple exposure to air is sufficient at times to destroy them.

But, if oxygen destroys the vibrios, how can septicemia exist, since atmospheric air is present everywhere? How can such facts be brought in accord with the germ theory? How can blood, exposed to air, become septic through the dust the air contains?

All things are hidden, obscure and debatable if the cause of the phenomena be unknown, but everything is clear if this cause be known. What we have just said is true only of a septic fluid containing adult vibrios, in active development by fission: conditions are different when the vibrios are transformed into their germs, [Footnote: By the terms "germ" and "germ corpuscles," Pasteur undoubtedly means "spores," but the change is not made, in accordance with note 3, above.--Translator.] that is into the glistening corpuscles first described and figured in my studies on silk-worm disease, in dealing with worms dead of the disease called "flacherie." Only the adult vibrios disappear, burn up, and lose their virulence in contact with air: the germ corpuscles, under these conditions, remain always ready for new cultures, and for new inoculations.

All this however does not do away with the difficulty of understanding how septic germs can exist on the surface of objects, floating in the air and in water.

Where can these corpuscles originate? Nothing is easier than the production of these germs, in spite of the presence of air in contact with septic fluids.

If abdominal serous exudate containing septic vibrios actively growing by fission be exposed to the air, as we suggested above, but with the precaution of giving a substantial thickness to the layer, even if only one centimeter be used, this curious phenomenon will appear in a few hours. The oxygen is absorbed in the upper layers of the fluid--as is indicated by the change of color. Here the vibrios are dead and disappear. In the deeper layers, on the other hand, towards the bottom of this centimeter of septic fluid we suppose to be under observation, the vibrios continue to multiply by fission--protected from the action of oxygen by those that have perished above them: little by little they pa.s.s over to the condition of germ corpuscles with the gradual disappearance of the thread forms. So that instead of moving threads of varying length, sometimes greater than the field of the microscope, there is to be seen only a number of glittering points, lying free or surrounded by a scarcely perceptible amorphous ma.s.s. [Footnote: In our note of July 16th, 1877, it is stated that the septic vibrio is not destroyed by the oxygen of the air nor by oxygen at high tension, but that under these conditions it is transformed into germ-corpuscles. This is, however, an incorrect interpretation of facts. The vibrio is destroyed by oxygen, and it is only where it is in a thick layer that it is transformed to germ-corpuscles in the presence of oxygen and that its virulence is preserved.] Thus is formed, containing the latent germ life, no longer in danger from the destructive action of oxygen, thus, I repeat, is formed the septic dust, and we are able to understand what has before seemed so obscure; we can see how putrescible fluids can be inoculated by the dust of the air, and how it is that putrid diseases are permanent in the world.

The Academy will permit me, before leaving these interesting results, to refer to one of their main theoretical consequences.

At the very beginning of these researches, for they reveal an entirely new field, what must be insistently demanded? The absolute proof that there actually exist transmissible, contagious, infectious diseases of which the cause lies essentially and solely in the presence of microscopic organisms.

The proof that for at least some diseases, the conception of spontaneous virulence must be forever abandoned--as well as the idea of contagion and an infectious element suddenly originating in the bodies of men or animals and able to originate diseases which propagate themselves under identical forms: and all of those opinions fatal to medical progress, which have given rise to the gratuitous hypotheses of spontaneous generation, of alb.u.minoid ferments, of hemiorganisms, of archebiosis, and many other conceptions without the least basis in observation. What is to be sought for in this instance is the proof that along with our vibrio there does not exist an independent virulence belonging to the surrounding fluids or solids, in short that the vibrio is not merely an epiphenomenon of the disease of which it is the obligatory accompaniment. What then do we see, in the results that I have just brought out? A septic fluid, taken at the moment that the vibrios are not yet changed into germs, loses its virulence completely upon simple exposure to the air, but preserves this virulence, although exposed to air on the simple condition of being in a thick layer for some hours. In the first case, the virulence once lost by exposure to air, the liquid is incapable of taking it on again upon cultivation: but, in the second case, it preserves its virulence and can propagate, even after exposure to air. It is impossible, then, to a.s.sert that there is a separate virulent substance, either fluid or solid, existing, apart from the adult vibrio or its germ. Nor can it be supposed that there is a virus which loses its virulence at the moment that the adult vibrio dies; for such a substance should also lose its virulence when the vibrios, changed to germs, are exposed to the air. Since the virulence persists under these conditions it can only be due to the germ corpuscles--the only thing present. There is only one possible hypothesis as to the existence of a virus in solution, and that is that such a substance, which was present in our experiment in nonfatal amounts, should be continuously furnished by the vibrio itself, during its growth in the body of the living animal. But it is of little importance since the hypothesis supposes the forming and necessary existence of the vibrio. [Footnote: The regular limits, oblige me to omit a portion of my speech.]

I hasten to touch upon another series of observations which are even more deserving the attention of the surgeon than the preceding: I desire to speak of the effects of our microbe of pus when a.s.sociated with the septic vibrio. There is nothing more easy to superpose--as it were--two distinct diseases and to produce what might be called a SEPTICEMIC PURULENT INFECTION, or a PURULENT SEPTICEMIA. Whilst the microbe-producing pus, when acting alone, gives rise to a thick pus, white, or sometimes with a yellow or bluish tint, not putrid, diffused or enclosed by the so-called pyogenic membrane, not dangerous, especially if localized in cellular tissue, ready, if the expression may be used for rapid resorption; on the other hand the smallest abscess produced by this organism when a.s.sociated with the septic vibrio takes on a thick gangrenous appearance, putrid, greenish and infiltrating the softened tissues. In this case the microbe of pus carried so to speak by the septic vibrio, accompanies it throughout the body: the highly-inflamed muscular tissues, full of serous fluid, showing also globules of pus here and there, are like a kneading of the two organisms.

By a similar procedure the effects of the anthrax bacteridium and the microbe of pus may be combined and the two diseases may be superposed, so as to obtain a purulent anthrax or an anthracoid purulent infection. Care must be taken not to exaggerate the predominance of the new microbe over the bacteridum. If the microbe be a.s.sociated with the latter in sufficient amount it may crowd it out completely--prevent it from growing in the body at all. Anthrax does not appear, and the infection, entirely local, becomes merely an abscess whose cure is easy. The microbe- producing pus and the septic vibrio (not) [Footnote: There is undoubtedly a mistake in the original. Pasteur could not have meant to say that both bacteria are anaerobes. The word "not" is introduced to correct the error.--Translator.] being both anaerobes, as we have demonstrated, it is evident that the latter will not much disturb its neighbor. Nutrient substances, fluid or solid, can scarcely be deficient in the tissues from such minute organisms. But the anthrax bacteridium is exclusively aerobic, and the proportion of oxygen is far from being equally distributed throughout the tissues: innumerable conditions can diminish or exhaust the supply here and there, and since the microbe-producing pus is also aerobic, it can be understood how, by using a quant.i.ty slightly greater than that of the bacteridium it might easily deprive the latter of the oxygen necessary for it. But the explanation of the fact is of little importance: it is certain that under some conditions the microbe we are speaking of entirely prevents the development of the bacteridium.

Summarizing--it appears from the preceding facts that it is possible to produce at will, purulent infections with no elements of putrescence, putrescent purulent infections, anthracoid purulent infections, and finally combinations of these types of lesions varying according to the proportions of the mixtures of the specific organisms made to act on the living tissues.

These are the princ.i.p.al facts I have to communicate to the Academy in my name and in the names of my collaborators, Messrs.

Joubert and Chamberland. Some weeks ago (Session of the 11th of March last) a member of the Section of Medicine and Surgery, M.

Sedillot, after long meditation on the lessons of a brilliant career, did not hesitate to a.s.sert that the successes as well as the failures of Surgery find a rational explanation in the principles upon which the germ theory is based, and that this theory would found a new Surgery--already begun by a celebrated English surgeon, Dr. Lister, [Footnote: See Lord Lister's paper in the present volume.--Ed.] who was among the first to understand its fertility. With no professional authority, but with the conviction of a trained experimenter, I venture here to repeat the words of an eminent confrere.

ON THE EXTENSION OF THE GERM THEORY TO THE ETIOLOGY OF CERTAIN COMMON DISEASES

[Footnote: Read before the French Academy of Sciences, May 3, 1880. Published in Comptes rendus, de l'Academie des Sciences, xc., pp. 1033-44.]

When I began the studies now occupying my attention, [Footnote: In 1880. Especially engaged in the study of chicken cholera and the attenuation of virulence--Translator.] I was attempting to extend the germ theory to certain common diseases. I do not know when I can return to that work. Therefore in my desire to see it carried on by others, I take the liberty of presenting it to the public in its present condition.

I. Furuncles. In May, 1879, one of the workers in my laboratory had a number of furuncles, appearing at short intervals, sometimes on one part of the body and sometimes on another.

Constantly impressed with the thought of the immense part played by microscopic organisms in Nature, I queried whether the pus in the furuncles might not contain one of these organisms whose presence, development, and chance transportation here and there in the tissues after entrance would produce a local inflammation, and pus formation, and might explain the recurrence of the illness during a longer or shorter time. It was easy enough to subject this thought to the test of experiment.

First observation.--On June second, a puncture was made at the base of the small cone of pus at the apex of a furuncle on the nape of the neck. The fluid obtained was at once sowed in the presence of pure air--of course with the precautions necessary to exclude any foreign germs, either at the moment of puncture, at the moment of sowing in the culture fluid, or during the stay in the oven, which was kept at the constant temperature of about 35 degrees C, The next day, the culture fluid had become cloudy and contained a single organism, consisting of small spherical points arranged in pairs, sometimes in fours, but often in irregular ma.s.ses. Two fluids were preferred in these experiments--chicken and yeast bouillon. According as one or the other was used, appearances varied a little. These should be described. With the yeast water, the pairs of minute granules are distributed throughout the liquid, which is uniformly clouded. But with the chicken bouillon, the granules are collected in little ma.s.ses which line the walls and bottom of the flasks while the body of the fluid remains clear, unless it be shaken: in this case it becomes uniformly clouded by the breaking up of the small ma.s.ses from the walls of the flasks.

Second observation.--On the tenth of June a new furuncle made its appearance on the right thigh of the same person. Pus could not yet be seen under the skin, but this was already thickened and red over a surface the size of a franc. The inflamed part was washed with alcohol, and dried with blotting paper pa.s.sed through the flame of an alcohol lamp. A puncture at the thickened portion enabled us to secure a small amount of lymph mixed with blood, which was sowed at the same time as some blood taken from the finger of the hand. The following days, the blood from the finger remained absolutely sterile: but that obtained from the center of the forming furuncle gave an abundant growth of the same small organism as before.

Third observation.--The fourteenth of June, a new furuncle appeared on the neck of the same person. The same examination, the same result, that is to say the development of the microscopic organism previously described and complete sterility of the blood of the general circulation, taken this time at the base of the furuncle outside of the inflamed area.

At the time of making these observations I spoke of them to Dr.

Maurice Reynaud, who was good enough to send me a patient who had had furuncles for more than three months. On June thirteenth I made cultures of the pus from a furuncle of this man. The next day there was a general cloudiness of the culture fluids, consisting entirely of the preceding parasite, and of this alone.

Fourth observation.--June fourteenth, the same individual showed me a newly forming furuncle in the left axilla: there was wide- spread thickening and redness of the skin, but no pus was yet apparent. An incision at the center of the thickening showed a small quant.i.ty of pus mixed with blood. Sowing, rapid growth for twenty-four hours and the appearance of the same organism. Blood from the arm at a distance from the furuncle remained completely sterile.

June 17, the examination of a fresh furuncle on the same individual gave the same result, the development of a pure culture of the same organism.

Fifth observation.--July twenty-first, Dr. Maurice Reynaud informed me that there was a woman at the Lariboisiere hospital with multiple furuncles. As a matter of fact her back was covered with them, some in active suppuration, others in the ulcerating stage. I took pus from all of these furuncles that had not opened. After a few hours, this pus gave an abundant growth in cultures. The same organism, without admixture, was found. Blood from the inflamed base of the furuncle remained sterile.

In brief, it appears certain that every furuncle contains an aerobic microscopic parasite, to which is due the local inflammation and the pus formation that follows.

Culture fluids containing the minute organism inoculated under the skin of rabbits and guinea-pigs produce abscesses generally small in size and that promptly heal. As long as healing is not complete the pus of the abscesses contains the microscopic organism which produced them. It is therefore living and developing, but its propagation at a distance does not occur.

These cultures of which I speak, when injected in small quant.i.ties in the jugular vein of guinea pigs show that the minute organism does not grow in the blood. The day after the injection they cannot be recovered even in cultures. I seem to have observed as a general principle, that, provided the blood corpuscles are in good physiological condition it is difficult for aerobic parasites to develop in the blood. I have always thought that this is to be explained by a kind of struggle between the affinity of the blood corpuscles for oxygen and that belonging to the parasite in cultures. Whilst the blood corpuscles carry off, that is, take possession of all the oxygen, the life and development of the parasite become extremely difficult or impossible. It is therefore easily eliminated, digested, if one may use the phrase. I have seen these facts many times in anthrax and chicken-cholera, diseases both of which are due to the presence of an aerobic parasite.

Blood cultures from the general circulation being always sterile in these experiments, it would seem that under the conditions of the furuncular diathesis, the minute parasite does not exist in the blood. That it cannot be cultivated for the reason given, and that it is not abundant is evident; but, from the sterility of the cultures reported (five only) it should not be definitely concluded that the little parasite may not, at some time, be taken up by the blood and transplanted from a furuncle when it is developing to another part of the body, where it may be accidentally lodged, may develop and produce a new furuncle. I am convinced that if, in cases of furuncular diathesis, not merely a few drops but several grams of blood from the general circulation could be placed under cultivation frequent successful growths would be obtained. [Footnote: This prediction is fully carried out in the present day successful use of considerable amounts of blood in cultures and the resultant frequent demonstrations of bacteria present in the circulation in many infections.-- Translator.] In the many experiments I have made on the blood in chicken-cholera, I have frequently demonstrated that repeated cultures from droplets of blood do not show an even development even where taken from the same organ, the heart for example, and at the moment when the parasite begins its existence in the blood, which can easily be understood. Once even, it happened that only three out of ten chickens died after inoculation with infectious blood in which the parasite had just began to appear, the remaining seven showed no symptoms whatever. In fact, the microbe, at the moment of beginning its entrance into the blood may exist singly or in minute numbers in one droplet and not at all in its immediate neighbor. I believe therefore that it would be extremely instructive in furunculosis, to find a patient willing to submit to a number of punctures in different parts of the body away from formed or forming furuncles, and thus secure many cultures, simultaneous of otherwise, of the blood of the general circulation. I am convinced that among them would be found growths of the micro-organism of furuncles.

II. On Osteomyelitis. Single observation. I have but one observation relating to this severe disease, and in this Dr.

Lannelongue took the initiative. The monograph on osteomyelitis published by this learned pract.i.tioner is well known, with his suggestion of the possibility of a cure by trephining the bone and the use of antiseptic washes and dressings. On the fourteenth of February, at the request of Dr. Lannelongue I went to the Sainte-Eugenie hospital, where this skillful surgeon was to operate on a little girl of about twelve years of age. The right knee was much swollen, as well as the whole leg below the calf and a part of the thigh above the knee. There was no external opening. Under chloroform, Dr. Lannelongue made a long incision below the knee which let out a large amount of pus; the tibia was found denuded for a long distance. Three places in the bone were trephined. From each of these, quant.i.ties of pus flowed. Pus from inside and outside the bone was collected with all possible precautions and was carefully examined and cultivated later. The direct microscopic study of the pus, both internal and external, was of extreme interest. It was seen that both contained large numbers of the organism similar to that of furuncles, arranged in pairs, in fours and in packets, some with sharp clear contour, others only faintly visible and with very pale outlines. The external pus contained many pus corpuscles, the internal had none at all. It was like a fatty paste of the furuncular organism.

Also, it may be noted, that growth of the small organism had begun in less than six hours after the cultures were started.

Thus I saw, that it corresponded exactly with the organism of furuncles. The diameter of the individuals was found to be one one-thousandth of a millimeter. If I ventured to express myself so I might say that in this case at least the osteomyelitis was really a furuncle of the bone marrow. [Footnote: This has been demonstrated, as is well known.--Translator.] It is undoubtedly easy to induce osteomyelitis artificially in living animals.

III. On puerperal fever.--First observation. On the twelfth of March, 1878, Dr. Hervieux was good enough to admit me to his service in the Maternity to visit a woman delivered some days before and seriously ill with puerperal fever. The lochia were extremely fetid. I found them full of micro-organisms of many kinds. A small amount of blood was obtained from a puncture on the index finger of the left hand, (the finger being first properly washed and dried with a STERILE towel,) and then sowed in chicken bouillon. The culture remained sterile during the following days.

The thirteenth, more blood was taken from a puncture in the finger and this time growth occurred. As death took place on the sixteenth of March at six in the morning, it seems that the blood contained a microscopic parasite at least three days before.

The fifteenth of March, eighteen hours before death, blood from a needle-p.r.i.c.k in the left foot was used. This culture also was fertile.

The first culture, of March thirteenth, contained only the organism of furuncles; the next one, that of the fifteenth, contained an organism resembling that of furunculosis, but which always differed enough to make it easy usually to distinguish it.

In this way; whilst the parasite of furuncles is arranged in pairs, very rarely in chains of three or four elements, the new one, that of the culture of the fifteenth, occurs in long chains, the number of cells in each being indefinite. The chains are flexible and often appear as little tangled packets like tangled strings of pearls.

The autopsy was performed on the seventeenth at two o'clock.

There was a large amount of pus in the peritoneum. It was sowed with all possible precautions. Blood from the basilic and femoral veins was also sowed. So also was pus from the mucous surface of the uterus, from the tubes, and finally that from a lymphatic in the uterine wall. These are the results of these cultures: in all there were the long chains of cells just spoken of above, and nowhere any mixture of other organisms, except in the culture from the peritoneal pus, which, in addition to the long chains, also contained the small pyogenic vibrio which I describe under the name ORGANISM OF PUS in the Note I published with Messrs.

Joubert and Chamberland on the thirtieth of April, 1878.

[Footnote: See preceding paper.]

Interpretation of the disease and of the death.--After confinement, the pus that always naturally forms in the injured parts of the uterus instead of remaining pure becomes contaminated with microscopic organisms from outside, notably the organism in long chains and the pyogenic vibrio. These organisms pa.s.s into the peritoneal cavity through the tubes or by other channels, and some of them into the blood, probably by the lymphatics. The resorption of the pus, always extremely easy and prompt when it is pure, becomes impossible through the presence of the parasites, whose entrance must be prevented by all possible means from the moment of confinement.

Second observation.--The fourteenth of March, a woman died of puerperal fever at the Lariboisiere hospital; the abdomen was distended before death.

Pus was found in abundance by a peritoneal puncture and was sowed; so also was blood from a vein in the arm. The culture of pus yielded the long chains noted in the preceding observation and also the small pyogenic vibrio. The culture from the blood contained only the long chains.

Third observation.--The seventeenth of May, 1879, a woman, three days past confinement, was ill, as well as the child she was nursing. The lochia were full of the pyogenic vibrio and of the organism of furuncles, although there was but a small proportion of the latter. The milk and the lochia were sowed. The milk gave the organism in long chains of granules, and the lochia only the pus organism. The mother died, and there was no autopsy.

On May twenty-eighth, a rabbit was inoculated under the skin of the abdomen with five drops of the preceding culture of the pyogenic vibrio. The days following an enormous abscess formed which opened spontaneously on the fourth of June. An abundantly cheesy pus came from it. About the abscess there was extensive induration. On the eighth of June, the opening of the abscess was larger, the suppuration active. Near its border was another abscess, evidently joined with the first, for upon pressing it with the finger, pus flowed freely from the opening in the first abscess. During the whole of the month of June, the rabbit was sick and the abscesses suppurated, but less and less. In July they closed; the animal was well. There could only be felt some nodules under the skin of the abdomen.

What disturbances might not such an organism carry into the body of a parturient woman, after pa.s.sing into the peritoneum, the lymphatics or the blood through the maternal placenta! Its presence is much more dangerous than that of the parasite arranged in chains. Furthermore, its development is always threatening, because, as said in the work already quoted (April, 1878) this organism can be easily recovered from many ordinary waters.

I may add that the organism in long chains, and that arranged in pairs are also extremely widespread, and that one of their habitats is the mucous surfaces of the genital tract. [Footnote: When, by the procedure I elsewhere described, urine is removed in a pure condition by the urethra from the bladder, if any chance growth occurs through some error of technic, it is the two organisms of which I have been speaking that are almost exclusively present.]

Apparently there is no puerperal parasite, properly speaking. I have not encountered true septicemia in my experiments; but it ought to be among the puerperal affections.

Fourth observation.--On June fourteenth, at the Lariboisiere, a woman was very ill following a recent confinement; she was at the point of death; in fact she did die on the fourteenth at midnight. Some hours before death pus was taken from an abscess on the arm, and blood from a puncture in a finger. Both were sowed. On the next day (the fifteenth) the flask containing the pus from the abscess was filled with long chains of granules. The flask containing the blood was sterile. The autopsy was at ten o'clock on the morning of the sixteenth. Blood from a vein of the arm, pus from the uterine walls and that from a collection in the synovial sac of the knee were all placed in culture media. All showed growth, even the blood, and they all contained the long strings of granules. The peritoneum contained no pus.