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 quantity 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 quantities 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 practitioner 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, quantities 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-prick in the left foot was used. This culture also was fertile.