Staphylococcus

“ Diseases caused by the Staphylococcus Aureus.—As the majority of pyogenic diseases are due to infection with the staphylococcus aureus, these will be described first.
Acute osteomyelitis is a suppurative process beginning in the marrow and tending to spread to the periosteum. The disease is common in children, but is rare after the skeleton has attained maturity. Boys are affected more often than girls, in the proportion of three to one, probably because they are more liable to exposure, to injury, and to violent exertion. ”

“ Infection with the staphylococcus albus, the streptococcus, or the pneumococcus also causes a mild form of osteomyelitis which may go on to suppuration.
Necrosis without suppuration, described by Paget under the name “quiet necrosis,” is a rare disease, and would appear to be associated with an attenuated form of staphylococcal infection (Tavel) . It occurs in adults, being met with up to the age of fifty or sixty, and is characterised by the insidious development of a swelling which involves a considerable extent of a long bone. ”

“ Now, if you can think of any possible chink through which a wandering streptococcus can, by any possibility, sneak into that wound, please suggest it, and it shall be closed immediately!
The intruders against whom all these preparations are made are two in number: Streptococcus pyogenes and Staphylococcus pyogenes—cousins, as you see, by their names. Their last (not family) name really [Pg 340] means something, and is not half so alarming as it sounds, as it is Greek for "pus-making." ”

“ The two common pyogenetic organisms, Staphylococcus albus and brevis, show no virulence. Also the pneumococcus, though often present, must be raised in virulence before it can produce untoward results. The foulness of the mouth is supposed to be due to the colon bacillus and its allies, but those obtained from the mouth are innocuous. Also to enable the Oidium albicans to attack the mucous membrane there must be some slight inflammation or injury. The micro-organisms found in the stomach gain access to that organ in the food or by regurgitation from the small intestine. ”

“ The common inflammatory bacteria—staphylococcus and streptococcus—cause suppuration in the majority of cases, but there are a few organisms such as streptothrix, spirochaete pallida, and in many instances the tubercle bacillus, which set up an inflammation of an extremely chronic type, rarely progressing to the formation of us, but leading rather to the development of a hard, solid mass of very slow growth, that may persist for months or even years. ”

“ The rabbits which received the dog's blood all survived the inoculations, whilst those which did not, succumbed in every case to the action of the Staphylococcus pyosepticus. So struck were the authors by these remarkable results that they repeated them, and their further investigations fully confirmed those originally obtained, proving that they were not "un fait exceptionnel." ”

“ Most cases are due to the staphylococcus pyogenes aureus and a few to the streptococcus. Typhoid bacilli may cause suppuration. The infecting organism is present in pure culture but sometimes a mixed infection occurs, and such cases are said to be severe.
In cases of chronic osteomyelitis with open sinuses and exposed bone, a great variety of organisms, pathologic and saprophytic, may be present. ”

“ But even the health of a speaker if satisfactory is not necessarily a safeguard against his dissemination of disease germs, for it is well known that the mouth secretions of healthy people may frequently contain the staphylococcus pyogenes aureus, and also, though less frequently, the diplococcus lanceolatus, both virulent microbes; whilst that diphtheria bacilli may be present in the mouths of people who are not suffering from the disease has been demonstrated repeatedly. What a capacity, then, for spreading evil does the public orator possess! ”

“ I have observed a principle, which I shall temporarily call the X Principle, in pus from a staphylococcus infection, which checks the growth of several strains of staphylococcus, and which dissolves the staphylococci from the pus in question. ”

“ Staphylococcus pyogenes albus, the white coccus, acts like the aureus, but is more feeble in power. When this organism is found upon and in the skin, it is called staphylococcus epidermis albus, an organism which is the cause of stitch abscesses.
Streptococcus pyogenes is found in spreading suppurations and in very acute abscesses. About 16% of acute abscesses contain streptococci. ”

“ The bacteriology of broncho-pneumonia presents no one micro-organism which can be definitely said to cause the disease. The micro-organism most frequently found, either alone or associated with other bacteria, is the pneumococcus, which occurred in 67% of a series investigated by Wollstein. Other organisms found are the streptococcus, particularly in bronchopneumonia following infectious fevers, the staphylococcus aureus and albus, and Friedlander's bacillus. In some cases the bacillus infiuenzae alone has been found, and the Klebs-Lofiier bacillus in cases following upon diphtheria. ”

“ During the 1889 epidemic Prudden examined by current bacteriologic methods seven cases of influenza and six cases of influenza-pneumonia. In them he found staphylococcus pyogenes aureus, streptococcus pyogenes, diplococcus pneumoniae, and in other cases he found a streptococcus. He concludes that the use of culture methods and media commonly employed has brought to light no living germ which there is reason to believe has anything to do with causing the disease. He emphasizes the probable importance of streptococcus pyogenes in particular in inducing the various complications. ”

“ More severe types, which are apt to prove fatal from a form of blood poisoning, may result when the valves of the heart are attacked by certain micro-organisms, such as the pneumococcus, which is responsible for pneumonia, the streptococcus and the staphylococcus pyogenes, the gonococcus and the influenza bacillus. ”

“ Fig. 3.—Streptococci in Pus from an acute abscess in subcutaneous tissue. × 1000 diam. Gram's stain.
Streptococcus Pyogenes.—This organism also varies greatly in its virulence; in some instances—for example in erysipelas—it causes a sharp attack of acute spreading inflammation, which soon subsides without showing any tendency to end in suppuration; under other conditions it gives rise to a generalised infection which rapidly proves fatal. The streptococcus has less capacity of liquefying the tissues than the staphylococcus, so that pus formation takes place more slowly. ”

“ Now large numbers of people wear collars and cuffs with frayed edges, or handle irritants with their fingers, but they do not necessarily contract boils or whitlows. Therefore, we see that there must be other factors to be taken into consideration to account for their presence. The orthodox germ-loving practitioner may tell you that a boil is a purely local disorder and that a certain form of microbe, known as the Staphylococcus pyogenes, is the cause of it. ”

“ The patient was a middle-aged man suffering from a chronic staphylococcal septicæmia and a secondary anæmia. He received a transfusion of 650 cc. of blood from a donor who had himself just recovered from a severe infection with staphylococcus aureus. The patient’s red blood cells underwent a temporary increase in number, but no other result was observed. One series of nine cases has been recorded by Fry, and in these the results leave some doubt as to the efficacy of the treatment. ”

“ The fluid, meanwhile, must be kept at an even temperature which will encourage the development of any spores it may contain. Even anthrax spores may be killed by 167°F. to 185°F., or 75°C. to 80°C., in a one and four-tenths solution of bicarbonate [Pg 15] of soda, in from 8 to 20 minutes. Dry heat is not so efficient as moist heat.
The following are the more important bacteria we meet in surgical conditions:
Staphylococcus pyogenes aureus—a microorganism producing yellow pus. ”

“ In others, they might be so intermingled that they could not be differentiated. The bronchi were filled with pus and often could be seen opening into large abscess cavities. The proliferation of the bronchial epithelium, as noted elsewhere, also was a striking feature in these sections. The pleural exudate was undergoing organization.
Streptococcus hemolyticus was found in the cultures of the lung, blood, pleural fluid, and bronchi. In addition, the bronchi and abscess cavities also showed Type IV pneumococcus and Staphylococcus albus. ”

“ When he added a drop containing the Principle to a growth of staphylococcus which was a gray film on the solid surface of agar, the drop was beautifully outlined by bare patches, as the enemy made its attack, so that the agar slant looked like moth-eaten beeswax. But within a fortnight one of the knots of which Gottlieb warned him appeared.
Wary of the hundreds of bacteriologists who would rise to slay him once his paper appeared, he sought to make sure that his results could be confirmed. At the hospital he obtained pus from many boils, of the arms, the legs, the back ”

“ This comes as already shown from gaseous distension, overloading, sudden shock or concussion, obstruction by dried ingesta, calculi, foreign 385bodies, parasites, etc., and by abuse of too powerful purgatives in cases of obstruction. The resulting infection is very abundant and varied, and the microbes accustomed to an anærobic existence in the intestines, multiply with extreme rapidity in the peritoneum and prove rapidly fatal. Beside the bacillus coli commune, there are usually staphylococcus and streptococcus pyogenes and not unfrequently the bacillus of malignant œdema. ”

“ When the infection becomes active, the contents of the cavity are transformed into a greenish-yellow pus from which the staphylococcus can be isolated, and the cavity is lined by a thin film of granulation tissue which erodes the surrounding bone and so causes the abscess to increase in size. If the erosion proceeds uniformly, the cavity is spherical or oval; if it is more active at some points than others, diverticula or tunnels are formed, and one of these may finally erupt through the shell of the bone or into an adjacent joint. ”

“ The invading organism is usually one of the staphylococci, less frequently a streptococcus, and still less frequently one of the other bacteria capable of producing pus, such as the bacillus coli communis, the gonococcus, the pneumococcus, or the typhoid bacillus.
So long as the tissues are in a healthy condition they are able to withstand the attacks of moderate numbers of pyogenic bacteria of ordinary virulence, but when devitalised by disease, by injury, or by inflammation due to the action of other pathogenic organisms, suppuration ensues. ”

“ When a bill has been in circulation for a short time and has become somewhat cracked, and its peculiar glaze worn off, the bacteria very easily cling to it without the presence of dirt and grease.
All inoculations gave negative results, the time limit being placed at from six to seven weeks. All of the guinea pigs showed more or less local reaction, with swelling of the lymph glands of the groin, but none gave any indication of even temporary illness. Inoculations of pure cultures of staphylococci, as well as of Bacillus verosis (which was at first suspected of being Bacillus diphtheria;) ”

“ The pus microbes, cocci, streptococci, staphylococci, and bacilli, have been found and adduced as causes, also diplococci, the bacillus hæmorrhagicus of Kolb, the streptococcus of strangles, the microörganism of contagious pneumonia and that of influenza, with a variety of others too great and too inconstant to be accepted as proof of cause. The fact that rarely more than one animal suffers in the same stable at the same time might be held to oppose the idea of contagion and of a definite organized germ. ”

“ Other bacteria than the acid-fast group are stained blue by Gabbet's method. Those most commonly found are staphylococci, streptococci, and pneumococci. Their presence in company with the tubercle bacillus constitutes mixed infection, which is much more serious than single infection by the tubercle bacillus. It is to be remembered, however, that a few of these bacteria may reach the sputum from the upper air-passages. Clinically, mixed infection is evidenced by fever. ”

“ In each case a simple inoculation experiment may decide the point at once. As a concrete example may be instanced an autopsy on an animal dead from an unknown infection. Cultivations from the heart blood gave a pure growth of a typical (capsulated) pneumococcus. Cultivations from the liver gave a pure growth of what appeared to be a typical (non-capsulated) Streptococcus pyogenes longus. The latter inoculated into a rabbit caused the death of the animal from pneumococcic septicæmia, and cultures from the rabbit's blood gave a pure growth of a typical (capsulated) pneumococcus. ”

“ Second, there is no acceptable clinical evidence that vaccination with the influenza bacillus, the Strepto­coccus, the Pneumo­coccus or the Micro­coccus Catarrhalis will influence the course of an infection due to one or the other of these organisms. It has been repeatedly found that a staphylo­coccus vaccine is of a certain degree of value when the infection with the staphylo­coccus is localized, but it is well known that general systemic infections with the staphylo­coccus are not at all benefited. ”

“ Some new light has been thrown upon the subject of pathogenic organisms in air by Neisser in his investigations concerning the amount and rate of air-currents necessary to convey certain species through the atmosphere. He states that the bacteria causing diphtheria, typhoid fever, plague, cholera, and pneumonia, and possibly the common Streptococcus pyogenes, are incapable of being carried by the molecules of atmospheric dust which the ordinary insensible currents of air can support, whilst Bacillus anthracis, B. pyocyaneus, and the bacillus of tubercle are capable of being aërially conveyed. ”