Stephanotis

“ This being nicely arranged, I hung her chalcedony charm from her neck, and fastened it to her waist-band. Then I caught up her clustering hair, nearly as thick and long as my own, after the Corsican fashion, snooded it close in ripples with a pink and white-striped mandile, and told her to love herself in the glass, while I ran off to the hot-house for a truss of Stephanotis. This, with a glossy sprig of Gardenia leaves to back it, I fastened cleverly into the clear mandile, on the curve of her elegant head, and my darling was complete. ”

“ He soon filled his buckets, and was by Annie’s side, in her garden, waiting for orders.
She pointed out those shrubs and flowers which were specially thirsty subjects, and told him the names of many of the plants.
“These many-coloured flowers are Balsams; that great bush, with its deep red flowers, is a Bouganvillia; and the creeper joining it, over the summer-house, with its bunches of waxy flowers, is called Stephanotis; it scents the whole garden at night.”
“I know the smell of that,” said Mat, “if I do not know the name, for you had a nosegay of it when I saw you in Sydney.” ”

“ Later on, the sickly yellow moon, high in the zenith, its pale light quenching that of the dying embers of the fire and waning itself before the dawn. The things it looked down upon—the heaving figures of the devotees—and all about the pure, sweet peace of the tropic night!
“‘Tom-tom-tom-tom-tom-tom-tom-tom,’ went the drum, and then I awoke with a shiver and began to dress. I stepped to the window for added light, and other noises than those of the drum welled up from the valley beneath. Air was stirring, and it blew through my jalousies and filled the room with the smell of the stephanotis. ”

“ It seems a waste of money, however; for there is hardly any one to make use of the wide roads, and the forest would appear quite as beautiful in its pristine luxuriance. To our eyes the addition of flowers from other countries is no improvement, though the feeling is otherwise here. More than once I have had a bouquet of common stocks given to me as a grand present, while orchids, gardenias, stephanotis, large purple, pink, and white azaleas, orange-blossom, and roses, were growing around in unheeded profusion. ”

“ But if the bacillus finds its appropriate food—dead or decomposing matter—in the glands, it at once takes up its abode in them and “begins housekeeping;” that is, it begins to multiply according to the method of fission of its cell and rate of multiplication, already described. During this process the multiplying cells excrete a toxin, which, being absorbed, creates a fever, the result of a true blood poisoning. This fever is called typhoid, because its prominent symptom, stupor, resembles that of typhus fever. The name, therefore, signifies nothing as to the nature of the disease. ”

“ Secondary toxic centres often develop in the course of this disease, notably in the glands, lungs and dependent organs, the hypostatic congestion resulting from lying in one position, causing stasis of blood, death and necrosis of tissue, both of the external and internal organs. All vessels connected with the dying tissues carry toxins to other parts of the body. Suppurating glands, and phlebitis of the femoral veins are examples of this secondary infection, and are accountable for the heart failure and collapse so often fatal during the second, third and fourth weeks of typhoid fever. ”

“ 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 ”

“ There is evidence that a _mixed infection_--that is, the introduction of more than one species of organism, for example, the tubercle bacillus and a pyogenic staphylococcus--increases the severity of the resulting disease. If one of the varieties gain the ascendancy, the poisons produced by the others so devitalise the tissue cells, and diminish their power of resistance, that the virulence of the most active organisms is increased. ”

“ The micro-organisms are conveyed by the blood-stream to different parts of the body, in which as in the original wound itself they both multiply and set up factories for the production of toxins. The disease commonly follows blows or wounds which have not been treated on surgical lines. Much laceration of the tissues at the time of the injury offers increased liability to infection. Septicaemia is frequent in spreading gangrene, in diseases of the periosteum, and in fevers such as scarlatina, diphtheria or plague, and in the puerperal state. ”

“ The typhoid bacillus during this time spreads into almost every organ and tissue of the body, and towards the end of the period, when the resisting forces of the body have been proved unable to counteract the attack and the fever is well developed, the condition of the patient is deplorable. The bacteria are everywhere throughout the system, although they are especially active in the small intestines. This inflammation may produce ulceration and the blood vessels may be attacked, so that hemorrhages or even peritonitis may occur. ”

“ 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. ”

“ Suffice it to say that a boil is produced by the proliferation of Staphylococcus pyogenes aureus and albus, Streptococcus pyogenes, or other pyogenic micro-organisms in the skin and subcutaneous tissue; that the organism gives rise to local and limited infiltration of the tissues with lymph which subsequently and rapidly dies, the necrotic core being surrounded by an areola of acute inflammation; that this core is separated by a process of sloughing and so got rid of, the resulting ulcer speedily healing and leaving a depressed scar, which, when occurring about the legs, may become pigmented. ”

“ In man it is found as a sequel of infectious diseases (pneumonia, pyæmia) , in Bright’s disease, cirrhosis of the liver and cancer, and in poisoning by lead, mercury or arsenic (Osler) . Cadeac, who found great numbers of streptococci in the false membranes in animals, is certain it is a microbian disease, and this is doubtless true, if qualified by the statement that the microbe as is so often the case with other intestinal affections, 222requires an occasion in the form of a diseased or debilitated condition of the mucosa to enable it to become pathogenic. ”

“ The extreme instance of bacterial invasion is found in some of the septicaemias in the lower animals, e.g. anthrax septicaemia in guinea-pigs, pneumococcus septicaemia in rabbits. In such diseases the bacteria, when introduced into the subcutaneous tissue, rapidly gain entrance to the blood stream and multiply freely in it, and by means of their toxins cause symptoms of general poisoning. A widespread toxic action is indicated by the lesions found—cloudy swelling, which may be followed by fatty degeneration, in internal organs, capillary haemorrhages, &c. ”

“ But the communication of the disease is not direct, by contact; it is indirect, by infection of drinking water, or of an atmosphere which may be remote from the person who is the source of the poison. A case of typhoid fever is introduced into a locality. The stools are thrown out on the ground or into a cesspool, whence they percolate through the soil into a well. The person who drinks water from that well runs a greater risk than one who sleeps in the same room as the sufferer and is in constant attendance on him. ”

“ For instance, the third commonest point of attack of the tubercle bacillus, after the lungs and the glands, is the bones and joints, as illustrated in the sadly familiar "white-swelling of the knee" and hip-joint disease. All the so-called septic organisms, which produce suppuration and blood-poisoning in wounds and surgery, may, and very frequently do, attack the joints; while nearly all the common infections, such as typhoid, scarlet fever, pneumonia, and even measles, [Pg 319] influenza, and tonsillitis, may be followed by severe joint symptoms. ”

“ In the human subject, multiplication in the blood-stream does not occur to any great extent. In some general acute pyogenic infections, such as osteomyelitis, cellulitis, etc., pure cultures of staphylococci or of streptococci may be obtained from the blood. In pneumococcal and typhoid infections, also, the organisms may be found in the blood. ”

“ Septicemia may be defined as an acute febrile affection, characterized by marked nervous, cutaneous and visceral manifestations, and due to the introduction into the system of bacteria and their toxins from an infected wound. It applies to diseases which present poisons in the blood that are of parasitic origin, the parasite itself being either present or absent in the blood. Septicemia, in strong contrast to the definition of toxemia, would include diseases arising from the invasion of the tissues and fluids of the body by animal or vegetable parasites or their poisonous products. ”

“ Syphilis is one of these diseases. It is not to be understood that there is a sharp line of division between these three groups, since in every disease we try as far as possible to use all the methods we can bring to bear. [Pg 61] In pneumonia we have to let the body largely make its own fight, and simply help it to clear out the poisons formed by the germ, and keep the heart going until the crisis is past. In diphtheria, nowadays, we help the body out promptly by supplying it with antitoxin from an outside source, before it has time to make any for itself. ”

“ Erysipelas, popularly known as "rose," is an acute spreading infective disease of the skin or of a mucous membrane due to the action of a streptococcus. Infection invariably takes place through an abrasion of the surface, although this may be so slight that it escapes observation even when sought for. The streptococci are found most abundantly in the lymph spaces just beyond the swollen margin of the inflammatory area, and in the serous blebs which sometimes form on the surface. ”

“ In the treatment of tetanus the first thing to do is to try to make the wound by which infection has taken place surgically clean. For though a wound free from the germs of suppuration may be the incubating place of the bacilli of tetanus, still in most cases there is also an invasion of septic germs, and the double infection makes the action of the tetanic poison the more virulent. If the local conditions are such that it is impossible to cleanse the wound, the free use of the knife or of the cautery or of pure carbolic acid may be resorted to, or an amputation may be performed. ”

“ 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. ”

“ Proper safeguarding of our water and milk supply is necessary if we are to keep typhoid away.
Blood Poisoning.—The bacterium causing blood poisoning is another toxin-forming germ. It lives in dust and dirt and is often found on the skin. It enters the body through cuts or bruises. It seems to thrive best in less oxygen than is found in the air. It is therefore important not to close up with court-plaster wounds which such germs may have entered. It, with typhoid, is responsible for four times as many deaths as bullets and shells in time of battle. ”

“ Now, of course, the presence of a foreign substance in the human body will not necessarily produce inflammatory action, it must become septic, and we must at once admit the possibility of an adult worm becoming affected with a streptococcus and thus produce an abscess and secondary lymphangitis, though the streptococcus might produce it without the dead worm. ”

“ While these are most common in the chronic infections and contagions, they often occur in acute typhoid fever, scarlatina, diphtheria, whooping-cough, &c. Proper blood supply and utilisation of waste is thus prevented. Organs cannot perform their function, and are predisposed to disease from disuse and from weakness of the disease-fighting phagocytes and antitoxins. From this results irregularity of organ function, which is hereditarily transmissible. The weakened vessel walls yield to strain, and thus produce local stomach, bowel, liver, gland, and kidney disorders. ”

“ It is possible that a certain flora is normal for the tract at sexual maturity, as in several other organs of the body, but under the strain of sexual excess, defective diet, or other weakening influences, these organisms may become pathogenic. Streptococci and staphylococci have at times been found in apparently normal parts of the body, and at other times they are found associated with severe pathological lesions in the genital tract. The degree of pathogenicity is of course difficult to determine, except as we find the bacteria associated with abnormal conditions. ”