Page images

nal prolapse of the anteverted and anteflexed womb can generally be restored to its normal position and held there, when the perineum is intact, and the vaginal contractility not entirely lost, as I have proven in several cases. By its agency, and that of the anteflexion pessary, presently to be described, posterior section of the uterine cervix will frequently be unnecessary, and the consequent dangers avoided. The same may be said of the operation for artificial fistula for cystitis, if the latter be dependent on uterine deviations."

Nearly all of the other anteversion pessaries possess one serious objection, namely: They have a posterior arch which stetches the posterior vaginal pouch. For a more accurate description of the Gehrung pessary I must refer the reader to Dr. Gehrung's articles in “Munde's Minor Surgical Gynecology."

[ocr errors]


By P. V. CARLIN, M. D., DENVER. The unique anatomical specimens referred to were taken from a subject in the dissecting room of the Medical Department of the University of the City of Denver.

The kidneys were normal in position and outline, and differed from that peculiar form of kidney designated as " Horse-Shoe Kidney,"

" ” in that they were wanting in the great curvature, length and constriction in the centre, so characteristic of the “Horse-Shoe Kidney." Each kidney consisted of two pelvices, separated by a fibrous septum, two ureters which united at a point, one and a half inches from the pelvices, to form a common ureter; two arterial supplies, the superior pelvis being furnished by a single artery which had its origin from the aorta, one line below the superior mesenteric; the inferior pelvis was supplied by two arteries which had their origin from the aorta, five lines below the inferior mesenteric. The renal veins united at a point about one inch from the pelvices to form a single vein.

The dimensions of the kidneys were as follows: The long diameter, 5 inches ; short, 27/2 inches; the circumference in the direction of long diameter, 1072 inches; in short diameter, 572 inches. The weigăt of each kidney was five Troy ounces.


[ocr errors]



LECTURE I. [The speaker was introduced by Dr. W. H. Draper, who remarked that the subject, “ The Relations of Fungi to Disease," was one which certainly at the present time recommended itself to us as one of the most important for our consideration. It had so revolutionized our ideas of the pathology of many diseases, and our methods of treatment, that it was not possible to give the subject too much attention. The gentleman who had been appointed to deliver the Cartwright Lectures on this occasion had had unusual facilities for acquiring practical experience in the study of the relation of the micro-parasites to disease; and he now took pleasure in introducing to the audience Dr. W. T. Belfield, of Chicago.]

Dr. Belfield opened his remarks by saying that in accepting this kind invitation to deliver the Cartwright Lectures he had, in compliance with the request of the Alumni Association, chosen this subject simply because of its intrinsic interest and importance, and also because there existed in the mind of the medical public in this country a divided opinion regarding it which seemed to him not to be warranted by the facts.

The speaker than referred to the inherent difficulties pertaining to the story of the subject under consideration; the necessity for extended facilities in pursuing investigations in the laboratory, the time and the expense necessarily involved, etc.-facts which, from the nature of our institutions, greatly limited original work in this direction in this country. In Europe, material aid was given original investigation of scientific subjects by the government. There had seemed to be a tendency on the part of the medical public in the United States to treat the subject under consideration as trivial or fanciful, and in general to ignore it. It was not his endeavor to present any original investigations, any theories or new views, but simply to state facts already established, and the deductions incident thereto, an effort which he was encouraged to undertake on account of some familiarity with the literature of the subject and a practical knowiedge of the methods of manipulation.

Dr. Belfield than briefly referred to the history of the discovery and the study of the subject of bacteria, and said that even as early as 1675 bacteria had been observed. Fuchs had observed them in animals which had died in septic infection in 1848, and others had observed them in anthrax in 1849-'50. Pasteur, in his work on Fermentations, published in 1861, was the first to endeavor to establish a genetic relation between plants and diseases. At that time bacteria suddenly acquired an interest for the pathologist. The attention of the profession was drawn to the subject by the works of such authors as Meyerhofer, Cohn, Rindfleisch, Recklinghausen, and others, published from 1865 to 1867. Actuated by the investigations of Pasteur, Lister adopted certain methods in the treatment of disease, clinical results of which led to a revolution in surgical methoils, and gave new vigor to experimental pathology. He would consume no more time with an historical sketch, but would proceed at once with a review of the evidence upon which the subject rested.

The definition which Cohn had given of bacteria as early as 1875 was applicable at the present day, with slight modification: "Cells devoid of chlorophyll, spherical, oblong or cylindrical, which reproduce themselves extensively by transverse division, and live either isolated or in families." · To this was to be added the power of reproduction which was known to occur in several species. Many bacilli were also known to possess a thread-like projection from the extremity by means of which they were capable of motion in liquids. Nutrition and assimilation were carried on, by a process of osmosis This simplicity of structure had given rise to the discussion as to whether the bicilli belonged to the animal or to the vegetable kingdom. Our knowledge at present with regard to chemical reactions incident to their vital activity was very limited. An interesting fact respecting them was that the putrefaction of albuminous substances was incident to the vital activity of certain varieties. Their simplicity of organization explained their extensive distribution throughout nature, They were to be found in currents of air, in the dust carried by the wind, etc. Certain errors in manipulation and misinterpretations of facts, which were so liable to take place even with the greatest of care and most improved methods and facilities for investigation, would account for the serious mistake made by Pasteur and others in saying that bacteria were capable of spontaneous generation. There were some at the present day who were of opinion that they were capable of spontaneous generation, but, so far as evidence went, there was no reason to suppose that bacteria, like all other organisms, did not always proceed from pre existing similar beings.

With regard to the nomenclature, unfortunately much confusion had arisen. Each investigator had been disposed to name each new variety according to his own individual fancy. The French school, following Pasteur, had in a loose manner made use of the terms vibrios, monads, torulaceæ, etc. Dr. Belfield thought that Cohn's classification was the fittest to survive, but it also would have to undergo some amendments.

[ocr errors]

According to this system, the bacteria were distinguished by form as micrococci, micro-bacteria, bacilli and spirilla. Each of these forms was then described.

The following was given as a definition of a bacterium : A mass of matter of definite shape and size, possessing or not possessing motion, of a certain chemical composition, having the power of growth and reproduction. No mass of matter could be said to be bacteria unless it possessed these qualities. Certain of these qualities, as said before, could be determined by examination under the microscope, and there were certain qualities which became manifest only under the action of reagents. For instance, aniline colors distinguished bacteria from such bodies as fibrin threads, fat granules, etc. But many of these qualities might exist in other bodies than bacteria, and lead to serious errors in deductions or statements of facts on the part of the observer. Instances of this kind were related.

But even the experienced mycologist could not determine with absolute certainty that a given body was one of the bacteria except by cultivation outside of the body, demonstrating its reproductive power.

But with this arose practical difficulties which it was not always possible to overcome. Many objects might come in contact with the particle under examination which might also contain bacteria, and it was necessary to liberate the particle from all adherent organisms. We might, however, observe the strictest rules in this direction, and yet be unable to say postively that our precautions were altogether efficient. Dr. Belfield then selected cases from the literature of the subject, going to show how mistakes which had been made in this direction had led to very erroneous conclusions.

Two ways had been chiefly adopted in the isolation of bacteria from the blood or tissues of the animal for examination. First, by infiltration through some porous substance, as paper. But the imperfection of this method was evident. The method of cultivation could be divided into three groups, the first and the earliest being the worst, namely, in flasks or tubes containing the nutrient liquid. The errors liable to and which had grown out of this method were referred to at some length, and consisted chiefly in the extreme liability, at any of the transfers, to the admixture of foreign matter with the original. Should other living organisms become mixed with the bacteria being experimented upon, that which multiplied fastest, other things being equal, would, after few transfers, be the only one remaining.

It seemed to the author that the substitution for this method of one which he would proceed to describe would hasten the solution of many problems now involved in obscurity, and would tend to avoid much con

[ocr errors]

fusion which at present existed with regard to this subject. The only means by which an organism in a culture could be shown positively to be the progeny of that which had first been transplanted was, that it must have been observed to proceed from it by continuity of structure, and this could only be done by direct observation under the microscope. The method to which he alluded was that introduced three years ago by Koch, and consisted in the substitution, for a liquid vehicle for the nutrivion and cultivation of the organism, of a solid material. A solution of gelatin, or beef extract, or peptone. or other material, according to the species of bacteria which it was desired to cultivate, was sterilized and spread upon a disinfected slide, and allowed to dry. A heated needle was then dipped into the material containing the bacteria and drawn lightly over the substance upon the slide, by which a scratch was made, to the edges of which the bacteria adhered. The slides were then placed in the incubator. The liabilities to error in this method consisted in the difficulty of thoroughly sterilizing the culture solid, and the danger of other organisms being planted with the one experiinented upon. But by this means it was possible to observe the growth by continuity of the organism in successive cultures, in transferrng it to a second and a third slide, and so on, multiplying it indefinitely. By this method alone were we able to demonstrate that an organism injected into an animal from the tenth or the hundredth culture was structurally the same as the organism taken from the animal which had suffered from the disease in which the original bacterium had been found.

Dr. Be'field then described the method of observing the bacteria under the microscope, and the best instruments for that purpose.

Before discussing the relation of bacteria to the body in disease, the speaker referred to their relations to the animal in health and after death. It had been a widely disputed question as to whether bacteria ever occurred in the animal in a perfectly healthy state, the affirmative view having been taken by Billroth and some others, but it was denied by Koch, by Pasteur, ard by Ehrlich, who stated that they had never detected bacteria in the healthy animal. The failure of putrefactive bacteria to reproduce themselves in healthy tissue, according to experiments referred to, would go to show inability to struggle against the normal cells indigenous to the soil upon which they were planted. Some bacteria showed power of existence only in tissue in which vitality had entirely ceased, while others seemed to possess the power of existence in the presence of the animal cells when the latter suffered from impairment of nutrition and the tide of life was turning against them. Abnormal composition of the blood seemed to favor the development of some bacteria after they had found their way into the tissues. An illustration of this fact was seen in

« PreviousContinue »