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Transcript
ix
APPLIED
BACTERIOLOGY
FOR
NURSES
CHARLES
LECTURER,
F.
PREVENTIVE
PHYSICIANS
AND
OF
HEALTH
PUBLIC
COLUMBIA
EDUCATION,
EDITION,
B.
S.
GRUND,
COLLEGE
OF
CHIEF,
PUBLIC
HEALTH
M.
NEW
AND
DEPARTMENT
YORK
REVISED
LONDON
COMPANY
1920
OF
SECTION
SERVICE
D.
THOROUGHLY
SAUNDERS
D.
HYGIENE,
LABORATORY,
CITY
rHILADELPHlA
W.
M.
UNIVERSITY;
U.
RESEARCH
HEALTH,
THIRD
AND
IIEDICINE
SURGEONS,
MARIE
BACTERIOLOGIST,
BOLDUAN,
OF
-^^^iVTol
Copyright,
June,
1913,
by W.
1914.
October, 1916.
1918.
Company.
Saunders
B.
Revised,
reprinted, and
January, 1918, and
Reprinted
Revised, reprinted, and
August,
Copyright,
1919,
by W.
Reprinted
PRINTED
Saunders
May,
PRESS
B.
SAUNDERS
PHILADELPHIA
July,
recopyrighted
1919
B.
IN
Reprinted
recopyrighted
1920
AMERICA
OF
COMPANY
Company
TO
PREFACE
aim
the
With
of
disease
vermin
by
of the
note
a
frequent
of
influenza,
of
to
connection
deemed
note
a
advisable
takes
the
up
use
has
been
In
of
of Cole
all of
and
the
to
these
constantly
been
of
has
the
kept
as
wounds,
to
pandemic
disease.
of
the
life-history
now
according
vaccine
therapy
fever
lice.
original work,
knowledge
the
to
Trench
spread by
the
been
Pneumococcus
discussed.
newer
ployment
em-
wounds,
war
recent
Under
in
article
an
INIalaria,it has
on
list of diseases
of
the
organisms
been
of
of
the
of that
the
on
added.
chloramines;
in
description
Dochez.
additions,
practical application
has
types
lipovaccines
added
a
fully
care-
wide-spread
the
virus
chapter
different
classification
the
add
The
and
chapter
been
of infected
perfringens;
the
to
the
been
transmission
addition
gangrene
the
has
the
treatment
gas
on
with
mosquitoes.
the
solution
of Bacillus
inclusion
In
antiseptic
occurrence
the
in
of present-
has
matter
played
to
abreast
work
Disinfestation;
Dakin's
on
entire
new
led
has
and
Pediculosis
on
role
important
the
Thus,
of
the
EDITION
book
this
considerable
and
revised
THIRD
keeping
bacteriologic science,
day
to
THE
to
the
nursing
in mind.
C. F. B.
Washington,
D.
C.
PREFACE
dominates
Bacteriology
nursing
that
a
facts
and
understanding
correct
principles of
part of
following pages
nurse's
every
application of
the
clear
a
work.
her
that
A
been
infection
perusal
has
been
introduced
been
of
nature
bacteria
the
have
give the
been
added
of the
principlesalready
gainsaying
the
study
the
of
instruction
little
value
to
nothing
laid
is
the
for individual
demonstrations
been
will show
York
has
of
the
pathogenic
their
to
of
pathology
discussion
presentation
the
While
there
is
laboratory exercises
writers
may
feel that,
simple
very
work.
added
so
far
well
be
the
in
as
stituted
sub-
Suggestions
at
no
practical
end
chapters.
New
the
give
to
Many
down.
laboratory
have
the
only enough
fair idea
a
concerned,
teacher
In
of transmission
because
of individual
nurses
by
modes
student
bacteriology,the
demonstrations
such
or
pensable
indis-
an
immediate
chapters
Sufficient
omitted,
have
and
portant
im-
principlesunderlying
described.
would
is
the
on
of
art
more
equipment.
laid
the
ordinary
infection
science
various
presented.
to
the
introduced
of
of the
of
nursing,
has
of all the
study
a
been
to
conception
that
mental
subject
general bacteriology
student
has
emphasis
of the
large a part
so
City.
3
for
of the
CONTENTS
GENERAL
BACTERIOLOGY
CHAPTER
I
PAGE
Historic
11
CHAPTER
Character
Bacteria
of
14
CHAPTER
Methods
Studying
of
Stained
of
25
V
27
CHAPTER
and
VI
Antiseptics
36
Chlorid
Mercuric
Carbolic
Crude
IV
Bacteria
of
Disinfectants
22
Smears
CHAPTER
Cultivation
III
Bacteria
CHAPTER
Preparation
II
37
Acid
Carbolic
38
Acid
38
Quicklime
39
Chlorid
of Lime
39
Dioxid
40
Sulphur
Formaldehyd
40
lodin
40
Poroxid
of
40
Hydrogen
41
Soap
Dakin's
41
Solution
Dichloramino-T
41
Halazonc
42
5
6
CONTENTS
CHAPTER
Sterilization
VII
PAGE
Heat
by
43
iMi-o
Dry
43
Heat
Hoat
Moist
Live
43
44
Steam
44
Under
Steam
Pressure
40
.
CHAPTER
Relation
Bacteria
of
to
Mil
Disease
48
Inflammation
50
CHAPTER
Transmission
Terminal
Diseases
Infectious
of
IX
55
57
Fumigation
Inseets
Carriers
as
of Infectious
CHAPTER
Quarantine
in
Control
the
of
Diseases
57
X
Infectiois
Diseasf.s
(iO
.
CHAPTER
XI
Immunity
64
Antitoxins
67
Bacteriolysins
08
Agglutinins
70
Opsonins
73
and
Preeii)itins
Anaphylaxis
Serum
and
Bacterial
Other
Vaecine
Antibodies
74
75
70
Therapy
Vaccines
77
Lipo-vaccines
SPECIAL
78
BACTERIOLOGY
CHAPTER
Typhoid
XII
Fever
81
CHAPTER
Dysentery
and
Cholera
80
CHAPTER
Tuberculosis
XIII
XIV
91
7
CONTENTS
CHAPTER
XV
Diphtheria
95
CHAPTER
XVI
Tetanus
101
CHAPTER
The
Streptococcus
104
XVIII
Infections
108
CHAPTER
Staphylococcus
XIX
Infections
CHAPTER
Ill
XX
Meningococcus
114
CHAPTER
The
XVII
Pneumococcus
CHAPTER
The
XXI
Gonococcus
117
CHAPTER
XXII
Syphilis
119
CHAPTER
XXIII
Ex.\nthemata
122
Scarlet
Fever
Measles
and
Small-pox
122
German
and
Measles
123
Cow-pox
CHAPTER
Filterable
PAGE
124
XXIV
Viruses
126
CHAPTER
Malaria
XXV
128
Mosquitoes
130
Yellow
132
Fever
Trypanosomiasis
133
""
CONTENTS
CHAPTER
XXVI
PAGE
Bacteriology
Milk
of
134
CHAPTER
Fermented
XXVII
Milks
140
CHAPTER
Bacterial
Food
XXVIII
Poisons
143
CHAPTER
Bacteriology
Water
of
Pollution
Natural
to
Be
146
Guarded
Purification
Water-borne
XXIX
Against
146
of Water
147
Diseases
Filtration
of Water
Domestic
Filters
147
Supplies
148
148
_
Purification
by
Chlorination
149
Purification
by
Distillation
150
Purification
by Boiling
Bacteriologic Examination
150
of Water
CHAPTER
Animal
Parasites
150
XXX
Vermin
and
152
Tapeworms
152
Trichina
152
Hookworm
153
Filaria
153
Pediculosis
153
CHAPTER
Practice
of
XXXI
Disinfection
154
Boiling Water
154
Steam
155
Steam
Under
Pressure
157
Heat
160
Chemicals
161
Dry
Preparation
of Patient
To
Spread
Prevent
Disinfestation
of
for
Operation
Contagious
Diseases
162
164
169
9
CONTENTS
CHAPTER
XXXII
PAGE
Collection
Materl\l
of
for
Bacteriologic
Exajmination
170
.
Sputum
170
Smears
Throat
171
Water
171
Milk
172
Autopsies
172
Urine
172
Feces
172
Fluid
Spinal
173
CHAPTER
Other
Important
Colon
Pathogenic
Micro-organisms
Bacillus
of
Paratyphoid
BacilH
Glanders
of Malta
Fever
Pyocyaneus
Plague
Anthrax
Bacillus
176
176
178
Bacillus
Edema
Mahgnant
175
177
Bacillus
Bubonic
175
175
Bacillus
Whooping-cough
Bacillus
Friedlander
(Pfeiffer's Bacillus)
Bacillus
Micrococcus
174
174
Pneumobacillus
Influenza
179
180
Bacillus
181
Bacillus
Perfringens
181
Leprosy
Bacillus
182
Trench
Fever
Microsporon
Oidium
Achorion
182
Furfur
Albicans
Polioinyehtis
185
185
Schonleinii
Trichophyton
Index
XXXIII
Tonsurans
185
185
185
187
APPLIED
BACTERIOLOGY
GENERAL
FOR
NURSES
BACTERIOLOGY
CHAPTER
I
HISTORIC
The
fact
that
organism
nowadays
of
called
that
bacteria
of
of
of
of the
the
Italian
earliest
living
an
putrefaction,
and
being spread
by
A
little
hoek,
strong
of
more
spoke
sixteenth
he
certain
in
lost.
were
conception
Fracastor,
In
century.
an
1546
disease
likened
kinds
has
resulted
has
was
ery
discov-
disease
fairlyaccurate
which
of
The
formerly
diseases
in
knowledge
and
and
which
a
in the
essay
to
diseases
of
as
"seeds."
than
Delft,
rain-water,
one
hundred
succeeded
Holland,
magnifying
living organisms
cheese,
form
infectious
of
scientist
to
old.
bacteria
lives
real
our
years
practice,
countless
nature
published
he
between
ing
by tiny liv-
universally accepted
so
realize
fifty
medical
caused
are
is
to
than
relation
the
saving
One
hard
is
less
revolutionized
the
bacteria
it
is
diseases
many
glass
in
by
tartar
decayed
which
scraped
meat,
years
in
he
from
later
Leeuwen-
constructing
observed
the
feces,
tiny,
teeth,
etc.
11
a
in
And,
12
although
it
the
were
suggested that
was
of
cause
in
succeeded
one
cattle,was
the
caused
by
some
two
why
reason
a
bacterium.
hundred
was
due
the isolation and
Thanks
the
to
difficultieswere
of
infections
on
as
and
of
at
imperfections
surrounding
difficulties
organisms.
of
and
Pasteur
of
tion
the founda-
convinced
due
at the
almost
an
it
to the
w^hat
sought
was
to the w^ound
might gain access
operationand
that
accordingly devised
He
which
caused
once
these
Koch
and
surgery,"whereby
'antiseptic
to killall the germs
at the time
the
production of disease,we
fermentation,became
of bacteria.
'
is known
and
followingsurgicaloperationswere
introduction
between
bacteriologysecurely laid. Prior to
had
carefully followed
Lister, who
this, however,
work
for the
seek
we
elapsed
successfully
overcome,
modern
Pasteur's
of
If
of these minute
cultivation
genius
sheep and
in
common
Leeuwenhoek
the
to
no
strated
physician,demon-
mechanical
to the
and
microscope
diseases,
of
years
by
find that
organisms
relationship. Finally,
disease
their role in the
of the
minute
a
recognitionof
this
these
French
bacteria
of
discovery
this
famous
a
anthrax,
that
NURSES
number
large
a
proving
1863, Davaine,
in
FOR
BACTERIOLOGY
APPLIED
subsequent dressings,
complete disappearance
surgicalinfections.
Following
progress
in
bacillus of
the
splendid work
bacteriologywas
fever
typhoid
was
of
bacillus,
by
Klebs
lockjaw, by
Kitasato
We
have
and
in
Koch
discovered
in
Loffler in
1889, and
already mentioned
Koch
marvelously rapid.
1880; the bacillus of tuberculosis,
by Koch
spirillum of cholera,by
and
Pasteur
that
by
in
The
Eberth
in
1882; the
1884; the diphtheria
1883; the bacillus of
so
on.
followingLeeuwen-
13
HISTORIC
hoek's
the
be
to
for
of
cause
that
group
of diseases
which
We
mad."
malaria
and
w^hile
certain
protozoa^ ;
as
by fungi.^
caused
are
by
living
a
infectious
to
that
they
diseases
For
example, typhoid
particular
a
devising
disease
to
means
the transmission
it is important
of the
not
The
that
others.
to
should
the
of
the
if the
fact
of
germ
term
classes
of
The
usually
yeasts/
and
by
is
reason
knowledge
germs.
used
''germ,"
this
some
this
frequently
several
attaching
from
For
have
also protozoa,
so
skin
possibilityis given of
bacteriology,-and
with
the
germ
but
and
the spread of the disease,i. e.,
characteristics
"microbe,"
include
the
known,
known
germs
importance
arises
caused
are
hair
Moreover,
nurses
merely bacteria,
synonymous
to
is
of the
is called
term
class
a
prevent
and
nature
of germs
great
communicable.
are
of the
diseases
as
An
though
germ,
syphilis,by tiny
The
now
certain
a
fever,diphtheria, tuberculosis,and pneumonia
by bacteria;
fact,
In
only with
bacterium.^
a
held
were
infectiousdiseases.
call
we
Is caused
necessarily by
not
"bacteria
associated
are
disease
organisms
great variety of diseases.
a
bacteria
know
infectious
these
people seemed
time
some
bacteria
of
discovery
study
includes
fungi.
and
the
laity,is
usually
taken
micro-organisms
just
mentioned.
^
Bacteria
are
multiply by
2
Protozoa
^
Fungi
*
Yeasts
transverse
are
are
a
microscopic,
microscopic,
peculiar
unicellular
vegetable organisms
that
division.
microscopic,
are
multiply by
microscopic,
process
unicellular
multicellular
unicellular
called
animal
organisms.
vegetable organisms.
vegetable organisms
budding.
that
II
CHAPTER
OF
CHARACTER
Bacteria
Seen
powerful
a
rods, sphere's,or
the
to
of these
to
inch,
that
so
floating
one-celled
in
vary
in
from
size
them.
dust
Bacteria
cell is
are
complete
a
tail, and
no
tains
con-
minute
a
not
size
^qq
often
pus
Even
each
head,
no
of
carry
i. e.,
tomed
unaccus-
of the
drop
air may
one
conceive
bacteria.
organisms,
is
tiny
a
the
There
They
for
little
as
appear
to
microscope
a
thousand
many
mote
of
they
It is difficult
spirals.
use
living organisms.
microscope
micro-organisms.
1^
minute
extremely
are
under
BACTERIA
even
dividual
in-
the
O
yoW
Fig.
1.
size
Comparative
"
bacillus,
most
powerful
within
the
cell.
surroundings,
two
of the
size of the
bacteria.
tv^'O.
rise to
proper
conditions
14
two
of
and
the
bacteria
certain
of
life of
then,
in the
bacteria
in
time
a
a
in turn,
of
multiply
suitable
and
little until
it also
on,
place
is the
divides
grows
goes
organs
bacteria
Placed
these
process
special
any
after
Each
so
(Jordan).
conceived.
parent,
And
giving
mode
be
blood-corpuscle, typhoid
bacillus
reveals
bacterium
a
red
influenza
The
can
forms
forming
and
human
microscope
that
simplest
of
inch
each
one.
very
divides,
division
Under
rapidly,
16
BACTERIOLOGY
APPLIED
these
in
themselves
each, and
still others
these
fours, and
arrange
termed
are
bacteriology besides
bacilli and
diplococci
impo'rtantrole.
an
preceding paragraph
a
when
multiphed
the
other
Fig.
3.
placed
hand,
Bacillus
"
behavior
tetani, showing
stain
of different
unfavorable
live for
in
it
was
stated
proper
spores.
(Kolle and
speciesof
that
bacteria
surroundings.
variation
is considerable
tnere
Fuchsin
others
of two
and
streptococci,
staphylococci,
spirilla,the
In
of
groups
medical
In
tetrads.
play
while
diplococci,
termed
are
NURSES
in groups
themselves
plying,arrange
FOR
Wassermann)
bacteria
in the
culture
Pure
On
on
agar.
"
when
placed in
surroundings. ]\Ianyquickly perish;others
some
time,
undergo
a
and
then
gradually
peculiartransformation
die
into
off.
a
Still
highly
A^g^ozigis a round or
and possessinga
oval body, usually highly refractive,
high degree of resistance against various destructive
agents. Spores, as such, clo_not multiply, and may,
therefore,be compared to seeds. A bacterium produces
resistant
form
known
as
spores.
CHARACTER
only
OF
Spore formation
singlespore.
a
bacilli.
fact that spores
The
17
BACTERIA
important, and
are
necessitates
resistant
so
a
is limited to
careful
anthrax, and
Some
They
Fig. 4.
bacillus of
bacteria
Flagella: Proteus
the
group
sulphur
ploying suital:)lemethods
have
to
of
little hair-like
Some
a
bacteria
have
little tuft at
flagella
on
of
or
all sides.
a
motile
It is well to
disease.
one
but
In
a
both
tioned
men-
bacillus of
about.
move
By
em-
large spirillum belonging
motile
act
to
(Zettnow).
bacteria
appendages,
(singularflagellum),which
spore-
be
motile.
being
as
bacteria
the
to
power
of the
edema.
malignant
vulgaris and
of
the
(lockjaw),the
the
possess
therefore,spoken
are,
"
the
cally
practi-
study
underlying sterilization. Among
principles
in medicine
forming bacilli encountered
may
the bacillus of tetanus
is
the
as
are
called
seen
flagella
swimming
arms.
singleflagellum,others have
ends, while
stillothers
have
The
ample
typhoid ])acillus is a good exall sides.
Imcterium; it has flagella
on
remember
fact,those
that
that
not
do
all bacteria
(the
so-called
produce
patho-
18
APPLIED
BACTERIOLOGY
FOR
NURSES
bacteria)are
ge7iic
teria
only a small proportion of the bacthus far known.
Many bacteria are very important
in preparing food for plants,breaking down
plex
comchemic
for
substances
into simpler substances
plant absorption. Still other
bacteria
suitable
useful
are
in
producing fermentations,in disposingof refuse,liquefying
etc.
sewage,
Bacteria
in the
air,in water,
touch.
]\Iost of the
in the
bacteria
that
carbolic
acid
it
infection of wounds
used
have
to
an
operation in
order
be
in the
We
the
have
during surgical
with
spray
bacteria
since
are
believed
was
operating room
kill the
to
a
"
everything we
air,however,
time
one
everywhere
on
of the
at
playing al^out
air.
almost
soil,and
entirelyharmless, although
they caused the
operations. Lister
found
are
found
dilute
during
which
might
that
this is
out
unnecessary.
It
stated
was
when
above
that
placed under
bacteria
a
suitable
much
of
temperature, sufficient moisture, absence
of
the
up
or
that
the
natural
pathogenic for
food
the
of
should
animal
have
body.
a
order
food,
this
food.
and
man
of oxygen,
the
with
composition of
of their
supply, to
absence
points in
living creatures
to have
as
In
animals
are
cultivated.
In supplying
is
the
nearly as possiblelike
the
case
of
bacteria
that the
that
accomplished by making
the
temperature
Just
well
always
composition resembling
This
principleappliesto
named.
it is
We
etc.
it is obvious
broths,milk, blood-serum,and
tei-ia
ditions
con-
the presence
light,presence
shall take
mously
enor-
These
conditions.
proper
relate mainly to food
multiplied
as
requirea different temperature
like.
at which
The
of
use
same
the
bac-
certain
tropicalplants
to
than
grow
do
hardy
CHARACTER
northern
or
OF
do
plants,so
to
best at
usually grow
than
in the
grow
bacteria require a
some
colder environment
a
body
a
19
BACTERIA
Bacteria
others.
of warm-blooded
temperature
warmer
animals
100"
near
tomed
accus-
F.
On
the other hand, the bacteria normally growing in water,
example, usually
for
60"
about
best at
grow
Fig.
showing
Streak
an
aerobic
to
temperature
a
bacteria,growing
in
temperature considerablyabove
culture
organism
of
the
which
require a
growth.
allowed
The
at
potato
will not
bacillus
manure,
100"
F.
(natural size),
under
grow
of
a
cover-glass
.
bacteria
for their
are
a
5."
(Williams)
All
Certain
F.
best
grow
to
certain
Moreover,
many
moisture
bacteria die if
they
dry.
which
necessityfor protectingbacteria
cultivate
of
amount
against an
undue
against sunlight,is
amount
understood
of
we
wish
larly
light,particu-
when
one
recalls
20
APPLIED
that
FOR
certain of the hght rays
bacteria.
on
BACTERIOLOGY
bacilkis
may
In
fact,so
be
killed
exert
resistant
by
NURSES
destructive
a
a
the tubercle
as
germ
hours'
several
action
to
exposure
direct sunlight.
So
far
is
three
effect of oxygen
the
as
to
concerned,it is interesting
large
classes
require oxygen
grow
if oxygen
whether
is
belonging to
belongingto
bacillus
the
of
hydrogen
in
and
colon
they
those
in
may
is that
that
of
bacillus
facultative anaerobes.
Novy jar,or
bacteria
aerobes, those
aerobe, so
an
conveniently grown
a
The
anaerobes.
facultative
bacillus of tetanus
are
will grow
anaerobes,and
goWqA
are
which
cultures.
called
are
anaerobes; the
are
are
class
di[)hthena is
bacillus of anthrax
cultures
second
are
will not
which
absent.
are
those
which
those
anaerobic
or
first class
the third class
the
tuberculosis;
edema
present, and
of bacteria
that there
note
growth, those
is present
the
to
growth
bacteria,namely,
Novy's jars for
"
oxygen
belonging
of
for their
Fig. 6.
The
the
on
an
nant
malig-
and
the
Anaerobic
atmosphere
be
of
grown
in
of
an
CHARACTER
air
of
atmosphere
by
"
glass
and
of
IMoldj^
or
magnified,
a
of
Spores
one
serum,
of
means
Demonstration.
Loffler
(an
motile
the
old
from
which
old.
culture
is
of
has
oxygen
bread.
been
Teeth
hay
bacillus).
not
pushed
baciUi).
throat
A
scrapings,
Hanging-drop
(hay
microscope
of
pieces
unstained.
organism
the
stracted
ab-
chemicals.
days
two
21
BACTERIA
OF
culture
under
a
preparation,
Be
careful
through
cover-
bly
prefera-
that
the
on
the
cover-glass.
jective
ob-
III
CHAPTER
METHODS
While
bacteria
a
compound
in
of
object
the
thrown
object,
and
into
the
up
coarse
adjustment.
various
to
the
ing
magnify-
form
their
without
is shown
instrument
and
down
by
upper
end
two
of
objectives
7)
the
to
have
to
bring
by
higher
But
even
the
finer
22
end
of the
tube
are
1 to
each
this
of the
powers
about
details
series
between
placed
with
a
this
of
of
the
equipment
bacterial
objective
numbers
by
the
J
it is
mirror.
called
mirror
and
it is difficult
This
sisting
con-
The
(3, 5,
inch).
lenses,
structure.
nose-piece,
together.
microscope
from
varying
Attached
5.
so-called
a
(", J, and
fractions
of
are
mounted
lenses
one
screws,
fine
'objectives,"
illumination
strong
is
is
The
tube.
the
usually distinguished
are
or
'
of
series
tube
the
three
or
a
of
the
the
called
from
numbered
and
stage,
other
These
oculars.
the
of two
means
into
or
in
lenses
the
the
attached.
are
on
upright
an
beneath, through
adjustment,
usually
are
placed
mirror
of
tube
the
is
the
bearing
base
or
series
Fitting
lower
carrying
using
an
the
eye-pieces
and
and
Such
and
stage
from
up
is moved
power
study
examined
be
to
light is
called
high-power
to
foot
heavy
a
which
to
tube
impossible
microscope.
It consists
The
with
seen
7.
Fig.
post,
be
can
is
glasses, it
BACTERIA
STUDYING
OF
When
important
In
the
the
to
can
order
denser,
con-
stage.
study
only
24
BACTERIOLOGY
APPLIED
in
value,
from
that
often
another.
one
stain
Gram's
it
Show
a
"
f"dng
(Image
glass
such
to
differentiate
will
be
seen
stain
the
as
is
used
NURSES
helps
This
and
Demonstration.
FOR
for
reading
to
when
tubercle
glass,
count
and
threads
bacteria
(p. 26).
bacilh
a
study
we
high-power
in
a
woven
erect.)
Demonstrate
the
compound
microscope.
(Image
inverted.)
magnifabric.
IV
CHAPTER
PREPARATION
In
tiny
bacteria
preparing
bit
of
etc.) is thinly spread
Then
the
in order
slide
is
(pus^ sputum,
on
glass
a
preparation.
drying, killing,and
coagulating
it will
to
remain
staining
for
sUde
air,
several
washed
and
in
blue,
of
however,
use
do
the
is
called
mordant,
to
stain
a
and
Some,
then
that
treated
however,
Most
withstand
of
stains
acids
the
to
and
methylenebacteria,
staining
thus
and
fluid
to
added
excellent
an
fuchsin
and
in
simple
readily,
is
acid
being
bacilli.
tubercle
bacteria,
with
The
stains
acid
g.,
off,the
poured
Some
the
e.
"
allowed
substance
carbolic
stain
to
above
bacteria.
The
Carbolic
of
is
fuchsin.
to
that
so
the
fluid
and
"
solutions
something
the
off in the
staining
simple
''bite in."
solution
said
was
add
to
extensively used
It
these
inordant.
a
of
or
wash
examined.
be
flame
is meant
blotting-paper
watery
are
take
not
with
to
gentian- violet,
it is necessary
cause
dried
the
examination
stain
The
ready
common
the
dry.
to
material,
not
methylene-blue
water,
then
and
with
minutes.
in
is
stains
of
this
By
a
culture,
allowed
through
ordinary
flooded
solution
watery
the
and
of the
slide
the
For
is next
preparation
stain
fixed
fluid.
slide
examination
exudate,
times
several
passed
'^fix" the
to
SMEARS
microscopic
for
material
the
STAINED
OF
were
for
also
used
example,
quickly
action
lose
of
in identifying
stained
when
their
color.
acids, retain25
26
color
their
ing
of
spoken
are
belong
is
bacteria
follows:
largely
devised
The
bacteria, spread
by
stained
usual
way,
are
violet
with
the
aid
of
the
stain
minutes
slide
the
washing,
Gram.
one
in the
several
(See
group.
method
staining
Another
as
acid-fast
the
to
and
then
is
treated
certain
way
violet
bacteria
stain,while
This
is
used
gonorrhea,
when
a
in
Bacteria
''Gram-positive,"
called
the
is extensively
meningitis,
violet stain
are
lose their
passing
in
that,
to
ordinary staining methods, specialprocedures
have
devised
for
teacher
may
this
size
of
flagellain
stainingspores,
capsules, etc.
is to
simple
exercise
as
say
demonstration
demonstrate
steps, tubercle
specimens
relative
we
the
for
and
For
called
stain
addition
various
ment.
treat-
are
"Gram-negative."
In
The
this
original
alcohol
method
which
in
the
of
retain
iodin.
absolute
treated
germs
of
without
of
reaction, and
the
end
with
the
slide
gentian-
the
retain
Gram's
w^hile those
of
off, and,
during
which
according~to
treated
At
out
the
on
solution
to
valuable
identifying
solution
AVhen
lose it
identifying
etc.
is carried
is washed
found
are
very
This
a
water.
others
in
poured
with
tensively
ex-
1.)
used
little heat.
a
wdth
Plate
fixed
a
is
test
bacilU, for these
and
with
Following this,the preparation
alcohol
This
identifyingtubercle
in
These
contact.
bacteria.
''acid-fast"
as
used
prolonged
after
even
NURSES
FOR
BACTERIOLOGY
APPLIED
possible,
of bacteria.
to
the
fix
students
in
their
been
teria
bac-
staining, explaining
staining (Ziehl's method),
let
motile
these
examine
minds
and
as
the
Gram's
many
appearance
the
stain.
stained
and
V
CHAPTER
OF
CULTIVATION
In
order
essential
to
that
properly
they
be
BACTERIA
it is
bacteria
study
absolutely
by themselves,
grown
i. e., not
m
Fig.
8."
Media
in tubes:
Broth; 6,
a,
agar
slant;
c,
(Hiss and
potato
Zinsser)
.
mixed
with
is necessary
a
to
lot
of
obtain
other
a
bacteria.
pure
culture.
other
In
We
words,
shall
assume
27
it
28
that
we
have
such
by
which
methods
Our
culture;let
a
plant
culture-medium,such
Fig. 9.
of
solid
a
beef
as
])lood-serum,potato,
culture-media
i. e.,
Fig.
they
10.
we
culture,
pure
we
of
have
culture
sterile
be
must
Method
"
be
must
and
need
to
etc.
tubes
do is to transfer
either
in
during
from
In
other
same.
fluid
a
the
on
fied
solidi-
germs,
plantingthe
inoculation
(McFarland).
containingour
sterile medium,
original
e.
g.,
plug.
All
little loopfulof culture
by
top with
a
the
that these
It is obvious
of the
at the
the
grow
gelatin,agar,
as
the tube
tube
consider
bacteriologicuse.
perfectlysterile.
at hand
broth, closed
for
absolutelyfree
holding
a
to
bacteria
such
medium,
now
-broth,milk, etc.,or
wires
Platinum
"
the
NURSES
us
continue
we
first step is to
surface
FOR
BACTERIOLOGY
APPLIED
a
cotton
CULTIVATIOxX
of the
means
broth.
however,
platinum
order
In
we
to
culture
the
the
wire.
The
is transferred,the
the cotton
plugs,and
the
before
flame
spreading the
loop
wire
germs
germs,
flame
that
may
until
have
(Eyre).
cools
tubes
in
a
moment,
the
again closed with
are
is at
laid down.
about
of sterile
other
in the
loop
germs
loop
the wire
being
the tube
to
carrying along
Incubator
"
29
BACTERIA
destroyingany
Fig. 11.
on
wire
avoid
first hold
it glows, thus
lodged
OF
once
Thus
is avoided.
passed through
all
danger
of
30
APPLIED
The
freshlyplanted
incubator.
Fig.
BACTERIOLOGY
12.
"
This
is
Streptococcus
culture
kind
a
FOR
of
pyogenes,
is
NURSES
placed
now
whose
oven
culture
on
walls
agar.
are
in
the
filled
larged
Slightly en-
(Williams).
with
water, and whose
by
means
of
interior is
a
lamp
or
kept at
gas
a
flame
uniform
perature
tem-
controlled
by
32
ture
planted
was
will
be found
now
less
slimy mass,
This
cloudiness
be covered
to
with
or
in the
in the
single bacterium
similar
to
bacteria
the naked
Fig. 14.
of
as
offspringof
index
an
material
very
in which
quantity
a
develop.
Such
less rounded
(McFarland).
pin's head
a
singleindividual,are
a
of the
number
of
that
This
teria,
bac-
spoken
developing
in the
livinggerms
If the
bacteria
originallyplanted
the
colonies
developing
we
specimen
fluid
then
to
of similar
masses
of colonies
that
of the
culture,and
of
of
visible
form
they
one
discover
can
of
on
noting
fluid
a
solid
the
is facilitated
by using
film,
of
by ]ilantinga
medium,
so
colonies.
the number
number
are
continuous
impossibleto distinguishseparate
It is apparent
in
or
ing
plant-
group
become
number
numerous,
it is
whole
plate cultures
that
in
wherever
medium,
groups
mass
is made
and
seed; so,
a
spots,
slimy
The
planted.
closely crowded
germs
for making
in size from
^'colonies."
is thus
were
dish
J inch in diameter.
the
solid
a
or
planting seed
in
forming usually more
eye,
Petri
as
each
from
These
develop.
varying
masses,
disks
"
Just
deposited
was
this
growth,
new
of
the surface
on
peculiar,more
a
culture,or
ground, a plant arises
bacteria
a
fluid
gelatin)it
of
small,rounded
of
tiny bacteria.
of
of.millions
up
with
number
a
the solid cultures,is the
on
(a kind
sterile agar
on
NURSES
FOR
BACTERIOLOGY
APPLIED
living
known
growing
of colonies
shallow
the
which
flat
glass
CULTIVATION
dishes,called
'Tetri
is
method
number
of
dishes"
livingbacteria
cultures
"
in milk
cultures.
Without
Fig. 16.
Appearance
of colonies
the
method,
the
preparation of
material
to
we
be
may
a
to
and
employed
in pure
"
''plates."This
or
ing"
''plat-
determine
the
in water.
Pouring plates (Eyre).
also
are
33
BACTERIA
extensively used
Fig. 15.
Plate
OF
say
in
isolatingbacteria
enteringinto the
on
gelatin in Petri dish (Williams).
that
number
details of
of
in
general it
consists
plate cultures
from
the plate on
examined, selecting
in
the
which
34
BACTERIOLOGY
APPLIED
the colonies
FOR
NURSES
closelycrowded, and then, by
of a sterile straightplatinum wire, carefully
means
of the bacteria from a singlecolony to
some
transferring
This process is spoken of as
tube of sterile medium.
a
not
are
a
plate.
*'fishing"
original material
bacteria,the
contain
but
the
when
turn
Smith's
"
species.
in
grown
others
sour
putrid, while
and
gelatin cause
do not.
media
studying and
example,
the
Certain
coagulate,some
others
each
(McFarland).
different
on
of
For
of
culture.
fermentation-tiibe
means
kinds
will
by ^'fishing"
in pure
the
though
even
different
many
of bacteria
important
that,
obtained
singlekind
a
various
fluid,while
to
contained
cultivation
an
It is obvious
cultures
Fig. 17.
The
too
apparently
certain
ing
identifybacteria
gelatin to
bacteria
cause
leave
cause
it to
it
stitutes
con-
become
milk
become
unchanged.
CULTIVATION
OF
media-containing
In
with
sugars
the
of
production
the
acid
we
is
gas
little
a
blue
The
Demonstration.
the
to
growing
by
should
teacher
the
with
others
the
to
changes
observed
best
htmus
color
still
studying
In
ferment
others
acid,
while
acid,
all.
at
add
the
whether
of
and
sugar
can
of
production
gas
bacteria
some
sugars
35
BACTERIA
do
the
ment
fer-
not
of
production
medium
and
red.
The
the
culture
note
formation
in
a
various
inoculate
media,
"
both
liquid
and
and
only
body
at
should
be
(e.
^.,
in
Agar-plate
organisms
hay
g.,
that
there
cultures
and
bacillus),
Some
pneumococcus).
duplicate,
both
growing
and
the
will
be
should
be
the
duplicate
made
perature
tem-
room
growing
organisms
of
no
at
latter
kept
growth
from
variety
at
under
milk
room
these
(diluted)
tap-water.
Streak-plate
scrapings.
(e.
show
to
conditions.
from
heat
using
heat
body
inoculated
temperature,
and
solid,
mentation-tu
fer-
cultures
may
be
made
from
the
throat
or
from
teeth
CHAPTER
RELATION
BACTERIA
OF
VI
TO
DESTRUCTIVE
Disinfectants
In
required
For
certain
a
Higher
the
to
kills most
be
is
who
by
effect
of
with
grow
grow
of
applied
low
less than
this
slowly
is
practically
freezing temperature
the
low
species.
Bacteria
usually
ordinary
growth
no
of
temperature
to
after
air
Hquid
bacteria
tures
temperaof
water.
Pasteur,
bacteria.
varies
The
ably
consider-
accustomed
to
to
or
grow
temperatures.
room
all
40"
at
die
bacteria
many
of
cease
at
posure
ex-
quickly
water
kilHng
bacteria
jurious
in-
an
short
a
exposure
on
at
exert
even
F.
100"
boiling-point
of
temperature
very
There
method
temperatures
body
at
hand,
"pasteurization,"
as
different
the
thrive.
to
Destruction
prolonged
bacteria
about
boiling
bacteria.
effected
spoken
first
of
order
is
that
so
temperature
considerably
This
other
that
out
in
this
the
on
pathogenic
also
heat
of
bacteria,
on
pointed
was
bacteria
temperatures,
action
can
it
degree
patliogenic
most
Antiseptics
and
previous chapter
a
INFLUENCES
off,
does
not
F.
but
At
even
certainly
kill all forms.
Bacteria
vegetative
spore
has
forms
already
36
also
vary
forms
appear
been
in
their
resistance
usually drying
to
resist
pointed out,
to
quickly,
drying
direct
drying,
while
certain
indefinitely.
sunlight
the
exerts
As
a
DESTRUCTIVE
BACTERIA,
destructive
action
heat; drying,
bacteria.
on
and
37
INFLUENCES
sunUght
is
The
combination
of
extremely efficacious
in
killingbacteria.
The
of chemicals
study
bacteria
on
importance.
which
exert
is
(disinfectants)
destructive influence
a
of great
Depending
on
the
intensityof
usually speak
of
these
substances
practical
their
tion,
ac-
being
either ''germicides" (germ killers)or
''antiseptics"
(preventinggerm growth). Every germicide in diluted
form is an antiseptic. The
conditions
under
which
the
we
disinfectant
Thus,
carboHc
in
than
acts
is of the greatest
acid
by
of alcohol.
The
is carried
process
of
rate
The
a
Mercuric
of the
or,
compounds
on
metals.
one
of the
with
for
the
these
commonly
increases
which
at
influence
of
the
on
of certain
bichlorid.
used
corrosive
The
fectants:
disin-
sublimate,
short, "bichlorid,"while
disadvantage of being
insoluble
substances,and
and
inert
of
acting
drawbacks, however, this
used
disinfectants
present day. It is employed largelyin the form
made
the
albuminous
action
commonly
forming
albuminous
Despite
most
of
mercury
called
strongly germicidal, has
extremely poisonous,
the
with
more
chlorid, also
bichlorid of mercury,
marked
presence
disinfectants,notably with
some
the
concentration
The
largelyinterferes
following are
solution
cent,
temperature
also has
on
disinfection.
substances
the
as
certain hmit.
a
in 5 per
is
efficiency
of salt,but diminished
by the
rate of penetration into bacterial
the addition
cells decreases
above
practicalimportance.
higher concentrations,and
increased
presence
better
acts
as
at
of
is
the
ready
tablets,
containingusuallysufficient "bichlorid"
to
38
APPLIED
make
a
BACTERIOLOGY
solution 1 : 1000
a
of water.
pint
tartaric acid
citric or
the formation
tablet is dissolved in
one
of the
contain
tablets
chlorid
ammonium
or
of insoluble
For
brought
when
will suffice,
into
albuminous
harmless
some
solutions
ordinary use
ing
identify-
of 1
with
contact
either
prevent
aid in
blue,pink,or j-ellowcoloring-matterto
the solution.
to
with
compounds
of the tablets also contain
Many
matter.
when
Most
NURSES
FOR
:
1000
bacteria,
vegetative forms within fifteen minutes.
be employed when
Stronger solutions,however, must
chlorid
Mercuric
is present.
much
organic matter
should not be employed to disinfect metal instmments,
it quicklyruins them
as
by its action.
stance
Carbolic
acid, or phenol, is a white crystalhnesubreadilyliquefied
by heat. It can be kept liquid
making
by the addition of 5 per cent, water or glycerin,
kill the
to
is sold in the
what
drug
stores
as
"pure
carboHc
acid."
ordinarilyused in the
form of a 5 per cent, solution in water, and, while it is
less powerful than mercmic
it has the advantage
chlorid,
of being only slightlyaffected by albuminous
material,
and of not acting on metals.
Its efficiency
is increased
salt up to saturation : 1 : 400
by the addition of common
For
it is
disinfectingpurposes
kills the
less resistant
remainder.
within
spores
from
a
day
Crude
very
A
numerous
a
kills the
1:100
solution kills the less resistant
hours, and
the
more
resistant in
to four weeks.
acid
little phenol.
an
cent,
few
carbolic
cresols and
makes
5 per
bacteria,and
neutral
emulsion
consists
By
mainly of
saponificationof
tar oils a
with
product
water.
cresols and
mixtures
is obtained
Creolin
preparationsof this character.
is
a
They
of
which
type of
are
aD
40
APPLIED
about
This
per
15
is
BACTERIOLOGY
pounds
FOR
added
are
NURSES
1,000,000 gallonsof
to
equivalentto approximately 0.5 part
1,000,000 parts of
dioxid
Sulphur
(See also
water.
page
water.
free chlorin
149.)
produced by burning sulphur
gas,
in
formerlyextensivelyused as a disinfectant for
been largelydiscarded in favor
sick rooms,
but has now
of formaldehyd.
Ordinarily4 pounds of sulphur are
air,was
for each
burned
kept sealed
is
room
cubic
1000
for at least
be efficacious the air in the
should
is burned
is
a
and
rats
gaseous
odor.
irritating
in the form
per
cent,
maUn."
of
It
eighthours.
in which
A
watery
^2 per
cent,
solution
of
minutes.
gas
each
in the
of
cubic
1000
disinfection
form
the
ounces
are
as
a
of the
bacteria
disinfection of sick
formaldehyd
discussed
on
p.
of tincture
of
should
The
be
40
*'for-
as
formalin
within
formaldehyd
feet of air space.
lodin,in the form
used
the
commercially
destroysthe vegetative forms
least 4
In order to
watery solution containing about
a
known
used
the
tremely
compound having an exis most
conveniently used
of the gas, and
In
and
sulphur
Sulphur fumigationis still
in combating the
vermin
room
be moist.
largelyused to kill
spread of plague.
Formaldehyd
feet of air space,
five
is
tensively
ex-
rooms.
At
allowed
for
details of such
167.
of
iodin,is extensively
disinfectant of the skin for surgicaloperations.
of
Peroxid
A
hydrogen
20
per
cent,
(H3O2)
is
solution
an
fectant.
energetic disin-
(a good
commercial
ing
hydrogen peroxid)will quickly destroy the pus-producwith
cocci and
spore-freebacteria. It combines
organic matter, becoming inert. It is prompt in its
action and
not
poisonous,but apt
to
deteriorate if not
is
It
properly kept.
abscess-cavities and
and
water
ordinary white
scrub
a
brush
have
Soaps alone, however,
Solution.
Dakin's
As
"
of soda.
0.475
quantitiesof
When
neutral
Dakin's
whereby
Dichloramine-T.
compounds,
a
and
be
a
result
of
Carrel
and
neutral
varied
hot
fulness.
use-
depended
upon
study
a
devised
Dakin
solution
of the
of
the
chlorite
hypo-
solution
hypochlorite,with
small
It is isotonic to blood-serum,
simple apparatus
solution
possess
soap
conjunctionwith
wide
a
of the
salts.
has
been
devised
readilybe prepared
can
Dakin
"
in the
even
in the
(Hlute
the
of
a
and
marked
from
Such
in
Since
use
bottles is advisable.
can
wounds
the
solutions
is made
once
then
be
be found
or,
favorable
properlyprepared will keep
ordinary
have
cordingly
ac-
dressingof
substances
used
are
better
chlora-
black
still,
a
tion
solu-
weeks.
of
ap])lication
in
the
conditions
for several
with
mixed
desirable to
lightdecomposes
of amber
Under
they
in the
use
paraffinoil,if it should
solutions, the
action
disinfecting
in chlorinated
oil,especially
solutions
solution.
cal
chemi-
two
dichloramine-T
blood-serum, and
Ordinarilythese
of solutions
eucalyptus oil.
chlorinated
also devised
into considerable
wounds.
form
exert
presence
come
infected
has
called chloramine-T
respectively.These
In
as
liquidchlorine.
pure,
mine
also
properly prepared
cent,
per
recently a
^lore
out
required.
the
with
treatment
antiseptic
contains
and
bath
cannot
of infected wounds.
treatment
an
disinfection is
thorough
when
in
and
disinfecting
power,
moderate
wasli
to
purulent sinuses,
and
Castile
"
extensively used
mouth-wash.
gargle and
Soap.
41
INFLUENCES
DESTRUCTIVE
BACTERIA,
these
twenty-four hours.
septic
antiFor
42
BACTERIOLOGY
APPLIED
should
application
which
consumed
is the
Halazone
allied
the
by
such
will sterilize
the
form
dry
borax.
tubes:
Dakin
to
broth
culture
and
has
sodium
should
of
of
1
10 cc.
10
:
300,000
a
or
loopful
(or colon) bacilli
each
periments
ex-
in
water
carbonate
from
the
in
prepared
been
inoculate
typhoid
subcultures
make
more
Dakin's
concentration
with
teacher
on
compound
a
drinking-water.
Halazone
The
"
is
designed especially for
a
made
of tablets
twenty-four-hour
following
of
minutes.
Demonstration.
depends,
ordinarily heavily contaminated
an
thirty
chlorine,
wounds.
and
that
frequent
more
active
the
as
given by
name
indicate
a
chloramines
of
disinfection
emergency
about
made,
preceding
the
to
NURSES
wounds
foul
very
be
action
the
rapidly
for
or
gangrenous
FOR
of
these
with
from
into
a
the
tubes
at
locc.
c.e.
plain.
J- J 000
Sterile
Biehlorld
Carbolic
Water
Fig. 18.
end
the
of
tubes
these
Instead
can
one
be
minute
into
of
made.
or
five
minutes
by inoculating
a
loopful from
plain sterile broth.
making
broth
subcultures,
agar
poured
plate cultures
VII
CHAPTER
STERILIZATION
In
making
employed
depends
be
to
e.,
water,
or
be
to
live
steam,
Fire.
of
books,
dressings,
other
and
in
this
convenient
and
alcohol
out
dry
of the
etc., by
kitchen
to
ovens
and
hour.
the
In
of
dry
will
stove
of
articles
the
such
cases
the
In
heat.
usually
oven
should
absolutely
pus-soaked
chiefs,
handker-
best
disposed
should
very
surgical
by
or
ment
instruit
dipping
alcohol.
the
we
of
use
often
may
is
fire
employ
laboratories
for
sterilizing glassware,
the
home
answer
remain
desired
mattresses,
bacteriologic
In
constructed
arc
flame,
instances
many
advantage.
means
temperature
In
"
cjuestion.
heat
special
lighting
then
Heat
(2) Dry
the
through
it
passing
it is
paper
other
or
of
boiling
it is sometimes
knife
a
form
pressure.
often
are
emergency
an
sterilize
to
by
into
In
way.
articles
rial
mate-
as
toys,
and
cups
similar
or
Infected
magazines,
sputum
paper
heat,
fire, thus
bacteria.
and
papers,
the
the
the
which
articles
in
in
under
steam
burned
infectious
the
destroying
of
be
can
live
dry
as
infected
Many
"
or
of
used
method
the
character
be
may
flame,
or
the
on
Heat
naked
bacteria
destroy
to
largely
the
rid
rugs,
heat
sterilized.
fire, i.
(1)
of
use
HEAT
BY
the
equally
range
exposed
about
for
of the
oven
well.
300"
about
The
F.,
an
44
BACTERIOLOGY
APPLIED
(3) Moist
Heat.
The
factors is to
It has been found
"
boil the
Fig.
so
are
of
simplest method
Surgicalinstruments
and
NURSES
that the
markedly increases the
of moisture
of heat.
FOR
19.
articles to
are
Hot-air
"
destructive
effect
combining these
be
two
sterilized in water.
usuallysterilized
sterilizer
presence
in this way,
(McFarland).
catheters,douche-nozzles,hypodermic
dles,
nee-
etc.
(4)
heat
The
Live
is
by
Steam.
means
"
Another
of live steam
accompanying figureshows
of
method
in
a
using
steam
moist
sterilizer.
the construction
of the
STERILIZATION
Arnold
sterilizer. This
steam
boilingpan,
hood,
The
drip water.
by
keeping
number
a
supply
the
shallow
very
which
with
the
the
small
constantly
The
boilingpan.
rapiditywith
by
catches
openings, thus
in the
of water
a
is surrounded
is connected
of small
design is
which
large pan,
a
large pan
a
of this
and
45
HEAT
consists of
chamber,
steam
a
the removable
pan
BY
which
vantage
ad-
steam
~
Fig. 20.
is
developed
and
water, 212"
used
to
growing
has
F.
is
This
form
various
bacteria.
order
been
complete
The
it is
the
that
of sterilizer is
nutrient
to
apparatus
within
temperature
approximately
sterilize the
In
(Fowler).
little attention
operation.
chamber
steam
sterilizer
steam
the
in
requires when
the
Arnold
"
boiling
extensively
media
be certain
customary
of
that
used
for
tion
steriliza-
to sterilize these
46
in the Arnold
sterilizer for
days.
This
all spores.
this form
destructive
heat
to
sterilizer,
heat
the
beyond
the
action
of
than
more
water
this.
in
to
The
a
an
more
steam
destruction
of
also be sterilized in
the
effective
not
in
under
is
For
possible
It is im-
required.
As
mously
enor-
pressure.
vessel
F.
be
can
or
soon,
in
Arnold
an
however,
tightly closed vessel,which
escape,
we
can
higher the
of steam
use
steam
it under
open
212"
higher the temperature.
fact that
of
apparatus
water, in
allow^ the steam
not
the
secutive
con-
sterilizer.
by employing
specialform
to
we
of three
of sterilizer.
increased
a
certain
Instrument
"
each
on
Surgical dressingsmay
(5) The
this
hour
an
makes
Fig. 21.
NURSES
FOR
BACTERIOLOGY
APPLIED
under
sterilization
pressure.
mainly
of the
because
pressure
than
Another
will
raise the temperature
pressure
It is
as
the
is
use
reason
so
steam,
of this
much
of
live
is the
VIII
CHAPTER
We
only
to
disease, i.
of
producers
positively that
prove
absolutely
bacterium
it is
be
always
found
be
possible
of
diseased
again
the
isolate
disease, their
commonly
with
the
do
bacteria
tissues, their
and
themselves
poison
the
bacillus,the
give
the
tissues
off
the
and
poisons
bones
to
48
causes
be
which
and
In
multiply.
cause
the
they lodge.
away,
etc.
of
the
jaw),
(lock-
of tetanus
these
while
deep
into
gives
rise
the
like
vSome,
deep
penetrate
germs
produce
the
to
body
severe
bacteria, for example,
other
In
destruction
this way
to
into
the
growi^h they
their
gradual
large parts of the lung
eaten
to
considerably
poisons, and,
penetrate
of
case
there
tissues in which
bacillus
the
possible
part
differ
bacillus
is absorbed
In
body
the
powerful
symptoms.
tubercle
the
body,
micro-organisms.
very
not
tion
injec-
from
bacteria
all these
attacked,
diphtheria
secrete
the
into
different
of
bacillus
be
it must
various
the
which
entrance
body
the
germ.
in
manner
it must
and
bacterium,
the
bacterium
by
disease
same
produced
thus
tissues
The
of
cultures
pure
the
reproduce
to
certain
a
Furthermore,
disease.
the
in
to.
are
order
In
this
that
necessary
that
bacteria
is due
disease
a
fact
pathogenic.
are
e.,
the
to
known
the
of
proportion
small
a
attention
called
already
have
MATION
INFLAM-
DISEASE.
TO
BACTERIA
OF
RELATION
THE
be
the
of
tubercle
destroyed
or
THE
Most
RELATION
for
germs,
certain
OF
BACTERIA
obscure
some
parts of the
usually lodges
in
the
TO
wall
The
the
of
is very
gonococcus
membrane
the
and
extent
bacterium
the
The
the
this in
resistance
of
a
dose
of
and
bacillus of
junctival
con-
The
eye).
nasal
passages.
the
produced by
same
depends
course,
introduced, but
the
patient.
also
We
shall
moment.
bacteria
important pathogenic
more
mucous
also the
the
greatly. This, of
the
the
spinal
respiratory organs;
throat
of disease
size of
degree
speak of
kind
also varies
largely on
on
chiefly the
the
diphtheria bacillus,
The
and
(outer hning of
affects
pneumococcus
intestine;the
to attack
prone
bacillus
the brain and
liningthe genitalorgans,
membrane
typhoid
small
meningococcus prefersthe liningof
cord; the
affect by preference
reason,
body.
49
DISEASE
the
are
the typhoid bacillus,
tuberculosis,
diphtheria
bacillus,dysentery bacillus,spirillum of cholera, the
the
pneumococcus,
pyogenes,
of
the
meningococcus,
tetanus,
plague,and
of
syphiHs,and
fungi.^
of
of
edema.
are
sleeping-sickness
The
germs
germs
of
of
of the
"cancer
The
malaria,
to
have
cancer
is still considerable
been
not
doubt
of
germs
tiny organisms
and
called
of barbers'
itch
smallpox, chiokenpox, scarlet
of these
nature
germs"
their relation
.
bubonic
hydrophobia
discovered, though there is
germ
the bacillus
glanders, of
ringworm
fever,2 measles, yellow fever, and
yet been
staphylococcus
the gonococcus,
anthrax,
malignant
protozoa.! The
are
streptococcus, the
diseases.
Several
described, but
yet been
whether
1
See
Definitions,page
2
gee
page
122.
alleged
only
not
proved, but
cancer
13.
not
whate\'er
doubt
no
have
is
a
has
there
germ
50
APPLIED
disease.
BACTEEJOLOGY
Some
authorities
disease,but the weight
belief.
On
the other
believingthat
the
claim
a
NURSES
that
of evidence
hand,
generallyregarded as
FOR
pellagrais
against this
appears
disease,most
has not
specific
germ
germ
articular rheumatism
acute
germ
a
is
bacteriologists
yet been identified.
Inflammation
Inflammation
is described
by agents
which
the
of inflammation
causes
have
like snake
important
most
of
produced depends
tissue
produced
cold,and, finally,
perhaps the
or
all,bacteria.
a
stances
poisonous sub-
acids,or other irritant chemical
heat
on
caused
injury." Among
find blows,
we
venom,
compounds, excessive
local reaction
"a
as
number
due to bacteria
it
The
of factors.
depends
of
degree
In the inflammation
the number
on
injury
of bacteria
introduced, the virulence of the organisms,the length
of time
and
they remain,
on
the resistance of the infected
tissues.
The
firstresponse
of the blood-vessels of the afl'ected
dilatation
a
quickening of
is
and
and
Sometimes
amount
reverse
red
white
be
may
blood-cells
Let
see
us
a
soon
as
If
also pass
takes
region and
blood-current,
blood-vessels
blood-corpuscles(leukocytes).
blood-cells large;
these germs
the
of
is small, but the
the
inflammation
through
the
place when
have
other
at
entered
wall
some
invade the deeper parts of the skin and
As
the
of blood-serum
true.
what
wall
a
ever,
quickening,how-
This
slowing of
the
white
of blood-serum
of
by
through
passage
the
flow.
blood
the
followed
soon
the
number
consists in
body
the part of the
on
times
is severe,
of the
vessels.
blood-
staphylococci
give rise to
they act
the
as
an
a
boil.
irritant
THE
RELATION
the various
to
OF
BACTERIA
cells around
of dust irritates the eye.
All about
which
suspended
The
irritation
felt
produced by
the blood-vessels
times
when
agent
acts
is not
the
the
their way
the
out
breaker.
tissues,and
this process
blood-cells
the
whether
fightis
there
and
the
not
yet
have
They
esting
inter-
an
exactly
act
after
contains
see,
their
microscope
can
serum
stances
sub-
If
fight.
one
law
a
shall
we
ten
up
or
one
the
see
It is all
over.
the
they
have
'^swallowed,"
leukocytes can
engulfed.
of
As
a
themselves
question now
combat
teria,
the bac-
destroy
the
rule,
some
a
destroying the
are
bacteria.^
dozen
a
enough leukocytesto
are
leukocytes,instead
they
now
ffow of
a
taking
whether
which
If this
(leukocytes)actuallyengulfthe invading
bacteria, sometimes
But
irritating
the wall of the blood-vessel
leukocytes in
under
many
leukocytesis a
this,as
aid the
which
white
the
are
mild.
police officers going
were
it flows
(leukocytes)
blood-corpuscles
offendingbacteria.
Accompanying
into the
watches
through
is very
slow^s,and
white
The
begins.
though they
as
and
the blood-current
case
hunt
short time
a
once
in this w-ay
though
this suffices,especiallywhen
only
blood-
at
time
short
a
there
process
and
for
the
blood-plasma.
Undoubtedly
for
make
cells are
the various
are
dilate,as
the irritant away.
wash
body
staphylococciis
the
and
tiny particle
a
fluid called the
watery
a
b}^ the blood-stream,
faster and
to
in
the
51
DISEASE
them, just as
flowing through
capillaries,
cells
TO
bacteria
teria
bacof
which
destroyed by
the
bacteria.
Meantime, while
bacteria, other
the
^
In
shows
connection
a
leukocvte
with
of the
some
cells
this the
filled with
are
leukocytesare busy fighting
busy massing
student
bacteria.
should
themselves
study Fig. 37,
which
52
solidlyaround
wall which
When
livingbacteria
to
The
has
in
pus
broken-down
and
the
and
body.
killed,so that,
are
li\'ing
leukocytes,there
proceeded in
abscess
an
of the
rest
of cellular and
the inflammation
abscess.
an
from
fighters
accummulation
an
conflict,forming a dense ringor
of the combatants
ringmany
in addition
now
of
scene
shuts off the
Inside the
is
the
NURSES
FOR
BACTERIOLOGY
APPLIED
is
bacterial debris.
this way
have
we
cytes,
of leuko-
composed
tissue cells,bacteria, fibrin,serum,
debris.
However, the inflammation
course
abscess
an
"
depends mainly
course
take
may
does
not
the nature
on
a
somewhat
always
and
ferent
dif-
result.
virulence
The
of the
invadingbacterium.,the part of the body invaded, and the
resistance of the patient. Thus
it may
happen that the
that
invading organisms are so virulent or so numerous
before the leukocytesand other cells have completed their
wall about
extended
the
of conflict the
scene
into the tissues far
leukocytes and
other
invadingbacteria
beyond.
body
cells
a
of tissue.
largearea
of
as
the
a
cellulitisor
a
and
attempt
meantime
to
involving
is spoken
This kind of inflammation
it is often
^undent infiltration;
due
to
streptococcus.
In
typhoid
fever
namely, an
localization
known
small
of
with
meet
ulceration.
another
intestine.
abscess
Instead
inflammation
whose
bacteria
of
here
the
have
a
lymph-follicles
in the
wall of the
scesses,
ab-
produces ulcers opening on
In
wall is
invade
we
forming circumscribed
of the gut.
outer
mation,
type of inflam-
In this disease
bacilli in certain
typhoid
the inner surface
When
we
''Peyer's
patches," situated
as
the
an
Again and againthe
gather
localize the conflict,
the inflammation
have
other
words,
an
ulcer is
missing.
pleura a variety of
inflam-
RELATION
THE
reactions
matory
may
''drypleurisy."
of the
In this form
together.
in which
glue the
to
Or
have
may
the
the number
of
of blood-serum
irritant which
with
meet
the amount
This
pus.
In
caused
in which
cases
of
serum
boil described
tissues and
is
out
passes
both
as
in the
toxin)causes
the
the
other
seen
coccus
staphylo-
itself invades
irritant which
produced mainly by poisons given
on
"empyema."
an
of
case
is
latter is well
thick
large,forming reallya
the
bacilli remain
of leukocytes
above, the bacterium
In
dilute the
Finally,we
the number
to
The
pass
One
to
the inflammation.
constitutes the
inflammation.
effusion,"
enormous.
this is intended
are
instances,
some
ately
deliber-
nature
"pleurisywith
a
pleurisyconstitutes
of
form
tion
the exuda-
is relatively
small,while the quantity
which
has
passage
defending leukocyteswhich
help thinking that
cannot
though
a
opposing pleuralsurfaces
two
have
may
we
of the blood-vessels
the
we
of inflammation
of fibrin,as
5o
DISEASE
defending leukocytesis accompanied by
intended
and
TO
Thus
occur.
of large amounts
out
BACTERIA
OF
off
by
the
teria.
bac-
diphtheria,where
in
tonsil and
inflammation
the
cases
gives rise
the
poison (diphtheria
the
inflammatory changes in various parts
of the
body.
In
case
the inflammation
the leukocyteswhich
re-enter
may
they
numerous
and
the
then
be
have
both
is slight,
first
may
absorbed
by
When
undergo
certain
serum
and
of the blood-vessels
passed out
circulation.
the
the
a
cells
kind
scavenger
of
are
more
digestion
cells of the
body.
When
and
pus
is formed
it usuallyworks
is dischargedeither
into cavities of the
body.
through
its way
external
to the
face
sur-
openings or
54
APPLIED
tissue
Injured
not
the
When
of
body
the
of
destroyed.
known
as
may
may
has
inflammation,
an
always
that
cells
they
or
severe,
result
BACTERIOLOGY
formation
a
scar.
of
This
FOR
if
recover
soften,
break
actually
been
we
connecti^'e
constitutes
NURSES
find
the
and
down,
be
destroyed
that
tissue
what
is
inflammation
there
take
to
is
the
as
is
the
moved.
re-
almost
place
subsequently
56
APPLIED
BACTERIOLOGY
is conveyed to
the
by
man
fleas which
infest these
would
been
have
in
not
rat, through the medium
animals.
difficult to
positiveterms
A
find
few
typhus
and
and
Anderson
disease is transmitted
fomites.
With
regard to
namely,
authorities
desquamation
these diseases
infected
It is
measles
two
and
of the skin is
are
conveyed
dischargeof
the
a
and
diseases
that
the
not
by
of childhood,
believe- that
factor, and
negligible
from
to
person
that
by
person
the
involved.
membrane
mucous
of
public health
to
more
Yet
work
proves
scarlet fever,
more
did
articles.
louse
body
common
and
coming
are
the
by
it
ago
is transmitted
recent
Mexico,
in
of
which
fever
other
investigations,
particularlythe
Goldberger
years
text-book
a
that
state
by clothing,baggage,
careful
NURSES
FOR
within
only
comparativelyrecent years that we
have
appreciated the importance and danger of mild,
and
of infectious diseases,
ambulant, or irregularcases
the frequency with which
doubtedly
they occur.
They are unof the most
one
in the transmission
unrecognized.
pass
"carriers,"or
harbor
?t
the
role in the
All these
of infection
More
because
recently we
who,
persons
dangerous
while
These
spread
they
themselves
may
undoubtedly play
tors
fac-
often
learned
have
specificmicro-organism, and
others.
to
and
common
of
well,
transmit
important
an
of infectious diseases.
observations
have
served
to
discredit the
fomites
rare
act
theory,and, while there is no doubt that in some
instances clothing,rags, books and toys, etc., may
of infection,
should devote our
as
a medium
we
tention
atof
principallyto the usual or common
means
infection.
proves
The
that
knowledge
infectious
we
now
diseases
possess
are
on
this subject
transmitted
by
THE
TRANSMISSION
than
rather
persons
INFECTIOUS
OF
by things by
by certain dischargesof
those
Terminal
questionAvhich
terminal
room
diseases
are
trouble
of
others,
infected,and
are
by
vermin.
insects and
The
who
with
contact
"
57
DISEASES
Fumigation
at
arises is as
once
by fomites, why
carried
fumigation?
room
need
the
As
of fact, a
matter
a
all the
to
go
of
If such
infectious diseases.
fumigation in
not
to
ber
num-
health departments have discontinued
progressive
tagious
of the terminal fumigationsformerly done after con-
of
most
diseases.
health
departments
being discontinued
in the others.
in
disease
followed
It should
efficient
more
of
air and
IMoreover,the reader
must
in such
is stillnecessary
1915, fumigation
and
and
continued
the
stress
of terminal
that
is laid
on
in
other
disinfection,namely,
repapering)when
in mind
bear
diseases
as
sary.
neces-
gation
that fumi-
typhus (to kill
(to kill mosquitoes), and
vermin), yellow fever
tagious
con-
and particularly
sunlight,
(i.e., repaintingand
renovation
interesting
understood, however,
methods
thorough cleaning,fresh
very
discontinuance
discontinuingfumigation,increased
and
ton,
City, Bos-
prevalenceof
in the
the
be
a
the
York
boroughs
of the
some
increase
No
York
New
in 1914
conducted
experiment was
fumigation.
In
mentioned
be
may
Providence, New
of
INIilwaukee.
and
these
Among
plague
(to kill rats).
Insects
Before
Carriers
as
of
Infectious
leavingthis subject,it will
little attention
to
in the transmission
the
role
played by
Diseases
be well to
devote
insects and
of infectious diseases.
vermin
This r6le may
a
58
BACTERIOLOGY
APPLIED
be
non-specific(merely mechanical)
when
bacilli
typhoid
infected feces to
merely
legs and
It does
fly is concerned;
in
but
insect.
from
as
other
some
need
be
not
is
fly's
speciesof
what
fly at all,
a
transmission
The
the
l^acillion
matter
not
fact,it
of
plague
probably of this kind, and,
far as our
mission
present knowledge goes, so is the transof typhus fever and trench fever by lice.
governing the
Quite different are the circumstances
infected rats to
is
man
specifictransmission.
malaria
from
is carried
mosquito
it is found
is unable
to
this is
The
by
the
biting mosquito undergoes
been
infect another
to
these
and
changes
it is
completed that
person.
occur
But
only
for
in the
the
some
up
tain
cer-
after these
only
mosquito
unknown
stomach
we
in the
tiny parasitesucked
characteristic changes, and
have
mosquito
malaria, as
In
of
mosquito
a
Culex
ordinary
the
by
the
seen,
patient'sblood
changes
always
are
'\Ahen
another
to
person
effect the transmission.
already
have
of these
sleeping sickness.
one
that
species Anopheles.
the
examples
Common
malaria, yellow fever, and
of
is able
reason
Anopheles
species of mosquitos. Jn yellow fever
conditions
entirelyanalogous,
are
sleeping-sickness
in other
not
and
in the
former
required,and
as
flies from
by
of the
transfer
proboscis.
some
carried
are
specific.Thus,
or
pitcher of milk, the transmission
a
mechanical
a
NURSES
FOR
a
speciesof mosquito
in the
latter
a
known
as
Aedes
is
speciesof bitingfly know
fly" effects the transmission.
followingis a partiallist of insects
"tsetse
The
which
carry
disease:
Yellow
fever
mosquito {Aedes calopus),formerly called
Stegomyiacaloyus.
THE
TRANSMISSION
Malaria
mosquito
fly
House
typhoid
domestica)
cholera,
Tick
organisms
carry
of
diseases.
other
transmits
sleeping-sickness.
transmits
andersoni)
(Dermacentor
spotted
may
palpalis)
fly (Glossina
Tsetse
and
59
DISEASES
macvUpennis).
(Anopheles
(Mmca
fever,
INFECTIOUS
OF
Rocky
INIountain
fever.
Tick
Stable
fly
transmits
annnlatus)
(Margaropiis
calcitrans)
(Stomoxys
fever.
Texas
transmit
may
infantile
(poliomyelitis)
paralysis
.
Flea
( Xenopsylla
Body
fever
trench
Bedbug
So
for
lice,
far
careful
and
the
lectidarius)
is
nurse
attention
other
carrier
of
bubonic
plague.
transmits
typhus
fever.
{Cimex
as
a
vestimenti)
(Pedicidm
louse
and
cJieopis),
vermin
to
transmits
concerned,
flies,
about
relapsing
the
above
fleas,
mosquitoes,
every
case
of
fever.
facts
call
bedbugs,
infectious
ease.
dis-
CHAPTER
THE
IN
QUARANTINE
X
OF
CONTROL
INFECTIOUS
DISEASES
Quarantine,
spread
of infectious
Venice
in 1403
Death."
small
to
All
Venice
check
in
before
then, is the
of
origin
of infectious
our
methods
and
this
of
has
of isolation
To
isolation
has
investigations
to
this
from
we
dealing
are
crusts
or
with
the
arrived
and
the
animal
has
the
the
on
kept
a
for
city. This,
of the
of
mission
trans-
change
a
these
duration
in
diseases,
of the
period
authorities.
as
of
period
the
result
of
the
absence
enforced
bacteriologic
experimentation.
guided by disappearance
scabs, and
of
port
were
come
spread
minimum
at
'Black
situated
they
enter
there
health
by
the
at
by
"quarantine,'' quadrayinta
affected
extent
been
Here
to
term
diseases
enforced
ships
on
^
dreaded
increasing knowledge
markedly
large
a
the
With
forty.
city.
allowed
being
efforts made
the
of the
spread
controlling the
special hospital
a
the
adjoining
forty days
the
of
from
arriving
isolated
island
method
a
dates
diseases
passengers
were
meaning
isolation, as
or
In
addition
of fever, freedom
of catarrhal
or
purative
sup-
processes.
The
period
varies
isolation
considerably
as
time,
of
general
in different
they prevail
therefore,
idea
of
we
aim
the
officials in their action.
60
required
in New
in
cities.
York
merely
considerations
to
different
In
describing
City
at
give
the
which
diseases
the
ditions
con-
present
student
guide
health
a
QUARANTINE
CONTROL
IN
OF
INFECTIOUS
patientillwith diphtheriain
A
isolated for at least two
kept
patientmay
negativecultures
weeks, and
dischargeduntil
be
not
York
New
after
obtained
61
DISEASES
have
been
this
logicaltermination
City must
be
then
the
even
consecutive
two
from
both
and
nose
throat.
In
contrast
to
diphtheriaby
in scarlet fever
the appearance
be
to
of the
possiblethat
duration
the
rash.
of the
be
this
sure,
serious catarrhal
In
typhoid
periodof
be made
normal
for
at
the
Accordingly,at
made
a
week
days
of
from
named.
]Mallory
fixingthe
days
isolation
are
was
Anderson
sufficient.
was
patientswho
to
isolation
after the appearance
monkeys by
is
fixed time
no
Stool examinations
after the
long
hand,
confine the
period
period of
To
free from
ten
as
days.
least
the
two
limit
In the
stools
return
fail to
the
has been
of food handlers
to
contain
consecutive
apart should
case
to
typhoid bacilli
for
patient'stemperature
(cooks, waiters, dairymen, etc.)
so
to
serve
released
five
that five
there
fever
least
other
pneumonic complications.
or
isolation.
should
be
experiments on
appliesonly
the
in this disease.
to school
Goldberger showed
longer
no
conveyance
definite basis for
Formerly
longer,but
is
observations
more
from
the
the
beyond
patient may
the
allowed to return
and
"
York
New
thirtydays
on
often
recent
a
In
Desquamation
of isolation necessary
In measles
least
at
processes,
weeks
(page 122) will furnish
much
rash.
Suppurative
several
for
patient
and
until
seriously
regarded and
more
It is
nearly arbitrary.
in
specialsignificance
of any
of infection.
are
is very
is maintained
City isolation
held
cultures, the period of isolation
of
means
of isolation in
work
is prohibited
typhoid
bacilli.
stool examinations
show
typhoid
bacilli
62
BACTERIOLOGY
APPLIED
before such
individual may
an
NURSES
FOR
be allowed to return
to his
work.
In
smallpox the patientis invariablyremoved
isolationhospital
of the Department of Health.
is maintained
the
until all scabs have
deep-seated''seeds"
beneath
to
the
Isolation
disappeared,including
the epidermis of the
soles of the feet.
In
tained
epidemiccerebrospinal
meningitisisolation is mainfor fourteen days,for it has been found that meningococci
in the nasopharynx of convalescents are very rare
after the twelfth
or
fourteenth
permit healthycontact
facilities
Whenever
day.
carriers should be
sought out
and
isolated.
In acute
anterior
the
(infantile
poliomyelitis
paralysis)
minimum
periodof quarantineis six weeks, a periodfixed
largelyas the result of experimentalwork on animals.
In yellow fever it is now
well established that the patient's
blood remains infective about
after
over,
days. Moreinfected mosquito it
three
having been bitten by an
requiresabout five days for symptoms
develop. (See
also page
short
133.) Isolation,
therefore, is relatively
and amounts, moreover,
from
only to screening
the-patient
mosquitoes.
In
typhus fever
need
recent
and
to
patientand
of the
other
Inasmuch
should be taken
by lice,care
would
for much
be maintained
not
of the fever to normal.
washing
work
as
to
tion
indicate that isola-
beyond
the
return
the disease is spread
destroyall lice by thorough
disinfection of his
clothing
belongings.
In cholera the termination
of isolation
rests
solelyon
of the stools.
examination
bacteriologic
consecutive
negative
requirement is two
the result of the
A
minimum
stools taken
at
is complete.
intervals of five days after convalescence
CHAPTER
XI
IMMUNITY
is well
It
naturally
do
known
only
attack
only
typhoid
certain
species,
we
make
of
the
use
and
immunity
against
anthrax;
against
tul^erculosis,
against
certain
frogs
them
infected
be
can
Another
is not
absolute.
this
These
a
natural
for
is
munity,
im-
example,
chilled,
by
tetanus
This
immunity
though
is that
immunity
had
they
one
and
keeping
individuals
form
lasts
there
are
of
said
small-pox,
are
to
a
safe
from
possess
yellow
the
exceptions.
in
viduals
indi-
tion;
particular infec-
is well
immunity
throughout
observed
of
attack
practically
are
fever, measles,
64
to
natural
natural
Chickens,
body
a
immunity
This
if the
iwr-
immunity
natural
cattle.
tetanus
dogs,
natural
a
susceptible
of
have
thereafter
scarlet
man,
or
natural
term
possess
a
the
warm.
who
immunity.
and
of
with
form
attack.
goats,
of
individuals
(lock-jaw);
diseases
made
unduly
frogs
to
mentioned
speaking
certain
tetanus
be
In
and
appear
be
may
by
against
can
latter
occur
animals,
others
possessed
immunity
however,
diseases
lower
gonorrhea.
chickens
Thus,
munity.
the
Among
man.
evidently
certain
the
while, conversely,
man;
fever, syphihs,
resistance
infectious
of
some
among
affect
not
that
lifetime
a
an
second
acquired
illustrated
fever.
of
in
Often
the
vidual,
indi-
65
IMMUNITY
In
studying this
"
hved
French
scientist who
idea of
producing
artificially
in order
attack.
w^eakening the
of the disease
to
produce
was
of
given
a
should
with
produce
a
run
life of the
the
to
vidual.
indi-
accomplished by artificially
be
w^hich
originalattack
the
that it
an
necessary
by
the
the
injectionof
immunity
against that
that
and
Salmon
not
was
of the disease
attack
mild
tion
infec-
experimental labor,Pasteur
country, showed
a
the
however,
produced. Subsequently
even
a
against another
necessary,
endanger
not
bacteria
would
bacteria
1895, conceived
attack
an
hving bacteria,but
of
to
originalattack
the
could
was
in this
it
considerable
this
that
Smith,
and
course
After
found
that
matters
mild
very
realized that
He
control
so
1822
protect the individual
to
Pasteur,
acquired immunity,
tion
injecdead
ticular
par-
infection.
attack
natural
only
previouslyoccurred
injected.
individual
with
This
typhoid
colostrum.
This
to the mother's
Before
form
of
not
shows
breast
examining
immunity,
previously
the
soon
to
only
ing
Inoculat-
only
bacilli protects him
againstdysentery,plague,
is often
offspring,transmission
to
mainly, according
effected
have
againstmeasles.
not
acquired immunity
mother
from
germs
of scarlet fever protects
attack
An
againsttyphoid fever,but
cholera, etc.
whose
or
which
particulardisease
the
to
againstscarlet fever,but
an
previous
a
lation
by the inocudisease,or artificially
of the
protectionextends
been
by
that is,the
bacteria, is always strictly
specfic,
of
has
caused
whether
Acquired immunity,
Famulener,
importance
of
mitted
trans-
being
through
the
placing baby
after birth.
into the nature
it will be
well
of this very
to
specific
call attention
to
66
important
certain
invasion
against bacterial
itself
these
overlooked
protectionafforded
skin
of
undoubtedly
is
defence.
especiallyto
defends
body
general. Many
of
theii' significance
is often
of
vigorous scrubbing
of the
the
this, and
''unbroken"
say
a
skin.
surgicaloperation
done
is sometimes
harm
or
we
broken
un-
important
most
remember
to
the
body by
prior to
skin
of the
the
to
one
that
in mind
bear
great deal
a
in
is well
It
sterilization
In the
the
:
(1) The
means
that
commonplace
so
are
which
by
means
NURSES
FOR
BACTERIOLOGY
APPLIED
applicationof
by
too
too
trated
concen-
disinfectants.
(2)
afforded
body
liable
more
healthy
powerful, is
membranes.
mucous
injuriously affecting these
condition
Any
and
intact
by
less
protection, though
similar
A
illustrated by the
measles
(which
marked
degree)
bacterial
to
invasion.
which
frequency with
the
affects
This
the
is well
attack
an
membranes
mucous
of
starting-point
is the
renders
other
of
to
and
a
more
serious infections.
acid
(3) The
large
of bacteria
numbers
of
factor
gastric juice undoubtedly
are
swallowed.
therefore,constitute
digestionmay,
in
which
determining
a
bacterial
destroys
orders
Dis-
ing
the decid-
invasion,especially
of the intestinal tract.
(4)
to
It has
kill
a
been
found
considerable
therefore,constitutes
that
number
another
fresh blood-serum
of
mode
is able
bacteria, and
of defence
this,
against
bacterial invasion.
(5)
The
white
called,appear
to
or
blood-cells,
be
leukocytes, as
they
designed especiallyto destroy
are
in-
67
IMMUNITY
vading bacteria. These cells take hold of, or rather
engulf,the bacteria and digest them.^
of defence is seen
mode
in what
(6) Still another
takes place in abscesses. When
these are examined, it is
found
area,
that the
body has built a wall
shuttingoff the bacteria
thus
products
from
the
of the
rest
around
body
the
to
invasion
manufactures
their
and
poisonous
body.
mechanism
to the
Returning now
acquired immunity discussed above,
response
the infected
the
of
find
we
specific
that,
in
by pathogenic bacteria,the
certain
specificsubstances
designed
destroythe invaders or to neutralize their poisonous
products.
These
bodies.
are
antagonisticsubstances
spoken of as antito
The
important antibodies
far known
thus
are
follows:
as
(1) Antitoxins.
(2) Bacteriolysins,
hemolysins (cytolysins).
(3) Agglutinins.
(4) Opsonins.
(5) Precipitins.
(6) Antiferments.
Antitoxins.
When
"
animal
an
gradually increasing doses
toxin
doses
withstands
kill hundreds
by
treated
animals
the
of the
von
contained
substances, such
leukocytes sluggish,so
exposure
so
Behring, who
Certain
or
not
to
cold
as
that
lead
to
theria
diph-
suffice to
This
which
exposure
on
with
time the animal
was
that the blood
alcohol,also
drunkeness
g., with
would
treated.
something
often
a
which
found
injected
e.
"
that after
poison
of animals
in 1890
^
of toxin
it will be found
"
is
the
bacterial
done
of the
neutralized
to
cold, make
part of
invasion.
an
dividual
in-
68
APPLIED
BACTERIOLOGY
the
diphtheiiapoison
was
natural
used
to
NURSES
rendered
and
whether
see
it harmless.
this blood-serum
animals
other
to treat
FOR
which
had
injectedwith diphtheria poison,and
Behring found
the animals
that the
which
the
serum
was
found
The
death.
from
to be
from
serum
animal
an
in appearance
And
from
when
even
and
test
will
for the
antitoxic
of the
save
animal
the
injectedwith
in
strength of
the
be
said
In
to
normal
to
have
does
not
differ
animal.
little difference
order,therefore,
how
small
an
animal
after
be
will
with a
injection
AYhen
guinea-pigs
little
found
that
be
often
death,
must
we
toxic
quantity of anti-
a
after
even
of the
-^-^-^cm.
as
y^V^
cm.
sufficient to
it has
been
diphtheria toxin!
suffices. The
is,therefore,expressed
serum
examples just cited the
a
antitoxic
its amount,
see
antitoxic
the
acid,
an
The
In
measure
fatal doses
fact,as
in
of this antitoxin in the serum,
serum
from
on
untreated
the two.
test, it may
ten
Sometimes,
in units.
toxin.
of diphtheria toxin.
certain amount
used
save
a
save
therefore,called
was,
chemically,but
presence
in order
especially
it in animals, and
serum
are
that of
alkah
an
with toxin
treated
between
recognizethe
to
against
tested
be discovered
can
of
poison. It
antitoxin,meaning
able to
was
the effect of the poison
exactlylike that
the
be
previouslybeen
doing this von
on
used
could
action of the substance
counteracted
i. e.j it neutralized
an
thus
serum
It
strength of
100
or
would
serum
of
500
units
respectively.
Bacteriolysins. Just
"
with
as
when
gradually increasingdoses
antitoxin
in its
an
of
blood, so also,when
it produces substances
which
animal
injected
produces an
teria,
injectedwith bac-
toxin
kill and
dissolve
69
IMMUNITY
ft
the
injected micro-organisms.
that fresh blood-serum
injected with
bacterium
bacilli the
injectedwith typhoid
from
serum
it is
bacteria
is
serum
a
spoken
bacteria
means
killed
the
this
by
AMien
as
dissolving.
also
action,w^e
which
being 'bactericidal,'^
It has
be
been
found
that
red
blood-cells
used
are
properties for
these;
are
this action
and
injected into
animal
acquires
chicken
blood-cells,but
animals.
speak
increased
Instead
of such
a
of
using
serum
as
serum
solvent
for
not
a
the
serum
as
kilhng.
serum
may
bacteria.
the
blood-cells from
the
bacteria
of the
here, again,
animal
an
scope
micro-
When
acquires dissolving
serum
when
the
of the
cells than
the
that
so
specific,
strictly
Since
bacteria
means
developed against other
the
of
^^bacteriolysin,"
a
speak
'
action
actuallydissolved.
are
of
other
of normal
the
under
is
time,
a
any
merely that
is studied
bacteria
that
seen
such
which
are
the
on
or
bacilli,
animal.
untreated
of
in very
even
typhoid bacilli,
effect is
destructive
an
serum
Hence,
power
will,after
serum
doses; tested against cholera
bacteria,its
the
of
numbers
enoraious
small
ing
increas-
gradually
enormously, but only for the particularkind
for injection. Thus, if an
animal
used
increases
kill
said
ber
num-
this destructive
bacteria,however,
of
amounts
ah^eady
is able to kill a considerable
bacteria;when
of
have
We
of
the
powers
blood-cells
action
a
is
chicken
injected
only
of
for
other
word
we
bacteriolysin,
hemolysin, meaning blood
dissolving.
The
term
"
"
cytolysin
dissolvingsera,
''
cyto
dissolving.
Investigationshowed
"
is used
to
embrace
all these
signifying cell; hence,
that the mode
of action
cell
of these
70
APPLIED
BACTERIOLOGY
dissolvingsera
constituents
which
has
almost
decomposes
stood
normal
days
its solvent
of
serum
from
complement,
because
action
other
is called the
When
it
body,
bacteria.
This
and,
completes
directed
destruction.
or
The
some
the
"
is
these
bacteria,careful
a
alone
typhoid
bacilli
are
of
with
one
typhoid bacilli)
a
by the gradual collection
At the end
of
an
hour
or
to
to
pare
pre-
animal
which
with
some
of
microscope
of changes. Thus, if
a
specificantityphoid
a
previouslyinjected
firstthat the motilityof
rabbit
notices
markedly
be unable
gradually increasing
under
,
bacilli becomes
an
observation
with
teria,
bac-
effects their
is needed
contact
from
(obtained,say,
invading
would
into
mixed
serum
the
or
yet unknown.
as
interestingseries
very
gradually
ambocei)tor
complement,
serum
brought
of bacteria
reveals
body.
of the
repeatedly injected with
doses
the
complements
this
lays hold
way
Agglutinins. When
been
as
stable constituent
destroy the bacteria;the amboceptor
has
of
against the injected
specifically
complement
in
a
This
its power.
the immune
the aid of the
the bacteria
from
it respondsby
(orother cells),
substance
The
have
to
even
is repeatedlyinjectedwith
of bacteria
with
found
serum
animals, is spoken
manufacturing large quantitiesof
immune
a
is present in all serum,
constituent.
the animal
that
serum,
restores
normal
of these
ever,
Curiously,how-
power.
little fresh
a
amljocej^toror
increasingdoses
requiredthe
One
be
may
constituent,which
of the
and
easily,so
animal, immediately
in
even
complex
very
several
addition
unstable
NURSES
different constituents.
entirelylost
the
very
somewhat
was
of two
jointaction
FOR
diminished.
is followed
This
of the bacilli into
clumps.
two, in place of countless
bac-
of
a
culture
broth
of dikited
means
blood
Fig.
23.
of
the
If
Fig.
twenty
a
typhoid bacilH, and
and
typhoid
Typhoid
bacilli
hanging-drop
complete
24."
to
"
of
Typhoid
bacilli
reaction.
then
examined
method
the
under
takes
place
partially agglutinated
one
mixture
by
unagglutinated (Jordan).
agglutination
thirty minutes,
positiveWidal
culture
this
speaks
This
means
of
scope.
microwithin
(Jordan).
having obtained
that
the
patient
73
IMMUNITY
is sufferingfrom
disease,for
fever
continues
serum
Agglutination reactions
employs
one
If it
and
at
the bacterium
used
making
for
for
"
We
have
blood-corpuscles"1.
destroy
substances
the
e.,
the
closelyrelated to,
serum.
typic clumping
by
typhoid
said
already
the
that
the
white
take
leukocytes
"
Sir Almroth
Wright,
present in blood-serum
power
increased
had
it were,
of the
amount
of
the
be
of the
appropriatebacteria.
These
a
tinguish
dis-
certain
creasin
of in-
leukocytes,and,
these
by properly administered
could
teria
bac-
up
that
the
that
argues
one
a
ing.
study-
is
English physician,discovered
furthermore, that
case,
against
one
a
(Jordan).
them.
appetite,as
in
that
In
made
least very
bacilli,showing
serum
Opsonins.
employed
be
this serum,
with, or
and
the
the reaction
bacterium
tests the
agglutinateswith
Typhoid
also
may
it is identical
25."
to show
agglutinatingserum
an
certain bacterium
Fig.
recentlyhad
identifyingbacteria.
for
manner
reverse
has
or
after convalescence.
time
some
the
typhoid
substances
sul)stances
injections
he called
74
BACTEKIOLOGY
APPLIED
They
oi^soniiis.
specific,
just as
are
and
bacteriolysins,
the
when
the
the
opsonic
staphylococcus pyogenes
this
for
power
germ
the
injected,only
are
the
of
amount
the
merely
he
opsonic
the
with
compared
in the
above
that
a
number
of different
(white
of
with
other
animal
(which, of
rabbit
serum
to
e.
"
If
a
course,
will
blood, but
g., from
rabbit
is
a
is
chicken
of
injecting
material,
egg-albumin
rabl)it's
when
a
mixed
any
precipitatewill
human
when
precipitate
with
be
blood
solution)the
albuminous
mixed
serum
from
against albumin
no
of
is highlysj^ecific,
action
"
teria
bac-
production
injected with
reallyan
produce
not
the
the
seen
bod}^ of
albuminous
that
duck
have
have
Wc
"
i)roducea precipitatewhen
is tested
serum
vaccine
observers
If,instead
This
that
help.
by
with
find
egg-albumin.
if the
produced.
human
power
chicken
that
shall
egg), we
the
ac(|uires
so
rabbit
exami)le,injecta
teria
bac-
same
bacterial
as
mal
nor-
believes
the animal
inject.solutionsof
bacteria,we
for
real
antibodies.
This
known
the
other
Antibodies.
Other
pressed
ex-
patient'sserum,
the
in
and
index.
of several
cells is followed
other
or
only
ing
measur-
serum,
Although Wright
of any
for
opsonic
of the
injectioninto
the
a
leukocytes and
same
failed to find the index
Precipitins and
in
calls the
infections,most
of
treatment
specialtechnic
is essential
opsonic index
this
a
i)ower
test.
one
say,
pneumococci
for
power
opsonic power
using the
sera,
is to
bacillij
typhoid
opsonin present
this in what
is
opsonic
devised
Wright
is affected.
antitoxins,
typhoid bacilli is affected;when
is enii)loyed,
only the opsonic
is affected; when
pneumococci
for
power
the
are
agghitinins;that
the
injected with
is
body
NURSES
FOR
any
mixed
other
with
blood.
75
BIMUNITY
concerned
antibodies
The
precipitins. The
criminal
whether
When
This
The
discussion
in such
Anaphylaxis.
into the
is
^When
"
body through
and
the
intestines,
they
digested,and
they
serve
of
to
appear
up
may
the
described
was
have
may
give
are
fatal.
serious
following
due
are
to
more
experimenting
arrange
of these
Some
matters
This
studies
Recent
of
splittingup
rise to
sometimes
channels
digesting properties;at
get rid of it.
rashes
above.
this
the
likelyto
with
that
phenomenon
of
bodies
anti-
antibodies
that
the
albuminous
It has
follow
guinea-pigs
the
venous
intra-
or
body
that
that
been
second
is
found
the
rashes
spoken
that
is
possible
injection will
of
toxin
antisuch
injections. In
second
it
this
substances
injection of diphtheria
cause.
g.,
they split
shown
and
e.
"
least
so
have
symptoms,
ever,
how-
When,
production
injected material, evidently
non-intestinal
ferments,
other
the
taken
are
certain
intramuscular,
cause
"
place.
the stomach
nourishment.
hypodermic,
further
is,into
by
on
through
injection they
as
acted
body
introduced
are
means
as
that
latter
certain
and
substances
mouth,
are
of
this is out
albuminous
the
produced.
are
extremely complex,
as
known.
^^'hen
antiferments.
work
a
addition
are
animal,
an
or
determine
In
meat.
injected,anti-antibodies
subject
blood
to
antibodies
injected into
producing
are
entire
horse
any
determine
human
also be used
of in
use
to
from
called
are
made
now
necessary
still other
are
reaction
is
are
may
contains
ferments
antibodies
by
reaction
foregoing,
responds by
is
it
blood-stains
sausage
the
to
where
certain
otherwise.
this
precipitintest
cases
whether
in
as
to
so
prove
anai)hylaxis.
76
BACTERIOLOGY
APPLIED
Serum
underlying the production of diphtheria
principles
The
antitoxin
lays hold
diphtheria,the
and
quickly
lies in the fact that
we
injectingthis
this kind
of
because
It
is,of
the toxin
of
case
to
give the
to
give a
to
be
In
have
Its
the person
small
case
not
been
tetanus
the
which
of
developed
cases
of
is threatening
to
act
antitoxin.
is most
on
In
important
have
been
or
expect
patient.
with
the
clinical results
diphtheriaantitoxin.
Moreover, if injectedintraspinally,
the
serum
ward
and
early as possible,
as
useful in the treatment
serum
often
tetanus
of tetanus.
administered
was
therapeuticresults
the
merely
has undoubtedly
preventiveinjections
antitoxin is very
past, when
munity
im-
antitoxin.
the
can
the
by
the
rum,
se-
part in the
already begun
antitoxin
strikingas
lives.
why
with
confer
active
no
also to all who
contact
in the form
many
has
neutralized
of tetanus
the
reason
it for
injected. We
the toxin which
of antitoxin
dose
as
so
the antitoxin
body
are
passive immunity,
as
diphtheria,therefore,it
full dose
the
saved
In
be
in direct
use
produce
can
man,
has taken
plainthat
cells cannot
eveiy
to
protective substance,
the cells of the
them;
once
health.
patient to
horse
a
immunity
body
of the
course,
off from
the
of
the man's
production
at
a
diphtheriaantitoxin
of
into
serum
againstdiphtheriaon
speak
the
get
can
antitoxin
diphtheria bacilli
restores
use
Injected into
by bleeding the animal, collectingthe
then
and
the
in the
great convenience
us, and
which
of the toxin
producing
described.
already been
have
patient sufferingfrom
The
Therapy
Vaccine
and
NURSES
FOR
were
very
fails in the
is because
poor.
treatment
the
venously^
intraOne
of
diagnosis
77
IMMUNITY
possibh^ be
cannot
abundant
time
treatment
of
the
until after the
with
combine
to
the
has
toxin
body
cells.
had
In
the
epidemic cerebrospinalmeningitis spinal
injectionsof
reduced
made
specificantimeningococcus
mortalityto
about
one-half
have
serum
that of
not
cases
treated.
so
So
far
the
as
results have
has
been
not
disclosed
In
difficulties which
many
of these
speaking
animal
an
produce merely
contains
also
to
all,when
bacterium
we
use
the
we
munize
im-
do not
which
serum
a
come.
over-
agglutinins,precipitins,opsonins, and,
of the
antibacterial
after
bacteriolysin,but
perhaps, stillother
Because
clinical
stillbe
must
it is better
sera
certain
against a
a
the
satisfactory.Investigation
very
"antibacterial/'because,
term
concerned
are
bacteriolysins
antibodies.
the
attending
non-success
has been
sera, attention
turned
of the
use
to treatment
of active immunization.
by means
Thus, when
we
injecta horse with diphtheria toxin in
order to produce antito^rin we
immunize; when we
actively
injectthe antitoxin into a child in order to protect the
child against diphtheria we
(See
passivelyimmunize.
of bacterial infections
99.)
page
Bacterial
in
Vaccines.
"
the patientwith
injecting
the
production on
already described, and
The
immunity.
the
ordinary
test-tube
about
Acti^^e Immunization
an
thus
hour
bringingabout
are
a
usually grown
and, after being washed
containinga
half
bacteria,thus
his part of the various
bacteria
way,
dead
consists
to
little salt solution, are
60" C
is insured by
Sterility
in order
suitable
to
ally
usuing
caus-
antibodies
condition
on
agar,
of
in
off into
heated
a
for
teria.
kill all the bac-
tests.
The
suspen-
78
APPLIED
sion is then
contain
BACTERIOLOGY
diluted
exactly
after which
certain
a
as
^"accine the
namely,
from
typhoid
vaccine
The
being made
five
"
are
oil.
this
By
suspended
less reaction, and
a
scientists for
and
S.
bacteria,
doses
in saline
not
doses
to
The
and
medical
doses,
dose
of
1,000,000,000.
doses,injections
which
solution, but
the
in
an
slower, there is
giAen at
first devised
was
lipo-vaccine
500,000,-
smaller
to
be
can
of the
staphylococcus
much
several
will
suspensionis
250,000,000
500,000,000
triplevaccine
Army
of
50,000,000.
to
massive
paratyphoid b)
U.
a
absorption is made
means
Such
million
days to a week apart.
in
lipo-vaccineis one
A
Lipo-vaccines.
centimeter
The
case
usuallygiven in
from
bacteria
the
is from
is from
are
of
vaccine."
15,000,000
vaccines
cubic
usuallygiven in
are
NURSES
injection.Such
In
vary.
ordinarydose
Gonococci
each
number
"bacterial
a
different vaccines
000.
that
so
it is read}'for
of
spoken
FOR
jection.
in-
one
by French
(typhoid, paratyphoid
has
since been
authorities
to
adapted by
wide
a
a,
the
variety of
vaccines.
or
At
the
present time
by
bacterial
other vaccines
or
Diphtheria. Antitoxic
"
or
toxin
for
injections
Tetanus.
"
either
treatment
sera
by specific
is employed in
"
therapeutically.Serum
serum
immunization.
Antitoxic
both
serum,
and
therapeutically
for immunization.
Epidemic
Cerebrospinal
therapeutically.Vaccines
Typhoid
serum
Fever.
vaccines
nor
Cholera.
"
"
use
Specificserum
results indifferent.
"
have
Vaccines
of
Specificserum
Meningitis.
been
used
tion.
for immuniza-
for immunization.
Neither
therapeutically.
has been
A^iccines
used
used
therapeutically;
for immunization.
BACTERIOLOGY
SPECIAL
CHAPTER
XII
FEVER
TYPHOID
The
Eberth.
10:000
It
inch
bacilli
is
motile
at
readily
of the
body
and
very
stained
when
do
do
according
Typhoid
media,
ferment
not
in
tose
lac-
litmus
milk
the
change
not
and
long
spores.
grown
by
1880
laboratory
colored
sixth
and
or
the
on
typhoid
color
In
in
the
already
6
in certain
fever
day
bacilli
small
early stages
and
mentioned.
parts
of that
is the
the
of
the
of the
organ
fever, of small
usually
are
found
intestine
of
they
In
development,
the
on
rose-
men
abdo-
back.
part of the
of the
blood,
disease
patient's trunk,
the
of
symptoms.
the
seventh
lower
parts of the wall
contents.
of
the
on
invasion
the
intestine, causing ulceration
feature
spots
lodge
constitutional
severe
the
essentially to
bacilli which
small
curious
about
spots
when
They
they
agar
is due
by typhoid
of the
found
inch
lo^ooo
ordinary
that
so
litmus
fever
wall
In
about
produce
not
the
on
in
medium.
Typhoid
A
does
temperature.
room
lactose
on
bacillus
and
(milk-sugar),
or
discovered
was
decolorizes
It
method,
grow
even
a
thick.
Gram's
to
bacillus
typhoid
the
the
in certain
in the
intestinal
and
disease
also
are
chiefly
they
present
wall
of
are
in the
the
also
rose
intestine
81
82
APPLIED
they
BACTERIOLOGY
ulceration,and
cause
blood-vessels,giving rise
the
ulceration
wall, and
the
bacilli
in the urine.
the
disinfected
and
flies
is
material
typhoid
infected
time
of
mild
do
to
may
happen
cases,
especiallywhen
the
of
oysters which
oyster is always
cases
a
are
oysters which
to
be
It is
been
the
traced
by
due
It is now
to
well
polluted with
is
more
"fattened"
"fattened"; the lean,
When
the
In
advisable, therefore, to
preferred.
recognized
un-
latter had
food.
This
been
a
typhoid-
caused
beds
from
have
in
"
undoubtedly
typhoid infection.
have
etc.
of
that in
been
previouscase.
oysters taken
sewage-pollutedwater.
no
handling
fected,
in-
numbers
have
been
food
becomes
enormous
cases
have
the
on
multiply so
cans,
"
when
flies carry
thus
Other
carry
with
that
milk
infections
dairy utensils
with
that
In summer,
bacilli
contains
Some
mon,
com-
privy directly into
a
thrive and
quite direct infection from
established
guarding
stools
happens
milk
city a large number
sewage
a
such
once
bacilli.
to
also
insufficiently
well,spring,or stream,
pitcher of
a
the
water.
something
in
cesspoolsare
deposit typhoid
If
washing
the
feces but
remember
typhoid
into
from
the bacilli at
to the
that
it sometimes
standing about.
of
in the
only
priviesand
find their way
short
tinal
intes-
of others.
kitchen, and
very
the
perforation.With
a
important to
happens
abound,
infected
the
entirelythrough
lead to the infection of others.
so
the
times
hemorrhages. Some-
severe
not
country, where
it often
frequentlyinvolves
peritonealcavity comes
the
peritonitis.In many
cases
found
This
NURSES
into the
of
are
againstinfection
In
to
this is called
development
typhoid
this
passes
of fecal matter
escape
FOR
a
apt
in
eat
gray
patient re-
from
covers
patientscontinue
the
feces
has traced
who
dairymen
be
must
taken
feces, of
and
urine
both
fever in which
established.
Many
mild
and
course,
resulted
typhoid fever, and
because
is
of the
one
like
stools,but,
freely,and
in
reallyremain
time.
a
mix
them
masses
stool
in the
the vessel.
into the
shallow
The
vessel
In
eaith
them
Chlorid
for the
about
city the
the
up
an
stool
can
country, where
closet,it
a
constipated
with
stick and
a
Ordinarily
with
is advisable
there
to
the
emptying
before
then
will
sufficient
a
in contact
hour
used
be
disinfectant
the disinfectant.
disinfectant
for
the
closet;in
break
with
the
keep
are
been
of others
taken.
hard,
of feces
a
quence,
conse-
have
to
feces for
the
with
to
thoroughly
it is wtII to
no
infection
the
that
way
in contact
stool,it is important
of
disinfectants,it should
all
such
If the
yet positively
efficient disinfectants
most
of
cases
infection is possible,
found
the
in
discharges,
as
typhoid precautionswere
no
of lime
been
the
care
fever,running
dismissed
therefore
great
not
of obscure
case
a
typhoid
a
that
all those
include
diagnosis is
the
The
having typhoid
all persons
subsequently
has
it follows
of
the presence
though
even
constitute
epidemicsof typhoid fever
this should
Moreover,
fever.
Such
typhoid problem.
properly disinfect
to
typhoid
bacillus carriers.
said
been
cases
perfectlywell.
are
of
such
were
has
what
From
bacilli in their
of the
number
a
of the
cent,
"bacillus carriers,"and
as
difficult feature
very
author
to
of
spoken
are
5 per
harbor
themselves
although they
persons
in about
to
usually disappear
bacilH
the
fever
the feces, but
from
a
typhoid
83
FEVER
TYPHOID
be
is
poured
merely
bury the
a
stools.
underclothing,night clothes,handkerchiefs,towels,
84
APPLIED
etc., of the
BACTERIOLOGY
Disinfection
them
for
Bichlorid
also be
and
stools
disinfecting
the hands
should
have
either
5
of from
solution,1 : 5000,
in
deodorizing
is the solution of chlorids put up
the purposes
of at
fecting
disin-
once
handling the patient,the
after
the
carbolic
cent,
solution
\^cryuseful
standing near
per
acid
of mercury
similarlyused.
druggists. For
many
accomplished by soaking
in carbolic
can
by
be
bed-linen,must
before it is given out to be laundered.
hours
cent.
NURSES
the
as
of these articles is
some
2 to 5 per
well
patient,as
disinfected
carefully
FOR
bed
acid
basin
a
nurse
containing
solution,or
1
:
1000
bichlorid of mercury,
other convenient
hand
or
some
than in
disinfectant of similar strength. In this more
any
other
flies out
When
infectious
of the sick
important
examined
are
of sterilebouillon
drop
a
it is
^\^len
to
such
the
typhoid patient is added
and
Blood
from
reaction
is very
the ''Widal
valuable
from
or
more,
blood
reaction
several
to take
the test is
blood
a
dried
however,
attempt
to
on
let
thousand
place.
The
and
to
This
is known
been
diluted
as
found
from
still produce this
fact,diluting
permits
the
collection of the blood
for
still
times
simple matter,
very
be
cases, in
some
a
begin
effect.
It has
fever.
typhoid patientcan
a
peculiarclumping effect;in
the
such
no
and
diagnosis,
typhoid
forty times
to
for
from
their movements.
cease
has
person
test" for
that blood
twenty
normal
a
once
be
to
in active
little blood
a
bacilli at
and
gather together in clumps
found
they will be
drop
a
the microscope
under
uniformly scattered throughout the drop
motion,
keep
to
room.
bacilli
typhoid
in
disease
as
a
couple of drops of
glass slide suffice. It is important,
and not
the blood dry spontaneously,
a
to hasten
the
drying by
heat.
TYPHOID
Thanks
done
largely
to
this
bacilli
individual
being
first
and
used
contains
each
much
typhoid
bacilli
killed
three
is
is
in
tecting
pro-
typhoid
tion
vaccina-
The
week
a
bacilli, and
apart.
second
the
lipo-vaccines
When
given
by
the
used,
injections
been
vaccination.
heat.
by
500,000,000
dose
has
antityphoid
1,000,000,000.
massive
a
of
Wright,
vaccine
carefully
consist
third
with
bacterial
very
one
of
through
a
purpose
should
The
work
infection
prevent
the
For
the
to
85
FEVER
are
single injection,
a
not
repeated.
The
of
results
have
been
develop
run
of
Treatment
a
milder
by
or
and
fever
typhoid
the
that
cases
do
course.
developed
vaccines
of
cases
vaccinated,
so
vaccinations
antityphoid
few
very
those
among
of these
protective
excellent;
usually
occur
such
of
cases
specific
fever
typhoid
has
sera
proved
by
to
means
be
out
with-
and
then
value.
Inasmuch
infections
experience
as
resembling
so-called
''triple
vaccine"
bacilli
type
paratyphoid
tj^pe
more
B.
severe
As
a
than
rule
the
from
shown
fever
typhoid
inoculation
bacilli, protective
a
has
now
due
are
to
is sometimes
consisting
A,
reactions
the
that
and
paratyphoid
practised
of
typhoid
bacilli,
paratyphoid
from
ordinary
triple
typhoid
vaccine
vaccine.
with
bacilli
are
CHAPTER
XIII
DYSENTERY"
CHOLERA
Dysentery
The
bacillus
dysentery
Japan,
and
Flexner
by
Gram-negative,
than
the
and
Acute
dysentery,
do
dysentery
bacillus
or
In
tropical
countries
a
to
organisms
called
of
speak
to
due
to
dysentery
typhoid
Like
swallowing
discharges
carried
are
and
of
of
become
86
countered,
en-
kind
(a
and
due
usually
closely
related
chronic
dysentery
it
of
the
to
variety.
is due
is,therefore, customary
and
''amebic
tery."
dysennot
are
Is due
fever, bacillary dysentery
bacilli
which
another
have
Sometimes
person.
sometimes
the
affects
The
nothing
but
mucus
the
to
fecal
the
bacilli
these
food
indirectly, on
carried
are
germs
is involved,
occur.
from
come
especially
large intestine.
superficial portion
soon
are
diarrheas, however,
dysentery
may
a
bacilH.
of the
ulceration
of
summer
Occasionally
Bacillary
membrane
form
cjuite directly,
drink.
varieties
is
climate,
some
ameba%
usual
is
smaller
mannite
^'bacillary dysentery"
The
It
in
not.
this
in
Shiga
somewhat
main
ferment
which
by
Philippines.
Two
which
those
the
bacillus,
bacillus.
those
sugar)
in
non-motile
typhoid
discovered
was
mild
In
but
stools
and
in
are
the
serum.
.mucous
only
cases
cases
severe
at
flies.
by
first
the
deep
fecal, but
The
mucus
88
FOR
BACTERIOLOGY
APPLIED
NURSES
Cholera
spirillumof
The
and
1884,
bacillus."
at
even
temperature,
room
liquefactionof
causes
can
well
grows
multiply
Fig. 27.
weeks
"
Spirillum of Asiatic
method.
Cholera
is
of Asia, hence
enormous
causing thousands
the
when
and
name
1000
a
not
bouillon
and
cholera."
gelatin
spirillum
produce
culture
(Frankel and
in India
"Asiatic
of deaths.
in
''comma
cholera
stained
when
epidemics of
Koch
on
grown
The
cholera, from
constantly present
the
called
It is motile, does
is decolorized
Gram's
by
ordinary culture-media,
on
old, showing long spirals; X
and
discovered
the medium.
in water.
spores,
to time
was
is often
its form
from
It
cholera
three
Pfeiffer).
according
to
other
parts
From
time
the disease invade
Europe,
DYSENTERY
produced only by swallowing the germs
since the germs
only from
invariablycome
is
disease
The
of cholera, and
patients,and
cholera
flies constitute the
produces
in the
and
contents
time
short
stools
in
this
period
are
at
first
yellowish,but
then
are
dischargesoften
culture.
gradually
When
their
resume
normal
the
tients
pa-
collapse. The
grayish
stools."
These
in practically
spirilla
takes
recovery
a
profuse
become
soon
the cholera
contain
of
'^rice-water
termed
In
and
of
duces
pro-
begin
abdomen.
INIany
state
a
poison
These
intense
at
the intestinal
the intestinal
the
the
becomes
die
white, and
pure
in
accompanied by vomiting.
is
and
diarrhea
the
intestine, but
of the disease.
colicky pain
and
diarrhea
the
absorption of
the clinical symptoms
with
spirillumdoes
superficial
layersof
The
membrane.
mucous
through
poison while multiplyingin
intense
an
infection
cholera
of
wall
penetrate deep into the
not
through
of infection.
typhoid bacillus,the
the
tion
pollu-
food
and
food
avenues
common
that sewage
of milk
the contamination
handling by
Unlike
it follows
of man,
the intestinal contents
of water,
89
CHOLERA
"
color
and
stools
the
place
cholera
the
disappear.
spirilla
disease
The
used
in
the
and
spread chieflyby contaminated
drinking, cooking,
for
washed
is
infected
like,may
and
others
the
hnen
who
are
of cholera
brought
the
disease.
recently
been
found
carry
cholera
germs
into very
\'egetables
some
in their
Wash-
women
with
close contact
their stools
in
Like
that
disease.
the
patients or
contract
washing.
particularly lettuce, cress,
water,
convey
and
water
are
i)ronc
typhoid fever, it
healthy
stools.
These
i:)ersons
are
to
has
may
sjioken
9U
of
in
APPLIED
as
"bacilli
BACTERIOLOGY
carriers,"
connection
So
far
with
as
the
already
Dysentery.
been
the
same
and
typhoid
prevention
precautions
described
under
FOR
have
NURSES
already
been
spoken
of
fever.
of
further
must
Typhoid
infection
be
is
taken
Fever
as
and
cerned,
con-
have
under
XIV
CHAPTER
TUBERCULOSIS
The
bacillus
bacillus,
not
only
but
also
of
the
glands
cold
grows
only
is not
slowly,
with
acids.
is
about
causes
very
bacilli
are
bacilli
from
found
in
of
in
man.
tuberculosis
of
of
liuniaii
intestines;
is
It
and
is
origin^
strictly
then
but
It
spores.
resists
decolorof
disease
all deaths.
cows'
as
an
disease
hence
tubercle
milk.
The
tubercle
from
controversy
the
established
practically
certain
man,
and
somewhat
in
in
The
tuberculosis,
tuberculosis
now
of
slender
a
is
produce
cows,
differ
is
white
meninges,
thick.
common
considerable
It
as
I.)
pulmonary
bovine
the
stained,
among
source
was
the
bacillus
not
once
in
lungs),
such
is, therefore, spoken
found
human
there
role
does
one-eighth
this
of
special media,
extremely
prevalent
of
inch
(See Plate
an
often
recently
75^0
It
bacillus.
Tuberculosis
bacilli
tubercle
difficulty,but,
''acid-fast"
the
The
and
motile,
with
ization
is also
kidney,
on
the
cause
disease, hip-disease,
tuberculosis
and
long
of
tuberculosis,
the
(scrofula), etc.
aerobic,
and
of
peritoneum,
inch
of
tubercle
It is the
(tuberculosis
(Pott's
abscess),
the
in 1882.
forms
bone
of
I'od, ipuo
stains
other
all
called
also
Koch
by
'^consumption'^
of
swelling,
tuberculosis,
discovered
was
tuberculosis
of
of
until
regarding
spread
of
that
while
always
other
and
those
caused
tuberculous
91
culosis
tuber-
monary
pulby
in-
92
BACTERIOLOGY
APPLIED
NURSES
FOR
fections,especiallyin children,are
infected
and
cows,
the
that
due
milk
to
should
danger
be
from
guarded
against.
In
the most
man
of the
is that
set
destructive
up
inflammatory changes,
result of these
a
usuallycoughed
up.
and
bacilli,
of
act
sputum
are
considerable
may
lodge on
form
of
in the
In
against.
this
to
a
During
the
infected
be inhaled
by
particles
in
(tuberculous
large quantities
of infection must
source
in
even
bacilli
be
guarded
ordinary pulmonary
usually found
are
to
menace
grave
intestine
found
are
matter,
tuberculosis tubercle
feces,owing
of the
bacilli
that
For
is
with tubercle
may
again constitute
so
tuberculosis
feces,and
a
sputum
these infected
vicinity.Or
as
furniture,
hangings, floor,etc.,in the
the
dust,and
into the air and
bacilli
and
sneezingtiny particlesof
and
enteritis)tubercle
in the
is loaded
This sputum
scattered
other persons
others.
of
cpantity
is,therefore,
highly infectious.
coughing
the
this situation
In
lung.
tion
infec-
of tuberculous
form
common
in
patientsswallow
the fact that the
the
some
of their sputum.
There
is hardly an
organ
the tubercle bacillus.
disease,is the
of the
as
which
Tuberculosis
common
cause
of
of the
be attacked
tuberculosis
hunch-back; tuberculosis
disease."
short,*'hip
infection
are
tuberculosis
water-on-the-brain,met
of the
Other
tuberculous
of the
tuberculosis of the
by
spine,or Pott's
is familiar
meninges (tuberculousmeningitis)
hydrocephalus or
with
to
us
in infancy;
hip-jointis usuallycalled,for
common
forms
of tuberculous
tuberculous
peritonitis,
kidney, tuberculosis
larynx,tuberculosis
of the eye, tuberculosis of
etc.
not
may
of
of the
the
pleurisy,
bladder,
culosis
skin, tuber-
bone, gland tuberculosis,
93
TUBERCULOSIS
As
already said,however, tuberculosis
far the
to
infection
the
prevent
that
the
always spitinto
into
a
In
of
should
sputum
handkerchief
contain
in
the
should
sweeping
Dry
be
From
wiped
what
has
be
a
droplets
a
paper
furniture,
catch
objects likelyto
and
sunlight
bacteria, it follows
should
be
dampened
are
that
provided.
permitted,dust
rag
said
been
each
tive's
consump-
unnecessary
sunshine
not
with
up
of
The
drying
of
of air and
maximum
no
that
destruction
the
burned
be
can
mouth.
other
or
Remembering
potent
the
to
disinfectant,
or
scatteringabout
of
bric-a-brac, hangings,
dust.
seeking
prevented by holding
be
should
room
In
carefullyinstructed
which
the
front
in
be
containingsome
cup
coughing,
lung is by
of others, therefore, it is important
vessel
a
infection.
of
consumptive
sputum
paper
day.
form
frequent
most
of the
should
with
crude
ways
aloil.
concerning the bacteriologyof
tuberculosis,other precautionswill suggest themselves.
bacilli
tubercle
When
are
for
grown
beef-broth,they gradually cause
with
loaded
poisons.
When
such
so
as
evaporated and filtered,
have
what
tubercle bacilli,
we
A
curious
thing
with
etc.
reaction
of
a
is known
as
culture
an
produced.
skin with
into
the
a
It
needle
reaction
when
also be
fected
in-
takes
creased
pains, in-
individual
tuberculin
can
reaction
applied by
rul)binga droj)of
and
scarifications.
from
individual
uninfected
This
is
tuberculin.
is that
tuberculin
normal,
become
entirelyfree
characteristic
diagnosticvalue.
scarifyingthe
tuberculin
is
In
glycerin
to
by fever, prostration,some
cough,
is thus
in
broth
a
be
to
this
a
tuberculosis,
place, marked
such
broth
injected into
quantities are
minute
no
about
the
time
a
A
positivereaction
94
is
APPLIED
denoted
of
the
spoken
solution
of
rise
of
to
the
the
to
a
form
is
an
This
ointment,
this
the
also
purpose
amounts
is
is
If
a
of
spoken
may
is
dihite
a
it
may
tion
conges-
as
into
tul^erculin
site
test
eyes,
marked
Rubbed
Moro's
used
of
form
reaction.
This
is
the
the
test.
the
the
at
making
into
dropped
in
Calmette
of
Pirquet
von
reaction
a
Tuberculin
and
the
tuberculin
reaction.
For
as
NURSES
changes
method
This
of
of
FOR
inflammatory
conjunctiva.
or
in
distinct
by
inoculation.
often
give
BACTERIOLOGY
also
the
junctival
con-
the
skin
give
rise
test.
in
very
the
minute
gradually
treatment
of
quantities
increased.
losis.
tubercu-
are
jected
in-
96
tion of
the
a
membrane
This
Somewhat
bacilh.
and,
while
the
under
the
over
a
and
membrane,
such
of
in order
for
germs,
not
on
grow
Knowing
of others.
then
to
examining
the facilities
rubbed
of
first
tube
a
for
the
of true
cases
theria
diph-
should
diagnosis,for
of Vincent's
those
amined
ex-
bers
num-
enormous
methods
correct
a
growth
be
tain
cer-
angina, will
the culture-medium.
the
of the
location
All the
and
mouth
glasses,and
the mouth.
interposea
pane
in order to
When
of
other
it
diphtheriabacilli,
to
measures
Disinfection
this purpose.
with
In
Both
carbolic
carefullydisinfected,
spoons,
and
usually show
to insure
example,
then
the surface
over
some
culture is made, incubated
a
will
difficult to devise
not
by
stainingwith
sterile swab
a
bacilh.
diphtheria
employed
by spreading
done
microscope.
culture
a
tell
physicians
most
not,
or
eighteen hours,
the
under
are
the infection is
addition,where
of
means
to
often
can
whether
be
In
microscope.
twelve
however,
slide,fixing,and
of sterile Loffler's serum,
from
diphtheria
numerous
methylene-blue, and
hand, by
at
are
on
alkaline
Loffler's
should
This
membrane
of the
cells,
diagnosisestablished by bacteriologic
the
examination.
of
bacteria,especiallyby streptococci,
of the membrane
have
preferto
fibrin,pus
membranes,
diphtheria bacillus
the
to
of
experienced chnician
an
the appearance
due
similar
other
produced by
contains
the sm'face
on
consists
granular debris,and
NURSES
membrane
peculiardirty gray
part.
and
FOR
BACTERIOLOGY
APPLIED
prevent the infection
nasal
acid
dischargesmust
being
should, of
examining
safeguard the
extend
course,
in
the throat
the
to
contact
it is well
patientand
latter when
be
useful for
very
things coming
glassbetween
is
the
aminer,
ex-
patient
97
DIPHTHERIA
coughs. Quarantine is usuallykept up
shows
examination
In
1893
Behring,
could
animals
poison,and
had
that
after
the
of
German
a
to
diphtheria bacilli.
that
injectionsof diphtheria
the blood
other
cure
fatal dose
a
bacteriologic
scientist,found
to
time
a
power
times
many
absence
be accustomed
acquired
with
the
until
of
of these
animals
animals
injected
diphtheria poison.
-^::^
Fig. 29.
test-tube.
and
from
the
which
has
1, A tube
"
Rub
the
without
of
swab
box
swab
gently but
touched
the
exudate
without
tube, plug
own
provided by the health
expert.
far back
and
pharynx and
sterilized cotton
In
rubbed
tonsils
gently
latter,and
but
officials.
thoroughly
tubes, and
This
laryngeal diphtheria
freely against the
rub
its surface.
breaking
both
swab
freely against the visible
culture-tube,insert it into the
in its
a
laying it down, after withdrawing the
of the blood-serum
the
blood-serum; 2,
is to
the
mucous
portion
the
over
place them
swab
to
is to
membrane
face
sur-
replace
Now
be sent
date,
exu-
plug
cotton
that
in
in the
the bacteriologic
be
passed
of the
(Anders).
alreadysaid that the diphtheriabacillus when
in broth produces a strong poison. In fact, the
grown
diphtheriabacilli produce alltheir evil effects through this
poison. The bacilli remain on the surface, i. c, they do
do they invade the deeper tissues.
not enter the blood, nor
In this respect they differ from
which, as
streptococci,
flammat
inalready stated, may also give rise t(^ a membranous
We
have
of the throat.
The
streptococci
penetrate
the
98
APPLIED
tissues,enter
BACTERIOLOGY
the
Fig.
30.
with
toxin.
Company,
The
of
as
Fig.
is taken
endocarditis,
body, arthritis,
etc.
Injecting horse
"
NURSES
often lead to inflammation
blood-stream, and
in other parts of the
pyemia,
FOR
(Courtesy of
H.
K. Mulford
Phila.)
poison produced by diphtheriabacilli is spoken
diphtheria toxin. The something in the blood
31.
"
Bleeding
hor.se
in
operating-room.
to insure
asepsis. (Courtesy
treated
animals
of H.
K.
Every
Mulford
precaution
Company,
Phila.)
of the
neutralize
the
which
effects of the
was
able
to
overcome
or
diphtheriatoxin is, there-
99
DIPHTHERIA
fore, called diphtheria antito.vin. At
this
diphtheria antitoxin
with
doses
graduallyincreasing'
period of
a
several
is made
at
would
ordinarilysuffice
animal
much
quarts
sometimes
collected
blood
is allowed
to
stand
place,it clots,and
is
the
for
serum
sterile
a
used
serum
fatal doses
a
of toxin
contains
The
ordinary sera
to 1500. units
In
the
should
be
certain
animal.
serum
so
This
the
of
market
in
the
serum
given by
but
injections,
in
When
there
1
will
As
to
a
just protect
toxin.
also
prevent
matter
cases,
several
are
injectionsmay
order
is
the
be
their
of fact, one
a
how
The
many
will
serum
centimeter.^
contain
from
antitoxic
full doses
Ordinarilythe
make
this antitoxic
strength.
cubic
per
on
severe
of
treatment
against
diphtheria the
given early and
to
cool
a
expressed by saying the
10,000 units,depending
it is well
this
500
centimeter.
cubic
treatment
is
on
the
quantity of the
units
many
now
per
vessel,in
also for its
by finding out
an
of blood
When
carefullytest
to
and
purity
in
latter is indicated
protect
horses.
clear,Hght-yellow fluid separates.
the
constitutes
blood-scrum, and
It is necessary
disease.
bleeding.
one
in
ten
as
as
a
diphtheria antitoxic
the
at
will
diphtheria toxin
as
bled,
over
horse
hundred
being
is
last the
at
kill several
the
fluid
diphtheriatoxin
to
Then
This
of
much
injection,as
one
by injectinghorses
months, until
stand,
present time
the
(from
severityof
the
of
means
3000
disease).
given
the
to
unit
is that
guinea-pig against
amount
100
a
vein.
family affected,
well
contracting the
late,
seen
injectionsdirectlyinto
in the
to
hy[)odcrmic
especiallywhen
children
serum
children, in
disease.
Such
of antitoxin
which
fatal closes of
diphtheria
100
BACTERIOLOGY
APPLIED
the
Reaction.
devised
a
simple
whether
or
not
that
demonstrated
about
and
60
that
this the
remain
of age
eight
develops in
is being used
marked
a
those
there
of age
only
between
five
year
while
cent,
per
immune.
are
individuals
immune
rises
75 per
o^'er
into
injection
diphtheriatoxin.
hours
one
immune,
50
infants
so
cent,
diphtheria.
to
of
amount
It has been
of newborn
forty years
test consists in the
The
At
had
individual
the
cent,
about
and
twenty
determine
to
in the blood.
per
proportionof
between
immune
are
90
over
cent,
per
fifteen years
After
whether
in their blood.
antitoxin
have
determine
which
to diphtheria
susceptible
was
diphtheriaantitoxin
not
by
units.
1000
Schick, of Menna,
ago
reaction
skin
to
usually
years
individual
an
infection;i. e.,
had
is
few
A
"
"immunizing injections";
as
for this purpose
dose
Schick
or
of
spoken
injectionsare
NURSES
FOR
is
Within
of
area
who
the skin of
redness
and
reaction.
no
practically
to
extensively
small
twenty-fourto forty-
in
susceptible;
are
a
determine
induration
those
The
the need
not
Schick
of
ceptible
sus-
test
actively
immunizing children exposed to diphtheriainfection.
When
immunize
a
we
against diphtheria by
person
of diphtheria antitoxin
the immunity conferred
means
lasts
only a
few
This
weeks.
is horse antitoxin and
in the human
been
bodv'.
adopted
of
For
making
by injectinghim
toxin,thus
antitoxin.
has been
to
This
so
this
a
is because
is reallya
extensivelytried by
yieldexcellent
plan has recently
againstdiphtheria
diphtheriabacilli and diphtheria
causing the body
plan,spoken
jected
in-
foreignsubstance
immune
person
with
the
reason
the antitoxin
of
as
Park
results.
to
produce
active
and
its
own
immunization,
Zingher,and
pears
ap-
CHAPTER
XVI
TETANUS
is caused
Tetanus
in
after
culture
pure
laboratory
animals
earth.
spite
of
the
bacillus
due
the
to
before
the
is
wound
that
made
by
i. e., it is
laboratory
in
has
oxygen
under
slender
by
to
rod,
Gram's
travel
for
laceration;
leads
gas
favorable
of medium
hydrogen
well
and
a
on
The
very
conditions,
length,
which
gas,
the
microscopic
in
or
bacillus
field,owing
air
tion
condi-
disagreeable
ture-medi
culodor.
is
a
decolorized
It is able
stain, i. e., it is ''Gram-positive."
across
in the
ordinary
is not
is
oxygen,
If this
the
the
bacillus
of
the
velopmen
de-
tetanus
to
presence
abstracted.
quite
its
usually cultivated
of
been
grows
producing
the
is
and
atmosphere
an
fulfilled,it
Grown
in
grow
wound
the
its toxin.
Fourth-of-July toy pistol.
not
tion
inocula-
disease, but
the
or
is
present
Thus,
into
puncture
frequently
most
anaerobe,
an
which
is
a
does
tetanus
from
which
wound
of
deep
be
favorable
so
earth,
This
elaborate
can
nearly
garden
occurrence
must
introduced
are
bacillus
small
with
work.
in
tetanus
disease.
rare
deadly
years
dust, garden
street
rarely produces
is not
a
as
type
the
them
conditions
its
dirt
and
five
1889,
producing
rather
a
certain
do
time
same
in
culture
pure
in
first obtained
was
relatively frequent
tetanus
can
bacteria
open
of
the
that
germ
a
if other
An
fact
the
with
at
of
in
inoculating
by
of
which
Kitasato
by
etc., tetanus
manure,
bacillus
a
succeeded
had
Nicolaier
In
by
to
the
101
pres-
102
of
ence
which
flagella,
It
body.
FOR
BACTERIOLOGY
APPLIED
shows
it has
around
arranged
are
greater resistance
bacteria to drying,to heat,and
because
NURSES
the
conditions.
to
power
The
than
produce
other
most
to chemic
disinfectants,
under
spores
is located at
spore
its entire
of the
end
one
verse
ad-
bacilkis,
and, being largerin diameter than the bacillus
of a
the appearance
itself,
givesto the latter somewhat
nail.
Heatino'
Fig. 32.
Bacillus
"
105" C. for ten
to
of tetanus, showing
Fuchsin
stain
kill tetanus
spores,
splintersof
wood
eleven
there and
mind.
and
have
caused
the
introduced
into
do not
invade
If the
conditions
is
are
the
on
agar.
alive
on
disease
after
wound
they
the
multiply. They give rise
bacilli
of the
body
produce
a
are
to
as
but
do, for
ample,
ex-
The
littlelocal
absent.
frequently
powerful toxin
generalsymptoms.
a
important to bear this in
favorable
they continue
disturbance;in fact,local symptoms
cause
remained
yet they have
streptococci.It
live and
But
culture
(Kolle and Wassermann).
bacilli are
tetanus
the
to
Pure
spores.
years.
When
remain
is sufficient to
minutes
toxin
which
can
is the
be sepa-
CHAPTER
THE
The
PNEUMOCOCCUS
the
implies,
It
twos.
was
organism
is not
corpuscle
discovered
Frankel.
by
usually
occurs
in
according
Blood
Capsulated
carbol-fuchsin,
Gram's
is
The
method,
pneumococci
partly
and
which
a
104
grows
little
by
on
blood
a
ordinary
or
from
XlOOO
occurring
is non-motile
pneumococcus
It
in blood
decolorized;
when
surrounded
usually
spores.
to
corpuscle
"*"
"
"
to
-^
*'
Fig. 33.
name
lance-shaped
*''
Pneumococci
its
As
stained
when
decolorized
diplococcus
the
called
also
pneumococcus,
ianceolatus,
Blood
XVII
thick
and
media,
blood-serum
the
"
Pneumococci
heart
of
a
rabbit;
(McFarland).
in sputum
gelatinous
does
but
has
not
blood
or
capsule.
produce
prefers
been
those
added.
THE
The
is
pneumococcus
from
which
closelyallied
it is sometimes
varieties of
Four
105
PNEUMOCOCCUS
hard
streptococcus,
distinguish.
to
pneumococci
the
to
recognized,as
are
lows
fol-
:
Type I, found
in about
and
pneumonia,
has
Type II, found
of
pnuemonia,
from
a
5 to
20
per
about
due
When
tests
a
the
60 per
about
cent.
of the
cases
60
cent.
per
mucosus,
causes
pneumonia,
in normal
of
cases
5 to
and
has
throats.
It
causes
pneumonia
and
has
10 per
to
a
cent.
give
the
best
results in
for
laboratory
I.
the
be taken
of
cent.
found
Type
to
of
cases
appears
determine
should
in
of the
collectingspecimens
to
25 per
cent,
per
mortalityof
of the
cent,
treatment
pneumonia
15 to 40
a
mortalityrate, from
Serum
care
cent,
r\" is often
Type
low
has
about
called the Pneumococcus
15 per
mortalityof
about
in from
and
Type III, also
mortalityof
a
of all cases
30 to 50 per cent,
of sputum
type of
that the
sterile bottle without
present,
pneumococcus
specimen
is
and
disinfectant,
fresh,collected
sent
at
once
to
laboratory.
The
is responsible
for
pneumococcus
of lobar
pneumonia
forms of 1 neumonia.
is
rhinitis
arthritis
keratitis
for
Other
frequentlythe
otitis media, with
endocarditis
and
more
than
infections in which
causative
cases
half of the other
agent
the pneumococcus
are
pleurisy,
its complicatingmastoiditis,
meningitis,
(inflammation of the valves
(inflammation of the nasal
(inflammation
(inflammation
Usually when
of the
most
the
of
of the
heart),
passages),tonsillitis,
and
joints),conjunctivitis,
of the
outer
pneumococcus
of
('()\ering
invades
the
the
ball).
eye-
lungs an
106
BACTERIOLOGY
APPLIED
extensive inflammation
involves
a
lobar
pneumonia;
it is called
king
In
of
this
red
lungs results.
when
or
it is scattered
there
is
marked
a
which
sponge
almost
solid and
has been
saturated
absorptionof poison from
fibrin.
from
affected
The
If the
its normal
and
carried off
body (white blood-cells)
to
the
high
patientrecovers
condition,the
date
exu-
cells
the scavenger
by
Some
a
is much
There
all this material, hence
lung graduallyresumes
being absorbed
air spaces,
compared
with pus.
the
with
Mixed
the
be
may
fever,delirium,rapid pulse,etc.
of the
as
the
throughout
pouring-out into
and
leukocytes,serum,
becomes
of
spoken
blood-cells,
pneumococci, and cell debris.
lobe
the
it is
more
cells
degenerated epithelial
are
If the inflammation
bronchopneumonia.
a
pneumonia
air spaces
of the
entire lobe
an
NURSES
FOR
of
it,to be
.
sure,
is
expelledby coughing.
In
pneumonia
numbers
in the
in
pneumococci
in rhinitis it is in the
ear;
conjunctivitisand
We
sec,
the
of
enormous
charged
dis-
pus
nasal
covering
in the
keratitis,
the
tion;
secre-
tonsils;
mucopurulent
eye.
therefore,that
of infection must
in
media, in the
in the exudate
tonsillitis,
secretion
found
are
in otitis
sputum;
the
from
in
the
be
great
a
different
many
guarded against.
So far
sources
the
as
care
pneumonia patients is concerned,
and care
should be carefullydisinfected,
all the
sputum
should
be taken
that, in coughing, particlesof sputum
are
of
into the air.
moist
spray
source
In
crowded
particlesby
of infection.
arfe often
face,and
lips,
too
hands
the
rooms
others
is
Patients
ill to
not
sprayed
inhalation
undoubtedly
sufferingfrom
of such
a
mon
com-
monia
pneu-
prevent their soilingtheir
with sputum, and the
nurse
should,
therefore,
be
this
from
in
nurse
It
is
sunlight
hours.
remains
that
encouraging
The
suspended
no
to
pneumococci
fine
loses
in
the
survive
the
air
sources
its
tion.
infec-
soon
after
pneumococcus
to
infectivity
in
dries
two
the
guide
to
Exposed
expelled
spray
main
pneumococcus
agents.
sputum
the
suffice
that
know
germicidal
pneumonic
of
against
infection
further
prevent
should
above
others
to
to
enumeration
given
guarding
sensitive
very
few
as
is
guard
The
source.
infection
of
her
on
107
PNETJMOCOCCUS
THE
coughing
so
hours.
direct
after
that
completely
a
CHAPTER
XVIII
STREPTOCOCCUS
The
Streptococcus
pyogenes^
and, independently,
isolated
Fig.
34.
by
"
also
oval,
and
individuals, though
readily
with
the
^
108
often
ordinary
Pyogenes
of
pus
but
stains,
pus
first
was
taken
from
an
or
scess;
ab-
Pfeiffer).
in
merely
Koch
spheric
are
eight, ten, twenty,
"
means
1882,
cocci
the
and
(Frankel
chains
in
occur
from
pyogenes,
XIOOO
in
The
1883.
by
observed
was
by Ogston
in
Fehleisen
Streptococcus
INFECTIONS
and
pairs.
retain
producer."
or
more
They
stain
the
color
STREPTOCOCCUS
when
treated
grow
readily on
according
various
blood
streptococcihave
that, when
so
each
We
colony
of
speak
media,
be
to
seen
of
blood,
on
containing blood,
surrounded
varieties
such
taining
con-
varieties
Many
solid media
on
They
prefer media
but
peculiardissolvingeffect
a
grown
is
method.
Gram's
to
blood-serum.
or
109
INFECTIONS
by
clear
a
zone.
''hemolyzing" (blood-
as
dissolving)streptococci.
is the
Streptococcus pyogenes
of infections
in
these
Among
man.
of
cause
a
great variety
be mentioned
may
erysipelas,cellulitis,
sepsis,puerperal infection,acute
otitis
bronchopneumonia,
peritonitis,
tonsillitis,
its
and
complicating mastoiditis,meningitis,enteritis,
arthritis.
endocarditis,synovitis,and
understood, however,
that
due
pyogenes,
to
streptococcus
learned
that other
of observers
merely
bacteria
hold
the
infection,but
is
media,
infections
these
for
be the
may
scarlet fever
that
It must
general opinion
already
number
A
cause.
is
always
are
have
we
streptococcus
a
is that
this
organism
secondary invader, probably through
a
be
not
the
tonsils.
The
Streptococcus
kill.
to
of
suffices.
1
per
Thus,
for from
F.
130"
Bichlorid
fortunately,is
pyogenes,
an
exposure
ten
of
to
twenty
mercury,
to
temperature
minutes
ordinarily
1:5000, carbohc
cent., kill the
cent., lysol,J per
a
ficult
dif-
not
germ
acid,
in
a
few
minutes.
It should
cautions
spread
will
be
which
of
dealing
a
should
nurse
streptococcus
differ,of
with.
to
unnecessary
course,
with
It is well
enumerate
take
infection
the
to
kind
in
to
all the
i)rc-
preventing
others.
of infection
the
They
one
is
remember, however, that
110
air
the
through
it is unreasonable
long
so
those
coming
Owing
to
the
has
the
of
surface
or
even
obstetric
for
An
been
in
with
pus
has
with
are
variable,
of
more
of
Vienna,
severe
the
uses
of
cases
bacterial
who
nurse
allowed
be
of
some
obtained
serum,
fections,
in-
to
care
in the
but
of
re}3orted
certain
in
is
serum
is
of
treatment
as
in the
extensively
yielded
observers.
from
Strei^tococcus
streptococcus
and
claims
infections
rather
servers,
ob-
different
to
api)ear
50
to
100
recommended.
usually
fever,
by
cases
large,
injecting
by
cultures
various
streptococcus
has
vaccines
hands
serum
scarlet
of
treatment
the
the
intravenously,
or
no
raw
streptococcus
kind,
of any
inner
the
that
with
directly
women
of
way
contact
results,
dose
The
good.
used
been
The
infections.
of
are
infections.
septic
imperative
mission
trans-
cases.
repeatedly
pyogenes,
in
it is
antistreptococcus
horses
The
uterus,
before
just
by
of
streptococci
from
infection
to
the
in
likelihood
susceptibility
extreme
ward.
the
in
unbroken
virulent
most
immediately
childbirth
after
The
others.
to
reason,
erysipelas
of
sepsis
much
is not
there
condition,
former
this
cases
remains
skin
the
as
isolating
puerperal
of
cases
on
tion
infec-
that
For
unlikely.
very
insist
to
keeping
fact,
In
is
NURSES
direct, and
always
probably
is
transmission
while
FOR
BACTERIOLOGY
APPLIED
l)e
c.c.
Moser,
treatment
good
by
favorable
of
results.
means
of
results
112
APPLIED
skin, and
In
be
to
appears
BACTERIOLOGY
contrast
to
unbroken
in various
in
carbuncles
Fig. 35.
we
the
far
The
as
are
has
not
also been
remembered,
kept
about
operations in
the
order
present in the air.
was
on
the
a
in the
lymph-glands, in
pyogenes
to this
kill the
of others
the
The
the skin is of
more
organism.
carbolic
germs
presence
is
concerned,
of
occurrence
Lister,it
acid
which
will be
solution
during
Experience, however,
unnecessary.
Boils
.
operating-room
to
mucous
(Giinther)
in air.
of
and
pyemia.
aureus
about
dust
spray
found
skin
much
worry
through
of the
of infection
source
a
infect
to
frequentlydue
very
staphylococcus in
that this
organism
Staphylococcus
"
reallyneed
playing
able
abscess
acute
the
of ^'stitch abscess."
endocarditis,
septicemia,and
empyema,
So
be
to
of
pathogenic bacteria,the
pustular affections
membranes,
and
other
skin.
inhabitant
cause
appears
NURSES
constant
common
most
staphylococcus
the
almost
an
be the
to
FOR
surgical
might
soon
of the
be
showed
lococcus
staphy-
importance, but this,too,
STAPHYLOCOCCUS
presents
The
main
the
spread
point
of
organism,
these
the
on
infections,
recent
dead
solution.
five
The
six
or
8
days.
the
and
are
staphylococci
are
given
localized
from
like.
the
attended
bacterial
lococcus
staphyvaccines.
300,000,000
to
in
salt
suspended
at
careful
the
has
of
the
steriUzation
the
to
other
means
of
indicates
success
and
against
resistance
this
chiefly
employed
injections
guarding
high
needles,
boils,
by
in
and
part,
abscesses,
ordinarily
500,000,000
is
infection.
controlling
mind,
considerable
infections
doses
pus,
hypodermic
years
of
treatment
The
in
nurse's
instruments,
In
in
in
bear
to
especially
attention
of
obstacle
great
no
113
INFECTIONS
intervals
of
about
CHAPTER
MENINGOCOCCUS
THE
meningitidis,
cellularis
in
baum
occurring
It
mostl}'
in twos
does
It
not
blood-serum
is not
or
to
exposure
on
The
meningococcus
tubercle
the
In
epidemic
is found
in the
and
the
It
In
the
has
also
in
present
forms
the
variety
been
nasal
of
about
with
10
such
caused
are
and
pneumococcus
meningitis
the
meningococcus
the
covering
drawn
only by
by
that
of
can
ture
punc-
be
mined.
deter-
of
patients.
is
meningococcus
patients suffering
meningitis,
cent,
meninges
of lumbar
present
the
bacteria.
of lumbar
means
means
meningitis
per
spinal
cerebro-
epidemic
other
secretions
of
ing
dry-
on
by
found
secretions
The
readily
meningitis
the
which
to
also
fluid
it is
cerebrospinal
contact
of
exudate
purulent
fact,
of
occasionally
epidemic
114
cause
cerebrospinal
puncture.
that
is the
cerebrospinal
in
dies
sunlight.
bacillus, by
and
streptococcus,
and
to
tive.
Gram-nega-
added.
been
direct
Other
meningitis.
by
resistant,
very
is
media
on
has
occasionally
according
is, it
except
fluid
ascitic
or
organism
well
grow
organism,
and
stained
that
decolorizes;
it
flattened
When
intra-
Weichsel-
by
(diplococcus),
fours.
of
method
Gram's
somewhat
a
Diplococcus
the
discovered
was
is
1887.
chains
small
in
called
also
meningococcus,
The
XX
and
in
the
persons
The
exact
from
nasal
the
in
mate
inti-
mode
of
THE
infection is not
known, but
nasal secretions.
which
should
This, of
be taken
the disease to
115
MENINGOCOCCUS
is
probably through infected
indicates
course,
in order
the
prevent the spread of
to
others.
Epidemic cerebrospinalmeningitis has
with
specificantimeningococcus
horses
Fig.
36.
"
lococci
from
outside
of the pus
the
of
meninges.
cells.
The
not
specificsera,
serum
than
before
in
the
cases
so
few
A
Between
is
containing dipin
of lumbar
means
the
exudate
are
delicate
a
death-rate
As
puncture, into
obtained
being
meningococcus.
serum
have
but one-half
been
that
with
in all treatment
a
employ antimeningococcus
meningitisproduced by
the
jecting
in-
representation of
accurate
an
by
microscope (Councilman).
it is useless to
employing
cells
cells there
pus
treated
meningococcus.
diplococci are
the
treated.
of
the
the results thus
encouraging,the
cases
of
been
obtained
serum,
cells: Pus
pus
illustration
spinalcanal,and
very
in
is injected,
by
serum
the
cultures
of cells in the field of the
group
The
with
Meningococcus
fibrillarof fibrin.
measures
It is
to
germs
other
important, therefore,
make
sure
that
the
116
APPLIED
is
case
as
really
already
The
spread
thus
on
to
is
not
in
one
done
obtained
Gram's
the
If
by
is
dried,
of
organisms
meningococcus
of
and
case
diplococci
of
lumbar
pus
are
of
sediment
stained
then
cording
ac-
meningococcus
will
cells.
Gram-positive
meningitis.
puncture.
the
centrifuged,
In
This,
meningitis.
means
fixed,
method.
interior
the
NURSES
meningococcus
Gram-negative
115.)
page
is
slide,
a
meningitis
mostly
of
one
stated,
fluid
FOR
BACTERIOLOGY
(See
be
found
Fig.
the
36,
case
CHAPTER
THE
micrococcus
The
Neisser
in
(diplococcus).
are
flattened
organism
When
their
decolorized,
difficultybe
fairly well
ascitic
fluid
has
resist
few
minutes.
But
found
method
the
a
alive
pus
to
agar
temperature
thick
after
a
lapse
of
bean.
is
gonococcus
It
only
can
but
either
thrives
blood
or
drying destroys it,
of 45"
smears,
the
(McFarland).
which
Quick
pair
to
coffee
a
artificial media,
added.
in
gives
"Gram-negative."
on
been
it cannot
been
of
in urethral
grown
and
has
appearance
Gram's
glucose
on
sides, which
pairs
the
form
which
by
in
occurring
coccus,
adjacent
i. e., it is
discovered
was
organisms
Gonococci
"
small
a
the
by
37.
gonorrhea
two
somewhat
Fig.
with
of
The
on
stained
GONOCOCCUS
It is
1879.
XXI
on
seven
C.
than
more
a
linen, etc., it
weeks.
117
118
APPLIED
The
BACTERIOLOGY
is the
gonococcus
ophthalmia,
chronic
indirect
but
in newborn
an
As
it is caused
found
in the
a
the
the result that
with
due
to
are
gonorrheal
affections
is
ophthalmia
infection,
through
become
has
baby
adults
soiled
and
usually
towels,etc.,
direct inoculation
by
vaginal discharge of
the
of silver nitrate in the eyes
solution
cent,
joint
prophylacticmeasure
a
important
vaginitis and
babies
gonococci
mother.
In
purulent
severe
most
chronic
as
endocarditis.
to
the
and
well
as
due
with
which
urethritis
NURSES
of various
cause
inflammations, among
gonorrheal
FOR
of
use
the
2 per
a
of every
born
new-
routine
practicein obstetrics,
number
of
gonorrhealophthalmia
of blindness
cases
has
neonatorum
rially
mate-
diminished.
In
of fresh pus
smears
found
the pus
within
with their behavior
many
of the
and this peculiarity,
cells,
together
toward
Gram's
diagnosis. (The meningococcus in
gives a
similar
and
not,
as
from
pus
meningitis
the gonococcus,
than
the
under
rule,occur
a
aids in the
stain,are
it is smaller
picture,but
does
gonococci will be
same
conditions.)
The
and
urethra
acute
A
and
at
in the
dormant
time
any
an
indifferent
fluid
has apparentlygiven good
solution),
The
000,000, repeated
Attempts
have
dose
at
been
by inoculatinghorses
so
far the
satisfactory.
set
vagina
fresh
a
up
vaccine,prepared by suspending
in
gonococcus
jointlesions.
but
remain
may
for years,
process.
killed
salt
gonococcus
varies from
intervals
made
to
with
results of its
(physiologic
results in
some
20,000,000to 1,000,-
of three
produce
to
a
have
not
da3^s.
seven
curative
increasingdoses
use
the
of
been
serum
vaccine,
specially
120
throat,
exceedingly
are
NURSES
FOR
BACTERIOLOGY
APPLIED
tions
these ulcera-
the dark-field microscope, scrapings from
are
A
to
seen
syphilitic
having
ing-cup or
a
of the
makes
infect
its appearance
the
on
The
lipor tongue
carried
also be
may
drink-
a
of others.
infection
cause
Infection
victim.
the Treponema pallidum.
patches may
mucous
and
spoon
infection then
with
swarm
with
Examined
infectious.
through
kissing.
Fig.
body
38.
on
a
(Park and
When
the
pallidum appearing as
Treponema
dark
by India ink
field,as shown
"
be
mother
on
the
from
syphihsis transmitted
shows
often
called "snuffles."
not
or
Williams).
disease
babies
bright refractive
ultramicroscope
is
The
given
to
cannot
bottle.
itself in the
secretion
infectious.
highly
a
nurse
parent
healthy
A
from
l^aby by
the
offspring,
what
nose
are
of such
syphiliticbaby should
wet-nurse
it,the baby
to
to
should
suckle.
be
If the
brought
up
121
SYPHILIS
A
that
be
fluid
devised
syphilitic
the
by
absence
diagnosis
AMiile
patients.
infection,
of
such
a
a
negative
infection.
syphilitic
or
positive
result
the
result
does
is
infections
This,
Beiiin.
blood
the
on
of
of
Wassermann,
either
performed
of
the
in
aid
great
test
can
cerebrospinal
indicates
not
indicate
a
XXIII
CHAPTER
EXANTHEMATA!
head
Under
this
measles,
scarlet
fever.
typhus
has
be
of
be
as
of
skin
exanthematous
the
Scarlet
Fever.
the
In
"
protozoan
found
but
antitoxin
the
from
that
in measles'
of
is the
Exanthemata,
eruption.
122
and
between
coccus-like
this
them
tiny
regarded
Other
in
blisters
servers
ob-
living
and
in
sues,
tis-
some
generally regarded
now
are
he
fever.
demonstrate
also
described
which
scarlet
of
They
tissues
growing
one
as
leukocytes.
trachea
tongue,
1
to
to
cause
the
1916)
children
disease, especially
the
oculation
in-
by
ill with
patients
cells
tissue
recently (March,
More
from
in
them
rashes.
degenerated
symptoms
humans
Mallory
1904
causes
unable
were
from
is
agent
cHnical
or
to
diseases.
glistening corpuscles
as
causative
typic
blood
or
definitely proved
animals
healthy
in
and
specific organism
no
The
and
''virus/'
produced
with
infection.
the
a
and
German
chicken-pox,
that
in
ahke,
are
demonstrated
of
cause
spoken
can
They
measles,
small-pox,
fever,
yet been
the
included
are
dying
the
from
lungs,
the
INIallory reports
a
early in the
tonsils, fauces,
epithelial cells.
In
of scarlet
of
has
fever, and
exanthem
=
a
of
course
of the
root
strongly Gram-positive
large bacillary organisms.
plural
isolating
form
He
lus
bacil-
it varies
believes
accordingly
breaking
out,
an
123
EXANTHEMATA
It
named
which
poison
a
necrosis
causes
coveringepitheliumand
and
leads
produces
denudation
and
to
It
of the
exudation
an
of
they
are,
scarlet
constant
the
reported have
results
The
this represents
and
fever
definite has
of
has
to
have
been
described, and
been
held
responsiblefor
bodies
nothing
but
proved about the bacteriologyof
been
a
similar
Bodies
"
accompanies measles,
w^hich
coryza
Measles.
bacillus
influenza-like
these
diseases.
The
the
in
of the rash of scarlatina.
German
scarlet
INIallory's
two
important discovery.
most
and
generalsymptoms
the
a
confirmed; if
yet been
not
throats
which cause
the severe
sore
streptococci
considered
fever are
as
by most bacteriologists
but secondary infection,and not as the cause
Measles
virus
these
patients.After
infectious.
In
through
The
one
virus
attack
is
55"
thereby
remains
C.
a
for
in
the
runs
made
course
has
passed
immune.
Berkefeld
infectious.
fifteen
that is,
filter,
It is
minutes,
destroyed
but
resists
No
development
drying for t went }--four hours.
place on any of the usual culture-media.
bacilli
cocci and
Bacteriologistshave found
a
time
were
considered
the
oculati
in-
longer
milder
that
have
measles
no
was
a
monkey
a
of
blood
has
by
monkeys
the blood
the disease
through
passes
to
disease
the fever abated
monkeys
This
fever.
who
investigators,
with
animals
the filtered material
by heating
the
subjects,and
in human
than
several
by
producing
in
the
patient during
demonstrated
succeeded
its nature, exists in
measles, whatever
of
of the
blood
been
for
serum
leukocytes.
The
an
scarlatinoB.
provisionallyBacillus
causes
of the
takes
which
disease.
124
know
We
described
also
Weigert
have
cells,which
these
that
now
forms
NURSES
FOR
BACTERIOLOGY
APPLIED
accidental contaminations.
were
included
"bodies"
epithelial
in
variouslyinterpretedas
since been
of tissue cells,or
as
generativ
de-
protozoa causing
disease.
the
"^l
"
*
!
Collectingvaccine from a calf. The
first
calves which
used
in the preparation of the virus are
are
with
washed, the long hair is clipped,and the skin is cleaned
bichlorid solution,then in an
alkaline
bath, and finallyall traces
of the antisepticsare removed
by thorough rinsing in sterile water,
is shaved.
after which
The
the surface to be operated upon
mals
anithen
are
conveyed to the operating-room, where
they are
Fig. 39.
Operating-room.
"
vaccinated
with
in the
are
under
Company,
In
to
the
about
six
When
is
modified
calves
develop
under
conditions
stable
propagating
days the virus
presumably
because
are
it
lesions very
and
similar
and
(Courtesy
identical
those
to
of H.
with
a
as
clean
isting
ex-
they
prepared
K.
is
as
for
Mulford
small-pox,
different host.
small-pox virus they
In monkeys
cow-pox.
with
to
kept
is removed
develops in
inoculated
similar
hospitals,after which
of modern
rigid aseptic precautions.
Phila.)
Cow-pox
being
virus
operating-rooms
transferred
possible.
use
tested
EXANTHEMATA
inoculation
and
holds
vice
in
century
with
and
has
This
man.
of the number
of
are
of
best method
virus
vaccine
dry skin,
where
sharp,
sterile
surface of the
Do
with soap
arm
paint the
not
sJiin
cuts
inch
longare made,
an
scratch
in
a
ginning
be-
drop
virus.
vaccine
Fig.40.
fiat of
the
on
the needle the virus
"
"
Linear
the eleventh
(From
day.
Medicine
Preventive
The
vaccination.
tion
erup-
Rosentiu,
Hygiene.")
and
rubbed
is then
gentlyinto
dry.
the scratches.
No
that the various
a
vaccinated
The
dressingshould
good, for they
shows
follows:
three
or
scratches
shown
do
formerly.
alcohol.
by
those which
and
vaccinatingis as
the outer
or
to
than
ing
lower-
constant
a
linear
parallel
With
and
made
inch
an
two
sudden
a
tion.
vaccina-
has been
vaccination
a
the
With
of
than
more
of
apart.
each
for
are
placed on
needle
proved
Two
drops
three
now
been
nature
of
followed
water,
with iodin.
or
protectiveaction
same
cases,
small-pox
milder
a
Carefullyclean
and
the
been
has
compulsory there
The
pox,
protects against small-
i.e., since Jenner, in 1796, introduced
"
In cA^ery country
occur
virus
cow-pox
versa,
125
shields often do
linear vaccination
is allowed
applied,experiencehaving
be
retain heat and
area
moisture.
made
as
more
The
harm
than
illustration
here described.
XXIV
CHAPTER
FILTERABLE
describing bacteria
In
in
50;^
from
size
bacterium
is
about
41.
"
Different
Berkefeld;
such
y^
to
lo;^
inch; the
inch
c,
and
however,
12(i
of
to
long.
readily
absorbent
construct
they
pathogenic
average
is obvious
It
varied
that
d
bacteriologic
Chamberland;
through
that
stated
was
c
types
tiny organisms
filters
it
h
a
"\g.
VIRUSES
d, Reichel
pass
filters:
Kitasato;
6,
(McFarland).
through
cotton
a,
ordinary
filters.
filters which
paper
It is possible,
entirely hold
XXV
CHAPTER
MALARIA
Malaria
is not
is
has
Laveran,
French
a
that
found
sexual
non-sexual
The
breeds
marshes.
in the
In
forms
the
stomach
they
and
free
set
are
pass,
of
a
matured,
segments,
stage
of
1:28
the
bite
where
they
which
can
fever
are
be
into
shed
of the
Here
a
they
the
the
male
mosquito
pools
of
the
of
the
into
tilizatio
fer-
days,
mosquito
the
they
round
stream
bloodthe
penetrate
of
indefinitely
free
red
fully
are
or
blood-stream.
setting
and
young
fourteen
to
until
number
into
of
a
human
mosquito
insect,
remain
repeated
marking
this
tract
and
both
species
of ten
end
others
of
stagnant
of
digestive
being.
divide
in
upon
life-cycles,
blood
development
the
human
and
cycle
at
the
into
through
corpuscles,
same
until,
a
wall
the
and
followed
hemameba,
largely
lives
proceeds
of
by
course
mosquitos,
the
Anopheles,
and
occurs,
in
in
the
distinct
two
place
forms
young
live
female,
which
takes
cycle, occurring
patients.
and
which
one,
1880
Grassi, and
Ross,
has
hemameba
the
in
which
parasite
Manson,
discovery,
Laveran's
in
and
surgeon,
army
'pro-
''hemameba
term
discovered
was
malarial
the
with
work
parasite
a
^'plasmodium
name,
by the
replaced
been
This
malarise."
old
Its
which
of
cause
micro-organism,
animal
an
the
disease,
(plural ^protozoa).
malarise,"
a
but
bacterium,
a
tozoon
of
infectious
an
oval
The
the
in
man,
of
amebulae.
120
MALARIA
Although
malaria
it
is
by inoculating a
the
can
There
the
three
are
The
parasite.
blood
the
in
slightlymotile,
tertian
motile
is
host
parasite is
the
in
forty-eighthours,
to
oval
bodies.
the other
than
motion
is dark
blood-corpuscleswhich
contain
shrink
its
pigment,
and
a
assume
cyclechieflyin
(e.g., the spleen),and
all in the circulation.
shape.
blue.
Romanowsky
body,
more
the
tively
ac-
human
The
pigment
quite fine.
show
more
two; they contain
and
quite fine.
parasiteare
the
This
type
The
apt
pletes
com-
of the internal organs
be difficult to locate it at
Its sexual
are
a
it then
and
color.
the blood
it may
All three types
The
brassy
in
and
and
small
parasitesare
which
little
cycle in
parasiteis yellowishbrown
Estivo-autumnal
red
its
febrile
a
amebulae.
round
glistening,but
quartan;
the
blackish-brown
coarse,
less
is
refractive
into six to twelve
divides into fifteen to twenty
very
causes
microscope,
tiny
a
contains
and
there
the
is
organism
completed
active ameboid
"
develops in
malaria
Under
day.
than
of the tertian
parasite
hours; hence,
It segments
pigment.
hemameba
(Plate II.)
tliird
the
of malaria.
relativelybenign
a
estivo-autumnal
seventy-two
fresh smear,
words,
estivo-autumnal
the
cause
of the quartan
organism
stage every
The
former
malaria,
mahgnant
of the
of
aid
other
spread
no
tertian, and
two
infection,while
be
can
a
practice,
the
In
recognized types
the
quartan,
The
there
mosquitos
without
mentioned.
particularmosquitos
without
disease, yet, in
transmitted
be
never
from
blood
with
person
the
patient sufferingfrom
malaria
produce
to
possible,experimentall}^,
forms
best stained
method
uses
crescentic in
are
with
a
methylene-
compound
ob-
130
APPLIED
BACTERIOLOGY
FOR
NURSES
by bringing together methylene-blueand
tained
eosin; the
soluble
alcohol;it
stains
deep pink,
and
water-
is soluble
resultingpowder
in
only
parasitesblue, red blood-cells a
blood-cells pale pink with blue
the
white
nucleus.
Apparently
there
exists
a
malaria; occasionally
to
acquired by
or
one
of Africa
coast
who
who
have
the
is
passed through
Koch
the
on
negroes
severely attacked
there, and
live
to
go
this to their
less
are
tricts
dis-
partial immunity
a
Thus
immunity
in malarial
residents
individuals
some
infections.
more
few
Also
infection.
escape
slight natural
a
w^est
than
has
peans
Euro-
attributed
having acquired a partialimmunity during
childhood.
malarial
The
certain
quinin, arsenic,and
campaign
also
parasitesin
with
hosts
their human
substances.
the
of
means
the
to
mosquito
killthe malarial
that,to
by
In
it is well
suppressing
to
in hand
nuisance, and, hand
other
against malaria
in this climate
attention
direct
actively destroyed by
parasites are
quinin.
Mosquitoes
It may
be well at this
point to give a
brief outline of the
of malaria
the transmission
Mosquitoes reproduce
which
the female
After several
lays
days
the eggs
"wrigglers,"which
seen
with
the naked
changes into
the
a
on
pupa,
and
of
and
hatch
winged insect, the
out
a
of
means
of stagnant
into what
water
After
from
by
surface
live in the
eye.
yellow fever.
themselves
the
in
concerned
those
of mosquitoes,especially
life-history
day
and
or
this,after
mosquito,
can
two
a
are
eggs
water.
called
readilybe
the
wriggler
val,
further inter-
emerges.
It
is
131
MALARIA
thus
to
that stagnant water
seen
breed.
of the
Both
water
wrigglersand
at
Fig. 42.
Life
"
the
on
mosquito breeds:
of the
water;
the
the
changing
to
surface, when
insect).
allowing its wings and
mosquitoes
body
and
go
lands, the
similar
In
and
through
transmit
which
has
The
The
a
therefore
of
glers
wrig-
the
mon
com-
the
on
face
sur-
larva, 3, 4,
ing
(8,descend-
pupa
(13, emerging;
eggs
similar
brown
breed
in fields and
and
of the
young
of development.
process
belong
the
to
varietyof
this
markings
on
in fresh-water
woods.
requiresthe drainage
or
14,
expand ready for flight,
commonest
draining
filling-in,
Their
of marsh
oiling of ponds,
and
measures.
contrast
to
the
a
ing
thread; 6, breath-
a
malaria
four dark
in stagnant water
extermination
The
mass.
The
wing. Anopheles mosquitoes
swamps
deposited
as
insect
float).
a
family called Anopheles.
each
the
showing how
pupa.
harden
to
as
is broT\Ti in color and
to
complete
malaria-carrying mosquitoes
The
If
disturbed; 9, 10, breathing; 11, 12,
The
using the pupal skin, 15,
the
thickness
through the tail;7, changing
from
eggs,
2, separating from
forming; 5, emerging,
surface
breathe.
of the water
Chart
The
1,
about
the
to
to
mosquitoes
asphyxiation.
cycle of mosquito.
house
for
come
in order
surface
die of
soon
pupae
pupae
brief intervals
film of oil is floated
and
is necessary
anopheles, the mosquitoes
which
132
APPLIED
transmit
yellow fever, Aedes
cisterns,in old tin
drains, and
and
woods,
malaria
like.
the
do
Adult
43.
female
few
be
"
Female.
Anopheles maculipennis (Howard).
mosquitoes live
days.
bite, it may
showing
of the
the favorite haunts
are
fields,
mosquito.
Fig.
a
in the
breed
not
Male.
but
barrels,
bottles, in stopped-up roof
They
which
swamps,
pests.
rain
dwellings,in
and
cans
domestic
calopus,are
around
and
in
breed
They
NURSES
FOR
BACTERIOLOGY
Inasmuch
of interest
the differences
month
a
only the
as
or
female
study the
to
between
the
longer;males,
male
mosquitoes
pictures,
above
and
female
sects
in-
(Fig.43).
YELLOW
FEVER
organism
Although the specific
yet been
identified,it
may
be
of
yellow fever
well to mention
has
the
not
disease
kind of
here, because, like malaria, it requiresa particular
mosquito (Stegomyia calopus) for
man
to
man.
The
disease
is not
its transmission
conveyed
from
by fomites.
133
TRYPANOSOMIASIS
The
bite
until
of
infected
an
twelve
There
is
and
the
days),
definite
a
The
days).
infective
after
filters.
blood
through
authorities
yellow
of
mosquito
infective
remains
these
three
is
days
finest-grained
the
five
(average
still
porcelain
126.)
page
Competent
patient.
the
blood
blood
during
of
bite
the
the
first
the
patient's
the
time
passing
(See
organism
of
infectious
become
not
bitten
between
definite
a
has
it
time
infectivity
and
(three
after
days
does
mosquito
incline
is
fever
a
belief
the
to
i.
protozoon,
a
e.,
that
the
unicellular
micro-organism.
animal
TRYPANOSOMIASIS
connection
In
may
be
This
said
about
dreaded
the
the
similar
mosquito,
''tsetse
by
malaria
fly."
the
cerebrospinal
fatal.
yellow
to
but
that
by
of
a
caused
species
of
characteristic
The
The
entering
disease
by
and
malaria,
appears
fever
a
word
"sleeping-sickness."
or
is
scourge
trypanosomes
fluid.
and
trypanosomiasis
African
somewhat
by
with
a
protozoon
transmitted
biting-fly,
known
symptoms
and
not
are
growing
to
be
as
almost
duced
pro-
in
the
variably
in-
XXVI
CHAPTER
Milk,
of
one
is at
diet,
the
and
growth
the
same
bacteria
The
they
of
under
the
most
approved
milk
absolutely
pathogenic,
unless
when
and
(a)
to
market
Best
the
(h)
cubic
Good
cause
Milk
milk
udder,
the
bacteria.
in
be
to
the
portance
im-
dairy.
sources
later
or
"
they
or
farm
may
at
considered
souring
the
render
and
milk
Broadly
"
three
even
with
to
obtain
the
a
fortunately,
milk
market
any
and
But,
allowed
are
Supply.
into
two
distribution,
found
they
thus
may
the
Grading
divide
they
at
of
not
are
have
cow's
the
at
being drawn,
from
free
for
practically impossible,
is
generally
consumer
the
methods
and
in milk
conditions
best
very
pursued
found
It
medium
bacteria; hence, great
of
it is
human
of
articles
excellent
methods
while
handling.
varieties
the
an
from
derived
stage
the
time
to
milk
the
fall into
important
generally
be
may
most
development
attaches
MILK
OF
BACTERIOLOGY
not
are
dangerous
to
multiply
curdling
unfit
dantly,
abun-
faction,
putre-
or
for
speaking,
to
use.
we
may
groups:
quality, showing
not
over
10,000 bacteria
centimeter.
quality,
not
500,000 bacteria
over
per
cubic
centimeter.
(c)
Poor
bacteria
In
with
per
summer
quality, 5,000,000
cubic
134
50,000,000
and
more
centimeter.
these
astonishing
to
milk
normal
rapidity,
and
soon
bacteria
render
multiply
the
milk
136
APPLIED
BACTERIOLOGY
FOR
certain disadvantagesas well
done,
with
fresh milk
is then
pathogenic bacteria, such
bacillus,are killed,as are
which
cooled
also the
milk.
properly
rapidly,the
If
tubercle
and
typhoid
as
souring of
the
cause
advantages.
as
which
NURSES
lactic acid
What
remains
varieties.
Among them
spore-bearing
putrefactiveorganisms,but these are present
the
are
numbers
only and
milk
in
condition
tainted
a
Normally,
the
of the
lactic acid
milk, keep
organisms,but
before
the
milk
than
unless
the
reason
dealers
ture.
tempera-
pasteurized
it may
have
tion
reac-
of these latter
carefullytreated,well cooled,
have
may
pasteurization of
should
in small
pasteurization.
growth
good quality
a
the
are
growi^h of putrefactive
the
kept cool,pasteurizedmilk
count
ahve
bacilH,by alteringthe
down
in heated
unchecked, and,
and
low
develop at
to
it is
was
been
unable
are
impossibleto tell whether
heated, i. e.,
reallyfresh when
But
is
bacilli,
raw
milk
terial
higher bac-
a
milk.
For
this
supplied by
ths
carefullysupervised by the public
be
health authorities.
Pasteurization.
Home
of
pasteurization
milk
There
"
has been
is
no
found
especiallyfor infants,and
have
been
them
being those
A
put
simple
upon
milk
the
a
wire
which
The
basket, into
water
is then
The
then
in the
lowered
milk
the
and
home
perforated cover
are
fitted
pailis heated
to
until the bottles
is steamed
bottles
are
several
in the open
corked
vantage,
ad-
pasteurizers
among
of Freeman.
pasteurizerfor
tin pail,having
of considerable
market, the best known
of Arnold
home
that
doubt
and
use
and
consists of
a
containing a
eight nursing bottles.
wire
the
boiling,
nearly touch
the water.
bottles for ten
steaming
crate
minutes,
is continued
BACTERIOLOGY
another
OF
fifteen minutes.
137
MILK
After that the milk
is
kept
on
ice until used.
Freeman's
consists
pasteurizer
and
cover
fitting
Fig. 44.
"
a
Arnold's
removable
apparatus
cylindricmetal cups,
The pailis filled with
Fig. 45.
from
The
and
milk
are
water
Apparatus
the top and
point.
cups
"
which
for
in these
a
pail with
rack, holdinga
for
milk
sterilizing
receive
to
a
the
groove
pasteurizingmilk
the water
bottles
of
are
is
tight-
number
of
(Ashton).
milk
bottles.
about
halfway
(Ashton).
l^roughtto
then
a
the
boiling-
placed into the metal
surrounded
by water,
which
138
APPLIED
serves
as
conductor
a
into the
removed
from
reaches
160"
twenty
minutes.
rapidly
cooled
water
in the
in
means
by
faucet.
Milk
in the
is then
stored
of Disease.
and
much
tuberculous
that
not
of the
of
both
water
at
that
level for
about
removed
and
better, the
hot
or,
found.
Of
the
fatal tuberculous
Besides
"
grades of
those
tubercle
is not
there may
a
so-called
from
of the
teria,
bac-
milk,
may
the
cow
suppurative
a
udder
tuberculosis
been
strated
demon-
in
is
cows
produces pulmonary
able
to set
children
and
infrequentlyspread by
bacillus is introduced
be
the kitchen
bacillus found
in small
run
milk in number
It has
that which
through uncleanly habits
is
the above
derived
elsewhere.
processes
Typhoid fever
the
milk
ice.
on
bacilli from
varietyas
same
to
streptococcifrom
lesions
while
attached
tuberculosis in adults, it is nevertheless
milk;
are
and
serious contaminations
more
mastitis,and the tubercle
or
pail is
inhabitants of all market
in the different
vary
frequent are
most
is immersed
replaced. Within
cover
water-bath,
inevitable
are
occasionallybe
the
pail,the
bottles
tube
Carrier
a
only, other
the
rubber
a
milk
The
which
remains
Then
of
as
in the
the
temperature
F. and
filled rack
pasteurizeris replaced by cold,which
which
and
boiling water
the
The
of heat.
the stove, and
minutes
ten
NURSES
FOR
BACTERIOLOGY
into the
milk
milkers, among
"carrier,"that is,an
even
up
infants.
means
of
directly,
whom
apparently
perfectly
healthyindividual who harbors in his intestines
virulent typhoid bacilli,
by contaminated
or, indirectly,
which
has been used to wash
water
etc.
utensils,
Asiatic cholera,dysentery, and similar diseases may
be spread in the same
but are
probably only
manner,
infrequentlydisseminated in this way.
Epidemics of
BACTERIOLOGY
scarlet
fever
traced
is
It
Fig.
contaminated
to
infect
milk
have
been
rectly
di-
milk.
keep
to
139
MILK
however,
diphtheria,
important
readily
its
and
OF
through
flies
the
from
milk.
filth which
A
fly
it carries
can
on
legs.
46.
Colonies
"
of
bacteria
transplanted
by
a
fly's
feet
(Magruder).
When
properly
pasteurization
against
at
the
of
all these
present
^'certified"
the
milk
various
time
grade,
pasteurized.
supervised
may
no
be
by
the
offers
infections.
milk,
sold
health
the
In
excepting
unless
it has
best
New
that
been
authorities,
protection
York
City
equal
to
effectively
According
XXVII
FERMENTED
MILKS
Metschnikoff,
to
associated
changes
the
generated
in
Moreover,
his
excessive
CHAPTER
intestines.
fact,
In
extensive
of
pronounced.
the
milk
has
by
Many
Chief
and
are
among
an
A
acid
140
lactic
acid
starter,
in
of
all
covers
fermentation
because
the
bacteria
of
milk.
raw
heated
milk
(''starter")
extensively used,
now
and
essential
an
usually
more
culture
as
sours
bacteria
is
diet.
acid
buttermilk
dealers
species
the
of bacteria
fermentation,
responsible
organism
Inoculation
which
their
to
milk
sour
the
and
Europe
milk
term
in
is
one
Metschnikoff.
different
lactic
in
special
added.
supplied
species
the
some
been
the
lactic
from
which
The
of
eastern
sour
upon
diet.
milk
of
acid
Europe
article
an
that
healthfulness
eastern
people
Ordinary
of
growth
Sour
to
of
as
looked
daily
parts
or
milk
of
bacteria.
greatly lessened
lactic
the
poisons
to
believe
to
be
can
ascribes
the
have
their
he
due
him
produce
people
sour
years
Asia
milks
is
of
many
western
part
certain
use
For
lead
which
tive
degenera-
putrefactive
putrefaction
bacilli
the
are
age
by
investigations
by introducing
of
old
intestines
intestinal
longevity
with
of
many
latter
for
are
spoken
of sterilized
but
the
the
of
milk
to
provoke
ordinarily only
natural
the
with
souring
lactic
common
as
able
are
milk
pure
of
acid
a
few
milk.
bacilli
streptococcus.
cultures
of these
FERMENTED
organisms and
two
of natural
the process
In
addition
a
is done
Fig. 47.
souring.
to
undergo
by fermenting
of lactic acid
mixture
Bacillus
"
reproducesvery closely
mixtures
this lactic acid
to
caused
sometimes
This
with
the milk
bacteria
bulgaricus of
the
drink, called koumiss
the Tartars
koumiss
In
from
often
a
being
this country
milk
contains
acid gas and
yeast
yeast.
with
A
well-
1000
.
a
small
is made
quantity
fresh milk
to
or
bacillary milk; X
is made
3^east and
with
and
is
fermentation.
(or kumyss),
milk,
added
koumiss
with
preparation
carbonic
mares'
fermentation,milk
alcohoHc
an
(Fairchild)
known
141
MILKS
as
a
by
of old
starter.
commercially by
lactic acid
bacilli.
not
only
lactic
acid, but
about
1 per
cent,
of alcohol.
menting
fer-
Such
also
142
BACTERIOLOGY
APPLIED
from
These
bacteria.
carbonic
nor
kinds
books,
fermented
and
acid
in
for
milks
the
bacillus
etc.,
with
lactic
neither
contain
made
are
acid
alcohol
gas.
directions
of
fermentation
by
preparations
acid
Detailed
lactic
milk
sterilized
NURSES
fermilac,
zoolak,
yoghurt,
Matzoon,
FOR
circulars
cultures
the
of
preparation
will
be
found
supplied
on
the
in
with
market.
nurses'
the
various
cook
various
144
APPLIED
toxin which
BACTERIOLOGY
acts
the
on
FOR
NURSES
which
but
nerve-cells,
ately,
is,fortun-
easilydestroyed by heat. The appearance
food gives no warning, although there
be
may
of the
slight
a
rancid odor.
Another
organism which
Bacillus proteus vulgaris. This
of the
appearance
This
food; boiHng
entirelycaused
and
ham,
not
cooked.
which
Anthrax
disease,as
been
anthrax
be due
may
and
the
are
spores
proteus infections
of sausages
smoked, but
are
from
resistant to
veiy
canned
of
stated
be the
can
carrier of infection.
contamination
of the water
poisonous bacteria
before,is an
for bacteria,and
certain
be due
in smoked
or
as
of
typhoid,
of "milk
excellent culture-medium
consequently,be responsiblefor
may,
epidemics
diseases
poisoning.
there
are
numbered
A colon-like bacillus has been
epidemics. WhoX
apphes
to the colon
to
to
group-
the presence
cases
milk
and
such
certain
demics
epi-
in Christiania
one
in three
isolated from
products,notably, cheese
these is due
record
on
6000
from
Apaii;
poisoning,"notably
in 1888, which
by
heat,
fish.
Milk, as
milk
the
suffice to kill them.
to sewage
development
man
calves'
{e.g.j oysters spreading typhoid fever),or it may
to the
less.
harm-
conveyed to
suffeiingfrom
cattle
or
its toxin
eating
be
to
is the
alter the
not
through gelatin made
as
ordinaiyboilingmay not
Fish, as well as meat,
This
renders
Europe
known
of calves
meat
well
As
by
in Northern
has
through the
feet.
also does
explainswhy botulinus
almost
are
trouble
cause
may
is true
of these
some
also
ice-cream;
weeks.
of the
poisoning
of bacteria which
belong
BACTERIAL
the foregoing it becomes
From
inspectionof all food stuffs is
such storingand preparationas
Where
condition.
145
POISONS
FOOD
that
evident
together with
necessary,
will
careful
keep
in wholesome
them
storage facilities exist
proper
(i.e.j large cold-storageplants),in wliich
edibles
are
kept at a constantlylow temperature, meat, fish,eggs,
be kept in good condition for months.
fruit,etc., can
of such facihties,
In the absence
perishablefoods must
w^eather it is not safe
In warm
be freshlyconsumed.
In the
than twenty-four hours.
to keep fish for more
home
foods must
be kept in the refrigerator.AMiile
bacterial growth at refrigerator
is very
temperature
and for this reason
the
slow,it is not entirelyinhibited,
be kept very clean.. It is especially
important
ice-chest must
that food spilledon
the shelves be immediately
from
time to
removed; the ice-box should be washed
time with a solution of soda in hot water
and quickly
cooled again; at all times it should be kept well filled
with
ice.
ice
fluctuations
The
supply
what
From
are
has
of
been
said elsewhere
in uncovered
around
suspiciousas
to color
foods
which
are
fruits
and
not
ficient
to insuf-
especiallyharmful.
it follows that
the house-fly,
stand
temperature due
food
no
must
vessels.
odor should
or
Food
be
perfectlyfresh
vegetables
"
should
of the habits of
which
to
is at all
discarded,and
all
including canned
"
be
be allowed
thoroughly
cooked
before eating.
When
bacterial
canned
food
decomposition
the toj)sof the
surface, making
what
''swelled head."
The
therefore,never
]0
cans
is known
contents
be used
may
as
of
for food.
has
a
a
taken
place
present
"blown"
''blown"
a
can
can
in
convex
or
a
should,
XXIX
CHAPTER
BACTERIOLOGY
All
human
of
turbid
disagreeable
Pollution
and
almost
depend
supply,
water
odor
Guarded
great
overflow
or
Shallow
water.
receive
richer
the
in bacteria
in pasture
than
lands,
may
a
with
while
and
a
possible
a
of
presence
Rural
"
minute
communities
wells
and
to
in
charge
dis-
drinking-
surface
farming
of
and
naturally
are
numbers
pools,
cess-
their
the
the
and
large
locate
so
rainstorm,
their
for
that
nearer
deep wells,
contain
some
absolutely harmless.
are
after
any
safety;
contaminate
wells, which
of
menace,
sinks, etc.,
not
from
contaminated
is necessary
stable
wash
its
serious
springs
on
may
local
be
the
are
care
privies, drains,
of
Against.
entirely
and
contamination
of clearness
to
algse that
be
to
a
ber
num-
variety
appearance
may
its lack
and
taste
plants
water
lesser
or
pathogenic
indicative
constitute
owe
may
of the
is direct
rarely
and
greater
naked-eye
sparkling
bacilli
water
water
is
water
clear and
typhoid
there
The
sources.
sample
very
wheif
only
WATER
a
those
bacteria, although
found
are
contain
probably
waters
of
OF
regions,
intestinal
bacteria.
cities the
For
a
very
mountain
and
be
important
springs
the
water
conducted
.146
of
supply
are
may
to
safe
and
and
serious
within
be
to
the
city,
often
reasonable
collect
a
in
distance
come
be-
AMiere
problem.
abundant,
allowed
has
water
pure
tance,
dis-
reservoirs
of
many
BACTERIOLOGY
miles.
Such
is taken
care
for
and
lakes
they
In
of water
must
often
take
these
cases
the
is
supply
a
their
available,
un-
from
supply
danger from
thickly settled,and
is
empties
its
rivers is
dilute
practically
is added
cities such
tion
pollu-
great, especiallyif the country around
is very
body
and
towns
rivers.
or
be excellent,provided proper
to
prevent pollutionat the reservoirs,but
to
large
most
is apt
water
147
WATER
OF
into
sewers
fast that
so
the
natural
the
town
of
water
some
pollutingmaterial
and
sewage,
after
town
The
same.
the
of
means
purification
entirelyunavailing.
are
Purification
Natural
with
bacteria
water
but
them
the bottom
to
killed
plants. Sunlight does
not
to
act
great depth,
any
in the
Freezingmechanicallyfrees
surface.
other
life-activities of certain
bacteria
kills many
water
bacteria,and
many
the
probably
in the
suspended
through
are
importantof
most
tation
sunlight. By sedimen-
of
large foreignbodies
the
carry
action
disinfecting
the
The
"
tion,
sedimentation,oxidaare
purification
the natural agents of
and
of Water.
from
water
the
at
water
certain
a
includingbacteria, by squeezing
percentage of impurities,
them
out,
hence
the
but
low
danger
temperatures
of
using
do
kill all germs;
not
ice from
polluted lakes
and
streams.
Diseases.
Water-borne
water-borne
and
diseases
are
The
"
furnished
contamination
as
well
of filtration.
as
The
of
both
draw
upon
towns
that
a
Asiatic cholera,
classic
strikingproof of
of
Hamburg
situated closelytogether,at the mouth
and
and
example
its
drinking-water and
the most
two
important
most
typhoid fever
the latter disease has
sewage
two
the
and
of
quences,
conse-
efficiency
Altona
are
of the river Elbe,
river for their water
supply.
148
APPLIED
When,
in 1892, the river
dischargesof
had
water,
a
cholera
but
few
a
examination
that
the
of all the
in other
as
there
use
in the
Bacterial
from
98
In
water.
of filter
of deaths
number
were
Y., has shown
remove
cities,the introduction
the
lives.
N.
Albany,
at
filtered
sand-filters
toll of 8000
a
used
the
could be traced
city,whose
bacteria
enormously reduced
which
of which
most
w^ater
sand-filters in
cent,
per
pollutedwith
patient,Altona,
cases,
of the
NURSES
became
water
yet completed, paid
not
FOR
while the latter
Hamburg;
to
BACTERIOLOGY
to
99
Albany,
plants has
from
typhoid
fever.
Filtration of Water
Supplies. Briefly,these filters are
"
huge
reservoirs which
upon
this
of
layerof
a
hold
smaller
sand, and
coarse
dirty water
top
gravel,then
these
individual sand
"dirt cover"
becomes
and
tenacious
be
scraped off
always
necessary
The
w^ater
4 to
4| inches
may
must
is
muddy,
usually alum,
fluids,and then
otherwise
Waters
to
acts
Filters.
"
a
finally
through,
hence
it is
beds.
filtering
much
infectious material
of
at
advisable
the
remove
two
which
rid them
it is often
plus impuritiesthrough
Domestic
as
to
which
least
to pass
month,
a
it
This
through the filters faster than
filtering.When,
before
water
once
at
through.
require sedimentation
color
about
flow
hour,
per
allow any
have
to
not
carried
be
to
the
coats
slimy covering.
a
layer
As
the top, and
but
reallyefficient filter,
the
forms
too
must
grains with
a
layers it
different
graduallydepositsits gross impuritiesat
the
stone,
of fine sand.
one
percolatesthrough
broken
coarse,
and
stone
the
at
layerof
a
as
the
the
same
to
add
dirty
very
purities
grossest im-
time, the
a
chemical,
egg-white in clearing
aluminum
jelly-like
thin
relatively
Household
are
hydrate
sand-filter.
filtration ought
to
be only
OF
BACTERIOLOGY
a
makeshift.
temporary
of domestic
but they
filters,
conscientious
and
intelligent
of the
Many
they
There
cheap
ones
be cleaned
cannot
culture-media
charcoal,and
149
WATER
are
some
costly,and require very
are
handlingto givegood
are
for bacteria.
is true
This
but
''filtered'' water
Good
in
types of domestic
Berkefcld
"candle," fitted
a
cylinder.
The
the
water
enters
the
porcelain candle, which
there
is
metal
cylinderis
it and
candle;hence
it becomes
candle
few
every
kill all germs.
There
be
must
largermetal
faucet,
except through
all bacteria.
But
the
"growing through"
then
the
of porous
to boil and
it in the
dry
filter is
imfiltered water
the
to
oven
again efficient.
between
connection
scrub
the
with
mix
may
two
filtered.
Purification
for
tight
otherwise
cylinders,as
the
a
that
the
and
to the
it
retains
necessary
and
a
attached
bacteria
days,
After
within
into
numbers.
cyHnder
a
out
pass
Pasteur
leave
cannot
of the
danger
of
consist
and
the
are
impurities,
gross
increased
greatly
filters
filters. Both
porcelaincalled
of sand,
which, after the firstfew days,
filters,
sponge
merely 'strainers/'
keeping back
allowing bacteria to grow" in them
the
table
veri-
become
soon
*
are
results.
useless because
than
worse
all,and thus
at
good types
very
by Chlorination.
example, now
of chlorin.
compressed
At
first chlorinated
is obtainable
in steel
liquidcarbon
dioxid.
While
the water
is
lime
suppliesby
means
used, but
was
now
(liquidchlorin)is preferred. This
cylinderssimilar
In
is added
is not
York,
]\Iany cities.New
disinfect their water
chlorin gas
part of chlorin
"
to
those
water
disinfecting
to
made
1,000,000
parts
number
for
suppliesyV
the number
sterile,
greatlyreduced, especiallythe
used
of
water.
of bacteria
of bacilli
150
APPLIED
of the
a
BACTERIOLOGY
of
modification
halazone,
amine-T.
chlorine
for
the
condense
the
it,i.
in
steam
organisms
destroyed,but
kept
back.
Such
is thought
of any
e., to
been
of
water
related
troduced
in-
tablet
a
dichlor-
to
by
to be
salts and
not
cold.
fying
puri-
Freshly
only all living
chemicals
in solution
quite expensive and
Its continued
some
of
it into steam
kept
since
any
is
water
method
convert
vessel
absolutelypure,
particularly
palatable.
water
the
to
iVnother
"
a
is
are
has
purificationof
compound
distilled water
are
method
emergency
by Distillation.
is to distil
water
diseases.
42.)
(See page
Purification
and
of the
chloramine
a
againstwater-
other water-borne
It consists in the addition
water.
of
and
Dakin
by
therefore,affords
protectingcommunities
typhoid fever
borne
A
This method,
colon-typhoidtype.
simple means
NURSES
FOR
use
drinking-
a
as
not
harmful, owing
to the
the likelihood to abstract
sence
ab-
salt from
the tissues.
easiest,
by Boiling. Probably the simplest,
Purification
and,
at
the
"
time,
same
of
purification
taste
water, by pouring from
by shaking it in
which
water
must
prevent
an
be
boil it for
kept
at
a
vessel
to
aerate
in
a
to
the
water
at
once.
drinking-
considerable
Of
it.
sterilize it for
height,
course,
surgicalpurposes
to
air contamination.
teriologicexaminations
made
for
properlycotton-pluggedvessel
of
Bacteriologic Examination
are
The
minutes.
ten
the vessel
boiled
of household
removed,
be
can
open
has been
safe process
very
is to
water
objectionable"flat"
or
a
in
order
and
If
to
to
of the
keep
enable
tap-water
one
is to
Water.
water
informed
to
be
"
Regular
supply
on
locate
of
the
a
bactown
purity
contamination
tested, it is
necessary
of
CHAPTER
ANIMAL
to include
animal
of
guarding
Tapeworms.
in
*
man
in
the
'bladder
flesh
is found
readily
killed
persons
who
his
When
cattle.
by
tapeworm
Trichina.
man
lodge
and
of
the
form
of
of
tiny
North
cattle, and, while
is liable
meat,
all,
to
it is
infect
to
that
ripe
he
accidentally
man
is liable
known
a
become
to
usually played
part
of
(eggs)
ova
by
"echinococcus
as
tapeworm.
the
the
takes
diate
interme-
pig
by
or
disease"
the
ripe
is
of
ova
a
ordinarily infecting dogs.
"
This
tiny
give
Trichiniasis,
152
the
accidentally swallowing
man
transmissible
these
the
disease
ing
life,exist-
tapeworm
meat
happens
the
of
tion.
infec-
meat.
happens
A
the
is similar
familiar
in
common
cooking
stomach
host,
and
The
raw
it
cycle
hogs
or
instances, the
against bacterial
tapeworm
cattle
in
eat
this
caused
of
commoner
infections
double
a
common
by
Sometimes
guarding
have
worms.''
America
into
the
as
such
against
^These
"
in most
venture
we
of the
some
because,
in
employed
bacteria,
to
concerning
of man,
VERMIN
AND
related
sense
words
parasites
those
and
no
few
a
methods
to
PARASITES
in
Although
XXX
as
is
to
a
pass
rise to
into
the
the
considerable
disease
is
in the
found
From
man.
worms
the
parasite
flesh
intestinal
muscles,
pain
called,
is
of
canal
where
and
uncommon
hogs
of
they
weakness.
in
ANIMAL
this country, where
is
Hookworm.
httle
disease
to live
parasiteappears
usuallytakes place through
The
walking, barefooted.
penetration of
the
to
what
constitute
the
is known
of
as
the
The
"
disease
is due
the
far
mode
by
a
the
as
of
indicate
known
and
the mode
lymph
is
"nits," are
or
of
are
spoken
and
"filariasis"
with
a
tiny
the
to
body
course
trench
lice
infection
is
suffice to
known
are
fever, and
is said to
have
of two
months.
The
hatch
fastened
out
in about
man.
(For methods
"Disinfestation,"page
to
spread
probably
louse
clothing. They
under
which
lice,called pediculosis
or
with
slightlyelongated,and
infest
phantiasi
''ele-
worm
This
passages.
about
eggs,
to
in three
of
three
or
four
5000
called
days
Lice
speciesare
combating
1G9.;
other
the hair of
eighteen days.
parasitic,
blood-sucking insects,and
see
rise
concerned, the descriptionof the
Infestation
"
sexuallymature
are
known
give
which
just presented,should
prevention.
(typhus fever,
offspringin
are
and
speciesof mosquito.
nurse
infections). The
and
and
quently
Subse-
is sometimes
as
lousiness,is important because
the host
itch."
infection,as
Pediculosis.
disease
due
w^orm,
chief among
worm
infection
to
blood
transmitted
So
those
young
intestines
the
those
''lazyworm."
Filaria.
invades
infection
are
"ground
as
The
the
by
in
hookworm.
and
symptoms
symptoms,
laziness.
with
and
in
sldn, especially
first
parasites enter
and
the
ham.
Rico
in man,
only
the skin
to ver}^ characteristic
anemia
in Porto
infection
to
tion
Infec-
raw.
(merely smoked)
common
is due
States
is eaten
pork
eating raw
to
A
"
the Southern
This
but
usually due
153
PARASITES
ness
lousi-
CHAPTER
Water.
and
which
one
establishments
is
hospital,
boiling
of
action
^lost
of time.
Fig.
48.
"
White
well
as
boihng.
water
the
anthrax
Any
end
of ten
bacteria
steel
vessel
for
answers
many
which
types
a
on
can
be
market
154
can
withstand
a
equipped
the
sufficient
killed
length
by boihng
and
handles
with
a
(Ashton).
while
a
spore-bearers,
half-hour
covered
and
of
constructed
Usually they consist
purposes.
tive
primi-
most
best
are
sterilizer,though,
the
tion,
disinfec-
the
sterilizer
office
require
the
for
if continued
minutes,
bacillus, may
in
as
perforated tray
at
in
bacteria
No
pathogenic
enajneled
used
be
can
of
method
simplest
The
"
DISINFECTION
OF
PRACTICE
THE
Boiling
XXXI
of
a
or
course,
to
covered
the
longer.
even
placed
like
over
a
there
suit
pan,
fire
are
various
fitted
155
DISINFECTION
OF
PRACTICE
THE
perforatedtray or wire basket, suppliedwith
handles,to enable one to lift the steriHzed instruments,
of 2 per
addition
The
etc., out of the boilingwater.
increases its
cent, of ordinary washing soda to the water
with
a
at the
action,and
disinfecting
for soiled
suited
come
glassand
metal
It is not
transferred
Catheters
are
have
added
been
forms
put
advantage
coatingof
to soak
for
a
pound
of green
heated
in this to
allowed
to
run
the form
Arnold
This
"
A
the
few
soap
70"
a
which
to
sterile lubricant
not
in 25
gallons,and
80"
the
over
be put
once
These
be
containing a
then
suds
be
may
are
replacedby fresh,in
are
method
C.
This
stains;it may
in cold water
fifteen to
second
at
hours
or
off and
then
which
twenty minutes.
of
using
heat
moist
is in
of which the
sterilizer,
sterilizer,
already described,is a good example.
of live steam
in
a
steam
type of sterilizer is extensivelyused in bacteriologic
laboratories for the
sterilization of
culture-media,and
mbber
dressings,
hospitalsfor sterilizing
Heating to 212" F. (100" C.) for an hour
in
acid
operation.
in water
since this fixes any
the linen is boiled
Steam.
boiled
Soiled linen should
boilingwater,
carbohc
in pure
before
fer
pre-
teaspoonfulsof liquidvaselin.
2
thin,even
a
for the
surgeons
some
kept
sterile water
to
to
entire surface.
into
reason
have these instruments
to
and
this
For
cuttingedge.
well suited
scissors,since it spoilstheir
and
sterilization of knives
catheters,irrigation
as
so
etc.,
pans,
material,for
infectious
instruments, such
tubes,forceps,etc.
particularlywell
is
dishes,trays,
with
in contact
that have
keen
for
hnens,
a
instruments.
sterilization
of
method
This
metal
rusting of
the
measure
prevents in
time
same
gloves,etc.
is
enough
to
156
APPLIED
disease germs.
destroy all
heated
that
to
degree
chemic
in the
heated
Arnold
three consecutive
Fig. 49.'
if not
"
Arnold's
all,of
between
as
the
long
so
such
time, undergo
a
media
sterilizer for
the
sterilizer
first
twenty
second
They
are
minutes
on
heatingdestroysmost,
(Boston Board
vegetatingbacteria,and
the first and
desirable
un-
subjected
are
fractional sterihzation.
days;
steam
culture-media,when
Some
changes;
is known
to what
for
NURSES
FOR
BACTERIOLOGY
heating the
of Health
form).
in the
interval
spores
possibly
present will develop into vegetativebacteria,in which
state
they
process
is
the death
first two
are
easilykilled by
repeated on
of all
the third
organisms
heatings.
the second
which
day,
may
heating.
in order
have
to
The
insure
escaped
the
Under
Steam
an
vessel
open
Pressure.
or
"
the
is
heated
that
is,at
\Yater
looselycovered
one
pressure
^Yhen
"
157
DISINFECTION
OF
PRACTICE
THE
"
cannot
temperature
in
mospheri
at-
above
^o
differs
sterilizer. Except in form, the autoclave
Fig. 50. Autoclave
but
slightly from the fuli-jacketedsterilizer (Fig. 22, page 47),
of heavy copper
with solid cast brass self-sealingdoor;
It is made
"
the
safety-valveis set
entirely around
retained
in the
the
at the
the steam
from
high
steam
instantly upon
212"
F.
that
to the
the
while
the
both
a
door
are
to
the
jacket extends
latent
moisture
any
heat
from
of
the
atmosphere.
heated
in
temperature and
of pressure
The
dry.
temperature of 130" C. and
amount
the
be
however, cannot
Surgical dressings
is open.
will evaporate
exposure
and
pressure,
autoclave
pressure
the
pounds,
The
(100" C), but when
container
so
chamber.
jacket
withdrawn
when
to relieve at 15
employed,
a
tightly closed
pressure
according
more,
may
increase,
be
reached.
158
APPLIED
Under
these
but
pressure,
NURSES
generated
readilythan
more
atmospheric
FOR
the steam
conditions
kills bacteria
only
generated at
steam
also
has
not
much
a
greater
penetrate to the interior of bulky objects,such
to
power
BACTERIOLOGY
or
clothing. Steam
mattresses, bundles of dressings,
as
under
is,therefore,a
pressure
A
good example
in
is shown
Fig. 51.
of
steam
high-pressure
ant.
disinfectsterilizer
Fig. 50.
Diagram showing
"
valuable
more
of
construction
a
steam
pressure
sterilizer.
Another
excellent type
consists of
metal.
with
gas
an
The
and
outer
space
within.
or
As
by
the
an
between
water, which
burner
of
w^ater
chamber, B,
of sheet
jacket made
these
two, A, is half-filled
either
of steam
grows
sterilizer
inner
is heated
means
steam
pressure
from
in
circulating
hotter,the
becomes
below
coils
air in the
rarefied,and
by
may
a
((7)
infecting
dis-
be
160
BACTERIOLOGY
APPLIED
for fifteen
infectingchamber
a
of
shghtlylower
largebundles
Heat.
"
NURSES
minutes, the
temperature, is reached
of clothes and
Fig. 52.
Pry
FOR
Autoclave
"
^When
instruments,such
as
the
or
same,
in
the
but
center
bedding.
(horizontalform).
rapid
sterilization
of
small
hypodermic needles,glass rods,
PRACTICE
THE
161
DISINFECTION
OF
passedthrough
of steriHzing
the
This is the regularmethod
the flame.
platinum wire used to transfer bacteria. But, except in
be
these articles may
etc.,is required,
an
should
method
this
emergency,
be
not
for
used
surgicalinstruments, as it destroysthe temper of steel
and ruins the cuttingedge of knives.
etc.,
Glassware, such as catheters,pipets,test-tubes,
.-
is sterihzed
in
sheet metal
with
p.
answers
well for
very
which
hour
one
the hot
below,
from
bmners
gas
of
made
box
a
is
required
glass-or metal-ware,for which
of an ordinarykitchen
The oven
the
be used.
alone it should
range
by
temperature of 150" C. for
a
is
walls,between
double
properlysteriHze
to
This
oven.
It is heated
air circulates.
and
hot-air
a
(See Fig. 19,
substitute.
a
44.)
Chemicals.
be steiiKzed
has
edge
carbolic.
carbolic
been
sterihzed
two
been
and
are
of
knives, which
keep
sterile is
accomplished
off the
the
A\'hen there
is any
first heated
placed for eightdays
in
a
in acetone, then into acetone
excess
of
11
boihng
be
may
also
kept in
Calgut
to
plugged
C. for
brittle.
with
its
it
sterility
3 per
cent,
solution
a
be
may
70"
about
into
iodin,and, finally,
a
ways
exposed
becoming
for four
in
'\^^len this has
moisture,
in tubes
doubt
that
catgut, and several
catgut
it sterile it is stored
tion
Men-
difficult materials
most
temperature of 150" C. without
keep
are
for its sterilization.
drive
cannot
therefore,kept
are,
of the
by dry heat, being
hours, to
fact
the
thermometers
One
devised
of
made
been
CHnical
to
objectswhich
foregoingmethods.
few
a
of the
any
solution.
to render
have
by
already
dulls the
pure
^There
"
days,to
mixture
to
a
To
cotton.
may
be
of iodin
remove
the
of acetone
162
APPLIED
BACTERIOLOGY
parts, Columbia
85
In this mixture
patientfor
night,to
of
kept until
Patient
the
cleanse it with
hot water
had
of green
practiceto
full bath
a
ether and
Then
a
been soaked
The
washing with
repeated and the
Just
before
soap
and
This
method
a
operation it
the
washed
with
it
very
tear and
These
place.
soap
the
on
used
as
an
holding the
alcohol
acid.
A
method
skin,and
substances
which
skin
by
glands
then
surgeons
skin
Alcohol
as
a
has
as
has found
a
by
some
bacteria
favor
of
operators.
by adding
tannin,ether,or
much
or
ening
hard-
strong tincture
be increased
may
teria
bac-
to crack
to ^^fix" the
tends
or
apt
were
sole disinfectant
such
for
hoped
inevitable
substances
and
action is transient,
to the
be
absolute
an
aseptic,gum-like substance,
either alone
the
patient's
uncomfortable
deep
Some
extensivelyused.
not
were
there; it is
This
of
intention
effect
green
with
skin
not
the
bacteria.
bichlorid.
and
that
found
with
scrubbed
sterilize the
and
scrubbing, since
harbor
to
the
in
rubber
with
ether
alcohol and
cumbersome
was
of
continued
the
25 per cent, solution
again
was
efficient to
fairly
was
amount
with
was
compress
place from three to twelve hours.
alcohol,ether,and bichlorid was then
skin covered with a bichlorid bandage.
patient. Moreover, it was
covered
solution
1000
covered
was
disinfection of the livingskin could
any
:
then
was
left in
tissue,and
to the
1
gauze
in
carefully
It
soap.
a
the
the preceding
on
with
paratively
com-
prepare
operation,and
green
in water; this
soap
skin^but
the
and
of mercury.
appliedwhich
Operation." Until
site of the
rinsed with alcohol and
of bichlorid
used.
for
recentlyit was
an
operation by
shave
NURSES
spirits 10 parts, glycerin5 parta
it is
Preparation
FOR
nitric
both here
PRACTICE
THE
receives
disinfection by iodin..The
is the
abroad
and
full bath
a
the
on
is
dressingwhatever
painting
The
but is
pronounced
more
used
the
unusually tender,as
has
skin
solutions
or
been
even
1 per
a
preparation
the
of the
scrubbing
the skin
and
can
the
folds
than
is old and
5
tains
con-
iodin;third,when
the
children;or, fourth,when
is
hands
antiseptic
cases
no
two
to
applied.
is
be used
soap,
at
the solution
more
for both.
A ten minutes'
bristle brush, using hot
a
of green
tincture
under
with
be
not
iodin
an
closelyallied with the
patient,and, to a certain extent,
of the
methods
same
advantag
Its greatest dis-
to, but the skin is cleaned
resorted
the iodin
before
Disinfection
in
of
alcohol,
solution of iodin in benzene
cent,
five minutes
operation.
with
previouslywashed
In emergency
plain water.
previous w^ashingis
with
the
that of
as
solution
the
decomposition products
skin is
same
lasting.
and
when
cent.);second,
no
sterile towels.
with
before
strong (itshould
is too
but
of iodin
development of
when
likelyto occur
is most
dermatitis;this
solution
a
occasional
is the
per
is the
iodin
of the
action
shaved,
are
is covered
repeated just
is
tion;
opera-
used; just before anesthetizingthe
in 50 per cent, alcohol and
The
the skin
operationis painted with
site of the
patient
evening preceding the
hairy portionsof
any
163
DISINFECTION
OF
the
and
base
water
and
giving specialattention
of the
nails and
a
to
the space
nails,is followed by rinsingin alcohol,ether^
bichlorid solution.
but
sterilized,
which
induces
driven
from
Hands
may
thus
when
they are immersed
sweating, countless
the
sweat
sterilized surface.
This
and
has
solmcoous
been
be
superficially
in hot
solutions,
bacteria
glands
will
to
be
the
repeatedlyproved by
164
BACTERIOLOGY
APPLIED
NURSES
FOR
to a
experiments,and surgeons have had recourse
of tanning; that is,immersing the hands
process
hardening sohition,such as 60 per cent, alcohol or
of
iodin.
of
operators prefer
and
operations
rubber
When
gloves are
the
before
skin,and
to
of
ture
tinctinuously
con-
the great
of the hand"
the
putting on
assistants.
the
soaking
Rubber
a
gloves during
wear
the
worn
in
substances,when
same
dermatitis.
severe
a
the
require
in bichlorid solution
cause
these
injuriousto
used, are
majority
of
Both
mild
gloves may
gloves
are
more
those of Hsle,their chief advantages
frequentlyused than
being that they are
not
do
porous,
not
appreciably
impair the tactile sense, and in certain cases, as in
exploringa cavity,their slipperycondition is a material
aid.
Against these are to be w^eighed their greater
initial cost
slightdurability.Rubber
their
and
be sterilized in the
can
sterilizer in which
same
should
boiled,but they
are
prevent their coming into
to
they
be
may
kept
for
gloves
wrapped in gauze
with metal; or,
contact
hour
an
be
ments
instru-
in the
Arnold
steam
sterilizer.
Disinfection
It
"
the
is
usually
far
Spread
the
more
of
Contagious
important
to
eases.
Dis-
prevent
spread of contagion during the patient'sillness than
it is to
all unnecessaiy
hangings.
as
In
well
A\ipedwith
1:2000
the
fumigate
convalescence.
be
Prevent
to
apartment
an
sick
oiled rag
of any
should
its contents
after
kept free of
furniture,and particularlyof rugs and
ture,
place of sweeping and dusting,the furnithe floor and
as
woodwork, should
any
The
bichlorid solution.
fumigation
and
room
or
with
No
can
efficiency
a
be
cloth moistened
with
steaming, spraying, or
be
carried
out
in
an
THE
PRACTICE
apartment which
aside
is
1G5
DISINFECTION
OF
occupied.^ Hence, during the illness,
thorough ventilation,and
from
the
already described,the important tilingis
precautions
destroyor
render harmless
dischargesor dressings,etc.,from
any
the patient. Anything of no value, as dressings,
should
be burnt
collected in rags
tmn
in covered
and
vessels,
carbohc
fluid;neither
purpose,
since both
of much
albuminous
of lime
milk
at
solution of chlorid of lime
Congress
by
quicklime
had
which
and
by
standard
gallonof water)
national
Inter-
the recent
Praus-
Demography,
of
method
be effected
or
disinfectingstools
generatedby pouring water over
previouslybeen mixed with the
of the heat
means
to 1
presence
of lime
of the
quart
(4 ounces
Hygiene
Kaiser's
advocated
nitz
of
in the
must
dejection. At
for each
be used
mixture
least 1
disinfectant
a
chlorid
When
matter.
received
be
is well suited to the
relativelyinert
are
thorough stirring. At
should
typhoid fever,
with
bichlorid
used, a good
are
mixed
once
nor
spu-
receptacles.
paper
intestinal diseases must
other
or
cholera,,
or
dischargesor
patients suffering from
of
Stools
nasal
likewise
immediately;
to
stool.
and cotton
Linen
has
already
been
indicated
bichlorid of mercury
be
hyd.
1
it
a
clothing,which
woolen
may
or
In very
1:50
in
chronic
would
is, however,
of infected
infectious
advisable
patient'sapartment
from
to
time
a
1
:
1000
be
by this
solution
time.
of
acid;
injured by boihng^
means
of formalde-
clothing removed
diseases,like pulmonary
thoroughly clean and
to
method
solution of carbohc
or
by
similarlydisinfected,
All bundles
a
for its disinfection
also be soaked
It may
process.
clothingis best boiled,and
from
tuberculosis,
disinfect
the
166
APPLIED
the sick
BACTERIOLOGY
or
be
must
room
from
wrung
anyone
else
boiled.
This
or
unless
is
the
on
After
have
they
especiallytrue
receive
at
change
of
others.
added
to be
All left-over food
convalescence
least
clothing before
of
be
not
first been
in
by
thoroughly
of
cases
used
diphtheria
all infectious
applied in
is to be burned.
full bath
Bichlorid
must
is established
one
ized
sheet,either steril-
a
way.
utensils
but ought
tuberculosis,
diseases.
NURSES
antisepticsolution,to prevent
patient'seating
The
in
wrapped
an
spreading contagion
FOR
he
and
have
is allowed
mercury
patient should
the
to
or
may
complete
mingle with
a
be
not
may
to the bath.
the
Among
after
infectious disease
an
in the
extensivelyused
it has
and
agents used
various
been
fumigate apartments
to
sulphurdioxid
has been
able,
past, but its action is not dependalmost
entirelysuperseded by
for-
maldehyd. -Sulphur fumigation is,however, still most
useful in killing
lice,
vermin, such as rats and mice, fleas,
Before fumigation the apartment
be cleaned,
etc.
may
all gross
infectious
is soaked
in 5 per
scraped off,and
solution,the
washed
Then
apartment
to
is
dispense
"
e.
solution
burnt.
All dust
all the
g., dried
hot
water
thoroughly
are
ventilated.
formalin
this
are
is
the
same
carefully
practicable.
liberallyapplied,and
faithfullycarried
with
work
out
"
of mercury,
with
is soaked
wood
etc.
sputum,
of bichlorid
it; also the walls, if
and
carefullyand
cent,
floors and
with
soap
material
If this process
it may
the
disinfection;
be
the
is
possible
latter is,
additional
safeguard. Before
however, an
starting
fumigation,all cracks and crevices,keyholes,and other
small openings are
tightlysealed with gummed
paper.
168
APPLIED
BACTERIOLOGY
FOR
NURSES
OF
PRACTICE
THE
169
DISINFECTION
DISINFESTATION
important
The
disease
and
delousing,
found
been
in
Where
this
as
To
it
as
the
be
war,
has
called,
practice
cordingly
ac-
it
has
of
means
in
garments
of
recent
of
application
often
of
is
reliable
the
by
the
In
most
may
danger
a
dry
gasoline
stroying
deheat
is
also
convenient.
more
fire, tetrachlorethane
be
may
inflammable.
is not
lice
keep
of
and
is
there
used,
is
transmission
by
"
the
clothing
effective
highly
the
attention.
of
one
in
anew
considerable
Immersion
steam.
lice
by
"disinfestation
or
that
lice
played
demonstrated
been
has
had
or
part
application
the
away
to
the
of
body
a
.
containing
grease
certain
The
odorous
other
effect
of
this
underclothing
So
far
crude
as
lice
at
the
of
by
will
picture
poisonous
the
night,
a
the
gases
is of
suffice
opposite
to
to
page
railway
then
effect
of
in
bound
a
in
disinfestation.
is shown
coach
service.
combing
and
washing
the
by
application
the
being
head
or
recommended.
is absorbed
grease
treatment
thorough
the
been
concerned,
are
usually
on
has
the
as
nevertheless
head
followed
morning,
In
;
off
heliotropin,
coumarfn,
substances
wears
petroleum
towel,
the
naphthalene,
the
cation
appli-
disinfestation.
CHAPTER
COLLECTION
XXXII
MATERIAL
OF
BACTERIOLOGIC
FOR
EXAMINATION
Oftentimes
bacteriologic
Much
attention
most
the
in
sterile
the
should
memorandum
all
the
and
is wanted
of
definite
from
the
disinfectants
statement
date
by
It
from
source
and
hour
is
important
which
the
to
a
smear
the
ture
cul-
by
a
of
the
of
lection,
col-
information
what
to
as
specimens
sent
such
and
patient,
bacteriologist.
to
and
accompanied
character
the
the
be
is made
preparation
obtainable
should
specimens
name
a
material
not
tory
labora-
the
smear
a
to
are
culture
Oftentimes
information
showing
material, the
table,
be
scopically
micro-
to
a
be
may
cultures
where
cases
same
should
hurried
be
culture.
the
All
alone.
add
from
invaluable
gives
less.
use-
little
a
examined
When
should
operating
or
with
laboratory
by
exception
be
to
bacilli.
In
delay.
made
be
avoided
An
sputum
tubercle
bedside
the
of
specimens
without
at
lected
col-
entirely
specimens
containers.
case
for
made
bacteriologic
cases
made
is
be
can
for
improperly
so
examination
its
trouble
the
been
laboratory
details.
to
in
be
that
of
collected
has
the
to
sent
examination
handled
or
In
material
the
not
cultures
to
are
desired.
Sputum.
sputum
has
170
"
Care
should
actually
been
be
taken
coughed
that
up.
the
specimen
Some
of
patients
BACTERIOLOGIC
FOR
MATERIAL
will hawk
spit out saliva,still others
Sputum
in
a
should
in
In
infants
and
children
small
means
of
thumb
forceps
a
cough,
sputum
the
the
child's throat.
with
the
expulsion of
should
the
Throat
membrane
the
patientin
Such
on
"
having
the
should
sputum
senger
by specialmes-
to
then
that
witliin
surface
and
for
some
send
made
off
during transportationto
the
of
some
been
hours.
previous
two
the swab
holding the
culture,being careful
accurate
of the
this
diagnosisit
exudate
bottles,and
laboratory.
on
is
the
the culture.
along with
bacteriologicexamination
collected in sterile 1 -ounce
as
swab, place the
antiseptichas
no
the
For
with
mine
to deter-
are
gently wipe
of the
spread
glassslide
Water
These
available,wipe
are
covered
is
desires cultures
sterile cotton
the surface.
also
a
throat
infection.
sure
throat
the
over
break
of
be sent
once
the
small
a
Make
the
to
at
good light,and
a
exudate.
Water.
be
determined.
of the
If culture-tubes
swab
purpose
When
"
nature
advisable
a
of the desired
some
the
should
Prepare
exudate
induces
in the collection of sputum
be taken
physician often
the
applied
or
bacteriological
laboratory.
Smears.
follows:
stick
a
This
by
clean, sterile bottle,ivithoid disinfectant,
a
specimen
to
with
held
gauze,
pneumonia patientsfor
to
but
paper,
obtained
be
can
in
be collected in
not
sputum
piece of
type of pneumococcus
the
piece of
a
do.
to
the gauze.
on
Specialcare
and
on
loss what
laboratory merely
the
to
or
a
bottle securelycorked,
small, wide-mouthed
boxes.
speciallyprepared water-proofed wood
in
from
sent
others will
nose,
a
or
reflex
will be at
handkerchief
gauze
only
be
never
the
from
coming
mucus
up
l7l
EXAMINATION
In
should
kept
cool
collecting
172
BACTERIOLOGY
APPLIED
from
water
faucet
a
FOR
should
care
typic specimen by allowing
before
time
collecting. In
reservoirs,etc.,
one
surface,for
a
undue
such
to
secure
milk
water
the
case
should
is to be
The
cream.
largenumber
contamination
with
from
a
hot
beneath
hot
a
from
the
contain
an
water
of the
the dust
air.
be
must
one
contains
always
a
sure
very
free from
first searingthe surface
then
cutting a pieceof
surface.
from
blood
or
secured
are
organs
Similarly,in
the surface
within
the
through
test-tube
or
some
springs,w^ells,
should
plugged
seared
with
tissue
ing
secur-
is
sterile hollow
a
the heart
be
of the
of the heart
iron,and then, with
needle
of tissue
bottle
seared
is draw^n
thrusting the
piece
of
examined,
of heart's blood
with
needle,blood
by
iron,and
the
specimens
firstseared
for
a
of bacteria.
"
organ
secure
run
probably
from
latter
Autopsies. Specimens of
outside
to
to
dip
not
specimen would
milk
taken
representativesample by thoroughly mixing
a
and
be
the
proportion of bacteria
Milk.^When
NURSES
cavity by
surface.
The
in
sterile
placed
and
cotton
a
at
once
carried to the laboratory.
Urine.
The
"
specimens
will be familiar with the collection of
nurse
of urine
for the
examination.
desired to
taken
make
a
Feces.
"
and
scopic
micro-
instances,however, it is
then
specimens,by
great
of
means
a
be
must
care
sterile catheter,
sterile bottle.
Bacteriologicexaminations
undertaken
typhoid
certain
cultures, and
to collect the
in
clean
In
ordinary chemical
bacilli.
in order
Such
wide-mouthed
bottle should
never
discover
specimens
bottle
be
to
more
and
than
of
feces
are
the
presence
be
placed
should
tightly corked.
half-full.
The
quently
freof
in
a
The
specimen
FOR
MATERIAL
should
be
without
Inasmuch
fluid
spinal
only
these
not
the
laboratory
should
be
should
be
in
a
kept
fectant
disin-
at
once
added.
to
bacteriological
of
means
care
clean,
the
as
by
importance,
fluid
specimen
circumstances
"
decisive
should
the
to
sent
added.
of
forward
be
summer
no
173
EXAMINATION
should
Under
Fluid.
Spinal
this
In
ice.
be
of
and
fresh,
delay.
with
cool
BACTERIOLOGIC
should
is
cultures
be
sterile
bottles
the
laboratory.
taken
or
amination
ex-
so
to
often
collect
test-tubes,
A
disinfectant
and
XXXIII
CHAPTER
OTHER
In
the
IMPORTANT
addition
following
Colon
PATHOGENIC
the
to
Bacillus.
Fig.
54.
"
and
Colon
plump,
the
occupying
capable
of
already described,
for
pathogenic
ones
rather
A
"
bacillus, normally
animals,
micro-organisms
important
are
MICRO-ORGANISMS
Gram-negative
intestines
producing
bacillus; twenty-four-hour
man:
of
infection
in
culture;
agar
and
man
man.
X
650
(Heim).
Occasionally
the
.174
infection
in
tube
connecting
the
kidney
man,
of
the
with
cystitis.
of
presence
examinations
produces
being pyelitis (inflammation
urinary
ureter) and
The
organism
form
commonest
funnel-shaped
the
this
as
an
colon
bacilli
indication
is used
of
fecal
in
sanitary
pollution.
water
Pro-
176
by
BACTERIOLOGY
APPLIED
FOR
NURSES
virus, perhaps ultramicroscopic(filterable),
as
some
and
yet unidentified,
so-called
the
that
influenza
lus
bacil-
(Pfeiffer's
bacillus)is reallya secondary invader.
would
probable that
seem
secondary
invasion
other
by
originalinfection
the
much
streptococci,
In this connection
be stated that
Nicolle,claims
nature
Now
and
demonstrated
Pfeiffer's
is very
fatal.
influenza bacillus appears
cough. Prophylaxis in
under
easy.
tigator,
inves-
French
the filterable
A
influenza
(Kr^l).
produces a tj^ical
bacillus similar
to be associated
of Malta
slightlyoval
rather
appears
1000
with
is similar
to
the
whoopingthat
to
cussed
dis-
Pneumococcus.
Micrococcus
growing
bacillus;X
then the influenza bacillus
meningitis. This
and
a
more
of the influenza virus.
Fig. 56."
or
have
to
makes
especiallyinfluenza
germs,
bacilli,pneumococci, and
it may
It
to
Fever.
"
A
very
small, rounded
micro-organism. Gram-negative,
feebly on
artificial media.
The
and
ism
organ-
be present in the feces of goats in Malta,
probably contaminates
the milk.
In
man
a
typhoid-
OTHER
like fever
discussed
Fig. 57.
"
is
produced. Prophylaxis is
under
Typhoid
Micrococcus
of
177
MICRO-ORGANISMS
PATHOGENIC
IMPORTANT
similar
to
that
Bacillus.
Malta
fever.
Carbol
fuchsin; X
1200
(Jordan)
.
Fig. 58.
"
Bacillus
stain
Bacillus
(Kollc and
Pyocyaneus.
widely distributed
12
Pure
pyocyaneus.
"
A
in
culture
on
agar.
Fuchsin
Wasserniann).
lus,
slender,aerobic, motile bacilnature
and
occasionallypro-
178
BACTERIOLOGY
APPLIED
ducing infections
in
the
a
production of
name,
that
to
or
NURSES
characterized
are
blue-greenpus,
signifying blue
pyocyaneus,
is similar
These
man.
blue
FOR
described
under
by
the
whence
Prophylaxis
pus.
Streptococcus
and
Staphylococcus.
Glanders
Bacillus.
Gram-negative,
A small bacillus with rounded
"
non-motile.
it produces the disease known
as
easilycommunicated
where
to
in
Common
man,
ends,
horses, where
glanders or farcy,and
it
produces
an
in-
'#'r
Fig. 59.
"
Bacillus
mallei
agar.
fection which
the
been
in the" pus
blood.
said.
Pure
fuchsin; X
1200
is fatal in 60 per
infective material
nose,
Carbol
(glanders).
exists in the
of
cent,
culture
from
glucose-
(Jordan).
of the
cases.
The
secretions
of the horses'
glanders nodules, and
frequentlyin
Prophylaxis
Glandered
is indicated
horses
should
by
be
what
has
promptly
just
stroyed.
de-
OTHER
IMPORTANT
In
diagnosing the
of
are
complement
animals
from
The
fixation
and
in horses
rounded
typicalfebrile
a
by
60.
"
"
Short,
Bacillus
pestis (bubonic plague) in
involving
from
the
man,
infection
the
occurs
disease
especially in the
rats, ground
In the latter
case
720
X
in two
lymph-glands;
lungs. The
(made
being
thick
rods
ends, Gram-negative, aerobic, and
the
man
to
of ''mallein"
means
The
lowed
fol-
reaction.
Bacillus.
Plague
of
means
agghitination reactions.
showing bipolar staining;
ing
by
the injectionof mallein
glanders bacilli),
Bubonic
In
tions
examina-
serum
is tested
serum
also be tested
can
by
Fig.
infection
service.
179
MICRO-ORGANISMS
PATHOGENIC
is
the
non-motile.
from
smear
rat's
liver,
(Wherry).
forms:
bubonic,
the
pneumonic,
in\olv-
spread directlyfrom
pneumonic
squirrels,and
with
other
form,
and
rodents
to
infection is usuallyintermediate
man
also
man.
through
180
fleas
APPLIED
BACTERIOLOGY
these
infesting
rodents.
destruction
form
of all infected
extreme
Prophylaxis:Discovery and
rodents, and
coughing, sneezing,etc., and
Anthrax
motile
Bacillus.
resistance
primarily a
Fig
61.
"
disease of cattle and
Bacillus
C.
of anthrax
Frankel
especiallythose
brings them
handle
Among
wool-sorters
is observed.
soldiers
from
were
bristles
came
cattle and
from
sheep
sputum.
hides
or
whose
had
not
China.
is combated
of
been
tion
of infec-
observed
shaving brushes
sterilized.
Prophylaxis:
by
occasionally
''malignantpustule."
cases
use
are
occupation
pulmonic type
recent
the
Anthrax
Fuchsin
of
to
ing
possess-
stain; X 2000;
Wassermann).
and
fatal
spores
agents.
form
very
the
of slender,non-
animals,
Some
traced
bristles which
a
from
with
contact
infected, usually in the
through
sheep,but humans,
spleen pulp.
(Kolle
prep.
who
into
in
infection
forming
destructive
to
in the pneumonic
the form
rods, Gram-positive, and
great
is
infection
in
IVIostly
"
NURSES
guard against
to
care
FOR
means
The
of
Most
among
made
of the
disease
in
immunizing
OTHER
IMPORTANT
injectionsof
PATHOGENIC
anthrax
vaccine.
properly dispose of
the
181
MICRO-ORGANISMS
Care
should
of any
carcass
be
taken
animal
dead
to
of
anthrax.
Edema
Malignant
with
the
a
strict anaerobe.
and
infections in
The
infectingwounds
of
result
fairlylong, thick
A
"
ends, Gram-negative,
square
It is
Bacillus.
with
forming
man
spores.
usually
are
earth.
garden
rod
Pro-
#'
'^^A
Fig.
pig
with
Bacillus
62."
of
after injection with
fuchsin.
thought
bacillus
of
gas
of
man
introduced
and
into
"
wounds,
and
as,
for
especially
earth.
Welch's
gangrene,
animals
all wounds,
organism,
This
capsulatus,is
Bacillus aerogenes
canal
with
infected
preparation, stained
Pfeiffer).
cleansingof
Perfringens.
Bacillus
the
be
to
Smear
culture.
(Frankel and
careful
phylaxis: The
those
broth
juice of guinea-
Tissue
edema.
malignant
a
1000
X
L
found
also
known
bacillus,
in the
in soil and
the
intestinal
dust.
cxam})le,in
or
as
the
When
recent
182
war,
APPLIED
BACTERIOLOGY
the contamination
by
dust, it
causes
formation
of
serious
a
FOR
NURSES
of wounds
with soil or
infection
characterized
infected
the
by
in the tissues.
^as
"^"x
\
^
\
Fig. 63.
Bacillus
"
perfringens,showing capsule;
bacilhis is
The
produces spores.
againstwhich, recently,an
antitoxin
This
some
has
Bacillus.
Leprosy
tubercle
utilized to
been
lesions.
It
(Hicks).
in
It is
under
produces a
has been
toxin
developed.
during
extent
Small, acid-fast
"
bacilli,found
cutaneous
1100
large rod, Gram-positive,and
a
certain conditions
X
the
war.
rods, resembling
in
large numbers, especially
the
yet established justhow
not
the
disease is communicated.
Trench
Fever.
infection which
of illness among
amount
febrile
disease,and
infections,is
called
filterable virus
the blood
also in the
the
caused
of the
now
"trench
knoAvn
fever, and
to
which
patients.Occasionallythe
and
enormous
be
a
sputum.
at
for
distinct
It is caused
fever."
(seeChapter XXIV)
urine
patient's
an
troops in France, and
for influenza,for rheumatic
first mistaken
other
An
"
by
a
is present in
virus is found
184
The
the
BACTERIOLOGY
APPLIED
disease
is
the excreta
is chiefly
by the
Achorion
by
preventionof
"
Oidium
the
by scratchinginto
infected lice. Prevention
from
Fig. 66.
NURSES
transmitted
louse;sometimes
common
Fig. 67."
commonly
FOR
bite of
the skin
of the disease
lousiness.
(Kolle and
Vvassermann).
section showing
schonleinii,
and Pfeiffer).
the
hyphse (Frankel
OTHER
IMPORTANT
PATHOGENIC
Microsporon
the
skin
disease
chieflyin
ness
a
or
O'ldium
known
of
"soor"
or
mold
a
the
of
man
is observed
of
undeanH-
conditions
with
mokl
a
jn'oducing
in
dren
chil-
'
This
"
the
ease
disan
which
scalp,
chronic
extremely
an
those
in
mouth
''favus/' is
as
affection
is
"thrush.'
producing
known
runs
the
Schonleinii.
Achorion
producing
conditions
combine
This
"
disease
as
under
who
mold
a
]:)rofuseperspiration.
to
Albicans.
the
is
''pityriasis." It
as
Hving
those
among
This
"
known
persons
tendency
is
Furfur.
185
MICRO-ORGANISMS
course.
Tonsurans."
Trichophyton
This
is
mold
a
disease
the
in
producing
known
man
as
"ring-worm."
"
of
microorganism
disease
has
yet been
not
is known
but
ing
infect-
The
Poliomyelitis.
to
this
68.
Fig.
lated,
iso-
human
hair
by
Points
A,
exist
of
Invasion
"
ton:
trichophywhich
at
parasitic fungi coming
m
the
blood
It
nasal
of
small,
very
and
individuals.
infected
be
must
secretion
for
it
through
Berkefeld
through
through
the
filter.
the
bite
infected
pores
The
of
nasal
of
disease
stable
the
from
the
epidermis
are
elevating
the
cuticle
the
hair
200
of
into
entering
X
passes
a
its
and
substance;
(Sabouraud).
a
is said
flies,but
discharges.
to
be
transmitted
probably
mainly
NDEX
Abscess,
Arnold
52
stitch,
sterilizer
112
Achorion
schonleinii,
effect
Acid,
of,
185
stained
on
definition
Acid-fast,
Aedes
calopus
Aerobic
of, 26, 77
58,
definition
jf
Agglutination
132
of,
20
bacilh,
typhoid
of,
nature
effect
of,
181
botulinus,
143
coli, 174
of,
mallei,
Anaerobic
definition
bacteria,
of,
20
Anaphylaxis,
parasites,
Animal
Anopheles
in
through
of
of,
dogs
food,
Antibodies
178
to,
64
144
against
67
Antimeningococcus
serum,
Antiseptic
Lister's,
surgery,
Antiseptics,
effect
of,
on
115
12
bacteria,
36
Antistreptococcus
Antitoxin
of
tetanus,
Antitoxins,
serum,
diphtheria,
110
99
103
nature
blue
of
diphtheria,
of
dysentery,
of
gas
of
glanders,
of
influenza,
role
of. 67
177
pus,
95
86
181
gangrene,
178
175
acid,
140
of
leprosy,
of
malignant
of
paratyphoid
of
plague,
of
pneumonia,
of
scarlet
of
tetanus,
of
tuberculosis,
of
typhoid
fever,
perfringens,
181
pestis,
and
180
of
of lactic
180
defence
as
bacteria,
58, 128
131
bacillus
immunity
75
152
malaria,
mosquitoes,
Anthrax,
of,
nature
15
143
of anthrax,
67
capsulatus,
aerogenes
enteritidis,
70
leukocytes,
on
material
of
172
definition
Alcohol,
of
collection
Bacillus
71
Agglutinin,
136
35
mosquitoes,
bacteria,
milk,
46, 157
teria, Autopsies,
bac-
from,
by bacteria,
for
Autoclave,
26
formed
sterilizer, 45
steam
182
edema,
181
fever, 175
179
175
fever,
122
101
91
81
179
Pfeiffer's, 175
187
188
INDEX
Bacillus,proteus vulgaris,144
Cancer, relation
181
Bacteria, fharacter
cultivation
effect
of, 13,
of
acid, effect of,
Carriers
14
disinfectants
and
of bacteria
to, 49
teria,
bac-
on
38
antisepticson,
of heat
Carbolic
of, 14
of, 27
definition
tuberculous
for
test
infection,94
177
pyocj'aneus,
Welch's,
Cy-LMETTE
and
in
the
transmission
of
disease,50
Cellulitis,52
30
cold on,
in
Chancre
30
syphihs, 119
important pathogenic species,Chicken-pox, quarantine in, 03
49
Chickens, immunity
in food
in
poisoning, 143
milk,
Chloramine-T
of, 29
of
methods
motihty,
relation
Chlorid
destructive
carried
by water,
quarantine in, 03
17
staining of, 25
78
Coccus,
09
serum,
Cold,
historic,11
and
role of, Colon
08
Behring, discovery
of
sanitary
effect
of,on
of
defensive
Blown
role
of
blood-
00
malaria
in, 128
cans,
Boiling
of, in
sion
transmis-
for
05
role of, 70
Cow-pox, 124
Creolin, effect of, on
in relation
Cultures, method
145
water
tions,
examina-
immunity,
Complement,
Culex
stains,test for, 75
role
Colostrum,
bacteria,37
Blood-
water
151
of mercury,
parasite of
bacteria,30
bacillus,174
in food poisoning, 144
antitoxin, 97
serum,
of, 15
leukocytes, 07
in
diphtheria
definition
effect of, on
on
Bacteriolysins,nature
Blood,
147
of, 79
treatment
Bacteriology,definition of, 13
Bichlorid
water,
spirillum,88
vaccines, 77,
Bactericidal
of
Cholera, bacteriology of, 88
formation,
Bacterial
teria,
bac-
fluences,
in39, 149
disease,48
spore
in disinfection
Chlorin
30
to
of, on
39
17
to
disinfectant,41
as
of lime, effect
studying, 22
of,
tetanus,
04
134
incubation
to
disinfection, Cytolysin, nature
bacteria,38
malaria, 58
of making, 27
to
of, 09
154
Boils, treatment,
vaccines, 79, 113
Bronchopneumonia,
Budding,
definition
with
bacterial
Daktx's
Davaine,
100
of, 13
solution, 41
anthrax
Delousing,
Dengue,
discoveries, 11
109
virus
of, 127
189
INDEX
Dichloramine-T
in
wounds,
bacteriology of,
fected
inExanthemata,
dressing
122
41
Diphtheria antitoxin, 99
Famulener
bacillus,95
185
quarantine in, 61
Favus,
Schick
Feces, collection of, 172
test, 100
treatment,
Fermentation
throat
smears
78
serum
in, 97,
34
milk, bacteriology of,
140
toxin, 98
Fermilac, bacteriologyof, 142
Diplococci,definition of, 16
of
Diplococcus
gonorrhea,
of
meningitis,114
of
pneumonia,
Filaria, 153
117
Filterable
viruses, 126
Filters,bacterial,126
domestic, 148
to,
104
of bacteria
Disease, relation
43
Fire for sterilization,
48
transmission
of
teria, Fixing of
bac-
on
Flies
testingof, 42
Disinfection
in
eases,
dis-
contagious
of drinking-water, halazone
Drinking-water,
Food
for
in
bacillus
carriers of disease, 55
as
poisoning, bacterial, 143
amebic,
36
86
fumigation,
Freeman's
bacteriologyof, 86
Epidemic
of nature
diseases, 11
bacillus
for
milk,
of
monia,
pneu-
175
Fumigation
cerebrospinal meningitis,
114
and
Estivo-autiunnal
infectious
after
57
terminal,
quarantine in, 62
of, 129
teria,
bac-
136
53
scrum
on
167
pasteurizer
Friedlander's
Empyema,
of,
conception
Fracastor's
of infectious
of, 86
effect
40
for
bacteria,
on
disease, virus of,
Formaldehyd,
150
destroying lice,169
effect of,
Dysentery,
typhoid fever,82
infection127
dis-
for sterilization,
43
Drying,
poliomyelitis,185
to
Foot-and-mouth
halazone
of, 42,
heat
to
Fomites
practiceof, 134
Disinfestation,169
infection,58,
139
for,
150
of
carriers
as
25
smears,
bacteria,17
motile
in relation
164
42,
microscopic
Flagellain
36
cultures, 34
for pure
Fishing
infectious,55
Disinfectants,effect of,
Dry
tube,
Fermented
171
of
65
immunity,
bacteriology of, 95
transmission
on
vaccines
malaria,
in, 78
site
para-
to
57
kill vermin,
with
Fungi,
sulphur,
definition
168
40
of, 13
eases,
dis-
190
INDEX
bacillus
Gartner's
in food
Incubator
soning,
poiInfantile
143
formation
Gas,
Gasoline
for
Gastric
of,by bacteria, 35
bacillus
gangrene,
dichloramine-T
bating
com-
measles, 123
Infectious
Glanders, bacillus of, 178
Goats, immunity to tuberculosis,Infestation
with
virus
destroying lice,169
disinfection
drinking-water, 42,
destructive
of
effect
of,
of, 127
carriers
as
as
introduction
of
cination,
vac-
125
Koch,
43
early work
in
bacteriology,
12
bacteria,26
Hemameba
infectious
on
dry, for destroying lice,169
of bacteria,31
in cultivation
to fix
of
disinfectant,40
Jenner,
by,
in, 79
diseases, 57
lodin
150
bacteria,36
sterilization
169
50
vaccines
and
serum
Insects
Heat,
combating,
bacillus,175
Influenza
stain,26
for
of
Inflammation,
of, 118
treatment
Halazone
dressing,
Infiltration,
purulent, 52
117
Gonorrhea, bacteriologyof, 117
for
in
lice,153
methods
64
Grease
tion
solu-
disease,definition of,12
fumigation after,57
quarantine against,60
quarantine in, 63
Gram's
also
for, 41
41
vaccine
Dakin's
wounds,
bacteria,66
Gonococcus,
See
Poliomyelitis.
destroying lice,169
of, in
bacteria,29
paralysis,185.
Infected
of, 181
juice, role
German
for
bacteriologyof,141
Kumyss,
malarise,128
Hip disease, 92
Hog
Hookworm,
Horses
Hot
for
of
153
Lactic
antitoxin, 98
Hydrocephalus,
immunity,
on
discoverer
Lazy-worm,
65
of
malaria
153
discoverer
Leeuwenhoek,
bacteria,40
virus
mission
trans-
parasite, 128
92
peroxid,effect of,
Hydrophobia,
to
bacilli in milk, 140
acid
Laveran,
air,sterilizingwith, 43
Hydrogen
in relation
Lactation
cholera, virus of, 127
of bacteria,
11
of, 127
Leprosy, bacillus of, 182
Immunity,
kinds
of, 64
Immunizing
Leukocytes,
Lice
of, 64
maternal
100
definition
transmission
of, 65
against diphtheria,
in
defensive
transmission
role
of
of, 66
disease,
169
infestation
methods
with,
of
153
combating, 169
192
INDEX
175
objective,23
Oil-immersion
Pneumococcus, 104
varieties of, 105
growth Pneumonia, bacteriology of, 106
lobar, 106
Opsonic index, 74
Opsonin, nature of, 73
Oxygen, influence of, on
of bacteria,20
Oysters in typhoid fever, 82
bacillus,175
Pasteurization, definition
vaccine
36
Poliomyelitis,185
mode
of transmission, 185
quarantine in, 62
of
milk, 135, 136
Pasteur's
early work
riology,
bacte-
in
virus
of, 127
disease,92
Pott's
12
of, 74
in
sterilizing,
of
Precipitins,nature
rabies,79
Pathogenic bacteria,definition of, Pressure, steam,
treatment
46
18
Patients, disinfection
of, prior to Protozoa,
Pediculosis,153
of combating,
methods
Pellagra
not
a
169
of
effect
hydrogen,
of,on
in control
Quarantine
diseases,60
in, 79
Quinin
parasite of,
effect
bacteria,
of, on
in
malaria, 130
cultures,32
in
destroying Rabies,
virus
Peyer's patches, 52
Rags
Pfeiffer's
Rashes
bacillus,175
Phenol, effect of, on
185
Pityriasis,
bacillus
Plasmodium
tious
of infec-
39
Petroleum, crude,
lice,169
vaccines
malaria,
Quicklime,
Pest, bacillus of, 179
Plague,
of, 177
129
quarantine in, 63
for
bacillus
Pyocyaneus,
Quartan
Pertussis,176
dishes
diseases,128
disease, 50
germ
bacteria,40
vaccines
of, 13
52
infiltration,
Purulent
Perfringens bacillus,181
Peroxid
definition
in certain
operation, 162
Petri
treatment,
79
100
of,
171
and
serum
Park, diphtheriaimmunity,
Parotitis,quarantine in, 63
of sputum
patients, collection
from,
Paratyphoid
Friedlander's,
Pneumobacillus,
albicans,185
OiDiuM
bacteria,38
of, 179
in, 79
malarias,128
Plates for growing bacteria,32
Pleurisy,dry, 53
as
of,79
treatment
of, 127
vehicles
after
of
serum
infection,56
injections,
75
Rats, destruction
of, by sulphur
fumigation, 40
in spread of
Rheumatism,
plague, 179
bacteriology of, 50
Rinderpest, virus of, 127
Rose
spots in typhoid fever, 81
193
INDEX
Scarlet
coccus
antistrepto-Stools,disinfection of, 38,
110
Streptococciin milk, 138
and
fever
serum,
Streptococcus, definition of, 15
quarantine in,61
virus of, 122
Schick
reaction, 100
Serum
therapy, 76
Skin
hemolyzing,
vaccines
or
in, 79
teria,
bac-
108
pyogenes,
Sulphur for fumigation, 40,
66
influence
Sunlight,
Sleeping sickness, 133
Small-pox,
109
infections, serum
protection against
as
39
of,
166
teria,
bac-
on
19
124
Swelled head, 145
quarantine in, 62
Smear
preparations, importance Syphihs, bacteriology of, 119
Wassermann
test in, 121
of, 170
Snuffles in syphihs, 120
Soap
disinfectant,41
as
Soor, 185
Sour
152
Tapeworms,
influence
Temperature,
milk, bacteriology
of
growth
of, 140
Spinal fluid,collection of,for bac-
Terminal
examination,
teriologic
definition
Spirilla,
of, 15
Tetanus
173
bacillus,101
bacteriologyof, 101
of, 16
Spores, character
Sputum, collection of, for
serum
Tetrachlorethane
patients,
Squirrelsin spread
of
of
plague, 179
15
fever, 132
by steam,
by heat,
46,
Throat
43
157
collection
smears,
Thrush,
Toxin
111
Steam, effect of, on bacteria,44
for destroying lice,169
for disinfection,
46
for sterilization,
44, 157
Stegomyia in relation to yellow
Sterilization
lice,169
185
diphtheria,98
of
Transmission
infectious
of
Trench
fever, 127,
transmission
182
by lice,58,
of, 127, 182
Treponema
pallida in
Trichina,
152
with
of,on
Triple vaccine,
85
abscess, 112
Stools, collection of, 172
13
syphihs,
119
Tricresol,effect
Stitch
184
virus
Trichoi)hyton tonsurans,
161
eases,
dis-
55
of instruments, etc., 155
chemicals,
of, for
examination, 97, 171
bacteria, 25
Staphylococcus, definition of,
pyogenes.
destroying
for
Tetrads, definition of, 16
171
Staining
78
treatment,
toxin,102
ination,
exam-
170
pneumonia
from
on
fumigation, 57
antitoxin,103
Spirillumof cholera,88
105,
of,
bacteria,19
Trypanosomiasis,133
185
bacteria,39
194
INDEX
Tsetse
transmission
in
fly
sleepingsickness,58,
Tubercle
of Wassermann
133
Water, bacteriologicexamination
Tuberculin, diagnostic use
of, 93
of, 93
Tuberculosis, bacteriology of, 91
nature
and
serum
of, 146,
150
collection
of, for examination,
171
disinfection
in, 165
of goats to, 64
immunity
syphilis,
121
bacillus,91
disinfection
for
test
vaccine
drinking-,
of, 39,
halazone
of, 42,
treatment,
149
in
fection
disin-
150
filtration of, 148
79
in
for, 93, 94
tests
transmission
Typhoid fever, bacteriologyof,81
of
of
vaccination
against,
typhoid fever,87,
by chlorination,149
stools,disinfection
of, 83,
150
by distillation,
84
fever,quarantine in, 62
natural, 147
Water-borne
in
Ultramicroscope
diagnosisof
syphilis,119
Urine,
147
purificationof, by boiling,150
78,85
Typhus
cholera, 88,
147
quarantine in, 61
use
of
collection
of sterile
Welch's
diseases,147
bacillus,181
Whooping-cough, 176
mens,
speciquarantine in, 63
Widal
172
in
reaction
typhoid fever,
84
Vaccination
against small-pox,
Wool-sorters'
125
method
from
Vaccine, collecting,
in
dressing,
41
Wright's investigations
Vaccines, bacterial,77,
of
on
sonins,
op-
73
78
boils,113
infections,113
Yeast,
in
lipo-,78, 85
Vaccina, 124
definition
sulphur fumigation in, 40
infection,94
141
fever, quarantine in,
transmission
virus
of, 127,
of, 58,
62
132
132
Yoghurt, bacteriology of, 142
quarantine in, 62
Vermin, 152
test
of, 13
fermenting milk,
Yellow
Varicella,quarantine in, 63
Variola, 124
Pirquet's
dichloramine-T
calf,124
therapy, 76
triple,85
of gonococcus
tion
solu-
in, 41
of, 125
in treatment
disease,180
infected,Dakin's
Wounds,
linear,125
von
of, 72
nature
for
lous
tubercu-
Zingher,
diphtheria immunity,
100
Zoolak, bacteriologyof, 142
