PURULENT INFECTION. The discussion which has lately been brought to a close in the Paris Academy of Medicine regarding purulent infection, cannot fail to interest surgeons in this part of the world, notwithstandthe fact that the opinions expressed during the recent debate
ing
general rule, neither original nor very conclusive. Academy seem to have been pretty nearly equally divided, the views of one portion of the assembly being explained by M. Guiven, and the other by M. Verneuil. The former surgeon maintains that septicaemia can only arise from the introduction of a specific poison from without through a wounded surface, and so into the blood: the poison, in fact, being inoculated into the system in the same manner as the poison of vaccine or syphilis might be, before it can produce its specific effects on those amenable to its influence. M. Verneuil, on the other hand, argued that septicaemia may be developed spontaneously from decomposing organic matter on the surface of a wound; the poison thus created he calls sepsine, and he thinks that having been generated in a wound, it is inoculable were, as a
The members of the
in infinitesimal
doses,
and
seems
to
"
like ferments."
act
however, according to M. Verneuil, escape outwards from a wounded surface, attaching itself to dressings or the hands of persons engaged in nursing the sick : it dries, and may in this way be carried about from one place to another ; being from time to time disengaged and disseminated like dust through the atmosphere, it may settle on an open sore and so gain access to the blood. M. Verneuil further inclines to the opinion that this sepsine may enter the blood with the air we This
sepsine
breathe.
may
He maintains with considerable force the idea that
pus cannot of itself
engender septicaemia
if introduced into the
system; doubtless, if pus cells gain an entrance into the veins, they may like other foreign bodies plug the smaller capillary vessels, producing secondary inflammatory lesions, the products of which can
engender sepsine,
and
so
poison
the
pus cells imbibing sepsine on the surface of carry the poison into the system; or lastly, these
patient, a
or
the
wound may
poison-bearing
cells may convey sepsine, spreading it broadcast through the and thus
inducing disease of a dangerous nature both far Among other proofs brought forward in favour of this doctrine, is the fact that in persons suffering from leucocythaemia, the white gobules of the blood by their accumulation, not uncommonly cause obstructions of the capillaries; emboli are thus formed: the blood clot may subsequently become displaced, or undergoing putrefaction, may excite local inflamation and septicaemia. M. Verneuil insists strongly on the fact that sepsine is a " its molecular fixed poison," consisting of organic mutter in state," which, ho says, may be separated from the pus gobules, air,
and wide.
"
dissolved in the fluid discharge on the surface of a wound. It most recent researches on this subject seems, therefore, that the incline us to suppose that the cause of septicaemia consists of
organic molecular matter, which acts on the organism of thoso prepared to receive it after the manner of a ferment, multiplying at a prodigious pace in the human body at the expense of
THE INDIAN MEDICAL GAZETTE.
42
constituents, the abnormal train of symptoms tliua engendered constituting septicaemia. "We have frequently insisted on the fact that the poison of cholera consists of a specific in organic matter, which, by entering the alimentary canal a state of molecular activity, is capable, under certain circumstances, of engendering changes there, which give rise to the symptoms of Asiatic cholera. Organic matter other than the poison of cholera, if in a state of decomposition, may give rise to a very analogous train of symptoms; examples of the kind are occasionally met with in this country among natives who are given to consuming fish in a state of incipient putrefaction. "We have demonstrated the fact that the molecular infecting matter of cholera may be preserved unchanged for an indefinite time when dry, and that it may be separated from water and other fluids by careful filtration; further, that its specific properties are destroyed by antiseptic agents. We see, therefore, how closely the organic poison of cholera resembles in its physical properties that of sepsine, and, according to M. Chauveau, the molecular matter which causes glanders, small-pox and such like disIt is by no means an uncommon thing to hear people eases. declare that we know nothing of the cause of cholera; we are convinced however that this is a mistake; we have the most conclusive evidence that cholera orginates in molecular organic matter, having specific properties, but no characteristic which in the present state of our knowledge is demonstrable, either by the microscope or by chemical tests; nor is it possible by these means to define with greater exactness the organic matter which constitutes sepsine, or if it comes to that, the particles from which a vast portion of the higher forms of animal life Bnt surely it would be unreasonable to argue, are developed. its normal
that because
we
cannot define the elements from which
man
is
developed, being unable to distinguish these from those of many other animals?that, consequently, we know nothing of the causes which produce man; we are fortunately acquainted with much that relates to his generation and growth, and if we would only allow ourselves to be guided by principles equally clear regarding the causes which produce cholera and such like diseases, we should be able to inculcate sounder doctrines than are at present in vaque to those around us, and thus probably in the course of time rid the world of a vast amount of suffering and unnecessary waste of life.
[February 1,
1872.
ing
general rule, neither original nor very conclusive. Academy seem to have been pretty nearly equally divided, the views of one portion of the assembly being explained by M. Guiven, and the other by M. Verneuil. The former surgeon maintains that septicaemia can only arise from the introduction of a specific poison from without through a wounded surface, and so into the blood: the poison, in fact, being inoculated into the system in the same manner as the poison of vaccine or syphilis might be, before it can produce its specific effects on those amenable to its influence. M. Verneuil, on the other hand, argued that septicaemia may be developed spontaneously from decomposing organic matter on the surface of a wound; the poison thus created he calls sepsine, and he thinks that having been generated in a wound, it is inoculable were, as a
The members of the
in infinitesimal
doses,
and
seems
to
"
like ferments."
act
however, according to M. Verneuil, escape outwards from a wounded surface, attaching itself to dressings or the hands of persons engaged in nursing the sick : it dries, and may in this way be carried about from one place to another ; being from time to time disengaged and disseminated like dust through the atmosphere, it may settle on an open sore and so gain access to the blood. M. Verneuil further inclines to the opinion that this sepsine may enter the blood with the air we This
sepsine
breathe.
may
He maintains with considerable force the idea that
pus cannot of itself
engender septicaemia
if introduced into the
system; doubtless, if pus cells gain an entrance into the veins, they may like other foreign bodies plug the smaller capillary vessels, producing secondary inflammatory lesions, the products of which can
engender sepsine,
and
so
poison
the
pus cells imbibing sepsine on the surface of carry the poison into the system; or lastly, these
patient, a
or
the
wound may
poison-bearing
cells may convey sepsine, spreading it broadcast through the and thus
inducing disease of a dangerous nature both far Among other proofs brought forward in favour of this doctrine, is the fact that in persons suffering from leucocythaemia, the white gobules of the blood by their accumulation, not uncommonly cause obstructions of the capillaries; emboli are thus formed: the blood clot may subsequently become displaced, or undergoing putrefaction, may excite local inflamation and septicaemia. M. Verneuil insists strongly on the fact that sepsine is a " its molecular fixed poison," consisting of organic mutter in state," which, ho says, may be separated from the pus gobules, air,
and wide.
"
dissolved in the fluid discharge on the surface of a wound. It most recent researches on this subject seems, therefore, that the incline us to suppose that the cause of septicaemia consists of
organic molecular matter, which acts on the organism of thoso prepared to receive it after the manner of a ferment, multiplying at a prodigious pace in the human body at the expense of
THE INDIAN MEDICAL GAZETTE.
42
constituents, the abnormal train of symptoms tliua engendered constituting septicaemia. "We have frequently insisted on the fact that the poison of cholera consists of a specific in organic matter, which, by entering the alimentary canal a state of molecular activity, is capable, under certain circumstances, of engendering changes there, which give rise to the symptoms of Asiatic cholera. Organic matter other than the poison of cholera, if in a state of decomposition, may give rise to a very analogous train of symptoms; examples of the kind are occasionally met with in this country among natives who are given to consuming fish in a state of incipient putrefaction. "We have demonstrated the fact that the molecular infecting matter of cholera may be preserved unchanged for an indefinite time when dry, and that it may be separated from water and other fluids by careful filtration; further, that its specific properties are destroyed by antiseptic agents. We see, therefore, how closely the organic poison of cholera resembles in its physical properties that of sepsine, and, according to M. Chauveau, the molecular matter which causes glanders, small-pox and such like disIt is by no means an uncommon thing to hear people eases. declare that we know nothing of the cause of cholera; we are convinced however that this is a mistake; we have the most conclusive evidence that cholera orginates in molecular organic matter, having specific properties, but no characteristic which in the present state of our knowledge is demonstrable, either by the microscope or by chemical tests; nor is it possible by these means to define with greater exactness the organic matter which constitutes sepsine, or if it comes to that, the particles from which a vast portion of the higher forms of animal life Bnt surely it would be unreasonable to argue, are developed. its normal
that because
we
cannot define the elements from which
man
is
developed, being unable to distinguish these from those of many other animals?that, consequently, we know nothing of the causes which produce man; we are fortunately acquainted with much that relates to his generation and growth, and if we would only allow ourselves to be guided by principles equally clear regarding the causes which produce cholera and such like diseases, we should be able to inculcate sounder doctrines than are at present in vaque to those around us, and thus probably in the course of time rid the world of a vast amount of suffering and unnecessary waste of life.
[February 1,
1872.
