Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 140

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189

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We may reach the conclusion that we have a tumor, " . cells are in general atypical, arising from epithelium of tr blastic origin. However, it retains throughout its epit? nature, never reverting to the connective tissue type. I :: adopt Adami's phraseology, we should speak of it as & cs: tional lepidoma or a mesothelial carcinoma, since it arises : what he calls a transitional lining membrane or epithelicz mesoblastic origin.

Since it varies so markedly from other reported p! tumors, we are not justified in making any broad generi. tions. We should expect tumors of such origin to show : variations.

EXPLANATION OF FIGURES.

1. Edge of one of the nodules on costal pleura. Leitz, (t. eyepiece 1.

2. Higher power of pleural epithelium shown in Fig. 1. 0: eyepiece, 1.

3. Villi on costal pleura between two larger tumor DE .. Obj. 2, eyepiece 1.

4. Costal pleura between two nodules. Shows the ner; also in the subpleural tissues. Obj. 2, eyepiece 1.

5. Base of a large costal nodule. Subpleural tissues stor: lower part of figure. Intracystic papilloma. Obj. 2, eyepie": 6. Higher power of part marked x in Fig. 5. The iv epithelial line corresponds in position to the serous covera: the pleura. Obj. 4, eyepiece 1.

7. From more superficial portion of same nodule show. Figs. 5 and 6. Proliferation of cells tending to fill up the spa" Obj. 4, eyepiece 1.

8. From highest point of nodule shown in Figs. 5, 6 5%: Advanced stage of process shown in Fig. 7. Solid epithelial : separated by connective tissue strands. Obj. 4, eyepiece 1.

9. Visceral pleura with extension of tumor into lung. 9: exudate on surface, below which is a layer of granulation : then small spaces lined by tumor cells, which extend further : the lungs as an adenocarcinoma. Note atelectatic lung in ." left corner of figure. Obj. 2, eyepiece 1.

10. Higher power of part of Fig. 9. Obj. 4, eyepiece 1.

11. Nodules on surface of lung More regular adenoma structure with papillomatous projections into lumen ! right of figure). Tumor cells of less typical structure inva .. atelectatic lung (lower left). Obj. 4, eyepiece 1.

12. Deeper portion of adenocarcinoma invading atelectatic !: Obj. 4, eyepiece 1.

13. Metastasis to bronchial lymph node. Obj. 4, eyepiece.

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THE JOHNS HOPKINS HOSPITAL BULLETIN, AUGUST, 1911.

PLATE XII

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e: Respirationsorgane. Aschoff's Lehrbuch d. path. Anat., 09, II, 280.

: Primäre Carcinom der Pleura. Deutsche med. Wchnschr., 97, XXIII, 324.

Les neoplasmes malins primitifs de la plèvre. Thèse, tris, 1905.

n: Ueber den sogenannten "Endothelkrebs " der Pleura. augural-Dissertation. Bonn, 1909.

tel: Zur Klinik der Lungen und Pleurageschwülste (En- thelioma pleurae). Deutsche med. Wchnschr., 1911, KXVII, 531.

Ler: Ueber den sogenannten Endothelkrebs der serösen tüte (Wagner-Schulz) : Ztschr. f. Heilk., 1897, XVIII, 209.

oren der Pleura. Deutsches Arch. f. klin. Med., 1903, LXXV, 337.

Harris: A Contribution to the Pathology and Clinical Features of Primary Malignant Disease of the Pleura. Path. and Bact., 1894, II, 174.

Herxheimer: Ueber Sehnenflecke u. Endokardschwieen. Beitr. Z. allg. Path. u. z. path. Anat., Jena, 1902, XXXII, 461.

Mönckeberg: Ueber das Verhalten d. des Pleuroperitonealepithels

bei der Einheilung von Fremdkörpern. Beitr. z. allg. Path. u. Z. path. Anat., Jena, 1903, XXXIV, 489.

Orth: Lehrbuch d. spec. path. Anat., Berlin, 1897, I.

Ribbert: Ueber Pleuratumoren. Virchow's Arch. f. allg. Path. u. path. Anat., 1909, CXCVI, 341.

PORT OF A CASE OF PUERPERAL INFECTION WITH ISOLATION FROM THE UTERUS OF B. INFLUENZA AND A NEW METHOD FOR MAKING BLOOD AGAR FOR ITS CULTIVATION.

By WILLIAM THALHIMER, M. D.

(From the Pathological Laboratory of the University of Virginia.)

ce the discovery by Pfeiffer in 1892 of B. influenza with methods for its cultivation and recognition, the pread occurrence and importance of this organism have here been recognized. At first it was believed to affect he respiratory tract, but many cases are now on record ningitis, endocarditis with bacteræmia and middle ear : due to this bacillus, which has also been recovered an infected gall bladder by Kinna and by Heyrovsky. om the urethra by Cohn. A search of the literature has ed, however, only one case where this bacillus was re- 1 from the female genital tract. This is a case reported ikault under the title " Influenzabacillen bei Pyo- und -Salpinx," and is briefly as follows :

ry .- Frau E., 40 years old, married 14 years, sterile. ears ago the patient was operated on for disease of the vary .* Since then has been troubled off and on with dys- hoa. Has been under observation for three and a half and since yesterday has had severe abdominal pain, and st night has had slight bleeding from the uterus.

3 .- Uterus small, ante-dextroposed, resting upon the sym- and behind it is a massive exudate.

tion .- April 22, 1905. Posterior vaginal incision with autery and opening of both sides of exudate. From right ved pus and from the left bloody serum. Drainage in- April 26, drainage removed. Slight discharge, a little ky 22, dilatation of opening. June 6, discharged. Uterus ed, still a slight exudate to right. Slight discharge. copic examination of pus showed many extra-cellular, Gram negative bacilli. A small number of the same nd in the fluid from the exudate of the left side. was a typical growth of colonies of influenza bacilli on baked agar and the same on agar smeared with pus. No

ature of this ovarian disease is not stated and therefore ble relationship between it and the attack of influenza, i in the additional note, cannot be determined.

growth, however, in bouillon and plan agar. Subcultures were easily grown on blood agar.

Additional History .- On further questioning, the patient said she had an attack of influenza eight or nine years previously, but none since then.

In light of this solitary finding in the literature the fol- lowing case seems worthy of being placed on record.

Mrs. - -. Thirty-one years old. Admitted January 19, 1911. Family History .- Negative, except that about one year ago the patient's husband was treated at the University Hospital for an acute unilateral gonorrheal epididymitis, the gonococci being found in smears.

Past History .- Usual children's diseases and a severe attack of influenza 15 years ago when the patient was 16 years old. This lasted for two weeks, with pains in limbs, cough and purulent expectoration, but the patient was not forced to take to bed. There has been no attack of a similar kind since then, but patient is prone to catch cold, having several attacks every winter. Genito-urinary history negative, menstruation normal, never any abdominal pain. Patient has one child two years old; this preg- nancy, labor and puerperium were normal.

Present Illness .- Four days ago after a normal pregnancy, patient passed through a normal labor, and felt tolerably well after the child was born, not feeling badly till three days after- wards, when she was troubled with a severe pain in the lower abdomen, She had no chills at this time but later in the night had several, and after each one felt feverish. The next day a physician was called who advised her to enter the hospital.

Status Præsens .- On admission patient's temperature was 105.4º F., pulse 140, respiration 30, and leucocytes 12,400. Except for tenderness in lower abdomen, especially on right side with slight muscle spasm, physical examination was negative. No mass could be felt.

Local Examination .- Patient taken to operating room, prepared for vaginal examination. Culture taken from uterine cavity on plain agar. Uterine cavity then investigated with little finger and no retained secundines found. Uterus was the size of normal in- voluting uterus at this period and no pelvic exudate was felt.

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Course in Hospital .- A moderate sized, firm, pelvic exudate de- veloped in the right broad ligament in two days, and was pal- pable and tender in the right iliac fossa. Temperature fell in three days to about normal and after that ran an up and down course, patient having chills on second and third days. Patient left hospital, against advice, 26 days after admission, still having an irregular low temperature and slight pelvic exudate, but the mass palpable in the right iliac fossa had disappeared.

Note Three Months Later .- Patient has had no further symp- toms since leaving the hospital and now feels entirely well. Blood culture, January 19, 1911, 4 P. M., was negative. Bacteriology of Culture from Uterus .- After 24 hours incuba- tion, the culture tube showed no visible growth, but a dulling of the entire surface. Smears revealed practically a pure culture of a very minute, slender bacillus and a few cocci in chains. Sub- cultures on blood agar gave in 24 hours a profuse growth of minute, discrete dew drop colonies and three or four raised, opalescent colonies, 1 mm. in diameter. The former proved to be the minute bacillus and the latter the coccus. These two organisms were isolated with difficulty by streaking them on blood agar tubes, and the coccus demonstrated to be a streptococcus. Its pathogenicity was not determined. The small bacillus grew as above on blood agar only, and did not grow on bouillon, serum bouillon, plain, glucose, and plain serum- and glucose-serum-agar, litmus milk, potato, and gelatin. It was Gram negative, stained densely and best with carbol-fuchsin diluted in water, and was then seen as a very' minute slender bacillus, showing a very polymorphic ap- pearance, sometimes straight, sometimes comma-shaped, and varied from coccoid forms, some at the limit of visibility, to bacilli from 0.5 to 1.0 g long. In all the subcultures this variation in form and size was noted. From the above data the diagnosis of B. influenze was made. This organism was sent as an unknown to Dr. George Baehr, of the Pathological Department of the Mount Sinai Hospital, New York City, and this same diagnosis arrived at by him.

The finding of the B. influenza in the case cannot definitely be explained, and to attribute it to the attack of influenza, 15 years previously, would certainly not be justifiable. But the similarity of this history to that of the only other recorded case is either to be considered as quite suggestive or else a rather unusual coincidence. The other possibilities to be con- sidered are an accidental infection at the time of labor or else an infection of some portion of the patient's genital tract with a streptococcus and the B. influenza, previous to labor. This may have occurred from coitus with her husband who was suffering from the venereal infection, but the B. influenza in this latter condition is also uncommon. What part of the in- fectious process was due to the influenza bacillus and what to a streptococcus could not be determined, but from the pre- dominance of the bacilli in the first culture tube, the surmise is justifiable that the B. influenze was also the main factor in causing the pelvic infection. It is interesting that the blood culture taken at the height of the temperature was negative.

The second part of this report concerns itself with a new blood agar medium for the cultivation of the B. influenza, but before proceeding with this it may be worth while to review briefly the history of blood media in relation to this organism. * The isolation of the B. influenza is very difficult and was

first performed by Pfeiffer. This he did by smearing ear tubes with pus from patients' bronchial secretions. Fric thet, cultures he was unable to secure growth in subinoculated por: agar tubes and realized that growth in the first culture Te due to some constituent in the pus. After trying many aci he secured typical growth on an agar tube whose surfs : been smeared with a drop of human blood removed asepziet- Next he undertook to find what constituent of blood mi? necessary one. He found that the B. influenza wolt grow on human blood serum but would grow on red telca made from washed red blood corpuscles. The final step Te. discover what constituent of the red blood cells was the de: tial one. Accordingly he laked some washed red blog! either by alternate freezing and thawing, or by additka : ether, which was later removed by evaporation in a va ... The stroma of the red blood corpuscles was removed by E's tion through a " kieselgur " filter. The clear, chemically ;= blood coloring substance, dissolved in 0.6% saline solutio - added in an amount of one drop to each tube of agar. I - tubes were inoculated with the B. influenza and colonie. peared as numerous on them as on blood agar. Growth .. occurred in hemoglobin bouillon, but not in tubes of ec. mixed with stroma of red blood corpuscles from which & .. hemoglobin had been removed.

Since this work other media for growing the B. inter . have been invented, but none are as satisfactory as blood &;

Beck, a student of Pfeiffer, continued this work and foc that blood agar made from pigeon's blood was the one Is favorable for this organism's growth, it growing more s on human and rabbit blood agar. Nastjukoff reported gros. of the B. influenza in pure culture on media of yolk of eg: . claimed this was due to hematogen, which he isolated in Voges, after many experiments, was unable to verify this s of Nastjukoff. Capaldi also refutes this work became found that the B. influenza grew very poorly on agar to v. he added lecithin or hematogen. Cantani reported satisfs:" growth on agar streaked with semen of animals, and ex that his work shows that the growth of the B. influenza (az: be attributed to hemoglobin alone, but is also due to chos" and serum albumin substances which occur naturally in xD. Kolle and Delius obtained good growth, especially on the " tom of the flask, when 0.25 to 0.5 cc. of pigeon's blood ". added to 30 cc. of bouillon, this shaken, and then frozen e. thawed to get the corpuscles laked and the hemoglobin in - tion. Grassberger thinks that one gets better growth of ti- influenza in symbiosis with staphylococcus or on mell- which staphylococcus was previously grown. Cantani .... that the B. diphtheria and gonococcus promoted growth " B. influenza, and Neisser grew it in symbiosis with the s .: " bacillus. Ghon and Preiss could not cultivate the B. fluenza on hemoglobin free media, but obtained luxur growth on hemoglobin agar. Richter investigated the "" of the B. influenza on the following media with unsatisfac:" results : sterile sputum, sterile bile, yolk of eggs, and agar" Schmiedeberg's ferratin.

* The following is extracted mainly from the article on Influ- enza by Beck, in Kolle and Wasserman's Handbook, Vol. III.

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ou w a siuwon of nematogen in water till the reaction is ngly alkaline. Boil or steam, sterilize, and filter ; the pre- tate is separated from the filtrate which latter is a bright fluid and can be sterilized in an Arnold steam sterilizer, tout coagulation or injury. This sterile preparation is ed to sterile liquid agar at 50°-60° C. and tubed. The atogen must be sterilized separately because the original linity must be preserved so that it will not coagulate when ed to 100° C. Huber reports that the growth is less luxu- t and slower on this medium than on blood agar, taking 1 2 to 8 days to become visible, but the B. influenza seems main alive longer, he having made successful subcultures he end of 35 days from a surface inoculated tube and at end of 60 days from stab cultures. This work is impor-

for it shows that oxyhemoglobin is not necessary for th of the B. influenza, but merely the iron radicle of the oglobin.

ne other medium is worthy of note: that of Bernstein and :ein from the Pathological Laboratory of Mount Sinai pital, New York. This is made from whole beef blood not from a definite blood or hemoglobin product. It is e as follows: " 400 cc. of beef blood are drawn directly a 500 cc. Erlenmeyer flask containing 30 cc. of a 1% solu- of ammonium oxalate (to prevent clotting) and 0.5 cc. of alin of 40 volume strength. The flask is shaken for two ites. Thirty minutes are required for sterilization of the 1, which is then transferred in small quantities into sterile nmeyer flasks and diluted with twice its volume of 0.9% le saline solution. This dilution reduces the actual alin content to one part in 2400 of blood. This is allowed and for 24 to 48 hours for diffusion of formalin and then d to agar or bouillon in proportion of one part to fifteen. iriant growths of pneumococcus, meningococcus, gono- s and influenza bacillus are readily obtainable."

résumé of these methods shows that the only media on 1 one can consistently and readily cultivate the B. in- tæ are those containing fresh blood, or hemoglobin ob- 1 from fresh blood ; for the slow growth on Huber's hema- media cannot be considered satisfactory. The method by Pfeiffer for obtaining hemoglobin is rendered compli- by the necessity of a freezing and thawing process or else e necessity of evaporating the ether in a vacuum, pro- es too cumbersome for use in routine manufacture of tory media. The method of Bernstein and Epstein is tain in yielding sterile media but when this is accom- 1 the media is very satisfactory. It is to be regarded with skepticism if 30 minutes contact with formalin in a dilu- of 1 to 860 is sufficient to sterilize the blood used. cent work of Post and Nicoll, which the author working Ir. Palmer has been able to confirm, would indicate that lin is inefficient as a bactericide at this dilution, in this of time.

od agar is usually made from blood obtained from a al patient. This is withdrawn with a syringe from the

venience of this method and the difficulty of obtaining permis- sion to get this blood, even when the laboratory is associated with a hospital is evident.

The two following methods were investigated in an attempt to provide a simple laboratory method for making a hemo- globin or blood medium capable of growing the B. influenza. Only the second one, however, proved successful.

The first investigation was an attempt to utilize a beautiful crystalline hemoglobin product, obtained from Armour and Company through the courtesy of their laboratory. A solution of this coagulated at 60° C., forming a muddy precipitate in a colorless fluid and was, therefore, impossible to sterilize when in solution. It was found that the material underwent no change when heated in a hot air oven at 115° C. for one hour, but this procedure did not yield a sterile product for, although it was tried a number of times, in every case when dissolved in sterile distilled water and streaked on agar, in a 24-hour aerobic culture, a profuse growth of a large spore- forming bacillus occurred. This organism was not identified. A solution of unheated hemoglobin in distilled water was next freed from bacteria by passing it through a sterilized Reichel filter. This gave a solution, brownish red by transmitted light, which was added to tubes of melted agar at 45° C. in quanti- ties sufficient to give a light brown medium, of about the same density of color as ordinary blood agar. There was al- ways plenty of water of condensation present, and although many inoculations were made of a strain of the B. influenza and the strain isolated from the above patient, in no case was a visible growth observed, though usually in 24 to 48 hours many typical forms could be demonstrated in smears made from the surface of the inoculated tubes, and in a few cases successful plants were made from these tubes to blood agar tubes and tubes of the media made by the second method. This is not considered as evidence of growth on this hemoglo- bin agar, but rather a proof of just the opposite. Certainly this is not practicable as a laboratory medium.

Second method : Freshly drawn beef blood obtained from an abattoir was collected in a wide mouthed jar and defibri- nated by shaking with a number of medium sized marbles. This was laked by adding an equal part of distilled water and rendered free from bacteria by passing through a sterile Reichel filter as above. This yielded a beautiful, clear, red fluid and 20 to 30 cc. of this were added to a liter of sterile melted agar at 45° C. and poured into sterile tubes. The medium which resulted was also perfectly clear, bright red and of the same density of color as ordinary blood agar. On this medium the two organisms, which were unsuccessfully tested on the hemoglobin agar, were successfully passed through 10 subcultures. The growth occurred in 24 hours, and was typical of the B. influenza, occurring luxuriantly in small, discrete, dewdrop colonies. Smears showed the typical morphology. Pneumococcus, streptococcus, streptococcus mu- cosus and gonococcus also grew luxuriantly.

This method is a modification of former methods, notably

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that of Pfeiffer, and is believed to be the simplest yet devised for making blood agar. Its chief advantage over that of Pfeiffer is that the laking agent is one which does not in- terfere with growth of bacteria and does not have to be re- moved. From 40 to 50 cc. of this laked blood can be filtered in 24 hours through a Reichel filter of 50 cc. capacity. Where a larger quantity is needed a larger filter can be used. It is evident that the hemolytic qualities of an organism cannot be tested with this medium.

In conclusion the author wishes to express his indebtedness to Dr. H. T. Marshall for his helpful suggestions in this work, and also to Dr. George Baehr for the strain of the B. in- fluenza used in this work and for his report on the organism which was isolated from the case reported.

The opportunity to study the above case was afforded the author by Dr. Makin, in whose service at the University of Virginia Hospital the patient was treated.

BIBLIOGRAPHY.

Bernstein, Eugene P. and Epstein, Albert A .: A simple method of sterilizing blood for cultural purposes. J. Infect. Dis., 1906, III, 773.

Cantani, A .: Die Verwendung des Sperma als Nährbodenzusatz. Centralbl. f. Bakt., 1897, XXII, 601.

Capaldi, A .: Zur Verwendung des Eidotters als Närhbodenzusatz. Centralbl. f. Bakt., 1896, XX, 800.

Cohn, P .: Eine primäre, nicht gonorrhoische Urethritis mit auf- fallend reichlichen Influenzabacillen. Deutsche med. Wchn- schr., 1905, XXXI, 1152.

Delius, W. and Kolle, W .: Untersuchungen über Infrom: munität. Ztschr. f. Hyg. u. Infectionskrankh., 1897, IL7 327.

Ghon, A. and Preiss, W .: Studien zur Biologie des Inteze bacillus. Centralbl. f. Bakt., 1902, XXXII, 90.

Grassberger, R .: Beiträge zur Bakteriologie der Inte Ztschr. f. Hyg. u. Infectionskrankh., 1897, XXV, 453. Heyrovsky, J .: Der Influenzabazillus als Erreger der Chiz, titis. Wien. klin. Wehnschr., 1904, XVII, 644. Huber: Ueber den Influenza-Bacillus. Ztschr. f. Hyg., 1001 ] 454.

Knina, O .: Der Influenzabazillus als Erreger der Cholecyr": Wien. klin. Wchnschr., 1909, XXII, 1234.

Kisskalt, K .: Influenzabacillen bei Pyo- und Hydrosuper Centralbl. f. Bakt., 1906, XLI, 701. Nastjukoff: Ueber Nährboden aus Eigelb für Bakterien-kult's Vrach, St. Petersb1893, XIV, 825, 892, 916.

Neisser, M .: Ueber die Symbiose des Influenzabacillus. Dentsz. med. Wchnschr., 1903, XXIX, 462.

Pfeiffer, R .: Die Aetiologie der Influenza. Ztschr. f. Hyg : fectionskrankh., 1892., XIII, 357.

Pfeiffer, R .: Vorläufige Mittheilungen über die Erreger de : fluenza. Deutsche med. Wchnschr., 1892, XVIII, 28. Pfeiffer, R. and Beck, M .: Dr. Bruschettini und der Intac bacillus. Deutsche med. Wchnschr., 1893, XIX, 816. Post, W. E. and Nicoll, H. K .: The comparative efficiency of st. common germicides. J. Am. M. Ass., 1910, LV, 1635. Richter, M .: Zur Aetiologia der Influenza. Wien klin W schr., 1894, VII, 529.

Thalheimer, W. and Palmer: The bactericidal efficiency of c. nine and some common disinfectants. J. Inf. Dis., 1911. 3 published.

Voges, O .: Beobachtungen und Untersuchungen über Infos und den Erreger dieser Erkrankung. Berlin. klin. Wchrs" 1894, XXXI, 868.

HYPERLEUCOCYTOSIS OF HIGH GRADE IN BRONCHO-PNEUMONIE IN A CHILD.

By CHARLES R. AUSTRIAN, M. D., Assistant in Medicine, The Johns Hopkins University. (From the Medical Clinic of The Johns Hopkins Hospital.)

On November 23, 1909, C. R., a colored child aged four years, was admitted to the Johns Hopkins Hospital, complain- ing of " cough and pain in the stomach and throat." The past history was negative, except for measles and chicken-pox one year ago. The illness which brought the patient for treat- ment began on November 9, fourteen days before admis- sion, with cough-at first unproductive, occurring in noc- turnal paroxysms, at times so severe as to induce vomiting, and later becoming more frequent with the expectoration of tenacious mucous sputum which was never blood-tinged. There had also been fever, night sweats, anorexia and constipation.

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 140

Author: Jacob Anthony Kimmell Publication date: 1910 Publisher: Number of Pages: 1189

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189