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
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