provement is a step in the right direction.
We have it in our power by proper organ-
ization and management to influence our
legislators to give us not only a suitable
dissecting law but also an act which will
enable the state to provide for the neglected
insane. Who can read without feelings of
sorrow and sadness the appeals of the
friends of these unfortunate people to the
superintendents of our hospitals.? Our
attention has been directed to the subject
time and again in various ways and it is
high time for the medical profession to
take some decided stand and emphasize the
great and urgent necessity of giving these
helpless people the benefit to be derived
from special treatment. I do not believe
that the facts are generally known by the
people. It is the duty of the profession to
try to inform them. As soon as the true
condition is understood I think there can
be no doubt but that ample provision will
be made. If it is not we will have the
consolation of knowing that we have per-
540
THE CHARLOTTE MEDICAL JOURNAL.
formed our duty. We can do nothing more.
We ought not to be satisfied with doing less.
It would add greatly to our usefulness if
every regular doctor in the State would
consider himself a member of our State
Board of Health. We would then have
the profession in shape to work on sanitary
lines which is really its true mission. A
little more zeal and earnestness in the work
of educating our people, would doubtless
induce them to respond, through their re-
presentatives, in a satisfactory way. Some
of r,uT members act as if they thought this
society could run itself. This is a very
great mistake. Good physicians cannot
attend these meetings at all except at a
great sacrifice and the work cannot be
properly performed without great labor.
So let us resolve to do our duty in the love
of it. If our State is to enjoy the benefit
of wholesome sanitary legislation it will, in
my opinion, have to be brought about
chiefly through our profession. Very much
that is written nowadays will scarcely be
read by the thinking people of the genera-
tion which is to follow us. If we make
higher moral and professional education
the passport and sanitary medicine the
watchword we need have no fears but that
our work will stand the test of time, the
great adjudicator which burnishes the gold
and buries the dross. The excellent work
performed by our Examining Board has
resulted in enlarged faculties for instruc-
tion in all the medical colleges of our coun-
try. The number of years have been in-
creased and the terms made longer so that
some of the commencements do not come
off in time for the applicants to be on hand
at the time that our Board of Examiners
meets. The change of meeting from the
15th, as first announced, to the 22nd was
but an attempt of those having the matter
in charge to meet this exigency. I hope
this question may be wisely determined. I
understand from Dr. W. W. Keen, Presi-
dent of the American Medical Association,
that the Gallinger Antivivisection Bill is
still pending and that the senator is trying
to push it all he can. I suggest that we
repeat our resolutions of protest and send
copies to our senators, also to the Senate
and House. If we could secure the active
opposition of Senator Pritchard, who is a
member of the committee, even to the ex-
tent of getting it out of the committee, we
would gain a great point. So far as I
know our profession is to be congratulated
on the fact that it is practically free, here
in North Carolina, from imbibing that
fallacious doctrines of the Osteopaths and
Christian Sientists. If any would like tc
see a satisfactory refutation of the doctrine
of Christian Science I would refer them to
Rev. W. P. McCorkle. Graham, N. C,
who has written the best book I have ever
seen anywhere on the subject.
As is usual on such occasions our Obitu-
ary Committee will have the painful task
of preparing appropriate resolutions of
respect to the memory of some of our
truest and best members who have been
called to a higher service. Among these
are Drs. Littlejohn, Gray, Turlington,
Hornaday, McDuftie, Tucker and Wood.
Having briefly endeavored to remind
you of a few of those things which I con-
ceive to be of some practical importance to
our society and State I hasten to conclude.
Recognizing a superintending Providence
in all things I trust that all our delibeia-
tions may be characterized by wisdom and
prudence so that when our work is finished
it may bring honor to ourselves, gratifica-
tion to our friends and usefulness to our
country. To have your coafidence and
esteem is a great distinction I do appreciate
it. Finally permit me to thank you all
again with assurances that wherever in the
Providence of God your lot may be cast
you will have my earnest prayers and
zealous wishes for your welfare present
and eternal.
The Annual Essay. The Relation of Bac-
teria to Disease.*
By R. H. Whitehead, M. D.,
Chapel Hill, N. C.
Mr. President^ Ladies a?id Gentlemen :
It has been objected to physicians as a
class that they hold themselves too much
apart from their fellow-citizens, that they
make too little effort to cultivate in the
general public a sympathy for the scientific
aspirations of their profession, and that they
thus become associated in the minds of the
laity only with actual sickness — as was cer-
tainly the case with the little baby, who,
when suddenly shown the photograph of
the family physician, immediately put out
her tongue. However that may be, it is
doubtless a wise custom of this Society
which decrees that at least one of its ses-
sions shall be thrown open to the public,
and that the subjects discussed on this oc-
casion shall be of a nature likely to appeal
to laymen as well as to physicians.
In trying to accomplish my part of this
task, I have chosen the subject of the Re-
lation of Bacteria to Disease. To an au-
dience composed only of physicians I should
*Read before the North Carolina Medical Society at
Tarboro, N. C, May, 1900.
THE CHARLOTTE MEDICAL JOURNAL.
541
feel it necessary to apologize for the choice.
The discovery of the connection of bacteria
with many pathological processes has, quite
naturally, produced a great deal of discus-
sion in the public press, and much of it is
full of erroneous statements. That class of
newspapers which has for some reason been
dubbed "yellow," frequently publishes the
most extraordinary articles concerning bac-
teriology, and over-zealous bacteriologists
have often heralded forth premature state-
ments of a somewhat alarming nature. It
is not strange that the conception of bac-
teria entertained by the public mind is more
or less hazy, that one community is "germ-
shy," another not shy enough. Moreover,
preventive medicine is bacteriological in its
very essence, and we can not expect to ac-
complish a great deal in this direction un-
less our efforts are approved and sustained
by intelligent public opinion. For these
reasons I have thought that I might best
fulfill my function as essayist on this occa-
sion by attempting to present some of the
elementary but fundamental facts of bac-
teriology.
I'he bacteria — for which germs, microbes,
and micro-organisms are synonymous terms
— are exceedingly minute vegetable organ-
isms which reproduce their kind by the
simple process of fission — splitting in two.
While there is an almost endless variety of
them, the simple classification based upon
their shape is quite sufficient for our pur-
poses. According to this classification a
spherical bacterium is called a coccus, a rod-
shaped one a bacillus, and a more or less
curved one a spirillum. In this connection
it is well to observe that some of the bac-
teria are capable of motion in a fluid envi-
ronment, and that this motility is due to
certain appendages called flagella, by means
of which they are able to dart about often-
times with astonishing rapidity. A still
more striking quality that some bacteria
possess is the ability to pass into a so-called
resting stage when subjected to certain un-
favorable influences. In this condition the
organism has changed its shape and appar-
ently also its constitution, is far less influ-
enced by external circumstances than the
mature bacterium, and is known as a spore,
This spore has the remarkable power of re-
turning to its original condition as a full-
fledged bacterium when the environment
again becomes favorable to its nutrition.
As regards the natural history of bacteria
we are in possession of a very extensive in-
formation. We know that, although class-
ed with plants, bacteria feed by preference
like animals. Plants, you know, by means
of their leaves and roots derive their nour-
ishment from simple stable chemical com-
pounds like water, carbon dioxide, and
ammonia; but the bacteria, like animals,
demands the unstable organic compounds.
In utilizing these substances as food they
bring about in them the most profound
changes, which fact, as we shall see pre-
sently, is of the utmost importance to us.
Another fact to be emphasized is that some
bacteria derive their nutrition only from
dead organic matter, are incapable of mul-
tiplication in living tissues, aud will quickly
perish even should they by any means be
introduced into such tissues. To this large
class of bacteria the general name of sapro-
phytes is given. On the other hand, those
bacteria which tlirive on living matter con-
stitute the parasites ; these are the disease
producing the pathogenic organisms.
Fortunately for the bacteriologist the para-
sites are also capable of growing in dead
matter. This makes it possible to cultivate
them in various laboratory media, to study
the characters and peculiarities of their
growth, to subject them to various condi-
tions favorable and unfavorable to them,
and to study their action upon animal tissue
at will, and so to identify and classify them.
At the outset, then, we are met by two
great classes of bacteria : the parasites,
which can multiply in living as well as
dead matter, and which are our enemies ;
and the saprophytes which live only in
dead matter, and are, for the most part,
our benefactors. Through the agency of
the saprophytic bacteria the various forms
of putrefaction are brought about, by them
most of the fermentations are effected, and
to them we are indebted for many other
useful processes — even the flavor of good
butter, you know, is due to bacteria. More-
over, they are the scavengers of the earth.
All waste and dead organic matter, whether
in the air, the water or the soil, whether
derived from animals or plants, is their
food, and in feeding upon it they decorn-
pose it into those simple compounds, in
which shape alone plants are able to assim-
ilate their food. Thus they are the pur-
veyors to the vegetable world ; and since
the animal world is dependent upon the
plants for existence, it follows, of course,
that the bacteria are essential to our exis-
tence. Thus they play the leading role in
the conservation of matter, that extraordi-
nary economy of nature, which does not
suffer a single atom to be lost ; they are the
active agents in that wonderful cycle from
life to death, from death to life again, the
constant interchange between the vegetable
and animal kingdoms, so that our modern
scientific realism has almost confirmed the
mystic philosophy of the old "Sultan of
the Persian song" who said :
542
THE CHARLOTTE MEDICAK JOURNAL.
"I sometimes think that never blooms so red
The rose as where some buried Caesar bled ;
That every hyacinth the garden colors
Dropt to her lap from some once lovely
head."
In addition to organic pabulum, the bac-
teria require water. Some moisture is ab-
solutely essential to their welfare, and sim-
ple drymg is fatal to many of the pathogenic
bacteria.
With respect to oxygen, they vary greatly
in their behavior ; some will not grow in its
absence, others will not thrive in its pre-
sence, and many do equally well either with
or without that element.
Temperature exerts a very marked influ-
ence upon bacteria. All the pathogenic
bacteria grow best at blood heat, but while
some, indeed, will not grow upon artificial
media at even a few degrees below this de-
gree, most of them develop fairly well at
ordinary temperatures. Extreme heat has
a far more injurious effect upon them than
extreme cold. We may say in general
terms that all bacteria and their spores are
killed by an exposure of a few minutes to a
temperature of i8o deg. F. On the other
hand, while bacteria do not seem to multi-
ply in ice, they are in many instances capa-
ble of existence in it, and are able to resume
development when brought into more favor-
able surroundings.
Again, most bacteria do best when the
chemical reaction of their environment is
neutral or faintly alkaline ; the presence of
even a very slight amount of certain acids
is quite sufficient to inhibit the growth of
many pathogenic germs.
Direct sunlight is one of the most unfa-
vorable influences to which bacteria are ex-
posed in a state of nature — they love dark-
ness rather than light. A great many
chemicals, such as corrosive sublimate, car-
bolic acid, &c., are very fatal t6 them, and
are freely used in surgical and hygienic
practice as germicides ; but we should bear
in mind that heat is, wherever it can be
applied, the most reliable of all germicides.
It follows, then, from what has been said,
that wherever there are waste organic mat-
ter, moisture, and ordinary degrees of tem-
perature, there bacteria are developing; in
short, they exist almost everywhere. But
it may be well to say somethiug as to their
presence in certain media, namely, air,
water, soil, and food.
In the air bacteria are quite numerous,
though the quantity and quality of them
vary much with circumstances which we
need not discuss. They are carried about
in the shape of dust by currents of air, and
are deposited here and there by gravity.
There are several facts in this connection to
be borne in mind. The saprophytes usually
are much more numerous than the patho-
genic germs. It appears that ordinary cur-
rents of air are unable to dislodge bacteria
from moist surfaces ; so that the organisms,
in order to be borne in the air, must be in
a more or less dried state. For example,
we are in no danger of inhaling the bacilli
of tuberculosis from the sputum of a con-
sumptive person, even though it may be
loaded with those germs, so long as it is
wet ; it has to be dried and in the form of
dust to become a source of danger through
inhalation. Again, since complete dessica-
tion is fatal to most bacteria — the bacillus
of tuberculosis is a marked exception — it
follows that they probably do not live in
dry air for any great length of time. Fur-
thermore, since air currents do not dislodge
bacteria from moist surfaces, bacterial dis-
eases are probably not conveyed directly
from one person to another "on the breath."
In all ordinary water, bacteria are fairly
numerous, but here, too, saprophytes are
the prevailing organisms. Indeed, water
seems to be the normal habitat of many
harmless bacteria, known, therefore, as
"the water bacteria." In a general way
we may state that the presence of pathoge-
nic organisms in water is due to contamin-
ation from the outside. But pathogenic
bacteria, as a rule, do not thrive in water;
for, since the amount of organic matter in
water is usually small, a struggle for exis-
tence must take place between them and
the water bacteria, in which the latter are
at home, acclimated so to speak — and, as
the fittest, survive. Then, too, running
water by the processes of sedimentation and
filtration tends towards a self-purification
in a comparatively short time. And yet,
in spite of the disadvantages under which
pathogenic germs labor when in water, the
fact remains that drinking water is by far
the most common vehicle of infection in
such diseases as typhoid fever and cholera.
The superficial layers of the soil, of
course, are teeming with bacteria, and it is
from this source that water is usually in-
fected. A fact to be noted is that soil is
the home of some of the most virulent germs,
especially that of lock-jaw — the bacillus of
tetanus. This microbe seems to prefer
garden soil and that about stables ; so that
we always regard with suspicion a wound
contaminated by this sort of soil.
With respect to the bacteria in food, I
can not help thinking that the danger to us
from this source has been exaggerated. In
the first place, we have a natural aversion
to spoiled food; then, too, the muscular
system of animals is not often attacked by
germs ; and, finally, we usually employ such
THE CHARLOTTE MEDICAL JOURNAL
543
degrees of heat in the preparation of our
food as to completely destroy bacteria.
There is no doubt, however, that disease
may be conveyed by food, either as the re-
sult of insufhcient cooking of diseased food,
or from contamination after cooking, if the
food be of a kind that w^e usually cook. A
fly's foot is very diminutive, but it is big
enough to 'carry many germs. Raw food,
such as milk and its derivatives, are much
more likely to convey disease. Milk is an
ideal culture medium, absorbs readily, and
so is liable to contamination from external
sources ; moreover, if the udder of the cow
be afi"ected by a bacterial disease, the milk
will doubtless contain the germs of that
disease.
We have next to consider the means by
which bacteria gain access to the body.
First among ihese avenues is the skin
Since this organ is covered by several layers
of horny scales, we may doubt if bacteria
are able to enter through an unbroken skin ;
but it is exceedingly common for organisms
to gain access to the tissues through solu-
tions in the continuity of the skin, though
such solutions may be the merest abrasions,
so slight as to escape observation entirely.
Many bacteria live in the secretions of the
skin glands, and while the large proportion
of these may be saprophytes, still patho-
genic organisms are almost normally found
there. It is easy to understand how a very
slight wound, even though made with an
instrument perfectly free from bacteria,
might introduce pathogenic germs. It is
in the skin that we are especially apt to find
the organisms usually associated with the
formation of pus — the bane of the surgeon.
This discovery and the application of means
to prevent the entrance of bacteria into
wounds, have, you know, brought about a
progress in surgery unprecedented in the
history of the art.
Another common avenue for the entrance
of germs is the respiratory tract. The upper
air passages normally contain numerous
bacteria, some of which are parasites; and
it is in this region that the dust of inhaled
air is arrested. As in the case of the skin,
so with mucous membranes, it is permissi-
ble to doubt if bacteria pass through them,
provided their lining cells are in a healthy
condition. Moreover, in healthy animals,
investigators have been unable to find bac-
teria of any sort in the deeper portions of
the air passages. Nevertheless, under cir-
i cumstances not well understood at present,
infection through the respiratory tract,
even its deeper parts, is quite common,
some of the most serious diseases, such as
pneumonia and consumption, being usually
contracted through that path.
Another avenue of entrance'is the alimen-
tary tract. Certain portions of it swarm
with bacteria, some of which are pathogenic
and under certain conditions may seize a
chance to enter the tissues. Then, too, con-
taminated water and food may introduce
other more dangerous organisms. But in
this case we derive considerable protection
from the fact that the stomach usually con-
tains an acid secretion, and acids, we have
seen, arrest the growth of many bacteria.
Thus Koch was not able to produce cholera
by feeding the germs to dogs until he first
neutralized the acidity 'of .the gastric juice.
.So that in each case we are provided with
barriers, which the bacteria must overcome
before they can invade the tissues.
But suppose that a germ has been intro-
duced into living tissue, it by no means fol-
lows necessarily that it will be able to exist
there — it may or may not. "A sower went
forth to sow his seed. * * And some
fell upon a rock ; and as soon as it was
sprung up, it withered away, because it
lacked moisture. And some fell among
thorns, and the thorns sprang up with it
and choked it. And others fell on good
ground, and sprung up, and bire fruit an
hundred fold." Now, bacteria are just so
many vegetable seed. They will not live
and multiply except in "good ground." It
is a time-worn observation that different
persons contract infectious diseases with
different degree of facility. Introduced
into the tissues of one man, bacteiia may
die without even an attempt at sprouting,
so to speak ; in another they may succeed
in growing, butif the attack is "mild;"
while in a third they find a suitable soil,
and work out their functions So that in
the equation of disease the bacteria, y, are
only one factor ; and an equally important
one is the soil, the unknown quantity x.
For we are much in the dark as to the na-
ture of susceptibility to disease. Of course,
we may say in general terms that various
circumstances, such as poor food, lack of
sun-light, bad ventilation, damp dwellings,
exposure to cold, various forms of intem-
perance and excess, and certain hereditary
states render us more liable to the attacks
of germs ; but in its essence the problem is
unsolved. If we should ever learn why
some tissues are not "good ground" for
bacteria in the same way that we know
why one soil is unfit for tobacco, and an-
other is unfit for corn, you can easily see
that a prodigious step would be taken.
Many 'investigators in many lands are
studying the question, approaching it from
different points of view, and we may at
least hope for success. At present we have
only hints, suggestions as to lines of research
544
THE CHARLOTTE MEDICAL JOURNAL.
to be followed, and can only say that living
tissues as such possess a certain amount of \
natural resistance to the bacteria. If this i
resistance is successful, we call it immunity.
The question now arises, how do bacterial
act.? What weapons do thev use in the
fight ?
Without entering into an account of how
the knowledge has been obtained, I may
simply state that the action of pathogenic
bacteria is due to chemical substances elab-
orated by them. To these bodies the gen-
eral term of toxins is applied. For the
most part, their exact chemical constitution
has not yet been established, though they
are believed to be allied to the albumins.
Many of them are exceedingly powerful,
far surpassing any poisons previously known
to us. The weapons, then, which bacteria
use are chemical poisons ; it is not unreason-
able, therefore, it may be remarked in pass-
ing, to hope that some day antidotes will
be discovered for them, just as we are now
in possession of antidotes for many other
poisons. These toxins are the agents which
produce most of the symptoms of bacterial
diseases ; for example, we may kill a guinea
pig by injecting a liquid in which the bacilli
of diphtheria have been growing, but from
which they have all been removed, just as
readily as by injecting the bacilli themselves.
Some of the toxins produce very profound
changes in the tissues attacked by them ;
thus, the toxins of the common pus organ-
isms first kill the tissue in their immediate
neighborhood, and then dissolve it. Others,
like the bacilli of tuberculosis, bring about
a proliferation of the cells which they attack
and this new tissue afterwards dies.
According to the relation of the bacteria
to the blood circulation, we may divide bac
terial diseases into two classes. In the first
class the germs are localized to one or more
situations in the tissues ; but while they
are not in the blood, the toxins manufac-
tured by them are absorbed by the blood,
and carried by it to all portions of the body.
Diphtheria and lock-jaw are good examples
of this infection. In the second class the
bacteria are living and multiplying in the
blood, constantly setting free toxins
greater or less amount, and are removed, to
a great extent, from our remedial measures.
Of these two cases, it is obvious that the
second is much the more dangerous, and
far more difficult to treat. However, the