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II. On Osteomyelitis. Single observation. I have but one
observation relating to this severe disease, and in this Dr.
Lannelongue took the initiative. The monograph on osteomyelitis
published by this learned practitioner is well known, with his
suggestion of the possibility of a cure by trephining the bone
and the use of antiseptic washes and dressings. On the fourteenth
of February, at the request of Dr. Lannelongue I went to the
Sainte-Eugenie hospital, where this skillful surgeon was to
operate on a little girl of about twelve years of age. The right
knee was much swollen, as well as the whole leg below the calf
and a part of the thigh above the knee. There was no external
opening. Under chloroform, Dr. Lannelongue made a long incision
below the knee which let out a large amount of pus; the tibia was
found denuded for a long distance. Three places in the bone were
trephined. From each of these, quantities of pus flowed. Pus from
inside and outside the bone was collected with all possible
precautions and was carefully examined and cultivated later. The
direct microscopic study of the pus, both internal and external,
was of extreme interest. It was seen that both contained large
numbers of the organism similar to that of furuncles, arranged in
pairs, in fours and in packets, some with sharp clear contour,
others only faintly visible and with very pale outlines. The
external pus contained many pus corpuscles, the internal had none
at all. It was like a fatty paste of the furuncular organism.
Also, it may be noted, that growth of the small organism had
begun in less than six hours after the cultures were started.
Thus I saw, that it corresponded exactly with the organism of
furuncles. The diameter of the individuals was found to be one
one-thousandth of a millimeter. If I ventured to express myself
so I might say that in this case at least the osteomyelitis was
really a furuncle of the bone marrow. [Footnote: This has been
demonstrated, as is well known.--Translator.] It is undoubtedly
easy to induce osteomyelitis artificially in living animals.

III. On puerperal fever.--First observation. On the twelfth of
March, 1878, Dr. Hervieux was good enough to admit me to his
service in the Maternity to visit a woman delivered some days
before and seriously ill with puerperal fever. The lochia were
extremely fetid. I found them full of micro-organisms of many
kinds. A small amount of blood was obtained from a puncture on
the index finger of the left hand, (the finger being first
properly washed and dried with a STERILE towel,) and then sowed
in chicken bouillon. The culture remained sterile during the
following days.

The thirteenth, more blood was taken from a puncture in the
finger and this time growth occurred. As death took place on the
sixteenth of March at six in the morning, it seems that the blood
contained a microscopic parasite at least three days before.

The fifteenth of March, eighteen hours before death, blood from a
needle-prick in the left foot was used. This culture also was
fertile.

The first culture, of March thirteenth, contained only the
organism of furuncles; the next one, that of the fifteenth,
contained an organism resembling that of furunculosis, but which
always differed enough to make it easy usually to distinguish it.
In this way; whilst the parasite of furuncles is arranged in
pairs, very rarely in chains of three or four elements, the new
one, that of the culture of the fifteenth, occurs in long chains,
the number of cells in each being indefinite. The chains are
flexible and often appear as little tangled packets like tangled
strings of pearls.

The autopsy was performed on the seventeenth at two o'clock.
There was a large amount of pus in the peritoneum. It was sowed
with all possible precautions. Blood from the basilic and femoral
veins was also sowed. So also was pus from the mucous surface of
the uterus, from the tubes, and finally that from a lymphatic in
the uterine wall. These are the results of these cultures: in all
there were the long chains of cells just spoken of above, and
nowhere any mixture of other organisms, except in the culture
from the peritoneal pus, which, in addition to the long chains,
also contained the small pyogenic vibrio which I describe under
the name ORGANISM OF PUS in the Note I published with Messrs.
Joubert and Chamberland on the thirtieth of April, 1878.
[Footnote: See preceding paper.]

Interpretation of the disease and of the death.--After
confinement, the pus that always naturally forms in the injured
parts of the uterus instead of remaining pure becomes
contaminated with microscopic organisms from outside, notably the
organism in long chains and the pyogenic vibrio. These organisms
pass into the peritoneal cavity through the tubes or by other
channels, and some of them into the blood, probably by the
lymphatics. The resorption of the pus, always extremely easy and
prompt when it is pure, becomes impossible through the presence
of the parasites, whose entrance must be prevented by all
possible means from the moment of confinement.

Second observation.--The fourteenth of March, a woman died of
puerperal fever at the Lariboisiere hospital; the abdomen was
distended before death.

Pus was found in abundance by a peritoneal puncture and was
sowed; so also was blood from a vein in the arm. The culture of
pus yielded the long chains noted in the preceding observation
and also the small pyogenic vibrio. The culture from the blood
contained only the long chains.

Third observation.--The seventeenth of May, 1879, a woman, three
days past confinement, was ill, as well as the child she was
nursing. The lochia were full of the pyogenic vibrio and of the
organism of furuncles, although there was but a small proportion
of the latter. The milk and the lochia were sowed. The milk gave
the organism in long chains of granules, and the lochia only the
pus organism. The mother died, and there was no autopsy.

On May twenty-eighth, a rabbit was inoculated under the skin of
the abdomen with five drops of the preceding culture of the
pyogenic vibrio. The days following an enormous abscess formed
which opened spontaneously on the fourth of June. An abundantly
cheesy pus came from it. About the abscess there was extensive
induration. On the eighth of June, the opening of the abscess was
larger, the suppuration active. Near its border was another
abscess, evidently joined with the first, for upon pressing it
with the finger, pus flowed freely from the opening in the first
abscess. During the whole of the month of June, the rabbit was
sick and the abscesses suppurated, but less and less. In July
they closed; the animal was well. There could only be felt some
nodules under the skin of the abdomen.

What disturbances might not such an organism carry into the body
of a parturient woman, after passing into the peritoneum, the
lymphatics or the blood through the maternal placenta! Its
presence is much more dangerous than that of the parasite
arranged in chains. Furthermore, its development is always
threatening, because, as said in the work already quoted (April,
1878) this organism can be easily recovered from many ordinary
waters.

I may add that the organism in long chains, and that arranged in
pairs are also extremely widespread, and that one of their
habitats is the mucous surfaces of the genital tract. [Footnote:
When, by the procedure I elsewhere described, urine is removed in
a pure condition by the urethra from the bladder, if any chance
growth occurs through some error of technic, it is the two
organisms of which I have been speaking that are almost
exclusively present.]

Apparently there is no puerperal parasite, properly speaking. I
have not encountered true septicemia in my experiments; but it
ought to be among the puerperal affections.

Fourth observation.--On June fourteenth, at the Lariboisiere, a
woman was very ill following a recent confinement; she was at the
point of death; in fact she did die on the fourteenth at
midnight. Some hours before death pus was taken from an abscess
on the arm, and blood from a puncture in a finger. Both were
sowed. On the next day (the fifteenth) the flask containing the
pus from the abscess was filled with long chains of granules. The
flask containing the blood was sterile. The autopsy was at ten
o'clock on the morning of the sixteenth. Blood from a vein of the
arm, pus from the uterine walls and that from a collection in the
synovial sac of the knee were all placed in culture media. All
showed growth, even the blood, and they all contained the long
strings of granules. The peritoneum contained no pus.

Interpretation of the disease and of the death.--The injury of
the uterus during confinement as usual furnished pus, which gave
a lodging place for the germs of the long chains of granules.
These, probably through the lymphatics, passed to the joints and
to some other places, thus being the origin of the metastic
abscesses which produced death.

Fifth observation.--On June seventeenth, M. Doleris, a well-known
hospital interne, brought to me some blood, removed with the
necessary precautions, from a child dead immediately after birth,
whose mother, before confinement had had febrile symptoms with
chills. This blood, upon cultivation, gave an abundance of the
pyogenic vibrio. On the other hand, blood taken from the mother
on the morning of the eighteenth (she had died at one o'clock
that morning) showed no development whatever, on the nineteenth
nor on following days. The autopsy on the mother took place on
the nineteenth. It is certainly worthy of note that the uterus,
peritoneum and intestines showed nothing special, but the liver
was full of metastatic abscesses. At the exit of the hepatic vein
from the liver there was pus, and its walls were ulcerated at
this place. The pus from the liver abscesses was filled with the
pyogenic vibrio. Even the liver tissues, at a distance from the
visible abscesses, gave abundant cultures of the same organism.

Interpretation of the disease and of the death.--The pyogenic
vibrio, found in the uterus, or which was perhaps already in the
body of the mother, since she suffered from chills before
confinement, produced metastatic abscesses in the liver and,
carried to the blood of the child, there induced one of the forms
of infection called purulent, which caused its death.

Sixth observation.--The eighteenth of June, 1879, M. Doleris
informed me that a woman confined some days before at the Cochin
Hospital, was very ill. On the twentieth of June, blood from a
needle-prick in the finger was sowed; the culture was sterile. On
July fifteenth, that is to say twenty-five days later, the blood
was tried again. Still no growth. There was no organism
distinctly recognizable in the lochia: the woman was
nevertheless, they told me, dangerously ill and at the point of
death. As a matter of fact, she did die on the eighteenth of July
at nine in the morning: as may be seen, after a very long
illness, for the first observations were made over a month
before: the illness was also very painful, for the patient could
make no movement without intense suffering.

An autopsy was made on the nineteenth at ten in the morning, and
was of great interest. There was purulent pleurisy with a
considerable pocket of pus, and purulent false membranes on the
walls of the pleura. The liver was bleached, fatty, but of firm
consistency, and with no apparent metastatic abscesses. The
uterus, of small size, appeared healthy; but on the external
surface whitish nodules filled with pus were found. THERE WAS
NOTHING IN THE PERITONEUM, WHICH WAS NOT INFLAMED; but there was
much pus in the shoulder joints and the symphysis pubis.

The pus from the abscesses, upon cultivation, gave the long
chains of granules--not only that of the pleura, but that from
the shoulders and a lymphatic of the uterus as well. An
interesting thing, but easily understood, was that the blood from
a vein in the arm and taken three-quarters of an hour after death
was entirely sterile. Nothing grew from the Fallopian tubes nor
the broad ligaments.

Interpretation of the disease and of the death.--The pus found in
the uterus after confinement became infected with germs of
microscopic organisms which grew there, then passed into the
uterine lymphatics, and from there went on to produce pus in the
pleura and in the articulations.

Seventh observation.--On June eighteenth, M. Doleris informed me
that a woman had been confined at the Cochin Hospital five days
before and that fears were entertained as to the results of an
operation that had been performed, it having been necessary to do
an embryotomy. The lochia were sowed on the 18th; there was not
the slightest trace of growth the next day nor the day after.
Without the least knowledge of this woman since the eighteenth,
on the twentieth I ventured to assert that she would get well. I
sent to inquire about her. This is the text of the report: "THE
WOMAN IS DOING EXTREMELY WELL; SHE GOES OUT TOMORROW"

Interpretation of the facts.--The pus naturally formed on the
surface of the injured parts did not become contaminated with
organisms brought from without. Natura medicatrix carried it off,
that is to say the vitality of the mucous surfaces prevented the
development of foreign germs. The pus was easily resorbed, and
recovery took place.

I beg the Academy to permit me, in closing, to submit certain
definite views, which I am strongly inclined to consider as
legitimate conclusions from the facts I have had the honor to
communicate to it.

Under the expression PUERPERAL FEVER are grouped very different
diseases, [Footnote: Interesting as the starting point of the
conception of diseases according to the etiological factor, not
by groups of symptoms.--Translator.] but all appearing to be the
result of the growth of common organisms which by their presence
infect the pus naturally formed on injured surfaces, which spread
by one means or another, by the blood or the lymphatics, to one
or another part of the body, and there induce morbid changes
varying with the condition of the parts, the nature of the
parasite, and the general constitution of the subject.

Whatever this constitution, does it not seem that by taking
measures opposing the production of these common parasitic
organisms recovery would usually occur, except perhaps when the
body contains, before confinement, microscopic organisms, in
contaminated internal or external abscesses, as was seen in one
striking example (fifth observation). The antiseptic method I
believe likely to be sovereign in the vast majority of cases. It
seems to me that IMMEDIATELY AFTER CONFINEMENT the application of
antiseptics should be begun. Carbolic acid can render great
service, but there is another antiseptic, the use of which I am
strongly inclined to advise, this is boric acid in concentrated
solution, that is, four per cent. at the ordinary temperature.
This acid, whose singular influence on cell life has been shown
by M. Dumas, is so slightly acid that it is alkaline to certain
test papers, as was long ago shown by M. Chevreul, besides this
it has no odor like carbolic acid, which odor often disturbs the
sick. Lastly, its lack of hurtful effects on mucous membranes,
notably of the bladder, has been and is daily demonstrated in the
hospitals of Paris. The following is the occasion upon which it
was first used. The Academy may remember that I stated before it,
and the fact has never been denied, that ammoniacal urine is
always produced by a microscopic organism, entirely similar in
many respects to the organism of furuncles. Later, in a joint
investigation with M. Joubert, we found that a solution of boric
acid was easily fatal to these organisms. After that, in 1877, I
induced Dr. Guyon, in charge of the genito-urinary clinic at the
Necker hospital, to try injections of a solution of boric acid in
affections of the bladder. I am informed by this skilful
practitioner that he has done so, and daily observes good results
from it. He also tells me that he performs no operation of
lithotrity without the use of similar injections. I recall these
facts to show that a solution of boric acid is entirely harmless
to an extremely delicate mucous membrane, that of the bladder,
and that it is possible to fill the bladder with a warm solution
of boric acid without even inconvenience.

To return to the confinement cases. Would it not be of great
service to place a warm concentrated solution of boric acid, and
compresses, at the bedside of each patient; which she could renew
frequently after saturating with the solution, and this also
after confinement. It would also be acting the part of prudence
to place the compresses, before using, in a hot air oven at 150
degrees C., more than enough to kill the germs of the common
organisms. [Footnote: The adoption of precautions, similar to
those here suggested, has resulted in the practically complete
disappearance of puerperal fevor.--Translator.]

Was I justified in calling this communication "ON THE EXTENSION
OF THE GERM THEORY TO THE ETIOLOGY OF CERTAIN COMMON DISEASES?" I
have detailed the facts as they have appeared to me and I have
mentioned interpretations of them: but I do not conceal from
myself that, in medical territory, it is difficult to support
one's self wholly on subjective foundations. I do not forget that
Medicine and Veterinary practice are foreign to me. I desire
judgment and criticism upon all my contributions. Little tolerant
of frivolous or prejudiced contradiction, contemptuous of that
ignorant criticism which doubts on principle, I welcome with open
arms the militant attack which has a method in doubting and whose
rule of conduct has the motto "More light."

It is a pleasure once more to acknowledge the helpfulness of the
aid given me by Messrs. Chamberland and Roux during the studies I
have just recorded. I wish also to acknowledge the great
assistance of M. Doleris.




PREJUDICES WHICH HAVE RETARDED THE PROGRESS OF GEOLOGY
UNIFORMITY IN THE SERIES OF PAST CHANGES IN THE ANIMATE AND
INANIMATE WORLD
BY
SIR CHARLES LYELL


INTRODUCTORY NOTE


Sir Charles Lyell was born near Kirriemuir, Forfarshire,
Scotland, on November 14, 1797. He graduated from Exeter College,
Oxford, in 1819, and proceeded to the study of law. Although he
practised for a short time, he was much hampered in this
profession, as in all his work, by weak eyesight; and after the
age of thirty he devoted himself chiefly to science.

Lyell's father was a botanist of some distinction, and the son
seems to have been interested in natural history from an early
age. While still an undergraduate he made geological journeys in
Scotland and on the Continent of Europe, and throughout his life
he upheld by precept and example the importance of travel for the
geologist.

The first edition of his "Principles of Geology" was published in
1830; and the phrase used in the sub-title, "an attempt to
explain the former changes of the earth's surface, by reference
to causes now in action" strikes the keynote of his whole work.
All his life he continued to urge this method of explanation in
opposition to the hypotheses, formerly much in vogue, which
assumed frequent catastrophes to account for geologic changes.
The chapters here printed give his own final statement of his
views on this important issue.

Lyell's scientific work received wide recognition: he was more
than once President of the Geological Society, in 1864 was
President of the British Association, was knighted in 1848, and
made a baronet in 1864. He possessed a broad general culture, and
his home was a noted center of the intellectual life of London.
He twice came to the United States to lecture, and created great
interest. On his death, on February 22, 1875, he was buried in
Westminster Abbey.

Persistent as were Lyell's efforts for the establishment of his
main theory, he remained remarkably open-minded; and when the
evolutionary hypothesis was put forward he became a warm
supporter of it. Darwin in his autobiography thus sums up Lyell's
achievement: "The science of geology is enormously indebted to
Lyell--more so, as I believe, than to any other man who ewer
lived."




THE PROGRESS OF GEOLOGY

[Footnote: The text of the two following papers is taken from the
11th edition of Lyell's Principles of Geology, the last edition
revised by the author.]


I

PREPOSSESSIONS IN REGARD TO THE DURATION OF PAST TIME--PREJUDICES
ARISING FROM OUR PECULIAR POSITION AS INHABITANTS OF THE LAND--
OTHERS OCCASIONED BY OUR NOT SEEING SUBTERRANEAN CHANGES NOW IN
PROGRESS--ALL THESE CAUSES COMBINE TO MAKE THE FORMER COURSE OF
NATURE APPEAR DIFFERENT FROM THE PRESENT--OBJECTIONS TO THE
DOCTRINE THAT CAUSES SIMILAR IN KIND AND ENERGY TO THOSE NOW
ACTING, HAVE PRODUCED THE FORMER CHANGES OF THE EARTH'S SURFACE
CONSIDERED


If we reflect on the history of the progress of geology we
perceive that there have been great fluctuations of opinion
respecting the nature of the causes to which all former changes
of the earth's surface are referable. The first observers
conceived the monuments which the geologist endeavours to
decipher to relate to an original state of the earth, or to a
period when there were causes in activity, distinct, in a kind
and degree, from those now constituting the economy of nature.
These views were gradually modified, and some of them entirely
abandoned, in proportion as observations were multiplied, and the
signs of former mutations were skilfully interpreted. Many
appearances, which had for a long time been regarded as
indicating mysterious and extraordinary agency, were finally
recognised as the necessary result of the laws now governing the
material world; and the discovery of this unlooked-for conformity
has at length induced some philosophers to infer, that, during
the ages contemplated in geology, there has never been any
interruption to the agency of the same uniform laws of change.
The same assemblage of general causes, they conceive, may have
been sufficient to produce, by their various combinations, the
endless diversity of effects, of which the shell of the earth has
preserved the memorials; and, consistently with these principles,
the recurrence of analogous changes is expected by them in time
to come.

Whether we coincide or not in this doctrine we must admit that
the gradual progress of opinion concerning the succession of
phenomena in very remote eras, resembles, in a singular manner,
that which has accompanied the growing intelligence of every
people, in regard to the economy of nature in their own times. In
an early state of advancement, when a greater number of natural
appearances are unintelligible, an eclipse, an earthquake, a
flood, or the approach of a comet, with many other occurrences
afterwards found to belong to the regular course of events, are
regarded as prodigies. The same delusion prevails as to moral
phenomena, and many of these are ascribed to the intervention of
demons, ghosts, witches, and other immaterial and supernatural
agents. By degrees, many of the enigmas of the moral and physical
world are explained, and, instead of being due to extrinsic and
irregular causes, they are found to depend on fixed and
invariable laws. The philosopher at last becomes convinced of the
undeviating uniformity of secondary causes; and, guided by his
faith in this principle, he determines the probability of
accounts transmitted to him of former occurrences, and often
rejects the fabulous tales of former times, on the ground of
their being irreconcilable with the experience of more
enlightened ages.

PREPOSSESSIONS IN REGARD TO THE DURATION OF PAST TIME.--As a
belief in the want of conformity in the cause by which the
earth's crust has been modified in ancient and modern periods
was, for a long time, universally prevalent, and that, too,
amongst men who were convinced that the order of nature had been
uniform for the last several thousand years, every circumstance
which could have influenced their minds and given an undue bias
to their opinions deserves particular attention. Now the reader
may easily satisfy himself, that, however undeviating the course
of nature may have been from the earliest epochs, it was
impossible for the first cultivators of geology to come to such a
conclusion, so long as they were under a delusion as to the age
of the world, and the date of the first creation of animate
beings. However fantastical some theories of the sixteenth
century may now appear to us,--however unworthy of men of great
talent and sound judgment,--we may rest assured that, if the same
misconception now prevailed in regard to the memorials of human
transactions, it would give rise to a similar train of
absurdities. Let us imagine, for example, that Champollion, and
the French and Tuscan literati when engaged in exploring the
antiquities of Egypt, had visited that country with a firm belief
that the banks of the Nile were never peopled by the human race
before the beginning of the nineteenth century, and that their
faith in this dogma was as difficult to shake as the opinion of
our ancestors, that the earth was never the abode of living
beings until the creation of the present continents, and of the
species now existing,--it is easy to perceive what extravagant
systems they would frame, while under the influence of this
delusion, to account for the monuments discovered in Egypt. The
sight of the pyramids, obelisks, colossal statues, and ruined
temples, would fill them with such astonishment, that for a time
they would be as men spell-bound--wholly incapable of reasoning
with sobriety. They might incline at first to refer the
construction of such stupendous works to some superhuman powers
of the primeval world. A system might be invented resembling that
so gravely advanced by, Manetho, who relates that a dynasty of
gods originally ruled in Egypt, of whom Vulcan, the first
monarch, reigned nine thousand years; after whom came Hercules
and other demigods, who were at last succeeded by human kings.