THE PRESENCE OF THE MICROCOCCUS IN THE BLOOD OF MA- 
LIGNANT MEASLES: ITS IMPORTANCE IN TREATMENT. 
Read before the College of Physicians of Pftfladelphia, June 7, 1882, 
BY JOHN M. KEATING, M.D., 
Lecturer on Diseases of Children in the University of Obstetrician to the Philadelphia Hospital. 
[REPRINTED FROM THE PHILADELPHIA MEDICAL TIMES FOR AUGUST 12, 1882.] 
I PROPOSE to present for your con- 
sideration this evening the report of a 
recent epidemic in the Children’s Asylum 
of the Philadelphia Hospital. The ward 
in which the disease first showed itself con- 
tained children between the ages of two 
and three years ; some of them had been 
deserted by their mothers, and others had 
been placed there temporarily whilst the 
mothers were employed in duties about the 
establishment. For the most part, these 
children presented a fair appearance of 
health; they were seemingly well nour- 
ished, of good development, though prob- 
ably they would have been classed as 
“strumous,” if their large features and 
tendency to glandular enlargements and 
eczematous eruptions had received careful 
attention. Together with all children of 
this class living in asylums, they certainly 
presented an open field for the production 
of those complications that are usually 
such fatal attendants upon measles. 
In order to save time, I shall in this 
paper simply narrate the history of the 
cases. The little patients were zealously 
cared for by Dr. H. E. Campbell, Resi- 
dent Physician, to whom I am indebted 
for the record of the notes taken at each 
of my visits. 
I shall also embody in this report the 
investigation undertaken by Dr. Henry F. 
Formad, now well known as the patient 
and thorough investigator of the micro- 
scopic appearance of the blood in diph- 
theria, associated with Dr. H. C. Wood, 
under the auspices of the National Board 
of Health. Dr. Formad examined almost 
daily the blood of each little patient, and 
together we noted the presence of micro- 
cocci in the malignant cases, and their 
absence in those of mild type. A record of 
these examinations was kept by Dr. W. A. 
Edwards, Assistant Pathologist, as also the 
records of the post-mortem examinations, 
and to him I am indebted for them. We 
entered this study with no preconceived 
views: the rapidity with which this ex- 
ceedingly fatal epidemic came upon us 
necessitated careful study in order to at- 
tempt, if possible, to discover its cause. I 
present also some photographs, which show 
well the appearance of the field in these 
cases. 
Case I.—J. F., aged 2 years and 3 months, 
was taken sick April 12, 1882. There had 
been no cases of well-defined measles in the 
house at that time, although it was epidemic 
in the city. The child had a sore throat, 
some cough, with fever. The throat-erup- 
tion was punctated and well marked. The 
child died in convulsions April 15, 1882. 
Autopsy.—An ante-mortem (chicken-fat) 
clot was found in the right heart, extending 
into the pulmonary artery. There was great 
systemic venous engorgement. A decided 
staining was noticed upon the cadaver, espe- 
cially about the temple, which caused the re- 
mark that the disease was probably one of 
the exanthemata. This child had been placed 
upon carbonate of ammonia, quinia, and digi- 
talis ; had had bromide of potassium, hot 
baths, and stimulants in small quantities. 
Case II.—M. J., aged 3 years and 5 months, 
was taken sick April 9, 1882. A slight erup- 
tion on the face was noted April 11, 1882 ; the 
next day the eruption was complete over the 
entire body. In this case the eruption was 
irregular, was decidedly that of measles, but 
of malignant type. Still, she did well until 
April 17, 1882, when suddenly the breathing 
became harsh, and pulse was rapid. At 4.30 
p.m. had an attack of suffocation, with rapid 
feeble pulse. There was general venous en- 
gorgement ; the face and lips were purple; 
pulse growing more rapid. Hot baths with 
mustard and frictions were used, and car- 
bonate of ammonia and digitalis given. It 2 
MICROCOCCUS IN THE BLOOD 
was suggested to bleed in this case, but the 
evidences of heart-clot were so marked, and 
the child had exhibited so many evidences of 
malignancy at the onset, that baths were used 
instead. April 11, 1882, at 3 a.m., she was still 
growing worse despite treatment, and shortly 
after had a violent convulsion and died. 
There was no autopsy permitted. 
Case III.—A. G., aet. 16 months. Took sick 
April 15, 1882. 
April 16 had prodromes of measles. The 
temperature and pulse ran as follows : 
16th. P.M. 102°. 
17th. a.m. ioi°, p.m. 103°, pulse 180. 
18th. a.m. 1020, p.m. 103°, pulse 180. 
19th. a.m’. ioi°, p.m. 1020, pulse 160. 
20th. A.M. IOI°, P.M. 102°, pulse 148. 
21st. A.M. IOO°, P.M. ioo°, pulse 180. 
In this case no defined eruption appeared 
on the body, although there was a decided 
papular eruption on the uvula and anterior 
half-arches of the throat. Whilst showing 
this case to the class, we noted streaks of 
grayish membrane in the fauces. The child 
had decided bronchitis, and the voice showed 
that the laryngeal mucous membrane was also 
affected. This child was not at that time very 
ill. There was no question in our minds at 
the time that it was affected severely by the 
measles poison,—that it was, in fact, another 
malignant case. It was carefully watched, 
the nourishment regularly given with quinia 
and iron daily, as was customary in all the 
cases. 
On the 21 st the breathing was noted as 
peculiar (I shall describe it hereafter). An 
emetic was ordered of ipecac, fearing an ac- 
cumulation of mucus from the bronchitis 
present, and also carbonate of ammonia and 
digitalis and hot foot-baths were given. The 
child’s intelligence seemed good, and it will 
be noted that the temperature was but ioo°, 
while the pulse was 180. 
At 8 p.m. a second attack of suffocation oc- 
curred, and the child died in violent convul- 
sions. The venous engorgement was very 
marked. 
Autopsy.—A. G., baby, aged 1 year. Post- 
mortem examination held ten hours after 
death. 
Heart. Left side and valves all normal. 
Right side. A large ante-mortem clot filling 
the cavity of the right ventricle, and extend- 
ing into the auricle; a clot was also seen in 
the pulmonary artery. 
Limgs. Left, normal. 
Right lung. At the base of this lung the 
lesions of pulmonary congestion were seen, 
especially where the lung approximates the 
diaphragm. 
Intestines. Slightly congested and hyper- 
aemic. 
Mesenteric glands. Enlarged and infiltrated 
by simple congestion. 
Kidneys. Normal. 
Blood. Taken from the heart-cavity as soon 
as it was opened and examined showed micro- 
cocci in the liquor sanguinis and in the white 
blood-corpuscles. 
Case IV.—J. F. McH., aet. 23 months. This 
child had a typical attack of measles. The 
case was shown to my ward class several 
.times throughout its course, the eruption was 
studied carefully in all of its details, and my 
friend Dr. John M. Taylor obtained for me 
an excellent representation of the measles 
in water-colors from this case. I refer espe- 
cially to these points as evidence that the 
epidemic was one of measles : the cases here- 
tofore were so irregular as to leave room for 
doubt to those hearing the recital of their his- 
tories. The eruption was rapidly disappear- 
ing, and desquamation had set in. April 21 
the bronchitis seemed to be aggravated, the 
respirations were 36, and expirations seemed 
unusually prolonged. The breathing was 
noisy ; the heart’s action was rapid, pulse 148. 
Suddenly, in the evening, an attack of suffo- 
cation came on, which was relieved by an in- 
halation of nitrite of amyl. On the morning 
of April 22 the heart was beating 168; the 
venous engorgement was very marked, the 
jugular veins standing out like whip-cords, 
the respirations were from 36 tp 40, but the 
temperature was 990. I saw the child at this 
time, and noted the gasping breathing, the 
feeble pulse, and the tumultuous action of 
the heart. There seemed to be capillary 
spasm, judging from the gasping breath, the 
imploring look which the child gave to all its 
attendants, and we at once gave an inhalation 
of nitrite of amyl. In a few moments it seemed 
relieved. The administration of carbonate of 
ammonia, digitalis, hot baths, etc., was rigidly 
adhered to. The child seemed comfortable 
until 4.30 P.M., when it had another attack of 
milder character, though longer duration, and 
in it finally died of convulsions. It was ob- 
served, says Dr. Campbell in his notes, that 
the convulsion was not as severe as in the 
previous cases. 
Autopsy.—]. F. McH., post-mortem made 
twenty hours after death. 
Eruption not well marked. 
Heart. Right ventricle contained a small 
ante-mortem clot. This clot was in the cav- 
ity of the ventricle, and did not involve the 
valves, either tricuspid or pulmonary. The 
left side of the heart was normal in every re- 
spect; contained no clot. 
Lungs. Normal, with the exception of hypo- 
static congestion at both bases. The pul- 
monary and costal pleura of the left side were 
inflamed and adherent in some places. 
Trachea. Inflamed, and containing a tena- 
cious mucous secretion. 
Lary7ix. Inflamed and hyperaemic. 
Liver. Normal. 
Intestmes. Peyer’s patches and the solitary 
and agminated glands infiltrated and hyper- 
aemic. 
Mesenteric glands. Enlarged and infil- OF MALIGNANT MEASLES. 
3 
trated; they were about the size of a grain of 
corn. 
Kidneys. Normal. 
Spleen. Amyloid bodies enlarged until they 
presented almost the appearance seen in a 
tubercular spleen. 
Blood. Taken from heart as soon as punc- 
tured. Micrococci were found in the liquor 
sanguinis and in the white blood-corpuscles, 
and they were mobile. In the corpuscles they 
were seen in great numbers in active movement 
of a vibratory or whirling character, and they 
appeared to have devoured the white cells. 
No bacilli were seen. 
Case V.—J. McG., aet., 26 months. Or- 
dinary case of measles. The eruption had 
disappeared on or before April 15. 
April 22. Child restless; marked bron- 
chitis ; cough paroxysmal upon waking, espe- 
cially after excitement; mucous rales coarse, 
and fine throughout lungs posteriorly; throat 
congested, and saliva at times tinged with 
blood. At this date the breathing was noted 
as noisy. Pulse 144, respirations 32, tempera- 
ture ioo°. 
April 23. Mucous rales becoming general, 
and not limited to areas as heretofore ; pulse 
152, respirations 34, temperature ioi°. In 
addition to the tonic and stimulating treat- 
ment, mustard poultices were applied to thorax 
and hot baths frequently given. Carbonate 
of ammonia was given now, gr. ij, every hour, 
and bisulphate of quinia by suppository, 
gr. ij, every three hours. In addition to this, 
the child was given, as were all the others, 
milk and lime-water, beef-tea, etc., at fre- 
quent intervals. We also used in this case 
the frequent administration of small doses of 
syr. ipecac to relieve the secretion, which was 
abundant and tenacious. 
April 23. Evening. Pulse was rapid, 160 to 
170; temperature 1022° ; breathing becoming 
labored and gasping (fish-like); venous stasis 
was becoming more marked. Increased the 
whiskey to about one ounce a day. The at- 
tacks of suffocation continued paroxysmally: 
the jugular veins stood out like cords at times. 
Nitrite of amyl gave immediate relief, but re- 
lapse soon followed; it was always followed 
by free emesis, which seemed to be in itself 
beneficial. About midnight a severe parox- 
ysm came on, and with it a convulsion, in 
which the child died. After death the venous 
engorgement was more marked, and heart- 
clot had been suspected for sometime before. 
This little patient was the first case whose 
blood Dr. Formad examined during life. The 
view of the fluid was photographed; micro- 
cocci were found in great abundance, acting 
especially on the white corpuscles. The blood 
was examined very shortly before the child’s 
death, when the symptoms of heart-clot had 
been fairly established, and the case declared 
hopeless. 
Unfortunately, no autopsy was permitted in 
this case. 
Case VI.—F. M., aged i\ years. This case 
ran a course as did the others, and I will only 
occupy time with a description of the post- 
mortem appearances. 
Eruption well marked on mucous mem- 
brane of buccal cavity, not so on cutaneous 
surface. 
Upon laying thorax open, lungs found to 
be anaemic, as far as arterial circulation was 
concerned, but dammed up with venous 
blood. 
Heart. Normal in size and weight. 
Right side contained a clot extending along 
the pulmonary artery for some distance: it 
was chicken-fat in consistence. 
Leftside. Normal. 
Spleen. Congested ; weight four ounces. 
Intestines. Along the small intestine could 
be seen a few Peyer’s patches inflamed, and 
well outlined against the comparatively nor- 
mal gut. The mesenteric glands presented a 
very good example of enlargement and infil- 
tration ; they looked like so many peas scat- 
tered throughout the mesentery. 
Liver. Normal. 
Kidneys. Normal. 
Brain. Not examined. 
Blood. Taken from heart-cavity as soon as 
it was open showed micrococci in the liquor 
sanguinis and in the white blood-corpuscles, 
in abundance; they were not mobile. A 
number of zoogloea masses were seen. 
Case VII.—C. M., aged 2J years. The 
eruption in the throat of this child was very 
well marked. A few crescentic points ap- 
peared in the temples, and the case rapidly 
developed malignant symptoms. 
April 21. Slight grayish suspicious patches 
of membrane are seated in the throat. The 
child is hoarse, and there is much bronchitis. 
April 22. Pulse rapid; respiration 28; 
breathing irregular. There is great general 
venous stasis, the skin dark and mottled. 
Dr. Formad examined the blood micro- 
scopically, and found it full of micrococci. 
He took a specimen sample for photography. 
Prognosis very unfavorable, as the child has 
fluttering heart and gasping breathing. Hot 
baths had been used freely with no success, 
so also salicylic acid, which had been sug- 
gested early in the disease. 
After consultation with Dr. Formad, the ac- 
count of which I incorporate in the summary, 
it was concluded to give at once 3ij of whis- 
key, and repeat it every hour; milk was con- 
tinued as the only other food. 
April 24. Pulse 144, temperature ioi°, res- 
piration 48. Circulation much improved. 
Venous engorgement relieved ; breathing 
greatly improved. The child continued to 
improve during the day. At the end of the 
twenty-four hours it had taken six ounces 
of whiskey, and yet it showed no effects of 
alcoholism. At noon the pulse was 140, res- 
piration 36 ; 6 p.m. pulse 132, respiration 32 ; 
I 11 p.m. pulse 132, respiration 26, and regular,’ 4 
MICROCOCCUS IN THE BLOOD 
breathing easy, though somewhat noisy, but 
not harsh. 
April 25. a.m., temperature 98°, pulse 128, 
respiration 26; p.m., temperature 98°, pulse 
108, respiration 24. 
April 26. a.m., temperature 98°, pulse 96, 
respiration 22 ; p.m., temperature 98°, pulse 
104, respiration 24. 
The respirations remained regular, and the 
child continued to improve. 
After the examination of the blood on April 
30, owing to the relative increase of the white 
corpuscles, it was decided to give Fowler’s 
solution of arsenic, gtt. ij, three times daily. 
The large doses of whiskey were kept up for 
three or four days, and gradually diminished. 
I give Dr. Formad’s reports, which he 
kindly wrote out for me : 
Microscopic examination of the blood in 
the above case. (Examination made with a 
one-sixteenth immersion lens.) 
Examination April 22, 1882.—Blood full of 
micrococci (sphero-bacteria), affecting many 
of the white blood-corpuscles ; also a large 
quantity of these fungi free and in various 
forms of grouping, mostly in zoogloea masses. 
White blood-corpuscles are in increased 
quantity ; precipitation of fibrin excessively 
marked under the glass. 
April 24. (Same case.) Micrococci pres- 
ent, but in diminished quantity ; white blood- 
corpuscles less affected; precipitation of 
fibrin less marked. 
April 26. (Same case.) Micrococci very 
marked, yet principally in zoogloea masses 
and free in serum, but not affecting the white 
corpuscles, although the latter are in increased 
quantity ; fibrin not noticeable. 
April 30. (Same case.) Micrococci pres- 
ent ; white blood-corpuscles still in excess, 
but not affected by micrococci. Red blood- 
corpuscles not readily forming rouleaux, 
having lost partly their biconcavity. 
May 3. (Same case.) Micrococci present in 
diminished quantity. W’hite blood-corpuscles 
diminishing in quantity. 
May 7. (Same case.) Same as last. 
May 18. (Same case.) Still some few 
micrococci present; blood otherwise appears 
normal. 
Case VIII.—J. W., aet. 8 months. May 
13, P.M. Eruption appeared on fifth day. 
The temperature ran as follows: 
May 13. a.m. , p.m. ioo;!0. 
May 14. a.m. ioif0, p.m. io2f°. 
May 15. a.m. ioi°, p.m. 103!0. 
May 16. a.m. ioi§°, p.m. 104°. 
May 17. A.M. ioi°, P.M. 102J0. 
May 18. a.m. 1020, p.m. 103!0. 
May 19. a.m. ioo°, p.m. 103°. 
May 20. a.m. 103I0, p.m. 1020. 
May 21. A.M. 105°, death. 
May 13. A fever mixture was given during 
the day. Quiniae et ferri citratis, gr. ij, every 
three hours. 
May 18. The eruption fading, but leaving 
a purple stain and mottled appearance of 
skin. Catarrhal pneumonia or collapse prob- 
ably exists, as the bronchitis is very extensive, 
the rales numerous, and subcrepitant. The 
blood examined under the microscope shows 
micrococci in the blood-corpuscles, but none free 
in the field. They are seen in great numbers. 
May ig, p.m. For the past two hours the 
child has been very restless, the breathing 
rapid and labored, and also spasmodic. No 
membrane on tonsils or fauces. Heart’s action 
very rapid, venous stasis marked, especially 
in the jugular veins. Gave hot baths (say 
Dr. Campbell’s notes), and covered him with 
blankets, with sopie relief. Increased the 
whiskey to 3>j every hour. 
In the evening gave an emetic. The child 
at night was breathing easier ; friction-sounds 
heard. 
May 20. At times strangulation would 
seem imminent. The venous engorgement 
increased, and the child died in convulsions 
on the morning of the 21st. 
The post-mortem examination showed pneu- 
monia and pleurisy with effusion. 
The following eight cases were all taken 
sick at once, and I shall simply give a 
general statement of them for the purpose 
of especially calling attention to the case 
of W. L. : 
J. J., aged 4 years; W. L., aged 5 years; 
E. C., aged 3 years, catarrhal bronchitis; 
W. W., aged 3 years; C. B., aged 2 years, 
catarrhal bronchitis; J. W., aged 5 years; 
J. D., aged 5 years; L. K., aged 5 years. 
Of these eight, seven presented severe but 
nevertheless typical examples of measles, and 
their blood was carefully examined by Dr. 
Formad and found normal. The case of 
W. L., who was taken ill at the same time as 
the others, showed from the onset a malignant 
tendency, giving a record such as I have al- 
ready described. Dr. Formad gave me the 
following as the result of the examination of 
the blood in this case, and I had frequent oc- 
casion of examining it with him myself. Let 
me say that as soon as the presence of micro- 
cocci was established, the child was placed 
upon 3>j doses of whiskey every hour, quiniae 
et ferri citratis in citric acid, gr. ij, every three 
hours, friction to the extremities, and warm 
baths, with milk and beef-tea. 
April 22. A few micrococci seen in the 
field. 
April 26. Again noted. 
April 30. Micrococci still present; white 
corpuscles increased, and marked precipita- 
tion of fibrin. None were noted as having 
penetrated the corpuscles; those that were 
found were simply in the serum. This chdd 
recovered, though every indication gave a 
very unfavorable prognosis. 
In presenting this detailed report I de- 
sire to call especial attention to the fol- OF MALIGNANT MEASLES. 
5 
lowing points,—viz., the microscopic ex- 
amination of the blood and the constant 
association of micrococci with the general 
manifestations of malignancy (a condition 
already well known), and the gradual but 
positive amelioration of all bad symptoms 
by treatment which was directed to the 
micrococci as the fons et origo of trouble 
(this, I believe, for the first time ex- 
hibited). 
It will be noted that the post-mortem 
examinations of these cases showed more 
or less simple pulmonary congestion, and 
at times simple enlargement of the glands, 
but usually so circumscribed as to preclude 
the possibility of its being the immediate, 
or even remote, cause of death. Again, 
the mode of death was peculiar: the fatal 
signs came on suddenly and with frightful 
intensity, the gasping breathing, the fran- 
tic efforts to obtain air (or really to aerate 
the blood), the imploring look, with con- 
sciousness not impaired, seemingly unduly 
acute, until the final convulsion or gradual 
cyanosis brought the end. The turgid 
veins, the occasional venous engorgement, 
the feeble pulse, and the fluttering heart 
pointed unmistakably to but one cause, 
the gradually forming right-sided heart- 
clot ; and the post-mortem appearances, as 
these notes show, gave us a large, tough, 
chicken-fat clot, obstructing the venous 
circulation, firmly planted in the right 
heart and its tributaries, which was too 
often exhibited to raise a question. One 
of the earliest symptoms of this impending 
danger was undue rapidity of respiration. 
The child seemed to be doing well, its 
eruption irregular, probably incomplete, 
or dark and mottled, and in blotches, 
when attention would be called to the great 
rapidity of respiration with a peculiar gasp- 
ing inspiration, fish-like in character. The 
other fatal symptoms would follow rapidly, 
and within twelve hours the child, despite 
carbonate of ammonia, warm baths, digi- 
talis, etc., would die of heart-clot. What 
caused this? 
In a short paper which appeared in the 
American Journal of the Medical Sciences 
for January, 1882, I gave the experience of 
a number of cases of diphtheria, scarlet 
fever, and measles, and then attributed 
the condition to an increase of fibrin due 
to the rapid tissue-changes and the malig- 
nancy of the type of disease, and urged 
the importance of pushing an alkaline 
treatment from the start. 
The microscope has shown here that 
something more is associated with this 
condition. 
The moment that symptoms of malig- 
nancy—viz., dark eruptions, feebly-defined 
crescents, delayed and imperfect appear- 
ance .of the eruption, with feeble circula- 
tion, high temperature, and pharyngeal 
false membrane—appeared, the examina- 
tion of the blood showed micrococci in 
abundance in the field. They do not simply 
lie as impediments to the free passage of 
blood, though they undoubtedly do this, 
and obstruct its passage in capillaries, but 
they surround the corpuscles, they enter the 
white corpuscles, and there develop with 
surprising rapidity, and finally cause some 
of them to rupture, and their contents will 
cover the field. Still, if they alone clogged 
the circulation in the capillaries, caused 
stasis in the lung, and thereby provoked 
an accumulation in the already enfeebled 
right heart, with blood having a tendency 
to coagulate, the cause of heart-clot alone 
would seem explained. 
We find that they develop with activity 
when the blood-current is retarded ; hence 
we find them spread throughout the heart- 
clot itself, possibly at times having been 
here arrested by the obstruction to the flow 
caused by the lung-congestion known as a 
frequent complication of these cases, and 
finally aiding, by a mechanical cause alone, 
the deposition of fibrin that forms the 
clot. They do more. They act upon the 
white blood-corpuscle, destroy it in all 
probability, or, at least, as one of the cases 
proves conclusively, prevent its change to 
red corpuscles, and thus, the oxygen-car- 
riers being either destroyed or reduced in 
numbers, with none to replace them, the 
tissues retain their detritus for want of car- 
riers to relieve them, and another factor is 
added to increase mortality. 
Granted, then, that the appearance of 
7iiicrococci is coincident with symptoms of 
malignancy, we must assert that, whether 
their association be post hoc ox propter hoc, 
they must have common cause; our treat- 
ment receives an impetus in a new direc- 
tion. 
I asked Dr. Formad what, in his experi- 
ence, most readily checked the develop- 
ment of micrococci in his culture solutions 
obtained from erysipelas, diphtheria, etc. 
He answered, alcohol. Dr. Campbell at 
once withdrew carbonate of ammonia and 
digitalis from the treatment for the future, 6 
MICROCOCCUS IN THE BLOOD 
and gave whiskey. Five children had al- 
ready died with the symptoms I have just 
described, and the sixth was exhibiting all 
the malignant symptoms, together with 
those which experience had taught us came 
from commencing heart-clot. The child 
had rapid gasping breathing, was becqming 
cyanosed, its heart was tumultuous, and 
the rapid pulse was growing weaker. The 
instructions were to give three ounces of 
whiskey within the next twelve hours, in 
frequent and small doses. The treatment 
was carefully carried out, and the child was 
saved. In this child micrococci were found 
in abundance in the blood, but none had 
penetrated the corpuscles, and for a long 
time the preponderance of white blood- 
corpuscles was noted, which continued 
until gradually the blood became normal 
under the use of arsenic. 
Again, let me illustrate another point. 
In one ward there were six cases at the 
height of eruption. I carefully examined, 
with Drs. Campbell and Markoe, each 
case. One case was found to be of a ma- 
lignant type. The child’s right cheek 
was hardened and inflamed, and the mu- 
cous membrane showed that glistening 
surface so manifest in cancrum oris. The 
breath was fetid, there were cerebral symp- 
toms, and a grayish exudation lined the 
fauces. We wished to test the microscope, 
so, without reference to any particular 
case, we requested Dr. Formad to examine 
the blood of all. In five the blood showed 
no micrococci, in one a large mass appeared 
in the field upon the first examination, and 
this one was the malignant case. This 
child was placed at once upon large doses 
of whiskey, and it was also given, in tonic 
doses, quini« et ferri citratisand citricacid. 
The vegetable acids have also this re- 
markable effect of checking the develop- 
ment of micrococci in culture solutions, 
especially acetic acid, but the mineral 
acids, also carbolic acid, it is said, have 
no such action. 
The bichloride of mercury also possesses 
this quality to a very marked degree. 
Now let me, for a moment, review this 
subject in the light of treatment, which to 
us is certainly of greatest importance. We 
may look at present upon the micrococcus 
as associated with the malignant symptoms 
of all complications known as “blood- 
poisoning.” It is found in erysipelas, in 
puerperal septicaemia, in diphtheria, and 
in malignant measles. Experience has al- 
ready taught us that alcohol, the vegetable 
acids, calomel, or corrosive sublimate, are 
the drugs per sc in septicaemia. 
The action of alcohol and calomel is too 
well authenticated in puerperal septicaemia 
to doubt their efficacy. 
We know of late how surprising a result 
will often attend the use of alcohol and 
corrosive sublimate in malignant diphtheria, 
and also the value of vegetable acids, es- 
pecially lemon-juice and claret, in this 
dreaded disease. 
My cases simply illustrate one part of 
the subject. In this recital I do not allude 
to the other death-producing complications 
which are so universal. Children with 
measles will die of cerebral complications, 
of pneumonia, of enteritis, and entero-coli- 
tis: with these we have nothing to do at 
present. Their treatment will, of course, 
depend upon the lesions: quinine, opium, 
hot baths, poultices, will all take part. 
I have simply brought forward the sub- 
ject of “ blood-porsoning” for your con- 
sideration, and, as these remarks are based 
upon the careful study of but one epidemic, 
they cannot be submitted as conclusive, but 
simply as illustrative of what may at some 
future time be accomplished by studying, 
not merely the bacteria anatomically and 
physiologically, but by experimentation 
with bactericides as antidotal in their action 
in diseases they may cause or complicate. 
The conclusions which seem warranted 
by the statements of this paper, and by 
observations made in other cases in the 
hospital, are as follows : 
The micrococcus is found in the contents 
of pustules and vesicles, and also in the 
blood taken from the measles-papule in 
ordinarily mild cases, without its being 
present in the blood taken from the punc- 
tured finger. In severe cases, called ma- 
lignant in this paper, owing to the rapid 
appearance of morbid symptoms, the blood 
shows early in the attack numerous patches 
of micrococcus in the field. 
In cases of rapid sthenic disease with 
high temperature and great tissue-change, 
the evidences of large quantities of fibrin 
with a tendency to coagulation are mani- 
fest. The rapid production of micrococci 
soon gives the mechanical impediment, 
and if stasis takes place from any other 
obstruction to the circulation, clots rap- 
idly form. 
The non-appearance of clots in malig- 
nant fevers attended with fluid blood, such OF MALIGNANT MEASLES. 
as low forms of typhus, diphtheria, etc., 
is simply due to the fact that rapid tissue- 
changes have resulted in decomposition, 
instead of into fibrin-forming substances, 
—no fibrin is formed, hence no clots,— 
but the micrococci are present all the 
same. These cases are held by some to 
be the malignant ones, but I think the 
foudroyante character of the others, just 
mentioned, entitles them to be placed in 
the same category. 
But the micrococcus, if left unheeded, 
may attack the white corpuscle as dis- 
tinctly seen under the microscope, and 
destroy its contents. The red cells also 
change in appearance, and finally prob- 
ably become, to all intents and purposes, 
useless in the economy. When such a 
condition is seen by the microscope and 
found extensive, a fatal prognosis can be 
given, despite the most active treatment. 
In cases where the white blood-cells are 
as yet unaffected, treatment, when active, 
will be followed by good results, provided 
the other complications, as visceral inflam- 
mation, etc., are not in themselves ex- 
cessive. 
Alcohol (whiskey in our cases) seems in 
some way, when given in large amounts, 
to check the progress of the marauders, to 
arrest the process of destruction, and, if 
needful, can be associated with quinine 
and iron in small repeated doses, digitalis 
perhaps, and frictions, baths and poultices, 
etc. As we have seen, the symptoms pre- 
sented are contemporary with the changes 
going on within the blood ; they may, in 
lieu of a careful microscopic examination 
of the blood, be taken as a gauge for treat- 
ment ; knowing what can and will take 
place, early active treatment will give the 
patient some chance for the future.