376 'BACILLUS PATHOGENIC IN MAN 



the body. The pyocyaneus bacillus produces these effects not only 

 through ferments, but by intracellular toxins. 



Our knowledge of the pathogenic importance of the bacillus pyo- 

 cyaneus in human diseases has been much increased by recent inves- 

 tigations. Thus, cases have been reported in which this bacillus has 

 been obtained in pure culture from pus derived from the tympanic 

 cavity in disease of the middle ear, from cases of ophthalmia, and 

 bronchopneumonia. Kruse and Pasquale have found the same micro- 

 organism in three cases of idiopathic abscess of the liver, in two of them 

 in immense numbers and in pure culture. Ernst and Schiirmayer 

 report the presence of the bacillus pyocyaneus in serous inflammation 

 of the pericardial sac and of the knee-joint. Ehlers gives the history of 

 a disease in two sisters who were attacked simultaneously with fever, 

 albuminuria, and paralysis. It was thought that they would prove to 

 be typhoid fever or meningitis, but on the twelfth day there was an 

 eruption of blisters, from the contents of which the bacillus pyocyaneus 

 was isolated. Jadkewitsch reports the case of a patient suffering from 

 eczema of the lower extremities, in whom three times during a period 

 of ten years there was eruption of boils containing blue pus, with accom- 

 panying symptoms of poisoning, emaciation, prostration, diarrhoea, 

 and paresis. Krambals refers to seven cases in which a general pyocy- 

 aneus infection occurred, and adds an eighth from his own experience. 

 In this the bacillus pyocyaneus was obtained post-mortem from green 

 pus in the pleural cavity, from serum in the pericardial sac, and from 

 the spleen in pure culture. Schimmelbusch states that a physician 

 injected 0.5 c.c. of sterilized (by heat) culture into his forearm. As a 

 result of this injection, after a few hours he had a slight chill, followed 

 by fever, which at the end of twelve hours reached 38.8 C.; an erysipe- 

 latous-like swelling of the forearm occurred, and the glands in the 

 axilla were swollen and painful. Wasserman reports an epidemic of 

 septic infection of the newborn, starting in the umbilicus. In all there 

 were eleven deaths. Lartigau found it in well-water, and in great 

 abundance in the intestinal discharges of a number of cases made ill by 

 drinking the water. It has also been found in a certain number of 

 cases of gastroenteritis, where no special cause of infection could be 

 noted. 



We may, therefore, conclude from these facts that the bacillus pyo- 

 cyaneus, although ordinarily but slightly pathogenic for man, may 

 under certain conditions become a dangerous source of infection. 

 Children would seem to be particularly susceptible. 



The differential diagnosis of the pyocyaneus from other fluorescing 

 bacteria is easy enough as long as it retains its pigment-producing 

 property. When an agar culture is agitated with chloroform a blue 

 coloration demonstrates the presence of this bacillus. When the 

 pyocyanin is no longer formed, however, the diagnosis is by no means 

 easy, particularly when the pathogenic properties are also gone. 



