CHAPTEE XIV. 



NOMA. 



THE most violent of the local effects of bacteria are seen in 

 various affections which terminate in gangrene, such as traumatic 

 gangrene and noma. Here, it is not a case of death of the tissues 

 as the result of violent inflammation, so much as a direct killing of 

 them by the ptomaines of the bacteria. In acute progressive gan- 

 grene, bacilli have been found which are apparently the cause of 

 the disease. In noma, long bacilli are present, which Lingard 

 has demonstrated to be the cause of the disease. In gangrenous 

 stomatitis in the calf, which affects this animal at particular seasons, 

 he has found bacilli which are very similar in appearance to those 

 present in noma in man. On cultivation they present characters 

 which render them easily distinguishable from other bacteria, and 

 on inoculation of these organisms into the calf a gangrenous sto- 

 matitis is again produced. 



Rauke's (" Etiology and Pathological Anatomy of Gangrene 

 resulting from Noma," Archives of Pediatrics, April, 1888) inves- 

 tigations on noma led to the following conclusions : Different forms 

 of gangrene resulting from noma can unquestionably occur sponta- 

 neously in children who have a tendency to disease of this character 

 that is, without contact with other cases of noma. The frequent 

 occurrence of cases of noma in public institutions, and the apparent 

 preference of the disease for localization upon the mucous membrane 

 of the different openings of the body, suggest that the origin of it 

 may be referred to the penetration from without of microorganisms. 

 In the zone of tissue contiguous to that which has undergone 

 necrosis from noma may be found cocci which have almost the 

 characteristics of a pure culture. At the periphery of the necro- 

 biotic zone which has been invaded by cocci the connective-tissue 

 is found to be in an active state of nuclear proliferation. The 

 entire condition is suggestive of the tissue necrosis in field mice, 

 which is caused by a chain coccus, and has been described by Koch. 

 Up to the present time the specific nature of the cocci which are 

 found in noma has not been shown. In the tissues which limit 

 the necrotic areas are found peculiar degenerative processes in the 

 nuclei which in some cases suggest karyokinesis. These changes 

 in the nuclei appear to belong to necrosis in general. 



