The Story of Germ Life Part 5

These poisons, produced in the first stages of putrefaction, are oxidized by further stages of decomposition into harmless products. But should it happen that some of these bacteria obtained a chance to grow vigorously for a while in organic products that are subsequently swallowed as man's food, it is plain that evil results might follow. If such food is swallowed by man after the bacteria have produced their poisonous bodies, it will tend to produce an immediate poisoning of his system. The effect may be sudden and severe if considerable quant.i.ty of the poisonous material is swallowed, or slight but protracted if small quant.i.ties are repeatedly consumed in food. Such instances are not uncommon. Well-known examples are cases of ice-cream poisoning, poisoning from eating cheese or from drinking milk, or in not a few instances from eating fish or meats within which bacteria have had opportunity for growth. In all these cases the poison is swallowed in quant.i.ty sufficient to give rise quickly to severe symptoms, sometimes resulting fatally, and at other times pa.s.sing off as soon as the body succeeds in throwing off the poisons. In other cases still, however, the amount of poison swallowed may be very slight, too slight to produce much effect unless the same be consumed repeatedly. All such trouble may be attributed to fermented or partly decayed food. It is difficult to distinguish such instances from others produced in a slightly different way, as follows:

It may happen that the bacteria which grow in food products continue to grow in the food even after it is swallowed and has pa.s.sed into the stomach or intestines. This appears particularly true of milk bacteria. Under these conditions the bacteria are not in any proper sense parasitic, since they are simply living in and feeding upon the same food which they consume outside the body, and are not feeding upon the tissues of man. The poisons which they produce will continue to be developed as long as the bacteria continue to grow, whether in a milk pail or a human stomach. If now the poisons are absorbed by the body, they may produce a mild or severe disease which will be more or less lasting, continuing perhaps as long as the same food and the same bacteria are supplied to the individual. The most important disease of this cla.s.s appears to be the dreaded cholera infantum, so common among infants who feed upon cow's milk in warm weather. It is easy to understand the nature of this disease when we remember the great number of bacteria in milk, especially in hot weather, and when we remember that the delicate organism of the infant will be thrown at once into disorder by slight amounts of poison which would have no appreciable effect upon the stronger adult. We can easily understand, further, how the disease readily yields to treatment if care is taken to sterilize the milk given to the patient.

We do not know to-day the extent of the troubles which are produced by bacteria of this sort. They will, of course, be chiefly connected with our food products, and commonly, though not always, will affect the digestive functions. It is probable that many of the cases of summer diarrhoea are produced by some such cause, and if they could be traced to their source would be found to be produced by bacterial poisons swallowed with food or drink, or by similar poisons produced by bacteria growing in such food after it is swallowed by the individual. In hot weather, when bacteria are so abundant everywhere and growing so rapidly, it is impossible to avoid such dangers completely without exercising over all food a guard which would be decidedly oppressive. It is well to bear in mind, however, that the most common and most dangerous source of such poisons is milk or its products, and for this reason one should hesitate to drink milk in hot weather unless it is either quite fresh or has been boiled to destroy its bacteria.

PATHOGENIC BACTERIA WHICH ARE TRUE PARASITES.

This cla.s.s of pathogenic bacteria includes those which actually invade the body and feed upon its tissues instead of living simply upon swallowed food. It is difficult, however, to draw any sharp line separating the two cla.s.ses. The bacteria which cause diphtheria (Fig. 28), for instance, do not really invade the body.

They grow in the throat, attached to its walls, and are confined to this external location or to the superficial tissues. This bacillus is, in short, only found in the mouth and throat, and is practically confined to the so-called false membranes. It never enters any of the tissues of the body, although attached to the mucous membrane. It grows vigorously in this membrane, and there secretes or in some way produces extremely violent poisons. These poisons are then absorbed by the body and give rise to the general symptoms of the disease. Much the same is true of the bacillus which causes teta.n.u.s or lockjaw (Fig. 29). This bacillus is commonly inoculated into the flesh of the victim by a wound made with some object which has been lying upon the earth where the bacillus lives. The bacillus grows readily after being inoculated, but it is localized at the point of the wound, without invading the tissue to any extent. It produces, however, during its growth several poisons which have been separated and studied. Among them are some of the most violent poisons of which we have any knowledge. While the bacillus grows in the tissues around the wound it secretes these poisons, which are then absorbed by the body generally. Their poisoning effects produce the violent symptoms of the disease. Of much the same nature is Asiatic cholera. This is caused by a bacillus which is able to grow rapidly in the intestines, feeding perhaps in part on the food in the intestines and perhaps in part upon the body secretions. To a slight extent also it appears to be able to invade the tissues of the body, for the bacilli are found in the walls of the intestines. But it is not a proper parasite, and the fatal disease it produces is the result of the absorption of the poisons secreted in the intestines.

It is but a step from this to the true parasites. Typhoid fever, for example, is a disease produced by bacteria which grow in the intestines, but which also invade the tissues more extensively than the cholera germs (Fig. 30). They do not invade the body generally, however, but become somewhat localized in special glands like the liver, the spleen, etc. Even here they do not appear to find a very favourable condition, for they do not grow extensively in these places. They are likely to be found in the spleen in small groups or centres, but not generally distributed through it. Wherever they grow they produce poison, which has been called typhotoxine, and it is this poison chiefly which gives rise to the fever.

Quite a considerable number of the pathogenic germs are, like the typhoid bacillus, more or less confined to special places. Instead of distributing themselves through the body after they find entrance, they are restricted to special organs. The most common example of a parasite of this sort is the tuberculosis bacillus, the cause of consumption, scrofula, white swelling, lupus, etc.

(Fig. 31). Although this bacillus is very common and is able to attack almost any organ in the body, it is usually very restricted in growth. It may become localized in a small gland, a single joint, a small spot in the lungs, or in the glands of the mesentery, the other parts of the body remaining free from infection. Not infrequently the whole trouble is thus confined to such a small locality that nothing serious results. But in other instances the bacilli may after a time slowly or rapidly distribute themselves from these centres, attacking more and more of the body until perhaps fatal results follow in the end. This disease is therefore commonly of very slow progress.

Again, we have still other parasites which are not thus confined, but which, as soon as they enter the body, produce a general infection, attacking the blood and perhaps nearly all tissues simultaneously. The most typical example of this sort is anthrax or malignant pustule, a disease fortunately rare in man (Fig. 32).

Here the bacilli multiply in the blood, and very soon a general and fatal infection of the whole body arises, resulting from the abundance of the bacilli everywhere. Some of the obscure diseases known as blood poisoning appear to be of the same general nature, these diseases resulting from a very general invasion of the whole body by certain pathogenic bacteria.

In general, then, we see that the so-called germ diseases result from the action upon the body of poisons produced by bacterial growth. Differences in the nature of these poisons produce differences in the character of the disease, and differences in the parasitic powers of the different species of bacteria produce wide differences in the course of the diseases and their relation to external phenomena.

WHAT DISEASES ARE DUE TO BACTERIA?

It is, of course, an extremely important matter to determine to what extent human diseases are caused by bacteria. It is not easy, nor indeed possible, to do this to-day with accuracy. It is no easy matter to prove that any particular disease is caused by bacteria. To do this it is necessary to find some particular bacterium present in all cases of the disease; to find some method of getting it to grow outside the body in culture media; to demonstrate its absence in healthy animals, or healthy human individuals if it be a human disease; and, finally, to reproduce the disease in healthy animals by inoculating them with the bacterium. All of these steps of proof present difficulties, but especially the last one. In the study of animals it is comparatively easy to reproduce a disease by inoculation. But experiments upon man are commonly impossible, and in the case of human diseases it is frequently very difficult or impossible to obtain the final test of the matter. After finding a specific bacterium a.s.sociated with a disease, it is usually possible to experiment with it further upon animals only. But some human diseases do not attack animals, and in the case of diseases that may be given to animals it is frequently uncertain whether the disease produced in the animal by such inoculation is identical with the human disease in question, owing to the difference of symptoms in the different animals. As a consequence, the proof of the germ nature of different diseases varies all the way from absolute demonstration to mere suspicion. To give a complete and correct list of the diseases caused by bacteria, or to give a list of the bacteria species pathogenic to man, is therefore at present impossible.

The difficulty of giving such a list is rendered greater from the fact that we have in recent years learned that the same species of pathogenic bacterium may produce different results under different conditions. When the subject of germ disease was first studied and the connection between bacteria and disease was first demonstrated, it was thought that each particular species of pathogenic bacteria produced a single definite disease; and conversely, each germ disease was supposed to have its own definite species of bacterium as its cause. Recent study has shown, however, that this is not wholly true. It is true that some diseases do have such a definite relation to definite bacteria.

The anthrax germ, for example, will always produce anthrax, no matter where or how it is inoculated into the body. So, also, in quite a number of other cases distinct specific bacteria are a.s.sociated with distinct diseases. But, on the other hand, there are some pathogenic bacteria which are not so definite in their action, and produce different results in accordance with circ.u.mstances, the effect varying both with the organ attacked and with the condition of the individual. For instance, a considerable number of different types of blood poisoning, septicaemia, pyaemia, gangrene, inflammation of wounds, or formation of pus from slight skin wounds--indeed, a host of miscellaneous troubles, ranging all the way from a slight pus formation to a violent and severe blood poisoning--all appear to be caused by bacteria, and it is impossible to make out any definite species a.s.sociated with the different types of these troubles. There are three common forms of so-called pus cocci, and these are found almost indiscriminately with various types of inflammatory troubles.

Moreover, these species of bacteria are found with almost absolute constancy in and around the body, even in health. They are on the clothing, on the skin, in the mouth and alimentary ca.n.a.l. Here they exist, commonly doing no harm. They have, however, the power of doing injury if by chance they get into wounds. But their power of doing injury varies both with the condition of the individual and with variations in the bacteria themselves. If the individual is in a good condition of health these bacteria have little power of injuring him even when they do get into such wounds, while at times of feeble vitality they may do much more injury, and take the occasion of any little cut or bruise to enter under the skin and give rise to inflammation and pus. Some people will develop slight abscesses or slight inflammations whenever the skin is bruised, while with others such bruises or cuts heal at once without trouble. Both are doubtless subject to the same chance of infection, but the one resists, while the other does not. In common parlance, we say that such a tendency to abscesses indicates a bad condition of the blood--a phrase which means nothing. Further, we find that the same species of bacterium may have varying powers of producing disease at different times. Some species are universal inhabitants of the alimentary ca.n.a.l and are ordinarily harmless, while under other conditions of unknown character they invade the tissues and give rise to a serious and perhaps fatal disease. We may thus recognise some bacteria which may be compared to foreign invaders, while others are domestic enemies. The former, like the typhoid bacillus, always produce trouble when they succeed in entering the body and finding a foothold. The latter, like the normal intestinal bacilli, are always present but commonly harmless, only under special conditions becoming troublesome. All this shows that there are other factors in determining the course of a disease, or even the existence of a disease, than the simple presence of a peculiar species of pathogenic bacterium.

From the facts just stated it will be evident that any list of germ diseases will be rather uncertain. Still, the studies of the last twenty years or more have disclosed some definite relations of bacteria and disease, and a list of the diseases more or less definitely a.s.sociated with distinct species of bacteria is of interest. Such a list, including only well-known diseases, is as follows:

Name of disease. Name of bacterium producing the disease.

Anthrax (Malignant pustule). Bacillus anthracis.

Cholera. Spirillum cholera: asiaticae Croupous pneumonia. Micrococcus pneumonia crouposa.

Diphtheria. Bacillus diphtheria.

Glanders. Bacillus mallei.

Gonorrhoea. Micrococcus gonorrhaeae Influenza. Bacillus of influenza.

Leprosy. Bacillus leprae.

Relapsing fever. Spirillum Obermeieri.

Teta.n.u.s (lockjaw). Bacillus tetani.

Tuberculosis (including consumption, scrofula, etc.) Bacillus tuberculosis.

Typhoid fever. Bacillus typhi abdominalis.

Various wound infections, including septicaemia, pyaemia, acute abscesses, ulcers, erysipelas, etc., are produced by a few forms of micrococci, resembling each other in many points but differing slightly. They are found almost indiscriminately in any of these wound infections, and none of them appears to have any definite relation to any special form of disease unless it be the micrococcus of erysipelas. The common pus micrococci are grouped under three species, Staphylococcus pyogenes aureus, Staphylococcus pyogenes, and Streptococcus pyogenes. These three are the most common, but others are occasionally found.

In addition to these, which may be regarded as demonstrated, the following diseases are with more or less certainty regarded as caused by distinct specific bacteria: Bronchitis, endocarditis, measles, whooping-cough, peritonitis, pneumonia, syphilis.

Still another list might be given of diseases whose general nature indicates that they are caused by bacteria, but in connection with which no distinct bacterium has yet been found. As might be expected also, a larger list of animal diseases has been demonstrated to be caused by these organisms. In addition, quite a number of species of bacteria have been found in such material as faeces, putrefying blood, etc., which have been shown by experiment to be capable of producing diseases in animals, but in regard to which we have no evidence that they ever do produce actual disease under any normal conditions. These may contribute, perhaps, to the troubles arising from poisonous foods, but can not be regarded as disease germs proper.

VARIABILITY OF PATHOGENIC POWERS.

As has already been stated, our ideas of the relation of bacteria to disease have undergone quite a change since they were first formulated, and we recognise other factors influencing disease besides the actual presence of the bacterium. These we may briefly consider under two heads, viz., variation in the bacterium, and variation in the susceptibility of the individual. The first will require only a brief consideration.

That the same species of pathogenic bacteria at different times varies in its powers to produce disease has long been known.

Various conditions are known to affect thus the virulence of bacteria. The bacillus which is supposed to give rise to pneumonia loses its power to produce the disease after having been cultivated for a short time in ordinary culture media in the laboratory. This is easily understood upon the suggestion that it is a parasitic bacillus and does not thrive except under parasitic conditions. Its pathogenic powers can sometimes be restored by pa.s.sing it again through some susceptible animal. One of the most violent pathogenic bacteria is that which produces anthrax, but this loses its pathogenic powers if it is cultivated for a considerable period at a high temperature. The micrococcus which causes fowl cholera loses its power if it be cultivated in common culture media, care being taken to allow several days to elapse between the successive inoculations into new culture flasks. Most pathogenic bacteria can in some way be so treated as to suffer a diminution or complete loss of their powers of producing a fatal disease. On the other hand, other conditions will cause an increase in the virulence of a pathogenic germ. The virus which produces hydrophobia is increased in violence if it is inoculated into a rabbit and subsequently taken from the rabbit for further inoculation. The fowl cholera micrococcus, which has been weakened as just mentioned, may be restored to its original violence by inoculating it into a small bird, like a sparrow, and inoculating a second bird from this. A few such inoculations will make it as active as ever. These variations doubtless exist among the species in Nature as well as in artificial cultures. The bacteria which produce the various wound infections and abscesses, etc., appear to vary under normal conditions from a type capable of producing violent and fatal blood poisoning to a type producing only a simple abscess, or even to a type that is entirely innocuous. It is this factor, doubtless, which in a large measure determines the severity of any epidemic of a bacterial contagious disease.

SUSCEPTIBILITY OF THE INDIVIDUAL.

The very great modification of our early views has affected our ideas as to the power which individuals have of resisting the invasion of pathogenic bacteria. It has from the first been understood that some individuals are more susceptible to disease than others, and in attempting to determine the significance of this fact many valuable and interesting discoveries have been made. After the exposure to the disease there follows a period of some length in which there are no discernible effects. This is followed by the onset of the disease and its development to a crisis, and, if this be pa.s.sed, by a recovery. The general course of a germ disease is divided into three stages: the stage of incubation, the development of the disease, and the recovery. The susceptibility of the body to a disease may be best considered under the three heads of Invasion, Resistance, Recovery.

Means of Invasion.--In order that a germ disease should arise in an individual, it is first necessary that the special bacterium which causes the disease should get into the body. There are several channels through which bacteria can thus find entrance; these are through the mouth, through the nose, through the skin, and occasionally through excretory ducts. Those which come through the mouth come with the food or drink which we swallow; those which enter through the nose must be traced to the air; and those which enter through the skin come in most cases through contact with some infected object, such as direct contact with the body of an infected person or his clothing or some objects he has handled, etc. Occasionally, perhaps, the bacteria may get into the skin from the air, but this is certainly uncommon and confined to a few diseases. There are here two facts of the utmost importance for every one to understand: first, that the chance of disease bacteria being carried to us through the air is very slight and confined to a few diseases, such as smallpox, tuberculosis, scarlet fever; etc., and, secondly, that the uninjured skin and the uninjured mucous membrane also is almost a sure protection against the invasion of the bacteria. If the skin is whole, without bruises or cuts, bacteria can seldom, if ever, find pa.s.sage through it. These two facts are of the utmost importance, since of all sources of infection we have the least power to guard against infection through the air, and since of all means 'of entrance we can guard the skin with the greatest difficulty. We can easily render food free from pathogenic bacteria by heating it. The material we drink can similarly be rendered harmless, but we can not by any known means avoid breathing air, nor is there any known method of disinfecting the air, and it is impossible for those who have anything to do with sick persons to avoid entirely having contact either with the patient or with infected clothing or utensils.

From the facts here given it will be seen that the individual's susceptibility to disease produced by parasitic bacteria will depend upon his habits of cleanliness, his care in handling infectious material, or care in cleansing the hands after such handling, upon his habit of eating food cooked or raw, and upon the condition of his skin and mucous membranes, since any kind of bruises will increase susceptibility. Slight ailments, such as colds, which inflame the mucous membrane, will decrease its resisting power and render the individual more susceptible to the entrance of any pathogenic germs should they happen to be present.

Sores in the mouth or decayed teeth may in the same way be prominent factors in the individual's susceptibility. Thus quite a number of purely physical factors may contribute to an individual's susceptibility.

Resisting Power of the Body.--Even after the bacteria get into the body it is by no means certain that they will give rise to disease, for they have now a battle to fight before they can be sure of holding their own. It is now, indeed, that the actual conflict between the powers of the body and these microscopic invaders begins. After they have found entrance into the body the bacteria have arrayed against them strong resisting forces of the human organism, endeavouring to destroy and expel them. Many of them are rapidly killed, and sometimes they are all destroyed without being able to gain a foothold. In such cases, of course, no trouble results. In other cases the body fails to overcome the powers of the invaders and they eventually multiply rapidly. In this struggle the success of the invaders is not necessarily a matter of numbers. They are simply struggling to gain a position in the body, where they can feed and grow. A few individuals may be entirely sufficient to seize such a foothold, and then these by multiplying may soon become indefinitely numerous. To protect itself, therefore, the human body must destroy every individual bacterium, or at least render them all incapable of growth. Their marvellous reproductive powers give the bacteria an advantage in the battle. On the other hand, it takes time even for these rapidly multiplying beings to become sufficiently numerous to do injury. There is thus an interval after their penetration into the body when these invaders are weak in numbers. During this interval--the period of incubation--the body may organize a resistance sufficient to expel them.

We do not as yet thoroughly understand the forces which the human organism is able to array against these invading foes. Some of its methods of defence are, however, already intelligible to us, and we know enough, at all events, to give us an idea of the intensity of the conflict that is going on, and of the vigorous and powerful forces which the human organism is able to bring against its invading enemies.

In the first place, we notice that a majority of bacteria are utterly unable to grow in the human body even if they do find entrance. There are known to bacteriologists to-day many hundreds, even thousands of species, but the vast majority of these find in the human tissues conditions so hostile to their life that they are utterly unable to grow therein. Human flesh or human blood will furnish excellent food for them if the individual be dead, but living human flesh and blood in some way exerts a repressing influence upon them which is fatal to the growth of a vast majority of species. Some few species, however, are not thus destroyed by the hostile agencies of the tissues of the animal, but are capable of growing and multiplying in the living body.

These alone are what const.i.tute the pathogenic bacteria, since, of course, these are the only bacteria which can produce disease by growing in the tissues of an animal. The fact that the vast majority of bacteria can not grow in the living organism shows clearly enough that there are some conditions existing in the living tissue hostile to bacterial life. There can be little doubt, moreover, that it is these same hostile conditions, which enable the body to resist the attack of the pathogenic species in cases where resistance is successfully made.

What are the forces arrayed against these invaders? The essential nature of the battle appears to be a production of poisons and counter poisons. It appears to be an undoubted fact that the first step in repelling these bacteria is to flood them with certain poisons which check their growth. In the blood and lymph of man and other animals there are present certain products which have a direct deleterious influence upon the growth of micro-organisms.

The existence of these poisons is undoubted, many an experiment having directly attested to their presence in the blood of animals. Of their nature we know very little, but of their repressing influence upon bacterial growth we are sure. They have been named alexines, and they are produced in the living tissue, although as to the method of their production we are in ignorance.

By the aid of these poisons the body is able to prevent the growth of the vast majority of bacteria which get into its tissues.

Ordinary micro-organisms are killed at once, for these alexines act as antiseptics, and common bacteria can no more grow in the living body than they could in a solution containing other poisons Thus the body has a perfect protection against the majority of bacteria. The great host of species which are found in water, milk, air, in our mouths or clinging to our skin, and which are almost omnipresent in Nature, are capable of growing well enough in ordinary lifeless organic foods, but just as soon as they succeed in finding entrance into living human tissue their growth is checked at once by these antiseptic agents which are poured upon them. Such bacteria are therefore not pathogenic germs, and not sources of trouble to human health.

There are, on the other hand, a few species of bacteria which may be able to retain their lodgment in the body m spite of this attempt of the individual to get rid of them. These, of course, const.i.tute the pathogenic species, or so called "disease germs".

Only such species as can overcome this first resistance can be disease germs, for they alone can retain their foothold in the body.

But how do these species overcome the poisons, which kill the other harmless bacteria? They, as well as the harmless forms, find these alexines injurious to their growth, but in some way they are able to counteract the poisons. In this general discussion of poisons we are dealing with a subject which is somewhat obscure, but apparently the pathogenic bacteria are able to overcome the alexines of the body by producing in their turn certain other products which neutralize the alexines, thus annulling their action. These pathogenic bacteria, when they get into the body, give rise at once to a group of bodies which have been named lysines. These lysines are as mysterious to us as the alexines, but they neutralize the effect of the alexines and thus overcome the resistance the body offers to bacterial growth The invaders can now multiply rapidly enough to get a lasting foothold in the body and then soon produce the abnormal symptoms which we call disease Pathogenic bacteria thus differ from the non-pathogenic bacteria primarily in this power of secreting products which can neutralize the ordinary effects of the alexines, and so overcome the body's normal resistance to their parasitic life.

Even if the bacteria do thus overcome the alexines the battle is not yet over, for the individual has another method of defence which is now brought into activity to check the growth of the invading organisms. This second method of resistance is by means of a series of active cells found in the blood, known as white blood-corpuscles (Fig. 33 a, b). They are minute bits of protoplasm present in the blood and lymph in large quant.i.ties.

They are active cells, capable of locomotion and able to crawl out of the blood-vessels Not infrequently they are found to take into their bodies small objects with which they come in contact. One of their duties is thus to engulf minute irritating bodies which may be in the tissues, and to carry them away for excretion. They thus act as scavengers These corpuscles certainly have some agency in warding off the attacks of pathogenic bacteria Very commonly they collect in great numbers in the region of the body where invading bacteria are found. Such invading bacteria exist upon them a strong attraction, and the corpuscles leave the blood-vessels and sometimes form a solid phalanx completely surrounding the invading germs. Their collection at these points may make itself seen externally by the phenomenon we call inflammation.

There is no question that the corpuscles engage in conflict with the bacteria when they thus surround them. There has been not a little dispute, however, as to the method by which they carry on the conflict. It has been held by some that the corpuscles actually take the bacteria into their bodies, swallow them, as it were, and subsequently digest them (Fig. 33 c, d, e). This idea gave rise to the theory of phagocytosis, and the corpuscles were consequently named phagocytes. The study of several years has, however, made it probable that this is not the ordinary method by which the corpuscles destroy the bacteria. According to our present knowledge the method is a chemical one. These cells, when they thus collect in quant.i.ties around the invaders, appear to secrete from their own bodies certain injurious products which act upon the bacteria much as do the alexines already mentioned. These new bodies have a decidedly injurious effect upon the multiplying bacteria; they rapidly check their growth, and, acting in union with the alexines, may perhaps entirely destroy them.

After the bacteria are thus killed, the white blood-corpuscles may load themselves with their dead bodies and carry them away (Fig.

33 d, e). Sometimes they pa.s.s back into the blood stream and carry the bacteria to various parts of the body for elimination. Not infrequently the white corpuscles die in the contest, and then may acc.u.mulate in the form of pus and make their way through the skin to be discharged directly. The battle between these phagocytes and the bacteria goes on vigorously. If in the end the phagocytes prove too strong for the invaders, the bacteria are gradually all destroyed, and the attack is repelled. Under these circ.u.mstances the individual commonly knows nothing--of the matter. This conflict has taken place entirely without any consciousness on his part, and he may not even know that he has been exposed to the attack of the bacteria. In other cases the bacteria prove too strong for the phagocytes. They multiply too rapidly, and sometimes they produce secretions which actually drive the phagocytes away. Commonly, as already noticed, the corpuscles are attracted to the point of invasion, but in some cases, when a particularly deadly and vigorous species of bacteria invades the body, the secretions produced by them are so powerful as actually to drive the corpuscles away. Under these circ.u.mstances the invading hosts have a chance to multiply unimpeded, to distribute themselves over the body, and the disease rapidly follows as the result of their poisoning action on the body tissues.

It is plain, then, that the human body is not helpless in the presence of the bacteria of disease, but that it is supplied with powerful resistant forces. It must not be supposed, however, that the outline of the action of these forces just given is anything like a complete account of the matter; nor must it be inferred that the resistance is in all respects exactly as outlined. The subject has only recently been an object of investigation, and we are as yet in the dark in regard to many of the facts. The future may require us to modify to some extent even the brief outline which has been given. But while we recognise this uncertainty in the details, we may be a.s.sured of the general facts. The living body has some very efficacious resistant forces which prevent most bacteria from growing within its tissues, and which in large measure may be relied upon to drive out the true pathogenic bacteria. These resistant forces are in part a.s.sociated with the productions of body poisons, and are in part a.s.sociated with the active powers of special cells which have been called phagocytes.

The origin of the poisons and the exact method of action of the phagocytes we may well leave to the future to explain.

These resisting powers of the body will vary with conditions. It is evident that they are natural powers, and they will doubtless vary with the general condition of vigour of the individual.

Robust health, a body whose powers are strong, well nourished, and vigorous, will plainly furnish the conditions for the greatest resistance to bacterial diseases. One whose bodily activities are weakened by poor nutrition can offer less resistance. The question whether one shall suffer from a germ disease is not simply the question whether he shall be exposed, or even the question whether the bacteria shall find entrance into his body. It is equally dependent upon whether he has the bodily vigour to produce alexines in proper quant.i.ty, or to summon the phagocytes in sufficient abundance and vigour to ward off the attack. We may do much to prevent disease by sanitation, which aids in protecting the individual from attack; but we must not forget that the other half of the battle is of equal importance, and hence we must do all we can to strengthen the resisting forces of the organism.

RECOVERY FROM GERM DISEASES.

These resisting forces are not always sufficient to drive off the invaders. The organisms may retain their hold in the body for a time and eventually break down the resistance. After this they may multiply unimpeded and take entire possession of the body. As they become more numerous their poisonous products increase and begin to produce direct poisoning effects on the body. The incubation period is over and the disease comes on. The disease now runs its course. It becomes commonly more and more severe until a crisis is reached. Then, unless the poisoning is so severe that death occurs, the effects pa.s.s away and recovery takes place.