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ARCHIVES OF OTOLOGY.

A BRIEF HISTORY OF BACTERIOLOGICAL EXAMINATIONS IN SUPPURATIVE OTITIS MEDIA, WITH REMARKS UPON THE RELATIVE VIRULENCE OF THE VARIOUS MICRO-ORGANISMS.'

BY WENDELL C. PHILLIPS, M.D., NEW YORK.

TH

HE general history of the development of bacteriology, so far as it relates to otology, has been so gradual that only of late have we come to place it in a position of importance. The literature of the subject, so far as it relates to published papers, has mostly been given in a rather indefinite way in connection with the reports of cases, with but little reference as to when, how, or by whom the various micro-organisms had been discovered. It has therefore required considerable search through both general and otological literature to gather the material together and place it in definite form before the members of this Society. Even now some historical details in relation to some of these micro-organisms are apparently not to be obtained. The various forms of micro-organisms observed in the pus of middle-ear suppuration are legion. During recent years bacteriologists have succeeded in clearly defining and classifying several varieties, and much speculation has arisen on the part of observers as to the exact position which should be given to these various organisms as causative factors.

Of the various organisms which from time to time have been found in the pus from the middle ear, the following more important ones may be mentioned in detail.

Read at the meeting of the Section on Otology, N. Y. Academy of Medicine, December 11, 1902.

First The micrococcus lanceolatus (Sternberg). This coccus was first described as having been found in the purulent exudate from the tympanic cavity by Netter (1). Park (2) considers it to be identical with the micrococcus pneumoniæ crouposæ (Sternberg), the micrococcus sputi septicemiæ, and the diplococcus pneumonia (Fränkel-Weichselbaum).

Second Bacillus (Friedlander). This was evidently depicted by Netter (3) as occurring in suppurative otitis media, but it remained for Zaufal (4) to definitely differentiate it.

Third Streptococcus pyogenes. There is considerable controversy as to who first described this organism in suppurative otitis media. It occurs in the illustrations of Netter (loc. cit). It was accredited by Flügge (5) to Zaufal (6) but Zaufal himself accredited it to Netter (7).

Fourth Staphylococcus pyogenes aureus. Fraenkel and Simmons (8) were evidently the first to find this organism in purulent otitis media. It is interesting to note that the case reported by them was one in which the middle-ear suppuration followed an attack of typhoid fever.

Fifth Bacillus typhosus (Eberth, Gaffky). Wolf (9) first found it in otitis media, and reported it in his inaugural dissertation. This paper is quoted freely in the Archiv für Ohrenheilkunde (10) and more extensively later on by Levy and Schroeder (11).

Sixth Staphylococcus pyogenes cereus. To Gruber and Weichselbaum (12) belongs the credit of first defining this organism in the pus of otitis media suppurativa.

Seventh Micrococcus tetragenus. Levy and Schroeder (loc. cit.) simply mention this organism.

Eighth Bacillus saprogenes. Levy and Schroeder (loc. cit.) mention it as having been found, and the description by Kanthar (13) is referred to.

Ninth Bacillus pyogenes. The earliest mention of this bacillus in otitis media is by Gruber and Weichselbaum (14).

Tenth Staphylococcus pyogenes albus. Gruber and Weichselbaum also first called attention to this organism (ibidem).

Eleventh Staphylococcus pyogenes citreus. To Netter

(15) belongs the credit of the discovery of this organism in the pus of suppurative otitis media.

Twelfth Diplococcus intracellularis meningitidis. Credit for the discovery of this coccus in the pus from otitis media must be given to Frohman (16).

Thirteenth and fourteenth: Staphylococcus pyogenes tenuis and the bacillus tenuis. These are mentioned to

gether by Scheibe (17).

Fifteenth Prudden and Northrup (18) are stated to have found a special species of streptococcus of identical reaction with the streptococcus erysipelatis, and suggest that perhaps this organism may be the cause of false diphtheritic membranes in purulent otitis media.

Sixteenth Klebs-Loeffler bacillus. The presence of this bacillus in otitis media suppurativa was first described by Moos (19).

Seventeenth Bacillus tuberculosis (Koch). We must give Nathan (20) the credit for being the first to find tubercle bacilli in purulent otitis media.

Eighteenth Gonococcus. Koenig (21), in a case of suppurative otitis media neonatorum, found the gonococcus in the discharge.

Nineteenth Bacillus of influenza, described by Scheibe (22). The identity of this bacillus has been questioned. The author next in time to lay claim to the discovery of an influenza bacillus is Haug (23). Several other publications

appeared during the same year.

Twentieth Bacillus coli communis. This organism was found twice by Chambers (24) whose cases were recently published.

Twenty-first: Smegma bacillus. This is a case of my own, operated upon for mastoid complication in chronic suppurative otitis media. The first report of the examination of the pus, hurriedly made, was that it contained tubercle bacilli. The patient's general history did not seem to warrant the presence of tubercle bacilli, and a further and more painstaking analysis led to a final conclusion that the bacillus found was that of the smegma. Since this experience, which occurred one year ago, I have learned in private

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