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ticular clearness in letters A and B, are supposed, by some, to be nourishing vacuoles for the nuclei. We have never seen any contractile vacuoles in any species. It is very significant that, in the fixed slides that have come to us from various parts of the country, to be spoken of later, we have seen very few, if any, illustrations of these progressive phenomena, as there seems to be a relaxing of the organism to quite a universal state with death. It is a very fre
body. In other words, with a combination of lenses giving about 600 magnifcations, the organism will cross the field in about three minutes. This figure also shows the migratory movement of the nuclei, spoken of in connection with the previous figure. Figure 8 shows an exceptionally rapid motility, in which in six seconds the organism has moved, virtually, half its own length. This is an unusual motility for this organism. We are all familiar with the fact that the
Half second intervals.
quent experience that when this type of organism is first observed on the slide that it is club shape in form, especially so if seen very quickly after mounting, which suggests that this is a normal poise and one it takes in its natural nourishing process in its habitat. When warmed on the artificial stage it frequently occurs that the organism becomes quite rapidly motile and will quite rapidly migrate across the field. This is particularly well illustrated in figure 7, in the first of which it has that characteristic club shape appearance and in six seconds has gotten under way and has migrated a considerable distance, as measured by the dimension of its own
root of a tree, as of a willow, can pass thru exceedingly fine and torturous opening in a clay tile and expand on the other side to ultimately block the sewer, forming a veritable net work. This property of making its cross section exceedingly narrow and of projecting and dragging itself thru exceedingly fine and torturous openings within the mass of a material, is particularly characteristic of this species, for we have seen it come to an apparently impenetrable blockade and force a hairlike figure into the mass slowly, but forcibly projecting the finger until it has extended a long distance into it, and finally by enlarging the end of the finger and
ally found it within the human tissue. It is exceedingly interesting that this species seems to dislike greatly to have death overtake it in the open and seems invariably to make for the debris, which may account for many people not finding it in their stained slides. It is also exceedingly interesting to note the great power of this little organism, for we have observed it as it would push itself into a mass of debris and crowd larger bulks of material out of its way. This is also particularly interesting as seen in the motion pictures. It has been quite significant to us that the presence of leptothrix in the patient's mouth is very often an index of the probability of find
becoming superimposed and in the third, fourth and fifth they are superimposed, and had we only the latter we could easily be misled. This figure also shows clearly the apparent ability of the organism to take in fluid and enlarge its mass, for its extending ectosarc, before the beginning of movement of the endosarc or diminution of its size, has presented an increase in volume that it is difficult to account for in any other way. This fig. ure always shows clearly the rate of projection of the pseudopod, the total change here representing three seconds. It should be noted that the nuclei were generally much larger in the encysted or spore forms than in the motile varieties.
The rate of motility of this species, the endameba Kartulisi, corresponds very closely to that of the common garden snail in proportion to its size.
There are motile bacteria and protozoa of the mouth, mostly of the small varieties, that have a speed of locomotion, which, in proportion to their size, would compare with that of the humming bird or the honey bee. We have found an organism in some mouths, the morphology and pathogenicity, of which we have not found in any of the litera
conception of its motility, in proportion to its size, can be obtained by comparing it to the speed of a dog, or equivalent to that of a man running at the rate of 12 to 15 miles an hour. This organism has cillia and a contractile vacuole and is probably a paramaecium. It is spoken of later in this paper in connection with a practical case. We have only found this organism in mouths with a prolific growth of motile mouth flora. It must be seen either in the microscopic field or in motion pictures to be appreciated.
Endameba Kartulisi. Showing two nuclei becoming superimposed and plowing into pseudopod.
Also apparent extension of ectosarc.
ture, which has a size between that of the erythrocytes or red blood corpuscles and the endamebae and has a motility so great that it can only be kept on the microscopic field by using low powers, by the constant adjustment of the mechanical stage, and it is so transparent as to be scarcely visible with the higher powers. It has a speed of motion probably one hundred times as great as that of the most motile endamebae. Figure 10 shows motion pictures of it, taken at the rate of one per twentieth of a second, there being no pictures cut out as in the former illustrations. In the picture in the upper left hand corner the organism is marked as A and its position is indicated at each succeeding twentieth of a second, and in six-twentieths it has passed entirely off this part of the field. This is shown here under a low power, approximately 400 diameters. A relative
SOME IMPORTANT CONDITIONS IN THE ENDAMEBA AND EMETINE PROBLEMS THAT ARE NOT
AS YET SATISFIED. Are endamebae directly related as a causative factor in so called pyorrhea alveolaris, and will emetine treatment cure the disease? There are many evidences to indicate that the answer should be affirmative, among them the following: Favorable Evidence.
1. The statements made by skilled bacteriologists (11) of known exceptional ability and world reputation.
2. The history of certain varieties of endameba and their known relation tɔ other lesions, (12) as for example, endamebic dysentery (13) of warm climates and its cure with emetine treatment.
3. Their frequent presence in pyor
A Cilliated Protozoan. Recently observed. Showing its extreme motility, which is probably 100 times that of the endameba. Intervals between views, one-twentieth of a second. Total time
crossing this field, twelvé twentieths of a second. It is usually larger than a leucocyte.
under uniform conditions. We have also had the presidents of the various state societies select for us a half a dozen of the dental pathologists of their state to co-operate with us in making observations. Correspondence with these two groups of men and the study of their slides indicate that, in the type of cases that have been selected by them for the smears, the presence of the endameba is almost universal at the time of and the conditions under which the observations were made. There are, apparently, few exceptions, which will be taken up later under the evidence against the endamebic etiology of pyorrhea.
Among this number I have absolutely cured five cases. The balance are still under treatment." (b) “I have been using the emetine since September last and would say that with one exception I have had the best results. I have used it by the stomach, subcutaneously, and by flooding the pockets, and have had gratifying results in all but one case, but in many of them I have had to be very persistent when, no doubt, others would have given up hope, etc.” (c) "In regard to the results of the emetine treatment would say that with but one exception I have had very gratifying outcomes. Some cases, of course, yielded more than Evidences against the endamebic etiology of pyorrhea and the treatment of the disease with emetine.
others and some are, apparently, entirely well. The case that refused to yield was one on which I have also used autogenous vaccine with negative results." Several of the other correspondents state that the emetine treatment is frequently, or generally, successful in improving, either in part or very materially, the condition, tho very few refer to them as being cured.
1. The statements of skilled bacteriologists, mostly specializing in dental pathology are that, while they find the endameba present, they do not consider it an important causative factor. (15).
5. The authors of this report have found an endameba on the apex of a root that had been extracted where the pyorrhea pockets of the mouth did not show endameba, and while it is possible that the sterilization about the teeth was not perfect enough to prevent the contamination of the root end at the time of its withdrawal thru the tissue, the fact that sterilization was used and that the root apex was very conical and that the smear was taken from the
very tip, strongly suggests that the organism was an inhabitant of the tissue about the apex.
2. The correspondence (16) with selected observers from different parts of the country shows the majority of them to be very conservative and reluctant to claim much benefit from the emetine treatment and some are strongly negative. I quote the following: (a) “My clinical experiments show that the treatment by emetine is not what it is 'cracked up' to be. I have tried it in every way possible in all kinds of cases and my experience is the same as in autogenous vaccination, that is that it does no good unless thoro instrumentation has first been accomplished and then it is not necessary.
Proper surgical work is what does the work and is a great deal better than the emetine treatment, etc." (b) “You ask for general observations as to the endameba. I will say that in the mouths I have found them I do not find them after I have carried out my thoro pyorrhea and prophylactic work, and this without the use of any drugs, whatever. I have used the emetine religiously and have found no results from its use in addition to results I obtained without it." We would also refer you to another paper published in this department of the Journal, which directly discusses this question. In the correspondence received 11% have been positively against the use of emetine, 47% conservative and noncommittal, in other words still earnestly studying its effects, and 42% are favorable to its use, generally in conjunction with thoro instrumentation.
6. The authors have also found three very motile endamebae of the Kartulisi variety in the blood of an extirpated pulp, which operation was done under novocain. The pulp was exposed mechanically, accidentally, after the removal of a poorly fitting gold crown. The exposure was covered with calxine cement for one week. We believe there was no possibility of the organism entering the tooth thru the artificial opening made into the pulp chamber unless it past thru the cement. This patient is suffering from an obscure irri. tation of an old heart lesion. This is a very significant finding and, so far as we know, the first time an endameba has been found in the tissues of the mouth, and suggests pathogenic nature of the Kartulisi variety.
7. It is possible that there is some metabolic that is produced by the endameba, which exerts an enzymic action.
3. A few observers, including ourselves, have not found the ameba present in certain cases before treatment with emetine and have found it in those