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PULMOXARF DISEASES CAUSED BT MOUTH-BACTERIA. 299

4. PULMONARY DISEASES CAUSED BY THE INSPIRATION
OF GERMS FROM THE ORAL CAVITY.
Comparatively few investigations or observations have been
made witli regard to diseases of the hings which may be brought
about by the inspiration of mouth-germs. The cases communi-
cated by Leyden and Juffe, as well as by James Israel, suffice,
however, to prove that an infection of the lungs by microbes
which have established themselves in the mouth is by no means
impossible.
In cases of gangrene of the lungs and of putrid lironchitis,
'"^
Leyden and Jaffe'^' found elements in the sputum which mor-
phologically, as well as in their reaction upon iodine, were iden-
tical'with those which occur in the mouth. They formed the
opinion that the germs always present in the mouth in such quan-
tities might be carried into the lungs with the inspired air, and
there, under favorable circumstances, proliferate. On intro-
ducing shreds and larger casts into the lungs of rabbits, they
observed in some cases considerable inflammation with gradually
progressing contraction of the trachea, and in others severe
inflammation, followed by the formation of abscesses.
J. IsraeP** has also furnished striking proof of the correctness
of the supposition that pulmonary diseases may be brought
about by the inspiration of germs from the oral cavity. In a
case of primary actinomycotic infection of the lungs, Israel
found a small irregular body, resembling a piece of dentine,
which he sent me for examination. It was found to consist of
a small fragment of dentine, surrounded by a chalky mass, com-
posed of phosphate and carbonate of lime, presumably tartar.
The microscopic preparations of this fragment revealed numerous
threads of the ray-fungus, and there can be little doubt that the
fragment was the carrier of infection.
Baumgarten ^^ also reports a case of primary actinomycosis of
the lungs with secondary propagation to the soft tissue of the
thoracic wall, caused by inspiration of the specific fungal ele-
ments accumulated in the lacunae of the left tonsil.
On the whole, however, it may be taken for granted that in-
fections of the lungs proceeding from the oral cavity occur more
rarely than we might be led to expect, as a very strong inspira-