Fetid Odor Research Articles

Nasal Foreign Bodies and Bromidrosis

To the Editor.— The article by Katz et al (241:1496, 1979) on body odor as a presenting symptom of nasal bodies in children may be misleading. As a medical student I was asked to evaluate the case of a young girl with bad breath whose mother would not bring the child into the examination room until she had explained the situation to me. This girl had had foul breath odor for three to four weeks, and her mother had tried all forms of mouth washes and gargles. As the child entered the room, an extremely fetid odor could be appreciated from a full 5-m distance. The odor was so strong that only by diligent inspection could one determine that it primarily emanated from the mouth. On examination, a small purulent area was noted in one nostril, and with pickups, a rolled-up piece of school notebook paper was found, measuring approximately

Evaluation of clindamycin and other antibiotics in the treatment of anaerobic bacterial infections of the lung.

Fifty patients who had pneumonia, lung abscess, or empyema, and whose specimens had a fetid odor, were presumed to be suffering from anerobic lung infection and were treated with clindamycin either orally (33 patients) or parenterally (17). Forty-six patients showed marked improvement or recovered; two also underwent lung resection, and thoracotomy was performed in 10. There were three outright treatment failures, and superinfection occurred in one patient. A review of the literature suggests that clindamycin and penicillin (in substantial dosage) are equally effective in treatment of anaerobic lung infection. Transtracheal aspiration is not deemed necessary if the patient is expectorating fetid sputum.

Solid Substrate Fermentation of Feedlot Waste Combined with Feed Grains

A new process is being developed for recycling animal wastes based on a solid substrate fermentation with cracked grains. To date, the work has been done mainly with corn and the liquid fraction of cattle feedlot waste. This liquid, separated by an oscillating 30 mesh screen, contains 10% solids in the form of microbial cells and either fine or soluble waste components; it has a nitrogen content of 3-4 mg/ml. When added to cracked corn at a ratio of 1:2, the thick liquid adheres to grain surfaces. Grain waste mixtures at about 40% moisture, incubated aerobically by tumbling in a slowly revolving (0.5 rpm) vessel, such as a small cement mixer, rapidly undergo an acid fermentation caused by the selective growth of lactic acid bacteria originally present in the waste; other waste organisms die. The number of bacterial cells increases 100 fold with 24 hr; yeasts emerge after extended incubation. The fetid waste odor quickly disappears as 0.1 meq of acid per wet gram of fermented solids is generated while nitrogen is conserved. The acids formed are primarily lactic and acetic, with lesser amounts of propionic and butyric. Exploratory tests with milo and wheat, as well as with wastes from hogs and cattle on different rations, indicate that the new process may be widely applicable. Diluted whole waste may be used when inclusion of fiber in the fermented feed product is of no concern. The solid state system provides an easily established selective environment for microbial growth. Specific organisms and added inorganic nitrogen may be used for a continuous operation to generate higher protein content in grain based rations.

Occurrence and predominance of the fish killer Cochlodinium polykrikoides on the Pacific coast of Costa Rica

Water samples were collected at several points along the Pacific coast of Costa Rica (10°00'N, 84°15'E) fortnightly from January 2003 to June 2004. During this period, dense red-ochre discolourations dominated by Cochlodinium polykrikoides were observed, particularly over the dry season. In 2003, the highest cell density of 1.75 × 108 cells l−1 was observed in October. During April and June 2004, extensive blooms were present, with the highest cell density (3.8 × 108 cells l−1) occurring in April. These blooms were accompanied by a strong fetid odour and large quantities of yellow foam. Fish mortalities also occurred near some coastal areas. The observed discolourations tended to be associated with the strongest north-west winds on the North Pacific coast of Costa Rica. To date, blooms caused by C. polykrikoides have been increasing in frequency and in extent. The previously unreported high cell densities and the increase in the duration and extent of these harmful algal blooms suggest that the environmental conditions have changed to the benefit of C. polykrikoides over other phytoplankton species that usually bloom at that time of year. The fish mortalities associated with C. polykrikoides blooms are cause for concern, as are the possible environmental changes contributing to the production of these extensive blooms.

Deodorization and healing: Hexetidine in periodontal surgery

A 0.1 per cent hexetidine antiseptic oral rinse was evaluated for its use as an immediate postoperative spray and as a twice-daily home rinse. Results with respect to healing, time needed for retention of the periodontal pack, and prevention of unpleasant odors associated with periodontal packs were evaluated and compared to a group of patients who underwent similar operative procedures and who used normal saline solution as an oral rinse. Kodachrome photographs provided visual evidence of the results obtained in both groups, and bacteriologic surveys in a limited number of subjects were also performed. 1. 1. Healing of the periodontal tissues was accelerated in the 0.1 per cent hexetidine antiseptic oral rinse group when compared to the saline-rinse group. 2. 2. The foul odor usually accompanying retention of the periodontal pack was effectively controlled. In the majority of cases the pack had no odor when removed. 3. 3. Responses by patients indicated increased comfort and better tolerance for the periodontal pack. 4. 4. A saline rinse was found to be capable of achieving beneficial results if repeated frequently, on an hourly basis, throughout the day. However, this increased the risk of periodontal pack dislodgment. Furthermore, most patients lacked the time needed for such frequent rinsing. 5. 5. In each case in which the fusiform bacillus was isolated, the subject presented the typical fetid odor associated with the periodontal pack. 6. 6. A clinical correlation appeared to exist between the presence of fusiform bacilli, odor formation, and delayed postsurgical healing. This pathologic triumvirate appeared to be interrupted and reversed by a 0.1 per cent hexetidine antiseptic oral rinse.

The use of oxygen and oxygen liberating substances in the treatment of anaerobic peritonitis in guinea pigs

P RIMARY peritonitis is that type which is due to pathogenic bacteria that have reached the peritoneum by way of the blood stream, a single species of bacteria such as the pneumococcus or streptococcus being responsibIe. Secondary peritonitis is due to pathogenic bacteria which have reached the peritoneum through breaks in the continuity of the gastrointestina1 tract, more than one species of bacteria being responsibIe through thdir combined effects. Extension of infection from adjacent abscesses may also bring about a secondary type of peritonitis. Accidental and surgical wounds may Iikewise introduce bacteria into the peritonea1 cavity which resuIt in secondary peritonitis. From time to time articIes have appeared in medica literature which cite cases of “Gas Peritonitis” or “Anaerobic Peritonitis.” Differences of opinion exist over the abiIity of strictIy anaerobic bacteria to produce peritonitis without being in association with other bacteria. Bacteria reported to be present in the exudate of secondary peritonitis incIude coIon baciIIi, streptococci, staphylococci, WeIch baciIIi and anaerobic non-hemoIytic streptococci. A summary of the Iiterature reviewed reveaIs conAicting opinions on the existence of “Gas Peritonitis” or “Anaerobic Peritonitis ” as an entity. VeiIIon and Zuber30 are generaIIy credited with being the first to isoIate an anaerobic non-hemoIytic streptococcus under the name of Micrococcus faetidus, a strictIy anaerobic coccus growing in short chains and producing gas and a fetid odor in cuhures. This organism had been isoIated in pure cuIture from a case of suppurative barthoIinitis, and in association with other organisms from cases of appendicitis, Ludwig’s angina and perinephritic abscess. Since VeiIIon’s report there have appeared in the Iiterature numerous articIes, some reporting series of cases, others deaIing with isoIated observations on the recovery of anaerobic non-hemoIytic streptococci in pure cuIture and in association with other organisms from various Iesions, as we11 as from heaIthy body cavities and surfaces. Tissier2g was abIe to isoIate from cases of putrid enteritis anaerobic nonhemoIytic streptococci which he described as a new species under the name of LanceoIatus anaerobicus. WhiIe undoubtedIy the anaerobic streptococcus is a norma inhabitant of the human gastrointestina1 tract, it is possibIe that some may be introduced from the mouth in the process of swaIIowing saIiva. McDonaId, Henthorne and Thompson’* reported a case of perforated duodena1 uIcer which was foIlowed two and onehaIf months after surgica1 cIosure by a subdiaphragmatic abscess, empyema thoracis, and muItipIe Iiver abscesses. The anaerobic non-hemoIytic streptococcus was obtained in pure cuIture from the Iatter. PresumabIy the organisms originated from the spiIIed duodena1 contents. GiIbert and Lippman” recovered these organisms in 25 per cent of their cases of suppurative ChoIecystitis. There is an abundance of Iiterature on the bacterioIogy of acute appendicitis, and numerous investigators1,%4,12,21,32 h ave shown that the anaerobic non-hemoIytic streptococcus forms part of the bacteria1 flora of acute suppurative appendicitis, gangrenous appendi-

SURGICAL TREATMENT OF ATROPHIC RHINITIS

Atrophic rhinitis is degenerative rhinitis in which the normal ciliated columnar type of epithelium is replaced by a nonciliated, stratified squamous type. The mucus-secreting glands are greatly diminished in number but not totally absent, so that mucus is still secreted. Textbooks of otolaryngology describe two groups of cases: (1) cases in which no odor is present in the nose and (2) cases in which there is a fetid odor. The condition in the latter group is commonly called ozena. CLINICAL CLASSIFICATION OF CASES OF ATROPHIC RHINITIS From a clinical point of view atrophic rhinitis should be considered as of four types: Latent Atrophic Rhinitis.—This type is characterized merely by a diminution in size of one or more turbinates and may be asymptomatic, requiring no treatment. Simple Mild Atrophic Rhinitis.—This type is characterized by atrophy of either the middle or the inferior turbinate or both, on one or both sides, but

Extensive Destruction of Lungs

The case described below represents so extreme a degree of destruction of pulmonary tissue as to be of special interest. Case History.—D. H., male, aged 41 years, consulted the author in February, 1939, complaining of cough, dyspnea, and asthmatic wheezing of eight years' duration which had become progressively worse for the past three years, with marked exacerbations and partial remissions. The cough had been productive of greenish-yellow sputum which, at times, had had a fetid taste and odor. Recently the sputum had been white. Since the summer of 1938, wheezing and dyspnea had been constant. The patient had lost 27 pounds since the onset of the illness. He had worked at various forms of labor—farm hand, general laborer, and house painter—until 1931. The past history elicited the story that he had coughed since childhood, that he had had “stomach ulcers” in 1929, and gonorrhea, complicated by stricture, in 1932. The family history was irrelevant. Physical examination was negative except for chest findings. The patient was under-nourished and breathed with obvious effort, the chest wall moving only slightly. There was hypertrophy of the accessory muscles of respiration. The chest was barrel-shaped. There was tympany over both sides with distant (almost absent) breath sounds over the entire right chest except along the base anteriorly, where distant sounds and expiratory rhonchi were heard. On the left, breath sounds were almost absent at the apex, gradually increasing in intensity to the region of the eighth rib posteriorly and the third rib anteriorly. There were scattered sibilant râles below the third rib anteriorly. These findings were practically identical with those of Richard Nauen, M.D., of the New York State Hospital for Incipient Tuberculosis, who had examined the patient in October, 1938. Roentgenograms showed complete absence of lung markings in the upper half of the right lung and upper third of the left lung, with herniation of the mediastinum to the left. There had been no noticeable change since the previous roentgenograms made four months before. Repeated examinations of sputum were negative for tubercle bacilli. The Wassermann test and other routine laboratory studies were negative. A diagnosis of chronic bronchitis, asthma, and pulmonary emphysema with giant bullæ had previously been made by Dr. Nauen. Further observation threw no additional light on the subject. The examining roentgenologist, H. L. Sampson, considered that the process should be termed congenital cystic lung involvement. In an attempt to determine any allergic factor which might be contributing to the patient's discomfort, he was studied at another institution by Dr. Harold Medivetsky. Death occurred in July, 1939, but autopsy was so long delayed as to render bacteriologic study inconclusive, except to indicate the likelihood that death was due to Type XVI pneumococcus pneumonia.

The Use of Zinc Peroxide in Infected Tumors and Radiation Necrosis

THE mouth contains a variety of anaerobic and micro-aerophilic organisms which under normal conditions are harmless saprophytes. However, when oral tissues become devitalized or diseased these same bacteria may cause an infection which is painful, debilitating, and resistant to treatment. The condition is characterized by a fetid odor and necrosis of tissue to form thick adherent slough, without a great deal of purulent discharge, unless there is secondary deep abscess formation. This type of infection so frequently accompanies tumors of the oral, nasal, and paranasal cavities that it has become one of the major problems in their management. The complication may occur in the primary tumor, in a post-operative cavity or surgical defect, or in an area of necrosis resulting from roentgen or radium therapy. Once the process has gained a firm foothold, it is difficult to overcome by ordinary measures. Instrumental removal of slough is inadequate. The usual oxygenic agents such as sodium perborate, potassium chlo...

Observations on the Bovine Blood Picture in Health and Under Parasitism

Observations made on 6 normal Jersey and Holstein calves between the ages of 2 days and 6 months showed an average of 8.70 million red cells, 10,674 white cells per cubic millimeter of blood and a differential leucocytic count as follows: Lymphocytes, 64.4%; monocytes, 12.2%; neutrophils, 19.6%; eosinophiles, 3.3%. Six counts made on each of 5 adult animals between the ages of 3 years and 6 1/2 years, which were on range and which were considered to be normal from the standpoint of the absence of disease, revealed an average of 6.39 million red cells and 10,225 white cells per cubic millimeter of blood, with a differential leucocytic count of: Lymphocytes, 58.1%; monocytes, 8.0%; neutrophils, 25.9%; eosinophiles, 7.0%. The feeding of a pure nodularworm culture produced in calf No. 95 a sharp drop of 2 1/2 million red cells 5 days after the administration of the larvae, with an increase of 5000 in the total number of white cells caused by an increase above the previous range of 17% in the number of neutrophiles. These general changes were of constant occurrence, though not so sharply shown in the 6 individuals which had a mixed infection of hookworms (Bunostomum phlebotomum) and nodularworms (Oesophagostomum radiatum) as in the 2 animals with the pure nodularworm infection. The calves used in all these experiments were kept under controlled conditions preceding and during the period of infection. For each experimentally parasitized calf, a control calf was kept under similar conditions. The same picture found in experimentally-produced cases of parasitism was noted in a naturally infected Brahma heifer about 1 1/2 years old. This animal was brought to the laboratory in a much weakened condition, greatly emaciated, and passing very small quantities of liquid fecal material with a very fetid odor.

GARLIC BREATH ODOR

The fetid odor that persists for many hours on the breath of one who has eaten garlic or onions is such a common occurrence that no one has any curiosity about it. Because the odor is so persistent, even though the mouth is clean, the belief has prevailed for many years that the odor comes from the blood by way of the lungs. The first experimental studies on the disposition of alliaceous essential oils (garlic and onion) in the body were reported in 1930 by Lehmann.¹He concluded from his studies that during digestion such oils pass into the blood stream, are then aerated from the blood into the lungs, and so pass into the expired air. The belief in a systemic origin of garlic breath odor is rarely questioned, but recently a report of experiments²from a department of applied physiology was published, stating that such was

PRIORITY IN METHOD OF TREATING BROMIDE INTOXICATION

To the Editor: —Referring to Weidman's note on Priority in Treatment of Bromide Intoxication (The Journal, October 25, p. 1281), Dr. Herman Goldenberg stated (The Journal, November 29, p. 1689) that, though he used the salt treatment of the latter condition before Harris and Hauser and Wile and his co-workers, he does not know who was the originator of this method. In an article published in the Neurologisches Centralblatt ( 29 : 74, 1910), Ulrich, inspired, as he states, by the experiments of von Wyss, successfully treated bromide intoxication with sodium chloride. Internal doses were from 2 to 3 Gm. three times daily, while the dermatoses, acne and ulcers, yielded to applications of a 10 per cent sodium chloride solution in the form of moist dressings, and 1 per cent solution used as a mouth wash relieved the fetid odor.

PERFORATING ULCER OF THE HARD PALATE RESEMBLING TERTIARY SYPHILIS

A man, aged 47, consulted one of us because of an ulcer, which had made its appearance on the roof of his mouth. His previous history was in all respects negative. One day he noticed a little soreness on the roof of his mouth, and a small white spot, to which he paid no particular attention, until within a few days an ulcer developed, gradually becoming larger and more painful. Despite his negative history, a syphilitic condition was suggested by several physicians. Physical examination revealed slight anisocoria, rather marked oral sepsis and gingivitis, especially around the posterior molars, an unpleasant fetid odor to the breath, and a well defined punched-out ulcer, about the size of a dime, situated on the hard palate, covered with a thick, creamy, easily removed exudate, and surrounded by a deep red, somewhat indurated areola. The base of the ulcer bled easily. The clinical picture certainly

TREPONEMA MUCOSUM (NEW SPECIES), A MUCIN-PRODUCING SPIROCHÆTA FROM PYORRHEA ALVEOLARIS, GROWN IN PURE CULTURE

1. A mucin-producing spirochoeta has been obtained in pure culture from a case of pyorrhea alveolaris. This organism is an independent species of the genus Treponema and, as it is recognized for the first time, I propose for it the name Treponema mucosum. 2. Morphologically the mucosum is difficult to separate from the pallidum and microdentium, but, through its biological properties and animal reactions it is easily differentiated from all the rest of the spirochoetae. 3. The mucosum is not parasitic in the strict sense of the term, but exerts a certain pyogenous action when the tissue has been so injured by foreign substances as to enable it to survive. 4. The strong fetid odor in the discharge from pyorrhea alveolaris is due, at least in part, to the presence of the mucosum in the affected tissue.

SOCIETY NEWS.

<h3>Congress of the French Society of Otology and Laryngology, Paris, May.</h3> —Moure terminated his address on ozena by protesting against the too frequent assumption that ozena is incurable. His treatment is merely nasal and retro-nasal antiseptic irrigations with sprays of the same and of oil after removal of the crusts when the patient wishes only to be relieved of the fetid odor. When more complete treatment is desired he adds vibratory massage every second day for a fortnight, then twice a week for a month, then once, and more rarely after this. The massage is followed by irrigation and removal of all the crusts and then with a spray of 5 to 25 per cent. nitrate of silver. He reports numbers of cures with this method sufficiently prolonged. It also enables the existence of complications to be determined and cured. General tonic treatment is necessary with it as indicated. Luc

Some account of the volcanic eruption of cosiguina in the Bay of Fonseca, commonly called the Coast of Conchagua, on the Western Coast of Central America

The particulars recorded in this narrative are derived partly from a voluminous collection of official reports transmitted from the authorities in various towns to the government of Central America, and partly from the information of intelligent eye-witnesses of the phenomena. The eruption occurred on the 19th of January', 1835, and was preceded by a slight noise, accompanied with a column of smoke issuing from the mountain, and increasing till it took the form of a large and dense cloud, which, when viewed from a distance of ten leagues to the southward, appeared like an immense plume of white feathers, rising with considerable velocity and expanding in every direction. Its colour was, at first, of the most brilliant white; but it gradually became tinged with grey; then passed into yellow; and finally assumed a beautiful crimson hue. In the course of the following days several shocks of an earthquake were felt, the last of which were most terrific. On the morning of the 22nd, the sun had risen in brightness; but a line of intense darkness denoted the presence of the same cloud which had before presented such remarkable is l appearances, and which, extending with great rapidity, soon obscured the light of day ; so that in the course of half an hour the darkness equalled in intensity that of the most clouded night: persons touched without seeing one another; the cattle hurried back to their folds; and the fowls went to roost, as on the approach of night. This atmospheric darkness continued with scarcely any diminution for three days; during the whole of which time there fell a fine impalpable dust, covering the ground at St. Antonio to the depth of two inches and a half, and consisting of three layers of different shades of grey colour: and for ten or twelve succeeding days the sky exhibited a dim and murky light. At Nacaome, to the northward of the volcano, the same degree of darkness was experienced, and the deposit of ashes was from four to five inches in depth, and exhaled a fetid sulphureous odour, which penetrated through every interstice in the buildings. The complete obscurity was only occasionally broken by the lightning, which flashed in every direction, while the air was rent with loud and reiterated explosions like the discharges of artillery, which accompanied each eruption of volcanic matter, and conspired to strike the deepest terror, and to spread among the inhabitants a universal panic that the day of judgement was arrived. On the 24th the atmosphere became clearer, and the houses were found covered to the depth of eight inches with ashes, in which many small birds were found suffocated. Deer and other wild animals flew to the town for refuge, and the banks of the neighbouring streams were strewed with dead fish. In Segovia, and as far as eight leagues from the volcano, the showers of black sand were so abundant as to destroy thousands of cattle; and many were subsequently found whose bodies exhibited one mass of scorched flesh. Within the Bay of Fonseca, and two miles from the volcano, it is stated that two islands, from two to three hundred yards in diameter, were thrown up, probably from the deposit of masses of scoriæ on previously existing shoals.