Journal of Hospital Infection (2008) 70, 369e372

Available online at www.sciencedirect.com

www.elsevierhealth.com/journals/jhin

Ogston’s coccus

S.W.B. Newsom*

Journal of Hospital Infection, Cambridge, UK

Received 2 October 2008; accepted 2 October 2008Available online 26 October 2008

KEYWORDSAbscess; Micrococcus;Ogston;Staphylococcus;Wound infection

* Address: 11 The Footpath, Coton,Tel.: þ44 (01954) 210228.

E-mail address: bill@newsom.dem

0195-6701/$ - see front matter ª 200doi:10.1016/j.jhin.2008.10.001

Summary One hundred and thirty years ago, Alexander Ogston, a surgeonin Aberdeen, first saw micro-organisms in pus from an abscess, which helater called ‘staphylococci’. He had already introduced ‘Listerism’ toAberdeen, but wished to know more about the cause of infections. He ex-tended Koch’s work on ‘traumatic wound infection in animals’ to humansby a series of ingenious experiments. He used the most modern German mi-croscopes and Koch’s stains to study pus from abscesses, and was first togrow staphylococci in artificial cultures (hens’ eggs). From 1878 to 1883the laboratory in his garden was a major UK bacteriology research labora-tory. Eventually he became Regius Professor of Surgery and had to ‘leaveresearch to others’.ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rightsreserved.

Introduction

It is 130 years since Ogston saw the ‘beautifultangles, tufts, and chains of round organisms,which stood out clear among the pus cells allstained with the aniline-violet stain I had used’ inpus from James Davidson.1 James had had a severe‘phlegmon’ (abscess) of the leg. He was lucky e itresponded to drainage and he lived on for over 40years.

Alexander Ogston (1844e1929) was the first tostudy wound infection in humans, and to him weowe the name ‘staphylococcus’, although if you

Cambridge CB23 7PX, UK.

on.co.uk

8 The Hospital Infection Socie

look in a microbial taxonomy book you will seeStaphylococcus aureus credited to Rosenbach. Adelightful personal look into his life from family,friends, colleagues and students was compiled byhis son Walter in 1943 and his work was celebratedin an ‘Alexander Ogston Centennial Conference’,the proceedings of which were published in1981.1,2

Ogston was a ‘larger than life’ man. He lived inAberdeen where he studied medicine and worked,but as a student in the 1860s he had a ‘gap year’and studied for a term in Vienna, and then movedto Berlin where he passed the summer term.Clearly, he was a linguist, which must have beena great help. In his memoirs he describes Rokitan-sky (Semmelweis’ teacher who also entertainedthe Listers) as ‘a great bear of a fellow, who spoke

ty. Published by Elsevier Ltd. All rights reserved.

370 S.W.B. Newsom

so badly I could not understand him’. However,Hebra (also a teacher of Semmelweis) was ‘a jollylittle ball of a man’. ‘Without exaggeration, I canhonestly say the only thing Virchow ever taught mewas how to strop a razor’.1,3,4

He qualified as a doctor in 1865, aged 21 years,and after various jobs (including six months asmedical officer to the smallpox hospital) he wasappointed as a full surgeon to the Aberdeen RoyalInfirmary in 1874. Despite Lister’s work, surgery inthe 1870s remained a major source of healthcare-associated infection. In 1869, James Simpson hadcoined the word ‘hospitalism’ to apply to surgeryin Edinburgh.5 Erichsen noted that between July1870 and December 1871 the outcome for amputa-tions in University College Hospital in Londonwere: cured, 59; died, 21. Nonetheless, this 26%mortality compared favourably with the 38% fromfour other London hospitals.6

In 1869, Ogston visited Lister, newly returned toEdinburgh as the professor. He wrote: ‘I called onLister, unknown and unannounced, and was re-ceived with all the sweetness and gracious cour-tesy that was part of his nature’. He then went toGlasgow and saw a knee joint that had beenrecently operated on using Lister’s method andwas perfectly healed. On his return to Aberdeen hetore down the notice over the operating room doorwhich read: ‘Prepare to meet thy God’. Antisepticsurgery went well in Aberdeen. The studentswrote:

The spray, the spray, the antiseptic sprayA.O. would shower it morning, night and day.For every sort of scratchWhere others would attachA sticking plaster patchHe gave the spray.

Lister’s ‘antiseptic surgery’ meant that a widerange of operations could be performed withoutthe problems of surgical site infection. Lister wenton to make the very first pure cultures of bacteria(in the front room of his home in 1878), usinglactobacilli. He was not concerned with the actualtypes of bacteria that cause disease. However, hehad Robert Koch’s book on ‘traumatic woundinfection’ translated by his assistant e WatsonCheyne. Koch’s work had been done while he wasstill a country doctor, and published in Germany in1878; the translation appeared in 1880.7 He hadused only animals e using inocula such as putridblood or putrid meat infusion, thus leaving thequestion of its applicability to humans. It was notuntil 1881 that Koch (then in Berlin) published histechnique for growing bacteria on the surface ofsolid media e so producing identifiable colonies.

However, he had had access to the latest technol-ogy through Dr Abbe at Zeiss e a microscope withan oil immersion lens and an Abbe condenser.Koch’s work helped to establish the Zeissmicroscopes.

Ogston was not content to follow Lister’s prin-ciples blindly, without enquiring into the causes ofsepsis. He clearly knew the continental literature,and had seen the paper that J.C. Ewart fromEdinburgh had published in the Proceedings ofthe Royal Society in 1878 on types of bacteria,and also that of Kohler from Berne on the findingof bacteria in cases of osteomyelitis and ‘strumi-tis’. Following his findings from James Davidson,he built a laboratory in a shed behind his house,got a grant (£50) from the British Medical Associa-tion (BMA), purchased a good Zeiss microscope andthe methyl-aniline dye used by Koch, and set abouthis research.

Discovery of the germ of acutesuppuration

Ogston wrote: ‘obviously the first step to be takenwas to make sure that the organisms found in MrDavidson’s pus were not there by chance’.1 So hestarted to examine pus from every abscess he couldfind. He used Koch’s staining methods, and triedvarious ways to grow the bacteria. Chambers onslides with cover slips were no good. Then he triedsmall bottles shielded from contamination by glass‘shades’, which let the air in. Cohn’s fluid (Cohnwas Koch’s mentor in Breslau), urine, ascetic orovarian fluid were tried as culture media. Some cul-tures were positive, but in the end he found the bestmedium was the hen’s egg. He was able to obtainpure colonies and to transfer these. His first testsused material from 82 abscesses, 13 of which were‘cold’ (probably tuberculous since they grew noth-ing). Sixty-five were unopened e so unlikely togrow contaminants. He then transferred the cul-tures into animals e guinea-pigs, white mice orwild mice. The results were conclusive. ‘I soonfound that there were two forms of micrococcus:one in the form of chains or necklaces to whichthe name ‘streptococcus’ had been given e I donot know by whom [Billroth], which produced themore violent inflammation, and the other growingin masses or clusters [like the roe of a fish], to whichI gave the name ‘staphylococcus’ which cause a lessviolent inflammatory disease’. He also showed thatthe bacteria were killed by heat or by Lister’s car-bolic acid.

Ogston also noted some contradictions: ‘It willnot have escaped the reader that my report iscontradictory. Why are micrococci so deleterious

Ogston’s coccus 371

when injected, and so harmless on the surface ofwounds and ulcers. It is no doubt possible thatthere exist micrococci precisely similar in appear-ance and growth and yet widely different in theeffects they are capable of producing’.8 He con-cluded that this might be the effect of air. Healso noted that transferring cocci in a dilution of1/146 016 000 of the original pus could still pro-duce abscesses.

Publication

Ogston described this as follows: ‘The final step ofconvincing the medical profession . proved to berather a thorny one. I had been too much encour-aged by the readiness with which my best studentsapprehended my discovery’. At the Aberdeenbranch of the BMA he was received with anincredulity, which was mirrored by the Editor ofthe British Medical Journal, who commented: ‘Cananything good come out of Aberdeen’. Lister stud-ied Ogston’s material e slides, eggs and animals eand declared he was satisfied, but Watson Cheynewas ‘very sceptical’.

Ogston had already presented a paper on ‘genuvalgum’ to the Surgical Congress in Berlin, and inview of the local opposition he decided to makethe first presentation of his findings in Berlin. On 9April 1880 he delivered his lecture on abscesses inexcellent German. It was subsequently publishedin Germany.9 The audience was so impressed thatdespite his youth (36 years old) he was made a ‘Fel-low’ of the German Surgical Society.

The following year he published the results ofhis findings in the British Medical Journal, whichprobably accepted his paper as it was in the formof a report to the BMA grants committee.8 Thereaf-ter his papers were refused, and appeared in theJournal of Anatomy and Physiology.

Conclusion

As we have seen, Ogston wondered why somemicrococci seemed to be harmless, and he con-nected the appearance of yellow pus from severeinfections with the colour of some staphylococcalcolonies which in several cases was ‘the deepestorange-yellow’. However, life moves on e in 1882he was appointed Regius Professor of Surgery inAberdeen and wrote: ‘The limited time and op-portunities I possessed in the midst of a big surgicalpractise have proved insuperable impediments,and I had to leave others to the pursuit of furtherenquiries’. Nonetheless during the years of 1878e1883, the golden age of discovery for bacteria e he

was a major player e and indeed the only one inthe UK.

As an addendum e in 1883 he called his coccusstaphylococcus e a name suggested to him by theProfessor of Greek, W.D. Geddes, following thegreek for ‘a bunch of grapes’. He had brokena rule for bacterial nomenclature e not surpris-ingly as it was only made in 1958. Naming is onlyvalid if it is accompanied by a description of thegenus, or by a reference to a previously publisheddescription. So in the textbooks the name staphy-lococcus is accredited to Rosenbach, who wasa surgeon who worked at Gottingen. Although heknew of both Koch’s and Ogston’s work he hadthe great advantage of being able to grow the bac-teria on solid media and differentiate the colonies.From 30 unopened abscesses he grew five types ofbacteria e far the commonest were the staphylo-cocci (‘I will here adopt the name proposed by Og-ston’ he wrote in 1886). He noted two types ofcolony distinguished by colour and so called themStaphylococcus pyogenes aureus, and Staphylococ-cus pyogenes albus. It is interesting to note thatthe original S. albus strains came from pus, andRosenbach proved their pathogenicity with animalexperiments. Once again Watson Cheyne came tothe rescue by translating Rosenbach’s paper intoEnglish.10

Ogston continued as Regius Professor of Surgeryfor another 27 years, and died in his 80s. He wasclearly a highly motivated man. He devoted timeto his family (eleven children), his hobbies (cy-cling, fishing, shooting), and his work. He tooka great interest in military surgery, and served inEgypt, and South Africa (where he survived ty-phoid, and was horrified at the provision ofmedical services), and over the age of 70 hevolunteered to go to the Balkans and later Italyin World War I. Despite the initial antagonism, theBritish Medical Association made him President,and his obituary filled several pages of the BritishMedical Journal in February, 1929.

In 1981 Sir Robert Williams, himself a majorfigure in staphylococcal research, wrote: ‘Medicalmicrobiologists owe a considerable debt of grati-tude to Ogston’s coccus e I estimate the Index Med-icus has cited well over 20 000 papers onstaphylococci in the last 30 years’.2 At the timehe wrote e the healthcare-associated problems ofstaphylococci were thought to be over e meticillinresistance was not often seen. Not so today. Keyingin ‘staphylococcus’ to Google scholar today reveals22 400 references in the last year! Perhaps weshould refer again to Ogston’s paper for a lastword from this amazing man: ‘Once establishedthe micrococci are hard to kill e the only thing I

372 S.W.B. Newsom

found effective was cauterisation with a strong so-lution of chloride of zinc’.8

Conflict of interest statementNone declared.

Funding sourcesNone.

References

1. Ogston WH, Cowan WH, Smith HE. Alexander Ogston KCVO.Aberdeen: Aberdeen University Press; 1943.

2. Macdonald A, Smith G. The staphylococci. Aberdeen: Aber-deen University Press; 1981.

3. Newsom SWB. Pioneers in infection control e Ignaz PhilippSemmelweis. J Hosp Infect 1993;23:175e187.

4. Newsom SWB. Pioneers in infection control e Joseph Lister.J Hosp Infect 2003;55:246e253.

5. Simpson J. Our existing system of hospitalism, its effect onthe results of surgical operations. Edinb Med J 1869;14:816e830.

6. Erichsen JE. On hospitalism and the causes of death afteroperations. London: Longmans Green & Co; 1874.

7. Koch R, translated by Watson Cheyne W. Investigations intothe etiology of traumatic infective diseases. London: TheNew Sydenham Society; 1880.

8. Ogston A. Report upon microorganisms in surgical diseases.Br Med J 1881;1:369e375.

9. Ogston A. Uber Abscesse. Langenbecks Arch Klin Chir VerDtsch Z Chir 1880;25:599 [translated as Appendix in Ref. 2].

10. Rosenbach FJ. Suppuration and septic diseases. In: WatsonCheyne W, editor. Recent essays on bacteria in relation todisease. London: The New Sydenham Society; 1886.