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 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

T H E O X F O R D HI S T O R Y O F P R O T E S T A N T
D I S S E N T I N G TR A D I T I O N S ,
V O L U M E IV
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

THE OXFORD HISTORY OF

PROTESTANT DISSENTING TRADITIONS
General Editors:
Timothy Larsen and Mark A. Noll
The Oxford History of Protestant Dissenting Traditions, Volume I
The Post-Reformation Era, c.1559–c.1689
Edited by John Coffey
The Oxford History of Protestant Dissenting Traditions, Volume II
The Long Eighteenth Century, c.1689–c.1828
Edited by Andrew C. Thompson
The Oxford History of Protestant Dissenting Traditions, Volume III
The Nineteenth Century
Edited by Timothy Larsen and Michael Ledger-Lomas
The Oxford History of Protestant Dissenting Traditions, Volume IV
The Twentieth Century: Traditions in a Global Context
Edited by Jehu J. Hanciles
The Oxford History of Protestant Dissenting Traditions, Volume V
The Twentieth Century: Themes and Variations in a Global Context
Edited by Mark P. Hutchinson
 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

The Oxford History of

Protestant Dissenting Traditions
Volume IV

The Twentieth Century:

Traditions in a Global Context

Edited by
J EHU J . HA N C I L E S

1
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

3
Great Clarendon Street, Oxford, OX2 6DP,
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It furthers the University’s objective of excellence in research, scholarship,
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 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

Contents

List of Contributors vii

Series Introduction xiii
Timothy Larsen and Mark A. Noll

Introduction 1
Jehu J. Hanciles

PART I: AFRICA

1. Emerging Streams of Dissent in Modern African Christianity 21

Jehu J. Hanciles
2. Charismatic Churches and the Pentecostalization of African
Christianity 52
Allan Heaton Anderson
3. Indigenization, Translation, and Transformation in African
Christianity 73
Akintunde E. Akinade

PART II: ASIA AND THE MIDDLE EAST

4. Protestant Dissenting Traditions in Asia in the Twentieth Century 89

John Roxborogh
5. Megachurches in Asia and the Dissenting Movement:
The Case of Yoido Full Gospel Church 106
Wonsuk Ma
6. Dissenting Traditions and Indigenous Christianity:
The Case in China 127
Peter Tze Ming NG
7. ‘Crying for Help and Reformation’: Dissenting Protestants
in Ottoman Syria 145
Deanna Ferree Womack
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

vi Contents

PART III: AMERICA AND EUROPE

8. Dissent as Mainline 165

Laura Rominger Porter
9. Southern Baptists and Evangelical Dissent 194
Bill J. Leonard
10. The Twentieth-Century Black Church: A Dissenting
Tradition in a Global Context 216
David D. Daniels III
11. Pentecostals and Charismatics in America 241
Cecil M. Robeck, Jr
12. Free Church Traditions in Twentieth-Century Europe 261
Toivo Pilli and Ian M. Randall
13. Dissent by Default: ‘Believing Without Belonging’
in Twenty-First-Century England 292
Sylvia Collins-Mayo

PART I V: LATIN AMERICA

14. Historical and Ideological Lineages of Dissenting

Protestantism in Latin America 315
Stephen Dove
15. Chilean Pentecostalism: Methodism Renewed 338
Martin Lindhardt
16. Dissenting Religion: Protestantism in Latin America 359
Virginia Garrard

PART V: THE PACIFIC

17. Localization and Indigenization of Christianity in the Pacific 387

Brian M. Howell and Michael A. Rynkeiwich
18. Fijian and Tongan Methodism 409
Jane Samson

Index 433
 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

List of Contributors

Akintunde E. Akinade is a Professor of Theology at Georgetown University’s

Edmund E. Walsh School of Foreign Service in Qatar. His publications include
Christian Responses to Islam in Nigeria: A Contextual Study of Ambivalent
Encounters (2014);The Agitated Mind of God: The Theology of Kosuke Koyama
(1996, co-edited with Dale T. Irvin); Creativity and Change in Nigerian
Christianity (2010, co-edited with David O. Ogungbile); A New Day: Essays
on World Christianity in Honor of Lamin Sanneh (2010); and Fractured
Spectrum: Perspectives on Christian-Muslim Relations in Nigeria (2013). He
serves on the Editorial Board of The Muslim World, Studia Historiae Eccle-
siasticae, Religions, The Trinity Journal of Theology, Journal of Inter-Religious
Dialogue, Orita: Ibadan Journal of Religious Studies, Odu: A Journal of West
African Studies, and The Living Pulpit. He is the book review editor for The
Journal of World Christianity published by Pennsylvania State University
Press. Within the American Academy of Religion, he has served on the
Editorial Board on its flagship journal, The Journal of the American Academy
of Religion (JAAR) and also on the International Connections Committee.
Allan Heaton Anderson is Professor of Mission and Pentecostal Studies at the
University of Birmingham. He is originally from Zimbabwe, and is the author
of many books and articles on global Pentecostalism, and he has also special-
ized on Pentecostalism in Africa. His most recent books are An Introduction to
Pentecostalism (2014), To the Ends of the Earth (2013) and Spreading
Fires (2007). His most recent books are Spirit-Filled World (2018), An Intro-
duction to Pentecostalism (2014), To the Ends of the Earth (2013) and
Spreading Fires (2007).
Sylvia Collins-Mayo is Associate Professor in Sociology at Kingston University.
Her research interests focus on youth and religion with particular reference to the
everyday faith of young people from Christian backgrounds. Her publications
include Making Sense of Generation Y (2006, co-authored with Sara Savage,
Bob Mayo, and Graham Cray); The Faith of Generation Y (2010, co-authored
with Bob Mayo, Sally Nash, and Christopher Cocksworth); and Religion and
Youth (2010, Pink Dandelion). Her current research includes the role of faith in
secular places of work and the sociological aspects of prayer practices.
David D. Daniels III is the Henry Winters Luce Professor of World Chris-
tianity at McCormick Theological Seminary, having joined the faculty in 1987.
He earned a PhD in Church History from Union Theological Seminary and
has authored over fifty academic journal articles and book chapters on topics
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

viii List of Contributors

related to the Black Church, Global Pentecostalism, and World Christianity.
Daniels serves on various editorial boards, including the board of the Journal
of World Christianity. He has delivered public lectures at colleges and semin-
aries across the United States along with presenting academic papers in over
twelve countries throughout Africa, Asia, and Europe.
Stephen Dove is Assistant Professor of History and Latin American Studies at
Centre College. He is co-editor of the Cambridge History of Religion in Latin
America (2016, Cambridge University Press). His research focuses on the shift
from missionary to local Protestantism in Latin America, and he is currently
working on a book manuscript based on research in Guatemala.
Virginia Garrard has been on the faculty at the University of Texas since 1990.
Her most recent work is The Cambridge History of Religions in Latin America
(2016, co-edited with Stephen Dove and Paul Freston). She is author of Terror
in the Land of the Holy Spirit: Guatemala Under General Efraín Ríos Montt,
1982–1983 (2010, Oxford); Terror en la tierra del Espiritu Santo (2012,
AVANCSO); Viviendo en La Nueva Jerusalem (2009, Guatemala); Protestant-
ism in Guatemala: Living in the New Jerusalem (1998, University of Texas
Press); and Beyond the Eagle’s Shadow: New Histories of Latin America’s Cold
War (2013, co-editor with Mark Lawrence and Julio Moreno. She has also
edited On Earth as it is in Heaven: Religion and Society in Latin America (2000,
Scholarly Resources); Rethinking Protestantism in Latin America (1993,
co-edited with David Stoll); and The History of Modern Latin America and
the World (2018, co-authored with Peter Henderson and Bryan McCann).
Her research interests include: historic memory and human rights during the
Cold War in Latin America, archives and digital humanities, and contempor-
ary Central American history. She is equally interested in religious movements
and ethnic identity in Latin America, Pentecostalism and other Protestant
movements, and the intersection of religion, culture, and politics in Latin
America.
Jehu J. Hanciles is D. W. Ruth Brooks Associate Professor of World Christianity
at Candler School of Theology at Emory University and director of its World
Christianity Program. Originally from Sierra Leone, he is the author of Euthan-
asia of a Mission: African Church Autonomy in a Colonial Context (2002), and
Beyond Christendom: Globalization, African Migration and the Transformation
of the West (2008). He has written and published mainly in issues related to the
history of Christianity, notably the African experience and globalization. His
current research aims to survey the history of global Christian expansion through
the lens of migration.
Brian M. Howell is Professor of Anthropology at Wheaton College. He
graduated from Wesleyan University (CT), majored in the College of Social
Studies, has Masters from Fuller Theological Seminary and Washington
 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

List of Contributors ix
University in St. Louis, and a Doctorate in Sociocultural Anthropology
from Washington University in St. Louis. He spent eighteen months in the
Philippines on doctoral fieldwork,with additional fieldwork in the Dominican
Republic and United States. His books include Christianity in the Local
Context (2008), Power and Identity in the Global Church: Six Case Studies
(2009, co-editor with Edwin Zehner), Introducing Cultural Anthropology
(2011, co-author with Jenell Williams Paris), and Short Term Mission: An
Ethnography of Christian Travel Narrative and Experience (2012).
Bill J. Leonard is James and Marilyn Dunn Professor of Baptist Studies and
Professor of Church History Emeritus at the School of Divinity, Wake Forest
University, where he was the founding Dean. He is the author or editor of
some twenty-five books with particular focus on American religion, Baptist
Studies, and Appalachian religious traditions. Leonard is a an ordained Baptist
minister.
Martin Lindhardt is an Associate Professor of Cultural Sociology at the
University of Southern Denmark. He has published numerous journal articles
and book chapters on Pentecostalism in Chile and on Pentecostal-Charismatic
Christianity and witchcraft in Tanzania. He is also the author of Power in
Powerlessness: A Study of Pentecostal Life-Worlds in Urban Chile (2012), and
the editor of Practicing the Faith: The Ritual Life of Pentecostal-Charismatic
Christians (2011), and Pentecostalism in Africa: Presence and Impact of
Pneumatic Christianity in Post-Colonial societies (2014).
Wonsuk Ma is Distinguished Professor of Global Christianity at Oral Roberts
University. He also serves as Dean of College of Theology and Ministry. His
research focuses on Asian Pentecostalism, Pentecostal mission, and global
Christianity. As the Director of Regnum Books during an Oxford tenure, he
was responsible for the publication of the thirty-five-volume Regnum Edin-
burgh Centenary Series. His publications include Mission in the Spirit:
Towards a Pentecostal/Charismatic Missiology (2010, with Julie C. Ma).
Peter Tze Ming NG is Professor and Chair of Chinese Christianity at China
Victory Theological Seminary of Hong Kong, and concurrently an Adjunct
Professor at both the School of Inter-cultural Studies in Fuller Theological
Seminary, Pasadena, USA and the Centre for the Study of Religion and
Chinese Society, Shanghai University, Shanghai, China, as well as a Senior
Researcher of Lumina College Research Institute, Hong Kong. Prof. Ng has
been Adjunct Professor of Sichuan University (2007–10), Lanzhou University
(2007–10), and Shanghai University (20058, 2010– present), all in the People’s
Republic of China. He has also been a Research Fellow at Yale University
Divinity School (1991), Adjunct Professor at Church Divinity School of the
Pacific, Berkeley (1992), and Distinguished Fellow of Ricci Institute, Univer-
sity of San Francisco (2002) in USA. Besides, he was appointed Visiting Fellow
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

x List of Contributors
of Wolfson College at Cambridge University (2005), Senior Research Fellow
of Oxford Centre for the Study of Christianity in China, UK (2007), Henry
Martyn Lecturer, UK (2007), and the Chairman of North East Asian Council
for the Study of History of Christianity (2007–9). His recent book is Chinese
Christianity: An Interplay between Global and Local Perspectives (2012, Brill).
Toivo Pilli is Director of Baptist and Anabaptist Studies, International Baptist
Theological Study Centre, Amsterdam, The Netherlands, and Associate Pro-
fessor of Free Church History and Identity, Tartu Theological Seminary,
Estonia. He is the author of Dance or Die: The Shaping of Estonian Baptist
Identity under Communism (2008).
Ian M. Randall is a Senior Research Fellow of Spurgeon’s College, London,
and the International Baptist Theological Study Centre, Amsterdam, and a
Research Associate of the Cambridge Centre for Christianity Worldwide. He
has written a number of books on evangelical movements.
Cecil M. Robeck, Jr is an Assemblies of God minister in the US. He serves as
Senior Professor of Church History and Ecumenics and Special Assistant to
the President for Ecumenical Relations. He has written widely on Pentecostal,
Charismatic, and Ecumenical issues.
Laura Rominger Porter is an independent scholar who writes and teaches
about American religion, slavery, and the US South. She holds a PhD in
History from the University of Notre Dame. She is the co-editor of Turning
Points in the History of American Evangelicalism (2017).
John Roxborogh (University of Otago) is an historian of Christian mission in
Asia and Southeast Asia. He is author of A History of Christianity in Malaysia
(2014), and co-editor of The Handbook of Popular Spiritual Movements in
Malaysia, Singapore and Indonesia (2015, with Michael Nai-Chiu Poon). He is
an Honorary Fellow in the Department of Theology and Religion at the
University of Otago, Dunedin, New Zealand.
Michael A. Rynkeiwich is Professor of Anthropology, retired, E. Stanley
Jones School of World Mission and Evangelism, Asbury Theological Sem-
inar. He is a graduate in anthropology from Bethel University, St. Paul, MN;
with a Master’s and Doctorate in Anthropology from the University of
Minnesota. He has carried out doctoral fieldwork in the Marshall Islands,
Micronesia (eighteen months), and missionary work in Papua New Guinea
(five years). His books include The Nacirema (1975) and Ethics and Anthro-
pology (1976), both edited volumes with James Spradley; two edited volumes
on Land and Churches in Melanesia (2001, 2004), and a textbook: Soul, Self,
and Society: A Postmodern Anthropology for Mission in a Postcolonial
World (2011).
 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

List of Contributors xi
Jane Samson is Professor of History at the University of Alberta in Edmonton.
She is the author of numerous books and articles on the nineteenth-century
Pacific world. Her current research concerns indigenous missionaries in the
Melanesian Mission. Her most recent project is the Cambridge History of the
Pacific Ocean (forthcoming, 2020), co-edited with Anne Perez Hattori.
Deanna Ferree Womack is Assistant Professor of History of Religions and
Multifaith Relations at Emory University’s Candler School of Theology and a
minister in the Presbyterian Church (USA). At Candler she teaches on the
history and practice of Christian–Muslim relations and directs the Leadership
and Multifaith Program (LAMP). Her research explores encounters between
American missionaries and Arab residents of Ottoman Syria in the pre-World
War I period. Her first book, Protestants, Gender and the Arab Renaissance in
Late Ottoman Syria is forthcoming from Edinburgh University Press (2019).
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi
 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

Series Introduction
Timothy Larsen and Mark A. Noll

There is something distinctive, if not strange, about how Christianity has been
expressed and embodied in English churches and traditions from the Refor-
mation era onwards. Things developed differently elsewhere in Europe. Some
European countries such as Spain and Italy remained Roman Catholic. The
countries or regions that became Protestant choose between two exportable
and replicable possibilities for a state church—Lutheran or Reformed. Denmark
and Sweden, for example, both became Lutheran, while the Dutch Republic
and Scotland became Reformed. The Peace of Westphalia (1648) established the
right of sovereigns to choose a state church for their territories among those
three options: Roman Catholic, Lutheran, or Calvinist. A variety of states
adopted a ‘multi-confessional’ policy, allowing different faiths to coexist side-
by-side. The most important alternative expression of Protestantism on the
continent was one that rejected state churches in principle: Anabaptists.
England was powerfully influenced by the continental Reformers, but both
the course and outcome of its Reformation were idiosyncratic. The initial
break with Rome was provoked by Henry VIII’s marital problems; the king
rejected the Reformation doctrine of justification by faith and retained the
Latin mass, but swept away monasteries and shrines, promoted the vernacular
Scriptures, and had himself proclaimed Supreme Head of the Church of
England. Each of his three children (by three different wives) was to pull the
church in sharply different directions. The boy king Edward VI, guided by
Archbishop Cranmer and continental theologians like Martin Bucer and Peter
Martyr Vermigli, set it on a firmly Reformed trajectory, notably through
Cranmer’s second Prayer Book (1552) and the Forty-Two Articles (1553).
Mary I reunited England with Rome, instigating both a Catholic reformation
and a repression of Protestants that resulted in almost three hundred execu-
tions. Finally, Elizabeth I restored the Edwardian settlement (with minor
revisions), while sternly opposing moves for further reformation of the kind
favoured by some of her bishops who had spent the 1550s in exile in Reformed
cities on the continent. In contrast to many Reformed churches abroad, the
Church of England retained an episcopal hierarchy, choral worship in cath-
edrals, and clerical vestments like the surplice.
The ‘half reformed’ character of the Elizabethan church was a source of
deep frustration to earnest Protestants who wanted to complete England’s
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

xiv Series Introduction

reformation, to ‘purify’ the church of ‘popish’ survivals. From the mid-1560s,
these reformers were called ‘Puritans’ (though the term was also applied
indiscriminately to many godly conformists). They represented a spectrum
of opinion. Some were simply ‘nonconformists’, objecting to the enforcement
of certain ceremonies, like the sign of the cross, kneeling at communion, or the
wearing of the surplice. Others looked for ‘root and branch’ reform of the
church’s government. (All Dissenting movements would remain expert at
employing biblical images in their public appeals, as with ‘root and branch,’
taken in this sense from the Old Testament’s book of Ezekiel, chapter 17.)
They wished to create a Reformed, Presbyterian state church, that is, to make
over the Church of England into the pattern that ultimately prevailed north of
the border as the Church of Scotland. Still others gave up on the established
church altogether, establishing illegal separatist churches. Eventually, England
would see a proliferation of home-grown sects: Congregationalists (or Inde-
pendents), General Baptists, Particular Baptists, Quakers (or Friends), Fifth
Monarchists, Ranters, Muggletonians, and more.
These reforming movements flourished during the tumultuous mid-
century years of civil war and interregnum, when the towering figure of Oliver
Cromwell presided over a kingless state and acted as protector of the godly.
But when the throne and the established church were ‘restored’ in 1660,
reforming movements of all sorts came under tremendous pressure. The
term ‘Dissent’ came to serve as the generic designation for those who did
not agree that the established Church of England should enjoy a monopoly
over English religious life. Some of the sects—such as the Ranters,
Muggletonians, and Fifth Monarchists—soon faded away. Others, espe-
cially Independents/Congregationalists, Baptists, and Quakers survived.
Crucially, they were now joined outside the established church by the
Presbyterians, ejected from the livings in 1660–62. Although Presbyterians
continued to attend parish worship and work for comprehension within
the national church, they were (as Richard Baxter noted) forced into a
separating shape, meeting in illegal conventicles. In 1689, Parliament
confirmed the separation between Church and ‘Dissent’ by rejecting a
comprehension bill and passing the so-called Act of Toleration. The
denominations of what became known as ‘Old Dissent’—Presbyterians,
Congregationalists, Baptists, and Quakers—now enjoyed legally-protected
freedom of worship, even as their members remained second-class citizens,
excluded from public office unless they received Anglican communion.
Over the course of the seventeenth century, all of these Dissenting move-
ments had established a presence in the British colonies of North America.
(They became ‘British’ and not just ‘English’ colonies in 1707, after the Union
of England and Scotland that created ‘Great Britain’.) In the New World began
what has become a continuous history of English Dissent adapting to condi-
tions outside of England. In this instance, Congregationalists in New England
 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

Series Introduction xv
set up a system that looked an awful lot like a church establishment, even as
they continued to dissent from the Anglicanism that in theory prevailed
wherever British settlement extended.
Complexity in the history of Dissent only expanded in the eighteenth
century with the emergence of Methodism. This reforming movement within
the Church of England became ‘New Dissent’ at the end of the century when it
separated from Anglican organizational jurisdiction. In America, that separ-
ation took place earlier than in England when the American War of Inde-
pendence ruled out any kind of official authority from the established church
across the sea in the new nation.
In the great expansion of the British Empire during the late eighteenth and
throughout the nineteenth century, Anglophone Dissent moved out even
farther and evolved even further. Canada, Australia, New Zealand, South
Africa, and other imperial outposts in Africa and Asia usually enjoyed the
service of Anglican missionaries and local supporters. But everywhere that
Empire went so also went Dissenting Protestants. The creation of the Baptist
Missionary Society (1792) and the London Missionary Society (1795) (which
was dominated by Congregationalists) inaugurated a dramatic surge of over-
seas missions. Nowhere in the Empire did the Church of England enjoy the
same range of privileges that it retained in the mother country.
Meanwhile, back in England, still more new movements added to the
Protestant panoply linked to Dissent. Liberalizing trends in both Anglican
and Presbyterian theology in the later eighteenth century saw the emergence
of the Unitarians as a separate denomination. Conservative trends produced
the (so-called Plymouth) Brethren who replicated the earlier Dissenting pat-
tern by originating as a protest against the nineteenth-century Church of
England—as well as lamenting the divisions in Christianity and longing to
restore the purity of the New Testament church. The Salvation Army (with
roots in the Methodist and Holiness movement) was established in response to
the challenges of urban mission.
Even further complexity appeared during the twentieth and twenty-first
centuries when Pentecostal movements arose, usually with an obvious
Methodist lineage, especially as developed by the Holiness tradition within
Methodism, but also sometimes with a lineage traceable to representatives of
‘Old Dissent’ as well. Historically considered, Pentecostals are grandchildren
of Dissent via a Methodist-Holiness parentage.
Whether ‘New’ or ‘Old’—or descended from ‘New’ or ‘Old’—all of these
traditions have now become global. Some are even dominant in various
countries or regions in their parts of the globe. To take United States history
as an example, in the eighteenth century Congregationalism dominated Mas-
sachusetts. By the early nineteenth century, Methodism was the largest Chris-
tian tradition in America. Today, the largest Protestant denomination in the
United States is the Southern Baptist Convention. Or with Canada as another
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

xvi Series Introduction

example, Anglicans remained stronger than did Episcopalians in the United
States, but Methodists and Presbyterians often took on establishment-like
characteristics in regions where their numbers equalled or exceeded the
Anglicans. In different ways and through different patterns of descent, these
North American traditions trace their roots to English Dissent. The same is
true in parallel fashion and with different results in many parts of Africa, Asia,
Latin America, and elsewhere, where Pentecostalism is usually the dominant
style of Protestantism.

THE F IVE VOLUMES OF THIS SERIES

The five-volume Oxford History of Dissenting Protestant Traditions is gov-

erned by a motif of migration (‘out-of-England’, as it were), but in two senses
of the term. It first traces organized church traditions that arose in England as
Dissenters distanced themselves from a state church defined by diocesan
episcopacy, the Book of Common Prayer, the Thirty-Nine Articles, and
royal supremacy, but then follows those traditions as they spread beyond
England—and also traces newer traditions that emerged downstream in
other parts of the world from earlier forms of Dissent. Second, it does the
same for the doctrines, church practices, stances toward state and society,
attitudes toward Scripture, and characteristic patterns of organization that also
originated in earlier English Dissent, but that have often defined a trajectory of
influence independent ecclesiastical organizations. Perhaps the most notable
occasion when a major world figure pointed to such an influence came in 1775
when Edmund Burke addressed the British Parliament in the early days of the
American revolt. While opposing independence for the colonies, Burke yet
called for sensitivity because, he asserted, the colonists were ‘protestants; and
of that kind, which is the most adverse to all submission of mind and opinion’.
Then Burke went on to say that ‘this averseness in the dissenting churches
from all that looks like absolute government’ was a basic reality of colonial
history. Other claims have been almost as strong in associating Dissenters with
the practice of free trade, the mediating structures of non-state organization,
creativity in scientific research, and more.
This series was commissioned to complement the five-volume Oxford
History of Anglicanism. In the Introduction to that series, the General Editor
Rowan Strong engaged in considerable handwringing about the difficulties of
making coherent, defensible editorial decisions, beginning with the question of
how fitting the term ‘Anglicanism’ was for the series title. If such angst is
needed for Anglicanism, those whose minds crave tidiness should abandon all
hope before entering here. Beginning again with just the title, ‘Dissenting’ is a
term that obviously varies widely in terms of its connotations and applicability,
 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

Series Introduction xvii

depending on the particular time, place, and tradition. In some cases, it has been
used as a self-identifier. In many other cases, groups whom historians might
legitimately regard as descendants of Dissent find it irrelevant, incoherent, or
just plain wrong. An example mentioned earlier suggests some of the complex-
ity. In colonial Massachusetts, ‘Dissenting’ Congregationalists in effect set up an
established church supported by taxes and exercising substantial control over
public life. In that circumstance, ‘Dissent’ obviously meant something different
than it did for their fellow Independents left behind in England. Nevertheless,
Massachusetts Congregationalism is still one of the traditions out-of-England
that we have decided to track wherever it went—even into the courthouse and
the capitol building. Much later and far, far away, Methodism in the Pacific
Island of Fiji would also take on some establishmentarian features, which again
suggests that ‘Dissent’ points to a history or affinities shared to a greater or lesser
extent, but not to an unchanging essence. Indeed, because Dissent is defined in
relation to Establishment, it is a relative term.
Another particularly anomalous case is Presbyterianism, which has been a
Dissenting tradition in England but a state church in Scotland and elsewhere.
When one examines it in other parts of the world, a sophisticated analysis is
required—for example, in the United States and Canada (where Presbyterian-
ism was once a force to be reckoned with) and in South Korea (where it still is).
In these countries one encounters a tradition originally fostered by mission-
aries and emigrants with both Dissenting and establishmentarian roots. By
including Presbyterians in these volumes, we communicate an intention to
consider ‘Dissent’ broadly construed.
Other terms might have been chosen for the title, such as ‘Nonconformist’
or ‘Free Churches’. Yet they suffer from the same difficulty—that all groups
that might in historical view be linked under any one term will include many
who never used the term for themselves or who do not acknowledge the
historical connection. Yet ‘Dissenting Studies’ is a recognized and flourishing
field of academic studies, focussed on the history of those Protestant move-
ments that coalesced as Dissenting denominations in the seventeenth century
and on the New Dissent that arose outside the established church in the
eighteenth and nineteenth centuries.
Still, the problem of fitting terminology to historical reality remains. The
further in geographical space that one moves from England and the nearer in
time that one comes to the present, the less relevant any of the possible terms
becomes for the individuals and Protestant traditions under consideration.
Protestants in China or India, for example, generally do not think of their faith
as ‘Dissenting’ at all—at least not in any way that directly relates to how that
word functioned for Unitarians in nineteenth-century England. Even in the
West, a strong sense of denominational identity or heritage has been waning
due to increasing individualism and hybridization. Such difficulties are inev-
itable for a genealogy where trunks and branches outline a common history of
OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

xviii Series Introduction

protest against church establishment, but very little else besides broadly
Protestant convictions.
The five volumes in this series, as well as the individual chapters treating
different regions, periods, and emphases, admittedly brave intellectual anom-
alies and historical inconsistencies. One defence is simply to plead that
untidiness in the volumes reflects reality itself rather than editorial confusion.
Church and Dissent, Anglicanism and Nonconformity, were defined by their
relationship, and the wall between them was a porous one; while it can be
helpful to think it terms of tightly defined ecclesiastical blocs, the reality of
lived religion often defied neat lines of demarcation. Many eighteenth- and
nineteenth-century Anglicans read Puritan works, while many Dissenters
imbibed the works of great Anglicans. Besides, an editorial plan that put a
premium on tidiness would impoverish readers by leaving out exciting and
important events, traditions, personalities, and organizations that do fall,
however remotely or obscurely, into the broader history of English Protestant
Dissent.
Which brings us to the second, more significant justification for this five-
volume series. On offer is nothing less than a feast. Not the least of Britain’s
contributions to world history has been its multifaceted impact on religious
life, thought, and practice. In particular, this one corner of Christendom has
proven unusually fertile for the germination of new forms of Christianity.
Those forms have enriched British history, while doing even more to enrich all
of world history in the last four centuries. By concentrating only on the history
of Dissent, these volumes nonetheless illuminate the extraordinary contribu-
tions of some of the greatest preachers, missionaries, theologians, pastors,
organizations, writers, self-sacrificing altruists and (yes, also) some of the
most scandalous, self-defeating, and egotistical episodes in the entire history
of Christianity. Taken in its broadest dimensions, this series opens the story
of large themes and new ways of thinking that have profoundly shaped our
globe—on the relationships between church and state, on the successes and
failures of voluntary organization, on faith and social action, on toleration
and religious and civil freedom, on innovations in worship, hymnody,
literature, the arts, and much else. It is a story of traditions that have
significantly influenced Europe, North America, Latin America, Africa,
Asia, the Pacific Islands, and even the Middle East (for example, the found-
ing of what is now the American University of Beirut). Especially the two
volumes on the twentieth century offer treatments of vibrant, growing forms
of Christianity in various parts of the world that often have not yet received
the scholarly attention they deserve. All five volumes present the work of
accomplished scholars with widely recognized expertise in their chosen
subjects. In specifically thematic chapters, authors address issues of great
current interest, including gender, preaching, missions, social action, politics,
literary culture, theology, the Bible, worship, congregational life, ministerial
 OUP CORRECTED PROOF – FINAL, 15/2/2019, SPi

Series Introduction xix

training, new technologies, and much more. The geographical, chronological,
and ecclesiastical reach is broad: from the Elizabethan era to the dawn of the
twentieth-first century, from Congregationalists to Pentecostals, from Cape
Cod to Cape Town, from China to Chile, from Irvingite apostles in
nineteenth-century London to African apostles in twenty-first-century Nigeria.
Just as expansive is the roster of Dissenters or descendants of Dissent: from John
Bunyan to Martin Luther King, Jr, from prisoner-reformer Elizabeth Fry to
mega-mega-church pastor Yonggi Cho, from princes of the pulpit to educa-
tional innovators, from poets to politicians, from liturgical reformers to social
reformers. However imprecise the category of ‘Dissent’ must remain, the vol-
umes in this series are guaranteed to delight readers by the wealth of their insight
into British history in the seventeenth and eighteenth centuries, by what they
reveal about the surprising reach of Dissent around the world in later periods,
and by the extraordinary range of positive effects and influences flowing from a
family of Christian believers that began with a negative protest.
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previously resistant; and, third, a suppurative infection, as above
described.
In contradistinction to these distinct events, separated by an
appreciable, sometimes a considerable, length of time, we recognize
a mixed infection, where two or more organisms are implanted at or
about the same time. An illustration of this is seen in most cases of
gonorrhea in which there is a synchronous attack made by the
gonococcus, which is a specific microörganism, accompanied by
staphylococci or streptococci, whose effect will complicate the case
and make it assume a less particulate type of infection. Mixed
infections may often occur in other ways, as syphilis and chancroid,
chancroid and gonorrhea, etc. Most cases of mixed infection belong
rather to surgery than to general medicine, and constitute an
apparent violation of the rule to which physicians often point—that
two distinct infectious diseases are seldom communicated or
acquired at the same time. Nevertheless, the facts remain as above.
Terminal Infections.—Terminal infections constitute an apparent
paradox, perhaps oftener in medical than in
surgical cases. Few people, as Osler has shown, die of the diseases
from which they suffer. The final exitus is due to a more or less rapid
infection which terminates life. These terminal infections are mainly
due to a few well-known microbes, such as the streptococcus,
staphylococcus aureus, pneumococcus, bacillus proteus,
gonococcus, bacillus pyocyaneus, and the gas bacillus. In surgery
such infections are, perhaps, most often seen in malignant
lymphoma, diabetes, tuberculosis, syphilis, cancer, and in the so-
called surgical kidney.

BACTERIA OF PUS FORMATION.

Bacteria which act as agents in the formation of pus are
collectively known as pyogenic organisms. These are divided into
two groups:
A. The Obligate; and
B. The Facultative.
Obligate pyogenic organisms are those whose activity is
manifested in the direction of pus formation, which seem to produce
it if they produce any unpleasant action whatever. On the other hand,
the facultative organisms are those which are known occasionally to
be active in this direction, and yet which are not always nor
necessarily so. The members of group A are fairly well known and
catalogued, and are not numerous. On the other hand, there is
reason to believe that many organisms may have the occasional
effect of producing pus, as it were, by accident or at least in a way
not absolutely natural or peculiar to themselves, but still are
frequently found when there is no pus present. A suitable list of the
facultative organisms, therefore, can hardly be made, and will not be
here attempted, the effort being only to mention the more common
organisms which play this facultative role. It may be mentioned also
that even the adjectives “obligate” and “facultative” are to be
accepted with some mental reservation, since staphylococci, for
instance, may be met with even in the absence of pus, although
nearly all that we know about these organisms implies that pus
would be the result of their presence. Furthermore, there are certain
other organisms, not, strictly speaking, bacteria, which also have the
power of producing either pus or pyoid material. These also will be
mentioned in their place. Some of them belong not only to the
vegetable, but also to the animal kingdom.
Obligate Pyogenic Organisms.—One of the characteristics of
A. The Staphylococcus Pyogenes Aureus, Albus, Citreus, the
Staphylococcus Epidermidis, etc.
the staphylococci as a group is the powerful peptonizing action
which they exert. Moreover, the chemical products of their life
changes seem to be more potent in a local than a general way,
leading to greater destruction of tissue in their immediate vicinity,
with greater inhibition of the chemotactic powers of the leukocytes;
that is, with more interference with phagocytosis, by which their
progress would be interfered with. Their presence is recognized by a
peculiar odor, as of sour paste, which should lead to a prompt
change of dressings and disinfection of the wound (by irrigation,
spraying with hydrogen dioxide, etc.).
B. Streptococcus Pyogenes and Streptococcus Erysipelatis.—These two
organisms do not differ in morphology nor characteristics, and, while
for some time considered as distinct from each other, are now by
most observers regarded as identical. The streptococci grow in
chains of variable length, and individual cocci vary in size. They grow
with and without oxygen, in all media, at ordinary temperatures, do
not liquefy gelatin, stain readily, sometimes but not invariably
coagulate milk, and vary in longevity. They differ extraordinarily in
virulence according to their sources.

Fig. 4 Fig. 5

Staphylococci in pus. × 1000. (Fränkel Streptococci in pus. × 1000. (Fränkel

and Pfeiffer.) and Pfeiffer.)

There are many streptococci not included under the above head
which are indistinguishable morphologically and in other respects,
and yet which are partly or entirely free from pathogenic activity in
man. A biological study reveals remarkable and unexplainable
transformation between the different members of this species, a part
of which may be referable to conditions pertaining to the organisms
infected, but part of which apparently pertains to the bacteria. It is
held by some that scarlatina is an invasion by certain organisms of
this class; this, however, is not yet definitely established. When
found in the stools of children with summer diarrheas they are
regarded as indicating ulceration of the intestinal mucosa.
In contradistinction to the staphylococci, the streptococci manifest
a predilection for lymph vessels and lymph spaces, along which they
extend with great rapidity. They have less peptonizing power than
the staphylococci (except in the absence of oxygen); hence
streptococcus infection assumes usually the type of widespread
infiltration rather than of circumscribed and distinct edema. One sees
remarkable instances of this in cases of phlegmonous erysipelas. It
is suggested also that the peculiar manner of growth of the
streptococci, in long chains which may coil up and entangle blood
corpuscles, has much to do with the formation of fat emboli and with
pyemic disturbances.
Both these bacterial forms have the power of producing lactic
fermentation in milk; and lactic-acid formation sometimes takes place
with suppuration in the human tissues, causing acidity of discharge,
sour odor, and watery pus. It appears also that these two pyogenic
forms have less power of ptomain or toxin formation than many
others, and, consequently, that the pyrexia attending suppuration or
purulent infiltration is not always to be ascribed to this cause alone,
for fever may in some measure be due to tissue metabolism
attending their growth, the metabolic products being pyretic. This is
in a measure substantiated by the fever attending trichinosis, where
the question of ptomain poisoning has not yet been raised.
C. Micrococcus Lanceolatus.—Micrococcus lanceolatus is also known
as the diplococcus pneumoniæ or the pneumococcus of Fränkel and
Weichselbaum, and as the micrococcus of sputum septicemia of
Pasteur and of Sternberg. It is of interest to surgeons because it
causes many localized inflammations and is a frequent factor in
causing septicemia; it is often present in the mouths of healthy
individuals. It may produce the various forms of exudates as the
result of congestion set up by its presence; also otitis media,
meningitis, osteomyelitis, and suppurative disturbance in the
periosteum, the salivary glands, the thyroid, the kidney, the
endocardium, etc.
 Fig. 6

Diplococcus pneumoniæ of Fränkel. (Karg and Schmorl.)

D. The Micrococcus Tetragenus.—Suppurations produced by these

organisms are prolonged, mild in character, not painful, but
accompanied by much brawny induration of tissues.
E. The Micrococcus Gonorrhœæ.—The micrococcus gonorrhœæ, or
gonococcus, is found constantly in the pus of true gonorrhea, in
many cases the pus being a pure culture of this organism. These
cocci are generally seen in pairs (biscuit-shaped), while their
inclusion within the leukocytes or their attachment in or to epithelial
cells is characteristic. Unlike other pyogenic cocci, they do not stain
by Gram’s method, being decolorized by iodine, by which fact they
may be distinguished. They are cultivated with difficulty, and are
known rather by their clinical effects than by their laboratory
characteristics; are human parasites, other animals, so far as known,
being practically immune. The gonococcus may also produce
abscesses, and may be carried to distant parts of the body, where its
effects are commonly noted as pyarthrosis, although endocarditis,
pericarditis, pleurisy, etc., are known to be due to it, and fatal pyemia
has been produced in consequence. In some way it is probably the
explanation of the post gonorrheal arthritis, wrongly spoken of as
gonorrheal rheumatism.
F. The Bacillus Coli Communis or Colon Bacillus.—This is an inhabitant
of the intestinal canal; varies extremely in virulence and somewhat in
morphological appearances; coagulates milk; is often associated
with other organisms; migrates easily both along the alimentary
canal and from it into the surrounding tissues or channels. It is a
disturbing element in the production of kidney and hepatic disease,
also in the production of appendicitis and peritonitis. Ordinarily its
pyogenic properties are not virulent; occasionally, however, it
becomes extremely virulent.
G. The Bacillus Pyocyaneus.—The bacillus pyocyaneus, a widely
distributed organism, often observed in the skin and outside of the
body; a motile, liquefying bacillus, growing at ordinary temperatures,
seldom seen alone, but occasionally producing pus without
association with other organisms; it stains the discharges and
dressings a bluish-green and imparts sometimes an offensive odor.
Suppuration caused by this bacillus is usually prolonged, but
characterized by little constitutional disturbance.
Facultative Pyogenic Organisms—i. e., those which have the
power of provoking
suppuration, but which have other and more distinct pathogenic
activities as well.
A. Bacillus Typhi Abdominalis.—This is found in many pus foci,
developing during or after typhoid fever. It is occasionally met with
alone, though most of these abscesses are really mixed infections. It
is generally found in the bone or beneath the periosteum. Such
abscesses are frequently seen in the ribs, and may not be noticed
until months after convalescence from the fever. The pus contained
within them is not always typical in appearance, but may be unduly
thin or unduly thick.
B. Bacillus Proteus.—Under this name are included three distinct
forms, which were originally described by Hauser as distinct species,
but which are now regarded as pleomorphic forms of the same
organism. It is a motile bacillus, met with in decomposing animal and
vegetable material, and occasionally found in the alimentary canal. It
has been known to produce pus, especially in the peritoneal cavity
and about the appendix. It may even cause general infection and
peritonitis.
C. Bacillus Diphtheriæ.—A non-motile bacillus, varying considerably
in size and shape, changing the reaction in sweet bouillon from acid
to alkaline; produces a dangerous infective inflammation of exposed
surfaces, with tenacious exudate amounting to a distinct membrane.
As a part of its life history it also produces a toxalbumin, which is one
of the most powerful cell poisons known, the disintegration of the cell
constituents due to its action being rapid and pronounced. This
accounts for the heart failures which are often reported in connection
with the disease.
D. Bacillus Tetani.—More will be said about this organism when
considering tetanus, and to that subject the reader is referred. The
tetanus bacillus is occasionally found in pus which comes from the
area through which the original infection was produced. But these
bacilli do not travel to any distance in the human body, and are
seldom found away from the area involved. Under most
circumstances the pus is the product of a mixed infection.
E. Bacillus Œdematis Maligni.—This organism will be more fully
considered under a different heading. (See Malignant Edema.) It is a
long, anaërobic bacillus, widely distributed in the soil and the feces
of animals. It is believed that this, like the tetanus bacillus, may
occasionally lead to formation of pus.
F. Bacillus Tuberculosis.—This organism likewise will receive fuller
description in an ensuing chapter. (See Tuberculosis.) The pus of old
cold abscesses in which the more obligate pyogenic organisms have
long since died usually contains this organism in mildly virulent form.
On the other hand, fresh suppurations occurring in connection with
tuberculous disease are mixed infections. There is reason to believe,
however, that this organism is capable of producing pus even when
none of these are present; for example, in that form of acute miliary
tuberculosis which is occasionally met with as bone abscess it may
be found.
G. Bacillus Anthracis.—This is one of the most malignant and
resistant organisms known, being in the highest degree poisonous
for the smaller animals, man being less susceptible. One of its
characteristic lesions in the human body is a form of pustule
commonly known as malignant pustule, the pus in which is usually a
pure culture of this organism. (See Anthrax.)
H. Bacillus Mallei.—This is the organism which produces glanders in
the lower animals and in man. That form of the disease known as
farcy, in which the infected nodules rapidly break down, is likely to
contain pus which will be more or less a pure culture of this
organism.
I. Bacillus Lepræ.—This is the microörganism which produces
leprosy, closely resembling the tubercle bacillus. It is constantly and
exclusively present in the lesions of leprosy, which are often of the
suppurative type, the bacilli being enclosed within pus cells; it is also
found in the fluid surrounding them. Although suppuration in these
cases may be in a large measure due to secondary infection, it is
positive that the leprous bacilli deserve to be grouped in this place.
J. The Bacillus Pneumoniæ of Friedlander.—The bacillus pneumoniæ
of Friedländer was at one time regarded as the cause of croupous
pneumonia, which is now known to be due to the micrococcus
lanceolatus. The Friedländer bacillus, however, is capable of
producing bronchopneumonia, and is occasionally met with in
empyema, suppurative meningitis, and inflammations about the
nasopharyngeal cavity, of which it is known to be an occasional
inhabitant.
K. The Bacillus of Rhinoscleroma.—A distinctive organism has been
described for this disease and given this name. It has such wide
morphological differences, however, that it is possible that it is only
the bacillus of Friedländer above mentioned. At all events, an
organism of this general character is constantly found in this disease
in the thickened tissues from the nose (Fig. 8).
L. The Bacillus of Bubonic Plague.—This was recently discovered by
Kitasato, and, in view of the recent ravages of the disease in the
Orient, has assumed considerable importance. It grows upon most
media, and is found in the blood, in buboes, and in all internal organs
of patients suffering from this disease. The smaller animals are
susceptible upon inoculation. Animals fed with inoculated foods die
also, showing the possibility of infection through the intestine. When
exposed to direct sunlight for a few hours the bacillus dies. The
general symptoms of the disease are those of hemorrhagic
septicemia and its consequences.
M. The Bacillus of Rauschbrand.—This is seldom, if ever, seen in this
country. It is known in England as “the black-leg” or “quarter-evil.” It
is an anaërobic organism, frequently met with in cattle, which causes
a peculiar emphysema of subcutaneous tissue, spreads deeply, and
is followed by a copious exudate of dark serum with gas formation.
The smaller animals are not ordinarily inoculable; but if to the culture
material there is added 20 per cent. of lactic acid, their
insusceptibility is overcome and they succumb to the disease. So,
also, as in the case of the tetanus bacillus, by addition of the bacillus
prodigiosus or of proteus vulgaris the disease may be produced in
otherwise insusceptible animals.
N. The Bacillus Aerogenes Capsulatus.—The bacillus aërogenes
capsulatus seems capable sometimes of causing pyogenic and even
fatal infection. Its presence is associated with gas formation. It grows
as an anaërobe.
O. The Bacillus of Chancroid.—The bacillus of chancroid identified by
Ducrey, and briefly described in the chapter on that subject.
 Fig. 7 Fig. 8

Rhinoscleroma: infiltration of tissues Bacilli of rhinoscleroma. × 1000.

about the nose. (Case reported by Dr. (Fränkel and Pfeiffer.)
Wende, Buffalo.)

YEASTS.
Busse was the first to call attention of clinicians and pathologists to
the role played by yeasts in certain infections. Since the original
observations of Busse in a case in which the organism produced a
general infection, the lesions of which were a combination of tumor
and abscess formation, various observers have noted the presence
of pathogenic yeasts, usually in skin lesions. Gilchrist and Stokes
were the first in this country to determine the nature of these
organisms, and their observations have been followed by the
detection of a large number of similar cases. In the skin lesions the
organisms are found in minute abscesses; in the subcutaneous
tissue and in the infections similar to those of Busse large abscesses
surrounded by extensive masses of granulation tissue characterize
the infection. The organisms can be detected in the pus by means of
an examination of the fresh unstained fluid (Fig. 9).
 FUNGI.
Besides the micro-organisms everywhere grouped as bacteria,
there are other minute organisms which have also the power of
engendering pus. One of these is the ray fungus, known as the
actinomycis, which causes the disease known as lumpy jaw or
actinomycosis. Suppuration is always a concomitant of the advanced
lesions of this disease, and, while it may be in many instances a
mixed infection, it is not necessarily so. Moreover, the pus produced
under these circumstances contains minute calcareous particles
which are pathognomonic, by which a diagnosis can sometimes be
made off-hand.
Besides these fungi, others, belonging rather to the class of
vegetable molds, which are yet pathogenic for human beings, may
be occasionally met with under these circumstances—e. g., the
fungus of Madura foot, the leptothrix, and other molds from the
mouth, while the different varieties of aspergillus may be found in
pus about the ear or even in that from the brain.

PROTOZOA.
The protozoa have the power of producing, if not absolute ideal
pus, something so nearly resembling it that we may include them
among the facultative pyogenic organisms. The best known of these
protozoa are the amebæ, which are met with in the intestinal canal in
some countries, occasionally in the United States, especially as the
exciting causes of a peculiar type of dysentery often accompanied by
abscess of the liver. In these abscesses the amebæ are found, and
no other organisms. Another group of the protozoa, known to
biologists as the coccidia, are also capable of causing pus formation,
more particularly in some of the lower animals. Numerous other
parasites, belonging higher in the animal kingdom, are undoubted
exciters of pus formation, though it is not necessary to lengthen the
list beyond those already mentioned.
 Fig. 9

Blastomycetic pus (fresh). × 1000. (Gaylord.)

Protozoa have recently been established as the active agents in

the production of smallpox and probably also of scarlatina. They
have been seen so generally in and around cancer cells as to make
it extremely probable that cancer is a protozoan infection. In syphilis
also they are found as the spirochetæ, now regarded as its cause.
 Protozoa are as ubiquitous as bacteria, but their recognition is as
yet more difficult, as but little is known of them. The numerous
stages through which they pass in completing their life cycles only
complicate the subject, while the difficulties encountered in
cultivating them are still to be overcome. As we become more
familiar with them we shall more frequently find them to be
pathogenic organisms.

CLINICAL CHARACTERISTICS OF PUS FROM DIFFERENT

AGENCIES.
Staphylococcus.—Dirty white, moderately thick, with sour-paste
odor.
Streptococcus.—Thin, white, often with shreds of tissue.
Colon Bacillus.—Thick, brownish, with fetid odor, or thin, dirty
white, with thicker masses.
Micrococcus Lanceolatus.—Thin, watery, greenish, often copious.
Bacillus Pyocyaneus.—Distinctly green or blue in tint.
Bacillus Tuberculosis.—Thick, curdy, white paste, or thin, greenish,
with small, cheesy lumps or even with bone spicules.
Actinomycis.—Thick, brownish white, with small, firm, gritty or
chalky nodules of yellow color.
Ameba Coli.—Thick, brownish red.

BACTERIAL DETERMINATION AS AN INDICATION IN

TREATMENT.
There is a practical side of great importance pertaining to the
recognition of the nature of the infectious organism in many cases of
suppuration and abscess. For instance, pus which is due to
streptococcus invasion indicates a collection which should be freely
evacuated and carefully drained. This is also true in essential
respects of staphylococcus pus, particularly that due to the
streptococcus aureus. Putrid pus from any source requires
disinfection and free drainage, the former preferably perhaps by
hydrogen dioxide. Pus which is due to the colon bacillus is not often
extremely virulent, which accounts for so many cases of appendicitis
recovering with or without operation. A collection of this pus needs
little more than mere drainage and opportunity for escape. Pus from
a recognizable tuberculous source may still contain living tubercle
bacilli. This means either that the cavity whence it came should be
completely destroyed and eradicated, or else that the margins of the
incision or opening through which it has escaped should be so
cauterized that infection of a fresh surface is impossible. The same
is true of abscesses due to glanders bacilli and to certain cases of
suppurating bubo following chancroid, where the whole course of
events shows the virulent character of the organisms at fault.

SUPPURATION.
Although it may be possible to produce in certain laboratory
experiments metamorphosed material which very closely simulates
pus, or, in fact, by injection of chemical irritants, to sometimes imitate
the suppurative processes, nevertheless, the student should be
brought face to face with the statement, to which for surgical
purposes there is no practical exception, that suppuration, i. e.,
formation of pus, is due to the presence in the tissues of the specific
irritants already catalogued and described, and of the peculiar
peptonizing or other biochemical changes which bacteria exert upon
living animal cells.
Coagulation Necrosis.—Coagulation necrosis is the term applied
to the characteristic changes occurring in
the tissue cells when thus attacked, which may be summarized as a
fading away of cell outlines, diminution in reaction to reagents, and a
merging of cells and intercellular substance. Coagulation necrosis is
not the only result of bacterial activity, but may be produced by other
causes. Nevertheless, pyogenic bacteria do not exert their
deleterious action upon the tissues without occasioning changes
included under this term. In an area thus infected, as already
described, leukocytes, i. e., phagocytes, are present in increased
number for purposes already mentioned. As we approach the centre
of activity phagocytes are more numerous than cells, and
intercellular barriers completely break down. When bacteria are
found in greatest number, there also occurs the greatest phagocytic
activity, and there also will be found the evidence of suppuration,
i. e., pus. As already indicated, the polynuclear leukocytes are most
active in the process of defence. Where coagulation necrosis is most
marked there has been the greatest activity of conflict with the
greatest death of cells. Around these areas bacteria and cells are
found in indiscriminate arrangement. Tissue vitality is impaired by
intoxication of the cells by the excretory products of the bacteria,
i. e., the so-called ptomains, toxins, etc., and their power of
resistance is thus weakened. From the mechanical results of
pressure tension around the centre of activity is increased, by which
tension vitality is still more impaired and more rapid tissue death
occurs. Thus there occurs migration or burrowing of pus; or, to state
it more clearly, the tissues break down in front of the advancing
destruction, and in the direction of least resistance. This is known as
the pointing of pus, which brings it many times to the surface, and
often in other and less desirable directions.
Abscess.—An abscess is a circumscribed collection of pus. The
term is used in contradistinction to purulent infiltration, in
which the collection is not circumscribed, but is exceedingly diffuse
and extends itself in various directions, the amount at any spot being
almost inappreciable. Purulent infiltration is regarded as the more
serious of the two conditions, as it is more difficult for pus to escape
under these circumstances than when it can be evacuated through a
single opening. The term phlegmon is one now generally used to
indicate a suppurative process, usually of the general character of
purulent infiltration rather than of abrupt abscess, but generally
employed to include both conditions. The adjective phlegmonous is
coupled with the names of other surgical infectious diseases to
indicate that it is complicated by suppuration, e. g., phlegmonous
erysipelas. Pus is a product of bacterial activity usually formed
rapidly rather than otherwise, and abscess formation or
phlegmonous activity of any kind is a question of but a few days.
Empyema means a collection of pus in a preëxisting cavity.
The significance of this condition is well described in the story of
inflammation and suppuration, to paraphrase Sutton, read
zoölogically, as though it were the story of a battle: The leukocytes
(phagocytes) are the defending army, the vessels its lines of
communication, the leukocytes being, in effect, the standing army
maintained by every composite organism. When this body is invaded
by bacteria or other irritants, information of the invasion is
telegraphed by means of the vasomotor nerves, and leukocytes are
pushed to the front, reinforcements being rapidly furnished, so that
the standing army of white corpuscles may be increased to thirty or
forty times the normal standard. In this conflict cells die, and often
are eaten by their companions. Frequently the slaughter is so great
that the tissues become burdened by the dead bodies of the soldiers
in the form of pus, the activity of the cells being proved by the fact
that their protoplasm often contains bacilli in various stages of
destruction. These dead cells, like the corpses of soldiers who fall in
battle, later become hurtful to the organism which, during their lives,
it was their duty to protect, for they are fertile sources of septicemia
and pyemia. This illustration may seem romantic, but is warranted by
the facts.
Around the margin of the site of an acute abscess a barrier is
formed by condensation and cell infiltration of the surrounding
tissues. This is not a distinct wall nor membrane, yet, nevertheless,
serves as a sanitary cordon to confine the mimic conflict within
reasonable bounds. This is the zone of real inflammation; within it
there are tissue destruction and coagulation necrosis. By virtue of
the peptonizing power of the pyogenic organisms the parts involved
in this necrosis gradually liquefy the intercellular substance
dissolving first. It is this which in the main forms the fluid portion of
the pus. Various tissues show widely differing resistance to this
softening process. In true glands the interlobular septa seem to
break down first, and in this way suppuration extends around the
acini or gland lobules, and thus pus may contain masses of easily
recognizable size. These masses are ordinarily known as sloughs.
It is by virtue of the so-called lymphoid cells, which are those
principally involved in producing the barrier or boundary of the acute
abscess as above described, that granulation tissue is formed, which
takes up the effort of repair as soon as pus is evacuated. This
boundary has no sharp limit, but shades off into healthy surrounding
tissues.
 Under the term “abscess” is meant that which is described as
acute abscess. Under certain circumstances, especially when they
are produced by the facultative pyogenic organisms rather than the
obligate, abscesses form more slowly, and may be spoken of as
subacute. These are terms used in contradistinction to the so-called
cold abscesses, which, although clinically bearing a certain
resemblance to the acute, are in almost every pathological respect
different from it. Cold abscesses will be considered under the head
of Tuberculosis. It is possible to have an acute pyogenic infection of
a cold abscess; in such case we have acute manifestations.
Gravitation abscesses are those where pus forming in one part tends
to migrate, usually in the direction in which gravity would take it,
extending into portions deeper or lower. Perhaps the best illustration
of this is the pointing of a psoas abscess below Poupart’s ligament.
Metastatic abscesses are those which are formed as the result of
embolic processes, each one being in miniature a repetition of a
lesion which has occurred at some other part of the body. The
underlying fact concerning metastatic abscesses is that the primary
process has occurred in some other portion of the body, whence it
has been distributed as above. These will be considered in the
chapter treating of Pyemia.
The product of all acute suppurative lesions is pus. This is an
opaque fluid of creamy consistence and whitish or grayish
appearance, varying in density, met with in amounts from a minute
drop to half a gallon or more. Under ordinary circumstances it is
odorless, and its reaction, either acid or alkaline, is very faint. It is,
like the blood, composed of a fluid and a solid portion. The solid
portion consists of so-called pus corpuscles and other debris of
tissue, which vary with the site of the disease and the parts involved.
The source of the pus corpuscles has been cited and the statement
made that they are in effect the bodies of phagocytes which have
perished in the biochemical fight for existence of the parent
organism. Cocci or bacilli are found in pus corpuscles and also in the
surrounding fluid.
Pus should be without odor, but under certain circumstances it
possesses an odor which will vary in character according to the
source of the pus or the nature of its principal bacterial excitant. Pus
from the upper end of the alimentary canal frequently has the sour
smell of gastric contents; that from the neighborhood of the lower
end, the fetid odor which is for the most part due to the action of the
colon bacillus. Inasmuch as colon bacilli are found in widely distant
parts of the body, they may also give an unpleasant odor to pus even
from a brain abscess. When the pus has become contaminated with
the ordinary saprophytic organisms, it may smell like any other
decomposing material. The older writers called it ichorous pus, while
sanious pus was supposed to be that more or less mixed with blood,
undergoing ammoniacal decomposition or else strongly acid. Pus
sometimes has a well-marked blue or bluish-green tint. This is due to
the presence of the bacillus pyocyaneus, already described. An
orange tint is sometimes given by the presence of hematoidin
crystals, due to the original hemorrhagic character of the infected
exudate. The former appearance indicates usually a slow course to
the suppurative lesion, while the latter has been regarded by some
as affording an unfavorable prognosis. Distinctly red pus, whose tint
is due to the presence of a bacillus giving bright-red cultures on
blood serum, has been noted in other instances. This can readily be
distinguished from blood, because upon dressings it does not
change color.
Pus may form superficially, when it is called subcutaneous
suppuration, in which case there is a minimum of pain, because
tension is not great and the distance to the surface is short.
Collections which form beneath the fasciæ, especially the deeper
fasciæ of the limbs and trunk, give rise to much more extensive
disturbance, both locally and generally, and frequently do not point
for many days; or, instead of pointing, burrow deeply and find their
outlet at some undesirable point. These are known as subfascial
collections. Subperiosteal abscesses give rise to still more pain,
because of the unyielding character of their limiting structures, and
the symptoms caused by them are acute and distressing.
An illustration of the pain which may follow deep suppuration may
also be seen in the ordinary panaritium, or bone felon, where the
path of infection is from without, but the destructive lesion is confined
within absolutely unyielding tissues, at least at first. Along certain
tissues infection spreads with rapidity. This is particularly true of the
delicate areolar tissue seen between tendons and tendon sheaths,
and the infectious process may follow this tissue wherever it shall
lead, even along complex courses.
The question often arises, Can pus be resorbed? There is no
question but that small amounts of pus are disposed of by
phagocytic activity, and the disappearance of purulent infiltration,
under the influence of favoring remedies, or even when let alone, is
not infrequently noted. True pus resorption is a question of
phagocytic possibilities, and can occur only in very limited degree, as
a result upon which it is not safe to count, and which is capable of
encouragement only up to a certain point.
One inevitable law seems to govern collections of pus, that when
they advance or migrate in any direction it is in that of least
resistance. This causes them to take peculiar and sometimes
disastrous courses, but it is a law which is never violated. It leads to
the bursting of abscesses into the brain, into the pleural cavity, into
the peritoneal cavity, the bowel, and elsewhere; it leads to a
condition where pus may travel along a path even a foot or more in
length, rather than come to the surface, a distance of perhaps an
inch, and affords one of the best reasons for early operative
interference so that the disastrous effects of burrowing may be
obviated. When the pus is limited to a drop or fraction thereof the
abscess is called a furuncle, especially when in the skin. The
average “boil” of the layman is a subcutaneous or subfascial
abscess. When the infiltration is pronounced, and when there has
been more or less extensive destruction of tissue, with perhaps
formation of numerous outlets for the escape of pus and detritus, it is
known as a carbuncle. (See Chapter XXVI.) In certain conditions
small superficial furuncles or boils form, sometimes in great number
and almost synchronously, or, as it were, in crops. This condition is
known as general furunculosis.
Signs and Symptoms of Abscesses.—The appearances by which pus
may be suspected or detected are those of congestion and
hyperemia, more or less abruptly circumscribed and markedly
accentuated. Along with these there is more or less edema or
edematous infiltration of the skin and overlying tissue, which permits
of that peculiar appearance known as “pitting on pressure.” Often,
too, there is a distinctly edematous swelling of the parts, especially
around the margin, with brawny infiltration of the centre of the
infected area. Numerous vesicles occasionally are noted upon the
skin, which may be filled with reddish serum. When softening and
pus formation occur, there is a condition which to the palpating
fingers gives the characteristic sensation known as fluctuation.
Fluctuation simply points out the presence of fluid beneath; but when
in an area marked as thus described fluctuation is noted, it means
the presence of pus. It is detected by manipulating in a direction
parallel to and concentric with the axis of the limb or part. The pain is
also in most instances significant; patients speak of it as having an
intense and throbbing character. With these local signs occur
symptoms indicating some degree of septic intoxication, i. e.,
pyrexia, chills, malaise, sweats, etc., which are corroborative
indications, their intensity being a reasonably correct index of the
severity and gravity of the local infection.
When a deep-seated abscess is suspected a careful blood count
will often permit a diagnosis to be made. This is conspicuously true
of cases of appendicitis. If leukocytosis is established there should
be immediate operation. (See Chapter II.)
It is seldom that a superficial collection of pus can be mistaken for
anything else. In small and superficial abscesses (boils, furuncles)
as pus approaches the superficial layer (epidermis) of the skin it may
be discovered through its thin covering. In deep lesions there is often
a doubt, even on the part of the most experienced. The measure
now usually resorted to for purposes of diagnosis and exact
recognition is the exploring or aspirating needle. The old exploring
needle was one of good size, having a groove along which, after
introduction, pus might pass. Since the almost universal use of the
hypodermic syringe, a small aspirating needle attached to the
ordinary syringe is the measure commonly adopted. Such a needle
may be introduced into the brain, into the liver, or into almost any
and every soft tissue without danger, and if properly manipulated is
almost sure to facilitate detection of pus. Exploration done with either
of these means and for this purpose should always be conducted as
an aseptic, even if a minor operation, in order that no extra infection