THE INFECTIOUS DISEASES. 201 



The bacteria which are found in the various phases of suppurative 

 inflammation may lie free in the interstices of the tissue with the exu- 

 date, or they may be in part within the cells which have gathered 

 about them (Fig. 92). Both within and without the cells the bacteria 

 may present those structural alterations which denote their death and 

 degeneration in the struggle for existence to which the two forms of liv- 

 ing beings, the microbes and the body cells, are subjected under the 

 conditions which mark infection. The local and systemic reaction, on 

 the other hand, and the cell necrosis which so frequently follows the 

 growth of microbes in the body are expressions of an unfavorable envi- 

 ronment to which the body cells as individuals and the body as a com- 

 posite organism are subjected, and to which they may successfully react 

 or under unfavorable conditions may succumb. 1 



In the softening of tissue involved in the development of abscesses 

 as well as in the removal of exudates by absorption it is probable that 

 the solution of the formed elements of the tissues is accomplished by the 

 development of lytic autolytic substances (see page 187). a 



Toxaemia. While the various forms of exudative inflammation are 

 more or less circumscribed, the soluble toxins 3 which are formed at the 

 seat of local bacterial growth may, without the dispersion of the germs 

 themselves, be diffused through the blood and the other fluids of the 

 body, giving rise to the symptoms and lesions of toxcemia fever and 

 various other forms of functional disturbance, albuminous degeneration 

 of the viscera, focal necroses, petechial haemorrhages, haemolysis, 4 throm- 

 bosis, leucocytosis, chromatolysis of the ganglion cells, etc. 



Of these alterations in the body which are of frequent occurrence in 

 many forms of toxaemia, whether induced by bacterial or other kinds of 

 poisons, 6 the only one which demands special notice here are the focal 

 necroses. These usually small, often sharply circumscribed areas of 

 dead tissue may be present in any of the viscera, but are often most 

 abundant and conspicuous in the liver. 8 They vary considerably in ap- 

 pearance, depending upon the stage of the tissue involvement. The cells 

 in the affected area may be swollen, the cytoplasm more transparent than 

 normal, while the nuclei may remain unstained with the usual dyes or 

 show various phases of fragmentation or disintegration; or they may 

 disappear altogether. Again, the cells in the involved areas may become 

 more coarsely granular than is normal, may undergo a change similar to 

 that seen in coagulation necrosis and with destruction of the nucleus may 



1 For an exhaustive review of suppurative inflammation from the modern standpoint 

 with bibliography consult Janowski, Ziegler's "Beitrage zur path. Anatomic," etc., Bd. 

 xv., p. 128, 1894. 



2 For fuller reference to removal of exudates by autolysis, see footnote, page 116. 



3 See reference to Oppenheimer, page 164. 



4 For a summary of facts relating to the hsemolytic power of various species of bac- 

 teria see Welch, "Huxley Lecture on Immunity," Med. News, October 18th, 1902, p. 

 730. 



5 See for effects of abrin and ricin intoxication Flexner, Journal of Exp. Med., vol. 

 ii,, p. 197. 1897; also Matter, Ziegler's "Beitriige," Bd. xxvii., p. 331, 1900, Bibl. 



6 It seems probable that this marked localization of the action of a soluble poison in 

 the tissue fluids may be due to some local vulnerability or susceptibility induced per- 

 haps by limited vascular disturbance or by nutritional defects otherwise induced. 



