MINUTE ORGANISMS TO INFLAMMATION 407 
tions to this effect.1 He has investigated by Koch’s methods a very large 
number of abscesses, and in every acute abscess which he has examined he has 
found the pus loaded with micrococci. Not only so, but, if he has an oppor- 
tunity of observing it, he finds the pyogenic membrane infiltrated with such 
organisms. There you have direct observation which seems at first sight to 
imply that the micro-organisms are the cause of the suppuration. But this 
same accurate observer has also investigated chronic abscesses in large numbers, 
and he has not found micrococci present in any; and therefore this same 
authority himself teaches us that micrococci are certainly not the sole cause 
of suppuration. And when we turn to the acute abscess, it seems to me that 
Dr. Ogston leaves us entirely without any explanation as to the origin of the 
infection in the part in which the abscess occurs. If we are to suppose that the 
micrococci are really the cause of the suppuration, we must also suppose them 
to be the cause of the inflammation which precedes it. But the inflammation 
that precedes the suppuration may be induced by some altogether accidental 
circumstance. For instance, a woman during lactation, with the mammary 
gland in a state of high physiological activity, corresponding with that of the 
digestive apparatus of a person after a hearty dinner, as before referred to, 
is disposed to ‘ take cold’ in the part; and as the result of an accidental chill 
an acute attack of inflammation may occur, threatening milk abscess. If we 
get such a case to treat in the early stages, the inflammation may never go on 
to suppuration at all; it may terminate by resolution. But if left to run its 
course it causes abscess. We can hardly suppose that the accident of exposure 
to cold could lead directly to the development of micrococci in the part. Nor, 
even if this were admitted, can we readily understand how any treatment that 
we can adopt could lead to their dispersion if they were the essential cause of 
the inflammation. And, further, there is this to be added, that if we treat 
such an abscess antiseptically, we find exactly the same results as in a chronic 
abscess. I had a case under my care lately in King’s College Hospital of a 
woman with a milk abscess of this kind, essentially acute. I opened it, and 
introduced a drainage-tube antiseptically, and there was not another drop of 
pus after the evacuation of the thick original contents—merely a serous oozing, 
and this rapidly subsided. Why did not the suppuration continue if the micro- 
cocci were the essential cause of it? I examined, along with Mr. Cheyne, some 
preparations which he was good enough to make for me, by Koch’s method, 
of the serum that came from this abscess three days after it had been opened, 
and we had to make a long search before we could discover a single group of 
micrococci. The main mass of those which, from Ogston’s observations, I 
* See British Medical Journal, March 12, 1881. 
