1 64 SUPPURATION AND ALLIED CONDITIONS. 



canal, the condition being known as pyelo-phlebitis sup- 

 purativa. 



Some conditions produced by the pyogenic organisms 

 demand special mention on account of their clinical import- 

 ance, namely, ulcerative endocarditis, acute suppurative 

 periostitis and osteomyelitis, and erysipelas. 



Ulcerative Endocarditis. This condition has been proved 

 to be a bacterial infection of the valves of the heart, and may 

 be produced by various organisms, chiefly pyogenic. Of 

 these the staphylococci and streptococci are most frequently 

 found. In some cases of ulcerative endocarditis follow- 

 ing pneumonia, the pneumococcus (Fraenkel's) is present ; 

 in others pyogenic cocci, especially streptococci. Other 

 organisms have been cultivated from different cases of the 

 disease, and some of these have received special names ; 

 for example, the diplococcus endocarditidis encapsulatus, 

 bacillus endocarditidis griseus (Weichselbaum), and others. 

 In some cases the bacillus coli communis has been found, 

 and in a few cases following typhoid the typhoid bacillus 

 has been described as the organism present, but further 

 observations on this point are desirable. It has not yet 

 been absolutely proved that the gonococcus affects the heart 

 valves, though there are grounds for believing that it does 

 so (p. 178). It has been described as being present in 

 some cases, but so far as we know it has never been culti- 

 vated from this situation. Tubercle nodules on the heart 

 valves have been found in a few cases of acute tuberculosis, 

 though no vegetative or ulcerative condition is produced. 



In some cases, though we believe not often, the organisms 

 may attack healthy valves, producing a primary ulcerative 

 endocarditis, but more frequently the valves have been the 

 seat of previous endocarditis, secondary ulcerative endocard- 

 itis being thus produced. In both conditions the affection 

 of the valves usually occurs in the course of suppurative 

 or inflammatory conditions elsewhere, e.g., in osteomyelitis, 

 in septic inflammations of the urinary passages, in pyaemia 

 and septicaemia, in the course of or following infective 

 fevers, and not very infrequently as a sequel to acute 



