162 CLINICAL BACTERIOLOGY. 



especially the proteus of Hauser (see Proteus-infections), 

 and the second is dependent upon the activity of a special 

 specific cause the bacillus of malignant edema (vibrion 

 septique, see Malignant Edema). In connection with the 

 pyemia and septicemia of human beings, therefore, there 

 are to be considered the streptococcus pyogenes, the staphy- 

 lococcus pyogenes, the diplococcus lanceolatus Frankel, 

 the bacterium coli commune, and the diplobacillus pneu- 

 moniae Friedlander. The starting-point of pyemia and 

 septicemia is usually a primary focus of suppuration or of 

 inflammation. If such a lesion can not be demonstrated, 

 the condition is designated cryptogenetic septicemia. Under 

 these circumstances the primary focus has, in the majority 

 of cases, merely escaped detection because of its obscure 

 situation. Among such concealed sources of septic dis- 

 orders may be mentioned mediastinitis, prostatic abscesses, 

 collections of pus in the accessory cavities of the nose 

 (antrum of Highmore, ethmoid sinuses, etc.). Only in 

 rare cases does pyemia or septicemia result from direct 

 absorption of the exciting agents of inflammation into the 

 blood from without or from an internal surface without the 

 formation of a primary focus. 



Bacteriologic Diagnosis. The bacteria can by no 

 means be demonstrated in the blood in all of the cases. 

 This should not occasion surprise in cases of septic intoxica- 

 tion, -as the microorganisms are present in the blood in 

 small number, if at all. In cases of pyemia the bacteria 

 can be more frequently demonstrated in the blood, espe- 

 cially at the time of the chills, when the infected thrombi 

 are set free and give rise to fresh metastases ; but even 

 here the results of blood-inoculation are often negative. 



The technic for examination of the blood is simple. 

 The finger of the patient is cleansed by means of soap, 

 alcohol, mercuric-chlorid solution, and ether, its tip is slightly 

 punctured with a lancet sterilized in the flame, and the 

 escaping blood is smeared upon culture-media by means of 

 the platinum loop heated in the flame ; eventually, plates 

 are made. It is better, because of the small number of 

 bacteria circulating in the blood at any time, to employ a 

 considerable, amount of blood. This is aspirated by 

 means of a sterilized Roux syringe from a vein distended 

 by compression. 



Metastatic abscesses are opened with aseptic precautions, 



