164 CLINICAL BACTERIOLOGY. 



itis, the empyema, the arthritis, etc., of puerperal sepsis 

 can only take place through the dissemination of the 

 germs by way of the blood-stream. 



It may be mentioned that, in the milk of nursing women 

 suffering from puerperal fever, pyogenic cocci can not rarely 

 be found. 



OSTEOMYELITIS. 



Osteomyelitis is not a specific disease. Staphylococci 

 have been most frequently found to be its exciting cause 

 both the aureus and the albus ; less commonly, the 

 streptococcus pyogenes, the diplococcus Frankel, the 

 typhoid-bacillus, and the bacterium coli commune have 

 been cultivated from osteomyelitic foci. In accordance 

 with these observations osteomyelitis may be considered 

 as a form of pyemia characterized clinically by its localiza- 

 tion in the bone-marrow. The skin and the open cavities 

 of the body constitute portals of entry for the bacteria. It 

 is, however, by no means necessary that primary foci 

 (furuncle, panaris, etc.) should exist in every instance. 

 The forms of life normally present upon the skin and 

 mucous membranes render superfluous such an assumption 

 in the individual case. Osteomyelitis occurs exclusively 

 in young individuals, and it has, therefore, been designated 

 the pyemia of the developmental period. In young in- 

 dividuals the growing zone of bone represents a point of 

 lessened resistance at which bacteria, when they gain 

 entrance into the circulation from any source, may lodge 

 and multiply. 



Experimental Evidence. If young animals (rabbits or 

 dogs) are inoculated by intravenous injection with pyogenic 

 microorganisms, subperiosteal abscesses and purulent in- 

 flammation of the medulla of bone occur. In older ani- 

 mals similar results are obtained only if previously a frac- 

 ture has been induced ; thus, to a certain degree, a point 

 of lessened resistance has been established artificially. 

 Under such conditions osteomyelitic changes take place in 

 the situation of the fracture. These experimental obser- 

 vations are in accord with the facts of human pathology 

 as osteomyelitis, as has been mentioned, is a disease of 

 early life. 



