53 



confirmed these results of Panum ; putrid emboli always 

 softened and excited suppuration ; others rarely ; it was 

 further established (Waldeyer) that puriform softening of 

 a thrombus can be caused by contact of pus or putrid 

 matters with the external surface of the containing vessel, 

 as well as by admission to its lumen. Since suppuration 

 in the immediate vicinity "of a vein may cause inflamma- 

 tion and thrombus formation in the vessel, it is apparent 

 that phlebitis, puriform softening of thrombi in short, 

 pyaemia may occur without any artificial solution of 

 continuity in the vascular walls. Experiment has always 

 shown that fluids (pus and putrid matter) capable of in- 

 ducing pyaemia, lose by boiling (Panum, Bergmann, Pas- 

 teur) or by filtration (Klebs, Zahn, Tiegel) this power to 

 cause metallic suppuration pyaemia though still able 

 to induce rapid and fatal infection septicaemia. Since 

 by these measures boiling and filtration the contained 

 organisms are destroyed or eliminated, experimenters are 

 unanimous in ascribing the induction of metastatic ab- 

 scesses to bacteria. 



The clinical evidence is almost as strong ; for, accord- 

 ing to the unanimous assertions of eminent surgeons 

 Nussbaum, Volkmann, Esmarch, Thiersch, Verneuil, 

 Schede, Gussenbauer, for example pyaemia is practic- 

 ally unknown after wounds which have been treated from 

 their inception by the Lister method, the avowed object 

 and essential feature of which is the attempt to exclude 

 organisms. 



Perhaps the strongest clinical evidence of the septic 

 influence of bacteria is afforded by the cases of so-called 

 spontaneous pyaemia, where no suppuration nor solu- 

 tion of continuity is detected. In many of these a closer 

 search would doubtless reveal a possible source of puru- 

 lent infection. Weichselbaum has recently called attention 

 to fatal cases of this kind in which the focus of infection 

 was found as suppuration in the nose and antrum. Yet 

 there still remain numerous cases in which pyaemia ap- 

 pears to proceed from deeply situated abscesses, which can 

 have had no direct communication with the external world 



