54 



after subcutaneous fractures, for example ; and still 

 another class in which a general infection without local 

 suppuration during the first few days occurs without ex- 

 citing cause, unless perhaps exposure to cold ; and until 

 the appearance of pus in the joints, etc., cannot be dis- 

 tinguished from acute rheumatism or from other infec- 

 tious diseases. To this category belong cases of acute 

 osteomyelitis and ulcerous endocarditis. The blood and 

 metastatic abscesses contain in these cases also the 

 usual micrococci ; the history presents, in fact, nothing 

 unusual except the obscurity of the infection. In some 

 of these as in one of osteomyelitis reported by Gussen- 

 bauer the bacteria were observed in the blood and in 

 the bone-marrow before suppuration had occurred ; the 

 general infection preceded the local affection. Such 

 cases must incline us decidedly to the view that the mi- 

 crococci caused not only the local suppuration, but also 

 the primary general infection. It is noteworthy that 

 such cases of primary pyaemia often follow exposure to 

 cold ; perhaps we should regard the retention of certain 

 material in the blood, this interference in excretion, as a 

 predisposing moment which has favored the develop- 

 ment of organisms; diabetic patients^ certainly are espe- 

 cially prone to local gangrene and septic infection after 

 a wound, and it is equally well known that a minute in- 

 cision, even needle-puncture of the dropsical skin in 

 amyloid degeneration of the kidney, exposes the patient 

 to erysipelas and pyaemia. Yet in some cases the bacteria 

 essential to pyaemia can and do exhibit their vital activ- 

 ity in the human body without the pre-existence of any 

 recognizable deviation from the usual health, and with- 

 out any discoverable solution of continuity in the integu- 

 ments. 



In this discussion I have assumed the etiological iden- 

 tity of the septicaemia and pyaemia of man with that of 

 processes marked by the same clinical and anatomical 

 features in animals. To such assumption objection may 

 be made, based on the known differences in the effects 

 produced on man and other animals by the same toxic 



