SEPTICAEMIA AND PY^MIA. 181 



leucocytic accumulation and the disappearance of any fibrin 

 which may be present. 



The liquefaction of the formed tissue elements in suppura- 

 tion depends chiefly upon a peptonising action of the organisms 

 or of ferments produced by them, and the progressive leucocytic 

 aggregation is most probably the effect of microbic products 

 which attract the leucocytes, or in other words exert a positive 

 chemiotaxis. From this it might be inferred that suppuration is 

 almost exclusively related to the presence of living organisms, 

 and this is found to be actually the case. Many experiments 

 have been performed to determine whether suppuration can be 

 produced by various chemical substances, such as croton oil, s 

 nitrate of silver, turpentine, etc., care, of course, being taken to 

 ensure the absence of bacteria. The general result obtained by 

 independent observers is that as a rule suppuration does not 

 follow, but that in certain animals and with certain substances 

 it may, the pus being free from bacteria. It is still, however, 

 questioned by some whether the pus thus produced really cor- 

 responds histologically and chemically with that due to bacterial 

 action. Buchner showed that suppuration may be produced by 

 the injection of dead bacteria, e.g. sterilised cultures of bacillus 

 pyocyaneus, etc. The subject has now more a scientific than a 

 practical interest, and the general statement may be made that 

 practically all cases of true suppuration met with clinically are* 

 due to the 'action of living micro-organisms. 



The term septicamia is applied to conditions in which the 

 organisms multiply within the blood and give rise to symptoms 

 of general poisoning, without, however, producing abscesses in 

 the organs. In all cases of septicaemia the organisms are more 

 numerous in the capillaries of internal organs than in the peri- 

 pheral circulation, and, in the case of the human subject, it is 

 often impossible to detect any in the blood during life, though 

 they may be seen in .large numbers in the capillaries of the 

 kidneys, liver, etc., post mortem. The essential fact in pycemia, 

 on the other hand, is the occurrence of multiple abscesses in in- 

 ternal organs and other parts of the body. In most of the cases 

 of typical pyaemia, common in pre-antiseptic days, the starting- 

 point of the disease was a septic wound with bacterial invasion 

 of a vein, leading to thrombosis and secondary embolism. Mul- 

 tiple foci of suppuration may be produced, however, in other 



