46 LOCALIZATION OF MICRO-ORGANISMS. 



Ribbert, on the production of myo- and endo-carditis in rabbits, 

 have shown that abscesses can be produced in other organs if the 

 pyogenic microbes are attached to foreign bodies which cannot pass 

 through the pulmonary filtrum. Thus Ribbert was able to produce 

 myocarditis by using a cultivation of staphylococcus pyogenes 

 auretis on potato, if he took the precaution in removing the culture 

 from the surface of the potato to scrape off also the superficial layer 

 of the potato itself. The particles of potato in these experiments 

 determined suppuration by causing localization of the microbes, as 

 the foreign bodies were too large to pass through the capillary 

 vessels and were not capable of removal by absorption. 



A subcutaneous fracture occasionally becomes the seat of an acute 

 osteomyelitis. 



Stein thai relates two such cases (" Ueber Vereiterung subkutaner 

 Fraktureu," Deutsche med. Wochenschrifi, No. 21, 1887). One case 

 occurred in a man twenty-eight years of age, who, having fallen 

 from a tree, sustained a fracture of the neck of the right femur, 

 also of the trochanter major, and a Colles's fracture of the right 

 forearm. Suppuration began in the hip-joint together with inflam- 

 mation of the knee-joint. In spite of early and free incisions the 

 patient died, thrombosis of the left femoral vein, and atrophy with 

 nervous disturbances in the right ulnar region being present. Post- 

 mortem revealed lobular pneumonia in the left lower lobe. The 

 second case was that of a woman thirty-four years old in whom, 

 under chloroform narcosis, reduction of a dislocation of the left 

 hip-joint was attempted. During the manipulation the head of the 

 femur was broken off. After twelve days an abscess had formed 

 at the seat of fracture, which was incised and drained. The patient 

 recovered. Steiuthal believes that suppuration in these cases was 

 the result of localization of pus- microbes in the tissues necrosed by 

 the injury. 



During my recent visit in Zurich (Four Months Among the Sur- 

 geons of Europe, p. 128, Chicago, 1887) I saw a very interesting 

 case of this kind in Kronlein's wards. In this instance infection 

 probably took place through suppurating wounds distant from the 

 fractures. The patient was a young man who had sustained several 

 subcutaneous fractures from a fall, and at the same time a lacerated 

 wound of the groin. The case . progressed favorably until the 

 wound commenced to suppurate, when he was suddenly attacked 

 by osteomyelitis of the fractured bones, which necessitated numer- 

 ous incisions for the liberation of pus at the points of fracture. 

 There can be no question that, in this case, the pus-microbes entered 

 the circulation at the primary site of suppuration and were arrested 

 at the places of fracture, where they found favorable conditions for 

 multiplication and caused a suppurative inflammation in the medul- 



