LOCALIZATION OF MICRO-ORGANISMS. 47 



lary tissue. Practically this case should teach us that in a patient 

 who has sustained a simple fracture it is exceedingly important to 

 guard against suppuration in any part of the body, for fear that 

 from a distant purulent focus pus-microbes may enter the circula- 

 tion and cause a suppurative osteomyelitis of the broken bone, in 

 the same manner as has been done by experiments on animals. At 

 the same time and place I examined a case of suppurative strumitis 

 due to a similar cause. The patient was a man of about forty years 

 of age, who had been operated upon for empyema by rib resection 

 some time ago. He had had a large goitre since childhood. Im- 

 provement after the operation progressed uninterruptedly until the 

 empyema was nearly well, when fever set in and the right side of 

 the struma became painful and tender. After a week fluctuation 

 was well marked, and a free incision was made, which gave exit to 

 a large quantity of fetid pus. The fever subsided promptly, and 

 the case again progressed favorably until, a week or two later, the 

 opposite side of the struma was attacked in a similar manner. I 

 was present when this side was incised. A large amount of the 

 same green, fetid pus escaped. The strumitis was unquestionably 

 of embolic origin, the pus-microbes which gained entrance into the 

 circulation from the pleural cavity found in the struma conditions 

 which favored their localization and growth, to be followed by a 

 suppurative inflammation of the swelling. 



Lebert observed secondary or metastatic strumitis develop six 

 times in connection with typhus, once with puerperal fever, three 

 times after pneumonia, and once after bronchitis. Kocher ( u Zur 

 Pathologic und Therapie des Kropfes," Deutsche Zeitschriflf. Ohirur- 

 gie, B. x.) met with it in cases of typhus, septic endometritis, and 

 after attacks of acute gastro intestinal catarrh. He calls special 

 attention to the fact that the strumitis almost without exception 

 occurred toward the close or after the subsidence of the primary 

 disease. Kocher believes that degenerative changes or injuries of 

 the struma serve as predisposing causes for the arrest of pathogenic 

 microbes which reach the organ through the bloodvessels. 



Localization of Microbes in Antecedent Pathological Products. 



Antecedent pathological products may serve the same purpose in 

 the body as a trauma in the determination of localization of patho- 

 genic microbes. Suppuration in a tumor, or a hyperplastic gland 

 with an intact cutaneous covering, indicates that in the tumor or 

 swelling pus microbes have been arrested, and that they have met 

 with a soil adapted to their multiplication and the exercise of their 

 pathogenic properties. The atypical vascularization in tumors and 

 the stenosis of the lumen of bloodvessels in inflammatory swellings 



