54 LOCALIZATION OF MICKO-ORG ANISMS . 



pneumonia, abscess, phthisis, typhoid fever, diphtheria, and gonor- 

 rhoea, while in some the result was negative, in others not only was 

 the specific microbe present, but other microorganisms were also 

 detected, showing that secondary infection had occurred. In some 

 lie found the gonococcus or pneumococcus with the staphylococcus or 

 streptococcus. Transportation of the microbes, from the primary 

 focus to the joints, occurred either by way of the bloodvessels or 

 lymphatics. The frequency of articular infection seems to be 

 governed by the size and form of the bacteria. The small round 

 or oval cocci, such as the pneumococcus, gonococcus, and pus- 

 microbes, obtain more ready entrance than the bacilli. 



in many instances of recurring suppuration years after the 

 primary injury or disease, we have reason to believe that the 

 microbes were introduced with a foreign body, or became encapsu- 

 lated in the granulation tissue during the healing process, and 

 remained there in a latent condition until by some accidental cause 

 the surrounding tissues had undergone changes favorable for their 

 growth. I have seen numerous cases of secondary osteomyelitis 

 ten to twenty-five years after the primary attack, which occurred 

 in the sclerosed bone, usually near one of the epiphyseal extremities. 

 In all of these cases the disease was deeply located, the primary 

 starting-point being in the same locality as in the first attack. A 

 patient who has once suffered from osteomyelitis during childhood, 

 is always prone to suffer from recurring attacks, and the disease, 

 without exception, selects the old site. The difficulties which deep 

 cavities in bone present to the final process of definitive healing, 

 offer an explanation why microbes are more liable to become buried 

 and permanently retained, than in suppuration in soft parts. 



Nepveu (Revue de Chirurgie, 1885, p. 353) reported two cases 

 of gunshot injury of the extremities in which, fourteen years after 

 the definitive healing, suppuration occurred at the former site of 

 injury. 



Numerous instances are on record in which foreign bodies have 

 remained in the tissues encapsulated for an indefinite period of 

 time without giving rise to any symptoms until the microorganisms 

 which were introduced with them exercised their pathogenic qualities, 

 because the surrounding tissues had undergone changes favorable 

 to such a process. A very interesting case of this kind is reported 

 by Rinne (" Der Eiterungs-process und seine Metastasen," ArcMv. 

 /. Mm. Chirurgie, Band xxxix. p. 70). In 1871, a man, thirty- 

 four years of age received a gunshot wound through the left shoulder- 

 joint. Langenbeck made primary resection of the joint, and the 

 wound suppurated for a number of weeks profusely but healed 

 completely at the end of three months. The patient remained in 

 perfect health for eleven years, when he was suddenly taken with 



