LOCALIZATION OF MICEO-O KG ANISMS. 55 



symptoms of acute osteomyelitis. When admitted {into Friedrich- 

 shain Hospital a few days later a free incision were made over the 

 resected end of the humerus and a large quantity of fetid pus 

 escaped. Free drainage and disinfection had no effect in diminish- 

 ing the severity of the general symptoms. Through another 

 incision, made a few days later, small particles of clothing were 

 removed. As the symptoms became more and more threatening 

 amputation was made through the shoulder-joint four weeks after 

 the commencement of the attack. Patient died a few days later 

 after well-marked symptoms of pya3mia had manifested themselves 

 for several days. 



The examination of the amputated arm showed old foci of in- 

 spissated pus in the medullary cavity of the humerus, which leaves 

 no doubt that the second attack of osteomyelitis was caused by 

 microbes which had remained in a latent condition for eleven 

 years. 



Gussenbauer (Deutsche Chirurgie von Billroth u. Luecke, Lief. 4, 

 S. 125) relates two such cases. In one a bullet perforated through 

 the scapula from behind and lodged in the deep tissues. The 

 shoulder-joint suppurated and had to be resected. The bullet could 

 not be found. The wound finally healed and the patient remained 

 well for twenty-three years, when suppuration occurred at the site 

 of operation ; fragments of cloth were removed through an incision 

 and the man recovered. 



At a recent meeting of the French Congress of Surgeons, Socin 

 reported a case that had come under his observation, in which a 

 bullet remained in the tissues, perfectly encapsulated, for sixty 

 years, when finally the pus-microbes which entered the organism 

 with it, and had remained all this time in a latent condition, caused 

 the formation of an abscess. 



