CHAPTEE VIII. 



SUPPURATION. 



THE wonderful results which were obtained by the antiseptic 

 treatment of wounds made it exceedingly probable that all wound- 

 infective diseases were caused by living microorganisms. The 

 probability was increased when Koch, in 1879, showed the direct 

 connection existing between certain traumatic infective diseases in 

 animals and the never-absent definite microorganisms. It requires 

 no longer any arguments to show, at this time, that all wound- 

 infective diseases, among them particularly suppuration, are, with- 

 out exception, caused by the introduction into the tissues of the 

 organism of specific pathogenic microbes. This part of the work 

 has been prepared with special reference to the etiology of acute 

 suppuration, as chronic suppuration is intimately associated with 

 that of surgical tuberculosis and other forms of infective diseases, 

 which usually pursue a chronic course, and differs greatly in its 

 pathology from the other. 



Etiologically, most of the purulent processes constitute more of 

 a unity than was formerly believed, and the clinical varieties are 

 mostly determined by the intensity of the infection and by the 

 manner of localization. The most conclusive evidence of the 

 correctness of this assertion is furnished by the fact that the same 

 streptococcus which produces a simple abscess is likewise the most 

 frequent cause of progressive gangrene and of that most grave 

 form of suppuration pyaemia. 



HISTORY. As in the case of nearly all infective diseases, years 

 before the specific microorganisms of suppuration were discovered, 

 living organisms were found and described in pus, and were believed 

 to be the cause of the suppuration. In 1865, Klebs detected in 

 the tubuli uriniferi in cases of pyelo- nephritis following suppura- 

 tive cystitis, between the pus-cells small, round cocci, which he 

 believed produced the infection. In 1872, the same author (Schuss- 

 wuuden, Leipzig, 1872) published the result of his researches 

 during the Franco-Prussian War on septic wound diseases. In 

 this work he again referred to the organism which he ha^ previ- 

 ously described, and showed that it existed in the tissues and 

 organs the seat of suppurative inflammation before pus had formed. 



