96 SUPPUKATION. 



should always be borne in mind where the presence of an aseptic 

 body in the living tissues has apparently been the cause of suppu- 

 ration. The tissues altered by the action of chemical irritants 

 constitute a foreign substance which may determine localization of 

 floating microbes, while, at the same time, the chemical alterations 

 which they have caused in the tissues have prepared a favorable 

 soil for their reproduction. Practically, in man, suppuration with- 

 out microorganisms is only possible on the surface of the body, 

 as the products of a suppurative inflammation in any of the 

 internal organs always show the presence of pyogenic microbes 

 which can be cultivated, and it is only rational to conclude that 

 the inflammation and subsequent suppuration were caused by pyo- 

 genic microorganisms or their products, the ptomaines. 



Pus-microbes in Different Suppurative Affections. 



Direct infection with pus-microbes can only take place through the 

 cutaneous and other accessible surfaces or through wounds. Suppu- 

 ration in the interior of the body, in the absence of a wound or 

 other recognizable infection-atrium, must be considered in the light 

 of an auto-infection with pyogenic microbes. 



1. SUPPUKATIVE AFFECTIONS OF THE SKIN. Longard ("Ueber 

 Folliculitis abscedeus infantum," Archivf. Kinderheilkunde, Bd. viii. 

 Heft 5, ] 887") has made a careful microscopi co-bacteriological exam- 

 ination of nine cases of furunculosis in young children. In four of 

 these cases he found the staphylococcus pyogeues albus alone, in 

 five cases in combination with the staphylococcus pyogeues aureus; 

 the identity of these microbes with those described by Rosenbach 

 was demonstrated by cultivations and experiments on rabbits. The 

 microbes were not found in the fecal discharges of the patients, but 

 were found, in small numbers, in the diapers of healthy unclean 

 children, as well as in the diapers of those stiffening from follicu- 

 litis. He believes that the pus-microbes were the direct cause of 

 the affection, and that the infection took place through the sweat- 

 glands, as the microbes were found in abundance upon the inner 

 surface of the membrana propria of these appendages of the skin. 

 As soon as they reached the subcutaneous connective tissue they 

 produced suppurative inflammation. 



Experiments on dogs and rabbits, by cutaneous inoculations with 

 pus-microbes cultivated from the furuncles, produced a slight swell- 

 ing and redness, and in some instances the formation of small pus- 

 tules. The result was always the same whether the pus was taken 

 from the cultivation grown from a furuncle, a suppurating wound 

 that healed without fever, or from a pysemic patient. The cuta- 

 neous inoculation experiments of Garre, Bockhart, and Bumm upon 



