100 SUPPURATION. 



means of differential diagnosis between suppurative and tubercular 

 empyema. 



3. PURULENT ARTHRITIS. Reference has already been made 

 to the bacteriological researches of Garre, who never found bacteria 

 of any kind in the serous effusions of joints. Suppurative syno- 

 vitis, in an intact joint, is always caused by localization of pus- 

 microbes in the synovial membrane, where their presence excites 

 a purulent inflammation. In this manner the metastatic suppura- 

 tive synovitis, as it occurs in pyaemia, in some cases of gonorrhoea, 

 and in some of the general infective diseases, is caused. In ani- 

 mals susceptible to purulent infection, the injection into a joint of a 

 pure culture of pus-microbes is usually followed by destructive 

 purulent inflammation, and, not infrequently, by the formation of 

 extensive para-articular abscesses. 



Hoffa (" Bacteriologische Mittheilungeu aus dem Laboratorium 

 der chirurgischeu Klinik des Prof. Maas," Wiirzburg, Fortsehritte 

 der Medicin, B. iv. S. 75), Kranzfeld (" Zur Aetiologie der acuten 

 Eiterungen," St. Petersburg, 1886, Centralblatt f. Chirurgie, 1886, 

 p. 529), and Krause (" Ueber acute eitrige Synovitis bei kleineu 

 Kiudern uud iiber den bei dieser Affection vorkomendeu Ketten- 

 coccus," Berl. klin. Wochenschrift, 1884, No. 43) have studied with 

 special care the bacteriological origin of suppurating joints in small 

 children a streptococcus, the identity of which with the one de- 

 scribed by Rosenbach was proved by cultivation experiments. In 

 one case the same microbe was also found in the products of a puru- 

 lent meningitis, which followed in the course of the joint disease. 

 The same streptococcus was found by Heubuer and Bahrdt (" Zur 

 Keuutniss der Gelenkeiterung bei Seharlach," Berl. klin. Woehen- 

 schrift, 1884, No. 44) in pus from a suppurating joint, and in the 

 diphtheritic membranes of a scarlet fever patient. Clinical expe- 

 rience and experimental research appear to prove that purulent 

 synovitis occurring independently of osteomyelitis is, in the 

 majority of cases, caused by the streptococcus pyogenes. 



4. ACUTE SUPPURATIVE OSTEOMYELITIS. Acute suppurative 

 inflammation in bone, when it occurs independently of an external 

 wound, and consequently of direct infection, furnishes one of the 

 most interesting, and, thanks to the patient and persevering inves- 

 tigations of a number of the foremost pathologists, one of the best 

 known forms of purulent infection. For years it has been con- 

 tended by some who made the etiology of acute osteomyelitis the 

 subject of experimentation, that it is caused by a specific microbe 

 not found in other forms of suppuration. Convincing evidence, 

 however, has been accumulating for a number of years which seems 

 to leave no further doubt that the ordinary microbes of suppuration 

 are the cause of this form of suppurative inflammation, and that the 



