PUS-MICROBES IX SUPPURATIVE AFFECTIONS. 103 



Ribbert (" Die Schicksale der Osteomyelitis-coccen im Organis- 

 rnus," Deutsche med. Woehenschrift, 1884, No. 24) made investiga- 

 tions to ascertain the extent of diffusion of the osteomyelitic cocci 

 in the organism. Twenty-four hours after direct injection into the 

 circulation he found them in all the organs, later only in the kid- 

 neys. In regard to their localization, the following conditions must 

 be taken into consideration : 



a. Embolic obstruction of capillary vessels. 



b. Elimination of pus-microbes through the kidneys. 



c. The influence of traumatism. 



Liibbert (Biologische Spaltpilzimtersuchung. Der Staphylococcus 

 pyogenes aureus und der Osteomyelitis-coccus. "Wiirzburg, 1886) 

 has studied the effect of the staphylococcus pyogenes aureus, the 

 microbe most frequently found in osteomyelitis in the different 

 tissues. From his experiments he came to the conclusion that the 

 intensity of its action varies greatly without a sufficient cause for it 

 being known. Inoculations with it of superficial abrasions pro- 

 duced no effect. Subcutaneous inoculations resulted in the forma- 

 tion of abscesses which at times became quite diffuse. Inoculations 

 of granulation surfaces proved harmless. Injections into the pleural 

 and peritoneal cavities were oftenest followed by intense general 

 symptoms. Injections into the trachea through a tracheotomy 

 wound produced suppurative tracheitis and foci in the lungs. In- 

 travascular injections were followed by symptoms indicative of 

 sepsis. Foci were also found in the intestinal mucous membrane. 

 Feeding experiments proved harmless. 



Kraske (" Zur Aetiologie und Pathogenese der acuteu Osteomye- 

 litis," Arehivf. Idin. Chirurgie, B. xxxiv. S. 701) has studied from 

 a clinical standpoint, the manner of infection in cases of acute osteo- 

 myelitis. In one case he could trace the infection distinctly to a 

 furuncle of the lip ; but, as a rule, he thinks that infection takes 

 place through a wound or abrasion of the skin. Infection through 

 the intestinal canal he considers possible, but not proven ; more 

 frequently it takes place through the respiratory organs, and in one 

 case he could locate the infection here with certainty. He asserts 

 that recurring attacks should not always be looked upon as the 

 result of former infection, but as a consequence of a new infection. 

 He formulates the result of his clinical studies as follows : 



a. The staphylococcus pyogenes aureus can produce osteomyelitis, 

 and, in fact, is most frequently met with in the osteomyelitic pro- 

 ducts. 



6. In a certain number of cases acute osteomyelitis is the result 

 of a mixed infection and is then most prone to pursue a severe 

 course. 



c. It is possible that the result of further investigation will show 



