RELATIONS OF PUS-MICROBES TO PYAEMIA. 127 



dungen," Verh. der Deutschen O-eselhchaft /. Chiruryie, J884) 

 examined the contents of metastatic joint affections in twelve cases 

 of puerperal pyaemia and invariably found streptococci, single and 

 diplococci, but never bacilli. 



Okinschitz (Dissertation, St. Petersburg. 1889) made the rela- 

 tionship which exists between the pus-microbes and pyaemia the 

 subject of bacteriological investigation. He found that pysemic 

 blood invariably contained either the streptococcus pyogenes or 

 staphylococcus pyogenes aureus, demonstrable by cultivation and 

 ordinary microscopical examination. As the hsemic microbes 

 seldom show any signs of fission, as compared with the bacteria at 

 the primary focus, it is reasonable to infer that proliferation takes 

 place mainly in the pus and not in the blood, hence the great 

 importance of thorough disinfection and destruction of primary 

 foci. The number of microbes in the circulating blood bears a 

 direct relation to the gravity of the disease ; if they are abundant 

 even in the absence of metastases in internal organs the prognosis 

 is grave, and if scanty even when metastatic foci exist the prospects 

 of a favorable termination are better. 



The occurrence of pyaemia from suppurating wounds or abscesses 

 does not depend so much upon the kind of pus-microbes which 

 have caused the suppuration as upon surrounding circutnstances. 

 The location and anatomical structure of the tissues in which the 

 primary infection has taken place exert an important influence in 

 the production of the disease. It is well known that suppurative 

 inflammation of the medullary tissue in bone is exceedingly prone 

 to give rise to pyaemia. Osteomyelitis, without direct infection 

 through a wound, is always due to an iutravascular infection 

 localization of pus-microbes in the capillary vessels of the medul- 

 lary tissue. The microbes come first in contact with the endothelial 

 cells after mural implantation has taken place, and the resulting 

 coagulation-necrosis in the tissues of the wall of the bloodvessels 

 leads to thrombosis. The products of the intravascular coagulation- 

 necrosis furnish a most favorable nutrient substance for the growth 

 and multiplication of germs, consequently the area of intravascular 

 infection is rapidly increased. The growth of the thrombus in a 

 proximal direction soon leads to extensive thrombo-phlebitis, and, 

 as softening of the thrombus takes place, to embolism and metas- 

 tatic suppuration. Pyaemia following a suppurative inflammation, 

 in a wound, or in the course of a phlegmonous inflammation in the 

 connective-tissue, is the result of an extra vascular infection. The 

 pus-microbes coming first in contact with the outer coats of the 

 veins, give rise to a phlebitis, which progresses from without 

 inward, and which is followed by thrombosis as soon as the iutima 

 is reached. The intravascular dissemination of the pus-microbes- 



