186 SUPPURATION AND ALLIED CONDITIONS. 



parts most frequently infected in this way (vide Figs. 

 5 1 . 5 2 )- 



Experimental. Occasionally ulcerative endocarditis is produced by 

 the simple intravenous injection of staphylococci and streptococci into 

 the circulation, but this is a very rare occurrence. It often follows, 

 however, when the valves have been previously injured. Orth and 

 Wyssokowitsch at a comparatively early date produced the condition 

 by damaging the aortic cusps by a glass rod introduced through the 

 carotid, and afterwards injecting staphylococci into the circulation. 

 Similar experiments have since been repeated with streptococci, 

 pneumococci and other organisms, with like result. Ribbert found 

 that if a potato culture of the staphylococcus aureus were rubbed down 

 so as to form an emulsion in salt solution, and then injected into the 

 circulation, some minute fragments became arrested at the attachment 

 of the chordae tendineae and produced an ulcerative endocarditis. 



Acute Suppurative Periostitis and Osteomyelitis. - 

 Special mention is made of this condition on account of 

 its comparative frequency and gravity. Becker in 1883 

 described a coccus which he believed to be the special 

 organism concerned in this disease, but it has been since 

 completely proved that this organism is simply the staphylo- 

 coccus pyogenes aureus. The great majority of cases are 

 caused by the pyogenic cocci, of which one or two varieties 

 may be present, the staphylococcus, however, occurring 

 most frequently. Pneumococci have been found alone in 

 some cases, and in a few cases following typhoid fever, 

 apparently well authenticated, the typhoid bacillus has been 

 found alone. In others again the bacillus coli communis 

 is present. 



The affection of the periosteum or interior of the bones 

 by these organisms, which is especially common in young 

 subjects, may take place in the course of other affections 

 produced by these organisms or in the course of infective 

 fevers, but in a great many cases the path of entrance is 

 quite unknown. That the organisms enter frequently by a 

 small surface lesion, and are carried by the blood stream to 

 the part affected, there can be no doubt. In the course of 

 this disease serious secondary infections are always very 

 liable to follow, such as small abscesses in the kidneys, 



