NATURE OF SUPPURATION 173 



en masse, where the tissue is not liquefied, and leucocyte 

 accumulation may be slight. When, however, suppuration is 

 taking place in a very dense fibrous tissue, liquefaction may be 

 incomplete, and a portion of dead tissue or slough may remain 

 in the centre, as is the case in boils. In the case of suppuration 

 in a serous cavity the two chief factors are the progressive 

 leucocytic accumulation and the disappearance of any fibrin 

 which may be present. 



Many experiments have been performed to determine whether 

 suppuration can be produced in the absence of micro-organisms 

 by various chemical substances, such as croton oil, nitrate of 

 silver, turpentine, etc. care, of course, being taken to ensure 

 the absence of bacteria. The general result obtained by in- 

 dependent observers is that as a rule suppuration does not follow, 

 but that in certain animals and with certain substances it may, 

 the pus being free from bacteria. It is still, however, questioned 

 by some whether the pus thus produced really corresponds 

 histologically and chemically with that due to bacterial action. 

 Buchner showed that suppuration may be produced by the 

 injection of dead bacteria, e.g. sterilised cultures of bacillus 

 pyocyaneus, etc. The subject has now more a scientific than a 

 practical interest, and the general statement may be made that 

 practically all cases of true suppuration met with clinically are 

 due to the action of living micro-organisms. 



The term septiccemia is applied to conditions in which the 

 organisms multiply within the blood and give rise to symptoms 

 of general poisoning, without, however, producing abscesses in the 

 organs. In all cases of septicaemia the organisms are more 

 numerous in the capillaries of internal organs than in the 

 peripheral circulation, and, in the case of the human subject, it 

 may be impossible to detect any in the blood during life, though 

 they may be seen in large numbers in the capillaries of the 

 kidneys, liver, etc., post mortem. The essential fact m pyaemia, on 

 the other hand, is the occurrence of multiple abscesses in internal 

 organs and other parts of the body. In most of the cases of 

 typical pyaemia, common in pre-antiseptic days, the starting-point 

 of the disease was a septic wound with bacterial invasion of a 

 vein leading to thrombosis and secondary embolism. Multiple 

 foci of suppuration may be produced, however, in other ways, as 

 will be described below (p. 186). If the term "pyaemia" be 

 used to embrace all such conditions, their method of production 

 should always be distinguished. 



