PERIOSTITIS AND OSTEOMYELITIS 217 



large size arid have not so much tendency to break down as in' 

 the case of staphylococcus infections. Other organisms have 

 been cultivated from different cases of the disease, and some of 

 these have received special names ; for example, the diplo- 

 coccus endocarditidis encapsulatus, bacillus endocarditidis griseus 

 (Weichselbaum), and others. In some cases the bacillus coli has 

 been found, and occasionally in endocarditis following typhoid 

 the Ayphoid bacillus has been described as the organism present. 

 The meningococcus and also the gonococcus have been shown to 

 affect the heart valves (p. 262), though such occurrences are 

 relatively rare. Tubercle nodules on the heart valves have been 

 found in a few cases of acute tuberculosis, though no vegetative 

 or ulcerative condition is usually produced. 



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 after- 

 wards injecting staphylococci into the circulation. Similar experiments 

 have since been repeated with streptococci, pneumococci, and other 

 organisms, with like result. Kibbert found that if a potato culture of 

 the staphylococcus aureus were rubbed down in salt solution so as to 

 form an emulsion, and then injected into the circulation, some minute 

 fragments became arrested at the attachment of the chords tendinese and 

 produced an ulcerative eudocarditis. 



Acute Suppurative Periostitis and Osteomyelitis. — Special 

 mention is made of this condition on account of this comparative 

 frequency and gravity. The great majority of cases are caused 

 by the pyogenic cocci, of which one or two varieties may be 

 present, the staphylococcus aureus, however, occurring most 

 frequently. Pneumococci have been found alone in some cases, 

 and in a considerable number of cases following typhoid fever 

 the bacillus typhosus has been found alone. In others, again, 

 the bacillus coli 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 

 the same organisms or in the course of infective fevers, but in a 

 great many cases the path of entrance cannot be determined. 

 In the course of this disease serious secondary infections are 

 always very liable to follow, such as small abscesses in the 

 kidneys, heart- wall, lungs, liver, etc., suppurations in serous 

 cavities, and ulcerative endocarditis ; in fact, some cases present 

 the most typical examples of extreme general staphylococcus 



