292 THE PYOGENIC COCCI 
accumulation of leukocytes in the anterior chamber of the eye— 
hypopyon. 
Pathogenesis.— ilfa?i.— Ordinarily the organisms exist on the intact 
surfaces of man as "opportunists," occasionally gaining entrance to 
the underlying tissues through abras'ions, chiefly in the skin, causing 
localized abscesses, furuncles or metastatic inflammations. Of the 
metastatic inflammations, acute osteomyelitis and endocarditis are 
the more common; less commonly generalized purulent pyemias 
develop. It is assumed that metastatic pyemias are caused either by 
direct invasion of the blood stream or less commonly by transmission 
of staphylococci in leukocytes to remote parts of the body; there 
they escape from the leukocytes and set up new foci of infection. 
SuppuratiA'e pleurisy and pericarditis are not imcommon. Accord- 
ing to Falls,^ pemphigus neonatorum is caused by Staphylococcus 
pyogenes. The strains studied by him were strongly hemolytic. The 
etiology of pemphigus is not as yet, however, definitely established. A 
pemphigoid eruption (pyosis) in young children is often caused by 
staphylococci. The occurrence of furunculosis in diabetics is so fre- 
quent as to lead to the supposition that not only is the general average 
resistance to invasion by staphylococci reduced in this disease; there 
may be a peculiar local lack of resistance in the skin itself. Occasional 
individuals exhibit a certain vulnerability to infection in particular 
regions ; the neck and buttocks are more frequently affected. Infections 
of the lips or nose are frequently very serious. One invasion appears 
to predispose to subsequent infection. Staphylococci frequently are 
secondary invaders in pulmonary tuberculosis, diphtheria and other 
severe infections. Generally speaking, staphylococci cause acute focal 
inflammations. Generalized infections of staphylococcus causation 
are relatively uncommon. Hemolytic staphylococci have been 
obtained from the local lesions and the blood stream in the occasional 
rapidly fatal case of pyemia. Prolonged infections frequently result 
in profound generalized symptoms; chills with intermittent fever are 
the more common clinical signs. Parenchymatous or even amyloid 
degeneration of certain glandular organs, notably the kidneys, is the 
more common pathological lesion in such cases. 
Experimental Rcpmdvctimi of Lesions.— A satisfactory explanation 
of the pathogenesis of staphylococci for man is not available. Neither 
the staphylolysin nor the leukocidin appears to play a prominent 
part in the morbid process. There is little definite evidence that the 
cell substance of the organisms themselves is the important factor. 
Nevertheless, the etiological relationship of staphylococci to furuncu- 
losis has been definitely established by the experiments of Garre- and 
Engels,'' both of whom rubbed virident cultures of these organisms 
up(m their skin, ])ro(lucing there typical furuncles. 
> Jour. Infec. Dis., 1917, 20, 86. 
2 Fortschr. f. Med., 1885, 3, 165. 
' Centralbl. f. Bakteriol., orig., 1903, 34, 84. 
