SUPPURATIVE LARYNGITIS. 261 
instant. But instead of being attended by little constitutional 
disturbance, as in the cases to which I have just referred, we 
now and then find that great constitutional derangement pre- 
cedes and accompanies the establishment of the suppurative 
action, — that instead of being situated in the cellular tissue un- 
der theskin,the collections of purulent-looking fluid are formed 
in cellular tissue more deeply seated. Again, in other cases, we 
find that they are not limited to the cellular tissue, but that 
the pus-blastema is exuded into the joints; and yet further, 
that it is, in rare cases, disseminated in masses through 
the viscera of the chest and abdomen. Now the transition 
from the first to the last-described state is by most insensible 
gradations ; the circumstances under which all occur are the 
same; and if it be granted that the first arises from a defi- 
nitely diseased state of the blood or system generally, I see 
not on what ground it can be argued, that the others, which 
differ only in the more wide diffusion of the local affections, 
may not also depend on the same diseased state of the blood. 
This disease seems very closely allied to that condition of the 
blood in which purulent discharges issue at the same time 
from several of the mucous membranes after some of the 
acute specific fevers, and to that chronic state in which 
every scratch or abrasion “ festers/’ as the vulgar say. The 
existence of this condition of the blood, or system generally, 
as a substantive disease, appears to have been in modern 
times first recognised by Tessier, in 1838. He, however, 
associated with it the cases in which disseminated abscesses 
are excited by the circulation of foreign matter in the blood. 
Tessier described the state referred to as a new pathological 
genus, under the name of the “ purulent diathesis ;” and he 
defined it to be a modification of the organism characterised 
by a tendency to suppuration in the solids and coagulable 
fluids.” 
“Amid much pathologically erroneous, the doctrine of 
Tessier appears to contain an important truth, viz., that in a 
certain number of cases of disseminated abscesses, the febrile 
disturbance is established before any local disease is set up, 
and, consequently, before any pus is formed, and by inference, 
that the abscesses are, in such cases, merely the effects of a 
special alteration of the element from which that blastema is 
exuded out of which they are developed.” 
“Although the morbid condition of the blood, which is thus 
manifested by its effects, is common as a consequence of the 
acute specific diseases, it sometimes arises without having 
been preceded by any other disease, i. e., as a primary sub- 
stantive affection.” 
XXIX. 
34 
