Etiology and has been found by Koch to be due mainly to chain-like cocci, which cause the blood corpuscles to become agglutinated in masses, which then form thrombi. On the other hand, staphylococci and strep tococci have also been found capable of inducing metastatic abscess. The bar rier between septicemia and therefore, is not, to say the least, solidly established, and many authors now com bine the two conditions under the name "septicopymmia." Ogston has shown, however, that the cocci more readily enter the circulation, whereas strepto cocci and staphylococci, even when pres ent through a septic state of the wound, only penetrate the harrier of granula tion tissue when in great numbers.
The chain-cocci enter the circulation, especially the veins, and, meeting here and there suitable surfaces, roughened, perhaps, through slight fibrosis, etc., form parietal thrombi of agglutinated corpuscles and cause local inflammation and suppuration of the vascular walls. From these preliminary foci more or less large suppurating thrombi are swept away by the blood-current, and, being thus transported to distant organs, there originate purulent processes. The tox ins of sapnemia or the micro-organisms of septicfemia when present are compli cating features. The lymphatic system may also act as a channel for the trans portation of cocci-laden thrombi.
The micro-organisms are to be found, not only in the white corpuscles, but also in the plasma and where metastatic abscesses have been formed,—in the lungs, pleura, pericardium, endocar dium, the spleen, the kidneys, the brain, the joints, etc.,—a feature of the dis ease which explains the great variety of symptoms witnessed.
The wound usually has a character istic appearance and odor. It appears grayish, greenish, or black. The sur rounding veins are often found to con tain suppurating thrombi, which in ad vanced cases may occupy the whole length of the venous trunk involved. In the joints the synovial membrane is at first merely congested, then suppura tion ensues: as in other forms of ar thritis, the knee is a preferred site in pyaemia, the shoulder being next in order.
Five cases of suppuration of the bron chial lymph-glands in pyaemia. Three occurred in young girls, and ended fatally in a few days, with the symp toms of a purulent meningitis. Autopsy revealed multiple cranial abscesses in all three patients, with perforation and subsequent meningitis in two of the cases. in each case the infection
started from a suppurating bronchial gland, under the bifurcation of the trachea, opposite the right bronchus.
The infection entered from the oesopha gus. All three cases were probably tuberculous. F. Schlagenhaufer (Wiener kiln. Wochen., June 6, 1001).
Prognosis.—The course of the disease varies greatly, and it may last from a week to several months. The prognosis of the disease is very unfavorable, how ever, and but a small proportion of cases recover. When the intervals between the chills are short and the metastases are numerous or involve important or gans, the likelihood of an early fatal ending is great. The disease is often linked with septicaemia, the manifesta tions of both forms being mingled, and the progress of the case toward a fatal ending is correspondingly hastened. Erysipelas has also been observed as an accompaniment of pyaemia, and also re duces the slight chances of recovery.
In the form of pyaemia attending gonorrhoea the morbid processes caused by the gonococcus do not vary greatly from those caused by pus-cocci. E. Finger (Wiener med. Woch., p. 248, '96) found that the behavior of the gonococci in and toward the affected tis sues, however, differs from that of the pus-cocci, in that the latter rapidly per meate the tissues and cause rapid break ing down of the same, while the gono coccus is less active and takes only paths of least resistance through the fis sures and lacunae of the epithelium and connective tissue. Again, the reaction of the tissues is somewhat different. The inflammation caused by the gono coccus is entirely purulent; the forma tion of granulation tissue is early and abundant. The gonorrhoeal process tends to the formation of connective tis sue and scars,—in the urethra as strict ure, in the prostate as destruction of the gland, in the suprarenals as thickening of the organs, and in the joints as anky losis. Finally, the gonococcus is de stroyed when exposed to a temperature of 103° or 104° F. for several hours, while the pus-cocci are far less suscep tible to such a temperature. From these considerations it follows that the gono coccus is less energetic in its action and is more easily destroyed than the pus cocci, and that the lesions produced by the former tend to run toward recovery more readily than those produced by the latter.