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This is illustrated in the axillary glands as a result of infected wounds of the fingers; in the femoral glands in infected wounds or purulent blisters on the foot; in the inguinal glands in gonorrhœa and soft sore; and in the cervical glands in the severer forms of sore throat associated with diphtheria and scarlet fever. The most acute suppurations result from infection with streptococci.
The nature of the inflammatory and suppurative processes will be considered in detail later; suffice it here to say that they are brought about by the action of one or other of the organisms that we have now to consider. It is found that the staphylococci, which cluster into groups, tend to produce localised lesions; while the chain-forms streptococci give rise to diffuse, spreading conditions.
In the deeply placed cervical glands, especially in cases of streptococcal throat infections, the suppuration rapidly involves the surrounding cellular tissue, and the clinical features are those of an acute cellulitis and deeply seated abscess. When this is incised the necrosed glands may be found lying in the pus, and on bacteriological examination are found to be swarming with streptococci.
It has been shown positively that acute endocarditis is due to micro-organisms, generally streptococci, staphylococci or pneumococci, and, more frequently than once believed, gonococci. The most frequent causes are acute rheumatic fever, diphtheria, pneumonia, cerebrospinal meningitis, scarlet fever, erysipelas, influenza, chorea, gonorrhea, sepsis and typhoid fever.
We have found that by painting with linimentum iodi, a ring half an inch broad, about an inch in front of the peripheral tender zone not the red margin an artificial leucocytosis is produced, and the advancing streptococci are thereby arrested.
Streptococci are also concerned in the production of spreading gangrene and pyæmia. It is less easily cultivated by artificial media than the staphylococcus; it forms a whitish growth. [Illustration: FIG.
A long rod may sometimes break up into several short rounded elements, which are clear and appear to have a somewhat increased power of resisting adverse conditions. The same may happen among the spherical forms, which only in rare instances form endogenous spores. Among the spheres which form a chain of streptococci some may occasionally be slightly different from the rest.
If these measures fail or are impracticable, it may be necessary to make one or more free incisions, and to insert drainage-tubes, portions of rubber dam, or iodoform worsted. The general treatment of toxæmia must be carried out, and in cases due to infection by streptococci, anti-streptococcic serum may be used.
The anaërobe most constantly present is the bacillus ærogenes capsulatus, usually in association with other anaërobes, and sometimes with pyogenic diplo- and streptococci. According to the mode of action of the associated organisms and the combined effects of their toxins on the tissues, the gangrenous process presents different pathological and clinical features.
The toxins of the streptococci are exceedingly virulent, and induce local death of tissue so rapidly that the protective emigration of leucocytes fails to take place.
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