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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.
Most commonly they appear about the joints of the fingers and at their extremities; but whatever parts are affected, if the situation will admit, these superficial suppurations put on a circular form, with their edges more elevated than their centre, and of a colour distantly approaching to blue. Absorption takes place, and tumours appear in each axilla.
Other forms of leucocytes may be present, especially in long-standing suppurations; and there are usually some red corpuscles, dead bacteria, fat cells and shreds of tissue, cholestrol crystals, and other detritus in the deposit.
But as I have never known fatal effects arise from the cow-pox, even when impressed in the most unfavourable manner, producing extensive inflammations and suppurations on the hands; and as it clearly appears that this disease leaves the constitution in a state of perfect security from the infection of the smallpox, may we not infer that a mode of inoculation may be introduced preferable to that at present adopted, especially among those families which, from previous circumstances, we may judge to be predisposed to have the disease unfavourably?
Most commonly they appear about the joints of the fingers and at their extremities; but whatever parts are affected, if the situation will admit the superficial suppurations put on a circular form with their edges more elevated than their centre and of a color distinctly approaching to blue. Absorption takes place, and tumors appear in each axilla.
Another instance has occurred of a young woman on whose hands were several large suppurations from the cow-pox, who was at the same time a daily nurse to an infant, but the complaint was not communicated to the child. In some other points of view the inoculation of this disease appears preferable to the variolous inoculation.
The occurrence of endocarditis, as indicated by alterations in the heart sounds and the development of murmurs, may cause widespread infective embolism, and metastatic suppurations in the kidneys, heart-wall, and lungs, as well as in other bones and joints than those primarily affected.
Streptococci invade the lymph spaces, and are associated with acute spreading conditions such as phlegmonous or erysipelatous inflammations and suppurations, lymphangitis and suppuration in lymph glands, and inflammation of serous and synovial membranes, also with a form of pneumonia which is prone to follow on severe operations in the mouth and throat.
This puncture was so severe that the arm was in a state of ecchymosis for six or eight inches upwards, and I doubt not that without the caustic, there would have been severe and long continued suffering, and perhaps painful suppurations.
The secondary suppurations are liable to be overlooked unless sought for, as they are rarely attended with much pain. In these multiple forms of osteomyelitis the toxæmic symptoms predominate; the patient is dull and listless, or he may be restless and talkative, or actually delirious.
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