on with the view of detecting the source of suppurative fever in the discharges of wounds; inasmuch as the substances, obtained by chemical analysis from the fluids reabsorbed in this disease, when injected directly (without being derived from purulent discharges) into the circulation of healthy animals, cause almost no constitutional disturbance. By analogy we are likewise deterred; for suppurative fever resembles more closely those diseases which are induced in animals by the injection into their system of vitiated blood than those inoculable by the discharges or excre tions. The Toxamic origin of Suppurative Fever.-Similar to, but not the same as the preceding, is the hypothesis concerning the toxæmic origin of suppurative fever. The facts suitable for the establishment of this theory are supplied by two different sources, -by experiments and by chemistry. If suppurative fever, properly so called, can be induced by the injection into the lower animals of blood, pus, or other fluids procured from a patient suffering from this disease, and if it can be induced only in this way, we are forced to the conclusion that one or all of these fluids contain the active principle of the affection. But the greatest possible care is necessary to guard against false conclusions being drawn from this source. There is sufficient proof that certain constitutional diseases, as syphilis, are not inoculable in the case of the lower animals; while, on the other hand, animals can be infected with small-pox by inoculation. One difficulty, however, may always be raised as to inferences deduced from such facts alone, viz., Is the morbid state produced in an animal by inoculation with the diseased fluid of a human patient exactly the same as that which furnishes the injected fluid? This can only be proved by the crucial test of first inducing the disease in an animal, and then infecting a healthy human being with the disease from the animal. But the application of such a test is denied to us. By chemical analysis, an abnormal constituent in any of the fluids of the body can be detected; and thus provided with the supposed virus, or active principle of the disease, we next endeavour to confirm our conclusions, by observing the action of the supposed poison in the case of healthy animals. Some chemists assert that, as in scarlatina, in cases of exhaustion, of starvation, and the like, there is hypinosis, that is, a deficiency of fibrine in proportion to the blood corpuscles; others (and this is the view most generally held in the present day) allege the contrary to be the case in suppurative fever. Vauquelin detected hydrosulphate of ammonia in putrid blood, while M. Bonnet of Lyons thinks that this salt exists in the blood of patients suffering from purulent infection, and that the principal symptoms are due to the presence of this substance. Professor Panum declares the poisonous agent in suppurative fever to be fixed, not volatile ; indestructible by boiling and subsequent evaporation to dryness; soluble in water, insoluble in alcohol, and so intense as to be comparable only with the poison of serpents, curare, and the vegetable alkaloids. He agrees with Weber in stating that filtered putrid fluids and sulphuretted hydrogen never cause infarctus, or metastatic abscesses, and that these lesions occur when morphological bodies of small size, but sufficiently large to obstruct the capillaries, pass into the circulation. These observers conclude that this disease is septic poisoning, accompanied by some element capable of leading to embolism. Mackenzie held that lactic acid, introduced artificially into the blood, was capable of producing the phenomena of some forms of puerperal pyæmia. Dr B. W. Richardson announced some time ago to the Epidemiological Society, that he had found the poisonous agent in pyæmia to be an alkaloid, which was derived from the decomposition of albuminoid substances. He calls it "septine," and says that it has the power of transforming albuminous substances into matter like itself. Another consideration regarding the supposed poison of suppurative fever, is its analogy with other animal poisons. This class of toxæmic agents differs from most in the fact, that the effects produced are not proportionate to the dose, as is the case with the poisonous substances furnished by the mineral kingdom. The effects, for example, of a minute quantity of septic animal matter introduced into the system by puncture in dissection, cannot be explained by any mode of operation such as inorganic poisons may be supposed to possess. "With regard to the poison exciting pyæmia," remarks Savory, "as it commonly appears after injuries and operations, although, so far as clinical observation goes, whatever indications there may be, there is no clear evidence that the effects vary as the dose; yet in experiments upon animals, the quantity of putrid matter or pus injected has a manifest and most important influence upon the result." Some animal poisons Savory considers to be formed within the body, and then to pass into the blood; and of this class the poison of pyæmia is a member. Such is the difference of opinion regarding this one animal poison—the noxious principle of this one fever. Its source is still unknown, its physical characters are as yet undetected, its chemical properties undiscerned, and its dose not yet defined. What is the "poison," "materies morbi," "exciting cause" of suppurative fever? Where is it developed, and under what conditions, and in what form does it enter into and reproduce itself in the system? These are problems which still remain to be solved. CHAPTER IX. DIAGNOSIS OF SUPPURATIVE FEVER. WHEN the characteristic symptoms of suppurative fever are well developed when the conjunctivæ and skin have a dusky, icteric tinge-when the breath has the peculiar "heavy," "sweet," "hay-like," or "purulent" odour-when the joints become inflamed and suppurate -or when secondary abscesses form in various parts of the body, the diagnosis of suppurative fever is as simple as that of typhus, small-pox, or any of the eruptive fevers. But, especially in the milder forms of the disease, suppurative fever is very frequently not recognised. When pyrexia is experienced four or five days after an operation or a delivery, and is followed by more or less prostration, without any of the above symptoms being well marked, this will probably not be termed an attack of suppurative or of puerperal fever. The following diseases are those which require to be distinguished from suppurative fever. 1. Meningitis is distinguished from pyæmia by Sédillot. It is of very rare occurrence that the cerebral symptoms presented by suppurative fever are so grave or so strongly developed as to be mistaken for those of meningitis. In Case IV. the patient exhibited very violent cerebral symptoms; but the other characters |