A system of surgery . cocci are not, of course, present in such numbers, nor arethey massed together, as in pysemic emboli, and thus the appearancesat the early stage just described would not be so typical, althoughwithout doubt the changes which are going on are essentiallythose which I have detailed. While these micro-organisms arenecessary for the production of acute suppuration, and while withouttheir presence acute suppuration could not occur, it does notfollow that whenever they are present acute suppuration must takeplace. On the contrary, in ordinary circumstances, it is pro-bably the
A system of surgery . cocci are not, of course, present in such numbers, nor arethey massed together, as in pysemic emboli, and thus the appearancesat the early stage just described would not be so typical, althoughwithout doubt the changes which are going on are essentiallythose which I have detailed. While these micro-organisms arenecessary for the production of acute suppuration, and while withouttheir presence acute suppuration could not occur, it does notfollow that whenever they are present acute suppuration must takeplace. On the contrary, in ordinary circumstances, it is pro-bably the rule thatother conditionsmust come into playto assist the actionof these micro-organisms ; but howfar these accessoryconditions are es-sential depends onvarious points inconnection moreespecially with thekind, the numbers,and the virulence ofthe organisms them-selves. As I havepointed out, theeffects of the organ-isms on the tissuesvary with the kindwhich is introduced;for example, thestaphylococci tendto form circum-. Fig. 15.—Section of Kidney, showing Changes following an Embolus composed of Pyogenic Cocci,o, Central plug o£ cocci; 6, clear space around; c, commencing in-filtration with leucocytes; d, kidney tubules. scribed abscesses, while the streptococci are especially concerned in the production ofdiffuse spreading suppuration. And among the staphylococci thedifferent species differ in the severity with which they act, and further,while in the case of the staphylococci—more especially of the rarerforms—the presence of various accessory conditions is almost essentialto their action, the streptococci, on the other hand, are apparentlymore or less independent of such secondary circumstances. Thatthe virulence of the individual varieties differs at different timesis evident, both from clinical observation and from the less virulent the organism is, the more does it becomenecessary for other factors to come into play in order that sup-puration may arise
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