The doctrine of present surgical pathology is that suppuration will not take place if pus-forming bacteria are kept out of the wound, which will heal by first intention without inflammation and without inflammatory fever.

In making this statement I am not unaware that there is a certain amount of fever following various severe wounds within twenty-four hours, even when no suppuration occurs.  This wound fever, however, is transitory; not high; and entirely different from the prolonged condition of high temperature formerly observed nearly always after operations and injuries.  The occurrence of this “inflammatory,” “traumatic,” “surgical,” or “symptomatic” fever, as it was formerly called, means that the patient has been subjected to the poisonous influence of putrefactive germs, the germs of suppuration, or both.

We now know why it is that certain cases of suppuration are not circumscribed but diffuse, so that the pus dissects up the fascias and muscles and destroys with great rapidity the cellular tissue.  This form of suppuration is due to a particular form of bacterium called the pus-causing “chain coccus.”  Circumscribed abscesses, however, are due to one or more of the other pus-causing micro-organisms.

How much more intelligent is this explanation than the old one that diffuse abscesses depended upon some curious characteristic of the patient.  It is a satisfaction to know that the two forms of abscess differ because they are the result of inoculation with different germs.  It is practically a fact that wherever there is found a diffuse abscess there will be discovered the streptococcus pyogenes, which is the name of the chain coccus above mentioned.

So, also, is it easy now to understand the formation of what the old surgeons called “cold” abscesses, and to account for the difference in appearance of its puriform secretion from the pus of acute abscesses.  Careful search in the fluid coming from such “cold” abscesses reveals the presence of the bacillus of tuberculosis, and proves that a “cold” abscess is not a true abscess, but a lesion of local tuberculosis.

Easy is it now to understand the similarity between the “cold abscess” of the cervical region and the “cold abscess” of the lung in a phthisical patient.  Both of them are, in fact, simply the result of invasion of the tissues with the ubiquitous tubercle bacillus; and are not due to pus-forming bacteria.

Formerly it was common to speak of the scrofulous diathesis, and attempts were made to describe the characteristic appearance of the skin and hair pertaining to persons supposed to be of scrofulous tendencies.  The attempt was unsuccessful and unsatisfactory.  The reason is now clear, because it is known that the brunette or the blond, the old or the young, may become infected with the tubercle bacillus.  Since the condition depends upon whether one or the other become infected with the generally present bacillus of tubercle, it is evident that there can be no distinctive diathesis.  It is more than probable, moreover, that the cutaneous disease so long described as lupus vulgaris is simply a tubercular ulcer of the skin, and not a special disease of unknown causation.