found in the anterior jugular and in some of the neighbouring veins. As a rule, bacteria are hard to find in blood clots, but in this instance the firmer and most fibrinous part of the clot from the anterior jugular vein contained numerous groups of short bacilli with rounded ends, and often in twos (Fig. 13). In some parts of the clot they grew in leptothrix of some length. This is not seen in the part of the clot which has been drawn. It is shown, however, in Fig. 16. The bacilli were in vast numbers amongst the fibrin, but in places where the blood corpuscles predominated none were seen.

The present seems to be a favourable opportunity for showing a microphotograph which Mr. Cosens has made of a clot from the femoral vein of another woman who died from septicemia after an operation for necrosis of the femur. The bacteria in the clot are short bacilli, the same morphologically as those which I have just described. The patient died fortyeight hours after the operation with coma and high temperature.

But to return to the case under consideration, the lymph which covered the visceral layer of the pleura was in places a quarter of an inch thick. Mixed with its cells and fibrin were bacilli of more than one morphological variety. By far the most

abundant were small oval bacilli 1.5 μ to 2 μ long and 0.75 μ wide, which occurred chiefly in pairs in short chains of from four to eight or ten elements (Fig. 14), and in small irregular groups. Here and there, especially near the free edge of the lymph, were a few short and thick round-ended bacilli in pairs.

FIG. 14.-Bacillary septicemia. Pleuritic lymph containing a variety of bacilli.

It seems probable that this was a bacillus which occurs in dead tissues, and is called by Sternberg the " bacillus cadaveris."1 I cannot speak so con

These

fidently about another bacillus which also was present in considerable numbers. It was about the size of the anthrax bacillus, but with oval ends; it grew in pairs, or in short chains with ill-marked intervals between the elements. The pleura was acutely inflamed with engorgement of its vessels and proliferation of its endothelium. Its tissues were interspersed with bacilli the same as those which have been described. Here, again, the small oval bacilli in pairs and chains were by far the most numerous. filled many of the smallest blood vessels and lymph spaces, but were absent from the blood which distended the larger arterioles and venules. Most of the air vesicles beneath the pleura were filled with pneumonic exudation, which contained numbers of the small oval bacilli. Bacilli were most numerous near the pleura, but both they and the exudation diminished in the vesicles further removed from the pleura. The tissues of the lungs also contained the two other kinds of bacilli seen in the pleuritic exudation. The pneumonia was the same as that in Fig. 11. No bacterial emboli were found in the capillaries of the pleura. description of the pleural lymph applies to that which covered the pericardium. It likewise contained numbers of bacilli with similar morphological characters. Slight histological differences were also observed. For

The

instance, the pericardial lymph was thinner and more villous and the subjacent endothelium detached in places as if by vesication. Thus the pericardial and pleural lymph probably contained three kinds of bacilli. The two largest are common in cadavers and may have been saprophytes. The small oval bacillus may also have been of the same nature, but the examination of the tissues of the heart, and, I might add, of the other organs, suggests that it played a much more important part, and was the cause of the septicemia. Many of the capillaries and smaller blood vessels of the heart were filled with these small oval bacilli (Fig. 15). In many places the dilated inter-muscular lymph spaces were also full of them, and where they were not crowded together the usual chains of from six to ten elements were seen (Fig. 16). Here and there the bacterial emboli filled minute blood vessels beneath the endothelial covering of the heart. Some of the muscle fibres also contained the bacteria in their substance, but not enough to distend their sarcolemma as in a case of pyæmic myocarditis described by Cornil and Babes.

The kidneys, too, had not escaped Their epithelium was slightly cloudy, and had desquamated in some of the larger collecting tubules.

1 "Les Bactéries," third edition, vol. i., p. 540 (Fig. 211)..

Some of the smaller tubules contained albuminous casts. The bacterial invasion of the kidneys seemed to have been but slight. With much trouble it was ascertained that some of the smaller capillaries and vasorum of the blood vessels and connective

vasa

tissue of the medulla contained bacterial emboli. It is to be noticed that the histological examination throws light upon two features in the clinical history. Apart from the pericarditis the bacterial invasion of