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288 THE MICRO-ORGANISMS OF THE HUMAN MOUTH. ;

pyogenes aureus, etc., are present, we may expect severe suppu-
rative inflammation and formation of abscesses.
Parts of the pulp infected with the Bacillus pulpse pyogenes
will also occasion suppurative inflammation.
Infections with various pathogenic micro-organisms (mixed
infections) will provoke divers phenomena. The progress of the
infection will in all cases materially depend upon the general pre-
disposition of the patient to infections, and upon his momentary
state of health. Consequently, apical infections exhibit all transi-
tions from a hardly perceptible reaction to the most dangerous
phlegmonous inflammations, accompanied by general symptoms,
such as high fever, chills, etc., which, as many instances show,
may lead to meningitis, as well as to pytemic and septicemic
processes, with fatal termination.
The connection between afl:ections of the teeth and severe dis-
eases of the jaw has already been pointed out by Hippocrates.
He wrote, " The jaw of the son of Metrodorus mortified in con-
sequence of toothache, and the gums became intensely swollen
the suppuration was moderate. J^ot only the molar teeth, but
even the jaw-bone itself was thrown off."
The following in part fatal infections proceeding from the
pulp may also be mentioned. They are almost without excep-
tion to be regarded as indirect infections. In all cases, except-
ing that related by Schmid, a local aftection first took place, and
only after h considerable quantity ol poison had accumulated at
the point of infection did the general infection occur.
Mr. Pearce Gould {Journal of the British Dental Association,
April, 1886) has recorded a case of death from alveolar abscess,
resultino; in thrombosis of the cavernous sinus. On admittance
the patient, aged fifty-seven, presented a sloughy opening in the
center of the right cheek. An incision was made from the out-
side, and six molar teeth were extracted. The trismus was
relieved, but cedema of the right temple appeared, and subse-
quently an abscess above the external angular process of the
orbit, and another in the posterior triangle of the neck, but the
internal jugular was not thrombosed. The respiration became
stertorous, pulse 126, small, temperature 103.8°, and crops of
Great oedema of the orbit, and
herpes appeared about the lips.