=Cryptogenetic or Spontaneous Septicemia.=--Cryptogenetic or spontaneous septicemia is a term applied to those cases in which the port of entry of the germs is no longer visible--_e. g._, a hypodermic puncture--or cannot be positively determined. On careful study this may be found to consist of a small focus where pus is forming within narrow confines and under great pressure. Under these circumstances, as Kocher has shown, toxic virulence is rapidly augmented. This is doubtless one reason why the septic features of many cases of osteomyelitis and appendicitis are so pronounced. SEPTICEMIA. According to the views thus enunciated, the difference between sapremia and septicemia is not one of character as much as of location. _In septicemia the putrefactive action is no longer confined to material enclosed by_ (_yet not of_) _the tissues themselves, but has spread from this to the surrounding living cells_, which are being attacked by bacterial enemies; in other words, we deal with _infection of living tissues rather than with mere intoxication_. This is a _progressive invasion_ of tissues by continuity, _with_ a constantly proceeding systemic _intoxication_ by poisons produced in larger quantities. So rapid may this action be--as may be seen in malignant diphtheria--that the individual speedily succumbs before evidences of abscess or local gangrene appear. On the other hand, providing that the toxic action is less pronounced or the patient’s vitality more enduring,--_i. e._, his tissues more resistant--abscess, phlegmon, or local gangrene may result in the destruction of tissue being limited to the environs of the parts first involved. Bacteria are also found in the blood. While septicemia then may be a direct continuance of an original sapremia, it is not intended to intimate that it may not originate _de novo_; that is, _many cases may begin as a pronounced septicemia from a local infection_. This is the case, for instance, with the majority of dissecting wounds, etc.