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MAN OF STRENGTH

FILTHY RICH LOVE - BOOK FIVE

SADIE KING

WANTAFREEBOOK?

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book!
Fox in the Garden is a bonus book in the Filthy Rich Love series,
exclusive to email subscribers.

William

When I escape for some air before the most important business call
of my life, I don’t expect to find a woman dancing barefoot in my
Zen Garden.

The last two years of my life have been spent working toward this
business deal. But now, all I can think about is her.

Ariel

Dad’s drinking is getting worse, and it’s starting to lose him clients.
So I step in and take over the gardening business. But who knew
our most

profitable client was such a silver fox?

He’s older than me, confident and handsome. The kind of man who
knows what he wants and isn’t afraid to take it. And I think what he
wants is me…

Click here for your free copy

Join the Sadie King Facebook group

Insta-Love Lovers

MANOFSTRENGTH

Tyler

We’re losing money at the fitness club, and I’ve gone undercover to
find out what’s going on. Then I meet Zoe. From the moment she
walks in on me in the gym showers, I know I need to have this
woman. She’s gorgeous, she’s defiant, and I’m pretty sure she’s
hiding something.

Zoe

There’s a reason I work out every day, a reason I’ve learned to

defend myself and run fast, and a reason why I never stay in one
place for long.

Then I meet the hot new personal trainer at the gym, and suddenly
I don’t want to run anymore. But will he still want me when he
learns the truth?

Man of Strength is a short and steamy romance featuring an older

alpha male and younger woman.

Book five in the Filthy Rich Love series. Each book in the series is a
standalone. No cliff-hangers!

Copyright © 2019 by Sadie King.

All rights reserved.

No part of this book may be reproduced in any form or by any

electronic or mechanical means, including information storage and
retrieval systems, without written permission from the author, except
for the use of brief quotations in a book review.

Cover designed by Designrans.

This is a work of fiction. Any resemblance to actual events,

companies, locales or persons living or dead, are entirely
coincidental.

www.authorsadieking.com

CONTENTS
1. Tyler

2. Zoe

3. Tyler

4. Zoe

5. Tyler

6. Zoe

7. Tyler

8. Zoe

9. Tyler

Epilogue

Filthy Rich Love

Get your insta-love fix!

TYLER

T he muscles in my back twitch as the hot water hits them. I’m

pumped from my workout, I pushed myself hard, and I know I’ll be
hurting tomorrow.

I pump soap from the dispenser into my palm, and the smell of
lavender hits my nostrils. I frown. It’s nice but not appropriate for a
men’s shower, especially at a gym. All fired up after a workout, you
don’t want to get into the shower and be reminded of your granny.
I sigh inwardly. Another thing I need to speak to someone about
when all this is over.

I lather myself in soap, giving each muscle a vigorous rub ‘til I’m
covered in foamy suds. I dip my head under the shower and close
my eyes, enjoying the feeling of the water running over me. I turn
around slowly to wash my back off and open my eyes.

Holy shit. There’s a woman standing by the door staring at me, and
she’s gorgeous.

She’s in figure-hugging Lycra that shows off her toned body. Her
tanned skin glistens with sweat, and there are dark patches on her
top between her breasts. Her dark hair is pulled back into a ponytail
and slicked back with sweat. It looks like she just finished a workout
and she pushed herself as hard as I have.

The blood rushes to my dick, and it rises out of the soap suds to say
hello. It’s lucky there’s a low wall separating the shower area so she
can’t see the instant effect she’s having on me.

I lift my arms and run my hands through my hair. Her eyes widen as
she watches the muscles ripple in my torso. Goddamn, she’s
enjoying the show!

And I’m enjoying her watching.

“This is the men’s,” I say.

“I can see that.” Her chin tilts up slightly, defiant.

“Women’s is the other side.” I indicate the door on the other side of
the room. She could go out the door she came in and walk around,
but I want to see her cross the room so I can check her out.

“It’s my first day here,” she says. “I got lost.”

She sticks her chin out even more as if daring me to challenge her. I
love a challenge.

“What’s your name?” I ask.

She pulls her eyes away from my abs and looks up at my face. God,
she’s beautiful.

“What’s it to you?” she says.

I let out a chuckle, and she frowns at me. I wonder what’s gotten
her so wary. She’s young, can’t be more than twenty years old, and
she’s got an attitude on her like she’s seen too much of the world.

“I’m Tyler,” I say. “I’m new here too.”

She lowers her chin slightly but doesn’t take her eyes off me.

“I’m a personal trainer here.” The lie comes easily, yet she pulls her
eyebrows together and squints at me.

Damn, she didn’t believe me. Everyone else I’ve spun my story to
has accepted it without question. Who is this girl, and why is she so
distrustful?

She starts across the room.

“Wait.”

I’m not sure what I’m going to say, but I know I can’t let her walk
away.

She stops and turns, but she’s across the room now and at a
different angle. I realize too late that when she looks back at me
there’s no wall to shield my goods.

Her eyes go wide when she sees me standing to attention. She looks
up at my face, and there’s a hint of a smile on her lips. For one
glorious moment, I think she’s going to walk over here.

Then she turns abruptly, pushes through the door, and she’s gone.

“Fuck.”

I stride out of the shower area and across the changing room. I pull
the door open. It’s only been a matter of seconds, but the corridor’s
empty. The door to the women’s changing room is opposite, but the
door is firmly closed. If she’d gone through it would still be swinging
shut. She must have gone down to reception.

I duck back into the men’s and grab my towel. It barely covers the
goods. Who the hell made these towels so small?

I stride over to my gym bag and pull on my shorts, and my personal

trainer t-shirt, and head out to reception. She’s nowhere to be seen.
Damn.

“You see a woman come through here?” I ask the girl on reception.

“Dark hair in a ponytail, this high—” I indicate her height with my

hand,

“—wearing black Lycra and carrying a gym bag.”

She smiles at me, twisting a strand of blond hair around her fingers.

“We see a lot of women come through here in their gym clothes,”
she says with a smile. I scowl at her. I’m not in the mood to be
flirted with.

“Did you see her or not?”

The smile drops from her face. “No need to be rude about it,” she
says with a sulk. “She left in a hurry about a minute ago.”
There’s a low gate where members have to swipe their cards to be
let through. I leap over it and stride through the door and out to the
parking lot.

The cold air hits my still wet skin, making me shiver. It’s pretty quiet
at this time of the morning, not a lot of people around. There’s a car
moving at the end of the parking lot. It must be her.

I set off at a jog, my bare feet slapping the pavement. I reach the
car as it gets to the barrier arm and bang on the window. A startled-
looking man squints at me in surprise from the driver’s seat.

“Sorry,” I mouth through the glass. “Thought you were someone

else.”

I scan the parking lot, but there’s no other movement. She must
have left on foot and fast.

The gym is at the end of an industrial estate with light factories on

the road ahead and open parkland to the right. On the left is a
footbridge that runs over a railway line. She could have gone
anywhere.

I climb the bridge hoping the height will give me a better view, but
there’s no sign of her. I turn in all directions, focusing on any
movement that catches my eye. But the sexiest woman I’ve ever
seen in my life has vanished.

I walk casually back into reception, jump the barrier again, and lean
on the reception desk. The receptionist scowls at me, and I curse
myself for not being nicer to her earlier. I lean forward and flash her
my biggest smile.

“Did you find her?” she asks.

“She’d already gone,” I say. “Left her phone behind. I was hoping to
catch her.”
“We have a lost property box,” she suggests.

“It’s a hell of a thing to be without though, isn’t it...?” I glance down

at her name badge, and she thinks I’m looking at her breasts,
“...Melanie?”

She picks up the strand of hair again and smiles at me.

“If you have her information, I can drop it off to her.”

“You personal trainers.” She mock rolls her eyes. “Always wanting
personal information for members.”

I wonder which hot-headed beefcake has been harassing the gym

members, and then I remember that that’s exactly what I’m doing.

“I can’t give out personal information,” she says. “But I’m going out
to the storeroom for a minute, and my computer’s open.”

She smiles at me conspiratorially, and I tighten inside at how easy

that was. She scoots away and I lean over to her computer, pulling
the screen around towards me.

I pull up the info from the exit barriers and find the last one to swipe
out. Zoe Canning. From there, it’s easy to click into her information.
18

High Street, right in the center of town. Challenge accepted.

ZOE

I run over the footbridge and into the park, taking a small path that
leads into the trees. My heart is racing and not just because I’m
running. I’ve just met the hottest guy I’ve ever seen. And I saw him
naked!
My cheeks are flushed and I’m not sure if it’s from running or from
my close encounter.

I don’t know how the hell I managed to walk into the wrong
changing rooms, but I’m so glad I did. He was ripped. Muscles
everywhere. I’ve seen some muscular guys at the different gyms I’ve
been to, but he was something else. I think he had an eight pack.

I don’t know why I ran. I was suddenly embarrassed that I’d been
literally staring at his body, and I couldn’t trust myself not to go over
there and wash the soap suds off him. Or maybe it was the lie.

I’ve become pretty good at reading people, and if he’s a personal

trainer then I’m the pope. He’s hiding something. But maybe we all
are.

So I ran. And now I’ll have to use the shitty shower at home and
probably be late for work for my first week on the job.

I pick up the pace, and ten minutes later I’m turning the key in the
rusty lock to the tiny apartment above Carl’s Diner.

I dump my gym bag and am already pulling my clothes off as I head

to the bathroom. The shower sputters to life and settles into a cold
trickle. I was hoping I could shower at the gym most mornings and
avoid my temperamental shower.

It was a good workout today and good to get a run in too. I feel
strong and fast, and hopefully that’s enough to give me a head start
if I ever need one.

The shower’s starting to warm up by the time I turn it off. I throw on

the pale green blouse and black skirt that is my waitress uniform and
head down the stairs.

It’s five past eight when I push open the door to Carl’s Diner.
Carl is a burly man with a messy beard and a bald head. His off-
white t-shirt is covered in grease stains, and it stretches too tight
over his round belly. He lifts his arm up and looks at his watch in an
exaggerated way.

“What time do you call this?”

“Sorry,” I say. “The showers at the gym were broken.”

He snorts. “There’s your problem right there. Messing around at the

gym.” For all his gruff appearance, I’m beginning to learn there’s a
soft heart in there somewhere.

He shakes his head in mock disapproval. “Too busy eyeing the men,
I bet.”

I turn away to grab an apron, so he doesn’t see my face go red. It’s

a bit too close to the truth today.

“Get those tables cleared,” he says. “You’ll have ten minutes less for
your lunch break.”

I’m only five minutes late, but I don’t argue. I need the job. Carl’s
Diner is not the nicest place in town. It’s cheap, greasy food mostly
cooked in the deep fryer. But it was the only place with a “help
wanted, board available”

sign, so here I am. For as long as I can stay, which is usually a few
months or sometimes only a few weeks before I get the prickles on
the back of my neck, the paranoia sets in, and I move on.

The morning passes quickly; clearing tables, taking orders, and

delivering plates of greasy omelets and fried breakfasts. The
breakfast rush has ended, and I’m wiping down a table when I hear
the tinkle of the doorbell signaling another customer.
“Take a seat and I’ll be with you in a moment,” I call over my
shoulder.

I finish clearing the table and turn to the customer. It’s him. Tyler,
the hot man from the gym, sitting in my diner and studying a menu.

My breath catches at the sight of him. He’s as gorgeous clothed as

he was naked. He’s wearing his green personal trainer t-shirt, and
it’s too tight for his big arms. The muscles press against the fabric,
straining to be let out.

It must feel glorious to have those big arms wrapped around you.
He looks up at me. His eyes are bright green. They almost match the
t-shirt.

“How many calories in the fried breakfast?” he asks with an innocent

smile.

“What are you doing here?”

“I wanted to see you again.”

My heart leaps in my chest.

“How did you find me?”

“I have my ways?” He means it as a joke, but it scares the life out of

me. If he can find me, anyone can. Shit. I’ve only been here a few
days, and

I’m going to have to move on again. He must see the panic on my

face, because his expression turns from jokey to concerned.

“I got your information from the gym’s database.” If this explanation

is meant to sooth me, it doesn’t. Shit. I’ll have to switch gyms, which
is going to be expensive. This is the only one that offers access to
every branch in the state, and I love these gyms.
He must see my scowl, because he reaches out and grasps my hand
in his meaty one. His touch is electric. Heat travels right up my arm.

It’s also comforting. I feel safe, like nothing could hurt me with him
around.

“It’s okay,” he reassures me. “Not all staff have access.”

He rubs his thumb against my hand, and the movement sends

tingles up my spine.

“What time do you finish?” he asks.

“I’m doing a double shift. I’ll finish at about ten.”

“Ten.” He nods as if considering something. My heart skips a beat;

I’m sure he’s going to ask me out. “Make sure you go straight home
afterwards.”

I pull my hand away and take my notepad out of my pocket, trying

to hide my disappointment.

“You’ll need to get up early in the morning,” he says. “Meet me at

the gym at six.”

“Tomorrow’s Saturday. It doesn’t open ‘til seven.”

“It’s a private session,” he says.

“I can’t afford a personal trainer.”

“It’s not a training session,” he says. “It’s a date.”

My stomach is doing double flips. Did he just ask me out on a gym

date? This perfectly sculpted man with the arms that could pin a girl
down and the easy smile.
“I thought we could work out together.” He takes my hand again,
and the heat coming off him sends those shock waves through my
body. He runs his hand up my arm to the elbow, and the shock
waves multiply. This man feels too good to the touch.

“You ordering something or just flirting with my waitress?” Carl calls

from behind the counter. I snatch my hand away and flip open my
notebook.

Tyler glances at the menu. “I’ll have the omelet and a coffee.”

“Coming right up.”

I hand the order to Carl and continue clearing the tables. I’m aware
of Tyler’s eyes on me, and the heat between my legs doesn’t cool
until he’s finished his meal and left.

I stand by the window and watch him cross the street. A group of
women at a nearby cafe turn to watch him pass. He seems oblivious
to the attention he’s getting, and it makes me smile.

My smile freezes when I see a black Chevy pick-up with tinted

windows parked across the road. It’s the same model as the one the
Harrison brothers drive.

They were extorting money from my mom. Charging her high rents
that a vulnerable sick woman couldn’t pay, then loaning her the
money at high interest rates.

When she passed away nine months ago, they demanded I come
work for them to settle her debt. I know what girls who work for the
Harrison brothers end up doing.

I refused and said I’d pay the money off my own way. One of them,
Darren, tried to get physical with me, and I fought him off and ran.
I’ve been running ever since. I hope I’m too much of a small fry for
them to worry about, but I keep myself fit and strong and ready just
in case.

The car’s probably a coincidence. There must be hundreds of black

Chevys with dark windows in the state. But I still spend the rest of
the shift glancing out the window, an uneasy knot building in my
stomach.

Sometime in the busy dinner rush the car disappears, because when
I take the trash out at ten, it’s gone.

TYLER

I ’m pacing the length of my hotel room thinking about this girl.

Zoe is the name I got from the gym database.

She’s got me on fire so bad I can’t concentrate on anything else. Her

tight body in her gym clothes this morning, that defiant chin, the
heat of her arm when I touched her. An image of her keeps running
through my brain, making me restless.

It’s not just the urge I have to possess her; I want to know about
her.

What’s she so scared of? Why is she so distrustful? I want to take

her in my arms and tell her it’s going to be okay, that I’ll look after
her now. I’ll keep her safe. I’m overcome with protectiveness for her.
She may think she’s tough, but I can see how vulnerable she is.

My head is crowded with thoughts of her, and I go into the

bathroom and splash cold water on my face, trying to bring myself
back to the present moment. I need to concentrate.
My whole business could depend on the next few days. I can’t let
some girl distract me. But she’s not just some girl, my heart
whispers.

“Focus,” I tell myself in the mirror.

I sit at the desk and pull my laptop towards me. I’ve been going
over the figures for the club, and something doesn’t seem right.

It has the lowest number of personal trainer clients of any clubs I’ve
visited so far, yet it’s in an affluent area and member numbers are
good.

I run the data from the past two years. It all looks fine until about
twelve months ago. There’s a steady decline. It starts small and
drops steadily until now, when the number of members using a
personal trainer is about 50%

lower than what it was two years ago.

Why has the manager not picked this up?

I scan through old board reports and regional meeting minutes.

There’s nothing mentioned about dropping PT sessions. I’d expect
the club manager to report something like this.

I sit back and run my fingers through my hair. From my experience,

if there’s a problem in one area there’s usually a problem in another.

I grab another coffee from the machine. It’s time to dig a bit further
into the accounts. It could be a long night.

ZOE

I ’m at the gym at 6 o’clock on the dot. The parking lot is empty.

The gym won’t open for another hour. I see movement inside, and
Tyler swings open the door for me. I’m not sure what type of
personal trainer gets all hour’s access to the gym, but I’m not going
to question it. We all have our secrets.

My breath catches at the sight of him, and my heart starts to race.

This is going to be an interesting workout.

“Want to start with some cardio?”

I’d like to start by ripping his clothes off and pressing myself against
those muscles, but I just nod and say, “Sure.”

We head up to the gym floor and take treadmills next to each other.

“So, where you from?” he asks, firing up his treadmill.

“I grew up in the East,” I tell him vaguely.

“You got family still there?”

“My mom died last year. She was the only family I had.”

He stops his machine and pulls the plug on mine. He takes his hands
in mine and makes me turn to face him.

“I’m sorry,” he says.

“Yeah, well, these things happen.” I look down and try to break
away from his grip, but he’s holding me too firmly.

Maybe it’s the human contact that I haven’t had in months or the
way he’s looking at me like he really cares, but before I know it my
eyes are welling up and thick tears are coursing down my cheeks.

He pulls me towards him and holds me in his strong arms. It feels so

warm and safe and natural. Soon I’m telling him all about Mom. Not
all of it obviously; I leave out the part about owing money for rent,
and how I’m constantly looking over my shoulder in case they come
for me.

I tell him the good things. The birthday cakes she made for me as a
kid, the glass of soda we always shared when I got home from
school, the Australian soap operas she loved to watch which I can’t
bear to see on the TV now.

All the things I’ve tried not to think about for the last nine months
because when I do my chest tightens and my stomach contracts. It
all comes out to this virtual stranger who doesn’t feel like a stranger
at all.

He lets me talk until the tears dry up, and my chest feels a little less
tight.

“Feel better?” he asks, pushing a strand of hair behind my ear.

“Sorry,” I say, suddenly embarrassed.

“Don’t be sorry. You can tell me anything. I’ll look after you now.”

His words send a thrill down me. I consider for a moment telling him
about the Harrison family and the money they think I owe them. But
he’s already been too kind, and I don’t want to burden him anymore.
Instead I pull myself up and wipe my face on my sleeve.

“How about this workout, then?” I say.

We get back on the treadmills and run at a comfortable pace. I ask

him about himself, and we chat for most of the run until the last five
minutes when we pick up the pace and do some hill work and we’re
both pushing ourselves too hard to talk.

After the treadmill, we hit the weights room. I go for the smaller
weights and he assesses my technique, making little adjustments to
my stance and telling me to keep my elbow up.
He picks up some heavier weights, and I’m so distracted watching
him pump his arms that I’m finding it hard to concentrate on my
workout.

“Want to do some mat work?” he asks.

Hell yeah, I want to get down on the floor with him!

We start with sit-ups. I lie back with my knees up, and he holds my
feet.

Even though his hands are on my shoes, I can feel the heat traveling
up my ankles and right between my thighs. He’s so close his breath
tickles my legs. Every time I sit up, he’s right there, his lips only
inches away.

My breathing becomes shallow, and all I can think about is leaning

further forward and kissing those thick lips. As if he’s reading my
thoughts, his hands move onto my ankles. I gasp at the contact. His
hand slides up my shin until he’s holding my knees.

The next time I sit up, he moves one hand to grab the back of my
head and pulls me towards him. His lips are surprisingly soft for such
a big man.

He presses them into mine and I open my lips, letting him in.

His tongue darts into my mouth and I open up for him, meeting him
in the kiss. It sends tingles all throughout my body from one set of
lips to another.

He pushes me back onto the mat, and I submit willingly. His hand
runs down my neck and over my breasts. It’s the most exquisite
feeling, this

strong man kneeling over me.

He nuzzles my neck with his lips; his hot breath sends shivers
through me. His scent fills my nostrils, hard-earned sweat and a
faint tinge of lavender.

I reach out to run a hand over his thigh and his arm shoots out and
he pins me down on the mat.

Suddenly I’m back in my mom’s apartment with Darren on top of

me.

He smells like stale bourbon and cigarettes. I’m struggling to get

free as he pins me down with one hand, the other hand fumbling at
his belt buckle.

The flashback is so strong I start to struggle. Tyler lets me go

instantly and sits up.

The greasy walls of my mom’s apartment fade. The smell of bourbon

disappears. I take in my surroundings. I’m breathing hard on the
exercise mat with Tyler sitting back on his heels, his hands in the air
as if showing me he means no harm.

“You okay?” he asks.

I nod, even though I’m not sure what the fuck just happened.

“I’m sorry. I thought you were into it. I wouldn’t do anything if you
weren’t.”

“I am into it,” I say, trying to get my breathing under control. “I’m

definitely into it.” He puts his hands down, seeming to relax a little.

“It just triggered some bad memories, that’s all.”

His brow creases, and anger flickers through his eyes.

“I’m sorry,” I say. “I didn’t know that was going to happen.” Damn,
I’ve ruined my chances with not only the hottest man I’ve ever seen,
but also the only person I’ve felt comfortable opening up to for as
long as I can remember.

“Who did this to you?” he asks, his hands curling into fists. “Tell me
who did this to you.”

I shake my head. “It doesn’t matter. It...” I can’t finish my sentence

before I’m crying again. Damn, I’ve spent nine months refusing to
cry, staying strong and looking after myself. One hour with this guy
and I’m blubbering like a baby. How does he make me feel so
vulnerable?

“Is it okay to put my arms around you?” he asks. The fact that he
has to ask makes me cry even more. I can only nod at him.

“Tell me what happened?”

I sink into his strong embrace and start to talk.

TYLER

T he more she tells me the angrier I get, until the blood is thumping
in my ears and my muscles are pulled so tight I might snap.

It’s a relief to know she was able to fight him off and got away
before he did anything worse. But still the thought that someone has
hurt my girl, treated her like this, makes me want to throw
something through the nearest wall.

This is what’s made her so defiant, so distrustful, and now so upset.

I hold her in my arms until she’s finished talking and her breathing is
calm. If I ever get my hands on this Darren, I’ll kill him for doing this
to her.

“I’m sorry to tell you all this when I just met you,” she says.
“Don’t ever apologize.” I lift her chin up, so she meets my eyes.

“You’re safe now. You’re with me.”

She nods and smiles at me, and my heart clenches at this vulnerable
woman who I’m suddenly desperate to protect from harm.

“This isn’t the way you thought this workout would end, is it?” she
says.

“There’ll be plenty of time for that.” I wipe away a tear from her
cheek with my thumb and bring my lips to hers for a gentle kiss, and
she responds.

It’s a lot gentler than the urgency of a few minutes ago, but I won’t
push her again. Even though my body’s aching for her, we’ll go at
her pace.

The gym door opens, and we break apart. The burning anger from
the story she’s told me turns to fury at the interruption.

“What do you want?” I bark, turning to the door. It’s Connor, one of
the other personal trainers.

“I want to get the floor ready for my first session,” he says.

I glance at the clock. Damn, it’s almost 7a.m. We’ve spent a lot of
time talking. Not how I expected the morning would go, but I’m
happy to have gotten to know my girl better and hopefully provided
some comfort to her.

Zoe gets up off the mat.

“I’m going to go shower,” she says, grabbing her gym bag. “I need
to get to work.”

She brushes past Connor and he gives her an appraising look,

following her ass with his eyes as she leaves the room. He turns
back to me with a

smirk on his face and nods appreciatively.

“Nice one, man. Let me know when you’re done. I’d like to take a
turn with that one.”

I move so fast he doesn’t see me coming. In one movement I’ve got

him pinned against the wall with my hand around his throat. “Show
some respect, asshole.”

His eyes bulge out of their sockets. “Sorry man, didn’t realize you’re
the territorial type.”

I squeeze him harder around the throat until his face goes red and
he’s making choking noises. “She’s my woman, and if you so much
as look at her again I’ll twist your body up so bad you’ll never train
again.” I let go, and he drops to the floor.

“I could get you fired for that,” he wheezes, clutching his neck and
trying to get his breath back.

“Try it and see what happens.” I push past him and stride down the
corridor to the showers. I turn the water to cold hoping it will cool
me off, but it does nothing to dispel my anger. After my cold shower,
I change quickly and head out to reception hoping to catch Zoe
before she leaves.

“You’re too late,” says Melanie with a smirk. “She high-tailed it out of
here about five minutes ago.”

Damn. I jog out to the parking lot, but she’s long gone. At least I
know she’s going straight to work. I’ll go around and check on her
when I get a chance. I’ve got clients booked all morning, and I need
to do some snooping around.
I uncovered some irregular accounts last night, and there’s definitely
something not right here. I need to play my role until I find out what
it is.

No better place to start then here, I guess. I walk back to the

reception desk and give Melanie my most charming smile. She starts
twirling her hair again as I lean my elbows on the desk.

“So, Melanie.” She smiles demurely, but there’s no blush to match

and her eyes are too knowing to be innocent. She’s a master at the
flirting game.

“How about I buy you a coffee?” I ask.

She perks up and leans in conspiratorially. “I’m not supposed to

leave the reception desk unstaffed, but Clarissa will be here in ten
minutes so I guess it can’t hurt.”

Man, she is so getting fired when all this is over.

“How about I come back when Clarissa gets here?” I tell her.
“Wouldn’t want to get you into trouble.”

“I can get into trouble all on my own.” She gives me a practiced

smile, and I wince at the level I’ve been reduced to. But my business
is on the line, and if I have to weather the flirting of an overeager
employee, then that’s what I’ll do.

“I’ll see you in ten,” I tell her.

Before heading to the café, I take a detour to the manager’s office.

The door isn’t locked, which is disappointing, and I let myself inside.

It’s a box-shaped office with a single desk and office chair. A

corkboard above the desk is plastered with staff schedules and
notices. A rickety filing cabinet sits in the corner.
I scan the papers on the desk and the bulletin board, but there’s
nothing of interest there. The filing cabinet is mostly full of old class
schedules and PT programs.

Wedged between two files, I find a list of old PT clients with names
crossed out in red. I stuff it in my pocket and head out to meet
Melanie.

ZOE

I hum to myself as I walk into town. I feel lighter, like the lead ball
that’s been sitting in my stomach for nine months has been lifted a
little.

It felt good to talk to Tyler. Even though I just met him, it’s like he
tapped into my most vulnerable parts and split me right open. I
didn’t realize how much I’d been holding it all in.

I turn the corner onto High Street, and my blood freezes. The car
from yesterday is back. It’s parked in the same spot directly across
the road from the diner. The tinted windows give no indication if
there’s anyone inside.

Taking deep breaths, I tell myself it’s a coincidence. Just a parked

car. I duck my head and cross the road, so I don’t have to walk past
it.

It can’t be Darren, I tell myself. How would he have found me? But
Tyler found me easily.

And just like that, the lead ball’s back weighing me down. Damn. I’m
going to have to move again. Just when I finally opened up to
someone.
Someone who’s kind, and thoughtful, and hot. I’m going to have to
leave before anything has even started.

He’s been so protective of me that I actually thought it might be

okay.

That I could forget my past and have a future with this amazing
man, a normal life.

I shake my head. How stupid of me. There will be no normal life for
me. I will always be on the run, looking over my shoulder. I can’t put
that on Tyler. It’s not fair.

It will be best if he doesn’t know, I decide. I’ll leave tonight as soon

as my double shift is finished. I’ll get my wages, pack my bag, and
go.

I pull open the door to Carl’s Diner, my heart a lot heavier than it
was five minutes ago.

“Good to see you’re on time today,” Carl says sarcastically from

behind the counter. “I need you to clean the fryer. Drain the fat off.
Saturday mornings are slow to start, so this is the perfect time to do
the deep cleaning.”

Great. I’m going to spend the next hour with my arms in a vat of fat.
I swallow down the frustration of another dead-end job.

I’m lucky to have a job, I tell myself. When this is all over, I’m going
to get myself a career, something with meaning. Yeah right. This is
never going to be over.

I must be staring into space, because Carl throws an apron at me.

“Come on, girl. Get to work.”

“Okay, okay.” I tie the apron on and lose myself in a “what might
have been fantasy” as I scrape fat into a plastic bucket.

The breakfast rush starts late on Saturday and runs on into lunch.
It’s after two o’clock before I get a break. The afternoon is just as
busy, and I’m shattered by the time ten o’clock rolls around.

I can’t get across the room quick enough to turn the sign on the
door to closed. I peer through the glass into the darkness. The black
shape of the car is still visible across the road. A shiver runs down
my spine. Hopefully it’ll be gone by the time I’ve finished cleaning
up.

I’m sweeping the floor when Carl appears from the office out back.

He’s swapped his greasy t-shirt for a checkered shirt, and his hair is
slicked back.

I raise my eyebrows.

“Got a date,” he says proudly.

“Who’s the lucky lady?” I ask, genuinely happy for him. Carl may be
a hard task master, but he’s a decent guy underneath.

“My wife,” he says, his confidence deflating a little. “My ex-wife,

actually. I’m trying to win her back.” He runs his hands through his
hair, and then wipes the excess gel off on a hand towel. “You okay
to lock up tonight?” he says, working a key off a key ring. “Don’t
want to keep the lady waiting.”

“Sure,” I say, a pang of guilt knotting my stomach at the way I’m

going to leave with no notice. “Um, is it okay to get my pay for the
week?”

He frowns at me. “You’re not gonna do a runner, are ya?”

“I’ve got a date too,” I lie.

“With that big fella?” he asks. “He should be paying, you know. Back
in my day, the man always treated the lady.” He goes over to the
register and gets some money out.

“I can pay for myself,” I say.

He chuckles. “Good for you,” he says, handing me the cash.

“Alarm codes are written here above the register. You’ll have thirty
seconds to get out and lock up.”

“Good luck with your wife,” I say as he heads out the door.

I’m stacking chairs to sweep around when I notice Carl’s denim

jacket hooked over the back of one of the chairs. It’s a warm night,
but he’ll probably want that later. I take it out back and hang it on
the coat hook where he’ll be able to find it easily.

I go back out to the restaurant and continue sweeping the floors. A

few minutes later, the door jingles as it opens.

“I wondered if you’d come back for your jacket,” I say, turning

around.

I stop mid-sentence; my blood freezes. Standing in the doorway is

Darren.

He’s got a smirk on his face and a sparkle of triumph in his eyes.

“Hello Jamie. Or is it Zoe now?”

I’m frozen to the spot. The color must have drained out of my face.
All these months of keeping in shape and running practice in
preparation for this moment. But all I can do is stare at him with my
mouth open.
“It took me a while to track you down.” He pulls down the blinds on
the diner door. Then he moves to the next window and slowly lowers
the blinds there.

“Good thinking with the name change. It took us a few more months
than I would have liked to find you.”

He moves to the next window, and as he talks casually lowers every

blind until we’re closed off in the diner. Anyone walking past can’t
see in.

“But I knew I’d find you eventually.”

My mind is screaming at me to do something while he’s still talking.

I’m holding the broom so tightly my knuckles are going white.

“How did you find me?” I ask, my voice coming out croaky.

“It wasn’t easy. My brother told me I should give up. It wasn’t worth
it for the money you owed.”

“I can give you the money,” I tell him, taking the cash out of my
pocket.

“That’s half. I can get the rest out of the register.”

He’s coming closer, his eyes darting to the wad of cash in my hand.

“Oh, but there’s interest on top of that. Nine months of interest. I

doubt there’ll be enough in the register of a crummy place like this.”

“How much do you want?” My mind’s racing. I know where Carl

keeps his safe with the big bills inside. I hate to do this to him, but I
don’t see any other choice.

Darren chuckles. “It’s not about the money.” He steps closer. I can
see his yellow teeth now and the pores of his greasy skin. “What my
brother

didn’t understand and what you don’t seem to have grasped is that
it’s really not about the money.”

I put the cash on a table and take a step back. He eyes it hungrily
and takes another step closer. My hand clenches around the broom.
I’ll only get one swing at him, and I need to make it count.

“You humiliated me,” he hisses, and I smell bourbon on his breath.

“You, a girl, gave me a black eye and got away.”

Somewhere inside I’m pleased to hear I gave him a black eye, but it
doesn’t help my situation. It was a lucky shot, and I don’t know if I
could do it again.

“You won’t get away this time.” He lunges forward. I dodge to the
right, sending a bar stool toppling to the floor. He grabs my arm and
spins me around.

“You won’t—” I bring the broom up with all my strength, and it

connects with his jaw with a satisfying thwack. A tooth flies out and
bounces on the linoleum floor.

“You little bitch.” He lunges at me, and I run for the door. An intense
pain fills my scalp as he jerks me back by the hair. I drive my elbow
backward and feel it connect with his ribs. His grip on my hair
loosens as he doubles over in pain.

I spring for the door and grab the handle just as it swings open. I
collide straight into Tyler’s bulk.

“What the...?”

Tyler’s arms close around me as Darren crashes into us. In one quick
move, Tyler has him by the neck.
“You okay?” he asks me as Darren squirms in his grasp.

I’m so stunned all I can do is nod.

“Is this the guy?”

I nod again.

“Good, ‘cause I’m going to beat the shit out of him.”

He releases his hold on me and brings his fist around to pummel

Darren, his anger thrown into every punch.

I put my hand on his arm. He stops mid-punch and turns to look at

me.

His eyes are full of fury, but they change to concern when he sees
the way I’m looking at him.

“I think he gets the message,” I say.

“You sure, sweetheart? Because I’ll finish him off if you give me the
word.”

I shake my head.

“Okay.”

He releases his hold and Darren slumps to the floor.

“You touch my girl again, you come anywhere near my girl again,
and I’ll kill you,” he says.

Darren nods, sending a clot of blood onto the floor.

Tyler gets a wad of cash out of his pocket. “Here’s the money you
think she owes you.” He counts off a stack of hundred dollar bills.
I’ve never seen so much cash altogether. “And some extra for your
medical bills.” He throws the money on the ground, and Darren
scrabbles around for it.

“Now get the fuck out of here.”

Darren scrambles to his feet and bolts out the door. Tyler turns to
me and without saying a word scoops me into his arms and carries
me out of the diner.

“We’re going to my hotel,” he says. “I’ll call someone to clean up the

diner.”

I sink into the plush leather seats of his car and let him take care of
me.

TYLER

I could have killed that motherfucker. Trying to hurt my girl.

Luckily she’s tougher than she looks.

I’m angry at myself for leaving her unprotected. Now she’s shaking
like a leaf and I want to calm her down, but every time I touch her
my dick gets hard and I want to run my hands over her body so bad.

I lead her into the hotel and up the elevator to the top floor. Her
eyes go wide when we walk into my suite. There’s a double living
area, a massive bedroom, and a bathroom that’s almost as big as
the shared one at the gym.

“Did he hurt you?” I ask when I’ve got her seated on one of the
sofas.

“He pulled my hair,” she says. “After I smashed his face with the
broom.”
“That’s my girl.”

She’s got some of his blood on her blouse.

“You want a shower?” I ask

“Yeah, please.”

I lead her around to the bathroom. There’s a walk-in shower with a

duel shower head. A clear screen separates it from the tiled drying
area.

I hand her a fluffy white towel from the heated rack.

“I’ll be in the living area when you’re done.”

She nods at me, and I leave her to it. My dick's getting twitchy at
the thought of her naked, but I take some deep breaths and make
myself a coffee.

I hear the shower start and imagine her stepping into it. Damn, I’m
going to have to distract myself for the next twenty minutes. I open
my laptop and stare at it for a few minutes. She’s probably soaping
herself down, lathering up over her tits.

There’s a noise behind me, and I spin around. Zoe’s standing in the
doorway that leads to the bedroom wearing nothing but the white
towel.

Her hair is slicked back, and she’s dripping water on the floor.

“Will you join me?” Her voice is croaky, and she’s looking at me
nervously like she’s afraid I’ll say no.

I’m across the room in an instant, pulling my shirt off as I go. I lift
her chin up to me and kiss her hard, claiming her mouth. She opens
her lips, and her tongue darts around my mouth.
She reaches up to lock her hands around my head. I feel the towel
slip off her and land between our feet. I press myself against her
wet body. My dick instantly hardens at the feel of her soft flesh
pressing against me.

I run my hand down her back ‘til I get to her ass. Soft and pliant,
and I grab a handful of flesh and pull her into me, pressing my hard-
on against her.

She feels fucking amazing to hold, but I want to see her. I take a
step back, and my breath catches in my throat. God, she’s beautiful.
Small perky breasts, tanned skin, and toned, defined muscles. It’s a
combination of strength and vulnerability, and it’s driving me crazy.

“Get back in the shower.” My breathing’s coming hard and fast, and I
want to explore that tight body.

She turns to walk back to the shower, and I get a look at that round
ass.

My God, I want to bend her over right now and take her like an
animal. But I hold myself back. My girl’s gone through enough
tonight. I have to make sure I treat her right.

I pull off the rest of my clothes and pull her into the shower with
me.

The hot water trickles over my body, making my skin tingle.

“I have to tell you something,” she says nervously. “I’ve never been
with a man before.”

My fucking God. She’s a virgin.

“Good,” I tell her.

“But I’m not experienced. I might not please you.”

I pull her close. “You already please me. And knowing I’ll be the first
and only man to have you pleases me more than you can know.”

She smiles at me, and it’s so good to see that smile back on her
face. I lean in and kiss her gently this time. It’s her first time, and
I’m going to take it slow for her, make it good for her. Then I’m
going to fuck her hard until she screams my name.

I pick up the soap and run it between my hands until it starts to

lather.

“I’m going to wash you clean,” I tell her, running it down her front
between her breasts. The soap makes my hands glide over her. I
start with circles of her stomach and move upwards to her breasts.

I’ve got a good lather now, and I run my hand over her breasts until
they’re slick with soap suds. I brush the nipple with my thumb, and
she moans. It’s the sweetest sound, and I want to make her do it
again.

“Turn around,” I tell her. She’s facing the glass panel, and she
reaches up to rest her hands against it. I’ve got her soapy breasts in
my hands, and I’m rubbing my palms against her nipples as my
cock's brushing against her ass.

I part her ass cheeks and press my dick in. It’s warm and inviting,
and I’d only need to bend her over a little to fuck her like this. She
quivers under me.

I take a big breath and let it out slowly. I need to hold myself back,
satisfy her first. I let my hands slide down to her hips as I sink to my
knees.

“Spread your legs.” She does, and I pull her hips back so her pussy's
over my face. I dart my tongue out, and she gasps. She tastes like
sweetness and sweat and fucking heaven.
I pull her hips down and sink my tongue into her. It’s fucking great,
but I want more. I nudge her around so she’s facing me again. She
looks fucking incredible from down here.

There’s a small patch of dark hair above her sexy pink folds. I run
my hand over it and move down to her pussy. I lean in and kiss her
pink lips.

She opens her legs for me, and I slide my tongue into her crease.
She gasps as I find her clit. I flick my tongue over it, tasting her
salty sweetness.

My dick’s longing to join the party but I focus on her, licking her up
‘til I feel her climax building. I slide a finger slowly into her pussy.
It’s wet and tight, and she whimpers as I glide it in and out.

She’s close now, and I pick up the pace. Her hands grab the back of
my head, and she pulls me towards her, pressing my face into her. I
grab her ass with my spare hand and press against her clit. A gush
of wetness floods over me as she cries out. Her pussy pulses against
my finger.

I don’t wait for her to stop before I start licking her again. It doesn’t
take long for the second orgasm to course through her. I wait ‘til she
stops trembling before standing up.

“That was incredible,” she says. She’s flushed from sex, and her eyes
are half-hooded. She looks down at my cock which is pointing
straight at her.

“Your turn,” she says. I don’t complain as she takes the soap and
lathers me up. She starts on my chest and works down over my
stomach.

“I’ve been wanting to touch this body ever since I saw you in the
shower,” she says, running her fingers over my abs. She has soft
hands but a firm touch. It’s driving me crazy.
She lathers the soap and takes my cock in her hands. Her grip is
firm as she strokes me slowly, letting the soap glide her along my
shaft. The water trickles out of the shower, and she lets it wash the
soap away as she kneels before me.

She looks up at me with dreamy eyes as she takes my cock in her

mouth. Oh God, her mouth is warm and wet, and she slides her lips
down the length of my dick.

She’s naked in front of me sitting back on her heels, her thighs

spread so I can see her pussy. Water runs down her shoulders and
trickles over her perky tits. It’s a glorious sight to watch as her full
lips slide up and down my cock. A hand reaches around and cups my
balls as her hungry lips keep their rhythm.

“I’m not going to last long,” I warn her. She picks up the pace, which
I take as a green light. I grab the back of her head and pull her
mouth towards me.

She opens her throat and takes in my whole length. I keep my eyes
on her tits bouncing up and down as I fuck her mouth. It’s so
fucking good I’m about to explode. At the last minute, I pull out of
her mouth and spray cum all over her tits, claiming them as mine
with my seed. When I stop shaking, I pull her to her knees and pull
her towards me into a hug.

“That was amazing,” I tell her. “You’re amazing.”

“So are you.” She smiles up at me, and I take her hand in mine and
kiss it, thinking I must be the luckiest man in the world. Her hands
are getting wrinkly from the water.

“You’ve been in here too long,” I tell her. “Go dry yourself off. I’m
just going to wash my hair.”

I spend an extra few minutes in the shower. Then I towel myself dry.
I’m whistling to myself as I walk to the bedroom, thinking of all the
ways I’m going to fuck her and claim her properly as mine. She’s
lying on the bed on her side wrapped in a bathrobe. I climb up
behind her.

“Ready for round two,” I say, nuzzling into her neck. There’s no
response. I lean over to see her face. Her eyes are closed, her
mouth slightly open. She’s completely crashed out.

Round two will have to wait, but I don’t mind. I’ve got a feeling we’ll
have the rest of our lives to fuck. Instead I get quietly off the bed
and switch out the light.

I go back to the other room and pull out my phone, making a quick
call to my assistant. I give her the address of Carl’s Diner and ask
her to go around, clean up, and bring over all of Zoe's things from
her apartment above.

She’s not happy about having to drive up here on a Saturday night,

but I offer a hefty bonus and she stops complaining. With that dealt
with, I sit down at my laptop.

There are a few emails waiting for me. I open the first from a Mrs. P.

Jones and start to read.

By the time I’ve finished the third email, my fists are clenched and
I’m pacing the room. I’ve found out what’s going on at the club.
Now I have to figure out how to deal with it.

I pick up my phone again and make another call.

ZOE
I wake up to sun streaming through the window. For a moment I
don’t know where I am, and then I remember last night. The attack.
Tyler beating the shit out of Darren, and then the shower.

Oh my, the shower. It was the most delicious experience, and just
thinking about it sends a thrill between my legs. I roll over and
Tyler’s facing me, already awake.

“Morning, sleepyhead.” His hair is ruffled, and there’s stubble on his

usually clean-shaven face. It’s bed-head hotness and definitely a
sight I could get used to every morning.

“Morning,” I say, stretching lazily. My body feels stiff in a few places

and still tingling in others.

“Coffee?” he asks. I nod, and he rolls out of bed. He’s naked, and
the sight of his toned back and ass retreating to the other room
sends a rush of heat and happiness coursing through me. It’s over.
My days of running are finally over, and this big, beautiful man is to
thank.

“How do you take it?” he calls through to me.

“A little milk, no sugar.”

He comes back into the room wrapped in a robe and holding two
steaming mugs.

“I’m going to grab a shave,” he says. “There’s something I need to

take care of this morning.”

I must not be good at hiding my disappointed pout, because he

leans in and gives me a kiss.

“I won’t be long, and then we can spend the rest of the day
together.”
“I have to work,” I say.

“No you don’t. You just quit.”

“What do you mean?”

“I’ve spoken to Carl, and you’re not going back. I’m going to look
after you from now on.”

“I don’t need looking after.” I’m caught between feeling elated that
this man is taking care of me and defiant that I don’t need anyone
to. He must sense my thoughts, because he takes my chin in his
hands.

“I know you can take care of yourself, but I want to take care of
you.

You’ll never have to work again unless you want to. And if you do, I
might

just have the perfect job.”

I’m intrigued and confused. All I can do is frown at him. He chuckles

at me and heads to the bathroom.

“Order some breakfast from room service,” he says. “I’ll explain

later.”

Realizing I’m not going to get an answer or a chance to touch him

again, I order some eggs, go to the other room, and switch on the
television.

When he comes out of the bedroom, I almost spill my coffee. I

hardly recognize him. He’s wearing an expensive suit that’s tailored
to his big frame. He looked imposing before, but now he looks
powerful. And my God, it’s sexy as hell. I must be staring, because
he gives me one of his deep chuckles which sends a shock of heat
right to my pussy.

“What’s the matter? You prefer me in the PT uniform?”

“I prefer you naked,” I say. “But this is a look I could get used to.”

“Good.” He plants a kiss on the top of my head. “I have to go,” he

says.

“Meet me at the gym in an hour. You won’t want to miss this.”

He grabs his laptop bag and heads out the door. I’m left wondering
who the hell Tyler really is.

An hour later, I swipe through the doors at the club. The blonde at
reception gives me her usual snide look. If I was running this place,
she’d be the first one to go. It’s a nice fantasy, and I give her a wide
smile. Nothing’s going to get me down today.

“We don’t open ‘til 7.30 on Sundays, so you’ll have to wait outside
for another half hour,” she says with a smirk.

“Tyler asked me to meet him here at seven.”

“Well, he shouldn’t be organizing PT sessions outside of regular

hours.

And besides, we have an emergency staff meeting starting, like,

now. So...”

At that moment, Tyler strides in. The blonde does a double take, and
her jaw almost hits the floor. He comes straight over and gives me a
quick kiss on the lips. The blonde’s jaw hits the floor again.

Other gym members start trickling in. It’s mainly the early crowd,
and I recognize the sleazy PT guy who’s been ogling me since I’ve
been here.
A guy with messy hair ambles in, tucking a crumpled shirt into his
pants.

“What’s this about?” the blonde asks him.

“Not sure,” he says, stifling a yawn. “Got a call from head office
telling me to get down here. It better be good.”

He freezes when he sees Tyler in his suit.

“What the hell? You been to a costume party, or something?”

Tyler fixes him with a steely look. “As General Manager of this club, I
thought you’d want to be here for this.”

The man straightens up, confusion crossing his still half-asleep face.

Tyler gives my hand a quick squeeze and then strides to the center
of the room.

“As some of you may have guessed, I’m not actually a personal
trainer.”

There are surprised looks, which I can only assume means no one
but myself had any suspicions.

“I’m Tyler Blunt.” The General Manager gasps and stands up

straighter.

Tyler continues “As of earlier this year, I took over the running of
Blunt Active from my father, who founded this chain of health clubs.”

There are murmurs of understanding around the room.

“My father built these clubs up from one single gym to expand all
around the country. But it’s no secret that in the last few years we’ve
seen a bit of a downturn. When I took over as CEO, I vowed to turn
that around.
“I’ve been going undercover at some of the least profitable clubs to
get a feel at the grassroots level for what is going on and where we
might improve.”

There are some nervous looks around the group.

“I chose this club because the profits were on the decline. And after
spending some time here, I know why.”

He pauses and looks around the room. The manager is standing at

attention, all signs of his hangover gone. A bead of sweat runs down
his brow. But he’s not as nervous as Connor, who’s inching towards
the door.

“There’s been fraudulent activity at the club.” Tyler fixes his gaze on
Connor. There are gasps around the room. Connor makes a break for
it and jumps over the entry gates.

At that moment, a policeman comes through the doors. Connor tries

to dodge around him, but the officer is a big guy, and in one quick
move he pins Connor to the floor.

“This the guy?” he asks as Connor squirms under him.

“That’s him,” says Tyler. “Started charging clients privately for group
training sessions in parks. Said they were part of the club and
pocketed all

the money. A pretty amateur scam, probably only making an extra

couple hundred bucks a month.

“But he got greedy,” Tyler continues. “Accessed the bank details of

members, started skimming money out of their accounts. Got their
details from his lovely assistant...” He turns to Melanie, who has
gone pale.
Another random document with
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previously resistant; and, third, a suppurative infection, as above
described.
In contradistinction to these distinct events, separated by an
appreciable, sometimes a considerable, length of time, we recognize
a mixed infection, where two or more organisms are implanted at or
about the same time. An illustration of this is seen in most cases of
gonorrhea in which there is a synchronous attack made by the
gonococcus, which is a specific microörganism, accompanied by
staphylococci or streptococci, whose effect will complicate the case
and make it assume a less particulate type of infection. Mixed
infections may often occur in other ways, as syphilis and chancroid,
chancroid and gonorrhea, etc. Most cases of mixed infection belong
rather to surgery than to general medicine, and constitute an
apparent violation of the rule to which physicians often point—that
two distinct infectious diseases are seldom communicated or
acquired at the same time. Nevertheless, the facts remain as above.
Terminal Infections.—Terminal infections constitute an apparent
paradox, perhaps oftener in medical than in
surgical cases. Few people, as Osler has shown, die of the diseases
from which they suffer. The final exitus is due to a more or less rapid
infection which terminates life. These terminal infections are mainly
due to a few well-known microbes, such as the streptococcus,
staphylococcus aureus, pneumococcus, bacillus proteus,
gonococcus, bacillus pyocyaneus, and the gas bacillus. In surgery
such infections are, perhaps, most often seen in malignant
lymphoma, diabetes, tuberculosis, syphilis, cancer, and in the so-
called surgical kidney.

BACTERIA OF PUS FORMATION.

Bacteria which act as agents in the formation of pus are
collectively known as pyogenic organisms. These are divided into
two groups:
A. The Obligate; and
B. The Facultative.
Obligate pyogenic organisms are those whose activity is
manifested in the direction of pus formation, which seem to produce
it if they produce any unpleasant action whatever. On the other hand,
the facultative organisms are those which are known occasionally to
be active in this direction, and yet which are not always nor
necessarily so. The members of group A are fairly well known and
catalogued, and are not numerous. On the other hand, there is
reason to believe that many organisms may have the occasional
effect of producing pus, as it were, by accident or at least in a way
not absolutely natural or peculiar to themselves, but still are
frequently found when there is no pus present. A suitable list of the
facultative organisms, therefore, can hardly be made, and will not be
here attempted, the effort being only to mention the more common
organisms which play this facultative role. It may be mentioned also
that even the adjectives “obligate” and “facultative” are to be
accepted with some mental reservation, since staphylococci, for
instance, may be met with even in the absence of pus, although
nearly all that we know about these organisms implies that pus
would be the result of their presence. Furthermore, there are certain
other organisms, not, strictly speaking, bacteria, which also have the
power of producing either pus or pyoid material. These also will be
mentioned in their place. Some of them belong not only to the
vegetable, but also to the animal kingdom.
Obligate Pyogenic Organisms.—One of the characteristics of
A. The Staphylococcus Pyogenes Aureus, Albus, Citreus, the
Staphylococcus Epidermidis, etc.
the staphylococci as a group is the powerful peptonizing action
which they exert. Moreover, the chemical products of their life
changes seem to be more potent in a local than a general way,
leading to greater destruction of tissue in their immediate vicinity,
with greater inhibition of the chemotactic powers of the leukocytes;
that is, with more interference with phagocytosis, by which their
progress would be interfered with. Their presence is recognized by a
peculiar odor, as of sour paste, which should lead to a prompt
change of dressings and disinfection of the wound (by irrigation,
spraying with hydrogen dioxide, etc.).
B. Streptococcus Pyogenes and Streptococcus Erysipelatis.—These two
organisms do not differ in morphology nor characteristics, and, while
for some time considered as distinct from each other, are now by
most observers regarded as identical. The streptococci grow in
chains of variable length, and individual cocci vary in size. They grow
with and without oxygen, in all media, at ordinary temperatures, do
not liquefy gelatin, stain readily, sometimes but not invariably
coagulate milk, and vary in longevity. They differ extraordinarily in
virulence according to their sources.

Fig. 4 Fig. 5

Staphylococci in pus. × 1000. (Fränkel Streptococci in pus. × 1000. (Fränkel

and Pfeiffer.) and Pfeiffer.)

There are many streptococci not included under the above head
which are indistinguishable morphologically and in other respects,
and yet which are partly or entirely free from pathogenic activity in
man. A biological study reveals remarkable and unexplainable
transformation between the different members of this species, a part
of which may be referable to conditions pertaining to the organisms
infected, but part of which apparently pertains to the bacteria. It is
held by some that scarlatina is an invasion by certain organisms of
this class; this, however, is not yet definitely established. When
found in the stools of children with summer diarrheas they are
regarded as indicating ulceration of the intestinal mucosa.
In contradistinction to the staphylococci, the streptococci manifest
a predilection for lymph vessels and lymph spaces, along which they
extend with great rapidity. They have less peptonizing power than
the staphylococci (except in the absence of oxygen); hence
streptococcus infection assumes usually the type of widespread
infiltration rather than of circumscribed and distinct edema. One sees
remarkable instances of this in cases of phlegmonous erysipelas. It
is suggested also that the peculiar manner of growth of the
streptococci, in long chains which may coil up and entangle blood
corpuscles, has much to do with the formation of fat emboli and with
pyemic disturbances.
Both these bacterial forms have the power of producing lactic
fermentation in milk; and lactic-acid formation sometimes takes place
with suppuration in the human tissues, causing acidity of discharge,
sour odor, and watery pus. It appears also that these two pyogenic
forms have less power of ptomain or toxin formation than many
others, and, consequently, that the pyrexia attending suppuration or
purulent infiltration is not always to be ascribed to this cause alone,
for fever may in some measure be due to tissue metabolism
attending their growth, the metabolic products being pyretic. This is
in a measure substantiated by the fever attending trichinosis, where
the question of ptomain poisoning has not yet been raised.
C. Micrococcus Lanceolatus.—Micrococcus lanceolatus is also known
as the diplococcus pneumoniæ or the pneumococcus of Fränkel and
Weichselbaum, and as the micrococcus of sputum septicemia of
Pasteur and of Sternberg. It is of interest to surgeons because it
causes many localized inflammations and is a frequent factor in
causing septicemia; it is often present in the mouths of healthy
individuals. It may produce the various forms of exudates as the
result of congestion set up by its presence; also otitis media,
meningitis, osteomyelitis, and suppurative disturbance in the
periosteum, the salivary glands, the thyroid, the kidney, the
endocardium, etc.
 Fig. 6

Diplococcus pneumoniæ of Fränkel. (Karg and Schmorl.)

D. The Micrococcus Tetragenus.—Suppurations produced by these

organisms are prolonged, mild in character, not painful, but
accompanied by much brawny induration of tissues.
E. The Micrococcus Gonorrhœæ.—The micrococcus gonorrhœæ, or
gonococcus, is found constantly in the pus of true gonorrhea, in
many cases the pus being a pure culture of this organism. These
cocci are generally seen in pairs (biscuit-shaped), while their
inclusion within the leukocytes or their attachment in or to epithelial
cells is characteristic. Unlike other pyogenic cocci, they do not stain
by Gram’s method, being decolorized by iodine, by which fact they
may be distinguished. They are cultivated with difficulty, and are
known rather by their clinical effects than by their laboratory
characteristics; are human parasites, other animals, so far as known,
being practically immune. The gonococcus may also produce
abscesses, and may be carried to distant parts of the body, where its
effects are commonly noted as pyarthrosis, although endocarditis,
pericarditis, pleurisy, etc., are known to be due to it, and fatal pyemia
has been produced in consequence. In some way it is probably the
explanation of the post gonorrheal arthritis, wrongly spoken of as
gonorrheal rheumatism.
F. The Bacillus Coli Communis or Colon Bacillus.—This is an inhabitant
of the intestinal canal; varies extremely in virulence and somewhat in
morphological appearances; coagulates milk; is often associated
with other organisms; migrates easily both along the alimentary
canal and from it into the surrounding tissues or channels. It is a
disturbing element in the production of kidney and hepatic disease,
also in the production of appendicitis and peritonitis. Ordinarily its
pyogenic properties are not virulent; occasionally, however, it
becomes extremely virulent.
G. The Bacillus Pyocyaneus.—The bacillus pyocyaneus, a widely
distributed organism, often observed in the skin and outside of the
body; a motile, liquefying bacillus, growing at ordinary temperatures,
seldom seen alone, but occasionally producing pus without
association with other organisms; it stains the discharges and
dressings a bluish-green and imparts sometimes an offensive odor.
Suppuration caused by this bacillus is usually prolonged, but
characterized by little constitutional disturbance.
Facultative Pyogenic Organisms—i. e., those which have the
power of provoking
suppuration, but which have other and more distinct pathogenic
activities as well.
A. Bacillus Typhi Abdominalis.—This is found in many pus foci,
developing during or after typhoid fever. It is occasionally met with
alone, though most of these abscesses are really mixed infections. It
is generally found in the bone or beneath the periosteum. Such
abscesses are frequently seen in the ribs, and may not be noticed
until months after convalescence from the fever. The pus contained
within them is not always typical in appearance, but may be unduly
thin or unduly thick.
B. Bacillus Proteus.—Under this name are included three distinct
forms, which were originally described by Hauser as distinct species,
but which are now regarded as pleomorphic forms of the same
organism. It is a motile bacillus, met with in decomposing animal and
vegetable material, and occasionally found in the alimentary canal. It
has been known to produce pus, especially in the peritoneal cavity
and about the appendix. It may even cause general infection and
peritonitis.
C. Bacillus Diphtheriæ.—A non-motile bacillus, varying considerably
in size and shape, changing the reaction in sweet bouillon from acid
to alkaline; produces a dangerous infective inflammation of exposed
surfaces, with tenacious exudate amounting to a distinct membrane.
As a part of its life history it also produces a toxalbumin, which is one
of the most powerful cell poisons known, the disintegration of the cell
constituents due to its action being rapid and pronounced. This
accounts for the heart failures which are often reported in connection
with the disease.
D. Bacillus Tetani.—More will be said about this organism when
considering tetanus, and to that subject the reader is referred. The
tetanus bacillus is occasionally found in pus which comes from the
area through which the original infection was produced. But these
bacilli do not travel to any distance in the human body, and are
seldom found away from the area involved. Under most
circumstances the pus is the product of a mixed infection.
E. Bacillus Œdematis Maligni.—This organism will be more fully
considered under a different heading. (See Malignant Edema.) It is a
long, anaërobic bacillus, widely distributed in the soil and the feces
of animals. It is believed that this, like the tetanus bacillus, may
occasionally lead to formation of pus.
F. Bacillus Tuberculosis.—This organism likewise will receive fuller
description in an ensuing chapter. (See Tuberculosis.) The pus of old
cold abscesses in which the more obligate pyogenic organisms have
long since died usually contains this organism in mildly virulent form.
On the other hand, fresh suppurations occurring in connection with
tuberculous disease are mixed infections. There is reason to believe,
however, that this organism is capable of producing pus even when
none of these are present; for example, in that form of acute miliary
tuberculosis which is occasionally met with as bone abscess it may
be found.
G. Bacillus Anthracis.—This is one of the most malignant and
resistant organisms known, being in the highest degree poisonous
for the smaller animals, man being less susceptible. One of its
characteristic lesions in the human body is a form of pustule
commonly known as malignant pustule, the pus in which is usually a
pure culture of this organism. (See Anthrax.)
H. Bacillus Mallei.—This is the organism which produces glanders in
the lower animals and in man. That form of the disease known as
farcy, in which the infected nodules rapidly break down, is likely to
contain pus which will be more or less a pure culture of this
organism.
I. Bacillus Lepræ.—This is the microörganism which produces
leprosy, closely resembling the tubercle bacillus. It is constantly and
exclusively present in the lesions of leprosy, which are often of the
suppurative type, the bacilli being enclosed within pus cells; it is also
found in the fluid surrounding them. Although suppuration in these
cases may be in a large measure due to secondary infection, it is
positive that the leprous bacilli deserve to be grouped in this place.
J. The Bacillus Pneumoniæ of Friedlander.—The bacillus pneumoniæ
of Friedländer was at one time regarded as the cause of croupous
pneumonia, which is now known to be due to the micrococcus
lanceolatus. The Friedländer bacillus, however, is capable of
producing bronchopneumonia, and is occasionally met with in
empyema, suppurative meningitis, and inflammations about the
nasopharyngeal cavity, of which it is known to be an occasional
inhabitant.
K. The Bacillus of Rhinoscleroma.—A distinctive organism has been
described for this disease and given this name. It has such wide
morphological differences, however, that it is possible that it is only
the bacillus of Friedländer above mentioned. At all events, an
organism of this general character is constantly found in this disease
in the thickened tissues from the nose (Fig. 8).
L. The Bacillus of Bubonic Plague.—This was recently discovered by
Kitasato, and, in view of the recent ravages of the disease in the
Orient, has assumed considerable importance. It grows upon most
media, and is found in the blood, in buboes, and in all internal organs
of patients suffering from this disease. The smaller animals are
susceptible upon inoculation. Animals fed with inoculated foods die
also, showing the possibility of infection through the intestine. When
exposed to direct sunlight for a few hours the bacillus dies. The
general symptoms of the disease are those of hemorrhagic
septicemia and its consequences.
M. The Bacillus of Rauschbrand.—This is seldom, if ever, seen in this
country. It is known in England as “the black-leg” or “quarter-evil.” It
is an anaërobic organism, frequently met with in cattle, which causes
a peculiar emphysema of subcutaneous tissue, spreads deeply, and
is followed by a copious exudate of dark serum with gas formation.
The smaller animals are not ordinarily inoculable; but if to the culture
material there is added 20 per cent. of lactic acid, their
insusceptibility is overcome and they succumb to the disease. So,
also, as in the case of the tetanus bacillus, by addition of the bacillus
prodigiosus or of proteus vulgaris the disease may be produced in
otherwise insusceptible animals.
N. The Bacillus Aerogenes Capsulatus.—The bacillus aërogenes
capsulatus seems capable sometimes of causing pyogenic and even
fatal infection. Its presence is associated with gas formation. It grows
as an anaërobe.
O. The Bacillus of Chancroid.—The bacillus of chancroid identified by
Ducrey, and briefly described in the chapter on that subject.
 Fig. 7 Fig. 8

Rhinoscleroma: infiltration of tissues Bacilli of rhinoscleroma. × 1000.

about the nose. (Case reported by Dr. (Fränkel and Pfeiffer.)
Wende, Buffalo.)

YEASTS.
Busse was the first to call attention of clinicians and pathologists to
the role played by yeasts in certain infections. Since the original
observations of Busse in a case in which the organism produced a
general infection, the lesions of which were a combination of tumor
and abscess formation, various observers have noted the presence
of pathogenic yeasts, usually in skin lesions. Gilchrist and Stokes
were the first in this country to determine the nature of these
organisms, and their observations have been followed by the
detection of a large number of similar cases. In the skin lesions the
organisms are found in minute abscesses; in the subcutaneous
tissue and in the infections similar to those of Busse large abscesses
surrounded by extensive masses of granulation tissue characterize
the infection. The organisms can be detected in the pus by means of
an examination of the fresh unstained fluid (Fig. 9).
 FUNGI.
Besides the micro-organisms everywhere grouped as bacteria,
there are other minute organisms which have also the power of
engendering pus. One of these is the ray fungus, known as the
actinomycis, which causes the disease known as lumpy jaw or
actinomycosis. Suppuration is always a concomitant of the advanced
lesions of this disease, and, while it may be in many instances a
mixed infection, it is not necessarily so. Moreover, the pus produced
under these circumstances contains minute calcareous particles
which are pathognomonic, by which a diagnosis can sometimes be
made off-hand.
Besides these fungi, others, belonging rather to the class of
vegetable molds, which are yet pathogenic for human beings, may
be occasionally met with under these circumstances—e. g., the
fungus of Madura foot, the leptothrix, and other molds from the
mouth, while the different varieties of aspergillus may be found in
pus about the ear or even in that from the brain.

PROTOZOA.
The protozoa have the power of producing, if not absolute ideal
pus, something so nearly resembling it that we may include them
among the facultative pyogenic organisms. The best known of these
protozoa are the amebæ, which are met with in the intestinal canal in
some countries, occasionally in the United States, especially as the
exciting causes of a peculiar type of dysentery often accompanied by
abscess of the liver. In these abscesses the amebæ are found, and
no other organisms. Another group of the protozoa, known to
biologists as the coccidia, are also capable of causing pus formation,
more particularly in some of the lower animals. Numerous other
parasites, belonging higher in the animal kingdom, are undoubted
exciters of pus formation, though it is not necessary to lengthen the
list beyond those already mentioned.
 Fig. 9

Blastomycetic pus (fresh). × 1000. (Gaylord.)

Protozoa have recently been established as the active agents in

the production of smallpox and probably also of scarlatina. They
have been seen so generally in and around cancer cells as to make
it extremely probable that cancer is a protozoan infection. In syphilis
also they are found as the spirochetæ, now regarded as its cause.
 Protozoa are as ubiquitous as bacteria, but their recognition is as
yet more difficult, as but little is known of them. The numerous
stages through which they pass in completing their life cycles only
complicate the subject, while the difficulties encountered in
cultivating them are still to be overcome. As we become more
familiar with them we shall more frequently find them to be
pathogenic organisms.

CLINICAL CHARACTERISTICS OF PUS FROM DIFFERENT

AGENCIES.
Staphylococcus.—Dirty white, moderately thick, with sour-paste
odor.
Streptococcus.—Thin, white, often with shreds of tissue.
Colon Bacillus.—Thick, brownish, with fetid odor, or thin, dirty
white, with thicker masses.
Micrococcus Lanceolatus.—Thin, watery, greenish, often copious.
Bacillus Pyocyaneus.—Distinctly green or blue in tint.
Bacillus Tuberculosis.—Thick, curdy, white paste, or thin, greenish,
with small, cheesy lumps or even with bone spicules.
Actinomycis.—Thick, brownish white, with small, firm, gritty or
chalky nodules of yellow color.
Ameba Coli.—Thick, brownish red.

BACTERIAL DETERMINATION AS AN INDICATION IN

TREATMENT.
There is a practical side of great importance pertaining to the
recognition of the nature of the infectious organism in many cases of
suppuration and abscess. For instance, pus which is due to
streptococcus invasion indicates a collection which should be freely
evacuated and carefully drained. This is also true in essential
respects of staphylococcus pus, particularly that due to the
streptococcus aureus. Putrid pus from any source requires
disinfection and free drainage, the former preferably perhaps by
hydrogen dioxide. Pus which is due to the colon bacillus is not often
extremely virulent, which accounts for so many cases of appendicitis
recovering with or without operation. A collection of this pus needs
little more than mere drainage and opportunity for escape. Pus from
a recognizable tuberculous source may still contain living tubercle
bacilli. This means either that the cavity whence it came should be
completely destroyed and eradicated, or else that the margins of the
incision or opening through which it has escaped should be so
cauterized that infection of a fresh surface is impossible. The same
is true of abscesses due to glanders bacilli and to certain cases of
suppurating bubo following chancroid, where the whole course of
events shows the virulent character of the organisms at fault.

SUPPURATION.
Although it may be possible to produce in certain laboratory
experiments metamorphosed material which very closely simulates
pus, or, in fact, by injection of chemical irritants, to sometimes imitate
the suppurative processes, nevertheless, the student should be
brought face to face with the statement, to which for surgical
purposes there is no practical exception, that suppuration, i. e.,
formation of pus, is due to the presence in the tissues of the specific
irritants already catalogued and described, and of the peculiar
peptonizing or other biochemical changes which bacteria exert upon
living animal cells.
Coagulation Necrosis.—Coagulation necrosis is the term applied
to the characteristic changes occurring in
the tissue cells when thus attacked, which may be summarized as a
fading away of cell outlines, diminution in reaction to reagents, and a
merging of cells and intercellular substance. Coagulation necrosis is
not the only result of bacterial activity, but may be produced by other
causes. Nevertheless, pyogenic bacteria do not exert their
deleterious action upon the tissues without occasioning changes
included under this term. In an area thus infected, as already
described, leukocytes, i. e., phagocytes, are present in increased
number for purposes already mentioned. As we approach the centre
of activity phagocytes are more numerous than cells, and
intercellular barriers completely break down. When bacteria are
found in greatest number, there also occurs the greatest phagocytic
activity, and there also will be found the evidence of suppuration,
i. e., pus. As already indicated, the polynuclear leukocytes are most
active in the process of defence. Where coagulation necrosis is most
marked there has been the greatest activity of conflict with the
greatest death of cells. Around these areas bacteria and cells are
found in indiscriminate arrangement. Tissue vitality is impaired by
intoxication of the cells by the excretory products of the bacteria,
i. e., the so-called ptomains, toxins, etc., and their power of
resistance is thus weakened. From the mechanical results of
pressure tension around the centre of activity is increased, by which
tension vitality is still more impaired and more rapid tissue death
occurs. Thus there occurs migration or burrowing of pus; or, to state
it more clearly, the tissues break down in front of the advancing
destruction, and in the direction of least resistance. This is known as
the pointing of pus, which brings it many times to the surface, and
often in other and less desirable directions.
Abscess.—An abscess is a circumscribed collection of pus. The
term is used in contradistinction to purulent infiltration, in
which the collection is not circumscribed, but is exceedingly diffuse
and extends itself in various directions, the amount at any spot being
almost inappreciable. Purulent infiltration is regarded as the more
serious of the two conditions, as it is more difficult for pus to escape
under these circumstances than when it can be evacuated through a
single opening. The term phlegmon is one now generally used to
indicate a suppurative process, usually of the general character of
purulent infiltration rather than of abrupt abscess, but generally
employed to include both conditions. The adjective phlegmonous is
coupled with the names of other surgical infectious diseases to
indicate that it is complicated by suppuration, e. g., phlegmonous
erysipelas. Pus is a product of bacterial activity usually formed
rapidly rather than otherwise, and abscess formation or
phlegmonous activity of any kind is a question of but a few days.
Empyema means a collection of pus in a preëxisting cavity.
The significance of this condition is well described in the story of
inflammation and suppuration, to paraphrase Sutton, read
zoölogically, as though it were the story of a battle: The leukocytes
(phagocytes) are the defending army, the vessels its lines of
communication, the leukocytes being, in effect, the standing army
maintained by every composite organism. When this body is invaded
by bacteria or other irritants, information of the invasion is
telegraphed by means of the vasomotor nerves, and leukocytes are
pushed to the front, reinforcements being rapidly furnished, so that
the standing army of white corpuscles may be increased to thirty or
forty times the normal standard. In this conflict cells die, and often
are eaten by their companions. Frequently the slaughter is so great
that the tissues become burdened by the dead bodies of the soldiers
in the form of pus, the activity of the cells being proved by the fact
that their protoplasm often contains bacilli in various stages of
destruction. These dead cells, like the corpses of soldiers who fall in
battle, later become hurtful to the organism which, during their lives,
it was their duty to protect, for they are fertile sources of septicemia
and pyemia. This illustration may seem romantic, but is warranted by
the facts.
Around the margin of the site of an acute abscess a barrier is
formed by condensation and cell infiltration of the surrounding
tissues. This is not a distinct wall nor membrane, yet, nevertheless,
serves as a sanitary cordon to confine the mimic conflict within
reasonable bounds. This is the zone of real inflammation; within it
there are tissue destruction and coagulation necrosis. By virtue of
the peptonizing power of the pyogenic organisms the parts involved
in this necrosis gradually liquefy the intercellular substance
dissolving first. It is this which in the main forms the fluid portion of
the pus. Various tissues show widely differing resistance to this
softening process. In true glands the interlobular septa seem to
break down first, and in this way suppuration extends around the
acini or gland lobules, and thus pus may contain masses of easily
recognizable size. These masses are ordinarily known as sloughs.
It is by virtue of the so-called lymphoid cells, which are those
principally involved in producing the barrier or boundary of the acute
abscess as above described, that granulation tissue is formed, which
takes up the effort of repair as soon as pus is evacuated. This
boundary has no sharp limit, but shades off into healthy surrounding
tissues.
 Under the term “abscess” is meant that which is described as
acute abscess. Under certain circumstances, especially when they
are produced by the facultative pyogenic organisms rather than the
obligate, abscesses form more slowly, and may be spoken of as
subacute. These are terms used in contradistinction to the so-called
cold abscesses, which, although clinically bearing a certain
resemblance to the acute, are in almost every pathological respect
different from it. Cold abscesses will be considered under the head
of Tuberculosis. It is possible to have an acute pyogenic infection of
a cold abscess; in such case we have acute manifestations.
Gravitation abscesses are those where pus forming in one part tends
to migrate, usually in the direction in which gravity would take it,
extending into portions deeper or lower. Perhaps the best illustration
of this is the pointing of a psoas abscess below Poupart’s ligament.
Metastatic abscesses are those which are formed as the result of
embolic processes, each one being in miniature a repetition of a
lesion which has occurred at some other part of the body. The
underlying fact concerning metastatic abscesses is that the primary
process has occurred in some other portion of the body, whence it
has been distributed as above. These will be considered in the
chapter treating of Pyemia.
The product of all acute suppurative lesions is pus. This is an
opaque fluid of creamy consistence and whitish or grayish
appearance, varying in density, met with in amounts from a minute
drop to half a gallon or more. Under ordinary circumstances it is
odorless, and its reaction, either acid or alkaline, is very faint. It is,
like the blood, composed of a fluid and a solid portion. The solid
portion consists of so-called pus corpuscles and other debris of
tissue, which vary with the site of the disease and the parts involved.
The source of the pus corpuscles has been cited and the statement
made that they are in effect the bodies of phagocytes which have
perished in the biochemical fight for existence of the parent
organism. Cocci or bacilli are found in pus corpuscles and also in the
surrounding fluid.
Pus should be without odor, but under certain circumstances it
possesses an odor which will vary in character according to the
source of the pus or the nature of its principal bacterial excitant. Pus
from the upper end of the alimentary canal frequently has the sour
smell of gastric contents; that from the neighborhood of the lower
end, the fetid odor which is for the most part due to the action of the
colon bacillus. Inasmuch as colon bacilli are found in widely distant
parts of the body, they may also give an unpleasant odor to pus even
from a brain abscess. When the pus has become contaminated with
the ordinary saprophytic organisms, it may smell like any other
decomposing material. The older writers called it ichorous pus, while
sanious pus was supposed to be that more or less mixed with blood,
undergoing ammoniacal decomposition or else strongly acid. Pus
sometimes has a well-marked blue or bluish-green tint. This is due to
the presence of the bacillus pyocyaneus, already described. An
orange tint is sometimes given by the presence of hematoidin
crystals, due to the original hemorrhagic character of the infected
exudate. The former appearance indicates usually a slow course to
the suppurative lesion, while the latter has been regarded by some
as affording an unfavorable prognosis. Distinctly red pus, whose tint
is due to the presence of a bacillus giving bright-red cultures on
blood serum, has been noted in other instances. This can readily be
distinguished from blood, because upon dressings it does not
change color.
Pus may form superficially, when it is called subcutaneous
suppuration, in which case there is a minimum of pain, because
tension is not great and the distance to the surface is short.
Collections which form beneath the fasciæ, especially the deeper
fasciæ of the limbs and trunk, give rise to much more extensive
disturbance, both locally and generally, and frequently do not point
for many days; or, instead of pointing, burrow deeply and find their
outlet at some undesirable point. These are known as subfascial
collections. Subperiosteal abscesses give rise to still more pain,
because of the unyielding character of their limiting structures, and
the symptoms caused by them are acute and distressing.
An illustration of the pain which may follow deep suppuration may
also be seen in the ordinary panaritium, or bone felon, where the
path of infection is from without, but the destructive lesion is confined
within absolutely unyielding tissues, at least at first. Along certain
tissues infection spreads with rapidity. This is particularly true of the
delicate areolar tissue seen between tendons and tendon sheaths,
and the infectious process may follow this tissue wherever it shall
lead, even along complex courses.
The question often arises, Can pus be resorbed? There is no
question but that small amounts of pus are disposed of by
phagocytic activity, and the disappearance of purulent infiltration,
under the influence of favoring remedies, or even when let alone, is
not infrequently noted. True pus resorption is a question of
phagocytic possibilities, and can occur only in very limited degree, as
a result upon which it is not safe to count, and which is capable of
encouragement only up to a certain point.
One inevitable law seems to govern collections of pus, that when
they advance or migrate in any direction it is in that of least
resistance. This causes them to take peculiar and sometimes
disastrous courses, but it is a law which is never violated. It leads to
the bursting of abscesses into the brain, into the pleural cavity, into
the peritoneal cavity, the bowel, and elsewhere; it leads to a
condition where pus may travel along a path even a foot or more in
length, rather than come to the surface, a distance of perhaps an
inch, and affords one of the best reasons for early operative
interference so that the disastrous effects of burrowing may be
obviated. When the pus is limited to a drop or fraction thereof the
abscess is called a furuncle, especially when in the skin. The
average “boil” of the layman is a subcutaneous or subfascial
abscess. When the infiltration is pronounced, and when there has
been more or less extensive destruction of tissue, with perhaps
formation of numerous outlets for the escape of pus and detritus, it is
known as a carbuncle. (See Chapter XXVI.) In certain conditions
small superficial furuncles or boils form, sometimes in great number
and almost synchronously, or, as it were, in crops. This condition is
known as general furunculosis.
Signs and Symptoms of Abscesses.—The appearances by which pus
may be suspected or detected are those of congestion and
hyperemia, more or less abruptly circumscribed and markedly
accentuated. Along with these there is more or less edema or
edematous infiltration of the skin and overlying tissue, which permits
of that peculiar appearance known as “pitting on pressure.” Often,
too, there is a distinctly edematous swelling of the parts, especially
around the margin, with brawny infiltration of the centre of the
infected area. Numerous vesicles occasionally are noted upon the
skin, which may be filled with reddish serum. When softening and
pus formation occur, there is a condition which to the palpating
fingers gives the characteristic sensation known as fluctuation.
Fluctuation simply points out the presence of fluid beneath; but when
in an area marked as thus described fluctuation is noted, it means
the presence of pus. It is detected by manipulating in a direction
parallel to and concentric with the axis of the limb or part. The pain is
also in most instances significant; patients speak of it as having an
intense and throbbing character. With these local signs occur
symptoms indicating some degree of septic intoxication, i. e.,
pyrexia, chills, malaise, sweats, etc., which are corroborative
indications, their intensity being a reasonably correct index of the
severity and gravity of the local infection.
When a deep-seated abscess is suspected a careful blood count
will often permit a diagnosis to be made. This is conspicuously true
of cases of appendicitis. If leukocytosis is established there should
be immediate operation. (See Chapter II.)
It is seldom that a superficial collection of pus can be mistaken for
anything else. In small and superficial abscesses (boils, furuncles)
as pus approaches the superficial layer (epidermis) of the skin it may
be discovered through its thin covering. In deep lesions there is often
a doubt, even on the part of the most experienced. The measure
now usually resorted to for purposes of diagnosis and exact
recognition is the exploring or aspirating needle. The old exploring
needle was one of good size, having a groove along which, after
introduction, pus might pass. Since the almost universal use of the
hypodermic syringe, a small aspirating needle attached to the
ordinary syringe is the measure commonly adopted. Such a needle
may be introduced into the brain, into the liver, or into almost any
and every soft tissue without danger, and if properly manipulated is
almost sure to facilitate detection of pus. Exploration done with either
of these means and for this purpose should always be conducted as
an aseptic, even if a minor operation, in order that no extra infection