SYMPTOMS. - The constitutional dis turbance, when suppuration takes place in a wound, is usually profound. There is a sudden and marked rise of tempera ture which may be preceded by a chill. If the abscess is confined to the wound, the pus may be easily liberated; but, if infection of the surrounding connective tissue has occurred, the pus may burrow in various directions, usually along the lines of least resistance, which will neces sitate the making of a number of coun ter-openings in order to check the sup puration. The inflammation may be come subacute, or chronic, and continue for many weeks. In this case the fever becomes remittent in character, with evening rise and morning fall to normal, like hectic fever, which is a suppura tion fever accompanying tuberculosis. Marked prostration, with weak, rapid pulse, and emaciation are present if the suppurative fever continue long. Diar rhcea and night-sweats are often present; septic poisoning or exhaustion may lead to a fatal issue unless the suppuration is checked. If the type be more chronic (lasting for months), emaciation will be more gradual, and amyloid degeneration of the kidneys, liver, and other internal organs, and enlargement of the lymphatic glands may take place.
—If the temperature does not fall at the end of a few days after the beginning of the healing process, but re mains high or ascends higher, it may be assumed that pus has formed in the wound.
—This fever is due to the absorption of ptomaines, or a chemical poison, developed as a result of a fer mentation induced by the presence of pyogenic bacteria. The bacteria are not always to be found in the blood or tis sues, and a decline of the temperature immediately follows the evacuation of the pus. There is no progressive infec tion of the system, as in pycmia.
PROGNOSIS.—The prognosis is gener ally favorable except when the fever is associated with tuberculosis, in which case it is very unfavorable.
— In acute suppuration, evacuation of the pus, thorough disinfec tion of the wound and all tracks of sup- I puration, and the complete removal of in fected granulations by means of the curette are indicated. Where joints are involved, resection must be considered, except when amyloid degeneration of the kidney is present (shown by examination of the urine), in which cases amputation may offer a chance for prolonging the life. In all cases a nutritious diet and a
liberal use of stimulants are especially needed. Fresh air, and plenty of it, is a great restorative. If the weather permit, the patient may be placed in a tent or •. out in the open air with great advantage.
Traumatic Delirium.—This term is ap plied to those forms of delirium which occur as the result of injury, and are not due to alcoholism, pyrexia, or the effects of amesthesia.
—This condition is usually marked by some pi cordial distress, ac companied by oppressed and sighing res piration. The pulse is soft and com pressible, but exceedingly rapid and bounding. The face is flushed. The tongue is moist and tremulous, and the skin is moist. There may be vomiting. The principal feature of this condition, however, is a peculiar delirium, very closely resembling that of delirium tre mens; and in many cases the resemblance is so close that it is often quite impos sible to draw the line between the two conditions. There are the same bright ness of the eye, heat of the head, con stant and irrepressible muscular action, and sleeplessness with wandering delir ium and rapid succession of spectral de lusions, usually of a frightful and painful character (Ashhurst). In some cases the delirium is of a mild character, the pa tient being haunted with extravagant ideas; in other cases the patient tries to get out of bed, and attempts to injure his attendants and soon becomes furiously maniacal (Druitt).
— This condition resem bles in many points the effect of pytemia, and cannot always be distinguished from it; fortunately the treatment of both is similar. Its resemblance to delirium tre mens has been noted.
—This condition is most fre quently seen in persons of middle age and intemperate habits, and in children after capital operations. In severe trau matic fever delirium may be present. Se vere burns, scalds, facial erysipelas, and cerebral lesions are liable to be accom panied by delirium. The seat of delirium is in the cortical gray matter of the brain. In some eases the delirium is caused by cerebral anTmia due to loss of blood.