WOUNDS (SEPTIC) AND GAN GRENE.
Septicaemia.
Definition. — SepticLemia is an acute febrile affection characterized by marked nervous, cutaneous, and visceral mani festations, and due to the introduction into the system of bacteria or their tox-. ins, or both, derived from an infected wound.
Varieties.—There are two varieties of septicemia: true septiccernia, in which micro-organisms, especially bacilli and micrococci, penetrate into the blood and there multiply; and saprcemia in which the toxins or ptomaines alone of the pathogenic organisms enter the system and cause chemical poisoning. Both varieties often exist simultaneously.
SaprEemia.—The symptoms of saprre mia are those of poisoning by a chemical agent. The disease sometimes begins with a chill, soon followed by a marked rise in the temperature; but in most cases the latter is the first evidence of the disease. The skin becomes cold and clammy; there is marked prostration and sometimes diarrhea. When these mani festations occur while a wound is pres ent, they are ominous, and the dangerous complication can often be avoided if the dressing of the wound is renewed and perfect antiseptic precautions are taken to thoroughly remove all septic matter from its surface. The constitutional symptoms often disappear of their own accord, when this is clone, if the systemic infection is not already sufficiently ad vanced to thwart all endeavors.
Wounds that are undergoing putrefac tive changes and free from healthy gran ulations usually represent the foci of in fection under such circumstances. The disease is also caused when an exposed surface such as that of the uterine cav ity is exposed to the effects of a putrefy ing placenta or clots. (See EcLAmPsrA.) Psoas abscesses or gangrenous wounds, peritoneal injuries, accumulations in the peritoneal cavity of blood-clots, and in , sufficiently-drained wounds represent the conditions which may give rise to sa praemi a.
The general poisoning induced as a result of the absorption of toxins in such acute infectious diseases as diphtheria, typhoid fever, etc., in which foci of in
fection occur, owes its origin to the latter also, through the absorption of toxins. The ingestion of poisonous foods, putrid meat, or other organic matter is also productive of a form of saprEumia.
True Septimmia.—In this condition, as stated, the septic infection is due to the presence of bacilli or micrococci in the blood. The invasion is more gradual and the symptoms develop less rapidly. Fever, headache, vomiting, diarrhoea. anorexia, great prostration, and mental torpidity—in a word, a general typhoid condition—constitute the array of symp toms witnessed when septicaemia is de veloping after an injury or surgical operation.
The fever is of the continued type and gradually increases, the temperature be coming suddenly raised when a period of danger is reached. In rare cases, how ever, fever is absent, and, when the ab domen is the seat of the injury (gunshot wounds, hernia, etc.), the temperature may even be subnormal. The pulse may be strong and rapid at first, but it grad ually fails in power until it becomes easily compressible and weak, though very rapid. After abdominal lesions the pulse may remain extremely rapid, while the temperature is subnormal.
In a certain number of abdominal op erations patients die of acute peritoneal septicaemia. The serious symptoms de velop within twelve hours after opera tion, and death occurs within thirty-six hours. Lesions found after death are dilatation of coil of intestines and fine arborescent vascularity of the peritoneal coat. The peritoneum may be dull, and a little sero-sanguinolent fluid is found in Douglas's pouch. Fatty degeneration of the liver-cells is found, commencing around each portal canal, and later spreads toward the centre of the lobule. Clinically these hepatic lesions are usu ally manifested by an icteric tinge of the skin (Jayle). One of the most striking symptoms is rapidity of the pulse, often without a corresponding rise of tempera ture. Hartmann (Annals de Gyn6n-, Feb., '96).