To affirm that the multiplication of bacteria through general infection is alone capable of causing septicemia is not warranted by our present knowledge. Toxins here, as in sapraimia, may, in ad dition to the rapid development of bac teria, act as a potent life-paralyzant. In deed, experimental evidence tends to show, in the case of animals at least, that such is the case. Koch attributes the disease to a special coccus, Ilosenbach to streptococci and staphylococci combined, and Besser to streptococci alone. It is probable, however, that a sharp line can not here be drawn, since many instances are distinctly combined infections. A mixed infection is commonly observed in various diseases: in diphtheria, for in stance. In some cases no trace of local infection can be found. The subject may or may not be in bad health, and general septicemia develops and runs its regular course. Osler alludes to 21 such cases, 13 of which are due to strepto coccus pyogenes, 2 to staphylococcus pyogenes, and G to pneumococcus. In 19 of these, however, the subjects were suffering from other diseases which were complicated with septicemia. This is the cryptogenetic form of Leube. Cases due to bacillus pyocyaneus have also been described.
The micrococcus tetragenus of GalIky is capable of causing general infections in man, as has been previously sus pected from its pathogenicity in animals. Chauffard and Ramond (Archives de Med. Exper., May, '96).
Case of septicaemia arising from ter tiary syphilitic lesions. The so-called cases of "syphilitic cachexia" are similar, and should be called "secondary invasion of the organism by germs developed in syphilitic ulcerations." Quinine and salicvlate of soda fail to act on the sec ondary septicsemia, but there is imme diate improvement of this secondary con dition when the primary cause is treated by antisyphilitic remedies. Surmont and Patoir (L'Echo Med. du Nord, July 12, '97).
In eighteen cases of pymmia and sepsis the so-called glycogen-reaction in the leucocytes of the blood noted. Experi ments made to determine whether the appearance of the substance in the leu cocytes is due to infiltration or to de generation, and conclusion is reached that it is due to latter process. Kaminer (Berl. klin. Woch., Feb. 6, '99).
Pathology. — The most prominent morbid change is in the blood, which is thin and tar-like, in many cases acid, and frequently found to contain a large number of micro-organisms. The gas trointestinal tract shows evidences of catarrhal inflammation, the mucous membrane being mottled and studded with hmmorrhagic areas varying in size and number. The lymphatic glands are usually more or less enlarged, the spleen likewise. Apart from these changes, there is little to attract attention. The kidneys are enlarged, the parenchyma is cloudy, the uriniferous tubules are in flamed, and their vessels contain pathog enic bacteria.
The changes in the blood are mainly due to the disintegration of the white corpuscles, and to a certain extent of the red through the influence of the toxins or of that of the micro-organisms them selves. These may be found in the re
maining leueocytes, and so crowded are they sometimes that the corpuscles prac tically become masses of bacteria.
Prognosis. — The prognosis of septi ceemia depends greatly upon the powers of resistance of the patient and the kind of micro-organism present. According to Settman (Munch. med. Woch., Jan. 15, '95), the most favorable prognosis can be established when staphylococci are found, less favorable if pneumococci are obtained, and least favorable if strep tococci are present or in mixed infection. The bacteriological examination of the blood will furnish, in cryptogenetic septicopymmia, the source of infection. Thus, if we find pneumococci, the lungs arc to be looked upon as the source of infection; if the bacterium coli, the in testines, binary passages, or a cystitis.
When the source of infection—a large septic mass or an infecting surface, etc.—can be reached and judiciously treated, the chances arc greatly im proved and the symptoms sometimes im prove immediately. This is especially the case in sapreemia; but, as it is al ways difficult to ascertain whether we are dealing with this form or the septiemmia, the information obtainable on this score is rather scant. The rapidity of the course affords some idea of the chances the patient has, and the prognosis may be said to be favorable if the symptoms show but slow aggravation. The rapid forms of septicmmia are invariably mor tal. Important is the fact, already stated, that cases of "abortive" septi cemia are often met with, the symptoms receding after a short period of progress. In septicmmia occurring as a complica tion of cceliotomy the chances of recov ery are very slight.
Treatment.—The proper observance of antiseptic surgery under all circum stances, whether the surgeon be dealing with a simple or severe wound, has re markably diminished the cases of septi cemia. As soon as fever attends an injury or an operation, nowadays, sus picion is immediately aroused that a sep tic condition of the exposed surface has appeared. The sooner the wound is care fully examined and rendered absolutely aseptic, the better. This is best effected by means of a bichloride solution 1 to 1000, after carefully clearing of any dis charge or blood that may be present. In injuries of the extremity, the latter may be left in a bath of borate of sodium, 20 grains to the ounce, for several hours, if need be, after clearing and disinfect ing the wound. Stitches should be re moved in order to reach every sinus or cavity that may serve as a nidus for in fectious agents. When a cavity cannot be reached conveniently, a syringe may be employed to wash it out. These measures are often sufficient in sa preernia to arrest at once the process; in septicemia the result depends upon the promptness with which they are carried out.