TRAUMATIC, OR SURGICAL, FEVER.— This fever was well known before the advent of the antiseptic treatment of wounds, as more or less inflammation was considered as one of the necessary feat ures of normal wound-healing even in the absence of suppuration. It may be observed during the healing of wounds which have not received antiseptic treat ment, especially where the wound is the result of an injury or is the seat of septic infection.
Symptoms.—The constitutional symp toms depend largely upon the condition of the wound and upon the degree and extent of the inflammation. A marked rise of temperature may be observed in twenty-four to forty-eight hours after op eration or injury, accompanied by a rapid pulse; hot, dry skin; furred tongue; scanty, high-colored urine; and, at times, a mild delirium. The patient usually feels warm and restless and com plains of great thirst. The thermometer will usually indicate a temperature of 102° F., or more, on the evening of the second day. The following morning the temperature will be slightly lower, but by evening it will have risen as high as, or higher than, on the preceding night. On the third or fourth day suppuration is established, and the wound becomes clean and filled with granulations, which pre vent the absorption of the pyogenic or fever-producing substances, and thus causes the temperature to decline. The other symptoms disappear with the de cline in temperature. The duration of traumatic or surgical fever is from seven to ten days.
Eliology.—This form is believed to be due to the absorption of ptomaines which result from a fermentative process in duced by the presence of bacteria in the secretions of the wound. Very few, if
any, bacteria are found in the blood dur ing this fever. When free discharge is established in the wound, the ptomaines are no longer absorbed, the temperature falls, and the symptoms improve. Septic inflammation may result from the infec tion of retained secretions, from the growth of bacteria in the track of one or more sutures forming a stitch-abscess, or from too great tension upon the lips of the wound.
Treatmen1.—A high temperature asso ciated with the other symptoms of fever should lead to the examination of the wound, as to its condition and the pres ence or absence of bacterial infection. All infected areas should be evacuated, and infected stitches removed. If much inflammation be present and the lips of the wound are red, swelled, and tender, the wound should be cleansed with an antiseptic solution (peroxide of hydrogen, sublimate, etc.), and drainage-tubes in serted,. or be reopened and moist anti septic dressings applied. The condition of each wound will determine the amount of interference necessary. The adminis tration of nervous sedatives or opiates may be for the relief of pain and insomnia.
Secondary Wound Fever.—This form of fever, sometimes called suppurative fever, occurs after suppuration is estab lished, and is more marked when there is greater or less retention of the pus.