PYEMIA.
Under the popular and misleading name of " Blood Poisoning " several septic conditions are included, as Saprcemia,Septiccemia, and Pyceima. The treatment of these are best dealt with in a single article, since the minor degree of septic intoxication—saprxmia—may easily pass into the more serious condition recognised as septicemia, and this in its turn may sometimes terminate in the grave form of pymnia, though each condition may appear and remain throughout clinically as a characteristic entity with the same causal pyogenic organisms present in all three.
Accepting Sapnemia as the form of septic intoxication which ensues when pyogenic organisms multiply in a wound or other local focus of infection and remain outside the blood-stream, the soluble toxins only being absorbed, the indications for treatment are obvious. The wound should be opened up and the most thorough irrigation by mild antiseptics carried out. As in dealing with the more serious types of septic infection, the more freely the incisions arc made the better; partial curetting or aspiration should be avoided as tending towards the danger of converting a comparatively innocent infection into one in which the pyogenic organisms obtain an entrance through the open mouths of vessels injured by ineffectual scraping. The antiseptics employed should for similar reasons be such as will not destroy the healthy tissues or retard phagocy tosis. A warm saturated solution of Boric Acid or a flushing of the septic area by Hydrogen Peroxide meets all the requirements, and the freest drainage must be provided for.
In the chronic form of saprxmia recognised as Hectic Fever the indica tions are similar—the septic area should be opened up freely and the most efficient drainage established when this is possible. In some cases, especially in those of tuberculous origin, the only procedure available may be to amputate the part in which the diseased process is going on in preference to attempting partial or conservative surgical operations.
A recognition of the pathology of sapronnia is essential in the satis factory treatment of the condition. The symptoms being the result of the absorption of the chemical or unorganised toxins, as in alkaloidal or ptomaine poisoning, eliminatory agents are always useful. Saline purgatives to flush out the bowel and diaphoretics and diuretics to expedite the elimination of the toxins by the kidney and skin are clearly indicated. The ineffectual attempts of nature in this direction should be
assisted and not thwarted by the surgeon, unless such should become so excessive as to endanger the life of the patient, as exhausting diarrhoea or profuse sweating. No advantage follows the routine administration of antipyretics in septic states with the view of continuously depressing the body temperature. When this reaches a height dangerous to life the wet pack may be employed, hut such is rarely necessary. The objections to the newer antipyretics do not maintain as regards Quinine, which, owing to its tonic and possibly to its restorative properties, may be freely given in all septic states. The Tincture of the Perchloride of Iron still holds a high position in the internal treatment of the various types of septic poisoning, and it may be safely combined as a routine with Quinine.
From what we know of the effects of muscular exertion in raising the temperature of phthisical patients, due apparently to the lowering of resisting power to infection, the most complete bodily rest in bed is essential in all forms of septic poisoning.
• The diet should be such as will permit of the least labour being thrown on the digestive organs, already weakened by the action of the toxins, and it should at the same time be such as will encourage elimination by the skin, kidney and bowel; hence a purely liquid diet is indicated with abundance of diluent drinks.
Symptomatic treatment will consist in the administration of such agents as will antagonise the effects of the toxins on the different organs. Thus vomiting may be relieved by gastric sedatives, ice and effervescing drinks; profuse diarrhoea must be controlled by astringents when it becomes exhausting, hut little good can he expected in this latter case by drenching the patient with the usual vegetable and mineral astringents. which arrest gastric digestion and never reach the intestine. Tannalbin, Tannigen, Tannoform and Tannocol in so-gr. doses in cachets all pass unchanged through the stomach and exert their local astringent action upon the bowel without upsetting digestion, and any of these drugs may be com bined with a small amount of Opium to check increased peristalsis. Cardiac weakness should be met by Pituitrin or Strychnine hypoder mically.