Exhaustive sweating may be checked by any of the agents employed for the relief of the night-sweats of phthisis as detailed under Phthisis.
Normal Saline solution is an agent of great value in the treatment of all forms of sepsis, since by its employment the mass of the blood may be increased and the deleterious influence of the toxins diminished temporarily at least. Whilst the rational ideal should be to first perform free yenesec tion in order to " wash " the blood, this unfortunately is generally contra indicated in sepsis unless in acute cases occurring in sthenic subjects. The saline may be given hypodermically by the bowel or by the veins.
As in the graver forms of septic poisoning the action of the toxins, apart from hac teriamia. invariably present, the applications of the above principle of treatment apply to both septiciemia and pyremia.
Where infection seems to he arising solely or mainly from a single focus, either in the wound or in the lymphatic glands draining the area, it may he advisable to remove by excision either the wound or the glands.
.tieptiorma, though theoretically recognised as that form of septic poison ing in which the pyogenic organisms have found their way into the blood and internal organs, is nevertheless clinically identical with severe sapraania, since the symptoms are mainly those of poisoning by the toxins. scpticiemia may be identified by finding the infecting micro-organism on culture of the urine or in the blood itself. Rut the important patho logical difference must he always kept in mind—in sapmmia the con stitutional signs and symptoms of poisoning pass off rapidly on the removal of the local site containing the microbes, whilst in septicvemia the general infection and continuous production of further quantities of toxins may continue even after amputation of the entire limb in which the original locus of infection was situated.
Nevertheless in every case the primary lesion should be freely dealt with when possible, as in sapriemia, in order to minimise the dose of the toxins. The treatment must be mainly symptomatic and carried out on the lines already detailed, the aim of the surgeon being to assist elimination of the toxins, maintain the strength of the patient, and to dilute the poison by the introduction of large quantities of Normal Saline into the blood stream, whilst each symptom is met by its appropriate indication.
Wernitz states that the change observed in desperate cases of sepsis treated by rectal injections of Saline is almost incredible, as seen in acute puerperal sepsis, in the summer diarrhoea of children, in typhoid fever, malignant scarlatina and plague. His technique is to start with lavage of the entire colon for hours, after which the saline is made to trickle into the bowel for about an hour at a time, during which 35 oz. will be absorbed, and this is to be repeated every 2 or 3 hours; the effects are much more satisfactory, lie t hinks, than when the fluid is put into the veins.
Serum Treatment cannot he said to have held its own in this serious condition; one thing, however, must be said in its favour—that it may safely he regarded as harmless if it fails to do good. The routine method is to inject c.c. of Polyvalent Antistreptococcic Serum and repeat the dosu daily or inject to c.c. every sixth hour.
l'accine Trealmed1.--The above remarks do not apply to the method of using a pacciiic prepared from a culture of the causal streptococcal organism, and in this lies the future hope of the successful treatment of septicemia. tlany authorities explain the fact that when improvement unmistakably follows the administration of the serum this only occurs when the latter accidentally functions as a vaccine. The dose of the inipole Institute vaccine consists of mo,000,000 organisms, but the best pro,.edure is immediately to administer a full dose of antistreptococcal serum or a close of the above vaccine whilst an autogenous vaccine is being prepared from the patient's blood or tissues.
Pyamia.--In this type of septic infection not only have the organisms gained free access to the blood, but metastatic deposits occur in various regions, and these continue by multiplication of their cocci and the pro duction of toxins to still further poison the organs and tissues of the body.