Chapter 17 - Surgical Diseases
Modern Surgery
Suppuration and Abscess
Ulceration and Ulcers
Malignant Pustule
Burns and Scalds
Frost Bite
Septic Wounds
Incised Wounds
Rules for Examining and Dressing Wounds
Antiseptic Dressings
Way Wounds Unite
Punctured Wounds
Lacerated Wounds
Granulation and Scarification
Gunshot Wounds
Poisoned Wounds
Way Broken Bones Unite
Different Diseases of Bones
White Swelling
Stiff Joint
Water in the Scrotum
Blood in the Scrotum
Varicose Veins
Deformities and Irritations of the Spine
Wry Neck
Foreign Bodies in the Eye
Inflammation of the Edge of the Eyelids
Disorder of the Lashes
Chronic Inflammation of the Lachrymal Sac
Inflammation of the Cornea
Inflammation of the Iris
Weakness of Sight
Imperfect Vision
Short and Long Sight
Affections of the Ear
Inflammation of the Meatus
Wax in the Ear
Inflammation of the Tympanum, Deafness
Bleeding from the Nose
Ingrowing Toe Nail
Chafing and Excoriation
Foreign Substances
Bleeding from Wounds
Proud Flesh
Compression of Arteries to Stop the Flow of Blood
Care of the Teeth
Rotting of the Teeth
Filling Teeth
The First Teeth
Cleaning the Teeth
Ulcer of the Stomach
Riggs' Disease

17.5 Pyaemia


THIS frightful affection has been called the bane of surgery. It is caused by a peculiar poison, resulting from the fermentation and disintegration of the tissues of a wound, which is taken into the system either by the veins or absorbents, and is usually accompanied by the formation of collections of pus in the various tissues and organs of the body. It follows very trifling as well as severe injuries, and it is a frequent sequela of surgical operations, oftentimes of a very slight character. The only tenable theory which can explain the different phenomena of this disease is, that the pyaemic condition is caused by the absorption of septic material, sometimes in a fluid, sometimes in a gaseous state, which unfits the blood for the processes of healthy nutrition, induces capillary stagnation and its consequences, low forms of inflammation in different parts of the body, as in the joints and serous cavities, and may finally produce those secondary, deposits of pus, in any or all parts or organs of the body, called metastatic abscesses.
When an internal organ is involved, the result is generally fatal. When suppuration attacks the integuments or the extremities, there is a fair chance of recovery.
Thence the disease has been divided into two classes: the internal or acute, the external or chronic pyaemia. When pyaemia involves the internal organs the course is usually rapid and fatal. When it attacks the external parts, it is slow in its course and may be recovered from.

Duration of the Disease. Sometimes its course is so rapid that the patient may die in two or three days after the appearance of the symptoms. As a rule, however, bad cases terminate during the second week. Some go on for six or seven weeks. In cases which recover, the patient goes through a long illness and may be left permanently crippled by secondary affections of the joints. As a rule, the longer a patient lives the better the hopes of a successful ending.
Pyaemic symptoms generally make their appearance after the fourth day. The first symptom is a chill ; this is repeated at irregular intervals, and is followed by profuse and exhausting sweats.
The hot stage which characterizes the. malarial paroxysms of intermittent fever is usually absent or but slightly marked. During the course of the attack, the temperature of the body, which is naturally 98.5 Fahrenheit, may rise six or eight degrees, and in ordinary cases its fall is, as a rule, gradual. The greatest elevation of temperature corresponds with the period of rigor. During the sweating stage the temperature falls again. Should the fall be sudden, a general breakdown of the powers of the patient is indicated. The pulse rate varies, according to the violence of the attack, from ninety to one hundred and thirty. The respiration is usually rapid, from forty to fifty a minute, and in many cases a hay like odor of the breath is present, which is considered pathognomonic of the disease. The countenance is flushed, the skin dusky, sallow, sometimes jaundiced and marked with sudamina.
The tongue is coated, and there is a complete loss of appetite, and often nausea and vomiting. The urine is frequently albuminous. When the brain is involved there will be sleeplessness, or delirium of a low, muttering kind; some unconsciousness, from which the patient can be aroused only to relapse.
Intense pain usually attends the secondary complications, though it is sometimes remarkable how slight the symptoms often are when severe local disease exists.
The wound becomes sanious, serous, and fetid; sometimes the secretions are arrested and the surface becomes dry and glazed . sometimes absolute sloughing occurs. Union, if progressing, will become disunion, and all reparative action ceases. As the disease progresses, the symptoms become profoundly typhoidal, and the patient may die comatose or from exhaustion.

The exciting causes of pyaemia are very obscure. It attacks the healthy as well as the feeble, those surrounded by perfect hygienic influences as well as those who are exposed to deleterious influences. It is found not only in hospitals but in private practice; but it is more prevalent in unhealthy places, in the overcrowded wards, and in those spots where ventilation and drainage is bad. It lurks among the poorly housed and poorly fed and clad, and wherever those influences exist which are depressing to the vital powers.

The general treatment in these cases is of paramount importance. It is the duty of the surgeon to see that the patient's room is well ventilated, and that it is frequently purified by cleansing and disinfectants. The wound is to be kept clean and well drained.
The dressings should be changed as often as four times a day, and saturated with disinfectant lotions.
When sloughing exists the charcoal poultice should be applied, and every measure pursued which will insure the outmost cleanliness of the patient and his surroundings.
The curative treatment is to be conducted on the same principles which guide the surgeon in the management of all cases of a typhoidal character.
The bowels if constipated are to be opened by a gentle laxative, and the different secretory organs restored to a healthy action as far as possible.
The vital energies of the patient are to be maintained or stimulated, and everything that tends to lower them must be warded off.
Quinine is the most valuable remedy we have for the treatment of pyaemia. Some surgeons give it in large doses and speak highly of its effects. It is valuable in doses of four or five grains every three or four hours. It may be combined with iron advantageously in some cases. The best combination is with the citrate of iron. Four grains of each are to be given four or five times a day.
Stimulants are also of great importance to maintain the powers of life. In some cases it is necessary to employ them freely to keep up the waning strength.
The diet should be as nutritious as the patient's assimilative powers will bear. Milk and the animal broths are the best.
When the stomach rejects nourishment it must be given by the rectum, enema of beef tea and milk with brandy being administered every four hours.
When the nervous system is disturbed by pain and want of rest and sleep, some of the forms of opiates or anodynes are to be given, small doses frequently repeated being better than large.
Should diarrhea exist it is to be kept under control. It should not be checked suddenly, as it appears to have an eliminative tendency in cases of blood poison.
Carbonate of ammonia in ten grain doses five or six times a day is a valuable remedy when other tonics cannot be tolerated.
When secondary abscesses form, they should be opened and kept cleansed by some disinfectant fluid, such as carbolic acid or the solution of the chlorinate of soda, in their proper strength.

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