90 HIS TOL OG Y OF NL ^TRIEy T PL UIDS. 



12. Py&mia and Septic&mia. 



The views of surgeons respecting the febrile and other con- 

 stitutional disorders following injuries have been greatly modi- 

 fied by the germ theory of disease. Billroth says: "By sep- 

 ticaemia we understand a constitutional, generally acute dis- 

 ease, which is due to the absorption of various putrid sub- 

 stances into the blood, and it is thought that these act as 



o 



ferments in the blood and spoil it so that it cannot perform its 

 physiological functions." "Pyaemia holds the same relation 

 to simple inflammatory and suppurative fever that septicaemia 

 does to simple primary traumatic fever; it is characterized by 

 intermittent attacks of fever and by the frequency of metas- 

 tatic abscesses and metastatic diffuse inflammation." Cheyne 

 says: " Septicaemia is a complicated affection, and probably 

 arises under several circumstances. Continued absorption of 

 the poisonous material (leucomaines) from wounds will keep 

 up a feverish state with all the symptoms of septicaemia, and 

 if long continued may end fatally. In other cases the micro- 

 cocci grow in the tissues of the wound and pour their prod- 

 ucts, or ptomaines, as they are called, into the blood; here 

 micrococci may be found in the blood, but the essential seat of 

 disease is in the tissues. In a third form micrococci grow in 

 the blood, and, multiplying there, give rise to the symptoms. 

 In a fourth form organisms grow in the blood, but they belong 

 to the class of bacilli. The last two cases correspond to what 

 is found in the lower animals. In them septicaemia is caused 

 by more than one form of organism growing in the blood and 

 giving rise to symptoms and post-mortem appearances which 

 can only be classed together as septicaemia." The results of 

 practical experience combine with microscopical observation 

 to show the advantages of great cleanliness and antiseptic 

 treatment in all surgical cases of importance. 



