CHAPTER X. 



SEPTICAEMIA. 



SEPTIC processes were among the first to excite interest in the 

 part played by microorganisms in disease, and it is due to this fact 

 that so much more has been said and written on septicaemia than 

 on any other microbic disease in surgery. Although some of the 

 best pathologists have been diligently investigating this subject for 

 years, we still remain in the dark concerning its true etiology, and 

 its relation to other infective processes. True sepsis is looked upon 

 as a general infection from some local source, unattended by any 

 gross pathological changes. Some writers have claimed the differ- 

 ence between septicaemia and pyaemia to be a quantitative and not a 

 qualitative one, while others maintained that pyaemia was a specific 

 disease sui generis, and that it was in nowise related to sepsis. 

 They resemble each other so far, that both are caused by micro- 

 organisms. 



HISTORY. The first reliable investigations into the microbic 

 origin of sepsis were made by Rindfleisch in 1866, and somewhat 

 later by Klebs, Recklinghausen, Waldeyer, and Hueter. Rindfleisch 

 found bacteria in abscesses, while the researches of Klebs (^Beitrdge 

 zur pathol. Anatomie der Sehussu-unden, Leipzig, 1872) initiated a 

 new era in the etiology of septic diseases. The latter author diifer- 

 entiated between septicaemia and pyaemia, although he claimed that 

 putrid and septic infection were the same. He found in the tissues 

 altered by septic processes, also in the lymph spaces and in the 

 blood, a microbe, a round coccus, isolated and in groups, which he 

 termed mikrosporon septicum. Rosen bach (Microorganismen bei den 

 Wound-infections Krankheiten des Menschen, Wiesbaden, 1884) in 

 three cases of septicaemia which he subjected to bacteriological ex- 

 amination, found the staphylococcus pyogenes aureus present each 

 time in the pus; in two of these cases he isolated and cultivated 

 from the products of septic inflammation the bacillus saprogenes. 

 In two of the cases no cultivation could be obtained from the blood. 

 In two cases of gangrene, with general septicaemic symptoms, the 

 microbe found was the streptococcus pyogenes. Intoxication symp- 

 toms from the introduction of putrid material, he attributed to the 

 presence of one or more varieties of the bacillus saprogenes, which 

 he designates, respectively, Nos. 1, 2, 3. No. 1 he cultivated from 



