SEPTIOEMIA AND PY^MIA 269 



tions, as they occur naturally, are due to the activity of 

 micro-organisms in almost all instances. 



Sapraemia, septicaemia, and pyaemia need defining. By 

 " sapraemia " is meant the constitutional condition arising 

 from the absorption of the toxic products elaborated by 

 micro-organisms, the latter being localised and absent 

 from the general circulation. In the acute form it is not a 

 common condition ; it occurs in the case of large unopened 

 abscesses and when fragments of placenta, etc., are 

 retained in the uterus after parturition. By opening and 

 draining the abscess or by clearing and washing out the 

 uterus the symptoms rapidly abate. In septicaemia not 

 only is there usually (though not necessarily) a local site 

 of infection, but in addition micro-organisms are present 

 in the general circulation. It is true they are not abundant 

 in the latter situation, and Cheyne believes that they are 

 to a large extent arrested in the capillaries. Micrococci 

 and streptococci are the commonest forms. Pyaemia is 

 characterised by the presence of micro-organisms, most 

 frequently streptococci, in the general circulation, together 

 with the formation of abscesses in various situations. 

 These arise usually from suppurative phlebitis with the 

 formation of septic emboli and thrombi. The sequence 

 of events, according to Cheyne, is (a) phlebitis in direct 

 connection with the wound ; (6) a thrombus impregnated 

 with micro-organisms is formed in the vein ; (c) this 

 softens and disintegrates, and particles or emboli are 

 carried to distant parts ; (d) these lodge in the capillaries, 

 with the formation of infarctions and abscesses. Sup- 

 purative pylephlebitis is a pyaemia affecting the portal 

 system of vessels. As regards the so-called chronic 

 pyaemia or multiple abscesses, Cheyne considers that it 

 differs from true pyaemia in that embolism plays no part. 

 Organisms, probably generally of low virulence, gain 

 access to the blood-stream, infect any locality where the 



