PURULENT INFECTION—PYOHAMIA. 177 
must avoid the stagnation of the pus. Frequent antiseptic washes and 
continued irrigation are the best means to use. Often enlarging 
‘incisions, counter-openings and drainage have to be made; though one 
ought, in a general way, to avoid the wounding of granulating layers ; 
there should be no hesitation, however, if the case is urgent. The red 
lot iron, a sharp or a long pointed cautery, is better than the bistoury : 
the eschar remains adherent to the tissues underneath until they are 
lined with granulations, the penetration of the micro-organisms cannot 
take place as upon bleeding surfaces. The washings should be com- 
pleted by irrigations with an antiseptic solution, sufficiently strong to 
destroy the germs still adherent to the granulations. 
For anfractuous wounds, carbolic or corrosive sublimate nebuliza- 
tion are very advantageous. If they exist on the legs, long tepid anti- 
septic baths of twenty minutes or half an hour and repeated several 
times a day should be prescribed. Antiseptic or simply absorbing 
powders may also be useful. 
Attention to hygiene should not be overlooked: spacious, well 
ventilated, moderately warm locality ; food of good quality : for weak 
patients, if appetite remains, abundant feeding, milk, tonics, a stim- 
ulant (alcohol, hay tea). 
The outset of pyohzemia is slow. Often the wound is but little 
changed ; the granulations are pale, soft, flabby, and suppuration is less 
abundant ; but there is no other prominent symptom, no diffuse tume- 
faction, no edema. As to general disturbances, they are those of a 
strong traumatic fever, with febrile rushes, chills, sudden thermic 
risings, inappetency, dulness, a kind of typhoid condition with dull 
coloration of the mucous membranes and an irregular pulse ; their mean- 
ing is positive, even when the patient has been previously under the 
influence of a more or less marked febrile reaction. To inspect the 
wound, enlarge it, cleanse it well, sponge its cul-de-sacs with strong 
disinfecting solution (chloride of zinc, carbolic acid, corrosive subli- 
mate), dust it with iodoform and irrigate it continually with cold water. 
This must be done at once. 
Cautery is useful to destroy the fungus granulations which conceal 
putrid centers, and to reach the infectious germs deep down. To try 
to “render the wound aseptic,” as advised by some, is evidently an 
illusion ; but it must be purified as much as possible. If purulent 
superficial collusions appear, they must be opened at once and treated 
as ordinary abscesses. 
The internal treatment, most uncertain in its results, consists in the 
administration of agents able to build up the strength, impede the pullu- 
lation of the microbes and neutralize the effects of their toxines. Among 
the numerous substances recommended, those that are most used are: 
alcohol, coffee, sulphate of quinine, carbolic acid, creosote, creolin, spirits 
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