Clinical Features.—Before antiseptic surgery was practised, pyæmia was a common complication of wounds. In the present day it is not only infinitely less common, but appears also to be of a less severe type. Its rarity and its mildness may be related as cause and effect, because it was formerly found that pyæmia contracted from a pyæmic patient was more virulent than that from other sources.
In contrast with sapræmia and septicæmia, pyæmia is late of developing, and it seldom begins within a week of the primary infection. The first sign is a feeling of chilliness, or a violent rigor lasting for perhaps half an hour, during which time the temperature rises to 103°, 104°, or 105° F. In the course of an hour it begins to fall again, and the patient breaks into a profuse sweat. The temperature may fall several degrees, but seldom reaches the normal. In a few days there is a second rigor with rise of temperature, and another remission, and such attacks may be repeated at diminishing intervals during the course of the illness ([Figs. 12] and [13]). The pulse is soft, and tends to remain abnormally rapid even when the temperature falls nearly to normal.
The face is flushed, and wears a drawn, anxious expression, and the eyes are bright. A characteristic sweetish odour, which has been compared to that of new-mown hay, can be detected in the breath and may pervade the patient. The appetite is lost; there may be sickness and vomiting and profuse diarrhœa; and the patient emaciates rapidly. The skin is continuously hot, and has often a peculiar pungent feel. Patches of erythema sometimes appear scattered over the body. The skin may assume a dull sallow or earthy hue, or a bright yellow icteric tint may appear. The conjunctivæ also may be yellow. In the latter stages of the disease the pulse becomes small and fluttering; the tongue becomes dry and brown; sordes collect on the teeth; and a low muttering form of delirium supervenes.
Secondary infection of the parotid gland frequently occurs, and gives rise to a suppurative parotitis. This condition is associated with severe pain, gradually extending from behind the angle of the jaw on to the face. There is also swelling over the gland, and eventually suppuration and sloughing of the gland tissue and overlying skin.
Secondary abscesses in the lymph glands, subcutaneous tissue, or joints are often so insidious and painless in their development that they are only discovered accidentally. When the abscess is evacuated, healing often takes place with remarkable rapidity, and with little impairment of function.
The general symptoms may be simulated by an attack of malaria.
Prognosis.—The prognosis in acute pyæmia is much less hopeless than it once was, a considerable proportion of the patients recovering. In acute cases the disease proves fatal in ten days or a fortnight, death being due to toxæmia. Chronic cases often run a long course, lasting for weeks or even months, and prove fatal from exhaustion and waxy disease following on prolonged suppuration.
Treatment.—In such conditions as compound fractures and severe lacerated wounds, much can be done to avert the conditions which lead to pyæmia, by applying a Bier's constricting bandage as soon as there is evidence of infection having taken place, or even if there is reason to suspect that the wound is not aseptic.
If sepsis is already established, and evidence of general infection is present, the wound should be opened up sufficiently to admit of thorough disinfection and drainage, and the constricting bandage applied to aid the defensive processes going on in the tissues. If these measures fail, amputation of the limb may be the only means of preventing further dissemination of infective material from the primary source of infection.
Attempts have been made to interrupt the channel along which the infective emboli spread, by ligating or resecting the main vein of the affected part, but this is seldom feasible except in the case of the internal jugular vein for infection of the transverse sinus.