These are surgical affections whose secondary complications in the way of abscesses, infarcts, tumors, etc., have been dealt with in other parts of this work. It will be well to group all of these infections with anthrax, glanders, etc., into a class of infections which may be followed by tardy or late surgical sequels that may call for more or less radical operation. In the case of gonorrhea this is best seen, perhaps, in the so-called pus tubes of the female pelvis, which often require removal years after the date of the primary invasion.
Endocarditis and pyemia are occasionally of solely gonorrheal origin, as well as peritonitis by extension from infected pelvic viscera.
THE PUERPERAL STATE.
This is seldom followed by surgical sequels, save in the instance of mechanical lacerations demanding plastic repair, or of septic infections, which, when life is saved, sometimes lead to disastrous consequences. Puerperal septicemia is in no respect different, pathologically speaking, from septicemia due to any other presumably streptococcus invasion; and the predilection which streptococci manifest for serous membranes, and especially joints, is well known. Consequently after puerperal fever one may meet with articular or peri-articular abscesses, affections of tendon sheaths, lymphatics, etc., or the complication may assume a different type, the veins and their contents being mainly involved, with thrombosis, infarct, etc., for its immediate results.
There is probably no disease of known or suspected germ origin which may not be followed by disastrous or unexpected surgical complications, while even degenerative changes, for which as yet no theory of parasitism has been invoked, are followed by conditions which may call for serious surgical measures. In other words, the surgical complications of any so-called non-surgical disease may loom up at any moment in any case.
CHAPTER XVI.
POISONING BY ANIMALS AND PLANTS.
Certain poisons or deleterious substances are introduced in various ways into the human system from without, some of which produce only symptoms of moderate intensity, while others are fatal. It is authentically stated that in India many thousands of individuals lose their lives every year as the result of the bites of poisonous snakes. In 1903 there were officially reported 23,164 deaths from this cause. Nothing approaching such injuries in frequency or intensity can be found in any other part of the world. Animal poisons may be introduced by animals of many species. The poison of hydrophobia has been described. The bites of the mammalia may be serious and may be followed by septic symptoms, but are not ordinarily regarded as due to any special toxin secreted by the animal. A number of reptiles, however, possess special poison glands which are connected, in most of them, with a tooth on either side of the upper jaw which is canaliculated, and serves as a duct through which the poison is injected when the animal inflicts its bite.
SNAKE BITES.
The principal poisonous serpents in North America are the rattlesnakes—of which there are several species, usually placed at eighteen—the copperheads, the moccasins, and the vipers. Some of these have movable poison fangs, some fixed. In other parts of the world others equally or even more poisonous are known.
The poison gland is analogous to the parotid in location and structure. The duct which runs through it is so dilated as to contain a small amount of the peculiar poison. The amount of poison contained in these reservoirs varies from eight to twelve minims, and is secreted somewhat slowly. It seems to be, in some cases at least, a glucoside; in others, a toxalbumin. It is capable of being preserved either dry or in alcohol or in glycerin. The active poisonous principle seems to pertain to a globulin or to a peptone. Almost all of these venoms are innocuous if swallowed, and like septic infections seem inoculable only through the tissues and the circulating fluids. According to Mitchell, the venom of the rattlesnake renders the blood incoagulable, paralyzes the walls of the capillaries, and facilitates escape of leukocytes into the tissues, thus making actual hemorrhagic swelling occur; while the red corpuscles rapidly lose shape and fuse into irregular masses and their hemoglobin is dissolved or disappears. This poison seems to paralyze both the respiratory centre and the heart. Cobra poison, not containing globulin, at least to a great extent, does not produce the rapid changes of rattlesnake poison.