Chronic Sapremia.
—Chronic sapremia is a better name for what used to be known as hectic fever. It is characterized by rapid, feeble pulse, a temperature but little elevated in the morning and rising to 102° or 103° in the latter part of the day, with profuse perspiration, or sometimes colliquative sweats that leave patients exhausted. There is usually a distinctive flushing of the cheeks. Emaciation is a marked feature in most instances. Hectic means simply habitual fever. It is met with particularly in tuberculous cases, whether of lungs or bones or joints, in empyema, psoas abscess, and most all chronic pyogenic infections. It is frequently followed by or associated with amyloid or waxy degeneration of the liver, kidneys, and spleen. This process commences in the walls of the bloodvessels and by its spread to the surrounding connective tissue leads to notable enlargement of these organs, with albuminuria, edema, ascites, and the usual associated phenomena.
Treatment.
—Treatment, in addition to that already indicated above, should be addressed to removal of the cause. In all instances it should comprise attention to elimination, digestion, nutrition, and fresh air. By such measures even distinct amyloid changes may be arrested, or possibly improved.
Cryptogenetic or Spontaneous Septicemia.
—Cryptogenetic or spontaneous septicemia is a term applied to those cases in which the port of entry of the germs is no longer visible—e. g., a hypodermic puncture—or cannot be positively determined. On careful study this may be found to consist of a small focus where pus is forming within narrow confines and under great pressure. Under these circumstances, as Kocher has shown, toxic virulence is rapidly augmented. This is doubtless one reason why the septic features of many cases of osteomyelitis and appendicitis are so pronounced.
SEPTICEMIA.
According to the views thus enunciated, the difference between sapremia and septicemia is not one of character as much as of location. In septicemia the putrefactive action is no longer confined to material enclosed by (yet not of) the tissues themselves, but has spread from this to the surrounding living cells, which are being attacked by bacterial enemies; in other words, we deal with infection of living tissues rather than with mere intoxication. This is a progressive invasion of tissues by continuity, with a constantly proceeding systemic intoxication by poisons produced in larger quantities. So rapid may this action be—as may be seen in malignant diphtheria—that the individual speedily succumbs before evidences of abscess or local gangrene appear. On the other hand, providing that the toxic action is less pronounced or the patient’s vitality more enduring,—i. e., his tissues more resistant—abscess, phlegmon, or local gangrene may result in the destruction of tissue being limited to the environs of the parts first involved. Bacteria are also found in the blood.
While septicemia then may be a direct continuance of an original sapremia, it is not intended to intimate that it may not originate de novo; that is, many cases may begin as a pronounced septicemia from a local infection. This is the case, for instance, with the majority of dissecting wounds, etc.