Ambrosia

“ The primary infection is usually in a wound--for example, a compound fracture--but cases occur in which the point of entrance of the bacteria is not discoverable. The dissemination of the organisms takes place through the medium of infected emboli which form in a thrombosed vein in the vicinity of the original lesion, and, breaking loose, are carried thence in the blood-stream. These emboli lodge in the minute vessels of the lungs, spleen, liver, kidneys, pleura, brain, synovial membranes, or cellular tissue, and the bacteria they contain give rise to secondary foci of suppuration. ”

“ The hæmorrhage is ascribed by Schlesinger and Weichselbaum directly to lesions of the mucous membrane caused by the larvæ; in the case reported by these writers there were found shreds of tissue as well as pus in the stool. The pains occurring spontaneously in the abdomen are at times influenced by position and attitude of the body, often they were more violent after rest and after evacuation of the bowels; often they were continuous, but in that case less intense; pressure on the abdomen is generally little felt. ”

“ Sooner or later, in most instances of the severe form of this disease, emboli from the ulcerations in the heart reach the different organs of the body, and of course the symptoms will depend on the place in which the emboli locate. If in the abdomen, there are colicky pains with disturbances, depending on the organs affected; if in the brain, there may be paralysis, more or less complete. In all infaret occurs in one of the organs of the body there must of necessity occur a necrosis of the part and an added focus of infection. ”

“ By the irritative character of the thrombi themselves, they excite inflammatory action in the adjoining tissues; in this way are produced multiple abscesses. Therefore, we find in persons who die under such conditions, abscesses in the brain, heart, lungs, kidneys and intestines; further we may find purulent inflammation and abscesses in the connective tissues.
It is now necessary to explain the nature and composition of both the thrombus and embolus, and how, through their mechanical agency, the process of embalming may become seriously impaired, if not altogether arrested. ”

“ Again, long standing disease, by affecting the nutrition of an organ and by inducing the deposit of morbid products, may result in atrophy, as frequently happens in affections of the liver and kidneys. Parts that are subjected to continuous pres sure are liable to become atrophied, as is sometimes seen in internal organs which have been pressed upon by tumours or other morbid growths, and is well illustrated in the case of the feet of Chinese ladies, which are prevented from growing by persistent compression exercised from birth. Atrophy may manifest itself simply by loss of sub stance ”

“ The fear of pregnancy after illicit coitus sometimes produces it.
In some unusual cases amenorrhea is present without any discoverable cause. The woman may be in perfect general health, and the sexual organs may be well developed, at least so far as can be determined by physical examination.
In amenorrhea there is often a general periodical disturbance that marks the times at which the menstrual bleeding should occur. There may be headache, flashes of heat, nervousness, nausea and vomiting, and a feeling of fulness and pain in the pelvis. ”

“ Ulcerative endocarditis, infectious osteomyelitis, pulmonary gangrene, general pyæmia, and, as is claimed by a few authors, typhoid fever, are often accompanied by multiple abscesses in the brain-substance. Usually the foci are small, as may be readily inferred from the fact that they are of embolic origin, the emboli being usually so small as to lodge in very small vessels, and that the fatality of the primary disease is so great as to cut short life before the abscess can reach larger dimensions. For the same reasons the symptoms they produce are rarely distinctive. ”

“ Sometimes the nasal mucous membrane becomes affected, and produces a discharge--at first watery, but later sanious and purulent. Necrosis of the bones of the nose may take place, in which case the discharge becomes peculiarly offensive. In nearly every case metastatic abscesses form in different parts of the body, such as the lungs, joints, or muscles.
During the development of the disease the patient feels ill, complains of headache and pains in the limbs, the temperature rises to 104 or even to 106 F., and assumes a pyaemic type. The pulse becomes rapid and weak. ”

“ Secondary abscesses are thus formed in those parts, and these in turn may be the starting-point of new emboli which give rise to fresh areas of pus formation. The organs above named are the commonest situations of pyaemic abscesses, but these may also occur in the bone marrow, the substance of muscles, the heart and pericardium, lymph glands, subcutaneous tissue, or, in fact, in any tissue of the body. Organisms circulating in the blood are prone to lodge on the valves of the heart and give rise to endocarditis. ”

“ Sometimes the blood persists as a collection of fluid with a newly formed connective-tissue capsule, constituting a hæmatoma or blood cyst, more often met with in the scalp than in other parts.
The impairment of the blood supply of the skin may lead to the formation of blisters, or to necrosis. Death of skin is more liable to occur in bleeders, and when the slough separates the blood-clot is exposed and the reparative changes go on extremely slowly. Suppuration may occur and lead to the formation of an abscess as a result of direct infection from the skin or through the circulation. ”

“ It will sometimes happen, that, after the symptoms of secondary inflammation of internal organs have commenced, an abscess will present itself near the surface of the body, and relief will be afforded to the part first affected; at other times, an obstinate and violent diarrhœa will precede recovery. Although the mode of treatment adopted may have little influence either in bringing on, or checking, such salutary actions, it is important to watch their occurrence, and perhaps still more important, to be careful not to mistake a remedial action for a symptom of the disease. ”

“ In acute cases multiple abscesses in the kidney may give rise to pain and albuminuria, abscesses in the lungs to dyspnoea, while acute peritonitis may arise from rupture of a splenic abscess into the peritoneal cavity, and sudden blindness be the result of the plugging of the arteria central is retinae. The duration of a case of pyaemia depends on the severity of the infection. Death may occur from the formation of abscesses in vital organs such as the brain and heart, or from exhaustion from continued suppuration, or chronic forms may after months pass on to complete recovery. ”

“ How curious and yet how intelligible is the fact that, though a headache may be induced by even a slight auto-intoxication, an abscess may exist within the brain without causing pain. When an obliterative endarteritis is threatening a leg with anemic gangrene, or when one lies too long in the same position on a hard bed, there is threatening injury from local anemia, and as a result there is acute pain, but when the obliterative endarteritis threatens anemia of the brain, or when an embolism or thrombosis has produced anemia of the brain, there may be no accompanying pain. ”

“ The Stoppage of such Bodies is sometimes attended, and that without much Violence, with a small Suppuration, which loosens them; and then they are either returned upwards through the Mouth, or descend into the Stomach. But at other Times an extraordinary Inflammation is produced, which kills the Patient. Or if the Contents of the Abscess attending the Inflammation tend outwardly, a Tumour is formed on the external Part of the Neck, which is to be opened, and through whose Orifice the obstructing Body is discharged. ”

“ The position of the abscess in relation to different joints is fairly constant and is determined by the anatomical relationships of the capsule and synovial membrane to the surrounding tissues. The bursæ and tendon sheaths in the vicinity may influence the direction of spread of the abscess and the situation of resulting sinuses. When the abscess is allowed to burst, or is opened and becomes infected with pyogenic bacteria, there is not only the risk of aggravation of the disease and persistent suppuration, but there is a greater liability to general tuberculosis. ”

“ The occurrence of endocarditis, as indicated by alterations in the heart sounds and the development of murmurs, may cause widespread infective embolism, and metastatic suppurations in the kidneys, heart-wall, and lungs, as well as in other bones and joints than those primarily affected. The secondary suppurations are liable to be overlooked unless sought for, as they are rarely attended with much pain. ”

“ This kind of abscess, though not itself dangerous, has given opportunity for the inoculation of venereal matter in the hands of accoucheurs, and of putrid matter from the dissection of diseased bodies; and has thus been the cause of disease and death. When putrid matter has been thus absorbed from a dead body, a livid line from the finger to the swelled gland in the axilla is said to be visible; which shews the inflammation of the absorbent vessel along its whole course to the lymphatic gland; and death has generally been the consequence. ”

“ As previously mentioned, O’Shea met with a case of hemorrhage into the cæcum which was mistakenly operated upon for appendicitis. Hæmothorax and hæemopericardium occur, especially associated with local inflammatory processes of tuberculous nature. The clinical aspect of hemorrhage of the gastro-intestinal and the genito-urinary tracts will be considered elsewhere.
In the scurvy of adults as well as that of infants, the nails and the hair are altered by the nutritional condition. ”

“ This is a disease peculiar to nursing women. The first symptom is a slight pain or soreness in some part of the "breast," which continues to increase for a day or two, when a chill, more or less severe, sets in, followed by high fever and quick pulse, headache and great restlessness. The gland swells and becomes very painful. This is generally a disease of rather slow progress, running eight or ten days and sometimes two or three weeks before abscess forms and "points" to the surface. ”

“ Pathology.—The abscess may involve one or more lobules, or engage almost the entire lobe, or the abscesses may be scattered throughout the whole lung.
Treatment.—Should hemorrhage occur, treat this case the same as for pulmonary hemorrhage. If no hemorrhage occurs, give the body a complete injection with a mild fluid and inject the pleural sacs from the first intercostal space or the apex of the cavity. For transportation, govern yourself according to the provisions of the transportation laws. ”

“ At the extreme periphery of the lung the danger is less, for the vessels are smaller and serious hemorrhage less probable, through the retention and decomposition of blood in small bronchi with later abscess formation is a contingency. The nature of the bridge of tissue is to be considered; should it be cicatricial, the result of prolonged inflammatory processes, it may be carefully excised without very great risk of serious complications. The blood vessels are diminished in size and number by the chronic productive inflammation, which more than offsets their lessened contractility. ”

“ On opening the chest, slight hemorrhages may be noted in the pericardium and in the visceral and costal pleuræ. The heart is frequently enlarged, and the pericardial sac contains an excess of serum; the right ventricle, however, is not found disproportionately hypertrophied. Pneumonia is met with very frequently and constitutes a common terminal infection.
On opening the abdomen we may note subperitoneal hemorrhages of the muscular wall or of the coils of intestine. The liver and spleen are generally normal, as is the pancreas. ”

“ Some time after the abscess forms, and frequently before ulceration takes place, the neighbouring lymphatic glands swell, and become affected with a similar action, and follow the same course with the original sore; only in them the progress is generally more rapid.
After ulceration takes place, sometimes before it, if the abscess be considerable, hectic fever takes place; the countenance becomes sallow and unhealthy; the pulse quickens, and becomes small and sharp; the strength fails; night sweats come on, and colliquative diarrhœa hastens death. ”

“ Thus, if the infection spreads upwards through the attic and tegmen tympani, it may lead to extra-dural abscess or to meningitis of the middle fossa, or to a temporo-sphenoidal abscess. Similarly, disease of the mastoid cells posteriorly may give rise to a perisinuous abscess, to meningitis of the outer surface of the posterior fossa, to lateral sinus thrombosis, or to a cerebellar abscess situated superficially and involving the outer portion of its lateral lobe just behind the lateral sinus; or caries of the floor of the tympanic cavity may give rise to thrombosis of the jugular bulb ”

“ Complications and Sequels.—Recovery without mishap is the usual result in mumps, with the exception of involvement of the testicles. Rarely there are high fever, delirium, and great prostration. Sometimes after inflammation of both testicles in the young the organs cease to develop, and remain so, but sexual vigor is usually retained. Sometimes abscess and gangrene of the inflamed parotid gland occur. Recurring swelling and inflammation of the gland may occur, and permanent swelling and hardness remain. Meningitis, nervous and joint complications are among the rarer sequels. ”

“ Inflammation of the Womb begins generally between the fourth and ninth day after delivery, and commonly with retention of the lochia: with fever, heat, and pain about the uterine region, elevation and hardness of the abdomen below, with tenderness and acute sensibility on pressure, irritation to urine and stools, colick, intense headach, strong full pulse. The whole, or different parts only, of the womb may be inflamed, whence the contiguous viscera of the pelvis will be differently affected. Where the inflammation is not violent, the crisis is about the fourth or seventh day from the attack ”