Septicemia

“ Septicemia is a condition wherein so-called pathogenic bacteria and their accompanying poisons are present in the blood. These bacteria may develop within the blood or they may be carried into the blood from some local point where they are developing due to the condition of the tissues as a result of interference with transmission of mental impulses. ”

“ When the wound has become “ surgically clean ” recovery is usually rapid.
Septicaemia is an acute infective disease differing from sapraemia in that the micro-organisms themselves are absorbed, entering the general circulation, and may on examination be found in greater or lesser number in the blood-stream itself. The organism or organisms grow and reproduce themselves in the blood or tissues. A number of different organisms have been isolated from the blood-stream in cases of septicemia. ”

“ The tendency of the disease is to subside spontaneously, but sometimes it is necessary to incise and drain the kidney, or even to remove it; while in others the infection is so virulent that the patient dies of septicemia. ”

“ There is nothing more easy to superpose—as it were—two distinct diseases and to produce what might be called a SEPTICEMIC PURULENT INFECTION, or a PURULENT SEPTICEMIA. Whilst the microbe-producing pus, when acting alone, gives rise to a thick pus, white, or sometimes with a yellow or bluish tint, not putrid, diffused or enclosed by the so-called pyogenic membrane, not dangerous, especially if localized in cellular tissue, ready, if the expression may be used for rapid resorption ”

“ Hemorrhagic septicemia is a name applied to a highly fatal, infectious disease existing in various species of domestic and wild animals, from a microorganism having definite biological characters and possessing the properties of producing clearly defined and characteristic lesions. ”

“ The worst cases of vaccinal infection are not, however, those which have external skin eruptions but in which there is little or no indication externally of purulent infection, except possibly at the sore itself, and in which the suppuration or infection extends inwardly and attacks one or more of the internal organs and kills by general internal suppuration known as “Pyæmia” or “Septicemia,” which may show itself by serious suppurations in lungs, bronchi, pleura, heart, brain or spine, or in the digestive or other organs. ”

“ Several forms of septicemia and pyæmia have also been studied satisfactorily in animals. Indeed, the analogy between these and the kindred forms of blood-poisoning in man is so close that there can be no reasonable doubt as to the similarity of cause. ”

“ Pathology.—The body does not undergo putrefaction as rapidly as in septicemia. The first effects of the morbid changes are found in the veins, which result in thrombi. These thrombi are found in the various organs and tissues of the body.
Treatment.—Use the precautions observed in the treatment for septicemia. Give the body a complete arterial injection using half strength fluid for the first bottle of the injection. ”

“ Pregnant women belonging to this class go into confinement with their blood so heavily charged with the by-products of an imperfect metabolism that they are very liable to have septicemia.
People who think they must have "three square meals a day" must have catarrh, rheumatism, tonsilitis, quinsy, pneumonia, typhoid fever, and all sorts of bowel trouble including appendicitis. ”

“ It is probable that these complications are all the result of septic infection and absorption, and since the modern antiseptic treatment of burns they have become much less common. The third period is prolonged until recovery takes place. Death may result from septic absorption, or from the wound becoming infected with some organism, as tetanus, erysipelas, &c. The prognosis depends chiefly on the extent of skin involved, death almost invariably resulting when one-third of the total area of the body is affected, however superficially. ”

“ In order that the treatment may be satisfactory, the abscess must be seen before it has opened. Then, except in very rare and peculiar cases, [6] there are no septic organisms in the contents, so that it is needless to introduce carbolic acid into the interior. Indeed, such a proceeding would be objectionable, as it would stimulate the pyogenic membrane to unnecessary suppuration. All that is necessary is to guard against the introduction of living atmospheric germs from without, at the same time that free opportunity is afforded for the escape of discharge from within. ”

“ No one who studies the results of empyema in the past can question that the greatest danger is from the blood-poisoning known as septicæmia, caused by the absorption of the septic infection by the lymphatics.176 No matter what may be the nature of septicæmia, it is sufficient that the vast surfaces of the pleura produce certain prurient secretions, which, when absorbed and carried into the circulation, cause hectic fever with its results. ”

“ From no surface in the body can absorption take place quicker than from the synovial membrane of a joint. So soon, therefore, as this membrane comes in contact with septic material, so soon does a severe septic fever make its appearance. The septic matter has gained the blood-stream, and the patient succumbs to septic poisoning. ”

“ The symptoms of SEPTICÆMIA LYMPHATICA.—The symptoms of blood-poisoning in the infectious diseases of childbed vary to a considerable extent according to the channel through which the septic germs enter the general circulation. In the murderous epidemics which prevail in lying-in hospitals the lymphatics are, as a rule, the vessels primarily invaded. It is to this form that the cases already described belong, where, with diphtheritic patches upon the utero-vaginal canal and sero-purulent oedema of the parametrium, there are associated pyæmic peritonitis and deformation of the blood-corpuscles ”

“ Pyæmia is closely allied to septicæmia. It is due to the setting free of bacterial emboli or septic emboli from a broken-down, septic thrombus in the neighborhood of the wound, and the circulation of these emboli in the blood until they are arrested and form the characteristic metastatic abscesses, especially in the lungs, joints, abdominal viscera, and parotid gland. Almost always the source of infection is an infected wound. Granulation does not prevent the occurrence of pyæmia, which, as a rule, commences at a later stage than septicæmia. ”

“ The accumulation of septic matter in the uterus after labor, in contact with the raw surface left by the separation of the placenta, would also present the conditions favorable to acute septic intoxication. In the present day, when the necessity of thorough drainage of wounds is so thoroughly understood, and the means at the surgeon's command for carrying it out are so efficient, it can only be under peculiar circumstances that a sufficient quantity of putrid serum or pus to yield the fatal dose of the septic poison is allowed to accumulate in the wound. ”

“ The prompt removal of the cause of septic absorption, the flushing out of the wound with weak antiseptic solutions, in order to mechanically remove any decomposing masses, and the establishment of proper drainage in deep wounds, is usually followed by a fall in temperature and an improvement in the general condition. A strong, preferably mercurial, purgative should be given to aid in the elimination of toxic material. For the same purpose the injection into the veins or into the cellular tissue of large quantities of normal saline solution is useful. ”

“ The micro-organisms are conveyed by the blood-stream to different parts of the body, in which as in the original wound itself they both multiply and set up factories for the production of toxins. The disease commonly follows blows or wounds which have not been treated on surgical lines. Much laceration of the tissues at the time of the injury offers increased liability to infection. Septicaemia is frequent in spreading gangrene, in diseases of the periosteum, and in fevers such as scarlatina, diphtheria or plague, and in the puerperal state. ”

“ If air destroys them, if their culture is impossible in contact with air, how can septicæmia exist, since air is everywhere present? How can blood exposed to the air become septic from particles of dust on the surface of objects or which the air holds in suspension? Where can the septic germs be formed? The objection seems a serious one, but it disappears before a very simple experiment. Take some serum from the abdomen of a guinea-pig which has died of acute septicæmia. It will be found full of septic vibrios in process of generation by fission. ”

“ Therefore, the term was made applicable to the morbid conditions existing in anthrax, glanders, typhus and typhoid fevers, variola, and also all forms of purulent and putrid infections. Guérin now adds: "Fortunately, for several years the most competent authors seem to have wished to [p. 954] reserve the name of septicæmia for what surgeons call putrid infection, and for the morbid state that the experimenters produce by the injection of putrid material into healthy animal tissues; it is consequently the experimental septicæmia which we aim at first and foremost."20 ”

“ The micro-organisms causing septicæmia are the same as those of pyæmia, but they differ somewhat in activity, and act upon a system with a modified susceptibility, and above all one void of lesions in the internal membrane of the vascular system. The symptoms can be developed by the introduction of the ptomaines and toxins alone, which hypothetical condition has been named septic-intoxication. In case of excessive doses of septic material, death occurs so early as to indicate simple narcosis. ”

“ Here the clean metallic surface presenting no recesses, like those of porous lint, for the septic germs to develop in, the fluid exuding from the surface of the granulations has flowed away undecomposed, and the result is absence of suppuration. This simple experiment illustrates the important fact, that granulations have no inherent tendency to form pus, but do so only when subjected to a preternatural stimulus. Further, it shows that the mere contact of a foreign body does not of itself stimulate granulations to suppurate; whereas the presence of decomposing organic matter does. ”

“ The term _sepsis_ as now used in clinical surgery no longer retains its original meaning as synonymous with "putrefaction," but is employed to denote all conditions in which bacterial infection has taken place, and more particularly those in which pyogenic bacteria are present. In the same way the term _aseptic_ conveys the idea of freedom from all forms of bacteria, putrefactive or otherwise; and the term _antiseptic_ is used to denote a power of counteracting bacteria and their products. ”

“ PREFERRED ANTISEPTICS ANTISEPTIC SOLUTIONS
These are solutions used for the destruction of and to arrest the progress of microörganisms that have found their way into wounds—the cause of sepsis, as exhibited by fever, suppuration, and putrefaction. These preparations are called antiseptics and are used to render parts aseptic. They vary much in their destructive power, effect on tissue, and toxic properties. ”

“ I am fully of the opinion that chemical antiseptics would be needless if absolute freedom from germs was easily obtained. When I know that even such an enthusiast as I myself is continually liable to forget or neglect some step in this direction, I feel that the additional security of chemical antisepsis is of great value. It is difficult to convince the majority of physicians, and even ourselves, that to touch a finger to a door knob, to an assistant's clothing, or to one's own body, may vitiate the entire operation by introducing one or two microbic germs into the wound. ”

“ Pathogenic bacteria are invariably associated with puerperal fever, and to them the infectious qualities of the disease are due. I have been explicit regarding the evidence concerning bacteria in septic diseases, because it places the question of the infectious group of puerperal fever cases in the following position: Experiences occurring clinically, as well as those produced upon animals, teach us that certain lesions and symptoms, similar to those we are accustomed to regard as characteristic of puerperal fever, results from septic poisoning. ”

“ Persons of this temperament are more liable to absorption of morbid products within the body, which are in a state of decomposition, producing an infection of the blood, technically termed septicæmia. The fatal results which so suddenly follow child-bed fever are thus produced. This kind of poisoning sometimes takes place from the absorption of decomposed exudation in diphtheria, and, though rarely, from decomposing organic products collected in the lungs. Whenever the absorption of poison does take place, fatal consequences usually follow. ”

“ This man has what is called septic fever, which is produced by an infection of the system from bacterial germs, which were produced by the wound, so that the blood carried the germs throughout the body, and produced what is called a toxic condition. Toxic means poison, or poisoned state. When the blood is thus affected it is unable to do its proper duty, and a high heat is produced within. ”

“ As a matter of fact, however, one feels that in many of these cases the intercurrent pneumonia or infection—frequently of the bladder,—bedsores, sepsis, and the like, are merely accidental incidents in a condition that is leading to death, and which has caused a lowered resistance to infection. In certain instances where nursing is exceptionally good and where no such infection occurs, the patient continues to grow weaker and weaker, paralyses of all the muscles follow and finally paralysis of deglutition or 198respiration may lead to death. ”