Septicemia.

Definition.—That morbid process commonly known as blood poisoning, in which, with or without a local site of infection, there is an invasion of the blood by bacteria or their toxins.

Etiology.—Whether the disease is caused by streptococci, staphylococci, or a combination of micro-organisms, or to septic intoxication due to the ptomains developed from these organisms, or all these forces combined, has not been definitely determined. On one point, however, all are agreed, and that is, that there must be an absorption of septic material.

Thus it may result from the retention of a partially decomposed placenta or fetus, or a pus tube; old tubercular cavities in which is broken-down tubercle; from septic fluid in the pleural cavity, or from typhoid ulcers. It may be possible that chemical poisons or toxins when absorbed give rise to this condition. The trimming of a corn, the injury from a fish-fin, may be the open. door whereby the poison may enter.

Pathology.—The blood is found to be dark, diffluent, and rich in bacteria. The liver and spleen are soft, dark in color, and show cloudy swelling. The lymphatics are swollen as a result of the inflammation that invariably exists.

Symptoms.—The symptoms of septicemia vary very greatly, according to the degree or kind of infection. Thus in sapremia, the infection is due to septic intoxication from putrefaction changes, and is caused, not by the presence of micro-organisms in the blood, but by ptomains, where the symptoms are less severe than in true septicemia. and where both cocci and toxins are present in the blood. The period of incubation is from one to three or four days.

If caused by ptomains due to changes in milk, cheese, or canned goods, the forming period is very short, only a few hours. A slight chill, accompanied by great gastro-intestinal irritation, ushers in the disease. Febrile reaction follows the chill, the temperature reaching- 103°, 104°, or 105°. The pulse, at first full and frequent, soon becomes small and rapid, with more or less prostration. In the more severe cases, delirium may early manifest itself, though the more frequent condition is that of dullness and apathy, changing to coma.

If there be local infection, as from the puerperal state, the symptoms may develop more gradually. Preceded by prodromal symptoms a marked chill announces the fever, which gradually rises until the temperature reaches 104° or 105°. The tongue, at first broad and coated with a dirty fur, changes to a dry brown coating. The breath is offensive, and the lochia fetid. The skin is dry and more or less constricted; urine high-colored and offensive.

The fever is irregular, sometimes showing marked remission; again of a typhoid type. A low muttering delirium, followed by coma and great prostration, frequently is the warning of the inevitable termination—death. Again the septicemia may be a combined infection as in diphtheria, pneumonia, tuberculosis, endocarditis, etc. Here the symptoms of the local disease precede, and often mask for a long time, the true condition. Thus in a case of diphtheria, the patient may have seemingly passed across the danger-line of a malignant form of the disease. The membrane disappears, the throat clears up, and yet our patient does not convalesce. There is a low, irregular fever, the pulse is small and feeble, the heart is poisoned by the toxins engendered, and the patient dies of heart-failure caused by septicemia; or, if recovery take place, weeks elapse before the patient's health is restored.

What is true of this disease is sometimes observed in pneumonia, erysipelas, and others of a kindred type. Where the infection is due to toxins, the symptoms are of a very grave nature, typhoid in character, the tongue early showing evidence of sepsis. The secretion tells the same story, while the nervous system confirms the evidence of both. Death is usually the termination of this form, in from three to seven days.

Diagnosis.—The history of the patient will assist materially in making our diagnosis. A retained placenta, a puerperal peritonitis, a tubercular ulcer, and kindred lesions, would shed much light on the case, while toxins from milk, ice-cream, cheese, canned goods, etc., would be equally plain, and local injuries could not wen be overlooked.

Its more rapid development and less marked initial chill would enable one to differentiate it from pyemia. In the latter disease the fever is more irregular, chills and rigors recurring as in malarial fever. A jaundiced appearance of the skin is more pronounced in pyemia, and, while not constant, should have weight in recognizing the disease.

Prognosis.—The prognosis will depend upon the character of the poison, the amount of infection, the ability of the system to remove the offending cause, and the skill with which we meet the septic processes by antagonistic remedies.

If the offending cause can be removed before the system is thoroughly infected, the case will terminate favorably. Where there is great gastro-intestinal irritation, the circulation rapid but weak, and when delirium appears early or coma becomes marked, the prognosis will be unfavorable.

Treatment.—It seems hardly necessary to say that we must get rid of all sources of putrefaction that are still further poisoning the patient. If a pus tube be the offending organ, it should be removed or drainage established. If the uterus contain offending material, it should be emptied of all debris. Where there is a diseased endometrium, it should be thoroughly curetted, and, when necessary, this should be followed by flushings with mild antiseptic solutions. Usually, however, the curetting alone is sufficient.

When due to suppurative peritonitis, the abdomen should be opened and free drainage allowed. In some cases a thorough flushing of the abdominal cavity with a weak saline solution will give satisfactory results. Any and all cavities that contain pus should be emptied when it is possible.

The internal medication will depend upon the phase of sepsis as shown by well-defined symptoms. Thus, a patient with a broad, pallid, dirty, heavily leaded tongue, would need a saturated solution of sulphite of sodium, while a patient with bad breath, foul secretions, and yellow, dirty tongue would need a saturated solution of potassium chlorate and hydrastis.

Where the tongue was dry, lips and teeth covered with sordes, the mucous surfaces red,

will give good results.

Where the tongue is full and discolored, the tissues are full and purplish or dusky in color, echinacea or baptisia should be given. The organs of excretion should be kept free, that as much of the effete material as possible may be eliminated through these channels.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.