Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    163/864 page 147
    Pj'remia, moreover, is especially frequent after infective osteomyelitis and infective periostitis, even before the suppurating cavity is opened and exposed to the outer air. Here the poison probably depends upon a special form of micro-organism, as it ■n'ould also appear to do when occurring in connection with erysipelatous wounds, diifuse cellulitis, and hospital gangrene, and when occur- ring, as it sometimes does, after gonorrhoea, ulceration of the intestines in typhoid fever and dysentery, and ulcerative endocarditis. Very occasionally pytemia follows the most tri\dal operation or injm'y, as the .subcuta- neous division of a tendon or a portion of fascia. Here, again, it is probably the result of the introduction of infective micro-organisms at the time of the operation. At times no local source of infection can be discovered ; the disease is then spoken of as idiopathic pytemia, and it is believed that the poison, probably an infective micro- organism, gains admission, as in infective osteomj'elitis, periostitis, and ulcerative endocarditis, through a mucous surface. Pytemia, however, is seldom developed except where the patient is exposed to unfavourable hygienic conditions, amongst which may be especially mentioned overcrowding in ill-ventilated and badly-drained hospitals, particularly where a large number of suppiu'ating and foul wounds are congregated together in the same ward : whilst the general debility induced by unsanitary dwellings, poor living, town Hfe, and the abuse of alcohol in that it lowers the resisting power of the tissues, further predisposes to the disease. Pathology.—The post-mortem appearances are similar to those in sopticEemia, plus jmrulent collections in one or more situations, or (.lisseniinated throughout tlie body. Thus, thci'e is the same rapid tendency to putrefaction, dis- integration of red blood-corpuscles, staining of the vessels and tissues, minute extravasations {pefer/riw) beneath the serous membranes, congestion of the -sdscora, enlargement of the s])leen, and in many cases the iiresonce of micro- cocci in the blood and various tissues and organs. The body is emaciated, and the skin yellowish and earthy in appearance. The pm-ulent collections may be found in the serous v''^''^' ^'^'^'^i^' the joints and indeed tliroiighout the body generally. There niay be one or more moderate- sized colloctions f)f ])us: or an organ, as tlio lung, may be riddlod ])y II, iiiniibor of siiia,ll abscesses varying in si/e I- 2
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