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Blood Poisoning - Pyaemia.Symptoms.- Pyaemia may occur at almost any period after the infliction of the injury except the first few days. The first indications are usually seen in a change in the appearance of the wound. So long as everything proceeds favorably, the edges of the wound remain smooth and white, and the matter discharged is of a creamy appearance. ' If blood-poisoning is to be expected, the edge of the wound usually becomes swollen and red, quickly changing to a purple or livid hue ; this change of color soon extends to the skin surrounding the wound, which becomes dark. The wound gapes, and the process of healing ceases quite abruptly. In some cases portions of the wound, which seem to be already closed, reopen. The matter discharged diminishes in quantity and exchanges its creamy appearance for that of a bloody fluid. While these changes are going on the patient experiences one or more severe chills, followed by high fever. He usually complains also of pain in the vicinity of the wound, though this may have been for days or weeks quite painless and comfortable. The subsequent history of the case may present either one of two distinct types. If the symptoms referred to have appeared within the first week after the receipt of the injury, the patient usually exhibits the symptoms which indicate an overwhelming blood-poisoning - technically called septiccemia. In this case he has one or more severe chills, followed by a very high fever, which continues without intermission. The mental functions are deranged ; the patient is completely prostrated, frequently has convulsions or delirium, and lies in a state of semi-unconsciousness, from which he is aroused with difficulty. This condition almost invariably terminates fatally within eight or ten days ; death may occur in two or three days. If the symptoms of blood-poisoning do not occur until after the first week from the infliction of the injury, the symptoms presented usually follow a different type. The patient has not only one or two chills at the beginning of the difficulty, but suffers from repeated chills so long as the state of blood-poisoning exists. These chills may occur every two or three days, or several of them may be observed in the course of the same day. The chills are followed by high fever, which, however, is not constant but intermittent ; that is, for some hours or days the heat of the patient's body may be about natural. The sufferer is prostrated also by profuse sweats, which may appear just after the fever, or may occur without any such preliminary. In most cases he suffers also from diarrhea. The mind is usually clear and the patient perfectly rational ; in this respect his condition is easily distinguished from that just described, called septicaemia. He is usually troubled with an obstinate dry cough, which resists the treatment ordinarily employed to relieve such an affection. In the course of a few days the patient complains of severe pain in one of the joints, usually the elbow or knee. The joint swells, though it may not exhibit any heat or redness, such as generally accompanies inflammatory swelling. After a time it becomes evident that the joint contains some liquid substance, and if a needle be inserted into this liquid it will be found that the contents of the joint consist of matter or pus. In a few days one or more of the remaining joints will become similarly affected, and before the patient recovers or dies - usually the latter-a series of abscesses involving the different joints are developed. Meanwhile the patient rapidly loses strength and flesh; the emaciation is often extreme. Treatment.-The treatment of the severe form of bloodpoisoning- septicaemia-is usually unavailing; the patient succumbs in a few days or a week. He should be liberally plied with alcoholic stimulants. An ounce of whisky and an equal quantity of milk may be mixed and given every three or four hours. In case the patient vomits, or is so stupid that he cannot be made to swallow, the whisky and milk may be given as an injection into the rectum. The diet should consist of milk, eggs, broth and similar nutritious food. As medicine, we may administer three grains of quinine four or five times a day. The second form of blood-poisoning, that in which the patient has repeated chills and an intermittent fever, offers somewhat better prospects for recovery, though even here the chances are that he will die. The first thing to be done is to secure perfect cleanliness of the wound. For this purpose the dressing should be entirely removed, and the wound and its vicinity carefully scrutinized to ascertain the existence of black patches of skin or tissue. Any of these which may be found should be at once removed. All the corners and nooks in the wound should be thoroughly syringed out, and incisions must be freely made in order to lay open anything which seems to be a collection of matter. The limb should be immersed in a trough containing hot water, with which carbolic acid or listerine had been mixed. If carbolic acid be used, about an ounce of it should be put in every quart of water. If listerine be employed, about two ounces to the pint of water will be required. If the patient be suffering from a compound fracture no dressing should be applied. The first object now is to save the life of the patient, and not to secure the perfect healing of the limb. All instruments, dressing, bandages, etc., which come in contact with the wound should be thoroughly cleansed with a solution of carbolic acid or listerine, and should be carefully kept from con tact with other wounds, for the matter which is formed in the wound, as well as the blood of the patient, is highly infectious - that is, if introduced into the body of another person they will produce the disease in him. It will be better that all such dressings be burned as soon as used. The room should be carefully and freely ventilated, and kept at a temperature of 65 or 70 degrees F. The medicines which have sometimes seemed beneficial in improving the condition of the patient are quinine, the salicylate of sodium, and the tincture of the chloride of iron. The following prescription may be administered : Quinine,...... One drachm. Tincture of the chloride of iron, - One ounce. Syrup of orange peel, - One ounce. Water, ------ Two ounces. Mix and give a teaspoonful in water five times a day. The salicylate of sodium seems to accomplish some, though not all, of the good which may be expected from the quinine ; and because of its comparative cheapness it has been much employed as a substitute. This should be given in doses of ten grains each four or five times a day. The patient will need alcoholic stimulants, which should be administered early in the disease \ it is a mistake to wait until the sufferer is so weak and emaciated that he can scarcely swallow or retain any remedies. Whisky should be given in the shape of egg-nog or mixed with an equal quantity of milk. There is but little danger of intoxicating the patient, who can endure an extraordinary quantity of alcoholic beverages without exhibiting the usual effects of alcohol. The food plays a very important part in sustaining the strength of the patient. He should have an abundance of milk and eggs and strong broths. In many cases the patient will prosper upon raw meat, which should be cut up very fine. Food should be administered at short intervals, say three or four hours, and in small quantities. In many cases it will become necessary to nourish the patient by the injection of liquid food into the rectum. No time nor effort should be wasted in attempts to control the diarrhea or the sweats of the patient, for these are probably efforts of nature to eliminate the poison from the system. At any rate, they resist the action of medicines so long as the general condition of blood-poisoning persists. Pyaemia often lasts for weeks, and even months; and for a long time it may be doubtful what the ultimate result will be. The case of the late President Garfield is an instance known to all, in which the patient wavered between life and death for nearly three months. In some cases the disease has been cut short by the amputation of a wounded limb. This is readily comprehensible when we remember that the poison in the blood which causes the symptoms proceeds from the wound. In fact, it seems as if each chill was an evidence of the entrance of a fresh installment of the poison from the wound into the blood. At any rate it has been frequently observed that after the patient manifested unmistakable signs of pyaemia, indeed, after the disease had lasted for weeks, recovery has occurred immediately after the amputation of the limb which had received the injury. A question so serious must, of course, be left to the decision of a surgeon. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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