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Updated: May 1, 2025
We have here to consider under the terms Sapræmia, Septicæmia, and Pyæmia certain general effects of pyogenic infection, which, although their clinical manifestations may vary, are all associated with the action of the same forms of bacteria. They may occur separately or in combination, or one may follow on and merge into another.
On June seventeenth, M. Doleris, a well-known hospital interne, brought to me some blood, removed with the necessary precautions, from a child dead immediately after birth, whose mother, before confinement had had febrile symptoms with chills. This blood, upon cultivation, gave an abundance of the pyogenic vibrio. The autopsy on the mother took place on the nineteenth.
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; on the other hand the smallest abscess produced by this organism when associated with the septic vibrio takes on a thick gangrenous appearance, putrid, greenish and infiltrating the softened tissues.
They receive lymph from the face, lips, floor of the mouth, gums, teeth, anterior part of tongue, and the alæ nasi, and from the pre-auricular glands. The lymph passes from them into the deeper cervical glands. They are frequently infected with tubercle, with epithelioma which has spread to them from the mouth, and also with pyogenic organisms.
On the other hand, in pyogenic infections in the substance of the liver, in the substance of the kidney, within the brain, in the retroperitoneal space, in the lobes of the lung, in the chambers of the heart and in the blood-vessels of the chest and the abdomen, in all locations in which muscular contractions can in no way assist in localizing the disease, pyogenic infections produce no muscular rigidity and no pain.
The subsequent changes depend upon whether or not the wound is infected with pyogenic bacteria. If it is so infected, suppuration ensues, a sinus forms, and persists until the foreign body is either cast out or removed. If the wound is aseptic, the fate of the foreign body varies with its character.
The primary, and perhaps the most striking, difference between the painless exanthemata and the painful pyogenic infections is that in the case of the exanthemata the protective response of the body is a chemical one, the formation of antibodies in the blood, which usually produce permanent immunity, while the response to the pyogenic infections is largely phagocytic.
#Pyogenic Osteomyelitis due to Spread of Infection from the Soft Parts.# There still remain those forms of osteomyelitis which result from infection through a wound involving the bone for example, compound fractures, gun-shot injuries, osteotomies, amputations, resections, or operations for un-united fracture.
As pyogenic bacteria are invariably found in the blisters of burns, these must be opened and the raised epithelium removed. The dressings subsequently applied should meet the following indications: the relief of pain; the prevention of sepsis; and the promotion of cicatrisation.
Such a state as that means mechanical interference with every organ in the thoracic, abdominal and pelvic cavities, and, besides the pressure and interference in drainage and the blowing into the abscess cavity and into the pyogenic membrane gas loaded with infection, there was an almost fatal interference with the action of the heart and lungs.
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