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Updated: May 31, 2025
It has been shown positively that acute endocarditis is due to micro-organisms, generally streptococci, staphylococci or pneumococci, and, more frequently than once believed, gonococci. The most frequent causes are acute rheumatic fever, diphtheria, pneumonia, cerebrospinal meningitis, scarlet fever, erysipelas, influenza, chorea, gonorrhea, sepsis and typhoid fever.
Amputation is the last resource, and should be decided upon if the hæmorrhage recurs after proximal ligation, or if this has been followed by gangrene of the limb; it should also be considered if the nature of the wound and the virulence of the sepsis would of themselves justify removal of the limb. Every surgeon can recall cases in which a timely amputation has been the means of saving life.
I attribute this freedom from sepsis to careful cleansing of the conjunctival sac and to other pre-operative precautions, but especially to the use, before and after the operation, of White's ointment a preparation of 1-3000 mercuric chloride in sterile vaseline.
This very interesting tradition was taken down by Mrs. W. Wallace Brown from a very old Passamaquoddy Indian woman named Molly Sepsis, who could not speak a word of English, with the aid of another younger woman named Sarah. It will be observed that it is said in the beginning that Glooskap produced the first human beings from, the ash-tree.
Another common cause of arteriosclerosis occurring too early is the occurrence of some serious infection in a person, typhoid fever and sepsis being most frequent. Syphilis is a frequent cause, especially of that form of arteriosclerosis which shows the greatest amount of disease in the aorta.
An abortion is as important a matter as a confinement and requires as much attention as the birth of a child at its full term. "The immediate dangers of abortion," says Dr. J. Clifton Edgar, in his book, "The Practice of Obstetrics," "are hemorrhage, retention of an adherent placenta, sepsis, tetanus, perforation of the uterus.
As a therapeutic agent it is almost without a peer, and yet it is so little used that it is practically a dead letter. Chemists are burning the midnight oil in their laboratories searching for new weapons with which to fight sepsis, while hot, boiled water, which is one of the best antiseptics in existence, is almost ignored. In the first place, its merits are not generally known.
We were told that the plates would break loose, that the screws would come out, that the patient would come to a bad end through the violent sepsis induced by the presence of a "foreign body" in the shape of the steel plate.
The clinical features of osteomyelitis in an amputation stump are those of ordinary pyogenic infection; the involvement of the bone may be suspected from the clinical course, the absence of improvement from measures directed towards overcoming the sepsis in the soft parts, and the persistence of suppuration in spite of free drainage, but it is not recognised unless the bone is exposed by opening up the stump or the changes in the bone are shown by the X-rays.
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.
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