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The bone becomes expanded, and the cysts may escape through perforations into the surrounding cellular tissue, and when thus freed from confinement may attain considerable dimensions. Suppuration from superadded pyogenic infection may be attended with extensive necrosis, and lead to disorganisation of the adjacent joint. Clinical Features. The patient complains of deep-seated pains.
#Sapræmia#, or septic intoxication, is the name applied to a form of poisoning resulting from the absorption into the blood of the toxic products of pyogenic bacteria. These products, which are of the nature of alkaloids, act immediately on their entrance into the circulation, and produce effects in direct proportion to the amount absorbed.
#Septicæmia.# This form of blood-poisoning is the result of the action of pyogenic bacteria, which not only produce their toxins at the primary seat of infection, but themselves enter the blood-stream and are carried to other parts, where they settle and produce further effects.
The sinus persists as long as any active tubercle remains in the tissues, and is apt to form an avenue for pyogenic infection. In deeply seated bones, such as the upper end of the femur, the formation of a cold abscess in the soft parts is often the first evidence of the disease. Diagnosis.
This superadded infection with pyogenic organisms exposes the patient to the further risks of septic intoxication, especially in the form of hectic fever and septicæmia, and increases the liability to general tuberculosis, and to waxy degeneration of the internal organs.
Pus was found in abundance by a peritoneal puncture and was sowed; so also was blood from a vein in the arm. The culture of pus yielded the long chains noted in the preceding observation and also the small pyogenic vibrio. The culture from the blood contained only the long chains. Third observation.
This is observed chiefly in chronic disease of pyogenic or tuberculous origin, and is usually attended with the formation of abscesses outside the joint. Ulceration of cartilage and caries of the articular surfaces are common accompaniments of the more serious and progressive forms of joint disease, especially those of bacterial origin.
The clinical features resemble those of other pyogenic infections, and there are wavy red lines running from the source of infection towards the nearest lymph glands. These correspond to the inflamed vessels, and are the seat of burning pain and tenderness. The associated glands are enlarged and painful. In severe cases the symptoms merge into those of septicæmia.
As the more severe forms of the disease may prove dangerous to life by pyogenic complications inducing gangrene of the limb, the question of amputation may have to be considered. [Illustration: FIG.
The infective form usually begins as a peri-phlebitis arising in connection with some focus of infection in the adjacent tissues. The elements of the vessel wall are destroyed by suppuration, and the thrombus in its lumen becomes infected with pyogenic bacteria and undergoes softening.
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