=Symptoms.=--In septicemia there is a period of incubation, usually two or three days, often longer. If this follows an operation, the mild fever which would indicate the slumbering fire is usually regarded as surgical fever. But when this rises and is followed by prostration, with alimentary disturbance, loss of appetite, headache, etc., followed by typhoidal symptoms, the alarm is sounded and should be quickly heeded. Usually, but not always, there is a preliminary or _premonitory chill_, after which prostration will be more marked than before. The severity of the symptoms cannot be foretold from the size, location, or character of the wound. The character of the fever is essentially continued, usually with morning remissions. Gussenbauer has called attention to a class of cases in which subnormal temperature is caused by the absorption of ammonia compounds. To these he has given the name _ammoniemia_. This condition may be seen in connection with gangrenous hernia, and has even been mistaken for shock (Warren). (See also _acetonemia_, in previous chapter.) In septicemia from infection of a visible portion of the body there are usually seen evidences of _lymphangitis_ and _perilymphangitis_ of septic character. These will be evidenced by tender and purplish lines, extending subcutaneously along the course of the known lymphatics or in connection with the more prominent subcutaneous veins. The _lymph nodes_, into which these visible vessels as well as the deeper ones empty, become _enlarged and tender_; the whole lymphatic system participates; the _spleen_ in aggravated cases becomes notably enlarged, and even the bone-marrow more or less involved. _Diarrhea_ is commonly an early but controllable symptom. A hematogenous icterus of mild degree is another frequent accompaniment. The conjunctiva becomes discolored and the skin slightly so. Should the blood be examined marked _leukocytosis_ will be noted, and should cultures be made from it, in many instances at least, the organisms at fault can be detected and recovered from it. The vigor of the heart muscle is seriously impaired; the _pulse_ becomes _rapid_ and _weak_. In scarcely any form of septic infection is this more prominent than in diphtheria; and microscopic examination shows the rapid disintegration of the cells of the heart muscle, as well as those of other parts of the body, even to the almost complete molecular disintegration of the nuclei. Erythematoid, pustular, and even hemorrhagic _eruptions_ are met with upon the skin, some of which are probably to be explained by thrombosis of the dermal capillaries. Certain _complications_ are not infrequent, among which inflammations of the pericardium and endocardium--_e. g._, ulcerative endocarditis--are frequent. As the case becomes aggravated the temperature rises irregularly; the hot, dry skin becomes cold and clammy; prostration and indifference more marked; diarrhea more