The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
colliquative; icterus more pronounced; urine more reduced in quantity
or suppressed; and these symptoms are succeeded by indifference, mental
apathy, stupor or delirium, and finally death, the patients being
comatose and collapsed.
While these are the general indications of septicemia, the _wound_ or
site of injury has undergone _changes_ which are also _characteristic_.
They comprise the _edema and redness of wound margins_, which may be
seen even in sapremia, followed by increasing _tumefaction_, escape
of _foul-smelling discharge_, and finally by _sloughing and gangrene_
of the parts involved. On microscopic examination the capillaries
are filled with infective thrombi and vessel walls infiltrated with
microörganisms, which abound also in the lymph spaces. Bacterial
infection can be traced in microscopic sections from the infected area,
from the point in the neighborhood of the wound where microbes infest
the tissues to points remote from it, where they are sparsely found,
if at all. The same evidences of infection may be traced along the
lymphatic vessels, and often the veins.
=Postmortem Evidences.=--The postmortem evidences of septicemia are
indicative on first sight: the blood is of the consistency of tar
and does not coagulate; evidences of putrefaction are plain to sight
and smell; the serous membranes, particularly the pia mater, are
often extravasated; the muscles are discolored and of a darker hue
than natural, edema of the lung is frequent; the intestines reveal a
gastro-intestinal catarrh, the duodenum and rectum showing punctate
hemorrhages; the spleen is darkened, enlarged, and softened; the
liver shows similar signs, less marked, and at times an emphysematous
condition due to putrefactive gases. Cultures can be made from the
fluids and tissues of organs thus affected. It is also of importance
to emphasize that such material is _powerfully_ and often fatally
_infectious_; some of the worst forms of dissecting wounds and
instances of _fatal infection_ have come from carelessness in making
these _postmortem examinations_.
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