As the lungs fill with the first crop of infected emboli, and the first series of metastatic abscesses form there, there is more or less _dyspnea_ and sense of oppression; there may be also _pulmonary complications_--pleurisy, bronchitis, etc., even pulmonary edema. Frequently there is expectoration of frothy and discolored sputum; occasionally there is blood in the sputum. A peculiar _sweetish odor of the breath_ has been noted by many observers in this disease, and is supposed to be idiopathic and characteristic. (See _acetonemia_ in previous chapter.) With the dispersion of the second crop of emboli from the lungs there is apt to be _icterus_, with evidence of _metastatic abscess in the liver_, and collection of pus as the result of coalescence of small abscesses. The sensorium is not so affected in pyemia as in septicemia, and in the former disease patients are more likely to be alert and active in mind. General _hyperesthesia_ and _restlessness_ are common. Colliquative sweats are also a feature of pyemia. There is the same liability to _eruptions_, etc., which may mislead or complicate the diagnosis. A dermatitis is seen sometimes in pyemia, the lesions assuming a papular or pustular form, due to local infections of the skin. Purpuric spots are also seen, and vesication is not infrequent. Within the mouth _sordes_ collect upon the _teeth or gums_; the _tongue_ becomes dry and brown and heavily coated. Diarrhea is less common in pyemia. The urine is usually scanty and high colored, containing solids in excess; albumin is sometimes found therein, as well as peptone. The presence of _peptone in the urine_ is probably an indication of the breaking down of pus corpuscles in various parts of the tissues. A significant objective evidence of pyemia is met with in the _metastatic collections of pus within the joints_, which occur relatively early, and which, if multiple, may lead to a correct diagnosis. One of the earliest joints to be involved is the sternoclavicular, although none of the joints are free from the possibility of invasion. The articular serous membranes seem to have the property of carrying and holding the infective thrombi better than any other tissue in the body. The _pyarthrosis of pyemia_ is for the most part painless, yet implies loss of function of the affected joints. The distention of these is usually evident to the eye, the fluctuation pronounced, tenderness not extreme, but the swollen part merges into tissues which are edematous and reddened. When pain in the limb is extreme, it is usually because of metastatic abscess within the bone-marrow cavity. In other words, we now have a _metastatic osteomyelitis_. In all cases of pyemia prostration is marked, yet the pulse is seldom weak, at least until toward the close of life. As cases progress from bad to worse _subsultus tendinum_ is often noted.