The _appearance of the wound_ or site of operation does not differ essentially from that already described under Septicemia. There is usually, however, _less discharge_, granulations are _smoother and dryer_, and if tissues are gangrenous they are not as wet and nauseous as in the other case. _Evidences of thrombophlebitis and lymphangitis_ will proceed from the wound toward the body, as in other instances of septic infection. =Prognosis.=--Prognosis is usually _bad_. While recovery may follow where metastatic infiltration has not been too general, the ordinary case of pyemia will die within twelve to fourteen days after diagnosis. Sometimes the entire process is much slower, and isolated cases occur which can be designated as _so-called chronic pyemia_, which differs but little from the acute form. A case of pyemia should not fail of recognition because there is no evidence of infection from without. A fatal case of pyemia has been known to occur from a suppurating soft corn which was not discovered during life; also from _peridental abscess_, etc., which had been overlooked. Death is the result of tissue destruction and septic intoxication. =Postmortem Appearances.=--In the vessels these consist essentially of _thrombosis_, examples of which may be seen, for instance, in the cranial sinuses and in the large veins. Aside from these, with the _enlargement and softening of the spleen_, the _liver_, and _lymphatic structures_, already described under Septicemia, the principal objective evidences consist in the discovery of metastatic abscesses in many or all parts of the body. As stated above, there is no tissue or organ in which they may not be found. The mechanism of their production has been already described. _Infarcts_ may also be met with, in the kidneys especially, the liver and spleen as well, and indicate areas already cut off from blood supply by thrombo-arteritis, in which abscess formation would have occurred had time been given. In the liver large abscesses may be found; joint cavities may be filled with pus; the lungs are usually the site of innumerable small abscesses. The other postmortem changes commonly noted are not difficult of explanation, but are not so characteristic or pathognomonic as to call for further mention. In a joint which has become filled with pus there usually has been loosening of the cartilage and more or less disorganization of all the joint structures, which appear to have undergone rapid ulcerative destruction and putrefaction. =Treatment.=--Treatment of pyemia is in large degree unsatisfactory. That which used to be the terror of surgeons in the pre-antiseptic era is now, thanks to Lister and others, almost abolished. Pyemia is a rare disease in modern surgical practice. Its possibility should be borne constantly in mind, however, and the necessity for careful antiseptic or for a rigid aseptic technique is in large degree based upon fear of pyemic consequences.