[Illustration:  FIG. 10.—­Charts of Acute sapraemia from (a) case of crushed foot, and (b) case of incomplete abortion.]

A local form of septic infection is always present—­it may be an abscess, an infected compound fracture, or an infection of the cavity of the uterus, for example, from a retained portion of placenta.

Treatment.—­The first indication is the immediate and complete removal of the infected material.  The wound must be freely opened, all blood-clot, discharge, or necrosed tissue removed, and the area disinfected by washing with sterilised salt solution, peroxide of hydrogen, or eusol.  Stronger lotions are to be avoided as being likely to depress the tissues, and so interfere with protective phagocytosis.  On account of its power of neutralising toxins, iodoform is useful in these cases, and is best employed by packing the wound with iodoform gauze, and treating it by the open method, if this is possible.

The general treatment is carried out on the same lines as for other infective conditions.

#Chronic sapraemia or Hectic Fever.#—­Hectic fever differs from acute sapraemia merely in degree.  It usually occurs in connection with tuberculous conditions, such as bone or joint disease, psoas abscess, or empyema, which have opened externally, and have thereby become infected with pyogenic organisms.  It is gradual in its development, and is of a mild type throughout.

[Illustration:  FIG. 11.—­Chart of Hectic Fever.]

The pulse is small, feeble, and compressible, and the temperature rises in the afternoon or evening to 102 or 103 F. (Fig. 11), the cheeks becoming characteristically flushed.  In the early morning the temperature falls to normal or below it, and the patient breaks into a profuse perspiration, which leaves him pale, weak, and exhausted.  He becomes rapidly and markedly emaciated, even although in some cases the appetite remains good and is even voracious.

The poisons circulating in the blood produce waxy degeneration in certain viscera, notably the liver, spleen, kidneys, and intestines.  The process begins in the arterial walls, and spreads thence to the connective-tissue structures, causing marked enlargement of the affected organs.  Albuminuria, ascites, oedema of the lower limbs, clubbing of the fingers, and diarrhoea are among the most prominent symptoms of this condition.

The prognosis in hectic fever depends on the completeness with which the further absorption of toxins can be prevented.  In many cases this can only be effected by an operation which provides for free drainage, and, if possible, the removal of infected tissues.  The resulting wound is best treated by the open method.  Even advanced waxy degeneration does not contra-indicate this line of treatment, as the diseased organs usually recover if the focus from which absorption of toxic material is taking place is completely eradicated.