Sleep.-It must not be taken that the absorption o septic matter is always an evil. we se certain persons who are always absorbing septic matter from dirty teeth or from neglected genito urinary catarrh, and who yet enjoy vigorous health. This apparent contradiction is explained in the following way:.
1. Degraded tissue-material, in minute doses, forms one of the normal stimuli of the heart; witness, for example, the exhilaration which follows exercise.
2. Larger doses over-stimulate the heart-athletic sleeplessness.
3. Over-doses cause profound sopor-toxic coma of extreme fatigue, of uraemia, and of puerperal septicaemia.
Sleep is also secondarily disturbed by the distressing itching of the dermatitis septica, which we call “nettle-rash.” Apis and Sulphur relieve this. I have sometimes stopped it completely by giving a very hot bath, followed by painting over the affected part; after patting, not rubbing, the patient dry, the following solution:.
Cocaine mur., gr. 2.
Chloral hydrat., j.
Glycerine, j.
Camphor, instead of Cocaine, and sometimes Sal ammoniac, will give relief.
The smarting may be stopped by.
Ichthyol, gr. 20.
Collodion flexile, j.
Applied pure three times a day.
The Skin.-Disregarding the rarer and more recondite results of sapraemia, we will glance quickly at the ordinary superficial phenomena of passive poisoning by purulent products in a female patient.
As the subject of chronic septic absorption enters the room, we are struck by her death-like pallor. There are exceptions. Some women become sallow, some bronzed, so as to resemble a case of Addison’s disease, [Addison’s, Drummond’s and Nothnagel’s diseases are all probably septic], or one of the other disorders connected usually with xanthelasma. Others present discrete spots of melanosis, the favorite sites being, as we have seen, the forearm and the face.
I have already noted multiple symmetrical petechiae on the cheeks of the aged, which have disappeared on removing rotten teeth. Purpura has been caused experimentally by injecting toxins into the circulations. Scorbutic petechiae are possibly of this nature. There are grounds, too, for looking upon general haemorrhagic purpura as septic in origin. Acne rosacea will follow pyorrhoea alveolaris and vaginal xanthorrhoea is often associated with pustule so the chin (acne menti). The rose spots on the abdomen of an enteric patent are probably of the same nature. It will be remembered that they do not appear during the first week of the disease; in other words, till there is time for the establishment of necrosis in the neighborhood of Peyer’s patches.
Raimondi found the same atrophy and degeneration of the bone marrow in saturnine case as appears to occur from septic causes in the course of male urethritis. .
A profound and inexplicable hydraemia + [Compare with recent observations by Dr. Archibald Garrod on the blood changes of rheumatism] should always arouse our suspicious of septic intoxication or of lead poisoning.
In old cases of septic invasion the corner of the mouth is prone to show a fissure. This cracking o the lip commissure appears preferentially on the side of habitual decubitus. It is not quite so insignificant a matter as might at first blush be thought, for the act of opening the mouth becomes so painful that the patient would cease to eat unless the corner were protected. A strip of adhesive plaster servers sufficiently well for this purpose.
I have found it acid even when escaping from the salivary duct, antecedent to its admixture with the mucus the mouth. It is possible that the mere subalkalinity of the blood which passes through the cortex [Compare observations of Hughlings Jackson.] may induce various neuro-psychotic phenomena, as ill-temper, headache, despondency, chorea, or epilepsy. We know that the last of these is influenced by the various salts of Sodium and Potassium. This property, possessed by the alkalies, of modifying some nerve storms, may depend on mere chemical action rather than on any specific relation to the pathological condition. The advent of the epileptiform convulsion is aided, doubtless, by the contracted state of the cerebral arterioles.
We have been accustomed to view puerperal convulsions as in part sapraemic, but chronic idiopathic epilepsy, not unusual as a result of lead poisoning, is not ordinarily recognized as a septic symptom. Professor Wood, of Michigan University, has narrated the particulars of a case, and I have myself placed two on record. [+ Septic Intoxication, pp. 52, 53. F.A. Davis & Co., Philadelphia, 1892.] One showed petit mal, associated with depravity, the other genuine epilepsy.
Recurrent nettle-rash, as well as lichen urticatus, especially the post-partum form, should lead us to search for septic intoxication, and to take immediate steps for its remedy.
Hyperhydrosis of the hands, the feet and the axillae is by no means uncommon in sepsis. Compare this with the localized sweats observed by Dr. Kent Spender in the course of osteo-arthritis.
Drs. Ord and Spender have also pointed out various sensory perversions as occurring in the course of rheumatic gout, itself often septic in origin. Such are lightning pains of the lower extremity, a sense of tearing up of the skin, spots of anaesthesia and of hyperaesthesia. These are common in septic cases. They serve to show that rheumatic gout is not merely a disease of the joints. [++ Compare with Charcot’s disease and with tabes.] Rheumatic tremors point in the same direction.
The temperature of the extremities rises during the chondritic stage of rheumatic gout. This increase in surface warmth is often diffused in the neighborhood of an articulation; it is not confined to the point of incidence of the arthropathy. Afterwards the limbs are prone to be purple and chilled. The arterial tension [On September 6th the right radial of gentlemen, aged 72, recorded 9 ounces whilst sitting down. Late in September be contracted a sharp attack of urethritis and the tension rose to 10 ounces.
A man of 36, with acute urethritis, showed 10 and 8 ounces in right and left radials. Out of 36 patients suffering from various slight disorders, 32 had differing radials. In 26 the right was the more vigorous; a greater disproportion was observed in women, whose tension rules much higher than that of men. Six persons, including both sexes, had the left higher.
Four only were symmetrical. 16 ounces right, 12 left, was recorded in septic goitre, with chondritis, eczema and severe varicosis, associated with suppurating endometritis in a woman of 51, wife of a seafaring man. The observations were taken by means of Dr. Rayner Batten’s manometer] is heightened at first by septine and is followed by increased vigor of ventricular contraction. But there is a later stage in septic invasion, where the systole is defective even to the extent of developing anginous symptoms, as I have more than once witnessed.
Mental solicitude and gloom are nearly always present in septic patients. The memory is sometimes seriously impaired during or after sepsis-as, for example, from enteric fever and diphtheria.
The Digestive Tract. -The septic tongue is peculiar, the type of acute sepsis being the enteric tongue; in chronic cases it may be coated, sometimes preternaturally clean, with raised, irritable papillae. Sometimes very thin at the edge, often oedematous-showing the marks of the teeth.
In acute sepsis, as after diphtheria, we may have pharyngeal paralysis; in acute saturnism, we get spasm of the pharyngeal constrictors. Both are prone to be followed, at a later stage, by incoordination of the muscles concerned in the swallowing.
Loss of appetite, resulting in emaciation, is common in both these poisonings.
I have seen three cases of recurrent gastralgia-of six weeks’ three years’, and ten years’ duration respectively- disappear on removing pus deposits. We have seen that Sepia appears to possess the property of causing pain, called “gastralgia,” in the terminal twigs of the anterior or ventral branches of the fourth, fifth and sixth dorsal nerves.
Drs. Pearson Irvine and Wm. Pasteur have shown that death from diphtheria, especially in boys, may come from paralyzed phrenic. This is confirmed by Suckling, of Birmingham. It is interesting as showing another point of contact between septic toxis and lead poisoning; for phrenic palsy occasionally closes the scene in acute head poisoning.
One of the last results of old-established septic intoxication is hepatic disease of lardaceous type. In these cases the liver ceases to seize upon and change the various degenerative gastro-intestinal products, which now enter the general circulation and prove most pernicious, especially to the nerve centres.
The Eye.-The eye-symptoms of sepsin present a superficial resemblance to those of lead, but there is a deep-seated difference.
The septic affections of the oculo-motor apparatus generally are familiar to us after diphtheria. There are good grounds for suspecting the existence of a septic glaucoma, which, though the eye-symptoms came on in the course of plumbism, may be viewed as saturnine; for it occurred in a woman fourteen days after her confinement, so it probably had septic elements in it. Mr. Lennox Browne, in his work on diseases of the upper respiratory tract, gives details of a very remarkable case of septic glaucoma. Mr. Browne quotes also some American observations on the same subject.
