is low, a grave prognosis is indicated. The tongue is
often dry and coated with a black crust down the centre, while the sides
are red. It is a good omen when the tongue becomes moist again. Thirst
is most distressing, especially in septicaemia of intestinal origin.
Persistent vomiting of dark-brown material is often present, and
diarrhoea with blood-stained stools is not uncommon. The urine is small
in amount, and contains a large proportion of urates. As the poisons
accumulate, the respiration becomes shallow and laboured, the face of a
dull ashy grey, the nose pinched, and the skin cold and clammy.
Capillary haemorrhages sometimes take place in the skin or mucous
membranes; and in a certain proportion of cases cutaneous eruptions
simulating those of scarlet fever or measles appear, and are apt to lead
to errors in diagnosis. In other cases there is slight jaundice. The
mental state is often one of complete apathy, the patient failing to
realise the gravity of his condition; sometimes there is delirium.

The _prognosis_ is always grave, and depends on the possibility of
completely eradicating the focus of infection, and on the reserve force
the patient has to carry him over the period during which he is
eliminating the poison already circulating in his blood.

The _treatment_ is carried out on the same lines as in sapraemia, but it
is less likely to be successful owing to the organisms having entered
the circulation. When possible, the primary focus of infection should be
dealt with.

#Pyaemia# is a form of blood-poisoning characterised by the development
of secondary foci of suppuration in different parts of the body. Toxins
are thus introduced into the blood, not only at the primary seat of
infection, but also from each of these metastatic collections. Like
septicaemia, this condition is due to pyogenic bacteria, the
_streptococcus pyogenes_ being the commonest organism found. The primary
infection is usually in a wound--for example, a compound fracture--but
cases occur in which the point of entrance of the bacteria is not
discoverable. The dissemination of the organisms takes place through the
medium of infected emboli which form in a thrombosed vein in the
vicinity of the original lesion, and, breaking loose, are carried
thence in the blood-stream. These emboli lodge in the minute vessels of
the lungs, spleen, liver, kidneys, pleura, brain, synovial membranes, or
cellular tissue, and the bacteria they contain gi