ve rise to secondary
foci of suppuration. Secondary abscesses are thus formed in those parts,
and these in turn may be the starting-point of new emboli which give
rise to fresh areas of pus formation. The organs above named are the
commonest situations of pyaemic abscesses, but these may also occur in
the bone marrow, the substance of muscles, the heart and pericardium,
lymph glands, subcutaneous tissue, or, in fact, in any tissue of the
body. Organisms circulating in the blood are prone to lodge on the
valves of the heart and give rise to endocarditis.

[Illustration: FIG. 13.--Chart of Pyaemia following on Acute
Osteomyelitis.]

_Clinical Features._--Before antiseptic surgery was practised, pyaemia
was a common complication of wounds. In the present day it is not only
infinitely less common, but appears also to be of a less severe type.
Its rarity and its mildness may be related as cause and effect, because
it was formerly found that pyaemia contracted from a pyaemic patient was
more virulent than that from other sources.

In contrast with sapraemia and septicaemia, pyaemia is late of developing,
and it seldom begins within a week of the primary infection. The first
sign is a feeling of chilliness, or a violent rigor lasting for perhaps
half an hour, during which time the temperature rises to 103, 104, or
105 F. In the course of an hour it begins to fall again, and the
patient breaks into a profuse sweat. The temperature may fall several
degrees, but seldom reaches the normal. In a few days there is a second
rigor with rise of temperature, and another remission, and such attacks
may be repeated at diminishing intervals during the course of the
illness (Figs. 12 and 13). The pulse is soft, and tends to remain
abnormally rapid even when the temperature falls nearly to normal.

The face is flushed, and wears a drawn, anxious expression, and the eyes
are bright. A characteristic sweetish odour, which has been compared to
that of new-mown hay, can be detected in the breath and may pervade the
patient. The appetite is lost; there may be sickness and vomiting and
profuse diarrhoea; and the patient emaciates rapidly. The skin is
continuously hot, and has often a peculiar pungent feel. Patches of
erythema sometimes appear scattered over the body. The skin may assume a
dull sallow or earthy hue, or a bright yellow icteric tint may appear.
The conjunctivae also may be yellow. In the latter stages of the disease
the pulse bec