omes small and fluttering; the tongue becomes dry and
brown; sordes collect on the teeth; and a low muttering form of delirium
supervenes.

Secondary infection of the parotid gland frequently occurs, and gives
rise to a suppurative parotitis. This condition is associated with
severe pain, gradually extending from behind the angle of the jaw on to
the face. There is also swelling over the gland, and eventually
suppuration and sloughing of the gland tissue and overlying skin.

Secondary abscesses in the lymph glands, subcutaneous tissue, or joints
are often so insidious and painless in their development that they are
only discovered accidentally. When the abscess is evacuated, healing
often takes place with remarkable rapidity, and with little impairment
of function.

The general symptoms may be simulated by an attack of malaria.

_Prognosis._--The prognosis in acute pyaemia is much less hopeless than
it once was, a considerable proportion of the patients recovering. In
acute cases the disease proves fatal in ten days or a fortnight, death
being due to toxaemia. Chronic cases often run a long course, lasting for
weeks or even months, and prove fatal from exhaustion and waxy disease
following on prolonged suppuration.

_Treatment._--In such conditions as compound fractures and severe
lacerated wounds, much can be done to avert the conditions which lead to
pyaemia, by applying a Bier's constricting bandage as soon as there is
evidence of infection having taken place, or even if there is reason to
suspect that the wound is not aseptic.

If sepsis is already established, and evidence of general infection is
present, the wound should be opened up sufficiently to admit of thorough
disinfection and drainage, and the constricting bandage applied to aid
the defensive processes going on in the tissues. If these measures fail,
amputation of the limb may be the only means of preventing further
dissemination of infective material from the primary source of
infection.

Attempts have been made to interrupt the channel along which the
infective emboli spread, by ligating or resecting the main vein of the
affected part, but this is seldom feasible except in the case of the
internal jugular vein for infection of the transverse sinus.

Secondary abscesses must be aspirated or opened and drained whenever
possible.

The general treatment is conducted on the same lines as on other forms
of pyogenic infection.

CHAPTER V

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