ons. The onset of the condition is marked by a feeling of
chilliness, sometimes amounting to a rigor, and a rise of temperature to
102, 103, or 104 F., with morning remissions (Fig. 10). The heart's
action is markedly depressed, and the pulse is soft and compressible.
The appetite is lost, the tongue dry and covered with a thin
brownish-red fur, so that it has the appearance of "dried beef." The
urine is scanty and loaded with urates. In severe cases diarrhoea and
vomiting of dark coffee-ground material are often prominent features.
Death is usually impending when the skin becomes cold and clammy, the
mucous membranes livid, the pulse feeble and fluttering, the discharges
involuntary, and when a low form of muttering delirium is present.

[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