breaks into a
profuse perspiration, which leaves him pale, weak, and exhausted. He
becomes rapidly and markedly emaciated, even although in some cases the
appetite remains good and is even voracious.

The poisons circulating in the blood produce _waxy degeneration_ in
certain viscera, notably the liver, spleen, kidneys, and intestines. The
process begins in the arterial walls, and spreads thence to the
connective-tissue structures, causing marked enlargement of the affected
organs. Albuminuria, ascites, oedema of the lower limbs, clubbing of the
fingers, and diarrhoea are among the most prominent symptoms of this
condition.

The _prognosis_ in hectic fever depends on the completeness with which
the further absorption of toxins can be prevented. In many cases this
can only be effected by an operation which provides for free drainage,
and, if possible, the removal of infected tissues. The resulting wound
is best treated by the open method. Even advanced waxy degeneration does
not contra-indicate this line of treatment, as the diseased organs
usually recover if the focus from which absorption of toxic material is
taking place is completely eradicated.

[Illustration: FIG. 12.--Chart of case of Septicaemia followed by
Pyaemia.]

#Septicaemia.#--This form of blood-poisoning is the result of the action
of pyogenic bacteria, which not only produce their toxins at the primary
seat of infection, but themselves enter the blood-stream and are carried
to other parts, where they settle and produce further effects.

_Clinical Features._--There may be an incubation period of some hours
between the infection and the first manifestation of acute septicaemia.
In such conditions as acute osteomyelitis or acute peritonitis, we see
the most typical clinical pictures of this condition. The onset is
marked by a chill, or a rigor, which may be repeated, while the
temperature rises to 103 or 104 F., although in very severe cases the
temperature may remain subnormal throughout, the virulence of the toxins
preventing reaction. It is in the general appearance of the patient and
in the condition of the pulse that we have our best guides as to the
severity of the condition. If the pulse remains firm, full, and regular,
and does not exceed 110 or even 120, while the temperature is moderately
raised, the outlook is hopeful; but when the pulse becomes small and
compressible, and reaches 130 or more, especially if at the same time
the temperature