Pyæmia certain general effects of pyogenic infection, which, although
their clinical manifestations may vary, are all associated with the
action of the same forms of bacteria. They may occur separately or in
combination, or one may follow on and merge into another.

#Sapræmia#, or septic intoxication, is the name applied to a form of
poisoning resulting from the absorption into the blood of the toxic
products of pyogenic bacteria. These products, which are of the nature
of alkaloids, act immediately on their entrance into the circulation,
and produce effects in direct proportion to the amount absorbed. As the
toxins are gradually eliminated from the body the symptoms abate, and if
no more are introduced they disappear. Sapræmia in these respects,
therefore, is comparable to poisoning by any other form of alkaloid,
such as strychnin or morphin.

_Clinical Features._--The symptoms of sapræmia seldom manifest
themselves within twenty-four hours of an operation or injury, because
it takes some time for the bacteria to produce a sufficient dose of
their poisons. 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 diarrhœa 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.