refer the purulent visceral deposits to capillary phlebitis, or its result embolism.

In addition to the elaborate essays we have specified in this summary, numerous references to various works which contain isolated and interesting examples of this disease, are given in the preceding historical notice of suppurative fever.

CHAPTER II.

DEFINITION OF PYÆMIA, OR SUPPURATIVE FEVER.

PYÆMIA may be defined to be a fever, which, attacking persons of all ages, is generally sequent on wounds, acute inflammation of bone, the puerperal state, surgical operations, or other sources of purulent formation and septic infection. It appears sometimes to prevail in an epidemic form. No one cause has as yet been found to produce this disease. The presence of pus is not necessary for its occurrence. The injection of putrid fluids, as also of chyme, and other healthy fluids, induces in animals symptoms like those of suppurative fever, and pathological appearances in the viscera similar to those met with in the early stages of this disease. The symptoms most pathognomonic of suppurative fever are, a more or less sudden invasion on the fourth or fifth day after an operation, marked generally by rigors, or by depression of spirits and great anxiety, followed by profuse perspirations; the pulse is generally rapid; the tongue is furred, then loaded, and by-and-by brown and dry; the skin assumes a dusky, sallow, and then a somewhat icteric tinge; there is very great prostration and emaciation; one or more of the joints swell, become red and painful, and may even suppurate; the breath has a heavy, sweetish,

or purulent odour; and there is laboured respiration, delirium, or other symptoms indicative of certain organs being chiefly involved. This fever has no fixed duration, but it exhibits certain stages, and generally abates or becomes intensified on the seventh, eighth, fifteenth, twenty-first, twenty-second, or twenty-eighth days, dating from the first rigor or other initiatory symptom. It is characterised by the formation of secondary abscesses in internal organs (most frequently in the lungs, the liver, kidneys, spleen, and brain), and also in the joints and cellular tissue.

I have designated pyæmia a fever, because it seems to me, that, regarding its origin, symptoms, progress, and pathology, this disease is more nearly allied to the class of febrile affections than to any other group of diseases with which we are acquainted. This view is further confirmed by the only treatment which has, as yet, been followed by success. A liberal and properly regulated use of stimulants, and of nourishing diet, has alone been found efficacious in averting that serious issue which has hitherto compelled surgeons to view a rigor after an operation as a death signal.

NOMENCLATURE.

This disease has been variously named according to the supposed source of its active principle, or essential

cause.

Phlebitis. From the days of Hippocrates, even to our time, this disease has been connected by writers with inflammation of the veins; and the term phlebitis

C

remains in medical lore as synonymous (according to some) with pyæmia. Hunter (1793) used this term. Riber (1816) referred the fatal symptoms to this complication. Carmichael (1818), Breschet (1819), and Abernethy (1830), also held this view. Guthrie (1827), Sir A. Cooper (1827), Bouillard (1825), Dance (1828), Cruveilhier (1829), ascribed the formation of secondary abscesses to capillary phlebitis. Cruveilhier, Dance, and Arnott (1829), regarded phlebitis and purulent infection as identical affections. Liston (1837), Teissier (1838), Samuel Cooper (1826), Syme (1848), Hyde Salter, Bransby Cooper (1833), Vidal, Nelaton, Bérard (1842), Lee (1850), all used this

term.

Purulent Diathesis.-This name was first given by Ambrose Paré (1582), and the disease thereby signified was ascribed to atmospheric influences. Boerhaave (1737) considered this condition to be excited by the absorption of pus through veins. This pus Morgagni (1740) traced to broken down tubercles, the particles of which becoming arrested in the capillaries acted as local irritants. The theory of the absorption of pus and other diseased secretions, was first held by De Haen (1761). Teissier (1838) strongly defended this doctrine. Legallois (1829) and Billroth (1862) used

this term.

Metastasis.-Cheston (1766) advocated the metastatic origin of this disease. He speaks of translations of matter from one part to another being frequently met with after amputations. Aretæus (in the second century) held this view also.

Purulent Infection.-Berthelot (1780) employed this expression, as also did Hodgson (1815), and

Velpeau (1826). Sédillot (1849) entitled his treatise, "De l'Infection Purulente, ou Pyæmie." Wood (1858) mentions it among his other synonyms for this disease. Toynbee (1860) uses this appellation. Panum (1863) terms it putrid or septic infection.

La fièvre jaune was the term applied by Larrey (1812) to this disease.

Constitutional irritation was proposed as a name first by Travers (1818), who considered the cerebrospinal system to be principally affected. Barthez (1843), Brodie, W. Philip, and Copland (1858), held that the ganglionic nerves formed the chief seat of irritation. This doctrine received support also from Rose (1828) and Desault (1794).

Pleurisie purulente des opérés was the appellation given by Velpeau (1826) to this disease, on account of the very frequent occurrence of pulmonary lesions after surgical operations.

Multiple bscesses.-The occurrence of such abscesses, especially in the liver, was mentioned by Larrey (1812), Bertrandi and Andouillé (1819), Pott, &c.; but this name was most strongly insisted on by Castelnau and Ducrest (1846), who considered it to be the most correct term which could be employed. Visceral abscesses were ascribed by these authors to an altered condition of the blood, and they preferred the term multiple" to the older one of " metastatic" abscess. Purulent absorption was the expression employed by Solly (1851), and he believed this process was performed by both veins and lymphatics. The doctrine of the admixture of purulent fluid with the blood in the system was held also by Home (1810), Montezzia (1813), Carmichael (1818), Quesnay (1819),