Pyaemia, or Blood Poisoning", as it is sometimes called, is an acute disease which is remarkable for the irregularity of the temperature. Instead of remaining steadily high, it rises and falls two or three times a day. When it reaches a high point the patient has a rigor, or shivering attack, followed by perspiration, in which the temperature falls. The patient is acutely ill, and suffers from sickness, vomiting, diarrhoea. The disease is due to the introduction of a microbe into the body. It was very common before Lord Lister introduced modern aseptic methods in surgery. More patients died as a result of pyaemia, or blood poisoning, after an operation than succumbed to the operation itself, and it was especially rife in times of war before hygienic measures were introduced, and our modern medical service organised. In ordinary life blood poisoning may follow as a result of a dirty or unhealthy wound. A mere scratch is sufficient for the introduction of poison; and neglected cuts and burns, especially in the case of servant-girls, who allow these wounds to become dirty, are liable to be followed by infection of the blood with the microbes of pyaemia. In severe cases abscesses occur in different parts of the body, with deposits of pus, or matter, and such cases should be immediately placed in the hands of a good surgeon.
The poison is not invariably from " without," as infection may arise from some internal condition, such as disease of the ear bone, or inflammation in other parts of the body, which may occur in association with appendicitis, for example.
Pyaemia was responsible for a great many deaths after childbirth in the days when untrained midwives were allowed to practise. This form of blood poisoning is called puerperal fever. A person is more liable to pyaemia when run down in health or living in an unhygienic environment. Lack of ventilation, overcrowding, and want of cleanliness favour the development of the disease. Treatment must be undertaken by a doctor, who will deal with the cause of infection. Modern surgery also has provided us with anti-toxic serums which influence considerably the progress of the disease. The patient's strength must be maintained by stimulants and nourishment.
Pyrexia. (See Fever.)
Quinsy. (See Suppurative Tonsilitis.)
Railway Accident Effects. After a railway accident, even when no injury has been sustained, a condition known as "railway brain" or " railway spine " very commonly arises. It is a form of neurasthenia, said to be due to inflammation of the brain and cord membranes, following upon shock. A person may seem perfectly well for days or even weeks or more after a railway accident or any other form of shock. Later on, headache, lassitude, and sleeplessness develop, and a condition of nervous instability with various mental symptoms may supervene. Depression of spirits and even melancholia may develop, and there is always disturbance of digestion and loss of weight, whilst various hysterical or emotional symptoms are very common. These same symptoms may follow upon any accident, and are frequent after motor accidents ; whilst men who take up flying very often complain of such neurasthenic symptoms, and say that they have lost their " nerve." The cause is due rather to mental and nervous strain than to any accident. A condition like " railway spine " or " railway brain " will often follow a slight blow or fall, without any injury, from a carriage or on a staircase. The subject is important, owing to the question of insurance payments. Ultimate recovery can be expected except when very serious symptoms are present. Treatment should be in the hands of a nerve specialist. The patient generally requires rest and change of scene, with fresh air and careful dieting.
1.Certain medicines, such as quinine and belladona, administered for any time are followed by a rash. Other rashes associated with toxins in the blood follow upon digestive disturbance, such as prickly heat and nettle-rash, which many people are subject to on eating shellfish and certain fruits, such as the strawberry. The rashes of teething are generally due to digestive derangement or improper feeding.
2. Various rashes appear in the course of the infectious fevers, such as scarlet fever, etc., according to the disease.
3. Rashes, again, may be of neurotic or nervous origin, such as locomotor ataxia, and in neuralgia. Herpes, which is a skin eruption along the couise of the nerves of the chest, is another example.
A remarkable form of hysterical rash is that which appears as stigmata, or bleeding points, in certain cases of tense religious excitement, with hysterical delusions. A general article on Rashes in the Nursery will be found on page 740, Vol. 1.
Refraction, Errors of. The perfect eye can focus objects at a distance and near at hand with ease and accuracy. A great many people, however, have what is called an error of refraction - that is, there is some defect in the mechanism of focussing which requires to be corrected by an external lens.
In cases of myopia, or near sight, the image looked at is formed not on the retina at the back of the eye, which is a natural sensitive plate, but in front of that membrane, and the retina is not getting a sharp image of what is looked at. To correct this defect a concave lens is required. If the glasses of a shortsighted person are examined they will be found thicker at the rim than in the centre, where the eye looks through. That is, the lens is biconcave. Such a lens acts by counteracting the natural lenses of the eye which are too convergent, with the result that the image focussed is not in front of the retina, but upon it. (An article will be given later upon the eye, with drawings, showing how the lens causes rays of light to bend just as a ray of light striking the water is sharply bent at an angle.) The action of a concave lens is to make the rays diverge or bend outwards. The action of a convex lens is to make the rays converge or bend inwards.
Hypermetropia, or far sight, is the opposite condition to myopia. The focussing power of the eye is] so feeble that the image of an object looked at is formed on a plain behind the retina and the person cannot focus near objects. Thus, a double convex lens is used which assists the two lenses of the eye to converge the rays of light more sharply and so focus clearly the image on the retina. In both myopia and hypermetropia the condition may be due partly to defective power of accommodation. The eye cannot accommodate itself to see objects at a distance or near at hand.
Presbyopia is found in old people, and is due to a rigidity of the lens of the eye. The eye cannot accommodate for near objects, so that, although the distant vision may be very good, it is impossible to read or see near objects without convex glasses.
Astigmatism is irregularity of the eye, so that the person is unable to see perpendicular or horizontal things equally well. For example, in looking at a gate, when the transverse bars are focussed the perpendicular bars are hazy, and vice versa. This type of eye defect is a frequent cause of headache, due to continual strain in focussing, and special glasses are required, according to the degree and type of astigmatism present.
It cannot be too strongly emphasised how important it is to have any error of refraction corrected by glasses. A person with defective vision is living continually under strain. The effort to focus or see things clearly causes fatigue of the delicate eye muscles, with more or less constant headache and other symptoms. Eye defect may be responsible for depression, irritability, and other symptoms, which make life more difficult and increase the tension of living. In young children eye mischief in the past has been responsible for many ills, but now parents are more alive to the relationship between headache and defective vision, and children have more chance of having the eyes tested, and any error of refraction corrected.
Rheumatic Fever, or Acute Rheumatism, is an acute disease caused by some toxic condition of the blood due to microbic or germ infection. The poison of rheumatic fever chiefly affects the joints, whilst one of the greatest dangers of the disease is that it is apt to cause an inflammation of the membrane of the heart. Young people are especially liable to the disease, especially if they are exposed to great changes of temperature and are thus apt to contract chills and wettings, which depress the vitality.
In a great many cases, one of the early symptoms is tonsilitis. The patient may suffer for a day or two from severe sore throat, chilliness, headache, and discomfort. Soon the joints become inflamed and painful. One joint after another becomes affected. The tongue is coated, the pulse is quick, and the temperature is generally raised Over 100 degrees. The perspiration is profuse and acid, with a typical sour smell.
The characteristic feature of the disease is the way one joint becomes affected, and, just as this is becoming better the next day another one is involved, the disease passing, as it were, from joint to joint. The joints are extremely painful on the slightest movement, and are hot and swollen.
In some instances the fever and joint symptoms last two or three weeks. In others, the patient may recover more quickly, but there is always the risk of a relapse. The chief injury is connected with the heart. The rheumatic poisons circulating in the blood directly irritate the membranes of the heart. The valves may become swollen and inflamed, and even permanently damaged.
The complications of rheumatic fever are very serious. Besides heart complications, pleurisy may occur ; whilst pneumonia and bronchitis are less common. St.vitus' dance and anaemia are very frequent after rheumatic fever.
The proper nursing of rheumatic fever is so important a part of treatment that the subject was considered under Sick Nursing in Winter. (See page 3259, Vol. 5.) Drugs have to be ordered by the doctor, who must see the patient every day in order to watch the heart. Rest in bed is, of course, necessary, and, as a rule, the doctor will wish the patient to dispense with sheets and lie between blankets. Simple milk diet, as in all fevers, is given. The joints will have to be treated with various lotions ordered by the doctor, and wrapped in cotton-wool.
During convalescence the patient requires a good deal of care, as the joints may again become swollen and the heart be affected at any time. Errors in diet, for example, may bring about a relapse, and exposure to chill is very dangerous. In many cases a long physical rest will be necessary, as the patient's heart is in a weak condition, and any exertion has carefully to be avoided.
If, however, reasonable care is exercised, and, during convalescence, rest is regarded as an essential part of treatment, complete recovery may be expected. Many of the cases of crippled heart and St. Vitus' dance which were formerly so common were due to a too rapid convalescence. To be continued.