We have repeatedly had to refer to a decomposition, a putrid decomposition [sepsis'] of the blood, as a consecutive crasis resulting from the degeneration of another crasis.

The conditions we are here concerned with vary, as the anatomical results show, with the causal influences at work, as also with the differences due to pre-existent erases.

Generally speaking, these conditions manifest themselves in decomposition, in dissolution, in necrosis, in a death of the blood, and they comprise the commonly called scorbutic, the chronic and acute, putrid states of the circulating fluid. A very broad line of demarcation, coming under anatomical notice, and which separates the states referred to into two series is that, in the one case, the sepsis has the character of a fibrin-cra-sis, in the other, that of a deficiency of fibrin. Accordingly, if we except the two common features of thinness and discoloration of the blood generally, a comprehensive view of all these states is not feasible.

Regarded from a clinico-anatomical point of view, the various conditions of septic crasis occur in the following forms:

1. The Purest And Most Simple Forms Of Sepsis

The Purest And Most Simple Forms Of Sepsis are:

(a.) A decomposition or necrosis of the blood brought about without any cognizable agent of fermentation is that due to a shattered state of the nervous system and of its function, proving fatal with lesser or greater rapidity [sometimes in a very few moments], according to the measure and amount of the shock. To this category are to be referred decompositions of the blood consequent upon concussion and severe injuries, concussion from a fall, from the extensive laceration or the crushing of soft parts or of bones; upon extensive amputations; upon the continuous, exhausting activity of the muscles in violent convulsions, of whatever kind; upon electrical shocks received [lightning]; upon mental emotion of an overwhelming nature. A very striking exemplification offers in the decomposition of the blood not unfrequently called forth by a difficult and exhausting act of parturition involving palsy of the womb; cases which often prove fatal after a very few days, or even hours.

In all these cases the blood is found attenuate, in color comparable to a raspberry jelly, or of a dingy red, facile of imbibition, expanded in volume, often engaged in gas-development, frothy. The blood-corpuscles are swollen up, the serum being deeply reddened by haematin withdrawn from them. Coagula, if present at all, appear as very inconsiderable, soft, curd-like fibrin-clots. The frequent large peritoneal exudates, occurring more especially in puerperal decomposition, are dingy-red, dull, thin, sometimes rather viscid fluids. The dead bodies present but little and evanescent rigor, much inflation, extensive and deep lividity. The internal organs, the heart's muscle, the parenchymata are lax, flabby; the bloodvessel coats and the endocardium, discolored from imbibition; those parenchymata whose bloodvessels are most injected are more or less discolored by imbibed serum. The blood is always largely accumulated in particular sections of the vascular system, be it in the nerve-centres, in extensive patches of the mucous membrane of the stomach and intestines, in the sexual organs of women, but most particularly in the lungs, as hypostasis.

The corpses pass into putridity, under the phenomena of gas-development in the bloodvessels, emphysema in the textures, copious transudation of a dirty-red serum into the serous cavities, and spontaneous vesication of the epidermis.

(b.) Those decompositions consequent upon faulty diet [true scurvy], the reception of corrupt matter, of miasmata, of animal poisons into the blood, etc.

The dead bodies present, generally, the characters already specified. Owing, however, to the expansion of the decomposed blood, transudations of blood-dyed serum in the shape of ecchymoses of the textures, and actual hemorrhages, are especially apt to take place.

2. A Second Form Of Decomposition

A Second Form Of Decomposition is that so frequently attendant upon hypinotic crasis, and which we have before described as an exaltation or degeneration of the typhous, of the exanthematous, of the cholera-, of the drunkard's dyscrasis. Its relation to the fundamental crasis may be regarded as a varying one. Here we may observe:

(a.) The putrid decomposition, impelled by a special external agent, becomes complicated with the hypinotic crasis, a septic venom being superadded to the exanthematous contagion or the typhous miasma. There being essential putrid decompositions independent of those other agents, and the symptoms of septic poisoning often occurring very early during the progress of the other diseases cited, such a relation is placed beyond all doubt.

(b.) The sepsis is a dissolution of the blood in the hypinotic crasis, resulting from the profound injury inflicted by this crasis upon the nervous system. This implies, either a very intense hypinosis [a very intense miasma or contagion], or else a very susceptible nervous system. Thus it may happen that typhus and exanthemata pass into putrid decomposition even in epidemics by no means of a malignant type.

(c.) Or, in fine, it is possible that a hypinosis occasioned by miasma or contagion, may, of itself and without the mediation of the nervous system, become degraded into a putrid crasis, simply through putrid conversion of the received miasma. It is in this sense, more particularly, that the exaltation or the degeneration of a primitive crasis to the putrid is to be understood. The blood and the corpse present the same appearances as in the first form; the marks of decomposition and putrefaction being, however, if possible, still more clearly defined. The different hypergemiae are also more distinctly expressed - such hypersemise as are proper to the original hypinoses. They occupy, frequently in the shape of ecchy-moses and hemorrhage of the textures into which they have degenerated, those organs or parts of organs in which the original hypinosis had localized itself; for example, the intestinal mucous membrane, in putrid typhus; the common integument and the great tract of the respiratory and intestinal mucous membranes, in exanthematous processes. Not unfrequently, the septic crasis of this form localizes itself in deep-colored, absolute stases, especially in peripherous organs, where, without a trace of organizable products, they terminate in necrosis of the blood and of the textures, with conversion thereof to a soft, humid, dingy, deep-red mass, - a gangrene-slough.

A stringent differential diagnosis from the blood itself is, however, not feasible in all the cases of the first and second forms. It is only to be deduced from the anatomical disturbance of the solids generally, and, in cases of the second form, in particular, from the products of the original hypinosis, - typhus, exanthema, etc. For instance, where the intestinal mucous membrane reveals the marks and residua of a typhous process, the sepsis will have arisen out of the typhus-crasis. Where obvious anatomical disturbance does not exist, - for example, in the case of convulsions, - or where the products of a hypinosis, owing to the early supervention of sepsis, are inconsiderable or only faintly indicated, and where, lastly, clinical records are wanting, the diagnosis must needs rest upon probabilities alone.

3. A Third Form

A Third Form, differing from the two former, is that of a sepsis of the blood resulting from the fibrin-crasis, especially the aphthous, and from pyaemia. It manifests itself, in the first instance, as a putrid decomposition, as a necrosis of the fibrin, which forthwith possesses itself of the entire blood-mass. It has been already discussed under croupous crasis r, and under pyaemia, as aphthous and purulent sepsis.