Pyemia or Septic Fever is a disease developed during the process of suppuration in wounds or the formation of abscesses, and is induced by the presence of pyogenic micro-organisms (bacteria) in the blood. It is accompanied with the formation of secondary abscesses in various parts of the body, which results from the invasion of micro-organisms and their growth into colonies and in such a manner establishing independent centres of suppuration. It never occurs before suppuration has been established. It is caused by suppurating wounds, and usually when the formation of pus is most active, although it may commence during any stage of the suppurating process. Pus microbes are the active cause of the disease, and it is more common to men of middle age, than to women, or children, or even the aged. The pus microbes cause the adhesion of the blood-corpuscles and the formation of thrombi (or clots of blood formed within the heart or in blood vessels). The symptoms of pyemia are chills, increase of temperature 1040 to 1060 F., ending in a profuse perspiration, a decrease of temperature to normal or lower. The fever is of an irregular, intermittent type, and the development of secondary abscesses is indicated by febrile exacerbations, and local inflammatory symptoms. Swelling of the parotid gland with the formation of metastatic abscesses is sometimes a symptom of this affection. The breath has a sweetish, purulent odor, the pulse becomes weak and rapid, and the strength rapidly fails. The tongue becomes dry and brown-coated, and the teeth and gums are coated with sordes. Erythematous patches appear, which have a tendency to form pustules. The prognosis is very unfavorable in acute cases of pyemia.

Treatment

The treatment is in a great degree prophylactic to prevent suppuration, and antiseptic treatment is indicated, and the wound rendered asceptic. Metastatic abscesses must be at once opened and disinfected. The constitutional treatment consists of nutritious and easily digested food, and alcoholic stimulants. Quinine in large doses is often employed, and carbonate of ammonium and digitalis during the stage of prostration. Pyemia resulting from aveolar abscesses demands the extraction of the affected tooth and curretting the abscess cavity, and after irrigating with antiseptic solutions, the cavity should be packed with antiseptic gauze, or iodoform gauze, and this continued until a healthy granulating surface is formed.

Shock And Collapse

Shock is the depression of the vital powers by severe injuries, surgical operations, or profound mental impressions.

Collapse is a state of nervous prostration, and both it and shock have been classed together. Collapse arises from various causes of which shock may be one, but shock may occur instantaneouslv in a healthy person, whereas collapse is generally manifested in persons who have been subjected to a prolonged nervous strain which has greatly exhausted them. Prolonged dental operations depress the vital powers of those already exhausted from disease, overwork of mind or body, and sometimes in chlorotic girls, pregnant women, and delicate children; hence, such conditions should be recognized by the dentist, and properly appreciated, and all operations of a painful or prolonged character should be avoided, if possible, until such times as the improved condition of the patient will justify; or, if imperative, treatment which will allay nervous irritability and prevent shock, should be instituted.

Treatment

The patient should be laid as flat on his back as possible, or even with the head lower than the rest of the body - the feet and extremities raised. Some authorities recommend as a good plan occasionally to bandage the extremities from their tip towards the body, in order that the blood they contain naturally may be pressed to the vital organs. Should cyanosis occur it indicates that the head is being too much depressed.

Warm stimulating drinks, such as of whiskey, brandy, etc., diluted, are serviceable if they can be swallowed. When the patient cannot swallow, almost as much benefit can be gained by resorting to enemata of hot coffee with brandy, with ammonium carbonate, etc. Nitrite of amyl will assist in equalizing the circulation. The hypodermic use of strychnia, and tincture of digitalis, will stimulate the activity of the heart. Failing respiration may be stimulated and sustained by atropia hypodermically injected also. Care should be exercised in giving strong liquors, for if the patient cannot swallow, some of the irritating fluid may escape into the larynx, and the coughing may be so violent as to prove fatal; the same is true of inhalations of strong volatile stimulants. Reaction must not be established too quickly. External heat is often beneficial, such as the warm bath, hot water bottles or bags. Artificial respiration may also be resorted to in extreme cases, or galvanism - the Faradic current to stimulate the diaphragm, applied with one pole over the phrenic nerve, the other over the diaphragm. Small chips of ice, made by standing the piece with the grain upright, and splitting off a thin edge with the point of a pin, if the patient can swallow them whole, will allay nausea and vomiting: also, if the patient can swallow, twenty drops of aromatic spirits of ammonia in a little water may be given every two or three minutes, until four or five doses have been taken. Smelling salts (ammonia), or cologne on a handkerchief may be of service in mild cases.

Fainting-Syncope

Persons may often faint without any perceptible cause, but debility of the nervous system favors it ; or it may occur from the sight of blood. In nervous patients fainting may occur after severe hemorrhage, etc. The symptoms are expressionless face, pallor of skin, lips, and oral mucous membrane, coldness of surface of body, irregular respiration, breathing being irregular in rate and depth, dilated pupils, mental apathy, loss of voluntary muscle-movement, and occasionally nausea and vomiting.

Treatment

The patient should be placed in such a position that the head will be lower than the body: if sitting in a chair she should not be removed but the chair lowered backwards, the head being supported, until the floor is reached. This backward and downward movement is readily made in a dental chair by lowering the movable back. Usually the consciousness returns as soon as the head of the patient is lowered. The dress should be loosened about the neck and chest. For an adult, a teaspoon-ful of brandy in a little water, or twenty drops of aromatic spirits of ammonia in water, may be given at short intervals, until consciousness and restored action of the heart occurs.