Complications due to chronic toxaemia.—The most common complications are those which arise as the
result of a chronic toxaemia ; they include pulmonary osteoarthropathy, amyloid
disease and nephritis. The symptoms and joint effusions associated with
pulmonary osteoarthropathy usually clear up quickly as soon as the chronic
suppuration in the chest has been controlled. It is important to realize that
amyloid disease is also reversible, provided that it has not been present over
a long period. In many cases the
symptoms and signs of amyloid degeneration
improve greatly but do not disappear entirely ; albuminuria is particularly apt
to persist in a mild form. Although nephritis is not common it is of particular
importance to the surgeon, because patients with this complication are often
bad risks for major surgical operations.
Brain abscess.—A. chronic empyema may also be responsible for pyaemic abscesses,
particularly in the brain. A persistent headache with nausea or vomiting should
always lead the clinician to suspect a brain abscess, but, even if these
suspicions are confirmed, all hope of the patient's recovery need not be
abandoned, for numerous authenticated cases have been successfully treated
during recent years by appropriate neurosurgery.
