Extravasation

“ When we consider that the area of the extravasation was sufficient to involve often one or two entire lobes, and that death was in most of them very sudden, the cases may be adopted as showing the action of causes similar in kind, if not in degree, to those operative in undoubted pulmonary apoplexy. ”

“ Cases of extravasation or of effusion, terminating by the formation of a sac, pouch, reservoir, or foyer surrounding it, while the rest of the cavity remains free from inflammation, are so rare in natives of our northern climates that I am indisposed to infer that they do take place, except as very accidental circumstances. The fact that such things do take place should be borne in mind, and surgery should not be wanting in giving its aid, under all well-considered and reasonable circumstances. It is easier to do nothing than to think and to act. ”

“ The state of the brain differs much according to the mode of death. Sometimes great congestion and even actual extravasation of blood are found in the heads of persons who have died of excessive continuous drinking,—the excitement of such a debauch being apt, as already mentioned, to induce apoplexy in a predisposed habit. Accordingly extravasation was found by Professor Bernt of Vienna in no less than four cases of the kind, two of which happened in the persons of young men not above twenty-two years of age ”

“ If the urine escapes into the cavity of the abdomen, the patient inevitably perishes, and that very speedily; and when the cellular tissue of the pelvis is the seat of the extravasation, little hope can be entertained of recovery, though the fatal termination may not be so rapid as in the former case. When the urine is effused into more external parts, as into the perineum or scrotum, the danger is also imminent, if the fluid is allowed to accumulate and become extensively infiltrated ”

“ Defensive ferments, which decompose the albumen of blood corpuscles, are frequently met with in carcinoma. Any extravasation of blood into the tissues, however slight, will give rise to this kind of defensive ferments.
Within the domain of pathology there is no field which would not lend itself to researches based on the methods we have described. We will call attention to some. In the first place we can try, by means of defensive ferments directed against certain kinds of cells, to discover those organs which are giving off substances that are out of harmony with the blood or the plasma. ”

“ In the dog, pampering and traumatism. In cattle forced feeding, emaciation, microbian infection. In birds, tubercle, tæniasis, microbian infection. Lesions: extravasation, intracapsular, or through capsule into the peritoneal cavity. The extravasation bulges of a deep black, covering a dark softened, pulpy, hepatic tissue, with light colored fatty tissue around. Clots may be stratified from successive bleedings. Liver usually enlarged. Symptoms: onset sudden, or preceded by stiffness, soreness and other signs of hepatic trouble. ”

“ The kidneys are most seriously affected in acute and rapidly fatal cases. There may be œdema, with blood staining and even extravasation on their lower surface and in the adipose tissue. The gland may be enlarged and the cortical substance congested of a dark brownish red or black. Its capillaries are gorged with red globules in which the piroplasmata are very numerous. The medullary portion is much paler, and with fatty granules in the epithelium, and oil globules in the tubules. The renal pelvis is more or less petechiated and marked by extravasations. ”

“ There are no waterproof walls in the body of man to impede the percolation of liquids freighted with promiscuous Passengers from the alimentary canal; Passengers designed to nourish the organs for which they have an affinity. But there are those that have no organic affinity, and these are tramps, vagabonds, and even murderers, disturbing and destroying the normal functions of the system. Through extravasation, that is, through fluid infiltration of tissues, these Passengers come to be one with us, and we make them part of our tissue ”

“ Associated with vascular dilatation there is extensive leucocyte extravasation into the perivascular spaces, the course of the line of the attack being mapped out by white and yellow lines and areas of exudation. ”

“ Pressure over the skin does not cause the colour to disappear as in ordinary cyanosis. It has been shown by Wright of Boston, that the coloration is due to stasis from mechanical over-distension of the veins and capillaries; actual extravasation into the tissues is exceptional. ”

“ The infiltrated cellular tissue is dark, fetid, broken down, and soft, sometimes seemingly in part dissolved by the putrescent urine; and, when the patient has survived a considerable time, it frequently resembles closely in appearance a portion of suppurated lung. When active practice is not adopted after extravasation of urine has taken place, the cellular tissue around sloughs along with480 the integuments; rapid depression of the powers of life ensues, with great disturbance of the sensorial functions. ”

“ Bright’s cases there was a small ecchymosis in the cortical substance on the outer side of the anterior lobe, and not extending into the medullary matter. Fallot mentions an instance of suffocation from charcoal vapour, where a little coagulated blood was found between the layers of the arachnoid membrane of the cerebellum in the region of the left occipital hollow. [2104] Three instances of extravasation are enumerated in a list of German cases analysed by Dr. Bird. ”

“ For an account of the scurvy of the lungs, see Sect. XXVII. 2.
M. M. Fresh animal and vegetable food. Infusion of malt. New beer. Sugar. Wine. Steel. Bark. Sorbentia. Opium?
16. Vibices. Extravasations of blood become black from their being secluded from the air. The extravasation of blood in bruises, or in some fevers, or after death in some patients, especially in the parts which were exposed to pressure, is owing to the fine terminations of the veins having been mechanically compressed so as to prevent their absorbing the blood from the capillaries, or to their inactivity from disease. ”

“ If no complications supervene, the swelling subsides, and recovery may be complete in six or eight weeks. If the extravasation is great and the skin threatens to give way, or if the vitality of the limb is seriously endangered, it is advisable to expose the injured vessel, and, after clearing away the clots, to attempt to suture the rent in the artery, or, if torn across, to join the ends after paring the bruised edges. If this is impracticable, a ligature is applied above and below the rupture. If gangrene ensues, amputation must be performed. ”

“ When transudations are unhealthy, they may accumulate in serous cavities or in cellular structures, and constitute dropsy. Exudation is the result of inflammation, and the product effused coagulates and becomes the seat of a new growth of tissue. Exosmosis means the passage of fluid from within outward, and is a process constantly taking place in health; while transudation takes place because the blood is watery and the tissues are feeble and permeable, permitting the serum and watery elements of the blood to pass into certain cavities, where they accumulate. ”

“ If suppuration is fully established, evacuation of the contents, followed by antiseptic applications, constitutes the best method.
A saturated solution of boric acid or a lotion of corrosive sublimate (one to three grains to the ounce) applied to the immediate neighborhood of the boil or boils tends to prevent the formation of new lesions. Frequent washing of the parts with soap and water or tincture of green soap and water is also a preventive measure of value. In repeatedly infected areas, mild exposures to x-rays, at intervals of a few days, will often prove of curative value. ”

“ Although the arteries have been injected, yet we find that sometimes the fluid does not reach the cavities. Any cavity may contain gas or material for decomposition, such as blood, pus, lymph, or as in perforation of the intestines, feces in the abdominal cavity. Besides these we always have the bacteria of decomposition, called saprophytes, which have thoroughly invaded the organs and tissues of the body as soon as sixteen hours after death. Then, if for any reason the fluid has not reached a certain part, fermentation, and putrefaction will immediately set in. ”

“ Effusions of water into large cavities, as into that of the abdomen or thorax, or into the ventricules of the brain or pericardium, are more difficult to be reabsorbed, than the effusion of fluids into the cellular membrane; because one part of this extensive sponge-like system of cells, which connects all the solid parts of the body, may have its power of absorption impaired, at the same time that some other part of it may still retain that power, or perhaps possess it in an increased degree ”

“ Even without the removal of the cause the power of adaptation will enable the life of the affected part to go on, less perfectly perhaps, in the new environment. The excess of fluid is removed by the outflow exceeding the inflow, or it may pass to some one of the surfaces of the body, or in other cases an incision favors its escape. The excess of cells is in part removed with the fluid, in part they disappear by undergoing solution and in part they are devoured by other cells. ”

“ If the extraction presents any difficulties, one can often attain one's object by covering the tissue in the fresh state with a very thick layer of common salt. The mixture is allowed to stand for two to six hours in an ice-chest; the salt is then dissolved, and the washing carried on in the usual manner. One must never preserve an organ from which the blood has been incompletely abstracted, in any particular manner, with the intention of completing the process later on. All preservation media produce coagulation and alteration of the blood. ”

“ This is something slightly different from mere solution. Many of the solids of the tissue waste are of a nature to irritate and even disorganise the kidney, if they be brought to that organ for excretion in too concentrated form. There is no reason to suppose that the kidneys are liable to suffer from over-work if the specific secreting power of the [604] kidney cells be not too heavily taxed. If only the products of disassimilation be diluted, so that they can be passed through the kidney by the simple process of exosmosis, the organ will discharge its function without injury or exhaustion. ”

“ The accumulation of an excessive amount of inflammatory exudate may endanger the vitality of the tissues by pressing on the blood vessels to such an extent as to cause stasis, and by concentrating the local action of the toxins. Under such conditions the tension should be relieved and the exudate with its contained toxins removed by making an incision into the inflamed tissues, and applying a suction bell. When the exudate has collected in a synovial cavity, such as a joint or bursa, it may be withdrawn by means of a trocar and cannula. ”

“ Whilst, on the contrary, those fluids, which are effused by the retrograde action of the lymphatics, are for the most part mild and innocent; as water, chyle, and the natural mucus: or they take their properties from the materials previously absorbed, as in the coloured or vinous urine, or that scented with asparagus, described before.
2. Whenever the secretion of any fluid is increased, there is at the same time an increased heat in the part; for the secreted fluid, as the bile, did not previously exist in the mass of blood, but a new combination is produced in the gland. ”

“ The whole organism continues to swell by the formation of a watery liquid within it, and if its growth be rapid the fluid tension may cause the rupture of the enclosing connective-tissue capsule formed around the parasite, at the expense of the host, and the protrusion of the daughter vesicles. It is the consequent injury to the surrounding organs of the host, at this critical stage, often only reached after the lapse of several years, that occasions serious or even fatal results. ”

“ Others, considering the pain in his Kidneys during the Transfusion and the swelling of his Stomach, which was presently follow'd by Evacuations above and below, do believe, that the new Blood entring in great quantity, caused a plenitude, and a fermentation in the great Vessels, which could not but be follow'd by all those effects. To which may be added, that almost all those, into whose Veins other Liquors than blood have been injected, have found the same Accidents. ”

“ Wastes given off by the Blood in the Kidney.—In the glomerulus the blood loses by osmosis, through the very thin walls of the capillaries, first, a considerable amount of water (amounting to nearly three pints daily) ; second, a nitrogenous waste material known as urea; third, salts and other waste organic substances, uric acid among them.
These waste products, together with the water containing them, are known as urine. The total amount of nitrogenous waste leaving the body each day is about twenty grams. It [Pg 342] is passed through the ureter to the urinary bladder ”

“ There is reason to believe, that the daily use of opium contributes to produce gravel in the kidnies by increasing absorption, when they are inflamed; in the same manner as is done by fermented or spirituous liquor. See Class I. 3. 2. 11.
When the kidnies are so obstructed with gravel, that no urine passes into the bladder; which is known by the external appearance of the lower part of the abdomen, which, when the bladder is full, seems as if contracted by a cord between the navel and the bladder; and by the tension on the region of the bladder distinguishable by the touch ”