Injection

“ That the growth is not limited by the size of the mass injected is the author’s belief; in other words, the replacement of the new tissue is not proportionate to the injection, but that other forces, such as adjacent tissue pressure and presence and outer influences, as, for instance, the daily massage of the parts with the hands, have much to do with the final amount of tissue caused to be developed by the initial stimulus of the injection. ”

“ Injection of blood vessels may be performed on small animals, or on individual human organs after removal from the body. The object is to fill the vessels with a coloured fluid which will solidify afterwards. It is possible in the same organ to inject the arteries with a red medium, the veins blue, and secretory ducts, such as bile ducts, yellow or blue.
The most convenient basis for an injection mass is gelatine, as its solutions liquefy at a temperature of about 100° F., and solidify a little below that point, and when solidified cut readily, and do not tend to become brittle. ”

“ Usually, however, the injection can be made without resistance. Blood should be drained from these cases so as to allow as full capillary penetration as possible. When no arterial injection can be made, open the internal jugular and several other large veins, drain blood from them and then inject fluid while the tube is within the vessel. If necessary add a complete hypodermic injection to all parts of the body excepting the face. Give the cavities full treatment. For transportation, govern yourself according to the transportation rules.
Fatty Degeneration of the Arteries. ”

“ The Injection of Alcohol into the Nerve.—The alcohol acts by destroying the nerve fibres, and must be brought into direct contact with them; if the nerve has been properly struck the injection is followed by complete anæsthesia in the distribution of the nerve. The relief may last for from six months to three years; if the pain returns, the injection may be repeated. The strength of the alcohol should be 85 per cent., and the amount injected about 2 c.c.; a general, or preferably a local, anæsthetic (novocain) should be employed (Schlösser) ”

“ If in the injection of fluid, there is an obstruction in one of the blood vessels, leading to one of the organs, you will never be any the wiser, but if the obstruction is in one of the vessels supplying a certain area of skin, the condition will show up sooner or later, when that certain part will have to be treated hypodermically. Slow arterial injection with drainage of blood should be given and when symptoms of fermentation are present, include special attention to the abdominal cavity. ”

“ When a slight discharge takes place, in consequence of a slip of the foot, or some other external cause, we may also derive advantage from the use of the injection, but not so certainly as in the former case; and if the discharge be considerable, the injection will fail. It is better, in this case, to trust to the formation of a coagulum. ”

“ The most wonderful and satisfactory effect is the immediate consequence of the injection. To produce the effect referred to, a large quantity must be injected—from five to ten pounds in an adult—and repeated at longer or shorter intervals, as the state of the pulse, and other symptoms, may indicate. Whenever the pulse fails, more fluid ought to be thrown in, to produce an effect upon it, without regard to quantity. In one of the cases I have referred to, 120 ounces were injected at once, and repeated to the amount of 330 ounces in twelve hours. ”

“ The probability of escaping confinement is a great incentive to a patient to submit to an injection, when he would refuse operation.
Injections are not necessarily unphysiologic as the sufferer from a hernia has a physiologic deficiency which the paraffin accurately fills with normal connective tissue.
The dangers of injection can be eliminated. The technic is not difficult even when all precautions are taken. ”

“ The author has used the cold-injection method in over three hundred nose cases without a single case of sloughing, embolism, or death, and in no case was there secondary diffusion or hyperinjection. The only fault has been the desire on the part of the patient to be finished too quickly, which usually leads to a result not as satisfactory as when the injections are made sufficiently far enough apart to allow the formation of organized tissue at the site of injection. ”

“ Large hernia which have gone unreduced for years have not been treated by injection and discretion demands that for some time, or until injection treatments have been practiced upon many patients, that large ruptures which have been outside the abdomen for long periods be left to the surgeon or be injected only by practitioners capable of doing the cutting operation [Pg 70] in the advent of the failure of the injection treatment. ”

“ My liquid, employed as a bath or injection, without either danger or inconvenience, and which costs only two or four cents the quart.
I shall give here an example of injection; a corpse is injected by the carotid with from five to seven quarts of the acetate of alumine at 20°, and containing in solution about two ounces (fifty grammes) of arsenic acid. Four days after this injection, if it is intended to prepare the large and small vessels, inject by the aorta half a quart of a mixture, equal parts, of the essence of turpentine and essence of varnish ”

“ Injection of quinine.—— In any type of fever, if vomiting is persistent, if the brain is affected, or if the patient is insensible and cannot or will not swallow, recourse must be had to rectal, or intramuscular, or intravenous injection of quinine. In all cases in which life is in imminent danger, and in which the earliest possible action of the drug is of importance, it must be so administered. ”

“ If a fine injection but partially succeeds, it almost always shows vessels that really exist, but which were not sanguineous during life. Even the coarse injections of our dissecting rooms frequently exhibit these phenomena, especially in the face, the neck, &c.; and much more so, if the matter injected is very delicate, and managed with much address. I cannot conceive why physiologists have always taken as an indication of the blood vessels, the state of injected organs; by opening any part of a living animal, they may clearly see how deceptive this method is. ”

“ A piece of sterilised rubber tubing of suitable length, fitted with an injection needle and provided with a screw clamp, is now attached to the nozzle of the funnel and the operation [Pg 348] completed according to the requirements of the particular case.
This method is quite satisfactory when the injection is made into the pleural or abdominal cavities or directly into a vein but if the injection has to be made into the subcutaneous tissue the "fall" may not be sufficient to force the fluid in. ”

“ Necrosis.—Death of tissue may follow an injection of paraffin when too much pressure has been applied, or when too much has been injected into the tissue, cutting off the blood supply, or when the injection has been made into the skin instead of beneath it. Again, constitutional disease, such as diabetes or Bright’s disease, may superinduce the breaking down of the tissue. ”

“ To assure the operator against such difficulty the needle may be withdrawn after insertion, and if blood does not trickle from the wound it may be reintroduced without pain to the patient and the injection begun.
It is not advisable to correct the defect at one sitting. One third or one half of the depressed area may be overcome by one injection. The resultant tumefaction must then be thoroughly molded out, until little seems to have been accomplished by the injection. ”

“ In dysentery and other painful affections of the intestines, this is considered by the best medical authority to be a certain relief. Dr. Druit directs from one hundred to one hundred and twenty drops to be administered. A whole teaspoonful has been often used in severe cases. The less mucilage used, the more likely is the injection to remain in the rectum. An opiate injection for a child not over a year old may consist of two or three drops of laudanum mixed in three quarters of an ounce of mucilage. Opiate injections should not be administered often, without the advice of a physician. ”

“ Use is made of the abundance of body fluid in the connective tissue spaces whenever a subcutaneous injection is given, for what is done is to inject the desired material into the fluid which fills the spaces in the connective tissue just beneath the skin, trusting that it will pass from there to the blood, which it does rather gradually, and so is distributed about the whole body. ”

“ In cases of colic, where an active and speedy relief of the bowels is desired, this remedy has been highly beneficial.
Anti-Neuralgic Injection.
Take of Venice turpentine one half an ounce, and add the yolk of an egg, three fourths of a grain of extract of opium, and half a pint of water. Make the turpentine and egg into an emulsion, and by degrees add the water, in which the extract must previously be dissolved. An injection of simple water is to be first taken and retained, and then the above administered, which the patient must endeavor to retain. ”

“ This absorption, following such an injection, is productive of no harm to the human economy, and the new tissue caused to be formed by such injection truly enhances the cosmetic and surgical value of the method inasmuch as an encapsulated mass of paraffin is liable to displacement, spreading, and irregularities, should it be subjected at any time to external violence. ”

“ At no time should an injection be crowded into a dense tissue or where the skin is closely adherent, nor carried so far as to create a blanching of the skin. By carefully injecting the mass this danger should be overcome. ”

“ In France there is scarcely a family unprovided with an injecting apparatus, which is always used when there is the slightest obstruction or costiveness of the bowels. These people mostly use a simple clyster of milk and water, and sometimes water alone; in summer they use cold water, and in winter, water pleasantly warm. It is to the warm bath and the common use of injections that are to be attributed, in a great degree, the cheerful dispositions, the uniform health, and the practical philosophy with which these people bear the hardships and misfortunes of life. ”

“ The Dose of Atropia for Subcutaneous Injection.—I wish to answer the query of Dr. Sisson in the Practitioner of last month with every caution, but I have formed a strong opinion on the subject in question. A “Country Practitioner,” who wrote to this journal in February, states that he used to give hypodermic injections of more than 1⁄5 grain of atropia daily, to the same patient, for years. ”

“ Worm-Müller16 and Cohnheim17 have made some very interesting experiments on this question of plethora. By transfusion in dogs a state of artificial plethora is readily established, and the animals stand the injection of as much as 10 or 12 per cent. of the body-weight of blood, above which quantity a fatal result ensues. After an injection of 20 or 30 per cent. of the total amount of blood, the superfluous plasma and corpuscles are got rid of in a few days, while with a larger injection of 60 to 80 per cent. ”

“ The main point of injection is the common carotid artery. Before injecting the stomach and bowels, and before replacing the intestines into the abdominal cavity, the inferior vena cava is punctured a little below the renal vein, and the flow of blood allowed to take place in the cavity, from whence it may be either sponged or pumped out. ”

“ Only the operator thoroughly acquainted with the manner of disposition of paraffin should attempt the injection of hernia.
Simplicity.
To the skilled operator the injection treatment is exceedingly simple and the injection method must always be far more simple than the open operation can ever become.
A hernia can be injected without haste in from two to four minutes.
An assistant is of no use.
The open operation cannot be performed without the aid of several trained assistants, and without elaborate and expensive preparations, it is not feasable as anything but a hospital operation. ”

“ The infiltration of skin or canal being complete the needle must be withdrawn and the syringe emptied and the plunger pressed down so that the empty syringe is attached to the needle through which the paraffin injection is to be made when the operator has assured himself that the needle has been passed as far as desired without traversing or puncturing a vein. ”

“ The following quotations taken from the circular are admissions that these preparations are not innocuous:
“That the economy will tolerate to a surprising degree substances directly introduced through the blood stream is now well known. By the intravenous injection of 10 c.c. of methyl-phenol serum we throw into the human body a massive dose of an alien substance. ”

“ In fact, if you take from a French physician the warm bath and the injecting pipe, he cannot practise medicine with any kind of success. The importance of injections, both in the hands of physicians and families, has become so well known, and is now so highly valued, as to call forth the commendations of the most eminent physicians of both Europe and America. ”

“ Never superimpose an injection about the median line until the major defect in general has been overcome, and only then when the first injections have become settled and organized, as such untimely disturbance is liable to set up considerable reaction, with enough induration and resultant new connective-tissue formation to cause a decided lumpy or protuberant appearance of the part. ”