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In exceptional cases, blisters form over the seat of the effusion, or the skin may even slough, and the clinical features may therefore come to simulate closely those of an acute suppurative condition. When the skin sloughs, an ulcer is formed with altered blood-clot in its floor like that seen in scurvy, and there is a remarkable absence of any attempt at healing.
Captain Tremeau lay in front of us upon his back, with his arms and legs stretched out, and his sabre broken short off in his hand. His tunic was open, and a huge blood-clot hung like a dark handkerchief out of a slit in his white shirt. I could see the gleam of his clenched teeth from under his immense moustache. The Emperor sprang from his horse and bent down over the dead man.
Air was his poison air his shaft of death; and he killed by injecting it into the veins of his victims. The result of air coming into contact with the circulating blood of a human being is the formation of a blood-clot, and death is instantaneous the instant the clot reaches either the brain or the heart! That was his method.
He gave me what I thought I wanted, and it wasn't his fault that an insignificant blood-clot should beat him out on that day of days the corner in "R. P." It was never the Chicago crowd that could have downed him I'm glad to remember that. Well, there being only the two of us, it didn't matter so much; it wasn't as though there were a lot of helpless womenfolk to consider.
No, I don't think I should drink that whisky if I were you, you want to keep yourself cool and quiet." So Major Selby departed in his cab and I went home, and, having nothing better to do, turned up my notes on various cases of venous thrombosis, or blood-clot in the veins, which I had treated at one time or another.
When an incision is made into the bruise, the whole of the subcutaneous tissues are found to be infiltrated with blood-clot, and there is no clear margin. In the case of a post-mortem stain the edges are sharply defined, not raised, and, on section, mere bloody points are seen which are the cut ends of the divided blood vessels. These comprise incised, punctured, and lacerated wounds.
The meshes are filled in by growing tissue, and as it grows the tissue absorbs part of the sponge, which is itself an animal tissue and acts like catgut. Part of it is also thrown off. In fact, the sponge imitates what happens naturally in the porous network of a regular blood-clot. It educates the tissue to grow, stimulates it new blood-vessels and nerves as well as flesh.
The staining is of a dull red or slaty blue colour. It must be distinguished from ecchymosis the result of a bruise, by making an incision into the part; in the case of hypostasis a few small bloody points of divided arteries will be seen, in the case of ecchymosis the subcutaneous tissues are infiltrated with blood-clot.
The layer of coagulated blood and lymph becomes liquefied and is thrown off, and instead of granulations being formed, the tissues exposed on the floor of the ulcer are destroyed by the bacterial toxins, with the formation of minute sloughs and a quantity of pus. The discharge is profuse, thin, acrid, and offensive, and consists of pus, broken-down blood-clot, and sloughs.
"What is the matter with him, doctor?" asked Mrs. Selby. "It is, I think, a case of what is called blood-clot, which has formed in the veins of the leg," I answered. "Part of this clot has been detached by exertion, or possibly by rubbing, and, travelling upwards, has become impacted in one of the pulmonary arteries." "Is it serious?" asked the poor wife.
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