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#The Healing Sore.# If a portion of skin be excised aseptically, and no attempt made to close the wound, the raw surface left is soon covered over with a layer of coagulated blood and lymph. In the course of a few days this is replaced by the growth of granulations, which are of uniform size, of a pinkish-red colour, and moist with a slight serous exudate containing a few dead leucocytes.
If there is much exudate, the pressure on the heart of course increases, the cardiac dulness enlarges, dyspnea occurs and even perhaps later cyanosis. As the exudate accumulates, the patient must lie higher and higher in order that the fluid may gravitate to the lowest part of the sac and give the heart the greatest ability to work.
If the fluid exudate forms in sufficient quantity to cause pressure on the heart and lungs and interfere with their movement, the pulse beat is weak, the respirations quick and labored, the elbows are turned out and the feet are spread apart. All of the respiratory muscles may be used. The expression of the face may indicate threatened asphyxia.
A most valuable aid in dropsies due to heart deficiencies is the so- called dry diet, which means that as little liquid as possible should be taken in order that the patient's blood may resorb the exudate in the tissues and not have the blood vessels filled or overfilled with liquid from the gastro-intestinal tract.
The bacillus may be obtained by swabbing the throat with a piece of aseptic not antiseptic cotton wool or clean linen rag held in a pair of forceps, and rotated so as to entangle portions of the false membrane or exudate. The swab thus obtained is placed in a test-tube, previously sterilised by having had some water boiled in it, and sent to a laboratory for investigation.
Just how much this exudate may be prevented by the use of small blisters over or around the heart, and just how much watery stools and diuresis may prevent the advance of the exudate is difficult to determine.
The toxins cause coagulation-necrosis of the tissue cells with which they come in contact, the ferments liquefy the exudate and other albuminous substances, and in this way pus is formed.
The gonococcus is carried to the joint in the blood-stream and is first deposited in the synovial membrane, in the tissues of which it can usually be found; it may be impossible to find it in the exudate within the joint. The joint lesions may be the only evidence of metastasis, or they may be part of a general infection involving the endocardium, pleura, and tendon sheaths.
If abdominal serous exudate containing septic vibrios actively growing by fission be exposed to the air, as we suggested above, but with the precaution of giving a substantial thickness to the layer, even if only one centimeter be used, this curious phenomenon will appear in a few hours. The oxygen is absorbed in the upper layers of the fluid as is indicated by the change of color.
The indications for treatment in all other instances are: 1. To attempt to abort the inflammation. To stop the pain. To limit, if possible, the amount of exudate, and to diminish the exudate already present. To diminish the rapidity of the heart and to strengthen it. Abortive Treatment.
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