An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![made obscure. The appearance of oil-globules floating on tlie urine would be sufficient to determine the presence of fat embolism. The symptoms of acute septicemia are later in their development than those of embolism. They are acconi])anied by marked elevation of temperature. They arc more gradual in their onset, however active their course may be, and not infrequently are engrafted upon those of fat embolism. The sequence of the conditions of shock, ftit embolism, and acute septicemia is not infrequent, and, when its pos- sibility is borne in mind by the surgeon, will readily explain the course of many otherwise anomalous cases. Acute inflammatory states of the lungs arising from conditions entirely independent of fat embolism may develop rapidly after operations or injuries, and are to be distinguished from the efi'ects of fat embolism, which may also be present and which may be masked by them. The symptoms indicative of such acute inflammatory lung congestion are suffi- ciently clear for diagnostic purposes if attention is only directed to them. The danger is rather that the symptoms of fat embolism will be confounded with them than that they should be mistaken for fat embolism. The not infrequent occurrence of acute renal congestion, with total arrest of the urinary secretions, after a severe operation, is to be borne in mind by the surgeon in making his diagnosis as to the cause of threatening symptoms which complicate or super- vene upon the shock of the original operation or injury. The disturbance of cerebral conditions likew;ise, through embolism or cerebral hemorrhage, is to be borne in mind as a possible occurrence. Prognosis of Fat Embolism.—AVhen the symptoms indicating the presence of fat embolism are severe the probabilities of recovery are very slight. In its lesser degrees the disturbances caused by it are transient and are speedily and spontaneously recovered from. The prognosis depends upon tAvo factors especially—the amount of fat that has gained access to the circulation, and the ability of the heart to force the oil-globules through the capillaries of the lungs. Should this first danger have been overcome, possibilities of renewed danger from arrest of oil-globules in the capillaries of the brain or spinal cord in vital regions still exist. In such conditions a fatal result is not long delayed, a few hours only sufficing to bring the case to a close. When the pulmonary trouble is the chief one, a longer time may be ret^uired to determine the final result, whether recovery or death. At best, however, the struggle is a brief one, and is determined one way or the other within less than forty-eight hours. Treatment of Fat Embolism.—The first indication for treatment is to pre- vent, if possible, and at all events to diminish, the entry of fatty matter into the blood-current. The two conditions that foster this accident are the churn- ing up of bruised and broken fatty tissue by movements of a part, and the tension resulting from the accumulation of wound-secretions that have no vent. Immobilization of the injured part and relief to tension by provision for free drainage are therefore of primary importance. The second indication for treatment is to sustain and stimulate the action of the heart. For this purpose alcohol, digitalis, and strychnia in full doses will be found useful. REPAIR OF WOUNDS. The repair of all breaches of tissue is accomplished by essentially the same process, subject only to minor peculiarities of structure. This process has been described in a preceding section (Process of Repair). By reference to this section it will be seen that the essential element of repair consists in a modifi- cation of the normal nutritive processes at the seat of injury, by which the tissues to be repaired return to their embryonic state and new embryonic tissue](https://iiif.wellcomecollection.org/image/b21217014_0133.jp2/full/800%2C/0/default.jpg)
