Prognosis.
—Prognosis varies according to the extent of the injury and the proximity of the lesion to the heart and lungs; also to the possibility of continuous entrance of fat, i. e., from its continual absorption. Prognosis really depends upon whether the heart can be given sufficient vigor and endurance to continue pumping blood with its burden of fat through the pulmonary circulation. A secondary danger may come from the circulation of this fat-ladened blood through the capillaries of the brain. Should the source of motive power thus become paralyzed with resulting general enfeeblement, death may ensue. When well-marked evidences of fat embolism are present, but are followed by recovery, the worst of the trouble is usually over within forty-eight hours after it begins.
Treatment.
—Obviously treatment is mainly directed toward the heart, so that we may stimulate it to carry its load of fat through from the venous into the arterial system. If it can do this, the fat is disposed of by oxidation or is saponified by the alkalies in the blood. Physiological rest of the injured part is the first indication, however, and if this occurs in a patient, say with delirium tremens, powerful mechanical restraint may be necessary. The most effective cardiac stimulants are called for—alcohol, adrenalin, strychnine. In other respects treatment is largely symptomatic. Next to giving the heart vigor in this way, inhalations of oxygen give the most promise, because of the crying need of the system during this ordeal for this life-giving gas.[1]
[1] See paper by the author. New York Medical Journal, August 16, 1884.
PHYSICAL PROPERTIES OF THE LEUKOCYTES.
Phagocytosis.
—All leukocytes have the power of shifting their location. The lymphocytes, so called, being the youngest of the white corpuscles, show it less than the older forms. The eosinophile cells are less able to manifest the peculiar activities of the other forms. It is particularly the mononuclear and polynuclear corpuscles which are endowed with most pronounced activity. These have the power, like the ameba among the lowest forms of life, to not only spread themselves around inert bodies, like granules of carmine or other particles used for experiment, or the particles of coal-dust found in certain conditions in the human body, but they also have the power to englobe many living organisms, for the main part vegetable (bacteria). Under the microscope it is possible to see living bacilli, performing active movements, although enclosed in the nutritive vacuoles of the leukocytes, in some of the lower animals. This ameboid power possessed by these cells of thus attacking and disposing of foreign bodies or irritants has been demonstrated and proved, especially by Metchnikoff, and has been called by him phagocytosis. His views were for a long time disputed, and are perhaps not yet absolutely and generally accepted. Nevertheless, they fulfil every demand made upon them for explanation, and are susceptible of such demonstration under the microscope that we now have practically a new and apparently a correct theory of the inflammatory process. (See [Chapter III].) Any cell which has this property is known as a phagocyte. It is shared by some of the leukocytes with certain other cells to be spoken of later (wandering tissue cells). Cells which possess this power do not attract all microbes indiscriminately, and it is often the case that the leukocytes of an animal peculiarly susceptible to a certain kind of bacteria do not attract them at all, even though they are directly in contact. It is plausible that an explanation of the peculiar susceptibility of certain animals to certain diseases is furnished by this fact ([Fig. 3]).
Fig. 3
