374 LYMPH-STASIS AND SEROUS EFFUSIONS. 



process, so that they cannot at all be absorbed unchanged. Thus, particularly 

 poisons that act through ferments, such as snake-venom, ptomains and putrid 

 poisons, are destroyed by the stomach. Emulsin also behaves in the same manner. 

 If this ferment is introduced into the stomach while amygdalin is injected into 

 a vein of the same animal, poisoning by hydrocyanic acid does not take place, 

 because the emulsin is destroyed by the digestive process. If, however, emulsin 

 is injected into the blood and amygdalin into the stomach, hydrocyanic-acid poison- 

 ing takes place rapidly, because amygdalin is absorbed unchanged from the 

 stomach. Amygdalin is a glucosid (C 20 H 27 Np n ) that breaks up as a result of 

 the fermentative activity of fresh emulsin with the taking up of water, 2 (H,O) , 

 into hydrocyanic acid (CHN), oil of bitter almonds (C 7 H 6 O) and sugar, 2(C 6 H 12 O 6 ). 

 For observations on animals on the absorption of solutions from the parenchyma- 

 tous structures, either poisons whose action gives rise to conspicuous tonic symp- 

 toms, or such harmless substances as are readily discoverable in the blood and 

 subsequently especially in the urine are employed, as, for example, potassium 

 ferrocyanid. 



The author, in 1878, demonstrated that serum, injected into the subcuta- 

 neous tissue, is rapidly absorbed. The serum, which must be obtained from 

 an animal belonging to the same species or at least as indifferent as possible, 

 undergoes decomposition in the circulation, so that the production of urea in- 

 creases. Infusions of serum may, therefore, be given for nutritive purposes. 

 Febrile reaction is observed after such injections, as in the case of transfusion. 

 Solutions of albumin and peptone, oil, butter, dextrose, levulose, galactose and 

 maltose in solution have also been observed to undergo absorption. 



LYMPH-STASIS AND SEROUS EFFUSIONS. 



If obstruction to the efferent venous and lymphatic paths of an organ arises, 

 stasis results, and later abundant effusion of lymph into the tissues. This is most 

 distinctly recognizable in the skin and the subcutaneous tissue, where the soft 

 parts become swollen; while, without redness and pain, tumefaction develops, 

 with a doughy feeling, and pressure with the finger causes pitting. These are the 

 signs of lymph-stasis, which, if the fluid is especially rich in water, is designated 

 by the term edema. 



Also within the serous cavities, under like conditions, a similar collection 

 of lymph takes place. If numerous leukocytes migrate from the delicate blood- 

 vessels into such serous cavities and undergo multiplication, the fluid, richer 

 in cells, becomes more and more like pus. The multiplication of these cells gives 

 rise to the presence of a considerable amount of albumin, which may subsequently 

 be increased by absorption of water from the effusion. The latter will be made 

 particularly easy when the pressure in the fluid exceeds that in the small blood- 

 vessels. These sero-purulent effusions not rarely undergo a change in constitu- 

 tion later on, for which no reason has been found. The substances present are 

 in part products of the decomposition of albumin, such as leucin and tyrosin, 

 in part products of the retrogressive metamorphosis of nitrogenous substances, 

 such as xanthin, kreatin, kreatinin (?), uric acid (?) and urea. Further, endo- 

 thelial cells from the serous cavities; sugar in pathological serous and chylous 

 effusions and edematous fluid have been found; in the latter also diastatic fer- 

 ment, often cholesterin; and in the fluid of serous hydrocele and echinococcus- 

 cysts, succinic acid. 



f Not only the pressure from without upon the lymphatics, but, in general, 

 resistance of any kind that is present in the lymph-path may give rise to lymph- 

 stasis and serous effusions. Thus, lymph-stasis results from occlusion of the lymph- 

 atics in consequence m of inflammation and thrombosis (lymph-coagulation) ; 

 further, as a result of impermeable, swollen, inflamed or degenerated lymph-glands. 

 In these cases, however, the formation of new lymph-vessels is frequently ob- 

 served,' reestablishing the former communication. An effusion of lymph may 

 also take place into the serous cavities of the abdomen or the thorax, from rup- 

 ture of large lymph-paths, especially of the thoracic duct chylous ascites or 

 chylothorax. Interference with or even removal of all those factors that have 

 been found active in propelling the lymph onward will be capable of inducing 

 lymph-stasis. 



If stagnation of lymph can develop in this manner also on the part of the 

 lymphatic apparatus, the appearance of considerable amounts of watery lymph, 

 in the form of edema or anasarca, as well as of serous effusions, is often at the same 



