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Tous les autres exemplaires originaux sont film6s en commen^ant par la premiere page qui comporte une empreinte d'impression ou d'illustration et en terminant par la dernidre page qui comporte une telle empreinte. Un des symboles suivants apparaftra sur la derni&re image de cheque microfiche, selon le cas: le symbole — ► signifie "A SUIVRE ", le symbole V signifie "FIN". Les cartes, planches, tableaux, etc., peuvent dtre film6s d des taux de reduction diffirents. Lorsque le document est trop grand pour dtre reproduit en un seul cliche, il est filmi d partir de Tangle sup^rieur gauche, de gauche 6 droite, et de haut en bas, en prenant le nombre d'images ndcessaire. Les diagrammes suivants iSlustrent la m^thode. 1 2 3 f 2 3 1 2 3 4 5 6 T Unti facts '- the pra NEW YOl ■f II PHYSIOLOGICAL T7T THERAPEUTICS: A NEW THEORY. By THOMAS W. POOLE, M.D., M.C.P.S.,Ont Until we rely " upon Ic^lfcaldeduclions rather than on what are called 'lime-honored facts'— because they have been asserted for a century or two, though not facts at all— the practice of our profession will not improve." -Dr. T. Tnman. TORONTO: THE TORONTO NEWS COMI'ANY. NEW YORK : THE AMERICAN NEWS COMPANY ; LONIX1N : THE INTERNATIONAL NEWS COMPANY. 1879. Entered according to Act of Parliament of Canada, in the year 1879, by I'ikimas W FOOI.E, in the office of the Minister of Agriculture. The Canadian Poxt Steam Printing ffousf, Lindsay, Ont. lledicatiott. To JOSEPH WORKMAN, Esg., M. U, M.C.P.S, Ont., AS W l-'oRMKKIV I'RKSIDKNT Ol' Tl'r; Mf.UICAI. FACULTY OK IIIK I'ORON TO SCHCKll. OF Mkdicink. ; Latk Medical Superintendent ok ihe Provincial 1.1 NATic Asylum, Toronto; President ok the Toronto Medical Society ; Ex- President OK THE Canada Medical Association. lEhid (Seeas Is respectfully inscribed : In admiration of the valuable services he has rendered to Medi- » cal and Sanitary Science, as a Skilful Physician, a learned and eloquent Teacher of MediciJie, and a warm Friend of Humanity. By a former pupil, rHE AUTHOR. I ( WTiat system < relations including whereby that larg nervous The fa tion or e opinions If an : to call ii identifie( special ji observati from the cal, elect Theaj of inuscu power ov an obscu this assei other "g presentee Fully ( carried oi ruptions sustain t PREFACE. What is presented to the reader in these pages, is not a new system of medical , practice ; but it is a new theory of the inter- relations of nerve-force and muscular tissue throughout the body, including the relations of nerve and muscle in the coats of arteries whereby their calibre is regulated ; and of the mode of action of that large class of drugs which operate through the medium of the nervous system. The facts presented are not necessarily new ; but the interpreta- tion or explanation here gfiven of them, differs materially from the opinions generally accepted by the Medical Profession. If an apology be necessary for the apparent boldness of ventuiing to call in question accepted theories, with which great names are identified, perhaps beside the general plea of progressive ideas, the special justification may be urged, that the facts, experiments, and observations upon which this new departure is based, are drawn from the published works of our standard authorities in physiologi- cal, electrical and medical science, including those of recent times. The assertion of the inherent and independent contractile power of muscular tissue, and the function of nerve-force as a restraining power over it, is not new ; but has long ago found a place — though an obscure one — in medical literature. For the arguments by which this assertion is sustained ; for the new doctrines embodied in the other " general principles " ; and for the application of the facts presented in support of them, we are solely responsible. Fully conscious that our task has been very imperfectly performed, carried on as it has been during the brief leisure and frequent inter- ruptions of an active practice, and that our theory will have to sustain the ordeal of adverse criticism ; we are, nevertheless, of VI. I'KKFACl::. opinion., that from its practical importance, and the weight of evidence in its favor, we arc justified in submitting it to the Profession. Our references to authorities are perhaps more numerous than are ordinarily required ; but in a work of this kind, we ask the reader to take as little as possible on tru.st from us, and therefore have not spared to support the facts mentioned by ample references to our sources of information. The advancement of medical science will probably shew that some of the views expressed in this essay are untenable ; we are not without hope that it may confirm and establish others. Lindsay, Ontario, Canada, February ijtli, iSjg. ■^ (tKNKRAI, F'n'itt Geui Sfvnnil fin I'll iff I (if I, I TnK Kara •I' Fourth (if, Fifth fifm C How this' ■ Tl Thk Iris a VII. CONTKNTS. IXTRODUCTIOX. (iKNKRAI, I'RINCIIM.KH AsSfciUTKI) Page 9. CHAPTER r. FU'^f General Principle. Indkpevdknt Q)NTRA(rii,K Powkk ok MiTHcui.AR Tissue pp. lo .ji-,. CHAPTKRII. Sfrniiil iieni'i'itl Principle. Nervk-fori'K Restrains, (not Compels) Musrri.AR Contraction. pp. ;j() HI. CHAPTER FII. T/iirtf (ieiternl Principle. Klectkhit^ a Pahalyzlnc; A(ii;.\T. The Gai.vank' Current l>p. fi2 71. CHAPTER IV. THK KaKAUK oh l.NTERRUI'TEn CURRENT. APPLICATION OK Rl.KC THHiTY IN Disease pp. 74 JHi. CHAPTER v. h'oiirfh freneral Principle. — AvTXo>; ov KtUiOT ()i- H\y. np JU W~ CHAPTER VI. Fiff/i General Principle.- A New Theory of Vaso-Motor Xehvoi's Control over the Arterial System pp. !>7 117 CHAPTER VII. How this Theory Accords with the Phenomena 01 Inflamma- tion ANO Fever. The Heart and its Nerves pp_ iis_i'{5 CHAPTER VIII. The Iris AND PiTPiLLARY Chanoks pp. i;« 141 vlH. CONTENTS. CHAPTER IX. How THIS THEORY A. COHDH WITH CKUTAIN iRHEmil.AB CoNTRAi:- TIONH OK THB ALIMBNTABY TUBK ; VOMITINO. ET.^.. PP- "> '«"• CHAPTER X. Sixth General Principle. iJlovv^ Opbkandi ok Drooh Acting THROUGH THR NERVOUS SYSTEM.- DRUOH WHICH PaBAI.YZE VABO-MoTOR NBRVBKORCB. and SO TEND TO INCREASE ARTERIAI.CONTRACTION pp. 157 -2*4. CHAPTER XI. Uruos which Increase Vabo-Motob Nerve-korce, and so tend TO Induce Vascular Dilatation. pp. •itf< *« • ADDENDA. Note to § 81, p. 40, and to S 126, p. 63. li ii .141 1»« 'Itpi0l00ial iltm))[ttttir$. ). 157 aw. p. aOH-231. INTRODUCTION. GENERAL PRINCIPLE^ ^^SERTED. The general principles which underlie what follows, and which we hope to substantiate hereafter, may be stated thus : — (i) The muscles and muscular ti aes, generally, of the body, are endowed with an inherent contractile pc cr of their own, indepen- aeiit of nervous influenre ; but this con tra.i.ile power of the muscles is regulated for voluntary purpose:;, through the agency of the nervous system. (2) The influence exerted by the nervous system in its relations with muscular tissue, is that oi a restraining; and not that of a compelling power. Nerve-force, then, so far from being the ally, is the direct antagonist of muscular contractile power ; and the latter displays itself to the best advantage in proportion as the influence of the former is withdrawn. (3) Electricity is not a stimulus to nerve or muscle. On the contrary, its action is that of a sedative, anaesthetic and paralyzer to nerve tissue. It is through this quality of its action that it soothes pain ; while its " tonic" effects depend solely on the indirect improvement in nutrition brought about by an infinite number of contractions and relaxations of muscular fibre. These spasmodic contractions depend on the same condition as muscular spasms otherwise occurring : — that is to say, — they depend upon a partially paralyzed condition of some portion of the motor nervous system, setting muscular fibre free to contract, and not on any exalting or " vitalizing" quality whatever. (4) The contractions induced more especially in unstriped muscular fibre by ergot of rye, follow the same rule or law as irregular muscular contractions otherwise occurring: — that is to say, — they depend on the withdrawal of nerve-force, and the cessation of its ordinary restraint upon the contractility of muscular fibre, which beiiig thus left free to act, passes into a state of contraction. lO PHYSIOLOGICAL THERAPEUTICS. (5) The muscular fibres of the middle coat of the arteries, in the normal state, tend continually to exert their inherent contractile power in lessening the calibre of these vessels, and so diminishing blood supply : — while the vaso-motor nerves, ramifying among those muscular fibres, have for their function the restraining of this contractile power ; and when predominant, aided by blood pressure, induce dilatation of the blood-vessels with correspondingly increased vascular activity. (6) Certain drugs, by modifying the activity of the vasomotor nerves, (increasing their power by nutritive changes in the cells which generate nerve-force, or paralyzing the nerves themselves and so arresting their functional activity,) cause an increase or diminution of the calibre of the blood-vessels ; and so exert an important influence, not only over the nutrition and temperature of parts, but in controlling congestive and inflammatory processes, and so restoring normal circulatory activity. We now proceed to consider, in turn, the several general principles or propositions just enumerated ; to support them as best we may, from the writings of the recognized authorities, whose labors have built up the hypothesis we are to oppose, and from such general facts and considerations as we have been able to gather ; and to present the results to the reader for a just and unbiasssed con- sideration. CHAPTER I. MUSCULAR CONTRACTILE POWER INDEPENDENT OF NERVOUS INFLUENCE. 1. First general principle. — The muscles and muscular tissues generally, of the body, are endowed with an inherent contractile power of their own, independent of nervous influence ; but this contractile power of the muscles is regulated, for voluntary purposes, through the agency of the nervous system. 2. Dr. Carpenter is our chief authority here. He says : — " The opinion that contractility cannot be an endowment of an organized structure, is at once negatived by the fact that in plants we find tissues endowed with a high degree of contractility, and manifesting this property without any possible intervention of a nervous system, &c."* Again, — " In the lower class of animals, there is good reason to believe that contractility is more widely diffused through their tissues than nervous agency can be/'f "Rythmical contractions take place in the rudimentary heart, when as yet no nerves or ganglia have made their appearance.''^ •Human Physiology, Sth Am. Ed., (Smith) p. 324, tibid. tibid. AUTHORITIES QUOTED. II in the Tactile lishing J those )f this essure, :reased omotor e cells /es and inution portant rts, but ind so inciples ve may, >rs have general and to ed con- ERVOUS tissues itractile jut this urposes, — " The •ganized we find lifesting nervous Jason to gh their irt, when tibid. "The human foetus has come to its full size, so that its heart must have regularly acted, without either brain or spinal cord.''* Referring to spontaneous movements of cilia, of the heart and uterus, he says : — "When every source of excitement is excluded, we cannot but perceive that these actions take place with a spontaneity which can scarcely be accounted for in any other way than by considering them as expressions of the vital activity of the component cells of these forms of muscular tissue. . . It is impossible to assign any other cause for the movement ot the heart under such circumstances, than the attributes inlierent in the tissues which perform «V."f In his concluding remarks on certain muscular movements which have been observed after death, especially from cholera and yellow fever, this distinguished author says : — "Many circumstances indicate that these movements were due to the inherent contractility of the muscles, and were not in any degree dependent upon the operations of the nervous system.''^ Dr. Carpenter further assures us that " the intestinal tube, from the stomach to the rectum, is not dependent upon the nervous centres, either for its contractility or for its power of exercising it ; but is enabled to propel its contents by its own inherent powers y\\ Drs. Todd and Bowman express the opinion that "contractility is a property of the living muscular substance as such."^ Further quotations of similar import will appear as we advance. 3. We frankly admit that these opinions, conclusive as they ap- pear, were not intended by their authors to support a thesis such as is here enunciated. But they are not of less value on that account. Indeed it is not a little singular that physiologists in admitting so much, have still thought it necessary to supplement this avowed ijiherent contractile power with an assumed "stimulus" from the nervous system to evoke its action. But such was the dominant idea of the theory of the day, and the general facts of muscular contraction were interpreted accordingly. It is the object of these pages to show that this property of muscular contractility is capable of manifesting itself in tlte absence of any special natural or artificial stimulant : that is, that muscular contractility displays its effects in the body, when simply left to itself, and not restrained by nervous influence (as in the next proposition we assert it to be) in the normal state of the system. What, we ask, is the meaning of the term "inherent," which our physiologists so generally and so often apply to the contractile power of muscle "i Philologists define it as "existing inseparately," "implanted by nature," "not adventitious," "inborn," "naturally pertaining to." — (Worcester.) Its synonyms are, "innate," "inborn," "native," "natural," "inbred," &c. — (Webster.) Now an inherent •Human Physiology, p. 324. tibid, p. 131. Jlbid, 328. ol. Illbid, pp. 409. 410. §Physiol. Anat., p. 179. 12 PHYSIOLOGICAL THERAPEUTICS. contractile power, which is dependent on some other "power" for its operation is an absurdity. A locomotive has not an inherent power of motion. Gunpowder has not an inherent power of explosion. The admission of an inherent contractile power, is tantamount to an admission of the ability to use that power. Our phy- siologists, then, have entirely mistaken the meaning of the term they freely use, or they admit, pro tanto, the claim we put forward for this tissue. 4. Besides, apart from nerve-force, the several agents referred to in this connection as assumed "stimulants" to muscular contractile power, have certainly been misnamed, and really exert an influence of an opposite kind. In regard to one of these, especially, and the principal one — electricity — we hope to show, by and by, to the satisf iction of the reader, that so far from being a "stimulant" or an "excitant," it is truly a paralyzer oi nervous tissue, and tends propor- tionately to release the power of the muscle, and so to favor its contraction. 5. In pursuing this subject further, it will be convenient to consider it under the following phases : — {a) Active (voluntary) contraction. {b) Passive contraction (or tone). {c) Irregular (involuntary) contraction, (spasm, &c.) {d) Relaxation or flaccidity, (syncope, &c.) (e) Rigor mortis. 6. {a) Active (voluntary) contraction. — It seems desirable to remind the reader that motor nerve-force is not the only factor which has an important influence on muscular contraction. Sir C. Bell is the earliest authority for the statement that " no voluntary action can be performed without the assistance of a guiding sensation.*^ This has been called "the muscular sense." "In the majority of cases, the guiding or controlling sensation is derived from the muscles themselves, ot whose condition we are rendered cognizant by the sensory nerves with which they are furnished."* In certain cases one of the special nerves may supply a defect of the muscular sense and vice versa. "Thus, in complete anaesthesia of the lower extremities without loss of muscular power, the patient is as completely unable to walk, as if the motor nerves had been paralyzed, unless the defective sensorial guidance be replaced by some other ; and in similar affections of the upper extremities there is a like inability to raise a limb or to sustain a weight But in such cases the deficiency of the "muscular sense'' may be made good by the visual. Thus the patient who cannot feel either the contact of his foot with the ground, or the muscular effort he is making, can manage to stand if he look at his limbs ; and the woman who cannot feel the pressure of her child upon her arms, can yet sustain it as long as she keeps her eyes fixed upon it, but no longer — the *Dr. Carpenter's Human Physiology, p. 722. , THE WILL AND THE MUSCLES. 13 ^muscles ceasing to contract, and the limbs dropping powerless the moment that the eyes are withdrawn from it."* 7. We have introduced these considerations here for the purpose of showing, that while on the theory here advocated the motor nerves and muscular fibre are natural antagonists, yet the latter is not divorced from the influence of the nervous centres, even as regards the exercise of its contractile power. For not only by means of trophic or nutrjtive nerves (already referred to) but also, as now shown by means of the afferent nerves, transmitting to the centres "a guiding sensation" from the muscles , these latter are kept en rapport with the central ganglia, and thus the power of co-ordination of the different parts of the muscular apparatus is duly maintained. Thus the regularity and efficiency of muscular motion in response to the will is provided for, without any apparent necessity for guidance or direction fron» the motor nerves ; from which we infer that any assumed "stimulus" from these nerves is not a necessity in co-ordinate muscular movements, and as a consequence that all the conditions of normal muscular activity can be fulfilled, and are amply provided for, even though the motor nerves be regarded as exercising solely, a restraining and not a compelling power towards the muscles. 8. It is also necessary to bear in mind that when we will to make a certain movement, we are utterly unconscious of the selection of a particular muscle or of any number of muscles on the action of which the movement depends. What the will is concerned in is simply tJie result; the selection and combination of muscular movements required to bring about the desired result, not being effected by the will but by the intermediate agency of the automatic centres, the sensory ganglia. It is fortunate for us that this is the case, for otherwise we would be dependent upon a knowledge of anatomy for the power to perform the simplest muscular movement Dr. Carpenter, who is our authority for this statement, illustrates it very well, by the manner in which the muscles of the larynx are made to act in the production of vocal sounds. The will has no direct power over the muscles of the larynx, as is shown by the fact that we cannot raise or depress the larynx as a whole, nor move its cartilages, nor extend or relax the vocal ligaments, by simply willing to do so, no matter how strongly. But we conceive of a tone to be produced and we will to produce it; a certain combination of the muscular actions of the larynx then takes place in exact accordance one with another, and the predetermined tone is the result, t It is the same with other muscles of the body ; and the sense of effort which we naturally refer to the muscles, in willing them to contract, is nothing more than " the muscular sense," already referred to. J *Dr. Carpenter's Hum, Physiology, p. 722. tPhysiology, pp. 726-7. tibid, p. 726. fl'l^=^ 14 PHYSIOLOGICAL THERAPEUTICS. I!i 9. Now it may be claimed on our part that the motor nerve im- pulse or molecular change, which originates the voluntary contraction of muscle, may as readily be one which relieves the muscle from previous restraint, as one which supplies a "stimulus" to the muscle to contract. For, as just shewn, this impulse and the desired result are all that the will really has to do with the matter ; the motor ganglia, guided by the muscular sense directing the impulse to the proper muscle, the contraction of which does the rest. 10. The force or moderation with which voluntary muscular con- traction may be made to display itself, as in striking a gentle or a heavy blow, does not in the least embarrass this view of the case. For where a powerful impulse is directed by the will to ensure a heavy blow, as the result of the mental act, the release of a greater number of fasciculi of a muscle, (than for a lighter blow), and the simultaneous calling into play of a greater number of muscles, and doing so with greater suddenness, fully accounts for the increased result produced. Indeed this is the very explanation authoritatively given for the apparently increased strength ot muscular power dis- played by maniacs, or by persons laboring under great mental excitement, which in these cases is not attributed to increased nerve-force "stimulating" muscular contraction. Besides, it is distinctly avowed that "there is no evidence that muscular irritability [that is, its power of contracting under an assumed stimulus] can be increased by any cause operating through the nervous system."* Furthermore, modern research shows that in the cases refened to, the appearance of increased strength is delusive ; and that the condition of the nervous centres is one of weakened rather than of increased power. Thus Dr. Anstie bears witness to "the incredible violence and muscular strength of many patients who are sinking^ into a state of general paralysis of the insane," and who are best treated by food and stimulants."f- 11. It has been stated by Dr. Carpenter, (in apparent antagonism to the last quotation from his Physiology), that "stimulating agents^, as the moderate use of alcohol, nitrous oxide, opium, &c., which temporarily increase muscular power, do so hy primarily exciting the nervous systetn."l The action of these agents will be discussed elsewhere. It may suffice to remark here, that granting all that is here stated — that alcohol in moderate doses excites the nervous system in healthy states — that excitation may serve simply like the mental or maniacal excitement just mentioned, to call into play a greater number of muscles, or to do so more promptly than in ordinary states ; and like these conditions also, it is followed by a period of depression. The so-called food action of alcohol, especially in exhausting diseases, where great disintegration of tissue is going on, is of a *Dr. Carpenter's Hum. Physiology, p. 322. tStim. and Narcot., pp. 133-4. tPysiol. p. 322. PASSIVE MUSCULAR CONTRACTION. 15 ar con- entle or he case, nsure a greater and the ;les, and [icreased itatively wer dis- mental ncreased :s, it is ritabiiity s] can be em."* feferied that the rthan of n credible ; sinking^ ) are best itagonism ig agents ^ :c., which veiling tJu It may ited— that n healthy maniacal lumber of :ates ; and depression , exhausting m, is of a pp. I33-4. different character, and is not attended by signs of stimulation ; so that it need not be further referred to here. We think, then, that from the foregoing considerations, we are justified in concluding that in so far as active voluntary muscular contractions are concerned, there is nothing in the facts of the case at variance with our theory, and very much in favour of it, on sound physiological principles, 12. {b) Passive muscular contraction. — By this is meant that moderate contraction of muscles while at rest, which gives them a certain firmness, as contrasted with flaccidity ; and enables them to, resist the equally passive contraction of their antagonists. Some physiologists have attributed the maintenance of this state to the influence of the spinal cord ; and certain experiments of Dr. M. Hall appear to support this hypothesis, which, however, is repudiated by Drs. Todd and Bowman, as the following quotation will show : — "It has been supposed that the tone of the muscular system is maintained by the spinal cord. If by tone be meant what we have described as passive contraction, we can only remark that the phenomena which characterize that state are just as obvious in muscles taken from animals recently deprived of the spinal cord as in others ; and that the analogous state, rigor mortis, comes on as distinctly when the spinal cord and brain have been removed as if they were untouched. Healthy nutrition, in out opinion, supplies all tlie conditions necessary for the maintenance of the tone or the passive contraction ; nor is the spinal cord (although itself healthy) able to preserve the tense condition of the muscles, if they are not well nourished. The removal of the spinal cord indeed, immediately produces a flaccid state of the muscles of the limbs ; but this is owing to the immediate cessation of the slight degree of active contraction necessary to maintain a certain posture. A decapitated frog will continue in the sitting posture through the influence of the spinal cord ; but immediately this organ is removed, the limbs fall z.'^zxt, from the loss of the controlling and co-ordinating influence of the nervous centres" "After these remarks it is scarcely necessary to add, that we must enter our protest against the doctrine which assigns thv^ spinal cord as the source of muscular irritability. This doctrine, indeed, has but slender support either in reason or experience. It is contrary to all analogy to assign to one tissue the power of conferring vital I properties on another. If bone, tendon, and cartilage have their dis- tinctive properties, they possess them in virtue of some peculiarity inherent in their mode of nutrition, and do not derive them from any other texture. And surely it is too much to suppose tliat a tissue like muscUy so complex tn its chemical composition, and so exquisitely organized for the developement of its proper force, should be dependent \on tJie nervous system^ or a portion of it, for its contractile power !"* "Physiol. Anat., pp. 302-3. l6 PHYSIOLOGICAL THERAPEUTICS, Drs. C. Handfield Jones and Edward H. Sieveking express a similar opinion. Writing of muscular contractility, they say : — "It has been supposed by some that the power or quality was not resident in the contractile tissue, but in the spinal cord, from which it was conveyed by the nerves to the muscles ; but this view seems quite contradicted by observation and by analogy."* 13. Now this is very strong and unexceptionable authority in support of our theory ; for although these gentlemen, in accordance with the dominant idea of the day, regard this inherent muscular contractility as acted on by nervous influence, of the nature of a "stimulus," the theory here advocated admits the influence of nervous agency over the muscles to an equal extent, — only attribu- ting ta it a different mode of action, — a release of muscular force from restraint — which accords well with its inherent contractile power, instead of a motive power to contraction, which is unnecessary, see- ing this property is already existing in the muscular tissue itself 14. If the reader is not yet prepared to agree with us, as to the independenty as well as inherent contractile power ot muscular tissue, we ask him, (using the phraseology of Drs. Todd and Bowman) if it be too much to suppose that a tissue so comple: ■:, so exquisitely or- ganized, and so highly endowed as muscle, should be depending on the nervotis system for the use of its distinguishing property, — is it not a fortiori, too muck, to suppose that it is depending on other extraneous and accidental " stimulants" — such as the prick of a pin, the corrosion of an acid, or the chance proximity of a galvanic battery, for the exercise of that power } 15. On the theory we present, the passive contraction of muscle is amply accounted for by the moderate antagonism between nerve- force, tending to relax the muscle, and its own inherent contractile power which tends to shorten it. Both forces here are passive, or in operation to their minimum extent, and mutually antagonize each other, — thus maintaining a balance of power. 16. Irregular (involuntary) muscular contraction, — If the balance of power just referred to, be disturbed by any cause tending to weaken nerve-force, a preponderance is given to the contractile power of muscular fibre, which exerts itself just in proportion to the extent that nerve-force is withdrawn. If the balance of power be persistently accorded to the muscular tissue, the spasm into which it passes will be of the " tonic" or continuous kind : on the contrary, if nerve-force is only intermittingly depressed, and the mastery alternates between the nerve and muscle, the spasms will be of the " clonic" kind, — that is, alternated with relaxation. The primary failure of ner\'e-force in these cases, will be more fully discussed in the next succeeding chapter, to which this part of the subject more properly belongs ; and not only there, butthrough- *Pathol. Anat., p. 38. out thi furnish 17. \ from ar are free search ; errors ( summir applical "I. 1 emotion fancy, spasms, loss of o and acti probabli turbance nerves c cessatior Havin part of h we have pie te pare tractions the moto only in I ordinaril 18. Re and rela: minutes i cord, b)» discovera explain, j we no m deprives 19- It : 3e based follows or ivhich it : :ause of r mticipate 3ages (§ I eminent annot fai uscles, Stimulani Brit, and F( RELAXATION OF MUSCLE — FLACCIDITY. 17 f muscle n nerve- )ntractile issive, or tagonize balance nding to ntractile on to the DOwer be ito which contrary, mastery je of the be more lis part of : through- out the subsequent pages, ample proofs and illustrations will be furnished of the view here presented. 17. We cannot forbear, however, to make the following quotation from an eminent writer, now deceased, to whose luminous pages we are frequently indebted, and who has done much by patient re- search and thoughtful study to correct some of the popular medical errors of the day. Dr. Anstie makes the following remarks in summing up the narcotic effects of opium ; but they are equally applicable to the effects in question, otherwise occurring : — "I. To paralysis of the brain may be ascribed delirium, coma, emotional "excitement," involuntary memory, and involuntary fancy. 2. To paralysis of the spinal cord may be probably ascribed spasms, tetanic convulsions, paralysis of sensation, independent of loss of consciousness, tingling and creeping sensations on the surface, and actual pain. 3. To paralysis of the medulla oblongata may be probably referred clonic convulsions, tremor and shudderings, dis- turbances of respiration — vomiting. 4. To paralysis of the organic nerves of the heart may be probably ascribed the irregularity or cessation of the co-ordinated movements of that organ."* Having separately dilated on these several groups, in a subsequent part of his work, he says : — "All these convulsive phenomena, which we have mentioned, are constantly associated with more or less com- plete paralysis''^ Thus, then, spasms and irregular muscular con- tractions represent, not excessive nerve-force discharging itself along the motor nerves, but " a disturbed condition of the muscle, released only in part from the co-ordinating [nervous] influence which ordinarily governs its movements."^ 18. Relaxation of muscle, (Jlaccidity). — Why are the muscles flaccid and relaxed after a blow or a fall, causing syncope ; after two minutes immersion under water ; and after destruction of the spinal cord, b)» the process known as " pithing" } In the absence of any discoverable lesion, " something has happened, very difficult to [explain, and yet evident in its results." What that something is, e no more know than we know how a heavy blow on a magnet eprives it of its magnetic power, and yet such is the case.|| 19. It is not impossible that an argument against our theory may le based on the fact in question, on the ground that the flaccidity follows on the apparent cessation of the " stimulus" of nerve-force^ hich it is alleged on the theory of the day, is the chief exciting ;ause of muscular contraction. We have, however, in a great degree mticipated this objection, in the lengthy quotation made in recent lages (§ 12), from Drs. Todd and Bowman. If the opinion of these iminent physiologists be held of value, the relaxation in question ;annot fairly be attributed to a withdrawal of nerve-force from the luscles, for these gentlemen "protest" against Dr. M. Hall's *Stimulants and Narcotics, p. 168. tibid, p. 198. JIbid, p. 199. [Brit, and For. Med. Chirur. Rev., Jan., 1876, p. 4. — Braith, Retros., July, 1876, p. 245. i8 PHYSIOLOGICAL THERAPEUTICS, hi i 1 ij tl; doctrine, that the muscles owe their contractility to the spinal cord ; and, as we have seen. Dr. C. Handfield Jones and Dr. Sieveking agree with them in that opinion. The effect in question cannot therefore be urged as an argument against our theory ; for if muscular contractile power is independent of the nervous centres, injury of the latter of a paralyzing nature cannot cause a deprivation of muscular power. We are free to confess, however, that we desire a further reason for the flaccidity in question than the " loss of the controlling and co-ordinating power of the nervous centres." For it is not a little remarkable, that while in temporary syncope the contractile power of the muscles appears, sometimes greatly reduced or lost, they retain it in certain cases after somatic death of the body,* and perhaps in rigor mortis, under circumstances which appear much more unfavorable. 20. Physiological writers have but little to say on the question of " shock," and the direct causes which produce it. Dr. Carpenter, regarding nerve-force as a polar force, thinks there is a reversal of this force, or of its polarity, which occasions not simply a with- drawal or disturbance but an influence of an opposite kind, trans- mitted through the nervous centres, positively and directly antagonistic to the vital powers of the several tissues ;f and that to this the effects of " shock " are attributable. This hypothesis implies that nerve-force is not only active in muscular contraction, (on the ordinary theory) but that it is equally active in muscular relaxation, from shock ; since he specially disclaims mere negative results from the supposed " reversal " of the polarity of uerve-force. But it could hardly be an active agent in producing relaxation, except on the theory we suggest — as the antagonist to muscular contraction ; — unless, indeed, muscular tissue possesses active power of relaxation as well as active power of contraction, tor which, whatever justification might be found in organic muscles like the heart, there is no ground for the supposition in the case of voluntary muscles. 21. If we could accept the hint here given by Dr. Carpenter, — that nerve-torce is active in this state ; if indeed evidence were available that it is so active as to enable it to attain " a balance of power " over the muscle, a proximate cause for the relaxation would be apparent. Let us enquir'' ^further as to the condition of nerve- force in this and similar states. 22. In the first place, the fact is well established that uncon- sciousness or insensibility is no bar to the manifestation of the activity of nerve-force, as displayed in reflex actions of the spinal cord ; which are sometimes more vigorously called forth by peri- pheral impressions which fail to reach the sensorium, and are consequently unfelt, than from prickings or im'pressions of which *Dr. Carpenter's Human Physiology, p. 327. fPhysiology, p. 350. PERSISTENT VITALITY OF NERVE-FORCE. 19 stioii of rpcnter, ersal of a with- i, trans- directly .nd that pothesis traction, nuscular negative ve-force. axation, nuscular \ active ion, tor muscles : case of penter, — nee were alance of on would of nerve- it uncon- •n of the he spinal by peri- , and are of which 50. the subject was fully aware.* Were we to take the adherents of the orthodox theory on their own ground, — that muscular contrac- tion is depending upon a " stimulus " from the nervous system, — and point them to the well authenticated and numerous instances of muscular contractions occurring after somatic death, consisting not only of the movements of individual muscles, but even of whole iimbs.t they would feel compelled to admit the existence and activ- ity of nerve-force, even here. 23. Dr. Carpenter refers to the general death of the body, under the name of somatic death, and to the subsequent cessation of all vital changes in the body as constituting molecular death, which latter sometimes follows speedily on the former but in other cases may be long postponed. :J: 24. The behaviour of nerve and muscle to electricity after somatic and prior to molecular death, (which is immediately followed by rigor mortis,) proves that nerve-force is not extinct during the period in question. Electricity causes a contraction of the muscles so long as nerve-force is present in the nerve trunks or in their intra-muscular rauiifications. It does this, as we shall show to the satisfaction of the readt^r in a future chapter, \iy paralysing iJic nerve, and so setting the muscle free. When nerve-force is extinct and electricity can paraly::e it no further, it ceases to have any infiuetice on niHScular tissue, and this is true of the relations bctiveen nerve and muscle during life as ivell as after death. The fact then, that in somatic death and up to the time of molecular death, in which all vital operations finally cease and rigor mortis sets in, the muscles still respond to electricity, is a proof that nerve-force is present and operative in the nerve trunks or in their intra-muscular ramifica- tions. 25. We do not quote as a proof of the existence and activity of nerve-force, the well-authenticated facts as to " the persistence of vital changes in various organs and tissues of the body after the death of the body at large, as is manifested in the performance of ciliary and of muscular movements, in acts of secretion and per- haps even of nutrition, in the maintenance of the local circulation and in the generation of animal heat," or the still more remarkable fact of " the re-union (even after the lapse of some hours) of parts that have been entirely severed, such as fingers or toes, noses or ears, by adhesion between the cut surfaces when brought into apposition which could* not take place if the severed parts were dead."|| Though " .so intimate is the relationship, and so obvious is the in- Ifluence which nervous agency exerts over the operations of nutri- tion, secretion, &c., especially in the higher animals, that many [physiologists have regarded them as essentially dependent upon it." But Dr. Carpenter is of opinion that " for this assumption there is *Dr. Carpenter's Human Pljysiology, pp. 672, 674. tibid, p. 327. JIbid, p. 1055. I Dr. Carpenter's Human Physiology, pp. 237, 1055. 20 PHYSIOLOGICAL THERAPEUTICS. no valid evidence ; and the whole tendency of recent discovery has been to establish the doctrine of the essential independence of the vital endowments of each integral part of the fabric."* We cannot, •therefore, regard the remarkable phenomena above mentioned, so far as secretion and ordinary nutrition are concerned, as proof of nervous activity after somatic death, though, as we have just seen, tl\e presumption in favor of that view is so strong as to have led physiologists to that conclusion. 26. But there are conditions of the body, or of its parts, after somatic and prior to molecular death, which prove the persistence of nervous vitality in the former state. Thus the toe or ear, severed for several hours from the body, must be somatically though not molecularly dead. And we are assured by our highest authority that " it is quite certain that after an apparent cessation of all the vital functions," — which is somatic death — " recovery has sponta- neously taken place.""!* So that under even these extreme conditions nerve-force is not extinct, or resuscitation would be impossible. Here is a physiological experiment which will illustrate the per- sistence of nerve-force under the most unfavorable conditions. " The injection of blood into the carotid of an animal recently dead by hoemorrhage, and in whom reflex action had ceased, is speedily followed by a return of that faculty of the cord, even after its sepa- ration."J That nerve-force is necessarily present, and musculai contractile power also, wherever reflex actions occur, is too obvious to require proof or to be called in question. 2^. Now if nerve-force be thus present after the general death of the body, — that is in somatic and before molecular death, — it ought, a fortiori, to be admittedly present in syncope of a tempo- rary duration. But admitting that nerve-force is really present in these states, is there any reason to suppose that it is active to such a degree as to overbalance muscular contractility and produce relaxation } 28. It must be remembered that the condition of " shock " is not uniformly or necessarily attended by simple relaxation or flaccidity of the muscles ; clonic spasms or convulsions are not unfrequently present. || Thus, it will be within the experience of most persons who have hunted the smaller animals, that a moderate blow on the head will throw them into convulsions, while a severer one, which stretches them out as if dead is attended by relaxation. 29. There is a remarkable fact, comparatively little noticed, which may have a very important bearing on the state we are con- sidering. It is, that certain parts ot the brain exercise an inhibitory power over the reflex activities of the spinal cord, which ". more readily occur and are much more vigorous and complete in the *Ibid, p. 350. tibid, pp. 1057-8. JDr. Carpenter's Human Physiology, p. 675, by the editor, Dr. F. G. Smith, who refers to the Phil. Med. Exam., N. S., Vol. 8, p. 482. JjErichsen's Surgery, p. 275. Surgeon-Major Porter's Sui^eon's Pocket Book, pp. 152-3. absen fore, i poset inhibi a bah muscl nervoi pheno heavie over t latter, ous an overpo inactiv brain c Surely suppos vulsion " an ex for eith 30. I of shod ity. C commo that tal such to tractile flaccidil in the when tl 31. destroy to say paralysi thus oc< canal w dition vety sti force, portiom physiok efifects as an lontrol •Dr. ^ ;nter's H NERVE-FORCE IN SYNCOPE, ETC. 21 ;s, after sistence , severed ugh not uthority f all the sponta- )riditions ble. the per- »nditions. ntly dead speedily its sepa- musculai obvious death of ieath,— it a tempo- tresent in to such produce :k"isnot flaccidity frequently arsons who 1 the head ne, which : noticed, ; are con- inhibitory ich ".more lete in the )gy. p-67S.by bl. 8, p. 482. jok, pp. 152-3- absence than in the presence of the brain. The brain must, there- fore, in some way or other prevent reflex actions."* Now, if we sup- pose that the slighter blow, referred to above, only partially arrests the inhibitory action of the brain over the spinal cord, producing so near a balance of the relative powers of the spinal motor nerves and muscles that as one or the other gains the mastery during the nervous commotion, we have clonic convulsions, this part of the phenomena would be intelligently explained. In the case of the heavier blow we might infer that the inhibitory power of the brain over the spinal centres is annihilated, and, as a consequence, the latter, availing themselves of their freedom for " much more vigor- ous and complete " action, so intensify motor nervous activity as to overpower the contractile tendency of the muscles and hold them inactive and relaxed so long as the then present relations of the brain continue, that is until the latter recovers its full innervation. Surely this is a more reasonable view of the phenomena than to suppose, in accordance with the popular theory, that where con- vulsions attend this state there is an extraordinary development, or " an explosive disturbance of nerve-force in the cranial centres ;" for either of which the circumstances seem specially unfavorable. 30. If the popular theory be the true one, then in certain forms of shock we have nerve-force exhibiting itself with unwonted activ- ity. Can the advocates of that theory then deny that in the more common forms of syncope nerve-force is not also active. We think that taking all the facts into consideration there is reason to believe such to be the case, and that it is even able to control the con- tractile power of the muscles sufficiently to produce relaxation or flaccidity. The co-ordinate power, however, is wanting, as is seen in the irregular and aimless character of the muscular contractions when these are present. 31. But what of the flaccidity where the spinal cord is itself [destroyed by the process known as "pithing.^" There is this to say of the effects of this destructive operation, that while paralysis of the spinal centres would at once result, the irritation thus occasioned to the motor nerves at their exit from the spinal canal would be such as for a time to maintain an exaggerated con- Idition of their molecular force, producing at their peripliery an effect [vetj/ similar to that produced by an increase of ordinary nerve- force. That such is really the case, and that section or injury of [portions of the jjervous tissue is so interpreted by experimental )hysiologists, examples are numerous. Goltz thus interprets the iffects of section of the cervical sympathetic in the neck is an irritation rather than as paralysis of the nerves which :ontrol the cranial circulation, and refers to these nerves as *Dr. M. Foster, Hand-book for the Physiological Laboratory, p. 418. enter's Human Physiology, pp. 671, 675. Dr. Car- 92 F'lIVSIOLOGICAL TIIEKArEUTICS. vsiso-dilators* Dr. Brown-Sequard repeatedly refers to mechanical injury of nervous centres producing muscular spasms, which, in turn he attributes (as we believe erroneously) to increased nervous action.i* But from Drs. Todd and Bowman we select examples still more to the point. " By division [of the spinal cord] the whole organ was thrown into an excited state both above and below the section, and therefore manifested phenomena similar to those excited by volition. Indeed, we have seen the sphincter repeatedly contracting after division of the cord, without the application of any new stimulus to it ; and the dog continuing to raise and depress his tail as hug as the irritation of the cord produced by the section has continued^ A^ain. " When an animal is pithed he falls down apparently senseless, and exhibiting only such convulsive movements as may be due to the irri- tation of the medulla by the section, or such reflex actions as may be excited by the application* of a stimulus to somcpart of thetrunk.":[ 32. The last quotation proves that spasm or convulsion, as well as flaccidity, may attend destruction of the spinal cord. Both quo- tations prove that the peripheral effects wo have attributed to the operation are justified by the practice of physiological authorities. Of course, when the temporary effect of the irritation of the torn and abraded nerves at their origin in me spinal canal subsides, the peripheral effect on the muscles ceases with it. Nor would the nervous excitation referred to, while it lasts, appear to be able at most to effect more than a mere passive restraint on the muscles, (when spasms occur it is effecting less); for the destruction of the spinal centres of the phrenic and intercostal nerves brings the functions of these nerves to an end, resulting in the cessation of the action of the diaphragm and intercostal muscles ; and the animal dies from suffocation owing to failure of respiration. || 33. These considerations, we think, point strongly to the conclu- sion already hinted at, that in states of unconsciousness, syncope and somatic death (prior to molecular death) nerve-force is present and active, though for obvious reasons, neither to the mind of the individual nor in the appearances presented to the spectator, is the fact apparent. The presence and activity of nerve-force is inconsistent with mus- cular relaxation, on the accepted theory ; for on that theory nerve-force is a "stimulus'" to muscular contraction and this is absent. But taken in connection with what we have to advance in the next chapter, as to the restraining influence of nerve-force over inuscle, the facts of relaxation, and the other facts enumerated above, accord well with our theory. •Article in Canada Lancet, May, 1877, p. 273 ; copied from London Lancet, and originally from the then current number of the Brit, and For. Med. Chirur. Review. See also future chapter on vaso-motor innervation, § 199, 210. tLectures on Central Nerv. Syst., pp. 188, 192, 194. JPatholog. Anatomy, pp. 303-4. || Dr. Dalton's Physiology, pp. 441-2. RELAXATION OF ANAESTHESIA. 23 hanical in turn Lction.i" norc to an was on, and volition. ig after nulus to long as A^ain. ess, and the irri- may be trunk." t , as well oth quo- d to the thorities. the torn sides, the ould the e able at muscles, jn of the rings the ion of the le animal le conclu- , syncope is present ind of the itor, is the with mus- ,at theory nd this is dvance in -force over numerated and originally See also future Nerv. Syst., ,gy, pp. 441-2. 34. It will be seen, we trust, that in the foregoing observations we iiave not indulged in mere speculation ; but have f()llowed a series )f authentic facts, t<.i what appears their legitimate conclusion. While the acceptance of this cou'ilusion is so far favorable to our theory, its rejection docs not in ^..j least invalidate it ; for if we are vMKible to account for the relaxation of muscle, in shock or syncope, our friends the physiologists are equally unfortunate ; and if one hypothesis can survive this nog.i.tivo result, so can the other, especially as it has been so authoritatively shown from Drs Todd ind Bowman that the fact of relaxation, in the conditions mentioned, does not militate against us. 35. Thi- relaxation of amestlicsia. — We cannot close these remarks without a few words on the relaxation produced by chloroform and ether. As is well known, relaxation only occurs here as anaesthesia becomes complete. It is very frequently preceded by muscular rigidity. In the administration of chloroform there are undoubted signs of stimulation in the first stage of the process, but in the subsenuent stages the evidence as undoubtedly points to paralysis. Tha ^iio paralysis is of the cranial, rather than of the spinal centres, is sho\vn by the fact that those functional activities which one after iuothcr succumb, have all their centre in the brain, and that none of the phenomena can be referred directly to the spinal cord. The rirst evidence we find of cranial paralysis is that of mental incohe- rence, foolish talking, &c., which occurs in the next step beyond stimulation proper, and is an evidence of paralysis of the cerebrum, not unlike the similar state induced by alcoholic inebriation.* As the process deepens, the ganglia which regulate motor automatic power become paralyzed, leaving to the muscles a temporary •' balance of power," and these, in part released from ordinary ner- ous control, usually pass into a state of greater or less rigidity. The subsequent loss of motor power, as well as of the muscular sense and power of co-ordination, are due to the extension of the jsame paralyzing influence to the cerebellum. 36. Meantime the optic lobes, in which resides the cranial inhibi- ory power over the reflex activity of the spinal cord,f (referred to bove) have ceased to exert this function, and the independent otor power of the spinal cord is free to exert its " much more igorous and complete control " over the muscular system ; and its nnoticed power is seen in the relaxation of the muscular tissues hich supervenes as the foregoing stages become complete in full naesthesia. The medulla oblongata is the last of the cranial ganglia o succumb. When it does, respiration ceases ; blood stasis occurs, ccelerated by paralysis of the sympathetic system and of the nherent organic ganglia of the heart. 37. It has been customary to refer to the early occurrence of 'Dr. Anstie, Stim. and Narcot., pp. 172-3. +Dr. M. Foster, Hand-book for the hys. Labor., p. 418. I n 24 PHYSIOLOGICAL THERAPEUTICS. sensory paralysis, as beginning at the extremities ; but it may well be- questioned whether anaesthesia consists in preventing the sensation of pain from traversing the nerves. It is more probable that mes- sages of pain really reach the brain, but are there unfelt, owing to paralysis of those ganglia whose function it is to awaken the perception of them in the mind : because motor power, which originates in the brain, and sensation, which is peripheral at its starting point, fail together.* It is true that some narcotics par- alyze motor power, leaving the intellect clear almost to the fatal end ; but this is only another way of stating that while the ganglia are earlier paralyzed by some drugs, the cerebrum escapes their influence for a longer time. Here, then, as in normal repose, it would appear that " the spinal system never sleeps," but, like a faithful sentinel, only yields its functions when molecular, following somatic death, puts an end to all vital activities ; and muscle finally triumphs in the rigidity of death. 38. This is not all in accordance with orthodox ideas on this sub- ject ; but a great deal of orthodox nonsense appears in print, as, for instance, the assertion that among the causes of death from chloro- form is " excessive irritation of the sympathetic nervous system ;" that the vagus is " stimulated by asphyxiated blood ;" and again that " in every case of death from chloroform the cause of the death is excitation, either of the motor or of the controlling mechanism of the heart.""!' For an adverse criticism of these views of Dr. Rich- ardson, by Dr. A. Ernest Sanson, see the article in Braithwaite fol- lowing the one referred to, from Med. Times and Gazette, July, 1870, p. 107. 39. The truth of the view taken above, that it is the brain that is paralyzed and not the spinal cord, is shown by the fact that all the objective phenomena may be fully accounted for by paralysis of the brain and its ganglia, without any reference to the cord ; and by the additional fact that in threatened death from chloroform none of the usual means of resuscitation, — not even attempted artificial respira- tion, — can compare in success with flushing the brafn with blood, by Nelaton's plan of inverting the patient.J It is in the brain that the chief paralysis has occurred, (so far as the cerebro-spinal system is concerned) and it is to the restoration of function here that recu- perative efforts should be directed. Dr. M. Hall was right, after all, in attributing the tone of the muscles to the influence of the spinal cord, but not in the way he intended, not by a stimulus, but by a gentle restraint upon muscular contractility ^ which, when exaggerated, leads to muscular relaxation. *Dr. Anstie, Ibid, p. 305. tDr. B. W. Richardson, Braith. Retros., Jan'y, 1871, pp. 245, 250, 253, from Med. Times and Gazette, 1870, pp. 85, 574. JDr. Bradley, Braith. Retros., Jan'y> 1876, p. 249, from the British Medical Journal, June, 1875, p. 772. MUSCULAR CONTRACTION IN RIGOR MORTIS. «5 ' well be" msation lat mes- iwing to ken the , which il at its ;ics par- ;he fatal ganglia )es their le spinal ields its 1 end to gidity of this sub- it, as, for n chloro- system ;" nd again the death banism of 3r. Rich- ivaite fol- uly, 1870, in that is it all the rsis of the nd by the one of the il respira- blood, by Drain that lal system that recu- 'one of the le way he t muscular taxation. I'y, 1871. PP- :Dr. Bradley, 1875. P- 772. 40. Rigor Mortis. — This remarkable condition of the muscles occurs in the interval between molecular death and the setting in of putrefaction. When it commences the muscles have lost their " irri- tability ;" that is to say, no further paralysis of their nerves — as by electricity — ^will cause them to contract. When it occurs there can no longer be a doubt that death is real and vitality extinct. 41. The onset of rigor mortis is not usually delayed longer than seven hours. Its general di^ration is from twenty-four to thirty-six hours ; but it may be longer in appearing and it may pass off sooner, or be protracted through several days. It usually first affects the neck and lower jaw, but sometimes the lower extremities. When established, " all the muscles are affected alike, but the flexors are usually more contracted than the extensors, so that the fingers are flexed on the palm and the fore-arm on the arm ; anr* the lower jaw, if previously drooping, is commonly drawn firmly against the upper. It is remarkable that it is equally intense in muscles which have been paralyzed by hemiplegia, provided that no considerable change has taken place in their nutrition. When very strong it renders the muscles promiTient, as in voluntary contraction."* That the muscles are really contracted appears from the fore- going, as well as from the statements of other physiologists. Thus Drs. Todd and Bowman say : " The rigor mortis, or stiffening of the body after death, is due to the contraction of the muscles."-f* Dr Anstie says, " It is liotorious that the most steady and persistent contraction which muscle can possibly exhibit is that which sets in after death, which does not occur till the last remnants of vitality have disappeared, and which, once having commenced, never relaxes till putrefaction releases the tissue from the ordinary laws of molec- ular attraction.''^ Not only are the voluntary muscles contracted, but the involuntary muscles also. The muscular walls of the sever- al cavities contract firmly upon their contents. The same occurs in the arterial tubes to a remarkable extent ; while Prof. Valentine has shown that the muscular walls of the intestines are no exception to the Aule ; and even after separation from the body, portions of intestine exhibit so marked a contractile power as to cause the water v/ith which they have been filled to rise in a few hours t> a considerable height in a glass tube connected with one end of the [separated portion. || 42. Rigor mortis may set in immediately after death, as in some leases of aspjiyxia, and in apoplexy, from chronic softening of the [brain or spinal cord : also in poisoning by strychnine, and in cases [where strong currents of electricity have been applied before or after Ideath. Also in animals hunted to death, in typhus, and generally in death from slow and wasting disease, occasioning a great general iepression of the vital powers; or in more acute diseases which •Dr. Carpenter's Human Physiology, p. 332. tPhysiol. Anat., p. 179. tStim. and Narcot., p. 70. || Dr. Carpenter's Human Physiology, p. 334. 26 PHYSIOLOGICAL THERAPEUTICS. Ill powerfully affect the general vital energy, even though only of short duration, rigor mortis occurs early.* Assuming the foregoing opinions of the physiologists to be cor- rect, these facts support our theory, for in all these instances nerve- force may be presumed to be at a low ebb ; and when somatic death occurs, muscular contractile force soon finds itself unopposed and displays its power accordingly. In these cases putrefaction follows with corresponding rapidity. " On the other hand, when the general energy has been retained up to a short period before death, the rigidity is much later in com- ing on and lasts longer : this happens, for example, in many cases of asphyxia and poisoning, in which it has been said not to occur at all."'!' Here nerve-force may fairly be presumed to be capable of dominating the muscle for a longer time after somatic and before molecular death, which, as we have already seen, is sometimes long postponed. That the rigidity, when it once occurred, should be pro- tracted, is what might be expected in a previously well nourished muscle left to itself, in which contractile power has r ained unim- paired till death supervened. 43. It has been attempted to explain the occurrence of rigor mortis by attributing it to a lowering of the temperature of the body : " but with this it does not seem to have any relation, since it has been frequently observed to commence long before the heat has j entirely departed from the body, and appears first upon the trunk, which is the region last deserted by warmth." J 44. Dr. Carpenter further says, " Andther attempt has been made | to show a correspondence between the rigor mortis and the coagu- lation of the blood in the vessels; and there is certainly evidence! enough to make it appear that some analogy exists between these two actions, though they are far from being identical. After those! forms of death in which the blood does not coagulate, or coagulates! feebly, the rigidity commonly manifests itself least ; but this is by no j means an invariable rule."|| It will be seen from this how unsatis-| factory this " attempt " at explanation of the phenomena in questionj is deemed by this distinguished author. 45. At the time the hypothesis we are noticing was set on foot, itl was generally believed that there was a close similarity in composi-l tion between fibrin and muscular tissue, that the former served as al pabulum for the latter, or, as it is expressed by on© author, that] ** fibrin in a coagulated state forms almost the whole bulk of the tnuscles."§ Dr. Carpenter, who with other physiologists seems to liave entertained similar opinions at a former period, shows that thi^ view is quite untenable, and indeed, that " the evidence is precisely the other way."ir *Ibid, pp. 333'4. tibid, p. 334. JDr. Carpenter's Physiol., p. 332. II Ibid. § Wilson's Anatomy, p. 3$. IF Human Physiology, p. 201. •HumJ §Dr. CAUSES OF RIGOR MORTIS. n of short be cor- s nerve- ic death sed and . follows retained • in com- ny cases to occur capable nd before mes long Id be pro- nourished led unim- ; of rigor ire of the n, since it e heat has the trunk,] been made I :he coagu-, f evidence veen these I ^fter those coagulates tiis is by no )W unsatis- in question t on foot, it in composi- served as a luthor, that bulk of the ts seems tc >wsthatthii is preciselj iol., p. 332. p. 201. 46. It may be shown also that the normal proportion of fibrin, . compared with the whole mass of the blood, is so small that it is impossible it can be the cause of the contraction in question. Thus the fibrin is scarcely the one-hundredth part of the j^//d? constituents of the blood ; and the latter, in turn, constitute only about one-fourth of its whole bulk: so that the fibrin is normally about one-four- hundredth part of the blood as a whole. Estimating the quantity of blood in the human body weighing 144 lbs., at 16 or 18 lbs.,* would give about one grain of fibrin for each muscle of the body ; an amount; which, though sufficient for the coagulation in the blood, is surely quite inadequate to produce the phenomenon of rigor mor- tis in muscle. But even this small proportion of fibrin would not be available for action in the muscles, since the contraction of the entire arterial system, the ducts of the absorbents and the hollow walls of the stomach and intestines have to be provided for. Be- sides, the normal quantity of fibrin is greatly diminished, and apart from this, its power of coagulation is materially lessened in certain diseases, notably so in typhus,f in which rigor mortis often sets in with great promptitude, the limbs sometimes stiffening in from fif- teen to twenty minutes after death.]: In cholera, too, the blood often contains so little fibrin that it will scarcely coagulate, if in some cases it does so at all ; and yet here rigor mortis may be said, in general, to be simply a continuation of the cramps and contrac- tions occurring during life. || These facts seem completely to dis- prove the hypothesis that rigor mortis is the effect of coagulation of the blood ; and, indeed, this hypothesis is now quite abandoned in favor of the one to be next noticed. 46. It is proper to remark that fibrin is no longer believed to exist in the circulating fluid as fibrin ; but that it is formed in the process of coagulation, by the combination of two albuminous substances, which are closely allied as regards their chemical character, both of which are found in the plasma, or liquor sanguinis.§ 47. Dr. Brunton attributes rigor mortis to the coagulation of the plasma of the muscles, a fluid which " resembles the plasma of the blood, in possessing the power of coagulating spontaneously and separating into a clot and serum. To this clot, corresponding to the fibrin of the blood, the name myosin has been given." He fur- ther states that "muscle plasma is somewhat troublesome to obtain, as it coagulates too quickly in the muscles of warm-blooded animals to allow of its preparation from them ; and the muscles of frogs, in which it coagulates more slowly, are not always to be had in suffi- cient quantity."ir Now, if this muscular fluid, in coagulating produces rigor mortis, this act of coagulation should be co-incident with the setting in of the rigidity. The above quotation asserts that the myosin coagu- *Hum. Physiol., p. 156. tibid, p. 187. JIbid, p. 334. || Wood's Prac, , Vol. I, p. 717, §Dr. L. Brunton, Hiindbook for the Phys. Laborat., pp. 179, 183. IFIbid, 449. 28 PHYSIOLOGICAL THERAPEUTICS. lates too quickly to enable it to be procured, but rigor mortis is often delayed for several hours. Here is a discrepancy which augpjrs badly for this hypothesis. 48, Prof. Kuss, of Strasbourg, in his Lectures on Physiology, adopts the same view of the cause of rigor mortis. He says, " The rigfidity in question is owing to the coagjulation of the albuminous substance of the muscle (myosin) by the acids which it has formed."* Or, as he says elsewhere, it is " brought on by the acidity of the mus- cle, and is opposed by its alkalinity."f This has reference to the fact that when muscles are in a state of repose their plastic fluid has an alkaline reaction ; but after exercise or strong spasmodic contraction, and during fatigue, the reaction " becomes less and less alkaline and at length is completely acid." But before and after death from ordinary causes, the muscles are in a state of repose, and consequently their proper fluid must be presumed to be alka- line. Active exercise would convert this alkaline plasma into an acid one, but muscular activity under the circumstances is impossi- ble. The acidity is owing to increased activity of chemical changes, a process of combustion, in short, wherein oxygen is absorbed and carbonic acid evolved. This process is going on to some extent in healthy muscles, both when at rest and in action. But it is only in the latter case during severe muscular labor that combustion is sufliciently active for the formation of acid in the muscular fluid.:): If acid then He necessary to coagulate the muscular fluid, and is itself the effect of active muscular exercise, how is it produced in the muscles of a dead body } It cannot be the result of muscular activity during the closing days or hours of life ; nor can it be the result of any muscular action after somatic death. When, then, the I muscles Anally pass into molecular death, and with this rigor mortis { sets in, whence comes the acidity of the muscle plasma } And fur- ther, if such acidity be the effect, or product, of active muscular con- 1 traction during life, how does it come to be the cause, or inciting agent, to muscular contraction after death? For, during syncope,! when all muscular contraction ceases, the process of combustion is at an end and the fcnuation of acid in the muscle is necessarily I arrested, as Prof. Kuss proves by the blood being no longer render- 1 ed black or venous, as is the case while combustion is going on, but, 1 on the contrary, it presents nearly all the distinguishing features of arterial blood. II If the interchange of elements between the blood j and the muscle be arrested in s^cope, there are still stronger rea- sons why death should terminate the process. Whence then thel chemical change necessary to produce acidity ? And yet it appearsi certain that the muscle plasma becomes acid after molecular deathj (that is in the contraction of rigor mortis) as well as after contrac- tion during life ; and that it remains acid until putrefactive changesl *Pn>f. Kuss, Lectures on Physiology, p. 83. flbid, p. ii.X Ibid, p. 77. ||Ibid, p. 77,1 MYOSIN THEORY OP RIGOR MORTIS. 29 lortis is r which ^rsiology, rs, "The numinous Wmedr* themus- :e to the Stic fluid pasinodic s and less and after Df repose, be alka- a into an } impossi- il changes, )rbed and extent in is only in ibustion is liar fluid.J lid, and is roduced in f muscular it be the \, then, the igor mortis And fur- scula,r Con- or inciting g syncope, nbustion is necessarily ger render- ing on, but, features of I the blood ronger rea- :e then the t it appears cular death] ;er coritrac ive changes! u lllbid,p.77. occur, when it becomes once more alkaline, owing to the ammonia evolved in the process of decomposition.* Dr. Brunton says, ** Muscle, in dying, on entering into ngor mortis, becomes distinctly acid"\ Query.' Is not the acid reaction the result of the contraction of rigor mortis, just as it is the result of muscular contraction during life, and not its cause } 49. From these considerations we think it will be obvious that the attempted explanation of rigor mortis by attributing it " to the coagulation of the albuminous substance of the muscle (myosin) by the acids which it has formed," as quoted above from Prof. Kuss, is a hypothesis quite untenable. But may not coagulation of the myosin occur otherwise than through acidity, and thus give rise to contraction of the muscle ? Prof Kuss says, that " mineral acids, heat at 50°C. (122" Fah.) or anything in short which coagulates the myosin, either hastens or produces this rigidity." J This is doubt- less true as to results, but admits of a very different explanation. Mineral acids, or a temperature of 122" Fah., may well be presumed effectually to inteniipt molecular nerve action, (either in the nerve trunks or their intra-muscular ramifications, or in that secret arena where nerve and muscle come into intimate association ;) and thus by cutting off nervous restraint, leave the muscle to its own inherent con- tractility. This is what electricity does, and it has proved itself a powerful agent in hastening the onset of rigor mortis. We cannot, therefore, admit that this part of the explanation has any more force than the former. 50. Prof. Kuss further remarks that " an injection of serum or of alkaline liquid entirely prevents or delays " the setting in of cada- veric rigidity. This is true also, but it is not necessary that the injected fluid be alkaline, for he himself tells us that injecting hot water (experiment of Brown-Sequard) produces a similar effect, || [doubtless by assisting in maintaining for a time the existing polar- ity of nerve-force, and so prolonging its domination over the muscle, thus delaying molecular death. The injection of a mixture of alco- hol and carbolic acid (both of which coagulate albumen), for em- balming purposes, relaxes cadaveric rigidity after it has set in.§ But here (when rigor mortis has occurred), life is wholly extinct, molecular death has occurred, all vital operations are at an end, and the physical power of contractility alone remains in the muscle. The muscle is amenable, not to the laws of vitality, but to those of matter ; the modification of its condition from a state of contractility jto one of relaxation, by the injection into its substance of the fluids [mentioned, is purely a physical act, and when these have expended their influence it will return to its former contraction, until other [physical fortes disintegrate it in the process of putrefaction. *Pipf. Kuss, Lectures on Physiology, p. 83. fHand-book, &k,, d. ^62. {Prof. Kuss, [Lectures on Physiology, p. 83. ^ llfbid, p. 71. %T>t. Carrick, Uraith. Retros., July, 11871, p. 270. 30 PHYSIOLOGICAL THERAPEUTICS. 1 The fact, then, that during merely somatic death, ere nerve-force- has ceased to act, the injection into the arteries of warm water defibrinated b.ood, or other fluid, not necessarily alkaline, * ostpones the occurrence of molecular death, and with this the setting in of final rigidity, does not prove that the myosin is at all concerned in the process : the delay in question being equally well accounted for hy the prolongation of the existing relations of molecular polarity between nerve and muscle. 51. Here we are fortunately in accord with the older living phy- siologists, and before it is admitted that they were in error in attri- buting rigor mortis to muscular contraction, it must be conclusively shown : — ist. That the coagulation of muscle plasma and the setting in of | rigor mortis attend each other as cause and effect, and that the for- mer is invariably present as an essential condition of the occurrence] of the latter. 2nd. Jf the development of acidity in the muscle be due to I muscular contraction, and its presence be necessary to the coagula- tion of muscle plasma ; and this coagulation, in turn, be an essential! condition for the occurrence of rigor mortis, whence comes the I acidity after death, and during the repose of the muscles, ofl which the necessary contraction, as the first link in tu° series, is| wanting ? 3rd. Why should acidity of the muscles follow muscular contracj tion during life (as an effect), and precede it (as its cause) afterf death } 4th. Why is muscular plasma so copious, or so active, as to caus^ almost immediate rigidity after death from certain exhausting diseases, (and after the application of electricity), and yet permi^ rigidity to be much longer deferred when the muscular system ha been previously well nourished, almost until the hour of death .'• 5th. According to Dr. Lionel Beale, fibrin is non-living matter,' and is the product of the death of albuminoid bioplasm. If this \A true of fibrin, it is very likely to be true also of myosin, which said closely to resemble it. Coagulated myosin is dead : anj if the muscle also be dead, and its inherent contractile powe at an end, in what manner does dead matter, acting upon dea muscle, produce so perfect a counterfeit of muscular contractiod that one of the keenest observers of the day pronounces it "themoj steady and persistent contraction which muscle can possibli exhibit .?"t 52. Even if these conditions were fulfilled, the hypothesis question sustained, and the fact established, that rigor mor depends upon the coagulation of the muscle plasma and not upo post mortem contraction of the muscles, the fact would not affe our theory further than to deprive us of a very striking !llustrati(| ^Disease Germs, pp. 136-7. tDr. Anstie, Stim. and Narcot., p. 70. OTHER POST MORTEM CONTRACTIONS. ere nerve-force of warm water caline,: ostpones he setting in of ill concerned in ;U accounted for olecular polarity ilder living phy- in error in attri- it be conclusively the setting in of and that the for- of the occurrence luscle be due to y to the coagula-l rn, be an essential /hence comes the I the muscles, ofl k in tu° series, is| muscular contrac-l IS its cause) afteif active, as to causi ^ertain exhaustini r), and yet permil iscular system hr hour of death ?• non-living matter, oplasm. If this b f myosin, which « osin is dead : anj it contractile pow( acting upon dez auscular contractioi louncesif'themo uscle can possibl , the hypothesis , that rigor moi lasma and not up act would not aff( striking illustrati( rcot,,p. 70- 31 •of muscular contractile power in the absence of nervous agency, of which numerous other, though less remarkable, examples are npt wanting. 53. Such are the principal facts in regard to rigor mortis. If the reader adopts the view that the muscles are really contracted in this state, he will either agree with us that their contraction is the result 'of their own inherent contractile power, which survives the general life of the body and of the nervous system, or else that the muscles are still acted on by the " stimulus" of nerve-force, which according to the accepted theory is essential to the display of muscular con- traction, a view of the case which under the circumstances seems too palpably absurd. On the other hand, if the myosin hypothesis be regarded with favor, much additional proof will be necessary to justify it, while at present theie appears to be much force in the arguments against it Notwithstanding Professor Kuss's adoption of this theor){, we find him saying that " muscular contractility is a purely physical pro- perty of elasticity ; tAe rigidity of a corpse is a phenomenon of the same order as mtiscular contraction in the living body'"* 54. Other post mortem muscular contractions. — We have already made a brief reference to other post mortem muscular contractions, which are very remarkable in themselves, accord well with our theory, and are deserving of more than a passing notice. These muscular movements have been especially noticed after death from cholera and yellow fever. In some of these cases, the balance of power between nerve and muscle appears to have been so nicely maintained in somatic death, that what is called " mechanical stim- ulation," — in reality depression — applied to the muscles themselves, and acting doubtless on their intra-muscular nerves, ** gives rise to movements strongly resembling the ordinary actions of the living state." In other cases, these muscular contractions "are frequently [spontaneous," and occur without the aid of the so-called " stimulus," [shewing them, as Dr. Carpenter admits them, to be *^due to the \inherent contractility of tlte muscles y and not in any degree dependent uipon the operation of tlte nervous system.'* The truth of this con- clusion was shown by Dr. Dowler, who " proved experimentally by [completely separating limbs which exhibited these movements, from the trunk of the body, that the influence of the nervous jystem was not in any degree essential to their production."f The following are among other examples of these post mortem muscular lovements. "In one case, about ten minutes after the cessation of •espiration and circulation, Mr. N. B. Ward saw the eyes open, and lOve slowly in a downward direction ; this was followed in a minute •r two subsequently by the movement of the right arm, (previously lying by the side,) across the chest ; there was also a slight move- *Lectures on Physiology, p. 88. tDr. Carpenter's Human Physiology, pp. 327, 328. 33 PHYSIOLOGICil THERAPEUTICS. i'.il! ment of the right leg, and these movements of the limbs (those of tlje eyes occurring only once) were repeated to a greater or less degree four or five times, and fully half an hour elapsed before they finally ceased. In a case observed by Mr. Helps, the subject of which was a man of remarkable muscular development, the fingers continually twitched and trembled after respiration had ceased, and the fibres of the muscles were in a state of rhythmical motion, so> that when the fingers were pressed on the belly of the biceps, a sensation as of the pulsation of an artety was plainly felt ; the muscles of the arm acted forcibly even on a slight irritation^ (?) the forearm being powerfully flexed when the biceps was struck with the side of the hand, and the fist being doubled or the hand extended, according as the flexors or extensors on the forearm were irritated in the same manner." In some of the similar cases recorded, con- tractions of various muscles continued for th'-ee or four hours, and then the muscles passed into a state of rigidity.* 55. "Some curious rhythmical movements have been observed by Dr. Brown-Sequard, in the diaphragm, intercostals and some of I the muscles of locomotion, both after death and after section of their nerves during life. These movements could not be in any way dependent upon reflex action, because they took place when the | muscles were completely cut off from th'i nervous centres ; some- times to the number of from five to twenty in a minute, and for as I long as a quarter of an hour after death ; and occasionally recurring in a living animal for many months afterwards, especially when the| respiration was impeded and the circulation hurried."*!* 56. These two classes of muscular contraction can neither be at- 1 tributed to nervous agency nor to coagulation of plasma of either! the blood or muscles ; and the only explanation possible for themj is that given above by the distinguished author from whom wel quote. How natural they seem when looked upon simply as the! eflfect of the gradual relaxation of the restraint of nerve-force overl the muscles ; exhibiting itself first in one fasciculus, or in one! muscle, then in another, until finally the muscles become whoU) free, and then pass at once into a state of general rigidity, and sc remain until this wonderful property of contractility is ruined in[ putrefaction! 57. The principle for which we are contending, finds anothed striking illustration in " the post mortem contractions of the par] turient uterus, to such an extent as to expel the foetus of which the] patient had died undelivered ; a phenomenon which has been several times recorded :" and in the remarkable case witnessed hj Dr. Robert Lee, " in which the patient having died suddenly f ror the rupture of the uterus and escape of the fcetus into the abdomj •Dr. Carpenter's Human Physiology, p. 327. tGazette Medicale, 1849. Note Dr| Carpenter's Human Physiol., p. 319. INDEPENDENCE OF UTERINE POWER. 33 those ol r or less ore they ibject of 5 fingers sod, and otion, so. biceps, a felt ; the tt, (?) the : with the ixtended, : irritated •ded, con- lours, and and for as Lr recurring r when the| ther be at- la of eitherl le for them whom wej nply as the -force over or in one| Une whoU] ity, and s( iS ruined in| ,ds anothe of the par f which thi has bee atnessed b; idenly tro the abdom 849. Note Dil inal cavity, the uterus was found, when an exomination was made twenty-four hours after death, to be completely inverted."* In the act of parturition " the contractions of the uterus, which are alone sufficient to expel the fcetus when there is no considerable resistance, are not to be regarded as reflex : and it is only in the co-operation of those associated [voluntary] muscles, which come into play in the second stage of labor, when the head is passing through the os uteri and is engaged in the pelvic cavity, that the assistance of the spinal cord and its nerves is called in."-!- The same author, writing of parturition, says, again, "In this act, the muscular walls of the uterus are primarily concerned ; for a kind of peristaltic contraction takes place in them, the tendency of which is to press the contents of the cavity from the fundus towards the os uteri, and finally to expel them ; and this contraction is alone suffi- cient to empty the uterus when no impediment is presented to the exit of the fcetus, as we see in the occasional occurrence of post mortem parturition. . . There is no proof whatever that these changes are dependent upon nervous influence ; in fact, there is much evidence that the parturient action of the uterus is not the result, (as some have maintained it to be) of a reflex action of the spinal cord, but lis due to its inJierent contractility: for numerous instances have occurred in which normal parturition has taken place, notwithstand- ing the destruction of the lower part of the cord, or the existence of complete paraplegia, which marked its functional inactivity ; and the continuance of the peristaltic action for some time after somatic Ideath, when neither the cerebro-spinal nor the sympathetic system can afibrd any supply of nervous power, is yet a more satisfactory [proof of the same position."]: 58. Uterine contractions may, however, be excited by reflex .ction in various ways, and by the influence of certain drugs opera- :ing through the nerves supplying that organ, but we shall have eason to see, in future chapters treating of ergot and electricity, :hat it is rather by withdrawing nerve influence than as a "stimulus," :hat uterine contractions are thus induced. Meanwhile, the facts ecounted above show us in the action of the uterus, a palpable iroof of the inherent and independent contractile power of muscular issue, displaying itself in the entire absence of nervous agency, and iurviving even the general life of the body. With such an illustra- ion, from the authentic records of physiology itself, the wonder is, lot thai the principle we are advocating should be asserted, but |hat it has not long ago been generally promulgated. For a fuller ;onsideration than has yet been given to the present doctrine of ihysiologists regarding the " excitability " of muscle, through the igency of so-called "stimulants" to the muscle itself, or its motor lerves, see § 86. *Dr. Carpenter's Human Physiology, p. 334. t Ibid, p. 696, J Ibid, pp. 979, 980. i 34 PHYSIOLOGICAL THERAPEUTICS. 59. We do not expect, or intend, to exhaust in this chapter the proofs and illustrations of the truth of the principle now asserted ; for additional evidence in support of it will be found throughout this entire essay. But, before concluding, it will be well to remark that the general principle here advocated is not invalidated by the fact that certain poisonous gases and narcotic drugs diminish or abolish the response of the muscles to the action of electricity.* This is what physiologists mean when they allude to muscular " irritability " being " deadened " or " destroyed " by the agents in question. When it is considered that muscular fibrillae average about l-io,cxx)th of an inch in diameter.-f (in some instances as low as I -20,000th) and that on the integrity of this delicate structure de- pends its power of contraction, it need excite no surprise that the imbibition of liquids and gases, destructive to all delicate tissues, should so alter the microscopic relations of the ulti- mate components of the fibres as to impair or destroy this physical property. 60. But there is a further explanation of the fact in question which must not be lost sight of. The narcotics mentioned paralyze the nerve-trunks or the intra-muscular nerves ; and this effect, once- carried to a certain degree, a relation is established between the nerve and muscle, which the additional paralysis of electricity does not materially alter. In proportion as nerve-force, has been extin- guished, there will be less of the same kind of action to be produced | by electricity, and less effects to follow. If the nerves are entirely paralyzed, electricity will produce no effect at all on the muscles, J I and in physiological parlance, their "irritability" will be said to be " destroyed." II One of these modes of explanation refers to the action of these poisons on the nerves, the other to their action on the muscles. It is quite reasonable to inter that both these tissues suffer from the imbibition of these noxious agents, inj which case, a double cause would exist for the loss of " irritability ' referred to. 61. Nor are we prepared to yield our ground to the fact that the! nutrition of muscular tissue suffers, or is impaired, from causes! operating through the nervous system, as from lesions of nervous[ centres, or from wounds or injuries of nerve trunks, which serve to connect these centres with the periphery. Such impaired nutrition! or atrophy, as is well known, may be the result of mere disusej (owing to enforced quietude from wound or injury), or it may arisf from injury of those nerves, or of those filaments of compoun(j nerves, which preside over the nutritive functions. Thus, " when nerve is injured, the muscle may be paralyzed [to the will], sensaj tion destroyed, or nutrition attacked. But, for obvious reasons! *Dr. Carpenter's Human Physiology, p. 320. nolds, Lee. on Clin, uses of Elec. p. 37. tibid, p. 306, $Dr. J. Russell RejJ II See chapters on Electricity. !il!!i^ AN IMPORTANT ADMISSION. 35 ct that the rom causes ; of nervou^ ch serve td 3d nutrition nere disuse t may arisf f compoun' us, "when will], sensaj ous reasons .J. Russell Re! tricity. these triple results will usually occur in one and the same case, but in differing degrees, as motor, sensory, or nutritive nerve fibres hap- pen to suffer more or less."* This dependence of the muscular tissues upon the nervous system for their proper nutrition, is quite in accordance with what is known as to the mutual relations existing between the several parts of the living organism ; and is quite as consistent with the views of the relations of the motor nerves to the muscles, here advocated, as with the one currently received. 62. It has thus been shown that an active power of contraction is present in muscle, as in the fcetal heart, before the existence of any nervous system or nerves ; that in the lower forms of life this pro- perty is much more extensive than any corresponding nervous system ; and that the facts, as at present established, appear to show that this inherent contractile power displays itself, (as in rigor mortis) after all nervous life is extinct. This being the case, we think our first principle, or proposition, may be claimed to be fairly established. 63. We desire, in concluding this chapter, to invite the reader's attention to the fact that what we here ask him to accept is but a very slight extension of a doctrine freely accepted and taught by most of our leading physiological writers. Indeed, very frequently they seem on the point of admitting all we claim, and appear as if they really intended to do so, and yet stop short on the very brink of the announcement. Here is an example of this, from Dr. Car- penter, who combats the teaching of some physiologists, " that muscles, though not depending on nerves for their peculiar vital power [of contractility] are yet dependent upon them for the exercise of it."f If the " hypothesis " here objected to by Dr. Carpenter be untrue, then the opposite of that proposition must be tfue, namely, that muscles are neither dependent on nerves for their vital power, . nor for the means of exercising it, which is equivalent to saying that they possess an inherent contractile power of their own, inde- pendent of nervous agency, and this is precisely what our first general principle, or proposition, asserts. Taken by itself, the fact of the existence of this endowment in muscular ftJare is a most interesting one ; but, associated with other facts, bearing upon the relations of the musculo-motor nerves to the muscles, and of the vaso-motor nerves to the muscular fibres of the middle coat of the arteries, it assumes a practical importance in the study of disease and certain kinds of drug action, which deserves- attention, and which will be referred to in subsequent chapters. The closing sentence of this first proposition, asserting the influ- ince of the nervous system in regulating muscular contractile power,. for voluntary purposes, is universally admitted and needs no special * Drs. Mitchell, Morehouse and Keen, Gunshot Wounds, &k., p. 76. tHumaa [Physiology, p. 325. 36 PHYSIOLOGICAL THERAPEUTICS. proof. That this regulating power is a restraining one, however, is not generally admitted, and will be considered in our next propo- sition. CHAPTER II. NERVOUS INFLUENCE RESTRAINS, NOT COMPELS, MUSCULAR CONTRACTION. 64. Second general principle. — The influence exerted by the ner- vous system in its relations with muscular tissue is that of a restrain- ing and not that of a compelling power. Nerve-force, then, so far from being the ally, is the direct antagonist of muscular contractile power; and the latter displays itself to the best advantage in proportion as the influence of the former is withdrawn. 65. A missing link. — A beautiful illustration of muscular activity in a peculiar form, is to be found in the spiral tendril of the pedicle of the vorticella ; while the evidence of " a missing link," in current physiology, is furnished by the account physiologists afibrd of the force which opposes the avowedly inherent contractile power of that muscular filament. The vorticella is one of the microscoi)ic infusoria. Its body is generally oval or spindle-shaped. In several species it is furnished with a stem-like appendage, which consists of a transparent sheath, containing a fine thread-like muscle, coiled like a spiral spring. The distal end of this pedicle is usually attached to some fixed object in the water ; and when at rest, or dead, the spiral muscle is found closely coiled and the pedicle shortened to the utmost. When the animal is active, the sudden elongation of the spring projects the body forwards, perhaps in search of its prey ; and as occasion requires, (as when disturbed), the coil is as suddenly con- densed and the body retracted. When fully extended, some species are one-twelfth of an inch in length, but others diminish to one-two- thousand-three-hundrecUhs.* Professor Rouget, quoted by Professor Kuss, of Strasbourg, in I "his Lectures on Fiiy-iOlogy, in describing the mechanism of the vor- ticella, says, " It frequently happens, during the life-time of the animal, that the contractile fibril is severed , and thus the continuity between it and the body, or the trophic centre of the whole animal, is broken: in this case, although the sheath is perfect, the body, living and swimming by means of its vibratile cilia, drags at its infprior part the dead contractile fibril, rolled up like a tendril, hav- ing forever lost the power of further elongation."f Whether the loss of this useful organ, as thus described, is the result of disease or injury, or whether at some stage of the develop •Pritchard's Infusoria, p. 278. tProf. Kuss, Lectures on Physiftlogy, p. 89. A SPIRAL MUSCLE. 37 tnent of the animal the pedicle is shed, or separated by a similar natural process appears not to be certainly known. When in its normal state it is a part of the organism, and is regulated " by external conditions as though the animal were possessed of con- sciousness or will."* 66. Prof. Rouget has no hesitation in attributing the shortening of the spiral filament to " an inherent property of the living muscu- lar fibre " composing it, which property he regards as *' a necessary result of its structure and of its elasticity.""!' This is quite in accord with the opinions of other physiologists as to the endowments of muscular tissue, already quoted, and is undoubtedly the true explanation. 6t. Neither this physiologist. Prof. Kuss, nor any other, seems to perceive that muscular contraction is in this way amply provided for, without the necessity of assuming the existence of an additional power or " stimulus " to its contraction, derived from nerve-force. The excessive provision thus (hypothetically) made to ensure con- traction of muscle, is the more noticeable when contrasted with the laborious and even ludicrous attempts to find the power by which this spiral muscle is elongated. 68. Prof. Rouget says, " The lengthening of the fibre is the result of the forced extension of the spring by means of a movement con- nected with the act of nutrition." What that " movement " is, or in what way it elongates the muscle, he does not indicate. Again, we quote, " during life, the tendency to shorten is combated by an extending cause, which prevails during the repose of the muscle." J Here, then, is an undefined " movement," " an extending cause," and subsequently " a moving cause," put forward to oppose the inherent contractile power of the muscular tissue, and so to elon- gate the spiral. Is this physiological science ^ Why, such an explanation would be laughed out of the lecture room, if made by an obscure individ- ual, like the writer ; but coming from distinguished physiological chairs, it is, simply, indicative that there is " a missing link " here which physiology has not yet supplied. 69. That missing link is to be found in the doctrine that nerve- force is a restraining and not a compelling power towards muscular fibre. Here is the complement to the half-truth which Prof. Rouget acknowledges. , Inherent muscular power contracting and shorten- ing the spiral on one hand, and on the other nerve-force inhibiting or arresting that contractile power of the muscle, and so producing relaxation. 70. We cannot,, of course, explain the hidden process by which the molecules of the nerve act upon the molecules of the muscular fibre, to counteract muscular contractile power : nor can the physiol- *Pritchard's Infusoria, p. 586. tProf. Kuss, Lectures on Physiology, p. 90. ^^Ibid, p. 90-91. 38 PHYSIOLOGICAL THERAPEUTICS. ogist explain how nerve molecules operate so as to '* stimulate " the muscle to contract ; but one mode of action is as conceivable and as possible as the other. 71. In ordinary muscular repose, the nervous polarity may be 'assumed to be adjusted so as to dominate the muscle, and secure that degree of relaxation known as muscular tone. A modification of this polarity, whether brought about by the operation of the will, or as the result of mechanical agents or of a paralyzing disease, sets the muscle free, and it passes into a state of contraction accord- ingly ; in the former case, in obedience to volition, and subject to co-ordinative power ; in the latter cases, irregularly, as in spasm and convulsion. 72. Such a view of the case, we think, suffices for ordinary mus- cular contraction. But in the case of this microscopic spiral, there would seem to be a necessity for some active power of elongation as well as of contraction. A mere negation of contraction will not suffice, because the animal darts forward with a degree of suddenness, elongating the spiral in doing so. Perhaps this necessity may be met by assuming that while nervous force negatives the con- tractile power of the spiral muscle, and relaxes it, the action of the vibratile cilia, (which are readily seen moving with extreme velocity) propels the body forward, as we have already seen is the case, when the pedicle is dead or no longer capable of activity. 73. Enough has been said to show that the principle for which we are contending not only loses nothing by comparison with the ordinary physiological theory, but that it presents (as we think) a much more natural and reasonable explanation of the phenomena of muscular contraction and relaxation. The proofs on which this principle is to be sustained and the answer to objections which naturally arise, have now to be entered upon. 74. On the very threshold of this chapter we will be met by the exclamation, "" If this principle or proposition be true, why does not a imiscle at once contract wJien its motor nen>es are cut, as in wound or injury f This is so important an objection, and we are so little embarrassed by it, that we proceed to answer it at once, before passing to the more positive proofs of the principle asserted. In order to do this, however, it is necessary to consider what is | known of nerve-force and its mode of action on muscular fibre cells. 75. " Nerve-force is developed through the agency of cells . . . and is to be regarded as but a peculiar modus operandi of the same | [vital] force as that which is elsewhere operative in cell develop- ment."* The special cells which generate nerve-force are those of the! vesicular or grey matter of the nervous centres, and the gelatinous [ fibres of the sympathetic ganglia.*!* •Dr. Carpenter's Human Physiology, pp. 132, 350. tibid. POLARITY OF NERVE-FORCE. 39 The sensitive and motor nervous cords, or trunks, composed of white fibres, do not contain these peculiar cells, or arc supplied with them only exceptionally at the peripheral extremities of the sensi- tive nerves and nerves of special sense.* ^6. These tubular nerve cords are, therefore, regarded not as originators, but simply as conductors of nerve-force ; or of the molec- ular change, in which that force manifests itseirf 'J1. Of the precise manner in which nerve-force is brought into communication with muscular force nothing certain is known. The following quotation from Drs. Todd and Bowman appears to em- body the view of physiologists on the subject : — "There are no textures which exhibit such proneness to molecular change, under the influence of their proper stimuli, as nerve and muscle. . . . The changes, however, which take place in nerve, when in action, are known to us only by the effects which they produce on the sentient mind or on muscular parts. There is no alteration in the physical appearance of the nerve or its fibres, which can be detected by our aided or unaided vision. Yet from the rapidity with which stimuli applied to nerves produce their effects on distant muscular parts ; from the instantaneous cessation of these effects on the removal of the stimulus, and the speedy renewal of them on its reapplication, we can refer the phenomena to nothing so well as a molecular cliange, rapidly propagated along the course of the nerve from the point of application of the stimulus. And in the instantaneousness of its production, and the velocity of its propagation, we may compare it to that remarkable change in the particles of a piece of soft iron, in virtue of which it acquires the properties of a magnet, so long as it is maintained in a certain relation to a galvanic current these properties being instantaneously communicated when the circuit is completed, and as instantaneous- ly removed when it is broken. A state of polarity is induced in the particles of the nerve by the action of the stimulus, which is capable of exciting an analogous change in other particles, whether mus- cular or nervous ; whence results the peculiar effect of the nerve's influence." .f 78. From this view of the molecular changes which bring nerve and muscle cells en rapport, it will be evid v. ,'hichever view we take of the action of nerve-force, whether we regard it as compell- ing muscular contraction or restraining it, we will have to associate in our minds, a certain state of polarity of the molecules with contraction, and an altered or revjrse state, with relaxation of the muscular fibres. 79. We will also have, (from the very nature of the case'y to attri- bute to this polarity a certain fixedness or stability, in maintaining its present state until that state be altered by the power of the will; by *Dr. Carpenter's Hum. Physiolog}', pp. 132, 342, 879. tibid, pp. 335, 349, 351, ^S^•c. JPhysiol. Anat., p. 212. 1 ^ 40 PHYSIOLOGICAL THERAPEUTICS^ purely reflex action of the nervous centres ; or by some physical agency, such as heat or electricity, &c., acting on it externally. If this state of polarity were fickle or readily changeable, it would be liable to constantly fail us, perhaps in critical moments, and permit relaxation to occur when contraction was most desirable, and vice versa. 80. This state of fixedness or stability of the existing molecular polarity is further shown by the fact that when it is disturbed by agents, such as electricity, it tends to resume its former state imme- diately on the withdrawal of the disturbing cause. Thus, also, a muscle in a passive state contracts with a sudden spasm when a bullet passes through it, or impinges on or near its motor nerve, but quickly resumes its previous state of relaxation.* Here, no doubt, the molecular polarity between the nerve and muscle cells is dis- turbed or reversed by the shock ; but soon recovers itself and reclaims its power of restraint over the muscular fibres, which it had temporarily relinquished. From these considerations it will be evident, we think, that while the polarity of the molecules seems easily — because naturally — reversed by an impulse from the nervous centres, a comparatively powerful influence is necessary to effect this change when operating outside of the nervous circle. 81. And now for the application of this. Suppose the muscle to be in a state ot relaxation, (i. e.) of non-contraction, as when ordi- narily at rest. T/iat state will be maintained so long as the necessary molecular change required to bring about contraction does not take place in the proximate nerve fibres, 82. When the central ganglia, either acted on by the will, or by impressions received through the afferent nerves, invoke muscular contraction, the necessary molecular change traverses the whole course of the nerve, and at the poxnt of contact with the muscular fibre cells, effects the necessary polar change, and muscular con- traction follows. But suppose the motor nerve trunk to be cut across, the molecular change will be interrupted at the point of section, and will be unable to pass further. As a consequence, the distal portion of the nerve, that with which the muscle is associated, receives no impression. Its molecules are undisturbed. No change has been induced in their polarity. The conditions necessary to a reversal in the state of the muscular fibre have not been brought about, and in the I absence of this necessary change in the molecular polarity of the nerve, the muscle does not, and cannot contract. It is paralyzed to the will, indeed, but only because the mandate of the will has failed to reach it : otherwise the muscle is no more paralyzed than at any former time ; it is only awaiting the necessary re-adjustment of j molecular arrangements, to pass into the state of contraction. *Drs. Mitchell, Morehouse and Keen, Gunshot Wounds, drn:., p. 123. AN OBJECTION ANSWERED. 41 olecular rbed by e imme- , also, a when a erve, but doubt, [s is dis- tself and ch it had muscle to ^hen ordi- s necessary s not take /ill, or by- muscular :he whole muscular cular con- I molecular I be unable the nerve, impression, induced in . the state nd in the rity of the aralyzed to 1 has failed lan at any ustment of tion. If it have to wait too long for these conditions, that is, if the wound or injury of the nerve be a serious one, and its repair be long deferred, degenerative changes occur, both in the distal portion of the cut nerve* and in the muscles ; and these changes, sooner or later, so modify the relations of polarity between the nerve cells and the muscular fibre cells, that the latter cease to be restrained, and, as we know, pass into a state of contraction more or less permanent. 83. As to the action of electricity on the distal portion of the cut nerve, in inducing muscular contraction,"!* it is only necessary to remark here that there is no reason to infer that electricity does so by taking the place of nerve-force : and that it is quite justifiable to assume thst it acts by temporarily disturbing the existing molec- ular polarity, and that during this disturbance the muscular fibres pass from restraint and assume a momentary contraction. ' On the I withdrawal of the disturbing force, the disturbed polarity resumes its former state and its former control. It is by the effects thus produced on muscle, as we shall prove 1 by and by, the good effects of electricity result, by indirectly im- proving nutrition, and not from any "vitalizing "quality of its I action. When the normal molecular polarity is permanently overthrown, the physical forces (including electricity) are impotent to re-adjust it, so as to restore its proper relations to muscular fibre, which can only be brought about, if at all, through the influence of the central nervous organs. For it is fully established, that after wound or injury of a nerve, where voluntary power over a muscle has been [lost, voluntary power is sometimes restored before electricity has .ny effect in inducing contraction. :J: 84. In addition to this, however, we have to invite the reader's .ttention to what was said in a previous page, (§ 31,) as to the ordi- lary interpretation put by physiologists on the effects of section or injury of a nervous centre, or of a nervous cord, in continuing the :ransmission to the periphery, of nerve-force, in a manner not unlike :hat propagated by an excitation of a nervous centre. The quota- ;ions then made from the authorities apply here with equal force,^ ind account for the nerve continuing to exert a restraining influence iver the muscle so long as the irritation of the section or injury continues. 85. Another reason (but of less weight and importance) why luscles do not at once pass into a state of contraction, on section of leir motor nerves, is found in the fact that most muscles are func- jonally opposed by other muscles, as in the case of flexors and jxtensors : when the muscle of one group contracts its antagonist lust lengthen, and to this, its passive contraction offers a certain Dr. Lincoln's Electro-Therapeutics, p. 73. tibid, p. 71. JDrs. Mitchell, More- Duse and Keen, Gunshot Wounds, 61-2. II Ibid. 52 PHYSIOLOGICAL THERAPEUTICS. contraction depends on the contractile power of the arterial coats ; which it is the function of the vaso-motor nerves to restrain, and consequently to dilate the vessels. The paralysis of the vaso-motor centres or nerves by " morbid blood " puts an end to this dilating and restraining power, leaves the muscular walls of the arteries free to contract, and a diminution of their calibre and cerebral anaemia are the direct results. This explanation will be found consistent with the relations of nerve and muscular fibre throughout the body, and is surely much more natural and physiological than to attribute an exciting effect in the nervous centres to the direct influence of poisoned blood. Either bad blood or deficient blood is a very unfavorable condition for the development of excessive nerve force, for " it is a law in physiology that the functional activity of an organ is directly proportionate to the supply of arterial blood to the organ."* TOO. With these considerations in view it is our duty to repudiate the assumption that under the condition of diminished blood supply the nervous centres pass into a state of undue activity, and developc motor nerve-force in an unprecedented manner. And this, too, at the very moment when another portion of the brain — the cerebrum — is so deficient in power as to permit the mind to lapse into uncon- sciousness, and plunge its faculties in oblivion ! lor. Nor do the convulsions occurring during sleep admit of any other explanation than that of diminished and not exalted nerve- power. For wc know that during sleep the brain is anaemic, and the blood moves in the cerebral vessels with diminished rapidity .•[• 102. Nor are puerperal eclampsia an exception to the rule of| epileptic seizures generally. This kind of convulsion is not peculiar to plethoric persons, but frequently occurs in pale, ill-nourished and anaimic subjects. Besides, there are grave reasons lor doubting that the state of I pregnancy is attended by increased healthy nutrition. The nutritive functions are usually materially disturbed, and this condition in turn induces alterations in the blood, J and this fluid "though increased in quantity is more generally impoverished, containin<^ fewer corpuscles, less albumen and a larger proportion of water.' We have, conjoined with these conditions, in the majority of cases, a high degree of mental anxiety, not unfrequently cedema, and serous effusions, " by which a considerable drain of the nutritive elements j of the blood is produced." 103. Indeed all the circumstances under which eclampsia occurl justify the words of Dr. Hughlings Jackson when he says : "Allj clinical evidence points to this one general conclusion, that nervej tissue is enfeebled in convulsions. Whether it be itself primarilyl at fault, or whether it suffers from want of blood, is poisoned by badj •Dr. RadclifTe, Lectures on Epilepsy, etc., p. 238. tDr. Madden, Braith. Retros., Jan., 1875, P- 24'- t ^f- Barnes. I! I I' I THE EPILEPTIC STATE. 53 ,1 coats ; ain, and so-motor dilating erics free anaemia :onsistent the body, than to he direct condition a law in 3 directly "* repudiate )od supply i develope lis, too, at erebrum — ito uncon- mitof any [Ited nerve- la^mic, and •apidity.f the rule of lot peculiar jrished and | he state of he nutritive ondition in d "though , containint; of water.' y of cases, a ,, and serous! ve elements' Tipsia occur sa/s : "All that nerve :lf primarily oned by bad , Braith. Reti05,, blood, or torn by cerebral hoemorrhage, there can, I think, be little doubt that it is enfeebled." * 104. Dr. C. B. RadclifiTe.f approaches this question of excited or depressed vital function, in convulsion, tremor, spasm, &c., by considering how the great functions of respiration, circulation and innervation are affected ; believing that the activity or inactivity of these must furnish a correct measure of the degree of vitality in the system at the time. The subject is discussed at considerable length from this point of view, and Dr. Radcliffe finds abundant evidence to show that these important functions are constantly more or less impaired, not only during the convulsions, but frequently also in the intervals between them. This author shews, among other things, that the strong and full pulse which so often accompanies the fully developed epileptic con- vulsion, i i a pulse of black blood, and not a pulse of red blood ; the pulse of suffocation, the apnaeal pulse, which he holds to be quite consistent with the conclusion that convulsion is connected with vital depression and not with vital excitement. He shows that convulsion and spasm are never co-incident with state of active febrile excitement of the circulation, and that if [■convulsions, spasms, &c., occur, in connection with such a state, it lis during the cold stage ; and he advances reasons for believing [that the stage of febrile excitement is actually antagonistic to :onvulsion. The convulsions which may attend Bright's disease are believed )y this author to be owing to a pale and watery condition of the flood, conjoined, perhaps, with uraimic poisoning ; but in any case, with unmistakable signs of great vascular debility, a state quite Incompatible with increased vital energy. 105. T/ie treatment of tlie epileptic state is a practical illustration •f the truth of the foregoing pathological views. Dr. Anstie says : The removal of muscular tremor, spasms and convulsion is one )f the most striking effects which is produced by stimuli." And igain : " The action of small doses of chloroform in arresting ;onvulsive movements affords a good example of the operation of linute quantities of a substance which, in large doses, is a narcotic ind paralyzer." He then narrates " a good illustration of the action »f small doses of chloroform in cutting short convulsive attacks," fhich fell under his own notice in King's College Hospital. Else- where he assures us that the action of small doses of chloroform, by ihalation, is that of a stimulant, and that the narcotic, or paralyzing fects, are to- be carefully avoided, as highly conducive to invoke •nvulsion. He continues : " The operation of an undoubted :imulant, such as carbonate of ammonia, in a five-grain dose, ■oduces smaller, but precisely similar, effects. . . . . Inter- *Braith. Retros., July, 1871, p. 204. See also Jan'y. 1875, p. 24i-2;and Jany, 1869, p- 17-230 of the same publication. t Lectures on Epilepsy, «5«:., pp. 158, 166, 191. 54 PHYSIOLOGICAL THERAPEUTICS. irJB! mediate between chloroform and ammonia, in the degree of its efficacy in arresting convulsive movements, is alcohol. I have notes I of several cases of epilepsy in which I was assured by the patients that they could sometimes ward off a fit completely by taking a tumblerful of hot brandy and water, or a glass of wine, as soon as any threatenings were perceived ; and in two very severe cases under my care, alcohol has appeared to be absolutely the only remedy | which was capable of mitigating the violence and duration of the paroxysms (chloroform could not be tried); in one case ammonia had completely failed, in the other it produced only trivial effects. In one of these cases I had the opportunity of personally observing the arrest of a fit, which was imminent, b^ Jose of brandy. I was! conversing with the patient, in his ow. house, when a curious expression of horror and bewilderment passed over his face, he began to stammer in his speech, and the head was jerked several! times spasmodically toward the right shoulder. A hot glass ofj brandy and water was immediately administered, and the suffererl sat down quietly, the convulsive jerks ceased in a minute or two,[ and although the patient continued trembling and shaking fori some time, there was no return of the threatening symptoms. T/iel convulsions of teething in children form another class of diseases fori which there is very considerable reason to believe that alcohol isl one of the best remedies possible It it is needless toj dwell upon the well-known effects of alcohol in relieving many! kinds of muscular spasm ; the most familiar instances, perhaps, are! its beneficial influence upon colic ; and upon spasmodic asthma, inl both of which affections it often acts favorably : it is proper to remarkf however, that the use of intoxicating doses is entirely unnecessary! and, I believe, indirectly very injurious by the after depression which it causes. I would venture also to express the opinion that! the very sensible relief which is often experienced in spasmodiJ asthma, from the inhalation of the smoke of tobacco and oi stramonium, may be procured without carrying their action so faij as to produce a truly narcotic or paralyzing effect." io6. Dr. Anstie then proceeds to " consider the measures whidj are calculated to eradicate the convulsive tendency,'' and here " it i| impossible not to see at a glance, that these remedies are l11 oI them probably — the great majority certainly — such as direct!)! tend to improve nutrition. One by one the various sedativa remedies appear to lose the confidence of the profession, that is td say, as far as regards their employment in sedative or depressing doses." Cod liver oil, iron, quinine and the bromides of potassiur and ammonium, are mentioned as among the principal remedies! all of which " are probably to be looked upon as agents which ten{ to restore nutrition to a healthy state."* ^Stimulants and Narcotics, pp. I23-I29. EFFECTS OF STRYCHNIA. 55 ree of its lave notes e patients • taking a as soon as /ere cases ily remedy ion of the ; ammonia rial effects. ' observing! dy. I was a curious lis face, he ked several! ot glass of! the sufferer] ate or two, shaking fori toms. TIu\ diseases fori it alcohol is ! needless to rving many perhaps, are : asthma, in r to remark! innecessaryj • depression! opinion thai 1 spasmodi icco and oil action so faf jsures whid i here " it ii 2S are cU oi L as directl)] ous sedativ on, that is t( »r depressinj of potassiu: sal remedies| ts which teni The use of the bromide cf potassium, and the other bromides, as remedies for epilepsy, will be discussed in the chapter devoted especially to drug action. 107. The phenomena of poisoning by strychnia has been, till [recently, regarded as a typical example of "exalted" functional activity of the spinal cord, shewing itself in increased sensibility to |external impressions and strongly marked convulsions. In regard to strychnia, as well as many other drugs, but little is [known as to the manner in which they impress the organism. It would excite no surprise in the mind of the professional reader, if (the true mode of action of strychnia should, on due investigation, [prove to be of a different character from that which has been issigned to it, most probably in deference to the old " doctrine of stimulus," now greatly in need of thorough modification. (Dr. lAnstie). The complete reversal of opi-^ion in regard to digitalis is [notorious. The acetate of lead, so iar from being a dangerous remedy, is now proved to be quite innocuous, and in large doses {(without opium,) to be a most valuable remedy in post partum haemorrhage. (See paper read before the Canada Med. Association, September, 1877, by J. Workman, Esq., M.D., of Toronto, to the truth of the facts of which, as taught many years ago by Dr. Work- lan, the writer takes pleasure in bearing witness). Other examples )f modified opinions as to the action of drugs might also be quoted. Dr. Anstie says of Dr. Harleji's investigations of the. action of strychnia, that they were the first scientific attempts to elucidate the true range o^ this drug. He shows that " it is extremely probable that it acts by preventing the oxygenation of the blood, in which ;ase it can hardly be supposed to communicate increased force to [he nervous system. Rather would it appear probable that it reduces the muscles to a condition in which they obey the laws of inorganic natter."* Dr. C. B. Radcliffe makes the following remarks on this subject : I' It has been shown by Dr. Harley {Lancet, June and July, 1856) [hat air which has remained for some time in contact with blood, to 'hich strychnia or brucia has been added, contains more oxygen ind less carbonic acid than air which has been left in contact with [imple blood for the same length of time. It has been shewn, that to say, that blood poisoned in this manner respires less freely than )ure blood. . . . that the strychnia has worked a change in the )lood which may in one sense be looked upon as equivalent to loss j>f blood ; for blood which cannot become arterial is as good as )st to all purposes of life. Nay, this change may be looked upon [s equivalent to copious loss of blood, for in the experiment . . . very minute quantity of the poison has the effect of depriving Ihe blood of full two-thirds of its natural power of becoming )rterial."t * Stim. and Narcol., p. 72., t Lectures orj Epilepsy, 6--c., p. 91, d-^z. 5| it to be explained that, as already remarked, among the most valu- able remedies for this state are the " anti-spasmodics " — as they arej called — but as Dr. Anstie shews,-f- all of which are really stimulants Do we then really attempt to cure an over-excited state of thel nervous centres by additional free stimulation } The proposition \\ absurd. 122. Other considerations might be urged, in addition to thel foregoing, in support of this proposition ; but some of these will find a more appropriate place in future chapters. We may veni briefly recapitulate what has already been advanced, as follows :— | 1. The fact that contractile power is an inherent and independenl property of muscular tissue, renders it unnecessary that a similaf power over muscular contraction should be vested in nervous tissue! 2. It has been shewn that when nerve-force may be expected tq be acting normally, spasms and irregular muscular contractions arJ less prone to occur and in fact do not occur, whereas irregular musj -cular contractions are constantly present in states of the nervouj •Therapeutics, p. 454. f Stimulants and Narcotics, pp. 80, 123, 6^c. DR, WEST AND SIR CHARLES BELL QUOTED. 6l nnot be e tetanus ?s till the it is said ilation of inus here e centres in others; properly :es of the e nervous nly quote Iseminum, rge doses 1 ;hen excite] the tetanus I of nervous )r in other nerves, put :ercise over' e to assert I f of rigidity! ition to the )f these wili e may verj 5 follows :— independent lat a simila ervous tissue] expected t itractions an ■regular mus the nervou centres when nerve-force may be expected to be in abeyance or wanting. 3. Since the absence of nerve-force offers the most favorable conditions tor muscular contraction, there must be something in the relation of nerve to miiscle wliich retards or restrains the action of the latter. And further, nerve-force cannot act the part of a "stimulant" to muscular contraction. 4. That such is the case is further proved by the well authenti- cated fact that the best remedies for spasm, tetanus, convulsions, and other abnormal contractions of muscles, are stimulants, the action of which is temporarily to reinforce nerve-power, and so to increase its restraint over muscular contractile power; thus preventing the state in question. 5. From all of which, it is impossible to conclude otherwise than that the function of nerve-force is to restrain muscular contractile po>ver, as asserted in the general principle at the head of this chapter. 123. We have to remark here, that we do not claim originality for the views propounded in the two " general principles " thus far considered. The application of the facts and the collation of the arguments by which these views are sustained are, however, entirely our own. But both the independent contractile power of muscular [tissue and the function of nerve-force as a restraining power over it, e been asserted long ago. In the appendix to Dr. C. B. Rad- liffe's Lectures on Epilepsy, &c., which we have so often quoted, |we have found, since commencing to write these pages, that so early IS 1832, Dr. West, of Alford, England, published an essay, which iractically embodied these views. Prof. Engel, of Vienna, in 1849, ,nd Prof. Stannius, of Rostock, in 1852, have also written on this iubject, but their publications have not come within our reach. Soon after the publication of Dr. West's remarks, Sir Charles iell gave countenance to these views in a lecture at the Royal College of Surgeons, England, in which he said " that relaxation ight be the act, and not contraction ; and that physiologists, in (tudying the subject, had too much neglected the consideration of lie mode by which relaxation is effected."* * Appendix to Dr. C. B. Radclifte's Lectures on Epilepsy, p. 277. 6s PHYSIOLOGICAL THERAPEUTICS. CHAPTER III. • — » ELECTRICITY :— PARAtYZING ACTION OF THE GALVANIC CURRENT, 124. Without an exception, we believe, all who have written on this subject hold that electricity is a stimulus, an alterative, a tonic, or that it possesses one or other of these qualities in combination with sedative eflfects.* The testimony of these gentlemen will, therefore, be all the more valuable (as unprejudiced and involuntary witnesses) if we can shew, directly and conclusively, from their published evidence, that electricity is an anaesthetic, in some of its eflfects equivalent to a narcotic, and constantly, to a greater or less degree, a paralyzer ; and that the beneficial eflfects which it undoubtedly accomplishes by its action on muscular fibre, as an aid to local nutrition, are brought about by a greater or less degree of j paralysis of the motor nerves which are subjected to its action in I the process of its application. 125. Before entering on the main part of this subject we must| first, in a few words, invite attention to the present state of opinion as regards nerve and muscle currents of electricity. For the ideas I generally accepted on this subject, more especially as regards the supposed existence of a somewhat complex system of nerve and muscular currents of electricity, the sciehtific world is largely indebted to the exhaustive labors and ingenious experiments ofl Matteucci and M. Du Bois Reymond. In view of so much industry, one can hardly read, without a feeling of regret, that the conclusions of these eminent electricians have, in recent times, been seriously] discredited. Professor Trowbridge, of Harvard College, has accomplished,! with artificial muscles and nerves, all that M. Du Bois Reymond didj with real ones ; and has thus shewn that the currents in questioni were derived from chemical action taking place between the moistj nerves and muscles and the contiguous metallic electrodes : that, inl fact, the supposed currents did not originate in, or belong to, eitherj the muscles or nerves, but were wholly extraneous to ^ ")th.-f* Tlys remarkable announcement clears away a vast fabric of ideas! and speculations, which had been built up in connection with this! subject. Consequently in our present enquiry we have to deal only with the relations of electricity to nerve and muscle, as it eflfectsj these when applied to the surface of the body. 126. It may be as well, here, to clear the ground a little furtheij by remarking that while some arguments can be adduced foj * Dr. Lincoln's Electro-Therapeutics, p. 55, &^. Drs. Beard and Rockwell, Med. am Surg. Elec, 2d Edition, p. 253. t See Beard and Rockwell's Med. and Surg. Elec, 2\ Ed., pp. 107-110. POPULAR ER&ORS REGARDING ELECTRICITY. ;e tpiantit)- .uul Ukv tension. In batteries proilucin^; this kind o( electricity there is no helix, ami no interrvi[)tin^; spring;; but tin current flows on C()ntinuously and noiselessly. It proiluces little (n t'o pain, except a slight i)ricklin|.; or burniu}; sensation in the skin at the points where the application is made. TIHs .surface irrit.i tion will be uu>r»' ;'})parent if the skin is tender or abraded, or ili very sironi; current l)e used. 133. Dr. C. n. RadclitVe. in the lectiart llict ,1 W( ( iirr( .litrer rlrcti \)r effect to an is pa.s .•)r. leticci cfTect.' nerve inittin chides porfioi t(;rms l<> he not res and fill sistenr oljvioii; I lie net If it current IS (jiie 'o in, n •malaj le^'ularl Jiervou.f /roni pt niotor -xtent 1 It is uul will ecoverl ■ve thinl '35. nlUienc ust que periments by Professor Eckhard, of Giessen, which show that tlBheory action of the continuous galvanic current upon the nerve ofB *Seeal| • Drs. l^ard and Rockwell, Med. and Sufg. Elec, 2nd Ed., p. 472. I3r. An.sl»"{J"'iKe (| Neuralgia, p. 252. Dr. Lincoln, Eleclro-Theiapeutics, p. II9-120. ^led. (Hj rAIi ■ the coil the term iiinply f'" )k rlie(w:ni»lc linil) [of a frnj,'| is to produce ;i Htate of paralysiH in the |);irt within the ( irciiit, and that this is the case e<|iially whether the n a juotor nerve is altogether (lifTerent from that of the instantan<-ons currents »;f high tensifin electricity; that instead of prong as any portion of it is subjectetl to the action of a cf>ntinuous current, ":J 534, It will l>e noticed that these observations are couchcfl in terms which end)race tin; popular theory. I'Jectricity is assumed to be a stimulant to the nerves, and when this " stimulus" docs not result in muscular contraction, it is said to paraly/c the nerves and uuiscles. Apart from eor)sid(,'rations as to the logical con- sistency, or otherwise, of the conclusion thus formed, one fact is ol)vious, that the profoutul an.esthesia recorded shews that so far a.s the nerves are concerned, they .tt least are completely j>araly/ed. If it be said thai the state of the cord, i)X nerves, under this current, which perimlts it to be ut, prickrd, torn, &c., without };ain, is one of an;esthesia, and resendjies the effects of ether or chloro- fom, rather than paralysis, we answer that the two conditions are .uialag^)us. I)r, An.stie describes the ana;sthetic state as "a regular and progressive extinction of the vital jjropertics of the nervous system A state of paralysis which spreads from periphery to centre; which involves the brain, the sensory and motor nerves, and the .sympathetic system to nearly an equal .xtent"|| It is true that the para.ysis of electricity is of short duration ; uid when the current ceases to act on the nerves, they speedily ecover their wonted function r but that it is paralysis while it lasts, ve think the foregoing facts lully prove, 135. As for the non-appearance •iments, it i^l rs to the full experiments! ely to prove 3 to say thaj w thinks ol thftt botl'l igor-mortis^ he vitality ol ;ci's case ol Df the painful )unted for b| we shall sea ire the applj are the ton| count for thj a better coJ • be held I 53- i.. :Dr. Cj vol. I, p. W produr- more profound paralyzing effects on the nerves, permitting a greater freedom to the muscles to contract. 137. T?ir- relief of Pain. — The paralyzing effects of the galvanic current, which we have just seen, are amply sufficient to account for the relief it affords, though often only temporarily, in painful affec- tions. Like narcotics generally, electricity blunts sensation, and stultifies the sense of pain either in the nervous branches origina- ting or transmitting the painful impressions, or in both. But unlike narcotics, which, if taken into the' system, influence the greater part of the organism, the powers of this subtle agent are limited to the parts which it impresses, either directly or by reflex actiori. It may be said that the mere prevention of the sensation of pain is not removing its cause, or curing it. The objection is an old one, and applies equally against anodynes generally. But every intelli- gent physician knows that pain, if unrelieved, tends to perpetuate itself ; and that, as a matter of fact, to relieve certain kinds of pain is a great step towards curing them. " Is there pain to be relieved T is the first question (say Drs. Beard and Rockwell) to be asked and answered when the propriety of using electricity is under consideration. If the answer be in the affirmative, and the pain ij relieved by electricity, then the theory here advocated presents a reasonable explanation of its mode of action, quite apart from any assumed stimulating, tonic or vitalizing quality of its action whatever. nS. 1 lie r morbid states. — Not only is the cure or mitigation of purt y neuralgic pains thus accounted for, but so also is the benefit obtained in a great number of morbid states, depending on direct or reflex irritations of some part of the nemons circuit. The number of such diseases is greater, perhaps, than is generally supposed. Among them are congestion and inflammation of the eye, and of other organs ; alterations of the cornea ; amaurosis, anresthesia, syncope, epilepsy, tetanus, muscular atrophy, herpes-zoster, erythema, pemphi- gus, urticaria, hypertr , hy of bone, ptyalism,* diabetes,-f influenza,:^: Icedemaand dropsy, || ptosis, unilateral sweating, difference in the temperature of the two sides of the body, local lividity or pallor, atrophy of skin, nails, or cellular tissue ; hypertrophy of the skin, local hypersemia or anaemia, mydriasis, myopia, &c.,§ most or all of /hich, and probably other morbid states, may be traced to a direct jor reflex irritation or excitation of some part of the nervous system. It need excite no surprise that an agent like electricity, which jean be brought to exert its benumbing influence over every part of the nervous system, should be found useful in the various irritated states, often apparently widely different from each other, which { *Dr. Brown-Sequard, Phys. &^ Path., Central Nervous Syst., pp. 157,207. ItBraith. Retros.July, 1871, p. 106. tCopeland's Dictionary of Med., Vol. 2, p. 430. JllDr.B. W. Richardson, Disc, on Prac. Physic, pp. 62-3. Brit. Med. Times, June, 1872. S Dr. Lincoln's Electro-Therapeutics, p. 133. ;o PHYSIOLOGICAL THERAPEUTICS, depend upon direct or reflex impressions of one part or another of the ramifications of that system. The theory here advanced accounts for the beneficial effects of | electricity in fcuring or mitigating these irritated states. Drs. Beard and Rockwell state, that " in the great majority of nervous diseases . . . . sedation is mor*? needed than stimulation."* Under the view of electricity here shown, we have the necessary " sedation " to | the excited or irritated nerves, plainly and naturally resulting from its use. 139. Before dismissing this part of the subject it is incumbent on! us to notice the following opinions, which seem to negative the foregoing views of the paralyzing action of electricity. They are the opinions of Volta and others, in the first years of the present | century, and are thus summarized by Dr. Pereira : — " The electric current acts like other stimulants on the nerves of I sensation, and excites the special function of each nerve. Thus when transmitted to the nerves of touch it excites pain, the shock, and other disagreeable sensations ; along the optic nerve it causes] the sensation of light ; along the gustatory nerve, a remarkable taste ; along the auditory nerve, a sound ; and along the olfactory nerve, a I sense of smell."t What is here stated, however, is more apparentl than real. Sensations are felt when the neives are only partially! paralyzed ; pain and shock when other nerw^s, not directly acted onl by the current, are pressed upon violently by the sudden contractioni of the muscles which they traverse, or, perhaps more probably stillj by an alteration of their normal molecular vibrations, resulting froml the more active disturbance in the molecules of adjacent nerves or| tissues, for there is reason to believe that pain results from a dy- namic perturbation in non-nervous tissue, continued along the nerves] transmitting it. J These nerves being apart from the direct range off the electric current, are still able to transmit a note of warning toj the seat of consciousness, and hence "the pain, shock, and other disf agreeable sensations referred to." The sensations of light in the eye, produced by electricity, are also! occasioned by a gentle pressure in the corners of the orbit, accomi panied by a slight movement of the finger, or by a blow, even irl the dark. Prof Huxley says: — "It is doubtful, howevei, whethel these effects of pressure or shock, really arise from the excitation oil the retina proper, or whether they are not rather the result of thi violence done to the fibrti of the optic nerve apart from the retina." [ They appear to be simply the results of vibratory sensations, con] sisting in molecular changes, transmitted along the optic nerves tc| the central organs of vision, and as these resemble in character tha impulses transmitted along the nerve resulting from the undulationi of light impinging on the retina, they are translated as such by thfj * Page 267. Dr. Meyers also, p. 305, f Materia Medica, Vol. I, p. 95. :J:Dr. Anstie, Neuralgia, p. 12. || Elementary Physiology, p. 222. THE GALVANIC CURRENT INTERRUPTED. 7i mind in the process of perception. For it must be remembered that " vision is, in fact, the art of seeing things which are invisible " (Dr. Brown) " that is of acquiring information by means of the eye which is neither contained in the sensations of sight themselves, nor logic- ally deducible from the intimations which those sensations really convey."* The sensations of light referred to, however, are produced by mild or moderate currents. It the charge of electricity be sufficiently strong, neither the optic, auditory, nor any other nerve, will continue to transmit vibratory sensations ; but complete arrest of function will result, and total blindness or deafness may tollow, as has ac- [tually been the case in a patient of Duchenne, who suffered " a total destruction of sight immediately after galvanization."-f Here is ! a further practical proof, if such were needed, of the paralyzing action of electricity. Mild currents produce " a tingling or numb- ness ;" stronger , ones, " a decidedly anaesthetic effect ;" and if the current be increased, the " benumbing " or paralyzing process is complete. (§145). These several effects are but progressive stages of one uniform process swiftly leading to paralysis of nervous tissue, which corresponds to the similarly uniform process by which narcosis — that ip, paralysis — is produced by drug action. | Such is our reply to the statements contained in the quotation [above made. In the first issue of a work of this kind it is impossi- ble to anticipate all objections ; but we trust the candid reader will rperceive that we do not seek to shrink from, or conceal, at least the Imore obvious of these. 5;, THE GALVANIC CURRENT INTERRUPTED. 140. Before leaving the consideration of galvanic or continuous dectricity, it is necessary to notice the effect produced when this :urrent is interrupted. A continuous, interrupted current sounds |like a hybernicism ; but what we have to say here is very important to the general subject. The galvanic current, as from a Stohrer or other battery, or from series of Smee's, Grove's, or other cells, may be " interrupted, not )nly by opening the circuit in the metallic part, or by withdrawing the sponge electrodes from contact with the body, but by even \noving tlum by a gliding motion tohile still maintaining contact with ^lie surface of the body^'W When this is done the quality of the cur- fent undergoes a marked change. It then closely approximates in character and effects to the faradic or interrupted current of the coil lachine. Dr. Carpenter's Human Physiol., p. 890. tDrs. Beard and Rockwell, Med. and >urg. Elec, 2nd Ed., p. 640. J Dr. Anstie. || Dr. J. Russell Reynolds, Lee. on Clin, usesof Elec, pp. 73, 97. :i!!IWli 72 PHYSIOLOGICAL THERAPEUTICS. Dr. C. B. Radclifife explains this modification of the galvanic current as follows : — " There is reason to believe that the condition of the galvanic current at these moments [of opening and closing the circuit] is widely different from that which obtains in the inter- val between these moments There is, indeed, reason to believe that the galvanic current is traversed, at the moments of closing and opening, by instantaneous currents of high-tension electricity."* We have already seen the effects of galvanic or /ow- tension electricity on the nerves when a current of moderate strength is employed, and that it often, indeed generally, produces anaesthesia and A profound degree of paralysis of the nerves without inducing corresponding muscular contractions. The effects of faradic or high-tension electricity have yet to be noticed ; but it may be said here that they differ from the former in that muscular contraction is a special feature which attend the interrupted current ; and espe- cially the interruptions of the galvanic current, which we are now considering. Indeed, muscu r contractions can be produced byj interrupting the galvanic current, after failure to effect this by the use of the ordinary interrupted or faradic current of the coil machine.-j* And this result occurs, notwithstanding that both forms of batteries furnish simply modifications of the one agent — electri- city — and, also, notwithstanding that both these modifications of| electricity produce paralysis of nervous tissue. 141. From what has been said above, it will be obvious that thel same galvanic battery may furnish either a continuous current ofl low-tension, or an interrupted current of high-tension, producing a[ different effect ; and this change of current and effect may bej brought about by the simple and perhaps almost unh-^^ded move-l ment of one or both of the sponge electrodes from one part of thel surface to another, while still in contact with the body of the patient! Thus, without care, the operator may really be employing one ofj these modifications of electricity, while intending to employ thel other : and, worse still, if he cure his patient and report his case, hel will not only have deceived himself, but will deceive others, as toj the value of one kind of electricity in a certain ailment, whereas thel credit in reality belonged to the other form of electricity. There il no doubt that this error has frequently been made. Here is aiif illustration. Dr. M. Meyers says : — " Benedict used the constant curJ rent in paralysis of the muscles of the eye, and has published tha following : He placed the copper pole on the forehead and stroki\ ti cheek with the zinc pole for several minutes, &c." j Here the galvanic, or continuous, current was nominally beind used : but as by moving the electrode in " stroking the cheek," thj circuit was •*' opened and closed," " made and broken," or intenupted we have what would have been a low-tension current had * Lectures on Epilepsy, Paralysis, «2r»c., p. 66. JElec. in Prac. Med., p. 152. tDrs. Beard and Rockwell, p. 332.J SPECIAL CONSIDERATIONS. 75 jalvanic mdition closing e inter- eason to nents of i-tension ; or low- strength laesthesia inducing iradic or T be said ;raction is ind espe- are now duced by lis by the 1 f the coil I tDothforms] t — electri- cations of I \s that the current of reducing a may be ded move- )art of the the patient, ying one of mploy the' lis case, he :hers, as tol whereas the] There isj Here is ai onstant < blished tb and stroke inally beinj cheek," thi intenuptei nt had thi ckwell, p. 332 poles been stationary, transformed into a current of high-tension, in all respects similar, only more powerful, tothefaradic or interrupted current of the coil apparatus. That the current is really interrupted by such a movement as stroking the cheek we have the high au- thority of Dr. Reynolds, already quoted, and that interrupting the j^alvanic current materially modifies it, we have the evidence of all electro-therapeutists ; while Dr. RadclifTe has furnished the reason for the different efTects thus produced. The same considerations apply to the mode of " central galvaniza- tion " recommended by Drs. Beard and Rockwell,* "one pole — usually the negative — is placed at the epigastrium, while the other is passed over the forehead and top of the head ; by the inner bor- ders of the sterno-cleido-mastoid muscles ; from the mastoid fossa to |the sternum and down the entire length of the spine." What is here recommended to be done, under the name of gal- anization, is, in reality, a form of faradization, almost identical /ith a vigorous current of ordinary, interrupted, or high-tension lectricity, and any benefit which follows to the patient ought cer- ainly to be credited to this latter kind of current. 142. It should be specially noted, that if the advantages of the rue galvanic current are desired, the poles, or electrodes, must be kept tationary. Dr. Anstie insists strongly on the necessity of avoiding nything which may cause interruption, or even variations in the alvanic current, when used for the treatment of neuralgia. The urrent, he says, must be not only continuous but constant. \ Here is desired to obtain the simple anaesthetic and paralyzing effects low-tension electricity, and to avoid the muscular commotion rought about by the high-tension electricity of an interrupted rrent. , Drs. Beard and Rockwell are not unaware of the dififerent effects luded to ; for they say elsewhere in the same work, " In beginning treat a patient by central galvanization, we should u.se very mild, arcely perceptible currents, particularly round the head and neck, d even on the cervical spine, and great pains should be taken to •Old breaking the current, and the application should be only of a oment's duration.";!: This briefness of the application is intended to avoid the giddi- ss or tendency to syncope, which is not un frequent in galvaniza- n of the central nerves. With this object ii. view it is very pro- and prudent. But in so far as it affects the quality of the cur- t it is most objectionable. For what is the result .-* The closing d opening of the galvanic circuit are only separated by a moment- interval. At both the opening and closing, currents of high- sion are flashing along the conductors, and it is these that the tient receives, and not the soothing flow of a continuous current 2nd Ed., p. 412. + Neuralgia, p. 253. +Page 422. i % 74 PHYSIOLOGICAL THERAPEUTICS. K It' as was intended. If any benefit follows, it is the interrupted or I high'tension electricity, and not " galvanization," which is entitlcfl f to the credit. Perhaps a better method of avoiding both "the unpleasant symp- toms" and the high-teiision currents, would be to begin the applica-j tion with an imperceptibly weak current, and then, with pole>i stationary, gradually increase the strength of the current to tin desired point, and as gradually reduce it to zero , when the polesl may be withdrawn. Even this plan will not ensure the constancy] desirable ; but it may prove least open to objection. We think the above facts and considerations fully establish thel truth of the first part of our "third general principle." The remain i der of the facts asserted, as regards the " tonic " effects of electricity I will be considered in connection with the faradic current, with whicli| they are most prominently associated. •CHAPTER IV. THE FARADIC, OR INTERRUPTED CURRENT OF ELECTRICITY. 143. This kind of electricity has too many synonyms. It wai discovered by Faraday in 1832, and bears his name. It is a currenj induced in a coil (or coils) ot wire, by a primary galvanic currcntj traversing a circuit in the interior of the coil. Hence the apparatui which produces it is called an induction battery. For the reasof given, it is called a secondary current. And inasmuch as this curl rent only exists at the moments when the first current in till primary circuit begins and ends, or is made and broken, it is als called an interrupted zwxtoxsX. It is sometimes called an instantanco\\ current, because it ceases almost as soon as begun ; but with a veri rapidly vibrating spring as an interrupter, the flashes may be madi to succeed each other with great rapidity, so as to produce a sens| tion of almost continuity. As the induced currents attending tli| opening and closing of the primary circuit, traverse the coil opposite directions, the poles being thus alternately reversed, ttl united effect, unless modified by special arrangements, is a to and/ri or alternate current. Thus the several names here placed in italij are all applied to one and the same kind of electricity. Besides, i is a current of low quantity, and /ii^A tension. The instrument-makers profess that their electrical machini furnish both the galvanic and faradic currents ; but, practically, tli is untnie and impossible, unless where special and separate arrang ments are made for both, by actually enclosing two separaj apparatuses in one box, which would be unwieldy from its bulk. f age 2( Ibid, pp. PARALYZING EFFECT OF THE FARADIC CURRENT. ;5 144. We have now to consider that part of our " third general principle" which asserts that the " tonic " effects of electricity depend solely upon the improved nutrition, brought about by an infinite number of contractions and relaxations of muscular fibre. We have already quoted Drs. Beard and Rockwell as to the first question to be asked and answered when electrical treatment is proposed, namely : — " Is there any pain to be relieved ?" and we have shown the special adaptation of the galvanic current for the relief of painful conditions. We now quote their second question to be asked and answered with a view to electrical treatment, namely, " Is there any need or chance for improvement in local or [general nutrition .-'"* We propose here to show the special adapta- I tion of the faradic current for this purpose. 145. Paralyzing effects of tlie faradic current. — Perhaps, before Iproceeding directly to this part of the subject, it may be as well to [produce the authorities to show that faradic electricity produces [sedative, anresthetic, or paralyzing effects, as does the galvanic. Drs. Beard and Rockwell bear personal testimony to the truth of [this. They say : — " There is no question that electric currents do [have a benumbing effect. The result ol various experiments that Iwe have from time to time performed in this department, seem to |be conclusive. We have had teeth extracted while a strong faradic current was passing through the jaw, and feel assured, from personal experience, that the electricity caused the pain to be less severely Ifelt. That the pain caused by the prick of a pin, for example, is ■less sensitively felt when a strong faradic current is passing through jthe part where the puncture is made, we have practically demon- strated on the hand and other parts of the body."i* These authors quote Althaus to the same effect, and add, that .norr, of Munich, has availed himself of the ansesthetic effects of ilectrization for opening felons and buboes. Again, " In rhinitis, pharyngitis and laryngitis, we have for three years been accustomed continually to make use of the benumbing effects of electrization." finally, "A French physician, M. Victor Revillout, has obtained similar results from applications of the faradic current to the uterus ifter cauterization."! " . The " benumbing effects" referred to, as before remarked, corres- )ond to similar effects produced by narcotics ; except that the effect )f electricity is more localize ', and passes away with greater [apidity. Drs. Beard and Rockwell more than once refer to the " numbness," decidedly anaesthetic," and " benumbing effects " of both the gal- vanic and faradic currents, || expressions which are not at all consist- ent with the assumed action of electricity as a " stimulus." Indeed, may be safely taken for granted that the adoption of this term in *Page 263. tMed. and Surg. Elec, 2nd Ed., pp. 122-3. Jlbid, p. 123. [Ibid, pp. 306, 379, (St-c. 76 PHYSIOLOGICAL THERAPEUTICS. the case of electricity, as in that of a pinch, burn, or the application of a chemical irritant, such as a dilute acid, before referred to, resulted not from any proof that a stimulant action was really excited, but solely as from the readiness with which it seemed to explain tlu prevalent theoretic opinions of the time as to the relations of nerve and muscle. Thus the exigency of a theory, and not any real fouii dation in fact, led to the action of electricity being called a stim ulus. (§ 86.) I 146. The production of muscular contraction. — The ^xQ.i\t forte of the faradic current is the production of muscular spasm. Tik experience of thousands of persons, who, at one time or another, have "taken a shock," would confirm this statement. That this i>| its effect when made to act on the nervous centres, we have tin authority of all electricians. Dr. Moritz Meyer says : — " If we allow | the current of a rotary machine [faradic] to work on the spina! marrow, by bringing the upper and lower ends of the same in connection with the two poles, there arises a general and rigid i cramp of all the muscles of the body and extremities, since all thciij nerves spring from the spinal marrow."* . Drs. Beard and Rockwell say : — " Labile or stabile [moving c stationary] interrupted currents are best adapted to produce mu> | cular contiactions.''^- As ''his, then, is the characteristic effect of this current, its bciu ficial effects, when present, must be sought in this quality of it| action. 147. The theory here advocated offers a ready explanation of tlu mode in which this result is brought about. By paralyzing for moment the motor nerves, the inherent contractile power of thtj muscle is permitted to come into play, and contraction takes plaaj accordingly, followed the next moment by relaxation. If thJ shocks follow each other with great rapidity, the spasms occur iij such rapid succession as to appear almost continuous. And just irj proportion as this is the case, does this current approximate to tliJ galvanic, or truly continuous current, for the relief of pain-: while irj proportion to the coarseness, or slowness, of the successive electriJ throbs, will be the effects exerted on the muscles. 148. — Improvement in local nutrition. — Not only is the muscle aj a whole thus exercised, but each fasciculus and individual fibre i| subjected to alternate contractions and relaxations. This is to dJ for the muscle and all its parts, and for all other muscular structure! brought within the circuit, what is equivalent to active exerciscj and if this be not continued to weariness, against which there is reiterated warning, the effect can hardly fail to be beneficial to i^\ muscular apparatus. * Elec. in Prac. Med., p. 75. t2nd Ed,, p. 370. EFFKCTS OF ELECTRICITV ON MUSCLES. 17 Increased muscular activity augments tiic temperature, and attracts an increased supply of blood.* With this necessarily comes more pabulum and an increase of local nutrition. That this is the real manner in which electricity e.verts an indirect " tonic " effect, and not by any direct " vitalizin;^ " influence on the system, is evident from the nature of the case, and is proved b)- what follows : Drs. Beard and Rockwell assure us more than once, indeed they reiterate it, that "the leading and general effect of localized electri- zation ... is improved nutrition. "f And again, " To accom- plish improvement in nutrition is the great object of electrical treatment.''^ They even show how this improved nutrition is brought about ; and excepting that they refer the effect to the "stimulating" effects of electricity on the nerves, their explanation of the process agrees exactly with what has been advanced abr ^'c. They say of the faradic current :— " The powerful and tonic eft ^ • [of this current] .... are partly and quite largely due to th^. passive exercise and consequent oxygenation and other important changes in tissue that result from the several thousand niusadar con- tractions that take place during an ordinary sitting^W Atrain, '* The.se mechanical effects of the taradic current arc due to its rapid interruptions, which cause contractions, not only of the muscles, but also of the contractile fibre cells, thus .stimulating the circulation, and with it the processes of waste and repair. In this respect its action is similar to that of rubbing, pounding movements and vibrations. These mechanical effects are especially indi- cated in the treatment of diseases of the abdominal viscera, which are supplied with contractile fibre cells ; aniesthesia and general muscular debility."^ 149. — An objection ansivcrcd. — It may be asked, why it is, in the case of" mixed " nerves, where sensory and motor filaments are lound in the same nerve trunk, both are not uniformly paralyzed. We answer, that such is frequently the case ; and the exceptions to the rule arc to be accounted for in the same way as one endowment of a mixed nerve escapes in wound, injury or disease, while the other imay be paralyzed. It has been suggested that this may be owing to the grouping of the fibres of motion and sensation in different [bundles, thus comparatively isolating each ; or that there may be differences of structure or sensitiveness which make one more liable [to suffer than the other.1i 150. WJiy the muscles are not equally paralyzed %vith the nerves. — [The enquiry will also be pertinent, " If the electric current paralyzes a motor nerve, why not also paralyze the muscle .-'" The answer is jeasy. Nerves and muscles are not similarly affected by this agent. * Dr. Carpenter's Phys., pp. 315, 329. t2nd Ed., pp. 379, 409, &^. t Ibid, pp. 1284,265,271. Dr. Meyer^sElec, pp. 373-4. i; Page 300. § Ibid, p. 300. HDrs. IMitcliell, Morehouse and Keen, Gunshot wounds and other injuries, pp. 18, 19. 78 I'MYSIOLOGICAT- THERAI'EUTICS. The phcnomciKi of "elcctrotonus" displays itself only in that portion of the nuisclc between the poles; while in the nerve the influence extends for a distance alon^ the nerve outside the poles.* Nor is this all. Dr. M. Meyers assures us that nerves possess a [greater " electrical irritability than the muscles," and in a notet of his book he cjuotes M. Claude Bernard to the effect that the motor nerves arc more irritable than the sensory, and that muscles are much less so than nerves. Dr. Radcliffc has shewn that the resistance offered by the nerves to a current of electricity is nearly three and a-half times greater than that offered by muscles. J Now, it appears established that "all conductors of electricity become heated more or less /"// proportion to their resistance " to the current. The tissues of the body arc no exception to this rule.|| From this it is reasonable to infer that the general, as well as the thermal, action of electricity is more intense on animal tissues, in proportion to their resistance. The skin and bones are poor con- ductors, and the effects of electricity on them would seem to justify this inference. Let us apply this to the badly conducting nerves, and we shall see good reason, according to Dr. Radcliffe's figures, why- electricity should impress or paralyze them more intensely j than the muscles : because in proportion to the greater resistance offered by the nerves to electricity, will be the effects it displays. \ 151. AnotJier objection, — Facial paralysis. — We can fancy the intelligent reader objecting to the theory here advanced, from what occurs in unilateral facial paralysis. He will naturally say that here, as a matter of fact, the face is drawn towards the healthy side, the muscles of which remain all powerful ; while those of the paral- yzed side, although liberated from the restraining control of theiij motor nerves, fail to pass into a state of contraction, as muscles soj conditioned, on this theory, ought to do. He will even tantalize us by the behavior of the orbicularis, pal- pebrarum muscle, supplied by the facial nerve, the conduct of whichl may appear specially embarrassing to our theory, since it not only! shows no sign of contraction itself, but allows the levator palpebraei which derives its nervous supply from the motor oculi, and is in a pro-l vokingly healthy condition, to keep the eyelid permanently open.f j Here, again, he will tell us, it is the muscle alleged to be held inl bondage by nervous restraint, — that is the healthy muscle, — whiclil contracts ; while the paralyzed ones, which ought to be " free tcl assert their inherent contractility," to use our own words, flatiyl refuse to do so. In short, he will evidently feel that the situationl threatens to become serious for the success of our theory ; whichl appears already exploded by this vigorous bomb-shell ! • Dr. Lincoln's Electro-Ther., p. 52, «S^■c. t Pa^e 145. J Drs. Beard and RockwellJ pp. 181-2. Illbid, pp. 189, 161-2. §Dr. W. A. Hammond, Diseases of the Nerf vous System, p. 722. AN OnjI'XTION ANSWERED. 79 It may help us out of our seeming dilemma, if we, in turn, ask a question. Suppose the accepted theory to be correct, that elec- tricity is a stimulus to muscular contraction, how do you account for the fact that in facial paralysis from brain disease the muscular contractility under electricity is usually perfect, and may «.ven be abnormally increased ;* while in the same paralysis of peripheral orifjin, neither the galvanic nor faradic currents, however powerful, arc able to cause the muscles to contract. What is your " stimulating tonic" about here that it does not '* vitalize" the nerve, and, acting as an alter ego of the nerve-force, compel muscular contraction ? How do you account for the singular and unexplained fact that after failure of the continuous galvanic and faradic currents in these cases, the slowly interrupted galvanic current succeeds in producing the desired contraction, and in this way, through the muscle, aids in restoring the lost function }\ The difference in efTect between the latter and the former kinds of electricity you cannot explain, at least Dr. Reynolds states that it has not yet been explained (p. 29) ; for on the accepted theory these several kinds of electricity should all be " excitors" or " stimulants" to nerve action, and through this to muscular con- traction. Doubtless, you will find it necessary to attribute the non- contractility of the muscle, under the circumstances stated, to the fault of the muscle itself, and not to the nerve. This is the view taken of the cause of peripheral facia! paralysis by the authorities. :J^ The patient has been subjected to a current of cold air, or to pro- longed exposure at a low temperature ; the blood has been driven from the cheek to the interior organs ; the muscular fibre cells have suffered a deprivation of their customary pabulum, and, as a result, arc now unable to fulfil their wonted functions. Perhaps also that unknown factor which attends the rlieuf.iatic state, may also con- tribute its quota to bring about this resuk. So far your explanation is orthodox, and your pathology will suffice for us. How is this state best remedied } Let Dr. W, A. Hammond answer : — By promoting healthy nutrition generally, and of the muscles in particular. This is to be done by tonics, by pa.ssive exercise, kneading the muscles, &c., and the persistent use of electricity. "If the induced current will cause the muscles to contract, it should be used ; if this will not cause contraction, then jthe interrupted galvanic current is to be applied. || Drs. Beard and JRockwefl (p. 520), and Dr. Reynolds also (pp. 28-29), testify to the jgood effects of the latter kind of electricity. •Dr. Reynolds, Lee. on Clin, uses, p. 37. Braith. Retros., July, '70, p. 55. t See Dr. j. ; Russell Reynolds's Lee. on Clinical usesof Elec., and Drs. Beard and Rockwell's Med. [and Surg. Elec, 2nd Ed., for these facts, in their remarks on facial paralysis. J Dr. J. R. Reynolds, Lee. on Clinical uses of Elec, pp. 27-8. Dr. W. A. Hammond, Diseases of Nervous System, p. 727. || Diseases of Nervous System, p. 730. i,^,iHH^|Utip— — ■ ^> ruvMioiourrAi im u siiii ihn. IliUiiHl 'J»H^ »"»».\IOlMhi(l \\w PiMUmIoiiv ntil the Ih'iihiM iil \\ lii< I \\^«Mv il\iUM\rl «loh\iHiUr»l \\\ i\ [\t\\\ , \\\\i\'u IntnllttH'i iIm llilim p,Uh*«l I l\r l»,U:\»U •' 0< |>i>\\rl i^ i»lt 1 'jmI l>» t ••< IhkI mI |||c lit I M , .uul \luH ('« \\h\ n\'«t,>ni.m«Mni't (umnlt nl Iiu;hI(i ilrtltlilU, "i \\\\\\\ vo^\^i\\\^>M^^ \\"*^«i |> H'Mii'i. Ihi I i|iiililiiiiiin Uot\\«'>l\ UW \\\'y\V .\\\\\ \IU» !. t. h ilioulil IlilVM' lln II mill lliil niil\ t\> »\^>*^M»" \\W <\j\uIiImU1I\I, hut ll II UiirMMMV t'Vrll In |M\t on\l«M,iUv o l«Hli»' luii'ti iiliK (ilMi'i lit'liMf Hir\' \ i\\\ jhimIiim' i mi ^\\\\ti>Mi \y\ ,u>iMn;>lHU 'hi*, Lijiiiii t, in iiimim « itm 't, llir iiii'ii n<(\-nvr » (Ua ^i »*( IhrMlnvvh iiUnnipliil i;,il\,iiiii nnit'iil (ti)! |(t) Im \\hi\l\ tlu> u->it»,\\iii\iv; iiwMi'i 111 i\i' I! 'uiliii inillv |>.ii ih i il In |iriiiiii \H,^ (l«\)v\V v>t » ^^^\(\,U «llll\ \\{\ in Hit' mil ;» !( to tsilt IImi II ll i\^>\l\.u ni » (11 -i It ill. Ill *\\ I V 1 I ll ( l>l\ . till |>\o('iiii'iii i'l lii\ t'liilili lVv\V\»»<»\ .V« ''VO (\a\\^ •^\«'il. (Ii« luHiltiiiM I'l \\\y iiiii < It I'! ill llii'i vvil*. n\\i v;!}' J>^^V ,\'« niipiiut iih 111 i'4 t-llti It il. iiml llif miiiIhh Uli<\ ot {\w iwuM U- ii\viv\>'»»"^, i\ l«<\\»i j;i;ul< ol luivf |»ni,il\im will M\(^uv, ,\ Ml»'\lli,i'i llu ,hK,imI;ij;< mil ti|il\ «\t ,\v\\nu\tinf; <»n \\w y\\\\\h\\\ .»1mi liu- .lUililitni.il, .iini im 'ilij;lil \nvMit, \>t o\^^Ku^\ln!: \\\ a h ,r«tM\,il»U' iiMniin wli.il liii) iml jtrlitu t>vv\\ ,\v\vM\ntvAi Um. n.vtiuU, Ii>m\ it ij (h.il ,111 iiilt iiiiiticd palviiiin \ onvut svuv>\\\>^ \\\ \'^\\\\\\\\ \\\\\ \ vmti.iv titiMu m (lu'sc .iiitl 'liiiiii.ii i asi ,\t\o\ Uw vvMVt\nv\o\is ,\n\l (,ua«liv' vmuamI-* hiUf l.ulnl f' I*;.'. /\)*-,),'»,v.-.v rr/'^ /'.' ,v,i llh- plu ihmiumi,! kI innalyM; .. trvMW \os'ivMV^ \^< tl\o vMAuial »M -.piu,!! unlir.. ,\\v ol )M»'.M inhusl, ,\t\v\ .\COv'*l\t Wv^li with >M1 llu-v>l\ Wo |Mv»pi>'.(' In (ttll.lijrl llliiii hviolK . As «\ v\tK\;v tV»/A»;>/ /*\v?.v;,\, tlic nuhitmn .iiul * ttiili.u I till \ "I JWUSvWs vvin,\\»\ 1*H\}; wnwwp.uvod , mu\ ulun w.iiliii;; 01 .ilmpliy vVOm-s thv' o\pl,i\\AlivMi i>« U^ In- Ui\\\\\\ u\ Ihr nun" ilisii'.r ol llu limb;' This will bv^ \nuUi>t*HHl when wo vciunnlnM lli.il ,iUli(m[;h tho niusolv^ is jMialx rv.\l tv> tho will, it is still in itMnnuiiiii.ilioii uilli 'vho sv'.lvi\}in.\tc nv>tv>v oontws. IhIwoimi wIikU ,u»v1 ihc mui.mU: llu jUNni\ul nu>UvuUu vhani^os oonliiwio [o p.iss. Hovo oUvtncit\- is pvnvciloss [o\ lunul. " In vliioii i)t«)|)oilion to tho Amv>unl ot vvntr.utilit)- pivsonl is tho iisolcssncss nl I'lfHlrioily It Iho vvntractilit)- [lo olootrioit\ 1 ho jH-rtoot. .iltlu)ii}^;li tho p.ir.ilysi'; tv^ the w il K^ .iKsv^Uilc. you can dv> i\olhinL;,;j *S<>el"h, K«ssc'","< I ivunvs, etc., pp. 5J, 54, otc. I'vs. IhmiiI ,iiu1 ImuLwi 11. |). .ron. * l>t. J, Kusiicr Kcuvuis, I tvuiivs 'tc,. pp. ivS. jm, sj. s.(, ov\ »)i, t-ii-. ; I ii ^A$lMA, l\v»3. t'lvw ivJAin l^iscAifC. p. i;j. l>i. ]. Russell RiyiicMs. IccUuos, r(r., p. ft. J'.l I < ll'l' M V IfJ I'AIMI.VMIR, «» IS), lit \f'tiiitl ('iiiifh'\>\, i\\'»*/' [\ V'cti ((Mil III*' > i>u\iiu \\\\\y nf It miiii li jiiMnI, \ mil |(liij;iiii'ti'< I'l Inn I, lo Iim *<\ i\i'(.{tU i\y I'^i i iii\n}tini\ II \ iMi hill I. Ini Iii'iImhm, It IIimIi |ii iIm lly |iiOiilv'/'''l, l«iil Mffihti/ Hti(/ |i. ill I 1 1\' \M II Im t li I li ji il V, "t 'I'lMii I Ilii»?s eVf'd ill ' •:< » i('), yiitl I ni\ <|ii Mii|lilii|| IIIMII li\' !i|i(th iii|; ( Im l( M ily Id < li il limli "* W't Ml r ill ImiIIi till Ml' ( ;i'i( 'I, IIimI wIiim (Ik (miImIi'im i, |<'»l/(f, ilnlililh' I'l |MtvviiltHi-t fit iiifl llic )i!i»)ilv''i't VVIiy I* l'i»nfi('i»' fh^ [iiiiil (III ill m| i|ii||iiil\ :l|i IMij Ifil Ihr M«IV«^ ''» I'" fM fV'iCM Ij'f'^iit , lull 1"! Ill" (iniMi I'', ;iiiiliii lli('i(< ( M4(-M III'- rmi'iMilfif h\ii> in iiii| In nil t| III iiii|iinv'i iiH III, I'll il i'i ;iIm ;i»ly Im ,illliy I mm , it 'lo^«« mil ii'iiMilid liillii Hill liMl lli.il i't (I'll llir liiiiU 'if III' liMl''.' I«', l/l|t n' till (iiiiii II tiiiii, U'liif II ImIi II ' jil. Ill' iiii|Hll']r ''I ill' /yill in )tff |i,l r;;l(;i In I lie lililM |i T I' ' 1 1 il ily ( |li( m (I'll ii' I (If \i,(i\ < tf H UitlU: III \il:iliii III llii ili'ii;i;Ml III li/i. Ill' n I i'Mi w M . •■,i(^n f'/f !l(l«* li, |li,il .1 ^•iiilioii til IIm (HI vKii'i m;i'i4 i'l pithily/' 'I, .iii'l 'l»'ffi'i>y, IS ,111 .iililii i'lii^il |iiii(ily/i't "I ii'iv llnmti', wmil'l i ■\iii])i\ m-iy f*' .ibnii'ihril, W^ VVt' fillitll ')( r III lilt lir^f |i/ir,i{;t*t|;)i M,'i /// sf, III I iilii lly yiiiir, a\\*\ '-Ii'/W n'l ■■•,tyji 111 K .t|»|ir,ii.iiii I, .illi I livr III .1 > .i|»|iii' -iti'iii ., y'liir |/r'/}/f»o<;i4 is l/;i/| it i'i tinrlci') fi> utt iih " f 11(11, "iIk iitii'it I( 'I (Iriiv ii'illiiMi; fr'»ni flf <(>ri\, )n( ri\i'^» tiif l.illi I i'l iji'ir,t:;((l III ili 'ilmyt ij." J I Ik f(i'/l( :< iilar '.h;i;i(y; in vAntAt lu'iv'i Imir iii.ttiircMl't jf'iflf, i'i MO f«-«l>l'' that (oritrol nvtr th/; rriu^lc i'. Iiciii}; III', I ; ,iiiil wrir tlii iiutiiti'in '. [\\\,\\\\, in (I'lihiil hsiiiii, " If til'' f ontrartility of thr: fawAlc to clcctiii ily I lie W//I'//' ///>// ////\//rr/, (vviffi'^iit h'inj; lo'>t.j thrr'r is a ;(i()(l (l(Nil yoii may ilo." Wliat, tlii', i ;, i)r i<< ynolfh pTftCCuh to I'll lis. "Yon may restore, if it be lost, th?; mUritiim of tin- mw.r.lex, on may hriii}; back llieir hulk. If t.lie limh t on Clin uiits, (src, \t, 94. t Iht/i, pp. 89, 91. I hid,]). 88. 82 PHYSIOLOGICAL THERAPEUTICS. temperature. When the contr. tility has been defective, you bring that hack to its normal state, a. d : ou find then that you have very much improved the relationship of that limb to the will of the indi- vidual, — that is, you pro tanto improve, or it may be entirely cure the paralysis."* 157. To spi7ial paralysis, dXso, i\\Q same remarks are applicable. "When you find a certain amount of contractility, there is a great deal to be done, and much room for hope " in the improved nutri- tion which may follow. " For example, the action of the fingers may be rendered less clumsy : the extensors of the foot and toe so far improved that the great toe drags less upon the ground in walking. You may call into exercise the muscles of the limb ; you can improve their nutrition and their strength ; and you may do something towards efifecti- .., a change in the nutrition of the cord it.sclf "f In these two last cases the nutrition of the nerve and muscle has e"*dently suffered ; but not to the same extent as in the preceding one. The polarity of the molecules (§74) has " t been entirely reversed. There is something that electricity may do in temporarily suspending what nerve-force remains ; and so liberating the muscular contractile fibres, ^y r^pid repetitions of contractions and relaxa- tions (§148) in this way, blood and pabulum are attractco, -"^nd nutrition is improved ; which, after all, " is the great object of < lec- trical treatment.":;: 158. Early Rigidity. — This is a state of the muscles which attends cerebral paralysis ; and occurs in some cases " immediately after the commencement of the attack, whilst the patient is still in a state of apoplectic or epileptiform stupor The lesion of the brain in these cases is often a large one, seriously implicating some extent of the cortical grey matter, and destroying a consider- able area of the subjacent white substance." Ij This cortical, grey, or vesicular brain substance, is the originator of motor nerve-force ; while the white, fibrous, or medullary tissue, is its conductor.§ How admirably our theory comes into play here! With a large! lesion in the motor tract of the brain, causing motor paralysis, need we wonder that motor nerve-force is so enfeebled as to be no longer! able to restrain the inherent contractility of the muscular fibre cells, which pass into a state of contraction thus early, [-artly from theirl complete liberation from nervous control, and partly from their con- tractile power being as yet unimpaired, as happens at a further stage.* ' Dr. Reynolds forbids electricity here, because " it may do harm."*'! Why, he does not say. Other electricians fix upon various times, ranging from a week to ten months, within which this mode ol * Dr. Reynolds, Lectures, pp. 78, 79. f Ibid, pp. 89, 91. J Drs. Heard an 1 Rockwell, Med. and Surg. Elec, 2nd Ed., p. 284. |i Dr. 11. C. Bastian, Paral. fronj Brain Disease, p. 154. § Dr. Carpenter's Human Physiol., p. 742. If Dr. BastiarJ **Lectures, pp. 79, 80. tion, nerves fluencc cord ! genera in para times the nei and no Evci for eve plishinj 160. that el so.^o n a chau' does nc be emj; Dr. Brain Dis Morehous LATE RIGIDITY OF MUSCLES. *3 treatment may be attempted.* Of course there is the conventional supposed state of " irritation " pleaded as a bar to the use of a supposed "stimuKint," like electricity. But Dr. Lincoln points out " the narrowness of the view that excludes a method of treatment because it is of the nature of a stimulant. Stimulants are not neces- sarily excluded in the treatment of apoplexy, alcohol is not excluded. "i* We shall see, presently, that the " irritative " theory is a matter of doubt in " late rigidity ;" if indeed it be not simply a legacy bequeathed to modern times from ancient theories long exploded. We venture to attribute the danger of electricity in early rigidity to the already diseased condition of the nerve centres, and the con- sequently enfeebled condition of nerve-force, which can bear no further perturbation ; and its uselessness, to the healthy contractile power of the muscle, which admits of no improvement. 159. Late Rigidity, — Dr. Todd originated the idea that this state of the muscie was due to the process of cicatrization of the brain lesion, and its supposed irritation of adjacent nerve tissue. Dr. Bastian thinks " there is much room to doubt " this theory ; and that secondary changes in the spinal cord may have quite as much to do in producing it. " This latter vJew, and strong evidence in favor of it, have been forthcoming during the last few years.":}: Dr. Reynolds recommends faradization in this state. He says : — '' In late rigidity you may apply it without fear, and with consider- able advantage." But, then, it is best applied, not to tlie seat of the disease, nor even to the implicated muscles, but to the antagotiistic healthy ones, with a view of helping them, by improving their nutri- tion, to resist the contracting tendency of those muscles whose motor nerves are paralyzed !|| Not a word here about the " vitalizing" in- fluence of electricity on the paralvzed nerve centres of the brain or cord ! Indeed, every additional 'act but confirms the truth of the general principle we liave been discussing. By electrical treatment in paralysis, the muscles, including the sphincters, are simply some- times kept from wasting or atrophy by a species of exercise, until the nerve lesion gets well, or the patient succumbs. " Only this and nothing more !" Even this is something to be glad of. But it is unwise to claim for even a potent agent, more than it is really capable of accom- plishing, as has been too much the rule with electricity. 160. Electricity in nerve wounds. — " M. Duchenne is of opinion that electricity has no real utility in traumatic nerve lesions until so.^ie months, or longer, have passed away, and there has thus been a chau'-e for nerve repair. Until this time, he believes that its use does no good, and that atrophy and other changes go on whether it be employed or not."§ * Dr. Lincoln's Electro-Therapeutics, pp. 109, iio. tibid, p, 108. J Paral. from Brain Disease, p. 156. || Lee. on Clin, uses, (Stk:., pp. 67, 80. §Drs. Mitchell, j Morehouse, and Keen, Gunshot wounds, (^jk.,, p. 155. 84 PHYSIOLOGICAL THERAPEUTICS. This is, to say the least, very poor behaviour on the part of " nature's own tonic," and " vitalizer," as electricity is assumed to be. How is it to be accounted for on the popular theory } Will the ghost of defunct " irritability," once so potent under the tutelage of Brown and Broussais, be recalled from the Shades to do duty here .-' If so, let us hope that it will not be for long ; but that more rational views will soon prevail. As for our own .^.eory, we have explained it very badly if the I reader cannot make his own application of it here ; and see in it a I sufficient reason why electricity is useless in a nerve lesion. i6i. Anot/ier problem solved. — It is highly creditable to any] theory that it furnishe;s a reasonable explanation of certain phenom- ena, not otherwise accounted for : the *'act that it does so render.*! the truth of such a theory highly probable. The previous pages contain instances of the kind here alluded to, some of which havci heretofore remained unexplained problems in electro-therapeutic? equally with the one now to be introduced. The arrangement| adopted in treating of these, however, seemed most convenient. Here is the problem : — " Why muscles that are paralyzed .should! act [that is contract] more readily than healthy muscles, to a slowly[ interrupted galvanic current, has not yet been explained .-'"* There is here, indeed, a double problem of great interest. 1st. Why muscles, paralyzed to the will, should contract t(| electricity more readily than healthy muscles. 2nd. Why it is to a slowly interrupted galvanic current, rathcj than to a rapidly interrupted one of the same kind, or to the faradkj current, this is due. Let us consider these in order. As to the first, the theory here advanced offers natural explanation. The situation is this : — {a) The muscles possess an inherent power of contractility, anc| exert it in proportion as nervous influence is withdrawn. {b) In the limb, paralyzed to the will, the muscles arc to agreatej or less degree, emancipated from nervous control, owing to a di>| eased state of the motor centres or nerves. Hence, in order tl exert their power of contraction, the muscles have less resistance tl overcome than have the muscles of the healthy limb, the nerves o| the latter exercising normal restraining power. (d) As a consequence, a mild paralyzing current of electricitl sufifices to extinguish the reduced restraining power of the wcakcnei nerves of the paralyzed limb ; but is too feeble to effect this in tlif healthy one. As to the second part of the problem, its solution is to be deduce from the difference already shewn to exist between the instantancoti flashes of the quickly interrupted current, either galvanic or faratlij * Dr. J. Russell Reynolds, Led. on Clin, uses of Elec, p. 9S. an easy ancl ELECTRICITY IN SPASMODIC STATES.. 85 and the intenser effects produced by the longer electric throbs of the sloivly interrupted galvanic current. (See ^ 140.) Either of the former fails sufficiently to suspend molecular polar- ity in th 2 nerve, which we have seen, (§79) exhibits a tendency to fixednesi? or stability. But the more prolonged and more intense effects of the slowly interrupted galvanic current reach every molecule and effectually paralyze the action of the nerve, so that if a flicker of muscular contractile power exists, it has full scope to display itself in a degree corresponding to its strength. Another reason, doubtless, is to be found in the fact, that a slowly interrupted current is less irritating to the skin, and for this reason a stronger current can be borne than with rapid interruption.* Hence a more intense action, and a higher degree of paralysis is here possible. 162. Electricity in spasmodic states. — Why is it that electricity has proved of so little benefit in the treatment of spasmodic diseases .'' We shall show that the assertion implied in this query is true ; and it will be evident that the fact of the failure of electricity in these cases accords well with our general theory. For if spasms and irregular muscular contractions be due to a withdrawal of nervous influence from the implicated muscles ^§87) the use of an agent whose prime quality is to still further paralyze motor nerve-force could not be expected to prove beneficial. Nor : has it been. Drs. Beard and Rockwell have not a single case of cure to offer, and dismiss the subject in a cursory manner, with the ; remark that "the progno.'^is is unfavourable for all except rheu- !matic cases."-f- Nor is their outlook for tetanus and other varieties of spasmodic contractions any more hopf^ful.t The same may be said of chorea ;j| of which Dr. J. R. Reynolds writes, "the less one isays about chorea, and its treatment by electrici^^y, the better it will [be for therapeutic science."^ Now, it spasms and irregular muscular contractions are due to a repressed state of the nervous centres, and electricity were a }^sti'iniili(s or tonic, its good effects ought to be more marked. If ipasus or irregular muscular contractions were due to an excited or ictionally exalted condition of the nervous centres, and elecl.'icit}- were a sedative, its good effects ought to be more apparent. And if electricity be both a stimulant and a sedative — as has )een claimed for it,1l — on either hypothesis as to the state of the jiiervous centres, it should have deserved a more favorable record. We have heretofore shown on authority that is unquestionable, that spasm, convulsion, tremor, &c., depend on a depressed state of the nervous centres ; that electricity paralyzes those centres ; and Drs. Beard and Rockwell, Med. and Surg. Elec, 2nd Ed., p. 330. t2nd Ed., p. 555- +p. 557. lip. 604. §Lcc. on Clin. Uses, pp. 83, 102. Dr. Muritz Meyer in accord with the same views. Elec. in Prac. Med. (Ilarnmund) p. 349. T Drs. ieard and Rockwell, loc. cit., pp. 270, 459. S6 PHYSIOLOGICAL THERAPEUTrCS. hence we account for its failure to cure a condition of the nervou> apparatus which, primarily, it is calculated rather to aggravate, 163. T/ie case closed. — In order not to unduly extend these pages,! the foregoing imperfect exposition of the theory here piopoundcd must suffice for the present so far as this part of the subject is concerned. If we have not noticed all the objections which may be presented to these views, we have done so with those which appeared most prominent and most difficult of solutici, and we are| not aware of having passed over any of importance. If we were to attempt to sum up the conclusions at which wej have arrived, from what is advanced in the previous pages, we couldj hardly do so more succinctly than they are to be found in thel " general principle " with which we set out, and to which, if tht| reader desires, he may turn. APPLICATION OF ELECTRICITY IN DISEASE. 164. Having said so much in reference to the mode of action c| electricity, it may bo expected that we should add a few words ail to its practical application in diseased states. It is unnecessary tJ do this at an\' length ; partly bee luse, we think, the general indicaj tion for the use of this agent will be obvious from the vie\v| expressed of its mode of action in the preceding pages, and parthj because to write at length on this subject was no part of our origina| intention. 165. It is well to understand that in the use of the two kinds o| electricity we have referred to, which may be called ciirrm electricity, the quantity of electricity in the body, or limb, subjectea to this kind of treatment is not necessarily increased. Nor is tha body, or a portion of it, " charged " with a positive or negativj electricity, as is tiie case when " static," " franklinic " or " frictional| electricity is transferred to it by means of a Leyden jar.* The kind of electricity lasi mentioned is sometimes useful i\ medical purp'^'^es ; but for various reasons it is seldom used. 166. It also appears to be a fact that the ditference between thi poles is more depending on the chemical effects they producj than on any differential quality in the current itself. Thus oxyge and acids accumulate at the> positive pole and alkalies at the negal tive ; and on the chemical or physical effects thus produced in thj tissues, the phenomena of analectrotonus and catalectrotonif respectively are believed to depend.*!* For the same reason tl| local irritation of the skin, caused by the passage of the current, less severely felt at the positive than at the negative pole. This circumstance has given rise to the idea that the positive poij is best applied to the seat of pain if the pain be attendfil by a coij * Drs. Beard and Rockwell, 2nd Ed., p. 86. tlhiti, p. 115, TREATMENT BY ELECTRICITY. 87 Ujested or irritated condition of the parts affected, and the negative |to some indifferent part. The reverse, however, applies to painful I states depending on anaemia or malnutrition, where it is desirable to attract blood and pabulum to the scat of the disorder, as some- times occurs in the complex forms of " spinal irritation." To these {the negative pole is to be applied accordingly. It is often difficult to determine which of these opposite condi- jtions prevails in a given case, since many of the symptoms may be Ipresent in both these states, and hence a good deal is necessarily jleft, — here as elsewhere, — to the tact, judgment and experience of [the physician. This fact shows the impossibility of laymen treating themselves successfully by electricity, any more than by other means )f medication. Fortunately, in many cases of neuralgia it makes no difference [where the poles are placed relatively to each other, or in what lircction the current is passed, provided it is made to traverse the mplicated nerves so as to bring these under its influence.* 167. TJic galvanic current — -^hdX is especially necessary to remember in reference to this current is, that where it is desired to itilize its paralyzing power for the relief of painful or irritated lerves, the poles or electrodes ought to be stationary, and the current lot only continuous but constant, i. e., not subject to variations of [ntensity as it may be from defects in the battery and other causes. The alteration in the effects of this current, when interrupted, as )y simply moving the electrodes while still in contact with the body )f the patient, has been pointed out (§140) and is deserving of Serious attention. When it is desired to utilize the galvanic current to invoke mus- cular contraction in cases of loss of function of muscle, as from lisuse, it ought to be interrupted : and the slowly interrupted fcurrent is more potent for thit purpose than when the interruptions |ire rapid, for the reasons assigned. (§140.) In morbid states, either primary or reflex, where it is desired to ^enumb the nervous centres, or their leadint^ trunks, care mu.st be iken to begin with the minimum strength of current,— if necessary Jo be cautiously increased, — otherwise serious results may follow. Lmong these are dizziness or syncope, from vaso-motor nerve paralysis, permitting undue contraction of the vessels of the brain, sec chapter on vaso-moter nerve innervation) indefinable nervous- ness, and, in one case, total blindness from paralysis of the optic )crve.+ 168. General applications may be made by so placing the sponge ^ectrodes as to include between them the painful part. The cur- ;nt by preference should be passed in the direction of the iplicated nerves and not acros? them. Tb' head, face and neck *I)r. J. R. Reynolds, Lee. on Clin. U.ses, p. l8. Dr. Anslie, Neuralgia, p. 257. IIHs. Beard and Rockwell, 2nd Ed., p. 640. 88 PHYSIOLOGICAL THERAPEUTICS. are most susceptible to electric influence and the back and genital> least so. The strength of the current should be modified accord- ingly. Short sittings of a few minutes suffice, otherwise the paralyzing action on the nerves may be greater than is desirable. 169. To galvanize tJie head. — Place the poles at the forehead and occiput, or one on each ear, or mastoid process, &c., as one or | other portion of the cranial mass is desired to be brought under the influence of the current. 170. To galvanize the cervical sympathetic. — One (small) electrode I is to be placed in the auriculo-maxillary fossa, just behind the angle of the jaw. The other may be placed over the sixth or seventh cervical vertebra, in the depression just above the sternum, or by the side of the sterno-cleido-mastoid muscle.* It is to be remembered that when galvanism is thus applied, the! current and its effects are not limited to the sympathetic nerve, but| also to a greater or less degree affects also the spine, " the depressor ,[ the vagus, the phrenic and various branches of the cervical plexus,) if not that plexus itself."-f 171. The application of a paralyzing agent to these great nervel trunks may be justifiable and beneficial in certain painful or irritatedl states which they may influence, directly or by reflex action. It! must be seen how very dangerous a proceeding it is in cases ofl chloroform narcosis, or of asphyxia from drowning or other causel and how very readily the flickering lamp of life may be extinf guished by a process of further paralyzing organic nerves, whose) functional activity is already welUjiigh extinct. Drs. Beard and Rockwell record an instance of the danger thuJ incurred and of the fatal consequences in a case of opium! poisoning : — " Under ordinary methods the patient was recoveringJ but in order to expedite the progress faradization was tried. On| pole was placed on the ribs and the other somewhere on the neckj in order to find the phrenic nerve. Immediately the patient ceasel to breathe, and no further treatment availed to rescue her."+ The " instantaneous death of the patient " is attributed by thesel gentlemen to the employment of electricity, and in this case to tlij faradic current. The use of the galvanic current, especially interrupted, would be still more dangerous in asphyxia, narcosis o| paralytic " stroke." Dr. Ringer writes as follows on a cognate part of this subject ; " It is a question of importance whether galvanism should be use in danger from chloroform. The committee appointed by tli Medical and Chirurgical Society are of opinion that this agent useful, but that it is far inferior to artificial respiration ; but so)A autJiorities are wholly opposed to its use, on tlie score of its inflne7ice\ * Drs. Beard and Rockwell, 2nd Ed., pp. 372, 3, tDr. Lincoln's Electro-Therapea tics, pp. 130, I. % Drs. Beard and Rockwell, 2nd Ed., p. 640. || Med. and Surf Elec, 2nd Ed., p. 665. TREATMENT BY ELECTRICITY. 89 danger thui of opiunij recovering tried. One m the necl atient ceaseC ler.": ed by these s case to tli^ especially I, narcosis oj is subject: 3uld be usi nted by tlii this agent' n ; but son its influence llectro-Therape' Med. and Su: arrest ' very fcehly beating heart, and so diminish any slight hope of recovery!'* 172. The Faradic current. — Besides the general utility of this current for the improvement of nutrition, so often referred to in the prccedinfy pages, it will often be found effectual for the relief of cer- tain kinds of pain. When used for this purpose, a fine, rapidly interrupted current should be employed. The more perfect is this quality, and the nearer it thus approaches to the continuous current, the more effica- cious it yvill be found for this purpose. Here the milder paralyzing effects are indicated, without producing so intense an action as to call forth muscular contraction, or if so, only slightly : since this, in irritated conditions of the tissues, would only aggravate the pain. lOn the contrary, a coarser or more slowly interrupted current may be employed in preference, when muscular nutrition is chiefly de- sired : as in the class of cases where passive exercise, kneading, &c., tare called for. 173. General Faradization. — A very effectual method of using [faradization tor general purposes, and which has borne the test of xperience, is to place the patient seated on a large sponge, wet ith warm water, and connected with the negative pole introduced •eneath the chair, or stool. The positive pole, also armed with a ivarm, moist sponge, is then to be .stroked over the thoracic, umbar, and abdominal portions of the body, in the direction of the |ong axis of their muscles. The current should be of sufficient strength to cause these mod- Tatcly to contract, but not to cause painful irritation of the .skin. s in doing this the operator is benefiting the muscles at the ex- lense, so to speak, of the nerves which control them, the process ust not be long continued : or else lassitude, exhaustion and other [ffects may be induced, and proportionately defeat the end in view. The lower extremities may be treated in the same way, under [imilar precautions, with the negative sponge placed at the feet. All this necessarily involves considerable labor and time on the [art of the practitioner, and sometimes no slight inconvenience to le patient, who ought not, and need not, be much, if at all, exposed person. When evident good is to be accomplished these draw- cks can and will, of course, be borne. Conjoined with other suitable treatment, and the hygienic accom- niments of good air, suitable exercise and a proper dietary, many herwise incurable cases may, by this means, undoubtedly be cured relieved. Many disappointments, too, will be encountered ; but lese are inevitable under any mode of treatment. 174. It is in those morbid conditions where the entire muscular stem is badly nourished, and the functions generally are more or IS impaired, as in the state known as general debility, and in Therapeutics, p. 291-2. 90 PHYSIOLOGICAL THERAPEUTICS. dyspepsia, constipation, amcnorrhcca, spcrmatorrlicea, &c., depend in^ on diminislied local nutrition, or lessened functional activity of parts into which muscular fibre lar<,fcly enters, that most good is to be expected from faradization or any form of electrical treat- ment. So many local affections, however, are dependent upon, or asso- ciated with a lowered condition of the functions {jjenerally, that in many cases mere local applications will not suffice, and genera! faradization aided by other measures, medicinal, hygienic, and dietetic, will be necessary to promote a return to the normally healthy state. 175. As an example of its local use, in otherwise healthy states ofl the system, its effect on the mammary gland of a nursing womani in restoring the lacteal supply, when deficient, is very marked, and will often follow a few daily applications. This result is to bc| explained on the general principles already discussed, in accordance with which faradization promotes local attraction of blood, and witi:| it increased pabulum, and consequently augmented functional activf ity. (§ 148.) 176. Its effect on the parturient uterus, too, is worthy of specia, mention. In the so-called atonic states of that organ, when tiici flabby muscular walls have their contractile power unduly restrainccj by spinal motor nerve-power, the faradic current, by suspending tlicj influence of the latter, enables the weak muscular tissue to put fortlj increased activity. (See chapter on ergot of rye.) In this way, electricity may prove not only a useful adjunct ll ergot, but even a valuable substitute. Powerful contractions mail be induced in many cases, with the advantage that the effect can bJ regulated or suspended at will ; which is not the case with ergcj when once administered. The contractions, too, can be rendcrej intermittent, with obvious advantage over the persistent expulsivj efforts produced by ergot. To employ faradization for this purpose, one pole may be appliej to the fundus, and the other to the os uteri ; thus acting on tlj intra-muscular nervous filaments, or directly through the spiiii nerves, one sponge being applied to the back and the other over tlj uterus, in front. 177. As this reference to the therapeutic uses of electricity merely an incidental one in our general purpose, the leading priiiil pies here laid down must suffice. Wc have not undertaken to wri| a treatise on electricity ; and the student will find in the elaboraj volumes now before the public such additional details for his guii ance as he may deem necessary. hage. 9t CHAPTER V. ACTION OF ERGOT OF RYE. (78. Fourtli general princip/e. — The contractions induced, more especially in unstriped muscular fibre, by ergot of rye, follow the same rule, or law, as irregular muscular contractions, otherwise occurring; that is to say, they depend on the withdrawal of nerve- force, and the cessation of its ordinary restraint upon the contrac- tility of muscular fibre, which, being thus left free to act, passes into a state of contraction. 179. Unstriped, or involuntary muscles, arc not subject to the influence of the will. Tissue of this kind constitutes the double layer investing the alimentary canal. It also forms the muscular coat of the bladder, uterus, dartos, bronchial tubes, of all the large excretory ducts, of the middle coat of the blood vessels, and even furnishes some fibres to aid in promoting the contractility of the skin.* 180. The nervous supply to this unstriped muscular fibre is chiefly derived from the sympathetic system, especially in the abdominal viscera ; and this is true both of sensory and motor innervation. But the purely sympathetic, or gelatinous nerve fibres are accompanied throughout their course by tubular fibres from the cranio-spinal system, as they pass to their points of distribution.-f* 181. There are two peculiarities of this kind of muscular fibre worthy of mention, ist, The slowness or apparent sluggishness with which it contracts under the influence of so-called " stimuli," compared with the striped variety ; and 2nd, a very striking pecu- liarity, consisting in the rhythmical nature of the movements of parts consisting wholly or in part of this kind of fibre, deriving its nervous supply from the sympathetic, of which the movements of the heart and intestines are good examples. ;[: With the exception of these differences, unstriped, or involuntary, muscular fibre seems to be subject to the other general conditions which govern the striped, or voluntary, muscular fibres. 182. Ergot of rye is one of those substances which, in a marked manner, produces contractions of non-striated muscular fibre, where- ever this tissue is to be found in the body.|| Hence, under its influence, the calibre of the minute arteries is every where reduced ; and, as a consequence, it is extensively used in controlling hoemorr- hage, not only from the uterus but from the lungs, nose, &c., and for *Drs. Todd and Bowman, Phys. Anat., pp. 155-6. flbid, p. 500. :JDrs. Todd and Bowman, Path. Anat., p. 509. l;Dr. Ronayne, Braith. Retros., July, 1870, p. 199; and ditto, Dr. Lane, January, 1875, p. 174. 1u *>. .*^. IMAGE EVALUATION TEST TARGET (MT-3) i // .. <• ^>^ /;i Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, NY. 14580 (716) a72-4S03 V ^q\ '9> .V ■^ o 6^ % ^^ <^ <<' o^ w ^ I, ;. ;-f2 PHYSIOLOGICAL THERAPEUTICS. the same reason is recommended by Dr. W. A. Hammond, in spinal congestion, as an important agent in the treatment of that state. That it produces this effect — contraction of the vessels — has been demonstrated by Dr. Hammond, under the microscope, in the ca- pillaries of a frog's foot.* Its remarkable eflfect on the gravid uterus is well known. In this it resembles the action of electricity, as we have already shewn, and we see no reason to doubt that its mode of action is similar also. We have had evidence that narcotics, as well as electricitJ^ par- alyze the nerves and thereby cause convulsions and spasms of muscular fibre. Dr. Pereira assures us that the poisonous effects of ergot are similar to those of other narcotics,-!* and like them, p-o- duce spasms and convulsion. Have we, then, any right to regard the contractions of ergot as produced in an exceptional manner to the similar effects of other drugs, or to those of electricity ^ 183. If we had not been accustomed to regard ergot as a stimu- lant to muscular fibre, could we readily believe that an agent which produces such effects as dizziness, giddiness, faintness, feeble slow pulse, dilated pupils, pallid face, paralysis, gangrene, imbecility, delirium, coma and insensibility, tetanic spasms, convulsions and death,+ was really a stimulant } Dr. Anstie has shewn that other drugs which produce symptoms similar to these, including alcohol, are in every degree of their operation, after physiological effects begin, simply narcotics ; and that the very essence of a narcotic is that " it paralyzes, to a certain e^ftent, the nervous system." |i Perhaps, therefore, the thesis we have laid down, that ergot purely a paralyzer of nerve-force, and that it is through this effect of | its action it brings about the contraction of muscular fibre, may, on consideration, not seem so startling or absurd as when first presented Let us examine the facts arid see how far they agree with this hypothesis. 184. That various vital processes are not so dependent on the I influence of the nervous system as may sometimes be taken for granted, will appear from the following considerations : — In tliej embryo, the " action of the heart commences when as yet its con tractile parietes consist but in an assemblage of ordinary lookind cells ; no proper muscular tissue being evolved, and no nervous system being as yet developed from which the stimulus to move- ment can proceed ; and it is impossible to assign any other cause for the movement under such circumstances, than the attributesf infterent in ttie tissues which perform it." So again, ..." thel parturient action of the uterus cannot be fairly attributed to any of| * Diseases of Nervous System, p. 393. Dr. Sidney Ringer's Therapeutics, p. 509. tMat. Med., Vol. II, pp. 139, 140. J Ibid, pp. 139, 140. ijStim. and Narcoi. pp. 214, 244. INDEPENDENCE OF UTERINE ACTION. 95 the agencies which have been supposed to excite it ; but must be looked upon as one of those phenomena whose periodical recurrence is due to the regularity of the operations of its growth, whereby the tissue attains its maturity in a certain limited time and then dis- charges itself pf its vital force in the shape of motor power."* Again, in reference to uterine contractions in parturition, the same eminent author states : — " There is no proof whatever that these changes are dependent upon nervous influence : in fact there is much evidence that the parturient action of the uterus is not the result, as some have maintained it to be, of a reflex action of the spinal cord, but is due to its inlierent contractility ; for numerous instances have occurred in which normal parturition has taken place, notwithstanding the destruction of the lower part of the cord, or the existence of a complete state of paraplegia, which marked its functional inactivity ; and the continuance of the peristaltic action for some time after somatic death, when neither the cercbro-spinal nor the sympathetic system can afford any supply of nervous power, is yet a more satisfactory proof of the same position/'-f- Thus, again, " The /| is regulated ; and they are equally agreed that it is through thcl excitation of the vaso-motor, or vascular, nerves of that systcm| that the calibre of the arteries is contracted and vascular activityl diminished.il It is in regard to the mechanism by which dilatation of the bloocj vessels, especially the arteries, is effected, that much difference opinion has existed, and numerous theories have been propounded] It has been customary to attribute arterial dilatation in part t(j paralysis of the vaso-motor nerves, in consequence of which, it alleged, the arterial walls are relaxed, permitting passive dilatation I and in part to increased " suction power of the capillaries," owing t| increased rapidity of nutritive changes in the adjacent tissues.§ But it is admitted by physiologists that a mere passive relaxatioj of the arterial walls does not sufficiently account for all the phenof mena ot vaso-motor innervation, and notably so for what is seen t| occur in Bernard's experiment on the nerves or the sub-maxillai| gland,f to be referred to hereafter. (§ 211.). * Pathol. Anat., pp. 682, 683. tDr. Carpenter's Human Physiology, pp. 485, 49| J Dr. Burdon-Sanderson, Hand-book for the Physiol. Laborat., p. 244. ||Dr. Carpa ter's Human Physiol., pp. 486, 830. Dr. Beale, Disease Germs, p. 330. Dr. Burden Sanderson, Hand-book Physiol. Labor., dr»c., p. 244. §Dr. Brown-Sequard, Lecture (Sr%., p. 143. IT Dr. Anstie, Neuralgia, pp. 192, 195. THE ACCEPTED VASO-MOTOR THEORY. 99 Accordingly, some physiologists have hinted at the idea of active dilatation; and inferences from certain facts have been drawn, with a view of establishing the existence of two antagonizing sets of nerves, one, cerebro-spinal, for dilating the arteries, and the other symf ithetic, for contracting them. It was never attempted to be shewn how these antagonistic nerves were connected with the neces- sary muscular fibres for contracting or dilating purposes ; or demon- strated that more than one set of such nerves existed, or could exist, under the circumstances, so that the proposal has been dis- j countenanced as " wildly improbable."* 195. The vaso-motor theory, which has found most favor, and 1 which is now generally accepted by physiologists, is, that the sympa- thetic vascular nerves, when excited, contract the arteries, but that the power of these nerves is at times held in restraint, or " inhibited " I by another set of nerves, which act, not on the muscular walls of [the arteries, but on the ganglia of the contracting nerves ; placing [an embargo, or " break " upon them, as it were, and so favoring jvascular dilating power. Accordingly, drugs, as nitrite of amyl, which cause flushing and vascular fullness, are said to paralyze the /aso-motor nerves : or to excite the " inhibitory " vascular nerves, [which antagonize the former. The following schema, embodying this theory, is from a recent jublication.f 'I. Ganglia in the walls of the capillaries, or about them, regula- jting their calibre. "II. Spinal vaso-constrictor fibres, going to the muscle in the irterial walls. "III. Spinal nerve fibres, inhibiting the peripheral vascular ganglia, iraso-dilator fibres. "IV. Inhibitory fibres from the skin to the vascular ganglia in leir vicinity." 196. We shall have something to say presently in regard to this [erv complicated vaso-motor system of nerves, and their assumed ihibitory antagonists. The entire present vaso-motor system is kased not so much on certain facts, as upon the interpretation put Ipon certain acts; such as the section of a nerve or ganglion, and the lanner in which this afifects the blood vessels whose walls are sup- [lied by it. We have to suggest that the acts in question admit of very different explanation to that ordinarily given, while the fects remain unchallenged. In order to show that an interpretation of certain experiments, ^her than has been given, is possible and probable, the nature of parts acted on, the experiments performed, and the results, |ust be passed in review. This we shall do as concisely as possible. I* Dr. Anstie, Neuralgia, p. 192. tDr. Ott's Action of Medicines, Lindsay 6- Black- an, 1878. This author quotes Huizinga, Pfluger's Archiv.,Vol, XL, p. 207. Bow- Ich, Boston Med. Jour., July, 1877. m. w * ■; f i0 \ii' wm |i ■;■' ! 'fil ido PHYSIOLOGICAL THERAPEUTICS. As we have to deal with both the cranio-spinal and sympathetic hervous systems, the peculiar arrangement of each must be taken into account. 197. T/te cranio-spinal nerve centres, or ganglia, arc arranged on the principle of centralization of power, so to speak, /. r ., they arc I placed together in direct continuity. Their relationship to distant parts of the body is maintained by nerve-trunks, or cords, which convey sensitive impressions to, or motor impulses from, these | centres. Hence, the section of these nerve cords necessarily cuts off communication, or the transmission o( impulses, between these! centres and the peripheral parts or tissues of the body, to which] these nerves are distributed. 198. Tlie sympatJietic nerve, as it is called, may by comparison, bel said to have its numerous ganglia arranged on the principle ofl decentralization ; scattered as its centres of power, — ganglia, — aref throughout the trunk of the body, neck and head, each presiding over its own little dependency, and regulating for itself, under sub-j ordination to a higher centre, the special functions allotted to it{ charge.* Three kinds of nerves enter into the formation of these ganglia I namely, sensitive and motor (tubular) fibres, and the grey or gelat] inous tissue which specially distinguishes the sympathetic^ There are four of these sympathetic ganglia in the head, inciudin:] the adjacent sub-maxillary ganglion. There are two, sometime three, in the neck, on each side, one above the other. The heart ha its own special ganglia, and there is a long series in the thorax, 0^ each side of the spinal column in front, besides numerous others the lumbar and sacral regions, and among the viscera : all of whiclj are connected together by cords of communication which are vA mere nerves, but are true expansions of the ganglia in a cord-li'j form. J The four sympathetic ganglia of the head, besides their conne tions with the superior cervical sympathetic, also receive filamenlj which ascend the cervical part of the spinal cord, to animate tl( iris, and assist in supplying their peculiar influence to the blc vessels of various parts of the head.|| In addition to all this, we have the supreme executive, or chi| vaso-motor centre, which, whether located in the pons varolii, (I Bastian) or medulla oblongata, is by some physiologists believed 1 be inter-cranial ;§ though by others, subordinate centres are believij to exist in the spinal cord. •Dr. Maudsley, Phys. and Pathol, of the Mind. tDrs. Todd and Bowman, Pj| Anat., p. 506. Dr. Meryon, Functions of the Sympathetic, (S-'c, pp. 5, 41. JI Todd and- Bowman, Phys. Anat., pp. 499, 502, 503. ||Dr. Brown-Sequard, L^ctuij Phys. and Path., Cent. Nerv. Syst., p. 144. §Dr. Burdon-Sanderson, Hand-book ( the Phys. Labor., p. 244. SECTION OF THE SYMPATHETIC. 101 199. Experitnent on tlie cervical sympatlietic nerve. — It was shewn by Dr. Brown-Sequard and M. Claude Hernard (185 1-2) that section of the superior cervical sympathetic is followed by dilatation of the blood vessels of the head, heightened temperature of the skin, increased secretion from the glands of the eye, and generally aug- mented sensitiveness of the parts so affected. The state of tempo- rary relaxation of the vessels thus produced was attributed to paralysis of the vaso-motor nerves derived from the cervical sympa- thetic, which no longer ensured the normal contraction of the arterial walls, to accomplish which was held to be their normal function* The supplementary part of the experiment, relating to the effects of faradization applied to the central cut ends of the nerve, we shall consider separately. Now, the question is, does section of the superior cervical gan- glion cause paralysis of function of the ganglia of the brain proper, which, as we have seen, are semi-independent centres of nerve- power, equally with the cervical ganglion itself. If the answer be in the affirmative, then it must be shown by those who so answer it, that the cranial ganglia a z dependent for their vaso-motor power on the ganglia of the neck ; a conclusion which the facts just recited do not seem to warrant, and which appears quite gratuitous. Besides, it is a well-known fact that the vaso-motor fibres of the sympathetic have their origin in the cranio-spinal axis ; and that the several ganglia throughout the whole lengtii of the sympathetic chain are constantly re-inforced by motor antl sensitive filaments derived from corresponding portions of the spinal axis.i* The cranial ganglia receive their motor supply from contiguous nerves of the spinal, or tubular form, within the cranium. Thus the ophthalmic, or ciliary ganglion receives a motor branch from the third pair. Meckel's ganglion is supplied by motor nerve influence from the facial nerve. The otic ganglion receives a motor branch from the same nerve, while the sub-maxillary ganglion receives its motor nerve from the chorda tympani, a branch of the facial. J Thus we see that all the conditions necessary for independent functional activity are found in these cranial ganglia, which, as in the case of ganglia generally, of the sympathetic, " are so many little magazines of nei-ve-forcc ;"|| and that there is good reason to believe that these are in no way impaired in their local functional activity by section of the cervical sympathetic and their consequent isolation from the other ganglia of the sympathetic in the thorax, and other parts of the body. 200. We submit, then, with all due deference to the authorities, that paralysis of the cranial ganglia is not the result of section of *Dr. Brown-Sequard, lectures on Cent. Nerv. Syst., p. 140, etc. tDalton's Phys., p. 514. Dr. Brown-Sequard's Lectures, etc., pp. 144, 148. %Yix. Dalton's Physiol- ogy, pp. 514, 515. II Todd and BoNvman's Path. Anat., p. 509. 102 niYSlOLOGlCAL THERAPEUTICS. I the cervical ganglion : and that it is far more probable that the deep wound necessary for exposing the sympathetic in the neck, and the act of cutting it, cause an irritation both direct and reflex on these ganglia, and corresponding efifects on the fibres they supply to the blood vessels, which cause the latter to dilate and produce the phenomena referred to. 20I. This interpretation of tlie experiment in question is not unsupported, if indeed it has not been already suggested or asserted, as will appear by what is to follow. An article " of much more than ordinary interest and merit, on the vaso-motor nervous system," appeared in the British and Foreign Mcdico-Chirurgical Review, which was copied from the concurrent London Lancet into the Canada Lancet of May, 1877, page 273, in which the writer gives a summary sketch of the progress of this chapter in physiology, from Pourfour du Petit, in 1727, down to the present time. Having stated the various steps of discovery, which have led to what is at present known on this subject, the writer continues, "This clearly str.tes the modern theory as most usually accepted, and as innumerable hypotheses concerning the nature of obscure and so-called func- tional diseases and the action of remedies have been built upon it, // is i)nportant to point out tJuit this is quite inadequate to explain some -Other phenomena which have been observed, and that therefore it can only be considered as a partial expression of the truth. Bernard, whilst investigating the secreting function of the sub-maxillary glands, found that irritation of the distal end of a cut chorda tympani nerve always dilated the blood-vessels of the tongue, and increased the secretion of the saliva, and Eckhard demonstrated the presence of vaso-dilator nerves, starting from the sacral plexus of a dog and going to the penis, to which he gave the name of nervi erigentes, as stimulation of them produced turgescence and erection of that organ. Claims for otlwr vaso-dilator nerves have also been put forward, and we must at any rate allow that DILATATION OF BLOOD-VESSELS IS NOT NECESSARILY A PARALYTIC PHENOMENA OF THE VASO-MOTOR SYSTEM. Must we then admit that there is a vaso-dilator system as widely distributed as the vaso-motor or constricti ve system ? Golts would explain all dilatation of blood-vessels as due to irritation of vaso-dilator fibres at the time of section, and appeals to the temporary nature of the dilatation as a proof of this, for the arterial tonus is always speedily re-established. In addition, he teaches that the calibre of the blood-vessels is regulated by local centres, which are in subordinate connection with the sympathetic and cerebro-spinal centres. The experiments on which he bases his inferences have recently been verified Goltz has also demonstrated that certain centrifugal vaso-dilator fibres have an independent origin from a centre in the lower part of the spinal cord, and other evidence supports the view that there are a series of OBJECTIONS TO THE ACCEPTED THEORV. 103 similar centres at intervals along the whole spinal cord .... We are, therefore, driven to a much more complex hypothesis than that which is generally adopted. Local vaso-motor centres arc probably distributed universally in juxtaposition with the blood- vessels, and each receives not only a peripheral .set of nerve-fibres, which must contain both vaso-constrictor and vaso-inhibitory or dilator fibres, but also a central or commissural set from a nerve centre higher in the scale. Tliis is again connected with a centre higher up, and so on throuf^hout the entire nervous system . . . It is obvious that if such an elaborate hypothesis be necessary, merely to hold together the well-ascertained results of modern experimental research, in this direction, and that even this may not do for long, more caution than is usually displayed must be tiken before we invoke its aid in the explanation of our daily clinical and pathological observations, and in describing the modus operandi of our therapeutic agents." 202. From this article, and the very complicated scheni. of vaso- motor innervation quoted a few pages back, both of which arc intended to convey the same modern theory .he lollow''.^ conclusions may be drawn : — (a.) That the present vaso-motor theory is only a pa'tia: truth. (h.) Th ' it entirely ignores the inherent contriXtilc power of the middle muscular coat of the arteries. (c.) That it is inadequate to explain certain physiological phenomena. (d.) That it lacks the simplicity and directness with which, in natural processes, means are adapted to an end. (e,) That it requires an elaborate and complicated nervous apparatus, in which one set of nerves are directly pitted, function- ally against other nerves of similar origin. (f.) That this system is too complex and too unsatisfactory to be of practical use fot clinical or therapeutical purposes. (g.) That the assumed existence of inhibitory nerves is due solely to the exigency of the theory ; for, as a matter of fact, they are not known to exist anatomically, while the existence, as well as the function of vaso-motor nerves, regulating the calibre of the vessels, have been demonstrated. (k.) That dilatation of the blood-vessels is not necessarily a para- lytic phenomena of the vaso-motor system. (i.) That there are strong physiological grounds lor believing in the existence of vaso-motor nerves, whose function it is to dilate the arteries, and that this evidence is furnished by advanced physiol- ogists themselves. In view of these facts, we are much encouraged in our endeavour to show that this elaborate hypothesis may be reduced to very simple proportions, and that but one set of nerves, to dilate the 104 PHYSIOLOGICAL THERAPEUTICS. m arteries, is all that is really required ; the contraction of these tubes being amply provided for in the inherent contractility of their muscular walls. We therefore proceed to produce further proofs that the interpre- tation here put upon the mode in which section of the cervical sympathetic affects the blood vessels of the head, is justifiable ; that is, that irritation and not paralysis of the vaso-motor nerves is the result of the section in question. 203. The partial closing of the eyelids, and the extension of the nictitating membrane across the eye, in the cat, witnessed in the celebrated experiment referred to, are regarded by Dr. Dalton, not as evidences of paralysis from division of the fibres of the sympa- thetic in the neck, but rather as occasioned by exaggerated sensibility [that is irritation] of the retina, as exists also in the integument : and the partial closing of the eyelids and pupil, he regards as a secondary consequence of that condition.* 204. Indeed, leading physiologists themselves, adopt the very mode of interpretation of similar facts for which we here contend, and in other experiments on nervous tissue, see in the effects of the irritation produced by section, the phenomena of excitation and not of paralysis. Thus, Messrs. Todd and Bowman, in referring to two experiments of Dr. M. Hall, which imply that the action of the sphincter is in part dependent on the cord, state : — " In both, [experiments], however, one on a horse, the other on a turtle, the observations were made immediately after the division of the cord, By tJtc division t/ie whole organ was thrown into an excited state, both above and beloiv tJie section, and therefore manifested phe:. *mena | similar to those excited by volition. Indeed, we have seen tk\ sphincter repeatedly contracting, after t/te division oftfie cord, without the application of any new stimulus to it ; and the dog continuing to raise and depress his tail, as long as the irritation of the cord producd\ by the sectior lias continued." •\' Again, " In a state of irritation of the cord, such as may be caused! by traumatic injury, erection, or semi-erection [of the penis], is frequently present." J To show that the same interpretation of the phenomena attending the section of nervous tissue is applied to the I inter-cranial ganglia, as well as to the spinal cord, we quote the! following : — " Destruction ol the medulla oblongata is followed byl the immediate cessation of the phenomena of respiration ; and thisi takes place whether it be simply divided or completely removed! When an animal is pithed [destruction of the spinal cord], he falls! down apparently senseless, and exhibiting only such convulsive! movements as may be due to the irritation of the medulla by th\ section, or such reflex actions as may be excited by the applicationl of a stimulus to some parts of the trunk." |1 We would rather seel * Physiology, p. 523. t Physiol. Anat., p. 300. J Ibid, p. 302. pbid, p. so+l THE EXPERIMENT CONTINUED. 105 ;e tubes of their interpre- cervical ble ; that es is the >n of the led in the ilton, not e sympa- jensibility egument : gards as a t the very e contend, ects of the on and not ing to two ion of the "In both, i turtle, the f the cord. xcited state, phei. ,.mena | )e seen tk\ rdy without continuing ord produced\ ly be caused le penis], IS ition of the plied to the re quote the followed by ^n ; and this :ly removed' ord], he fallsl 1 convulsive edulla bym application lid rather seel Hlbid, p. 30+1 the word " paralysis" in place of the word " irritation," in the line we have italicised ; but if this mode of reasoninpf, or rather this interpre- tation of the effects of section of nerve tissue be applicable to the cord and medulla, it cannot be objected to by those who use it, or endorse it, in the case of the cervical sympathetic, consequently it justifies our theory and accounts for the excitation of the vaso-motor nerves of that franglion, and the reflex excitation of contiguous ones in the cranial mass, dilating the vessels of the head, so long as the irritation produced by the section continues : and this, too, on what are regarded as sound physiological principles. In other experiments on the olivary column of the medulla oblongata, Dr. lirown-Sequard regards the thrust of a needle or a section with a knife as equivalent to excitation, and not paralysis, of these centres :* so that the view here suggested as to the effect of section of the cervical sympathetic, finds support from other authori- ties also. 205. It may be said our argument is inconsistent in that we have just attempted to prove the cranial sympathetic ganglia independ- ent of those in the neck, and that now we attribute dilatation of the cranial blood vessels to excitation of the cranial ganglia as a consequence of primary irritation, by section of the cervical sympa- thetic. It may be said, if these several ganglia are independent centres of nerve-power, irritation of one ought not to affect the others any more than paralysis of one would depress the others. But there is this difference. Irritation of a tissue, or of a nerve- [trunk, is transmitted through the sensitive nerves to distant parts, is known to influence even distant nerve centres : whereas laralysis is a negative condition, and can only affect the parts lirectly supplied by the paralyzed nerve itself From this it will be leen that our argument is consistent throughout. 206. We come now to the supplementary part of this interesting ixperimcnt on the sympathetic of the neck. Dr. Brown-Sequard, ind almost immediately after. Prof Bernard and Dr. Waller, »ointed out, that if a faradic current be applied to the cranial end of le cut cervical sympathetic, the phenomena of dilatation of the ilood vessels of the head are reversed. A state of normal con- ractility ensues, the temperature declines, and the eye and its [ppendages return to their usual state.f Believing electricity to be " excitant " to nervous tissue, these physiologists interpreted the lenomena in question in accordance with that theory, and saw in e assumed " stimulation " by electricity, of the cranial end of le cut nerve, a revival of its functional activity and a return of its 'dinary control over the dilated vessels. Hence the conclusion lat the normal function of the vaso-motor nerves is to contract the lood vessels. I* Lectures on Pi)ys. and Path. Cent. Nerv. Syst. p. 194. ctures, j?^., p. 140. tDr. Brown-Sequard's io6 PHYSIOLOGICAL THERAPEUTICS. 207. We have had proof, however, that an electric current paral- yzes the nerves ; that its anaesthetic power subdues their irritability ; soothes pain, and deprives them of their customary restraint over muscular fibre. Accordingly, we suggest that the true interpreta- tion of the results of this part of the experiment is this : — That as a consequence of the paralyzing action of electricity on the pre- viously irritated nerves, their dilating power is abolished, and the muscular fibre of the middle coat of the blood vessels is enabled to contract, as a result of its own inherent contractile power, when no longer restrained, and the calibre of the vessels is diminished accordingly, with a return to ordinary circulatory activity. According to this view, the contraction of tlie arteries is effected through the inherent contractile power of their muscular waUs^ and this tendency to coi'traction is perpetually antagonized, during life, by the functional activity of the vaso-motor nerves, tlie preponder- ance of which, aided by the pressure of the blood, results in a state of vascular dilatation. 208. II the reader finds it difficult to accept this view of vaso- motor nerve action, and in^^ists on adhering to the more orthodox opinion, that dilatation of the arterial tubes is the effect of paralysis of the vaso-motor nerves ; and that when these nerves are excited, the calibre of the vessels is correspondingly reduced ; we ask him to explain the general contraction of the arterial system which takes place within a few hours after death,* emptying the arteries into the veins, which are larger than the former^f leaving these collapsed and occluded. The muscular coats of the lymphatic vessels in the tail of the I tadpole empty themselves by contraction after death in the same I manner, j; and though in the case of both these and the arteries a subsequent relaxation occurs, this latter change is doubtless coin- cident with the loss of muscular contractile power owing to molec- ular changes from incipient decomposition. 209. Now \l paralysis of the vaso-motor nerves be attended by I relaxation of the arteries, as is the orthodox theory, then after death, when nerve-force is no longer operative, tlie arteries ought to k\ dilated. But such is not the case. Extinction of nerve force andl arterial contraction go together, and so also does the effect ofl faradization. On the contrary, those stimulants, foods or medi| cines, which re-inforce nerve power, are found to dilate the arteries; so that when we suggest, (in opposition to the prevailing theory) that arteries contractfrom tJie innate power of their muscular walh\ and dilate in obedience to nervous stimulus, we do so on true physil ological principles and in strict accordance with physiological facts] 210. The remarkable effects of irritation of the fifth pair of crania nerves in exciting destructive inflammation of the eye, are well] •Dr. Carpenter's Phys., p. 334. tDr, Burdon- Sanderson, Hand-book Phys. LabJ p. 239. X Ibid, p. 4S4. OTHER EXPERIMENTS. 107 known, and are frequently seen in the loss of one eye from irritative changes taking place in the other. Experiments have shewn that if the ophthalmic branch of this nerve be divided in front of the casserian ganglion, inflammation of the eyeball follows, with .much certainty. But when a division of the nerve is made behind that ganglion, no inflammation follows. This difference in result has been attributed to the section of certain fibres of the sympathetic, which join the ophthalmic nerve in front of the ganglion, but are absent in its rear.* Here again, the pheno- mena are interpreted as due to paralysis of the sympathetic, which permits dilatation to occur when its contracting power is suspended. Does not the experiment as reasonably establish that the nearer the ophthalmic ganglion is approached by a painful operation, the greater is the risk of irritating it, and thereby of producing a tem- porary exaltation of its dilating power, as we see in the inflammatory effects witnessed } This view of the case is strengthened by the well known effects of ganglia in retarding impressions which pass through them,i* so that in section behind the ganglion, this fact, as well as the greater distance from the eye, must be taken into account in estimating the results : and so also should the dreadful injury inflicted on the nervous system by the removal of portions of the skull and brain, in order to reach and divide these deeply seated portions of nervous tissue, as is the mode sometimes practiced. J That the inflammatory effects on the eye referred to, are due to irritation, rather than paralysis, of the vaso-motor fliaments con- tained in the fifth pair, after its section, finds support in the effects of the operation on the animal experimented on. Dr. Carpenter describes these as follows : — " When the whole trunk ib divided within the cranium, by the penetration of a sharp instrument, (which Magendie, by frequent practice has been able to accomplish) evi- dent signs of acute pain are given. After the incision has been made through the skin, the animal remains quiet until the nerve is touched ; and when it is pressed or divided, doleful cries are uttered which continue for some time, shewing the painful e^ect of the irri- tated state of tJie ait extremity y\ 211. Experiment on tJie sub-maxillary gland. — This gland receives its nervous supply from the chorda tympani ; a branch of the facial nerve, which in turn is an intra-cranial spinal motor nerve. As the I chorda passes to the gland, it is involved with, and is undistinguish- able from, the fibres of the sub-maxillary ganglion. A third nervous supply is that from the superior cervical ganglion of the sympathetic, namely, vaso-motor or vascular nerves, which accom- [pany the branches of the carotid artery to the gland. The peculiarity of the experiment is, that if the chorda tympani I nerve be faradized, the local arteries dilate and an afflux of blood • Dr. Dalton's Physiology, p. 523. t Dr. Carpenter's Physiology, p. 830. E:tDr. Ott, Action of Medicines, p. 62, (sk. || Human Physiology, p. disj. lo8 PHYSIOLOGICAL THERAPEUTICr^. B«',? li m <» 1 ,■ M. ¥ M mm 'ifl to the gland, with increased secretion, is the result ; whereas if the sympathetic be similarly treated, the arteries of the gland contract, blood supply is diminished and secretion arrested.* 212. These results appear to favor the popular vaso-motor theory, and are often referred to as a proof of its validity ; and correctly so, if electricity be an " excitor " of nervous tissue. The contraction of the arteries of the gland, under faradization of their vaso-motor nerves, is pointed to as a proof, both, that electricity is a " stimulus," and that it is the proper function of the vaso-motor nerves to restrain the calibre of the vessels ; since this is the result of their *' excitation." But the considerations suggested in a previous part ol these pages, shew that this mode of interpreting the phenomena in question is not in accord with other general physiological facts ; and especially with the one just shewn, that vascular contraction is found most gen- erally and vigorously, not when the vascular nerves are excited, but when they are dead. There must, then, be some other mode of explaining the results of this experiment on the gland in ques- tion ; and we have again to suggest that the application of our theory to the results reported, is at once simple and natural. In former pages, the effect of faradization in paralyzing motor | nerves, and as a consequence, producing a rapid series of contrac- tions and relaxations of the muscular fibres to which these nerves are distributed, has been fully set forth. (§ 148). By faradizing I the chorda tympani, — a motor nerve — the tissues of the gland and adjoining parts are subjected to this mode of influence and are mechanically excited. Blood and pabulum are thus attracted to the area of these vibratory changes, with a consequent increase of I functional activity, as seen in the augmented secretion. Dr. Brown- Sequard says of this part of the experiment, " I think that this I enlargement of the blood vessels must be due to a greater attraction of the arterial blood by the tissue of the gland ; and we explain | this increased attraction by the production of the chemical inter- changes between the secretory tissue and the blood, which are| rendered manifest by the secretion ot saliva then taking place."-f* Ludwig's explanation is to the same effect ; and though not sol intended, accords well with the effects here attributed to faradiza-j tion. Thus, to quote Dr. L. Brunton, " It was first demonstrated! by Ludwig that the increased secretion produced by excitation ofl the chorda is immediately dependent on increased activity of the! function of the secreting elements of the gland, and not on change\ in tfie bloodvessels; in other words, that in the sub-maxillary glandj the process of secretion is not a mere filtration, but is effected byl changes which go on within the gland itself, of such a nature as tol determine a current from the circulating blood towards the duct *Dr. L. Brunton, Handbook Phys. Labor., p. 468. Dr. Brown-Sequard's Lectures ot| Phys. and Path. Cent. Nerv. Syst., p. 149. t Lectures, etc., p. 149. THE SUB-MAXILLARY GLAND. 109 or theory, rrectly so, raction of ISO-motor stimulus," nerves to t of their lese pages, uestion is especially I most gen- e excited, ther mode d in ques- ion of our iiral. zing motor of contrac- liese nerves faradizing gland and ice and are attracted to increase of Dr. Brown- that this sr attraction we explain mical inter- , which are place."i* 3Ugh not sol to faradiza- emonstrated excitation of tivity of the . on changen icillary gland effected by nature as to ds the duct ard's Lectures ot This conclusion was based by Ludwig on the observation : first, that if the duct is constricted, secretion continues, notwithstanding that the pressure in the interior of the gland is greater than that in the arteries ; and secondly, that secretion continues after circulation has ceased, e. g., after the head has been severed from the body.* So much for the effects produced through the chorda tympani ; and now as to the effects shewn to result through the vaso-motor nerves of the sympathetic. Here the same paralyzing effects of faradization withdraws the control of these nerves from the arterioles with which they are associated ; contraction of the muscular fibres of these tubes results, reducing their calibre, diminishing the sup- ply of blood to the gland, and as a consequence, arresting its secre- tion. On this view, physiological consistency is maintained, for nervous torpor, whether from the death of the body, from tempo- rary paralysis by faradization, or, as we shall see by and by, from the paralyzing effects of certain drugs, is invariably associated with a contracted condition of the arterioles, lessened circulatory activity and diminished .secretion. 213. A supplementary experiment on this gland consists in cutting both the chorda tympani and the sympathetic, when increased secre- tion results, not however for some time after section, and may last for days or v/eeks.*|' May not the interval which elapses before the commencement of increased functional activity correspond to the time required to set up irritative action in the cut nerves and their vicinity ; and the irritation thus transmitted to the tissues of the [gland, by the chorda, and the dilatation of the arterioles, by similar [irritations transmitted along the vascular nerves, account for the increased secretion, which subsides after the irritative condition has ceased by the re-union of the nerves and the healing of the [wound } It is true that sthenic inflammatory action, at first, arrests [secretion , but the action resulting here, on tiie gland, is only second- [ary, and is not sthenic. We know also that increased secretion is [the rule, in the lower grades of inflammatory action, and in the [second stage of even the active forms, so that there is nothing in the explanation here offered against which exception can reasonably jbe taken on this ground. 214. Another observation which has been made, is, that the Dresence of curare in the blood affects the gland in a similar manner is section of the nerves ; and as curare is known to poison the terminal fibres of the motor nerves, the condition, at first sight, ^eems unfavourable for a dilatation of arteries and increased secre- [ion, on the theory here suggested. Dr. Michael Foster, however, ifter detailing the effects of curare, or urari, poisoning, states, that [he facts are intelligible only on the hypothesis that while thd motor Jerves are paralyzed, tlie sensory and central nervous system * Handbook for the Physiol. Laborat., p. 468. tDr. Urunlon, Handbook Physiol. Uborat., p. 473. sir J- no PHYSIOLOGICAL THERAPEUTICS, If" mi'- (ira/ys/s seems to be primary, and to depend on the direct action of a poison on the nerves and ves.scls."'f- Hcre it is directly implieil that the dilated condition of the blooil vessels, in inllammation, is a result of pandysis of the vaso-motor nerves, whose functioi;, as we have already seen, is presumed to be to contract the vascular channels. Similar e.\pressit)ns, embodying the .same theory as that we have been heretofore combating;-, abound in recent meilical literature, when treatinsjf of circulatory phenoniena. and need not be more specially cjuoted. Our medical teachers everywhere assume that nerve-force is a stimulant, or compelling power to muscular fdire, and causes its contraction in the blood vessels as well as in the case of the muscles. Now we have, in the precetlin*; i)at^es, evidence to show, that all the phenomena of muscular contraction, in its various forms ami under diverse circumstances, can be accounted for independently of nerve-force ; that nerve-force tloes not act the part of a stimulus or compelHni;' power in brini;ini;' about muscular contraction anywhere : .md that, in short, muscular fibre passes into a state of the mo.st rigid contraction, as in rigor mortis, when nervous influence is wholly withdrawn. This being thj case, can we belive that vaso-motor nerve-force is cxccptiotuxlly exerted to secure contraction of the blood vessels, and that the muscular fibres involved in this act, do not follow the same law which governs muscular fibre elsewhere, especially when the muscular fibres of the blood vessels arc known to possess, equally with similar fibres in other parts of the body, the power of self-contraction, when free to act, and are known to exert that power whol'v independent of nervous influence, as in the contraction and obliteration of their calibre, after the death of the body .'' 226. In addition to what has already been said on the inherent contractility of muscular fibre, we would remind the surgeon of how * Dr. Carpenter's Physiology, p. 566. Dr. Brown-Sequard's Lectures, 6^., p. 174. Sir James Paget, i:K. tBraith. Retros., July, 1876, p. 18. TORSION OF AKTKRIICH. lie [Nl-I.AM physiol ards this majority )nililioii:. and to vessel s."f he blood so-motot cd to be iibodyiiiti , abound cnomciia, teachers ^mpelUn^ he blood that all brms anil idently of imulus or .nywhere : the most is wholly aso-motor )n of the lis act, do elsewhere, are known the body, known to mce, as in ; death of e inherent eon of how iSr^., p. 174- frequently he is a witness of this property, not only in the retraction of the muscles, but in the oblitiTation of the calibre of the smaller blood vessels at the j)()int of section. We woidd also su^^p^est that in the o{)eration practised upon the cut ends of arteries, known as torsion for the arrest ol bleeding,', the hatnoslasis is not the result solely of the twistiti}^ of a portion of llie arterial tube, but is in pa/t dejjendin}^ on the destruction and paralysis of the vaso-tnotor nervous fdaments, which Dr. Heale has shewn to ramify upon and amon^ the muscular tissue of these ves- sels. In conse(|uence of this paralysis of the nerves which dilate these tubes, the contractile power with which the arteries are endow- ed is enabled to e.xert it.self, and thus hiernorrhaf^e is more effectual- ly prevented than it wovdd be by the simple twistinfj of the ves.scls, Thus it has becMi shown by Dr. Jiryant, as a result of numerous experiments, both on dead and living subjects, thai " in no single instance was there any evidence that the portion of vessel which had been twisted had lost, or was likely to lose, its vitality ; or that the parts about the vessel had received any material injury." And further, "In no case does it appear necessary, or even prudent, to twist the vessel till the end is twisted off ; for by so doin^ we do away with the chief sate^uard against bleeding."* Does not this evidently imply — thouf^h not so intended — that the twisting must be sufTicient to paralyze the dilatinf:^ nerves, but not enough to seriously damage the contracting muscular fdjres ? 227. We lil^ave already seen, in Dr. Hrown-Sequard's experiment, ({:}2I5), that to the sensitive nerves belong the power of initiating impressions, which through the nervous centres are transmitted to the vaso-motor nerves, and as these impressions are exciting or depressing, the influence of these nerves in restraining the contrac- tile power of the vascular channels is increased or lessened, and dilatation or contractioii of the vessels results accordingly.^ What has been proved to be true of the circulatory activity of one part of the body must be true of other organs and tissues. If the sensitive nerves of tic cranio-spinal axis be irritated by a burn, or a bullet, or those of the sympathetic system be similarly impressed by disease germ.s, have wc not a right to conclude that the reflex or ultimate effect of these sources of irritation on the corresponding vaso-motor nerves will be of a similar character; and that not paralysis but heightened activity will be the result: the increased dilating power thus invoked overcoming the contractile tendency of the vascular walls, permitting expansion from blood pressure, thus producing congestion and inflammation accordingly. Vaso-motor excitation, then, and not paralysis, would appear to be the true condition existing in the congestive stage of the inflammatory process. *Mecl. Chir. Trans., Vol. 61, i8^«8, p. 199. Braith. Retros., July, 1869, p.p. u6, 117. tDr. L. Bealc, Disease Germs, p. p. 330, 423. -^S 120 PHYSIOLOGICAL THERAPEUTICS. 228. That thisisthe true explanation, is further proved by the treat- ment adopted for the inflammatory process. Take an average sthenic case of ordinary occurrence. There are fever and the usual symptoms of acute congestion, with dilatation of the blood vessels, constituting hyperaemia of the tissue or organ affected, and perhaps also of contiguous organs. Now, in this case, the determination of blood to the part inflamed, is a very important factor in the process ; and of itself has nmch to do with the termination of the disease, favorably or otherwise. This is proved by a number of recorded cases of inflamed and sup- purating joints, or parts of limbs, where ligature of the principal arterial trunk of the limb has been followed by prompt and permanent amelioration of all the symptoms — previously severe — and an early cure of the inflammatory process.* In the cast just supposed, we cannot but believe that a diminu- tion of the caHbre of the engorged vessels, and a consequent lessening of the hyperaemia, would favor a slower growth of bioplasm (Dr. Beale) and tend to promote healthy cell-growth, and so favor recovery. f Let us, however, adopt the popular theory, and regard the vaso-motor nerves as paralyzed, and so unable to furnish the necessary " stimulus " or nerve force, to compel contrac- tion of the dilated vessels. Do we, as a matter of fact, act upon this view of the case, and set about stimulating or " toning up " the paralyzed nerves, with a view thereby to restore arterial contraction ? Not at all ! What are the remedies we employ ? Aconite, veratrum viride, opium or its compounds, occasionaly tartar-emetic, and other remedies of a similar class, conjoined with warm poultices to the external surface. These will suffice for the ordinary typical case which we are discussing. What are the effects of these remedies ? We call them " seda- tives," and all sedatives are to a greater or less extent, paralyzers. (Dr. Anstie.) Examined carefully, every one of them will be found to lessen the activity of either sensitive or motor nerves, or both : and if pushed to their ultimate effects, their paralyzing effects on the nei'vous system will be abundantly apparent. Here again the theory we are taught is ignored, and fails to exert its influence 011 the recognized treatment. 229. Apply this treatment to the theory propounded in these pages. Regard the vaso-motor nerves as not paralyzed in the inflammatory state, but irritated and excited ; not as compelling, by a stimulus, the muscular fibre of the blood vessels to contract ; but as restraining it from contraction, in the normal state ; and now, that this restraining power is exaggerated, by the intensity of nerve j action, producing abnormal dilatation of the blood vessels. These *Braith. Retros., January, 1876, p. p. 125, 132. tSee Dr. Wilks, Braith. Retros. July, 1869, p. 35. THE FEBRILE STATE. rar le treat- average le usual vessels, perhaps nflamed, much to therwise, and sup- principal ntipt and severe — diminu- Dnsequent ;ro\vth of owth, and heory, and unable to el contrac- act upon g up" the •ntraction r rum viride, and other ices to the ypical case liem " seda- paralyzers, ill be found s, or both ; g effects on again the influence on 2d in these yzed in the mpelling, by ►ntract ; but and now, sity of nerve 1 sels. These 1 Braith. Retros. several drugs, in one way or another, some acLing on the sensitive nerves, allaying, or rather paralyzing, their functional activity ; others acting similarly on the nervous centres, or on the vaso-motor nerves directly, lessen the undue nerve-power by a process of par- tial paralysis, and proportionably set the muscular fibres of the vascular coats free to fulfil their natural law of contractility ; and, in doing so, to reduce the dilated vessels to their normal calibre, and so equalize the circulation, diminishing the hyperaemia and favoring a return to the healthy state. Is not this explanation very simple and natural, and quite in accordance with what we daily witness ? We have not alluded, for want of space, to other remedies which may be called for in particular cases or stages of the inflammatory process. Those mentioned will suffice for the cure of the greater number of typical cases ; and as for others, a careful examination of their effects will shew them to be either excitors or depressors of vaso-motor innervation, and to dilate or contract the vessels accord- ingly, producing corresponding results in the tissues and parts to vvhich they are supplied ; or to be remedies which impress the ssues directly, without the intervention of the nervous system. We might dwell at further length on the phenomena of this state,, and on the action of remedies in effecting its cure. We might also quote numerous cases in illustration of the truth of the views just expressed ; but we are addressing intelligent physicians who have time and again witnessed the recovery of persons from inflam- matory affections by the means indicated, and to them such details are unnecessary. Their own ordinary experience will recall confirmatory examples of this kind. And it is well known that under this natural and scientific mode of treatment the severity and danger of the inflammatory process has been greatly lessened, compared with the results of a former treatment, in which general depletion and antiphlogistic regin^en of a lowering kind was often pushed to an extreme. We therefore leave these brief observations to the reader and pass on to other considerations. ADAPTATION OF THIS THEORY TO THE FEBRILE STATE. 230. The theory here propounded is equally adapted to illustrate I the phenomena of the febrile state. The first effect of the development within the system of the [the germs of fever, or of their intrusion from without, is a general iepression of nervous energy, in which the vaso-motor nerves of the )lood-vessels also share. As an immediate consequence, the restraining power of these nerves over the muscular walls of the irterioles is reduced, and if this lowering of power sinks below a f«SS!ft I i> I /I ' riKi 122 PHYSIOLOGICAL THERAPEUTICS. certain point, the muscular fibres of the vessels, no longer ade- quately restrained, exercise their contractile power, so as, to a greater or less degree, to obliterate the calibre of the blood-vessels and proportionately to prevent a due supply of blood from reach- ing the surface of the body and' extremities. A degree of paleness, chilliness and diminished exhalation from the surface of the body results. A further reduction in vaso-motor power intensifies this effect, and joined with consecutive depression of the motor nerves restraining the muscles, gives to muscular fibre throughout the body such a preponderance that irregular contractions of the voluntary muscles may occur, constituting a " rigor " or " shake," so often experienced in the cold stage of ague. 231. This depression of motor force, however, is not permanent. The spasm of the smaller blood-vessels which has prevented circu- latory activity in the extremities and external surfaces, has deter- mined an unusual supply of blood to the internal organs and nervous centres. Perhaps partly from this cause, often, no doubt, aided by artificial warmth or restoratives, the nervous energy is regained, and may even soon be in excess of the force necessary to antagonize the muscular fibre of the vascular channels ; and these, acted on by blood-presence, become unduly dilated, inducing an accession of the febrile state. In some cases the subsequent history will show a repetition of these extremes, chilliness being mixed -with fever, indicating that the contending nerve and muscular forces are carrying on their antagonism with varying results ; sometimes one of these having:; the preponderance and sometimes the other ; now muscular fibre gaining the mastery, arid by lessening the calibre of the arterioles, producing a chill ; then vaso-motor innervation triumphing, com- pelling the constricting fibres to relax and the vessels to become dilated. Rarely is nerve-force long held in abeyance. Usually after the I first onset, in the severer forms, it assumes control and maintains a .dilated state of the vascular channels constituting the febrile state, which may be nearly continuous, but, ^xcept in the more intense forms, usually admits of partial remissions, with a proportionate return to a normal state of the circulation. 232. Nor is this preponderance of vaso-motor nerve-force in thai presence of general languor and prostration at variance with the I theory here propounded, as will appear from the following consider- 1 ations. During an attack of fever a much larger amount of nitrogenous elements of the tissues undergoes transformation into urea andl other products for elimination than is to be accounted for by the! quantity taken in as food. To supply this excess the fixed albumen! of the tissues breaks down, and is transposed into these excreta. *'InI WASTE OF TISSUE IN FEVER. 125 all fevers the muscles become wasted, and on microscopic examina- tion tlie muscular fibres can be seen in the act of disintegration!'"^ " Fatty degeneration of the tissues sets in during the progress of a fever, especially when prolonged. This degeneration has been observed more particularly and fully in the liver, kidneys, heart, blood-vessels and voluntary muscles."f The contribution which muscular fibre throughout the body is thus obliged to make, to the general waste of tissue, affects also the muscular fibres of the blood-vessels, and the thinning out of their contractile cells by a degenerative process, leaving fewer of these for effective purposes, furnishes a clue to the general relaxa- tion of the vascular channels, even under the enfeebled dilating power of the vaso-motor nerves, which also suffer in the general exhaus- tion, though from the composition of nervous tissue it might be inferred to do so to a less degree than muscular fibre, which is richer in albuminoid materials. 233. Whether the increased temperature in fever is owing to the rapid oxydation of accumulated effete materials, as has generally been believed,|. or whether, according to Dr. Beale, it results from imperfect oxydation, associated with the undue increase o^ bio- plasm, |1 is a question which does not affect our argument, and which may be left in abeyance here. 234. Nor need we here enter into the discussion as to whether what we call inflammation js a distinct and different process from essential fever as has been generally believed. Dr. Beale, however, regards both as depending on the same essential phenomena. " A fever may be looked upon as a general inflammation, while an inflammation may be correctly regarded as a local fever."§ What is certain is, that a " tightening " of the vascular channels by a diminution of their calibre, from a state of undue dilation, has a beneficial effect in languid conditions of the circulation, as we sometimes see in fever, while both in this state and in inflammation the contraction of the vessels lessens hypera^mia, lowers the temper- ature and favors a return to health. If the effect of our remedial measures in these diseased states be duly considered it will be found that a change in this direction is really what they tend in great part to bring about. 255. Thus the use of baths of a temperature lower by ten or twelve degrees than that of the body, cold packing, and cold effu- sion, are among the processes in use by modern science for the relief of the more urgent febrile symptoms. Doubtless here the excessive heat is largely abstracted from the body ; but we know, too, that cold tends not only to paralyze the superficial vaso-motor nerves, •Dr. Charles Murchison, F.R.S., Braith. Retros., July, 1872, pp. 17,18, from Brit. Med. Jour., Feb., 1872, p. 175. t Dr. Sidney Ringer, Hand-Book of Therapeutics, p. 27. X Dr. Murchison, Braith. Retros., July, 1872, pp. 17, 19. || Disease Gems, pp. 328, 340, 6t^. § Medical Times and Gazette, Feb. 18, 1871, p. 183. Braith. Retros., July, 187 1, p. 30. .-I'sffili 124 PHYSIOLOGICAL THERAPEUTICS. but also by reflex action similarly impresses those more deeply seated, and thus both directly and indirectly favors contraction of the smaller vascular tubes whirh they supply. (§215.) Accord- ingly inflammation and its results are often prevented by the early application of cold, — as in surgical wounds, — if commenced suffi- ciently early. This argument is in no way affected by the well- known advantageous use of warm poultices in boils, whitlows, and other similar states ; nor yet in the use of similar appliances in inflammation of internal organs, for here the cataplasms are applied, not with a view of averting the inflammatory process, but rather of hastening its termination by resolution, or if need be, by suppura- tion. 236. Among the leading remedies for certain forms of adyQamic fever is quinine. According to Dr. J. H. Bennett, this drug, in large quantities, is a narcotic,* and Dr. Anstie, who has made the subject a special study, has declared that all the narcotics are paral- ysers, and exert this influence to a greater or less degree from the very first display of their physiological effects. Narcotics act chiefly through the nervous system, which Dr. Periera also says they paralyze.-f* If quinine, in large doses, be a narcotic, one of its effects would then be to paralyze the vaso- motor nerves, and so to favor the contraction of the muscular fibres of the dilated blood-vessels in fever, and with this restoration of normal circulatory activity, to lessen those wasteful changes which, as we have seen, prove so spoliative to the tissues and so exhaustive to the organism. Probably in this way it may assist in dissipating the abnormally increased bioplasm, on which Dr. Beale lays so much stress, by hurrying it along in the current of the blood to be oxydized and eliminated. This view of quinine as a paralyzer of the vaso-motor nerves finds some support in the fact, which experience has proved, that quinine acts on the uterus in parturition similarly to ergot by increasing the expulsive force ; and we have seen, in the previous pages, evidence is not wanting to show that this is not neces- sarily brought about by any stimulating action on the spinal nerves, but taken in connection with previously mentioned facts, that ergot does this by paralyzing the motor or restraining nerves of the uterus. If this is true of ergot it is equally likely to be so of the similar action of quinine. 2VJ. Again, "diffusible stimulants, as wine and coffee, are said to 'uteract the action of quinia."| If this fact be verified, it would ■ V f^f another link in the chain of proof ; for diffusible stimulants in- :'-- jc nerve-power, at least temporarily; and if they antidote viai.iine, the latter must depress it. Besides, the effect of quinine in profuse sweating, as in phthisis, in passive bleeding, in undue | * Clin. Lee, p. 879. tMat. Med., vol. I., p. 234. JDr. Ringer, Therapeutics, p. 523- rj • EFFECTS OF QUININE. 125 : deeply ction of Accord- he early :ed suffi- the well- ows, and iances in t applied, rather of suppura- which Dr. OSes, be a the vaso- :ular fibres toration of iges which, exhaustive dissipating lie lays so lood to be 5tor nerves >roved, that ergot by le previous not neces- inal nerves. , that ergot the uterus. the similar suppuration, profuse menstruation, spermatorrhoea, excessive secre- tion of milk, and profuse secretions generally, all of which it tends to .rrest,* and its effect in favoring the manifestation of increased contractility of muscular fibre,"t goes to confirm the same view : for increased secretion necessarily implies augmented blood supply, and when the former is arrested, the latter must be diminished. From all of which facts, it seems fair to conclude that quinine con- tracts the blood vessels, and from the arguments formerly adduced, we must infer that it does so under the same conditions as vascular contraction ordinarily takes place, namely, by depressing the vaso- motor — dilating — nerves, so as to allow the inherent contractile power of the muscular fibre of the vessels to assert itself, and dim- inish their calibre accordingly. Dr. Periera, however, furnishes us with contradictory evidence as to the effects of quinine on 4:he system. Besides narcotic and sedative, stimulating effects have also been ascribed to it. Among these latter, are excitement of the vascular system, with increased frequency and fullness of the pulse. J Perhaps these different effects may depend on the condition of the persons in whom they were observed. Thus, in a phlegmatic individual, of flabby fibre, with relaxed vascular walls, and perhaps cedematous limbs, quinine, or J "^italis, by " tightening" the vascular channels, may accelerate the flow of blood, quicken the circulation and improve the pulse, and so be considered a stimulant ; while in a case of fever, where the vessels are also abnormally dilated, but less relaxed, quinine, by a similar effect on the vessels, may reduce their calibre, diminish hypertemia, and so earn for itself the character of a sedative. So, also, if these effects be pushed to an extreme, and the arterial con- traction be such as to deprive the nervous centres of a sufficient supply of blood to maintain their functional activity, such symp- toms as " stupor, staggering, sudden falling down, convulsions, etc.,"|| reveal the narcotic effects of the drug. And yet, in all these cases, the general action of vascular contraction is evident throughout. But there must be something more in the action of quinine than simply contracting the blood vessels. Ergot does this effectually, and yet we never heard of ergot curing an intermittent fever. If, in addition to the effect just attributed to quinine, we add also anti- septic qualities, as regards the blood, we shall have fairly accounted for its complete powers in those febrile conditions in which its reputation is unrivalled. The association of a stimulating action with quinine is so general, that it is re£ceshing to find such an authority as Dr. J. H. Bennett doubting that it is even a tonic. In reference to the frequency with which quinine is administered to convalescents and weakly persons, who get better under its use, he says, " whether this is *Dr. Ringer, Therapeutics, p. 522. t Sundelin, Dr. Periera, Mat. Med., Vol. II, p. 684. :tMat. Med., Vol.. II., p. 681. liDr. Periera, ibid, p. 680. 126 PHYSIOLOGICAL THERAPEUTICS. owing to the quinine, or would not have occurred equally well without it, is a matter very difficult to determine." So valuable (otherwise) and expensive a drug " should not be wasted in endeav- oring to procure effects so very doubtful as the tonic virtues which have been ascribed to it."* But, notwithstanding this high authority, there are other authori- ties, and numerous facts, which go to prove that quinine, in small doses, in appropriate cases, does exert a tonic influence, not only on digestion but on the circulation, in pronfoting warmth of the extremities. The same is true of small doses of strychnia, (Dr. Anstie) and to a less extent of opium. Here these drugs would appear to act more in the capacity of foods than otherwise ; and by supplying some want in the system, tend tb act as restoratives to normal nervous energy. In this way they may assist the musculo- motor and vaso-motor nerves in their functional task of controlling the muscular fibres to which they are respectively distributed, and so favor healthy activity in the muscles and normal circulatory activity in the blood vessels. 238. The action of alcohol, when properly understood, would appear to be entirely similar. Dr. Anstie has shewn that under certain conditions of the body alcohol acts as a food ; not, indeed, in building up the tissues, but in preventing their waste. A? soon as this range of its effect is passed, and the apparent " excitement " ordinarily, but erroneously, attributed to " stimulation," has begun, the process of paralysis of some part of the nervous circuit has already commenced.-f* It does not require a clinical thermometer to prove that, in a state of ordinary health, alcoholic drink in large doses lowers the temperature. The most natural explanation that we know ot this fact is in accordance with the views here propounded, and which is equally applicable to other narcotics, namely : by paralyzing to some extent the vaso-motor nerves, these become no longer able to restrain the contractile power of the vascular walls, which, as a con- sequence, have their calibre lessened, and with a diminished blood- supply the temperature of the surface and extremities is also reduced. The vaso-motor nerves are not the only ones functionally depressed. The miisculo-motor nerves are also semi-paralyzed ; as we see in the unsteady gait or the positive inability to stand or walk of one intoxicated. That portion of the cranial mass through which the mind exerts its powers of volition, is also, in some part, paralyzed. Hence the indiscretions of speech and act which so often attend this state, with which everyone is familiar^ These latter effects are never reached in fever or exhausting disease, even though many times the quantity of alcoholic liquors be administered which would induce this state of mental and physical • Clin, Lee, p. 880. t See article on Alcohol, § 403 and § 459 of future pages. ACTION OF ALCOHOL. 127 paralysis in ordinary health. The vaso-motor nerve depression which would aid in setting the muscular fibre of the vascular walls free to contract, and so diminish the calibre of the dilated vessels, is only imperfectly induced ; and beyond the trifling gain in this respect, the undoubted benefits of alcohol in these cases, must be sought elsewhere than through its action on the nervous system. Opinions differ as to the manner in which alcoholic fluids produce beneficial effects in fever and exhausting disease. According to Dr. Anstie they do so by supporting the organism in the trial through which it is passing until the morbid process shall have passed over ; and so far act as a substitute for food.* Dr. Beale denies any such W * ■«■:;: 134 PHYSIOLOGICAL THERAPEUTICS. of frogs, poisoned with digitalis, where for hours before the general death of the body, the heart remains rigidly contracted ; as Dr. Harley has said, *' a dead heart in a living body."* It would also appear as if the effect of paralysis or excitation of the leading nerve trunks, cranio-spinal or sympathetic, in so far as these affect the heart's action, operate through the direct or reflex influence they exert over the cardiac vaso-motor nerves, in increas- ing or diminishing blood supply to the heart itself. 250. It is not pretended that this view of the manner in which the heart is controlled, is proved, or that it is more than suggested ; but if such a view were probable, as it appears to be, the elaborate and antagonistic nervous excitors, inhibitors, accelerators, depres- sors and " apparatuses," might be dispensed with, and the cardiac movements contemplated under circumstances very much simplified, and approximated to that of other rhythmical movements of contrac- tion and dilation witnessed elsewhere in the organism. Since the foregoing was written, we have been enabled, through the kindness of a medical friend, to peruse an account of a throm- bosis of one of the coronary arteries, ill the practice of Dr. Hammer, of St. Louis, U. S., in a translation from the " Gazetta Medica Italiana," made by Joseph Workman, M. D., of Toronto,^ which furnishes a strong corroboration of the views expressed above. We condense from this paper as follows : — The patient was a man thirty-four years of age, of robust consti- tution, but subject to articular rheumatism, from an attack of which he was recovering, when he suddenly fell into a state of collapse. Half an hour afterwards his pulse was forty in the minute, and during the next few hours it declined to twenty-three, then to six- teen, and finally to eight beats per minute. During this time the lips became livid and cyanotic, the face pallid, and the skin was covered with a viscid perspiration. There was dyspnea, but no pain. Careful auscultation of the heart revealed the fact that after each contraction, lasting one second, a clonic spasm occurred in the| heart's tissue, lasting five seconds, accompanied by an audible fremitus. Then followed a pause of absolute rest, of two seconds, after which the normal contraction, spasm and repose followed, and | so on in series. Dr. Hammer formed the opinion that the symptoms were due to I thrombosis of one of the coronary arteries, on the grounds that | if both were occluded the heart's action would be sooner arrested : and also from the peculiar action of the heart, which he attributed to| paralysis of half the organ. The patient survived nineteen hours : and on examining the heart, the right auricle ahd ventricle were] • Dr. R. Hughes, Pharmacodynamics, p. 261. Dr. Ringer's Therapeutics, p. 405. t This paper was since published in the Canadian Journal of Med. Science for November, 1878, p. 352. A REMARKABLE CASE. 155 le general . ; as Dr. itation of 1 so far as or reflex n increas- in which uggested ; elaborate :s, depres- lie cardiac simplified, ofcontrac- ;d, through f a throm- •. Hammer, :ta Medica to,t which bove. We ust consti- ck of which of collapse, ninute, and len to six- lis time the le skin was lea, but no ,t after each ] ■red in the an audible wo seconds, )llowed, and were due to grounds that er arrested ; ittributedto teen hours: Mitriclewere| peutics, p. 405' . i for November, found filled with coagulated blood. The tricuspid and semi-lunar valves were intact, and the cavities generally normal. But in prox- imity to the right semi-lunar valve of the aorta, and extending from thence to the commencement of the corresponding coronary artery, and quite occluding the latter, was a mass of whitish-yellow coagu- lated fibrinous deposit. Within the base of the coronary artery this fibrinous mass was very much discolored, more dry, interlaced, and of a greyish-red color. The aortic valves were not thickened, but the posterior one had coalesced over a small space with the right and left valves, and in the immediate vicinity whitish excrescences were found, from the apex of one of which a slender filament was traced to its connection with the clot, giving rise to tl;e idea, that while at first floating free, this had furnished a rallying point for the accumulation of coagula, till by its weight it had assumed the position mentioned. Thus the diagnosis during life was fully confirmed. We are glad to be able to add this very interesting fact, of the existence of which we were unaware when the foregoing pages were written. It shows how dependent the heart's action is on the local nutrition of its own nervous and muscular tissues, and how important a part the coronary arteries play in the process. Appar- ently just in proportion as the obstruction in the coronary artery increased, the heart's action failed, as indicated by the diminished frequency of the pulse, until it finally ceased entirely. The case is peculiarly valuable owing to the absence of other complications, and others of a similar kind will be awaited with much interest. CHAPTER VHI. THE IRIS AND PUPILLARY CHANGES. 251. The theory here advanced is adapted to explain the con- traction or dilatation of the pupil from disease and drug action. Is the iris a muscular structure, composed of radiate and circular fibres, or is it more properly to be regarded as an erectile tissue, is a question which is discussed at some length in Note B of Dr. Anstie's work on Stimulants and Narcotics. It is there shewn that the muscular theory has serious drawbacks, among which is the fact that in man the alleged circular fibres have never been clearly made out, and have been rather a matter of faith than of demonstra- tion. Their existence has been denied by many competent anato- mists, and we owe the references made to them probably in a great degree to the exigencies of this theory. 136 PHYSIOLOGICAL THERAl'EUTICS. n 'f 252. Dr. Fraser, of Edinburgh, shows that on this theory the pupil may be influenced in at least six dififerent methods, i. By cerebral irritation. 2. By cerebral depression. 3. By spinal irrita- tion. 4. By spinal depression. 5. By a combination of cerebral irritation with spinal depression. 6, By a combination of cerebral depression with spinal irritation. In carrying out this scheme, it is necessary to assume that some drugs both excite the cranial nerves and depress the spinal nerves, a,nd vice versa. Thus the dilatation of the pupil in poisoning by prussic acid is accounted for by Dr. Fraser, by declaring "that prussic acid irritates the cord and depresses the brain, and thus simultaneously paralyzes the con- strictor, and excites the dilator fibres of the iris."* Recent dissertations on the physiological action of drugs abound with assumed diverse efifects of the same drug, not only on different nerves, but even on the .ame portions of particular nerves, which are excited, paralyzed an J re -excited, apparently at the dictum of the experimenter, in a mo ,; extraordinary manner.^ 253. Dr. Anstie has pointc^ '»ut that such a presumed alternate excitation and paralysis by a drug is quite inconsistent with the universal and inevitable sequence of narcotic phenomena ; that all the phenomena of narcosis, whatever may be their external appear- ance, result from devitalization of that part of the nervous system which is immediately concerned in their production ; that the pro- cess of narcotism is an uniform one^ and tends entirely in the direction of nervous death. J " On the other hand the erectile theory of iridal movements has received a most important reinforcement within the last few years." Besides other facts bearing on this theory, M. Rouget has established the continuity of the vascular elements of the iris with those of the choroid, the continuity of the muscular fibres of the iris with those of the ciliary muscle, that the superficial appearance of radiation in the iris by no means indicates the course of the muscular fibres, which are not arranged in a regularly radiating direction, but obliquely, so that they intersect at various points in their progress ^rom the pupil to the corneal edge. These, and other considerations, induced Dr. Anstie to conclude " that the evidence greatly prepon- derates in favor of the view that the iris is an erectile tissue ; an offshoot of the choroid tissue, and that its inuscular elements sub- serve merely the same office as that of the like elements in erectile structures elsewhere." || Dr. Anstie, in accordance with the erectile theory, holds that a contracted pupil implies an iris distended with blood, and so, pro- jected towards the centre, from its ciliary attachment: while a dilated pupil equally implies an anaemic or empty condition of the •Dr. Anstie, Stim. and Narcot., p. 409. tSee Dr. S. Ringer's Hand-book of Ther- apeutics, and Dr. Ott on the Action of Medicines. Jlbid, pp. 407-8. ^ lllbid, p. 408. Also Dr. C. B. Radcliffe, Lectures on Epilepsy, Paralysis, etc., p. 2oi8. THE IRIS AND PUPIL. 137 heory the is. I. By inal irrita- )f cerebral )f cerebral leme, it is lial nerves dilatation or by Dr. cord and 5 the con- igs abound )n different ves, which dictum of d alternate it with the a ; that all nal appear- ous system at the pro- rely in the rements has few years." established lose of the J with those radiation in cular fibres, rection, but eir progress isiderations, itly prepon- ; tissue ; an ements sub- 3 in erectile lolds that a nd so, pro- nt : while a ition of the id-book of Ther- II Ibid, p. 408. iridal vessels, which permits the condensation of the tissues of the iris, and consequently a dilated pupil. In extreme narcosis, the contraction of the vascular walls, which tltus empties them of blood and dilates the pupils, he regards as an early rigor mortis of their muscular coats " which often happens locally before the death of the organism."* But dilatation of the pupil must be accounted for under other symptoms than these mentioned, that is, under no very extraordi- nary circumstances during life, and when the presence of rigor mortis cannot be entertained. Dr. Anstie does not follow up the hints he has given elsewhere, as to the independent contractile power of muscular fibre ; and con- sequently we are left to apply the theory we have been advocating, without any further aid from the authorities, who seem time and again almost to assert, and yet avoid it. 254. Then, under the theory we suggest, how are the pupil- lary changes accounted for } Take belladonna, which paralyzes the vaso-motor nerves of the eye, if applied locally, and of the brain, including the eye, if administered internally : and by thus suspend- ing the power of the dilating vascular nerves, permits unrestrained contraction of the muscular walls of the vessels, emptying them of their contents. The result is a diminution in the bulk of the iridal erectile tissue, which gathers itself towards its attached margin, leaving a larger pupillary opening. That belladonna acts in the way stated, in so tar as a diminution of the calibre of the vessels is concerned, is proved by its general action on glandular structures, in arresting secretion ; for, according to Dr. Radcliffe's physiological law, diminished blood supply has arrested secretion as its necessary sequence, just as vascular fulness is attended by augmented secretion.i" So, also, of all other drugs which dilate the pupil. This effect is at once produced by opium in the cat ; but not so in man, where hyperaemia of the brain is first set up, but in the last stage, when the vascular nerves are paralyzed and can no longer restrain the contractile power of the muscular walls of the vessels, these last attain the mastery, contract the arterioles, shut off the entrance of blood to the iris, which passes into the state produced earlier by belladonna, prussic acid and other narcotics, shewing the iris reduced to a mere ring, bordering its ciliary attachment, with widely dilated pupil. Precisely the same result is seen in the fatal narcotism of chloroform. 255. On the other hand, those drugs which cause contraction of the pupil, reinforce vascular nerve power, either locally, when dropped into the eye, or generally, when administered internally ; dilatation of the vessels follows ; a state of local or cranial hyper- 1 *Dr. C. B. Radclifte, Lectures on Epilepsy, Paralysis, etc., p. I etc., p. 238. 409. t Lectures, 138 PHYSIOLOGICAL THERAPEUTICS. semia is set up ; the erectile tissue of the iris is full of blood, in consequence of which its free border is pushed further away from its attached margin, and the pupillary opening is proportionately closed. (§ 387.) 256. It may be objecte:!, that profound paralyzers of motor nerves, like calabar bean, — which contracts the pupil, — are very unlikely agents to increase vaso-dilating nerve-power ; but it must be remembered that calabar bean contracts the pupil only when locally applied ;* (§ 387) and that other equally profound paralyzers — as aconite — act as local irritants, and set up hyperaemia in the surfaces with which they first come in contact. When this is the case on surfaces like the mouth, throat, etc., a similar action is to be anticipated in the more sensitive membrane of the eye. Thus, then, on the erectile theory, a dilated pupil coincides with an empty condition of the blood vessels of the eye, or of the brain, in which case the eye is included, while a contracted pupil coincides with a state of hyperaem'^. which may be local as regards the eye, or general, including ' hf ^:.i . with the brain. And these conditions of the blood vessels, on the theory we suggest, are in tan dependinsT on the relative preponderance of either of the two antagolstiw iorces which regulate the calibre of the vessels. Give vaso-motor nerve-force the preponderance, and the vessels dilate, contracting the pupil ; allow the muscular fibre of the arterial walls the mastery, and the vessels are contracted, the iris shrinks, and the pupil is enlarged. 257. Let us now enquire how far the facts of experimental physi- ology agree with the theory of pupillary changes, just suggested. Cojitraction of the p7ipil resnXts from the following conditions : — 1. The undulations of light, impinging on the retina, excite vibratory sensations, which are transmitted through the optic nerve to the corpora quadrigemina, from which centre they are reflected back along the motor oculi (third pair) to the eyeball, where the latter nerve supplies motor nerve-force to the ciliary ganglion and most of the muscles of the eyeball.*!' As the ciliary ganglion (sym- pathetic) supplies vaso-motor nerve filaments to the eyeball, inclu- ding the iris, the excitation of which would dilate the iridal vessels, expand the iris, and proportionately close the pupillary opening, this fact is quite in accord with our theory. 2. Section of the optic nerve, or irritation of it, as with a needle, causes the pupil to contract. J Here, the reflex action is similar to that caused by the vibrations produced in the nerve by light, only more intense, owing to the irritation being greater. As in the former case, our theory is equally applicable. 3. Faradization of the third pair contracts the pupil. || In former pages we have seen how the faradic current, applied to a motor *Dr. Anstie, Stim. and Narcot., p. 409. tDr. Carpenter's Human Physiol., pp. 685, 697. $Ibid, p. 715. Dr. Dalton's Phys., p. 436. |lDr. Carpenter's Phys.,pp. 831,880. CONTRACTION OF THE PUPIL. 139 (lood, in ly from ionately )f motor ire very it must ily when aralyzers ia in the is is the 1 is to be des with he brain, coincides he eye, or :heory we erance of calibre of ance, and ar fibre of ed, the iris ital physi- ;gested. tions : — na, excite ,ptic nerve e reflected where the iglion and Tlion (sym- iball, inclu- dal vessels, y opening, ti a needle, similar to light, only As in the In former :o a motor hysiol., pp.685, ITS., PP- 831. 88°' nerve, causes rapid contractions and relaxations of all the muscular parts to which the nerve is distributed, with determination of blood to the part, etc. The motor oculi is distributed to all the muscles of the eyeball, except one. The vibratory activity set up in these muscles, and doubtless also in other fibrous structures of the eye, fully accounts for the increased local hyperaemia of the iris, and consequent contraction of the pupil. Here, again, our theory is consistent with the facts. 4. Mechanical irritation of the third pair contracts the pupil.* This is simply the equivalent of the first and second facts noted, only that the irritation is direct instead of being reflected from the sensitive optic nerve through the nervous centre of vision. The same effect on the vessels is to be noted as formerly, with a similar accordance' between the facts and our theory. 5. Section of the cervical sympathetic nerve produces contraction of the pupil, with increased afflux of blood to the head and eyeball.'f' We have seen in No. 2 of the present series, that section and irrita- tion of the optic nerve are equivalent as to their effects. In a previous page, we have sought to shew that section of the cervical sympathetic was attended by irritation, and not by paralysis, of the vaso-motor nerves of the head, (§ 203) and have quoted Goltz, Dr. Dalton and ot hers, in support of that view. Whether that position be sustained or not, the hyperaemia of the eye, in the case, is pal- pable, and this state of the iris is consonant with a contracted pupil, , and so far sustains the erectile theory, and if, as we have argued, and as is the case after section of the optic nerve, the cervical sym- pathetic is irritated and not paralyzed, then our theory also is in perfect accord with the facts of the experiment. We may add, here, that Dr. Anstie, in alluding to the experiment in question, does not regard the nerve as paralyzed, for he says " such a procedure by no means cuts off all nervous influence upon the iridal vessels ; the vitality of the nerve beyond the section, at least, will remam in great part unimpaired, to say nothing of possible communications with the centres by circuitous routes. Under such circumstances, the condition of the iridal vessels is by no means one of inactivity ; on the contrary, the blood circulates through them with increased force at the same time that their calibre i:> enlarged. Contraction of the pupil results." J 6. Irritation of the corpora quadrigemina contracts the pupils. || This is a parallel case to Nos. i, 2, and 4, excepting that instead of the sensitive or motor nerve, it is the optic nerve centre itself that is irritated, and the irritation produces similar results in dilating the vessels, and equally accords with our theory. 7. Section of the fifth pair, after all the other nerves of the eye have been divided, contracts the pupil. The same effect is attri- *Todd and Bowman, Physiol Aiiat., p. 475. t Dr. Brown- Sequard's Lectures on Cent. Nerv. Syst., p. 140. J Stim. and Narcot., p. 408. ||Dr. Carpenter's Physiol, p. 708. I t 140 PHYSIOLOGICAL THERAPEUTICS. II ^1. II butable to faradization and to mechanical injury of the fifth pair, under the like condition of other nerves, only in a lesser degree. The ophthalmic branch of the fifth pair is generally held to have purely sensitive fibres, but its long branch to the ciliary ganglion is believed to contain motor fibres passing up from the cervical and dorsal spine to the iris.* Division or irritation of these in the cilio- spinal region affects the iris also ; but it would be tedious to follow all the conditions in question, and unnecessary to do so, since injury to leading nerve trunks of the eye, by exposure and section, or irritation, is quite sufficient to account for a state of hyperaemia of the iris and its surroundings, in the way our theory suggests, and this being the case, our object in applying these physiological tests is obtained. 258. Dilatation of tite pupil \s "pxodwQtd hy the following physio- logical conditions, which appear to be fewer than those causing contraction : — 1. Faradization of the cervical sympathetic dilates the pupil.f This nerve, differing materially both in its structure and functions from a cerebro-spinal nerve like the motor oculi, faradization pro- duces, of course, a different effect. Instead of causing spasmodic contractions, alternated with relaxations, as in the case of motor nerves, the effects of faradization on it 'viH be seen in the altered calibre of the arteries which it supplies. We have already claimed that its functions so far as the vascular nerves are concerned, are paralyzed, by faradization, and that as a consequence the muscular fibres of the arterioles being no longer restrained from exerting their inherent contractile power, the calibre of the vessels is reduced, and in the case of the iris, its tissue is collapsed in the manner already described, causing an enlargement of the pupil. Here, the erectile theory and our own, are in full accord with the facts quoted. 2. Section of the third pair causes the pupil to dilate. + The ciliary ganglion is so small, that as a depot, or " magazine of nerve power " it is soon exhausted. Its chief, and perhaps only supply of motor nerve-power, as is well-known, is derived from the short branch of the third pair, which enters it. When the third pair is cut, this channel for reinforcing its dilating nerve-force is cut off ; and the muscular fibres of the walls of the iridal vessels, no longer restrained by the ciliary (sympathetic) vascular nerves, act as they always do in like circumstances, and with similar results, diminish- ing or obliterating the calibre of the arterioles, contracting the width of the iridal tissue and correspondingly enlarging the pupil. Surely no theory could meet the circumstances of the case more fairly or naturally. 3. Hoemorrhage into the ventricles of the brain is attended by a dilated pupil. || What more probable explanation of the fact than •Dr. Carpenter's Physiol., p. 684. tibid, p. 881. JDalton's Physiology, p. 522 II Dr. Bastian, Paralysis from Brain Disease, p. 234. DILATATION OF THE PUPIL. 141 paralysis of dilating vascular nerve-power, attended by arterial contraction, emptying the vessels of the iris, producing retraction of its free margin and enlarged pupil. 4. Poisoning by belladonna, prussic acid, opium — last stage, — chloroform, ditto, and by other drugs, finds the pupil dilated. In some of these cases the vaso-motor nerves seem the last to succumb ; but when their paralysis is at length complete, and their dilating power is at an end, the non-vital, and consequently non-paralyzed contractile power of the arterial coats, reduces their calibre, blood is shut out out from the iris to accumulate in the venous sinuses or elsewhere, the erectile tissue of the iris retracts upon itself, and, as a consequence, the pupil is dilated. Thus, it will be seen, the theory here suggested is applicable to the advanced ideas of modern research, as to the nature of the iris, and to the condition of its vessels, on which its contraction or dila- tation depends ; as well as to the results of experimental physiology, which may be held to be crucial tests for any theory purport- ing to explain these phenomena. CHAPTER IX. HOW THIS THEORY ACCORDS WITH CERTAIN IRREGULAR CONTRAC- TIONS OF THE ALIMENTARY TUBE, INCLUDING THE VARIOUS KINDS OF VOMITING. 259. Are the irregular muscular contractions of the oesophagus and stomach, causing regurgitation and vomiting of food and drink, depending on increased motor nerve-force, acting reflexly, and " stimulating " the muscular walls of these organs to contract, in accordance with the accepted theory, or, are the phenomena in question more consistent with an assumed paralysis of the motor nerves, and the absence of nerve-force, leaving the expulsive efforts in question to depend entirely on the inherent contractile power of the muscular walls of the oesophagus and stomach ? We propose to endeavor to shew that the latter of thtfse queries must be answered in the affirmative ; that here, as elsewhere, nerve - force and muscular contractile power are direct antagonists, and that the latter displays its characteristic action, when the former is so modified that it may be said to be paralyzed or suspended. 260. The nervous supply of the oesophagus and stomach, as is well known, is derived from the pneumogastrics, which contain both sensitive and motor fibres, and from the branches of the solar plexus, (sympathetic), which plexus is partly composed of the splanch- nic nerves. 4 m 142 PHYSIOLOGICAL THERAPEUTICS. These latter are known to contain the vaso-motor nerves, of the stomach ;* and as besides these, the sympathetic nerve suppHes the abdominal viscera with motor and sensitive nerves, the stomach doubtless receives a share of these latter nerves also from the same source. 261. We now proceed to consider the dependence,^ or otherwise, of the irregular contractions of these viscera, on nervous agency. Dr. Dalton states that after division of the pneumogastric nerves, food and drink are swallowed as before, but accumulate in the lower and middle part of the oesophagus, and " owing to the paralysis of this canal, they are not conveyed into the stomach," and *' in a few moments are suddenly rejected by a peculiar kind of regurgitation."f Now, if the muscular walls of the oesophagus were paralyzed, as Dr. Dalton, and others, assume, it would be a mere flaccid tube, and could neither offer resistance to the passage of food and drink, nor could these be " suddenly rejected," as appears to be the case. The symptoms recorded point rather to constriction of the lower end of the oesophagus, resulting from the withdrawal of nerve-force and the consequent unopposed contraction of the muscular fibres con- cerned : just as in the extinguishment of nerve-force by death, other tubes, including the arteries, lacteals and intestines pass into a state of contraction. J Indeed, the " paralysis " in all these cases, appears to be that of nerve-force, and not of muscular fibre. 262. Dr. J. Reid reports the section of the vagi in a rabbit, which had been kept fasting for sixteen hours previously, and was then allowed to eat parsley. It died in five hours. The oesophagus was found (u\\, a.nd the stomach also, 6tit not distended. A good deal of the parsley had passed into the trachea and bronchial tubes, and even into the minute air cells of the lungs. || This experiment is quoted as a proof of the paralysis of the muscular walls of these organs. But the undilated stomach, under the circumstances, points rather to a contracted state of its muscular walls, which bear witness to the characteristic power of muscular fibre, when its antagonizing nerve-force is withdrawn. 263. Dr. Carpenter refers to this subject by stating that " if the pneumogastric be divided in the rabbit on each side, above the oesophageal plexus, but below the pharyngeal branches, and the animal be then fed, the food is delayed in the oesophagus, which becomes greatly distended.§ That is to say, the upper part of this tube, where the motor nerves are still intact, behaves in a normal manner, on the entrance of food ; while in its lower part, which has been deprived of the influence of nervous agency, and nerve-force is *Dr. L. Brunton, Hand-book for the Phys. Labor., p. 493. t Physiology, p. 473. t Dr. Carpenter's Physiology, pp. 454, 334. || Drs. Todd and Bowman's Phys. Anat., p. 491. § Phys., p. 404. THE CESOPIIAGUS AND STOMACH. 143 consequently in abeyance, the muscular walls pass into a state of contraction, and so constrict the calibre of the tube as to arrest the further passage of the superimposed injesta. Could any stronger proof be demanded" in justification of the truth of our theory ? Dr. Carpenter, however, further remarks, " that the action of the cardiac sphincter is reflex, and is dependent on the ' nervous circle ' furnished by the pneumogastric nerves and their ganglionic centres, would appear from the fact that when the trunks of these nerves are divided, the sphincter no longer contracts, and the food regurgitates into the CESophagus."* This statement is hardly quite in accord with the previous quotation. And yet, both may be strictly true, for, as this distinguished physiologist adds, " The re-opening of the cardiac orifice, on pressure from zvithin, is one of the first of that series of reversed actions which constitutes the act of vomiting."f May we not see the explanation of the opening of the cardiac sphincter and the regurgitation of the food from the stomach, in the contraction of the muscular coats of the latter, liberated from the restraint of nerve-force by section of the vagi ; thus occasioning the " pressure from within," which could not occur if the organ were paralyzed : just as the contraction of the lower third of the oesopha- gus, under similar conditions, caused the sudden ejection of the food upwards into the mouth, as stated by Dr. Dalton } 264. In the very animal referred to in these experiments, Dr. M. Hall found that " the simple contractility of the muscular fibre [of the oesophagus] occasions a distinct peristaltic movement along the tube, after its nerves have been divided, causing it to discharge its contents when cut across." | 265. We have further to quote as follows : — " The ofifice of the gastric branches of the vagi nerves, appears, from Dr. Reid's e: -peri- ments, to be, chiefly, to control the movements of the muscular coat of the stomach. Mechanical irritation of these nerves causes slow and vermicular contractions of this tunic. Section of them may cause in the first instance vomiting and loathing of food."|| The reader will please note the significance of the words we have placed in italics, and also the further fact that " irritation " by no means necessarily implies stimulation, and is much more likely to be equi- valent to paralysis ; for the molecular arrangements which determine the relation of nerve-force to muscular fibre, when deranged, e-x-t temporarily overthrown, as in the action of electricity, and while so deranged — that is while the irritation lasts — may be held to set muscular fibre free, 266. The effect of electricity, here, as elsewhere, is to cause uni- versal contractions of muscular fibre, as is seen in the glottis oeso- phagus and intestines. If what we have already urged, on the paralyzing effects of this agent on nervous tissue, be true, this fact, •Physiology, p. 404. t Ibid. ijibid. || Dis>. Todd tSr» Bowman's Physiol. Anat.,p. 493. 144 PHYSIOLOGICAL THERAPEUTICS. taken in connection with the preceding physiological proofs can leave no reason to doubt the antagonism between nerve and muscle ; or that the irregular contractions ol the stomach producing vomiting, occur, not through the increased " stimulus " of nerve-force on muscular fibre, but solely through the independent contractile power of the muscular walls concerned in the process. 267. Those who insist on maintaining the popular theory of the mode in which vomiting occurs must be prepared to shew that the drugs, methods, or agents, which induce vomiting, are such as, from their nature or quality, tend either to increase the physiological activity of the ceils whose function it is to elaborate nerve-force, or in some way to call into action increased motor nerve power from the ganglionic centres, which is thence conveyed as a " stimulus " to the muscles to be acted on. 268. Now, a fall, or a blow on the head, occasioning temporary " shock," or concussion, is very likely to be attended by vomiting. Is nerve-force here augmented, or is an increased stimulus evolved from the central ganglia, by which the gastric muscle is made to contract } Surely this is a condition of which the very opposite state of nerve activity may be predicated. Again, take the deathly nausea and utter prostration, bodily and mental, occurring during sea-sickness ; or the perhaps equally fam- iliar effects produced on the tyro who smokes his first pipe of tobacco, and let him who has fully experienced either, say it these states arc favorable to an increased development or discharge of nerve-force ; or if they are not, on the contrary, much more sugges- tive of a condition of the gastric nerves bordering on paralysis. Or, spread oui before us a list of the accredited emetics, and in- dicate which of them, in emetic doses, would be thought of as a stimuLant to nerve-force ; or which we would dare to administer, in such doses, in states of the system where exhaustion was predomi- nant, and in which we desire to restore the flagging energies. We have said, " in emetic doses," because it is in such doses that the nervous circle of the pneumogastrics and other motor nerves engaged in the reflex act, are said to receive the " stimulus " which produces emesis. 269. Those drugs, ipecacuanha, tartar emetic, &c., which cause emesis when introduced into the blood from any part of the system* are known as " specific " emetics. Dr. Headland classes them as special sedatives, and declares them to be nervous depressants, the effect of which is directly of an opposite kind to that of stimulants.f These, then, cannot produce emesis by means of a reflex action of a " stimulating" kind. See Apomorphia, § 325. The other and larger class of emetics, of the primarily irritant kind, as sulphates of zinc and copper, common salt, mustard, &c., * Dr. Headland, Action of Medicines, p. 106. t Ibid, p. 296. ¥■■,1-5 ACTION OF EMETICS. •45 >ofs can ■nuscle ; )miting, 3rcc on e power ' of the :hat the as, from iological force, or ver from iulus " to mporary romiting. evolved made to opposite )dily and ally fam- : pipe of ' it these harge of J sugges- ysis. ;, and in- t of as a inister, in predomi- jies. We ; that the s engaged produces ich cause e system* y them as sants, the mulants.t action of y irritant stard, &c., do not cause emesis when introduced into the system, elsewhere than in the stomach, as do the former. Inasmuch as when taken into the stomach, they can only irritate its own surface, by contact, and do not directly impress the diaphragm or other abdominal muscles, which are also called into action in vomiting, it is held that these extraneous muscles must be acted on reflexly through the same nervous channel as in the former case, namely, the pneumogastrics and motor nerves of expiration.* 270. There can hardly be any doubt that this reflex impulse is '^so of a depressing kind. As already pointed out, an " irritant " is by no means to be regarded as necessarily producing stimulation. Dr. Headland defines the term " irritation," used in this connection, as " a violent dynamical action on nerve and muscle, differing both from the healthy agency of a stimulant and the chemical operation of an astringent mcdicine."f A " dynamic " impulse of this kind may so affect a nerve as to disturb those mysterious molecular changes, b)' which ner\'c-forcc operates, and this perturbation may so affect the relations between nerve-force and muscular fibre as to release the latter from restraint. Indeed, it seems certain that both what we call increased nervous activity, and paralysis, are simply effects of the differences in the mode of motion of the molecular particles of which nerve tissue is composed ; such changes ha\ ng their start- ing point from the terminal filaments of sensitive nerves, and from the central or ganglionic origins of the motor.J 271. The only drug of this class of emetics, about the non-stimu- lating action of which any doubt need to exist, is mustard ; which, at first sight would appear to be an excitant. Dr. Ringer, however, points out how slight an effect this substance produces on the stomach, compared with its action on the skin ; and that it does not increase the gastric secretion. || Now, as this secretion is depending on the activity of nerve-centres, present in the walls of the stomach,§ and as these are evidently not stimulated by mustard, or the gastric secretion would be increased, we may reasonably infer that the larger nervous circle, before referred to, through which reflex ner- vous impulses take place between the stomach and brain, are equally unstimulated by mustard. There is, therefore, reason tO' conclude that the real action of mustard on these nerves is of a depressing kind, and like others of its class, acts by freeing the muscular fibre of the gastric walls from the influence of their restraining nerves, in accordance with the view of "irritation" just stated. 272. Tickling the fauces. — In regard to the manner in which vom- iting is brought about by titilating the fauces, there seems little reason why so innocent a procedure, should either excite or depress *Dr. Carpenter's Human Physiology, p. 408. t Action of Mcdicines,note, p. 105' tDrs. Todd and Bowman, Phys. Anat., p. 213. || Therapeutics, p. 360. §I)r. L. Brunton, Hand-book for the Physiol. Laboratory, p. 492. 146 PHYSIOLOGICAL THERAPEUTICS. the functional activity of the nerves concerned in vomiting. Still, if we nvust regard the effect produced, in this instance, as origina- ting in more than a mere ideo-motor impulse, called forth by a strong desire to produce emesis, and a fixed belief that this process will achieve it, we must refer it to a change in the molecular nerve current, which in this case is equivalent to depression. 273. Dr. Anstie distinctly refers to vomiting as an effect of paralysis of the medulla oblongata in narcotism,* and if this is true of one case, or of one series of cases, we have reasonable ground for attributing vomiting otherwise arising to depression rather than to excitation of the nerves concerned in it. 274. The vomiting of pregnancy. — Why the gravid uterus, in any stage of gestation, should occasion either stimulation or paralysis. of the gastric nerves, and by either process set up contraction of the muscular walls of the stomach, with its attendant results, is by -no means obvious. But that the rapid development going on, not only in the uterine tissue, but in the contents of that organ, during the early part of pregnancy, should require, and attract ':o itself a much larger than ordinary share of the vis nervosa of the body, is not at all surprising. Nor is it to be wondered at, that in conse- quence of this excessive demand for nerve-force on the part of the uterus, the stomach should suffer a deprivation of the same, with the consequences which follow such deprivation. 275. We see, very commonly, a similar state of things existing between the brain and the stomach. Severe mental effort, by attracting an unusual amount of blood and pabulum to the cranial ganglia, to replenish the corresponding waste, deprives the stomach of its customary supply, causing retarded and impaired digestion. A full meal, on the other hand, as is well known, is a very unfavor- able condition for mental labor : nerve-force being pre-engaged in the process of digestion, is, in most persons, unable to afford suffi- cient additional energy to the brain to carry on a simultaneous expenditure of nerve-force there. If severe mental effort or active muscul -r exercise be enforced, during these circumstances, digestion suffers proportionably to the diversion of nerve-force in each case. 276. These demands upon nerve-force, however, are at most only of periodical or occasional occurrence ; while in the case of the uterus, the progressive development and consequent demand for vital energjy iis incessant, for months at a time : so that the monop- oly and its consequences tend to perpetuate themselves. In our highly civilized communities, where physical necessi- ties, mental anxieties, social customs, late hours, and other concom- itants of life at high pressure, tend to exhaust nerve-force, the condition we are considering is more prevalent and distressing than *Stiin. and Narcot., p. 168. VOMITING OF PREGNANCY. 147 r. Still, origina- th by a process ar nerve effect of s is true ound for than to 5, in any paralysis, action of ts, is by T on, not n, during itself a body, is in conse- rt of the ime, with existing ffort, by le cranial stomach digestion. unfavor- igaged in ford suffi- lultaneous or active , digestion ch case. most only ase of the emand for le monop- .1 necessi- r concom- -force, the issing than in ruder states of society, where life is less artificial and more natural. If to these causes of nerve exhaustion, be added an irregular distribution of nerve-force among the organs, and the large extent to which it is monopolized by the impregnated uterus, we may find a sufficient explanation of the vomiting of pregnancy. Deprived of its normal nervous restraint, the gastric muscle ceases to be ade- quately controlled : slight additional causes of nervous depression give to its muscular fibres the preponderance over weakened nerve- force, and the result is seen in those irregular, untimely, and excessive spasmodic contractions of the stomach, by which its contents are ejected, with much suffering and inconvenience. This abnormal condition is sometimes continued during the greater por- tion of the period of gestation, until the uterus, having completed the process of storing up nerve-force in its thickened walls, utilizes it in powerful efforts for extruding its contents. 277. So far as we know, this is an entirely new and original method of accounting for the vomiting of pregnancy. If we avowed any feeling of diffidence in presenting it, we fear our statement would hardly receive the credence it deserves, seeing that we have already ventured to commit ourselves to so much not in the beaten track of present medical opinions. However, we think there is a basis of truth in it, and proceed to add, that this view of the ques- tion suggests a modification to some extent, of the method of treat- ing that condition. 278. Among the indications in question, which will naturally suggest themselves to the intelligent reader, are, the withholding of remedies of the purely " sedative " class, at least in sedative doses, which are often prescribed under the assumed necessity of *' quiet- ing " irritation of the gastric nerves. If these nerves are already too poorly supplied with nerve-force, from the cause assigned, we should seek, not indeed to starve those of the uterus, but to place those of the stomach in a condition for receiving a fuller supply. Here, as elsewhere, the expenditure should be kept strictly within the income, and an effort made by physical and mental rest and quietude, by good air, recreation and cheerful surroundings, and' such other hygienic influences as are available, to secure as large a margin as possible of surplus nerve-force over its consumption in the organism. Our efforts may be aided by gentle frictions over the stomach, and other means having a tendency to direct the attention and concentrate ideo-motor impulses to a greater extent on thai organ. 279. It is a circumstance favorable to our theory that many of the remedies which experience has sanctioned, will be found, here as elsewhere, to be in full accord with it Nux vomica has long: had a reputation in this connection. Cod-liver oil, where it can be in 148 PHYSIOLOGICAL THERAPEUTICS. u' ■ ■-i n borne, an'd phosphorus, suitably administered, ought to be indicated. Arsenic or quinine will sometimes be valuable, in suitable cases. A reference to the " food action " of these drugs will find : place in a future chapter. Drugs which aid in the nourishment of nerve-cells or nerve tissue, should be administered separately, rather than combined, and in small doses, which just approximate, but do not produce their ordi- nary pathogenetic effects. Vinum ipecacuanha deserves special mention for its power in controlling ordinary functional vomiting. It should be given in drop doses, or less for children, in a teaspoon- ful of water. In the vomiting of pregnancy it will often be of value, and may be alternated with one or other of the more purely neu- rotic remedies. Of course, undue acidity should be corrected with mild alkai s ; excessive flatulence with proper dietary regimen. Old bread should be preferred to fresh ; a moderate quantity of cold water substituted for hot drinks ; tea used sparingly ; ginger and peppermint slops, never. A fair quantify of good animal food is to be preferred to a diet chiefly of vegetables. Without proper regard to these and other minutiae, mere drug action, under any theory of the case, can- not be expected to succeed ; but in spite of our best efforts our success will sometimes be only partial. 280. We must not omit to notice two methods of treatment, directed to the uterus itself, which are vouched for as having promptly arrested the vomiting of pregnancy. One is, the mechani- cal dilatation of the os and cervix, by the finger. Two physicians, Dr. Copeman, President of the British Medical Association, and Dr. Thomas, of Swansea, report the favorable results of this procedure.* The other, and most recent method of treatment, for this condi- tion, is the free application of the solid nitrate of silver to the os and cervix uteri, from which procedure prompt and successful results are reported in the journals. We do not see anything in either of these modes of operation antagonistic to the theory above suggested. In both cases, the sen- sory nerves of the os and cervix are more or less irritated ; though, for various reasons, these vaginal mucous surfaces are less sensitive to such impressions than the external integument. The impression transmitted by these nerves to their centres, and from thence reflected back to the body of the uterus, is not necessarily of the nature of a scimulus ; as we have heretofore shewn in the case of other irritations of nerves. {§ 270.) To show how completely the term "stimulus" is sometimes improperly used, let us consider what is the effect of a caustic appli- cation to the too exuberant granulations of a wound or ulcer. These granulations, vulgarly called " proud flesh," do not indicate a *Brit. Med. Jour., 1875, PP- 637, 707. Braith. Retros., January, 1876, pp. 208, 2lo. CAUTERIZING THE OS UTERI. 149 dicated. e cases, place in ^e tissue, and in iir ordi- special omiting. 2aspoon- ofvalue, ely neu- alkai 3 ; d should bstituted nt slops, red to a lese and :ase, can- forts our reatment, s having mechani- lysicians, , and Dr. 3cedure.* is condi- the OS ul results operation J, ihe sen- though, sensitive npression thence y of the e case of ometimes 3tic appli- or ulcer. indicate a p. 208, 210. weak or lowered vitality of the sore ; on the contrary, there is too profuse a supply of bioplasm, or new forming material, undergoing excessive development. What we do by lightly touching the part with caustic, is to checjc redundant growth ; and in doing so we kill many of the bioplasts, and cause the remaining germinal matter to grow more slowly and more normally. This is not stimulation, but repression.* A similar excess of plastic or formative material, and correspond- ing cell growth, occurs in the inflammatory process. In chronic pneumonia, the application of blisters, when beneficial, is doubtless to be explained by the reflex influence they exert in contracting the walls of the dilated blood vessels, which, in consequence, convey less blood and pabulum to the focus of cell growth, thus favoring the extinction of the inflammatory process.i* We make this state- ment advisedly, because it has been shewn that the "^ spletive" or " revulsive " theories of counter-irritation are unsatisfactory or unten- able ; and that the remaining hypothesis which regards the morbid action within, as "superseded " by the artificial one thus created on the surface, is " really a relic of notions belonging to times which were antecedent to the birth of scientific physiology." + In the uterus, a greater, though normal, yet extraordinary, cell growth and development is going on, requiring a proportionate monopoly of nerve-force. Now, if here, by reflex action, through the sensory nerves acting on the vaso-motor and trophic or nutritive nerves, this process were restrained, or modified, so as to proceed less rapidly, and thereby make a less urgent demand upon nerve- force, more of this indispensible produci would be available for other organs, and for restraining the untimely contractions of the muscular walls of the stomach, thus exercising a favorable effect on the vomiting in question. Thus the two modes of procedure referred to above, may be regarded as forms of irritation, of a depressing rather than of a stimu- lating kind ; resulting in a diminished supply of blood and pabulum to the uterus, or in the lessened utilization of these, in the process in which that organ is engaged. This will not appear unreasonable when we remember that not only a retardation, but even an arrest, of cell growth and development, and the death of the foetus, occurs at times from causes operating directly or reflcxly through the nervous system. We may also call to mind in this connection, the reflex effects of irritation of the urethra by catheterization, and the violent rigors and physical depression which sometimes follow. 281. Infantile vomiting. — We have only to suggest on this sub- ject, that surely the presence in the infant's stomach, of undigested food, often in curdy lumps, cannot be the occasion of the calling forth of increased nerve-force ; and cannot act as a " stimulus " to *Dr. Beale, Disease Germs, p. 280, &^c. tibid., pp. 414,416,0.-^. J Dr. Anstie^ Practitioner, March, 1870, p. 156. Braith. Retros., July, 1870, pp. 70-1. fSo PHYSIOLOGICAL THERAPEUTICS. .:■: I M f- y: '■'U ' if •i ** the nervous circle : " and is much more likely to cause the trans- mission of a message to the brain, and such an arrangement of the molecules of the nerves concerned, as is^ equivalent to depression. The contraction of the stomach, which follow^ ejecting the offend- ing mass, results from the concurrent release of the inherent contractile power of that viscus. 282. T/ie intestinal canal. — We have now a few words to add in reference to the antagonism between nerve-force and muscular fibre in the control of the intestinal tube. This great canal, like all other muscular tubes in the body, undergoes a marked degree of contraction in its calibre after death, when nerve-force* is no longer present. Prof. Valentin has shewn that if a portion of an intestinal tube from a recently killed animal, be filled with water, one extremity tied and a glass tube connected with the other, the water will rise in a few hours to a considerable height in the tube, owing to the contraction of the intestinal walls.* Paralysis of the intestinal nerves, by electricity, also induces con- traction of the same intestinal fibres, and thus doubtless aids in expelling their contents, as this agent is known to do in certain cases. In chronic diarrhoea, with undue relaxation and distension of the intestinal walls, it need excite no surprise if faradization should exert a favorable effect in the same manner. Drs. Beard and Rockwell allude to cures of both constipation and diarrhoea by this agent, in the 2nd edition of their valuable work.-f In considering the action of belladonna (§ 331), this subject will be found partially discussed ; but must here be considered at greater length. 283. The proper peristaltic action of the intestines may be held to depend upon the maintenance of the due balance of power between the antagonizing forces which regulate its calibre. If motor nerve-force be in excess, the tube will be dilated. If vaso-motor nerve-force be also in excess, the glandulae and follicles will be freely supplied with blood, and as, a consequence, the secretions will be increased, perhaps to such an extent that a diarrhoea may result. If motor nerve-force be in abeyance, and muscular contractile power paramount, the calibre of this tube will be reduced, and if secretion be at the same time diminished, from vaso-motor paralysis, as is very likely to occur, the condition of the bowels will be one of sluggishness, torpidity and constipation. The proper way of remedying the latter condition, is evidently,, to assist nerve-force by nutritious food, moderate exercise, and, if need be, by food medicines, which augment the functional activity of the nerve-cells - ud thus contribute to its increased production. When this method is ignored, and constipation is treated by purga- tives, which are generally tissue irritants, and act by irritating the *Dr. Carpenter's Human Physiology, p. 334. t Pages 579, 580. ACTION OF CATHARTICS. 151 le trans- it of the pression, : offend- inherent ) add in liar fibre le body, ir death, as shewn [ animal, onnected siderable il walls.* [ces con- s aids in 1 certain listension adization T. Drs. tion and e work.f t will be it greater be held Df power If motor .so-motor be freely 3 will be result, ontractile d, and if paralysis, )e one of evidently, e, and, if il activity •eduction. Dy purga- tating the glandulae and follicles through which they are extruded from the blood, after having first passed into the circulation,* or in their way. down the intestinal tube, the effects on the general condition are merely temporary, and the chief result is, that as the outraged folli- cles become accustomed to this mode of assault, they treat it with less attention ; and, heavier battalions of pills, powders and drastics have to be thereafter brought into requisition, to compel obedience. Schroder van der Kolk is quoted as an authority for the state- ment, that " long experience and a great number of post mortem examinations have satisfactorily proved that chronic constipation is almost always dependent on contractions in the descending colon."f 284. The use of fruits, brown bread, &c., assists by the mechani- cal bulk of these, in overcoming the tendency to contraction: and the increased secretions poured into the canal, as the result of the tissue irritation referred to, aid, no doubt, in a similar manner. Besides this general action, as tissue irritants, which is common to them all, the saline cathartics, while in the blood, exercise a deteriorating effect on that fluid. The constituents of fibrin are diminished, and the tendency of the red corpuscles to aggregate together, is lessened.J This is a species of action which must be admitted to depress motor and vaso-motor nerve-force, and through the latter to lessen vascular activity. Hence the reputed advantages of these in acute febrile cases, where a mild antiphlogistic is indicated. II Indeed the action of cathartics generally produces a depression of nerve-force, as felt in the languor and weakness they occasion. So far as this affects the bowels, the result is to favor the contrac- tion of their walls : an J if these have been previously moderately dilated, an impetus will be given to their expulsive force. The pouring out of coj^ious secretions from the innumerable glandulae and follicles, tends to distend the bowels ; and in proportion to the vigor of the muscular contractions, on one hand, and the bulk of the foece.s, mechanically dilating the tube on the other, will be the resulting peristaltic action. To the same cause may be attributed the irritation of the sensitive nerves causing tormina or griping, which is rarely absent during the process in question. If we substitute for the distending pressure of foecal matter, a relatively large quantity of flatus, the product of mal-digestion, a nearly similar condition of the antagonists results ; the dilating influence of the nerves, aided by the expansive force of the flatus, sometimes occasions great distension, which, however, is usually limited to a particular portion or tract of the tube. This constitutes colic. •Headland, Action of Medicines, pp. 109, 337, tSr^c. t Dr. Richard Hughes, Pharma- codynamics, p.*42i. X Dr. Headland, Action of Medicines, p. 212. Illbid. m^ 152 PHYSIOLOGICAL THERAPEUTICS. 285. The treatment, which experience has justified, is in accord ,with the view just enunciated. Warm fomentations externally pro- duce a " sedative " effect, not only on the sensitive nerves which transmit the pain, but on the motor nerves which are promoting the dilatation. Sedatives internally, as opium or morphia, &c., by paralyzing these nerves, produce similiar beneficial effects, in the same manner ; and these means may be further aided if necessary by copious injections of warm fluids, to distend the bowels below the dilated portion, partly by their mechanical bulk, and partly by the stimulus they afford to the local nerves of this portion of the tube, and so favor the passing away of the flatus. Sometimes, indeed, one or other of the diffusible stimulants, by increasing dilating nerve-power in the constricted, or less dilated, portion of intestine, above or below the flatus, proves a valuable auxiliary in promoting thf object in view. 286. We have only to quote Dr. Carpenter to prove, not only the contractility of the muscular fibres of the intestines, but also that they are in no way dependent on nervous agency for the exercise of that endowment. He says : — " The ordinary peristaltic movements of the intestinal canal are fully accounted for by referring them to the contractility of the muscular portion of its walls, called into action by direct stimulation : and that they are not in any degree dependent upon nervous connection with the cerebro-spinal centres, is clearly shewn by their continuation after the destruction of these." Again, " The intestinal tube, from the stomach to the rectum, is not dependent upon the nervous centres, either for its , contractility or for its power of exercising it, but is enabled to expel its contents by its own inherent powers ; still we find that here as in other instances, the nervous centres exert a general control over even the organic functions, doubtless for the purpose of harmonizing them with each other, and with the conditions of the organs of ani- mal life."* What we ask the reader to believe, is, that muscular tissue comes under" the domination of that general "control" just mentioned ; not for the purpose of exciting contraction in its fibres, which, as we have just seen, is unnecessary, but for restraining that contraction, the continuance of which after the destruction of the nerves, is so clearly pointed out. 287. We submit that the natural and legitimate conclusion from all this, is strongly in favor of our views. We have seen that section of the pneumogastrics is followed by contraction of that portion of the oesophagus on 7, which is thereby deprived of nerve influence; and also that the stomach under similar conditions has remained contracted. It is admitted, apparently accidentally, that section of the gastric nerves may cause vomiting. And yet we do not pretend that either section o** paralysis of a motor nerve is usually or neces- • Physiology, pp. 409, 4''o. ACTION OF SPHINCTERS. 153 I accord illy pro- is which >ting the &c., by 5, in the issary by 2I0W the y by the he tube, i, indeed, dilating intestine, romoting only the also that (cercise of ovements referring Is, called ot in any sro-spinal istruction :h to the ler for its 1 to expel lere as in itrol over monizing is of ani- muscular rol" just its fibres, ning that ion of the sion from at section )ortion of nfluence ; remained section of >t pretend or neces- sarily attended by speedy contraction of the muscle it supplies, especially in the case of voluntary muscles. (§ 82). The continuance of the contractions of the intestinal walls after the destruction of their nerves, is a circumstance the advocates of the dependence of muscular fibre on a nervous " stimulus " would do well to explain. 288. In regard to the behaviour of the nervous system in its relation to the sphincters, we are fortunate in having simply to quote the authorities to show that our theory has nothing to fear from this quarter. Thus Drs. Todd and Bowman .state : — " The action of the sphincters of the anus and bladder seems, at first, peculiar. . . They are constantly contracted unless the contained matters are forced within them by a superior power. Now, their mass, and therefore their contractility, is superior to that of the wall of the cavity above ; consequently their passive contraction endures while that of the parts above is being gradually mastered by the accumu- lation of faeces or urine. But when these excretions at length excite active contraction in the walls of the cavities containing them, this overcomes the passive contraction of the sphincters and the evacu- ation occurs. The sphincters have striped fibres and voluntary nerves, by means of which we can, for a time, add active to passive contraction, and thus retard the expulsion ; but, as the accumulation proceeds, this power is diminished or lost, and the sphincters yield. The levator and sphincter ani frequently aid the accumulation ot the faeces by temporary active contractions, by which the faeces tending to dilate the sphincter are pushed backwards for a while. The rectum is thus preserved empty until the period immediately preceding defecation." " In paralysis of the lower part of the body from disease or injury of the spine, the vobmtary power of the sphincters is lost, and the faeces and urine pass involuntarily. But this is 710 proof as is com- monly imagined, tJuit the ordinary contractioti of tlie spJiincter is an active one, performed in obedience to a continuous nervous stimulus. The difference is, that it can now induce no active contraction through the nerves, to counteract temporarily, and in obedience to the will, tJte actii>e contractions of the parts above, which are not under the influence of volition, and are not paralyzed. Hence, whenever the faeces are driven against it, it gives way, against the patient's will ; and — if the sensitive nerves are also paralyzed — without his know- ledge."* Here the independent power of the intestines and bladder is again distinctly stated. " The parts above " the sphincters are not paralyzed ; but, on the contrary, their " active contractions " force open the passively contracted sphincter, which retains its inherent contractile power, and exerts it, but is unable to receive any aid from the power of the will acting through the motor nerves, and •Physiol. Anat., p. 180. ^S4 PHYSIOLOGICAL THERAPEUTICS. I»is consequently it is overpowered and yields to a pressure against which it has struggled in vain. How curious it is that silent forces should be thus operating within us, for our benefit, of which we are wholly unconscious ! The authors just quoted, further state :— ^" An examination of the action of the sphincter will show that the anus is kept closed ordin- arily dy tJie passive contraction of the muscle itself. .... Dr. Hall indeed cites two experiments which imply that the action of the sphincter is dependent on the cord. In both, however — one on a horse, the other on a turtle — the observations were made immedi- ately after division of the cord. By the division, the whole organ was thrown into an excited state, both above and below the section, and therefore manifested phenomena similar to those excited by volition. Indeed, we have seen the sphincter repeatedly contracting, after tlie division of tlie cord, without the application of any new stimulus to it ; and the dog continuing to raise and depress his tail as long as the irritation of the cord produced by the section has continued.* We need not support this part of the argument any further, since it will be seen from the foregoing how fully in accord our general theory is with the action of the sphincter, as presented by the eminent physiologists we have quoted. 289. Do any of our jocular and less thoughtful readers enquire, why, after section of the spinal cord, and the consequent " liberation of the muscles " of the dog's tail, from " the restraining influence of their nerves," — to quote our own words — and after the subsidence of the pain and excitation of the nerve tissue, consequent on the section, the tail does not continue to wag, from " the inherent con- tractile power of its muscular tissue," which is now entirely free to assert itself } If our friend will study the anatomical arrangement of the interesting part in question, he will find, that muscles, there as elsewhere, have their antagonizing muscles, and that when one contracts, its opponent must relax ; but when all the antagonists are in an equal state of relaxation, passive contraction, or rigidity, any motion of the part they govern is impossible. Our would-be critic will find it necessary to discover some better support for his argu- ment than the useful appendage referred to. 290. As a corroboration of the foregoing views of the activity of the intestinal muscular fibres, when released from the domination of their motor nerves, we append the following, which is communicated to us by a medical gentleman of ripe judgment and rare powers ol observation. This gentleman had a favourite dog, who became unaccountably ill, declining food and drink, lay continuously on the bare earth, on his belly, and looked very sad. After sixty hours Jiad elapsed, and seeing that the dog showed some aversion to drink- * Physiol. Anat., pp. 299, 300. POST MORTEM ACTION. iJS" against it forces we are m of the d ordin- . Dr. kction of —one on immedi- )le organ 2 section, cited by itracting, any new is his tail :tion has ler, since r general d by the enquire, liberation luence of ubsidence nt on the rent con- ly free to angement les, there when one jonists are idity, any J-be critic his argu- ictivity of lination of nunicated powers ol o became uously on ixty hours n to drink- ing, Dr. W began to fear the onset of hydrophobia. A medical fri'^nd attempted to administer a purgative bolus, but the dog snapped at him, and as a viscid saliva was running from his mouth, a coal sledge was brought into requisition, and the dog was killed by a blow on the head. While a grave was being dug in the vicin- ity, they heard a pretty loud sound, and on looking round were surprised to see that a copious black semi-fluid discharge had been expelled from the bowels, having an extremely offensive odor. How is this curious circumstance to be explained .<• The advocate of the accepted theory may claim that during life the intensified action of nerve-force so " stimulated " the sphincter of the rectum, as to retain the faecal mass ; and that death, by withdrawing that •' stimulus," left the sphincter paralyzed and relaxed, and hence the post mortem discharge. But to argue thus is to ignore the facts of physiology, which shew that the passive contraction of the sphincter is depending, not on nervous agency, but on the inherent power of the muscle itself. Voluntary effort might, indeed, temporarily, but not continuously, assist in maintaining this passive contraction and closure of the sphincter, but this would be the case much less in the dog than in man, because animals are accustomed to defecate whenever the pre- sence of faecps calls for this act. Is it not much more reasonable, and in accordance with physiol- ogical consistency, to assume that the retention of this mass was owing to the want of contractile power in " the parts above," which, during life, were overpowered by an antagonizing dilating force, and that when death put an end to this restraining power of the nerves, and left the muscular contractile power of the intestinal walls free to act, the necessary contraction took place, expelling the accumulated mass } The explanation we have supposed to be offered above, namely, an increased stimulus from nerve agency, compelling the sphincter to contract, — necessitates an unusual development of nerve-force on this occasion. But, we ask, were the physical conditions favorable for such an exertion of nerve-force, in excess of its ordinary activity .-• Sickness, fasting, solitude, and sadness — which the facial expression even of a dog can plainly indicate — were not favorable conditions for the development of such a marked increase of nervous energy. Indeed the very existence of such an exudation, indicated a depraved condition of the system, and its elimination, must already have severely taxed the vital forces. The situation then is not at all favorable, nay, it is inconsistent with increased nerve-force, which is itself a product of cell-life, depends on just such conditions as favor normal cell activity ''•enerally, and is not an entity, existing. siii generis. But it may be said, on the theory we advocate, there must also* have been a great preponderance of nerve-force, to restrain the con- 156 PHYSIOLOGICAL THERAPEUTICS. ' J- , 'i tractility, and consequently the expulsive force of the intestinal walls. Not so, because the mechanical bulk of this faecal mass, would, of itself, offer an obstacle to intestinal contraction, and this passive force, in conjunction with ordinary nerve-force, would suffice to prevent contraction of the muscular walls. By removing one of the allies — nerve-force — the balance of power is reversed, and muscle triumphs. 291. In now bringing this part of our subject to a close, we ask the reader to bear in mind that the quotations adduced in this essay, in favor of our theory, are drawn from writers wh.^se facts were compiled under the dominant idea of a hypothesis thty were engaged in establishing ; and from experiments, in recording which, they would naturally and innocently dwell most forcibly on those observations favorable to that hypothesis, to the perhaps uncon- scious omission of circumstances favorable to a different but un- thought of interpretation. To expect a full endorsation of the views here presented, in such a quarter, would be impossible. It will, of course, remain for the reader to judge, candidly and fairly, of the merits of this theory, in view of such authoritative admissions as we have been able. to gather, and from such general considerations as have served to show its adaptation to the pheno- mena of disease and remedial agents. We claim that there is a consistence in the assumed modes of action, both on the part of nerve-force and drugs, which contrasts very favorably with the accepted physiological theory of the action of both ; the latter theory, as we have already shewn, necessitating the alternate and even simultaneous presence of stimulation and paralysis in the same nerve, and by the same drug, in order to meet the exigencies of the theory. ACTION OF MEDICINES. 157 testinal .1 mass, .nd this d suffice one of I muscle we ask in this se facts ity were g which, on those i uncon- but un- i of the e. idly and loritative 1 general e pheno- lere is a le part of with the he latter nate and the same ies of the CHAPTER X. HINTS ON THE ACTION OF MEDICINES IN ACCORDANCE WITH THE THEORY HERE SUGGESTED. 292. Sixth general principle. — Certain drugs, by modifying the activity of the vaso-motor nerves, (increasing their power by nutri- tive changes in the cells which generate nerve-force, or paralyzing the nerves themselves, and so arresting their functional activity,) cause an increase or diminution of the calibre of the blood vessels ; and so exert an important influence, not only over the nutrition and temperature of parts, but in controlling congestion and inflammatory processes, and so restoring normal circulatory activity. 293. The principles advanced in the foregoing pages, although of much interest and importance to bqth physiology and therapeutics, would have their practical value materially enhanced, if they served to some extent to interpret the action of medicines and to guide to their proper application in disease. 294. How drugs act, in the various curative processes, is a prob- lem surrounded by the gravest difficulties, and one which, at present, it is impossible to solve. But in the case of many, which act through the agency of the nerves, the theory we have ventured to suggest affords a rational guide to their uses in morbid states ; and on this basis, aided by recorded facts, we propose to offer a few hints on this very difficult subject. In a general way, drugs expend their action : — (a.) In modifying the quality of the blood. {b.) In modifying the nutritive and functional activity of the tis- sues and organs, directly. (c.) In modifying the nutritive and functional activity of the tis- sues and organs, through the agency of the vaso-motor nerves, as regulators of the blood supply and pabulum which reach them. Of the first two of these modes of action, we have nothing suffi- ciently new or important to add to what is already taught, to justify a special reference to them here. They will be noticed incidentally, however, inasmuch as several drugs exert a direct influence over the blood and tissues, in addition to the indirect influence which they exert over the latter through the nervous system. 295. We have already had occasion, in the previous pages, to refer to the physiological law, " that the functional activity of an organ is directly proportionate to the supply of blood to the organ."* *Dr. C. B. Radcliffe, Lectures on Epilepsy, (S^h;., p. 238. 158 I'lIYSIOLOGICAL THERAPEUTICS. Guided by this leading principle, we may assume as a rule, that those drugs wjiich lessen or abolish the functional activity of an organ, — as a gland, — do so by diminishing its blood supply, and with this the pabulum on which its functional activity is fed : while the very reverse condition applies in the case of drugs which mani- festly increase the functional activity of an organ. Here, blood supply is augmented. This necessitates a previous dilatation of the arterial walls, which effect, in turn, depends on vaso-motor, — dila- ting — activity : hence the drug of this class is one which improves or reinforces the development ol nerve-power, of which the increased vascularity and augmented secretion are the consequences. 296. We have, then, before us, the distinctive effects of two classes of drugs, both acting through the nervous system. (a.) Dru^s, which, l^ paralyzing the vaso-motor nerves induce vascular contraction and its consequences, diminished blood supply and lessened, or arrested, functional activity, secretion, etc. (b.) Drugs, which, by reinforcing the vaso-motor nerves induce vascular dilatation, with increased afflux of blood, and as a conse- quence, augmented functional attivity. 297. We have to notice in this connection — and will refer to the fact hereafter — that increased secretion is not always, or necessarily, dependent upon dilatation of the blood vessels leading to the gland or tissue displaying this increased activity : for certain paralyzing drugs, as opium and calabar bean, in poisonous doses, occasion pro- fuse perspiration and an excess of other secretions, although they are at the time paralyzing the vaso-motor nerves, with the effect of diminishing the calibre of the blood vessels, and so lessening general vascular activity. Indeed, certain secretions, — including perspira- tion — continue to be formed after the general death of the body, and under these circumstances, they cannot be attributed to nervous influence, or to an increased supply of blood from dilated arteries. The explanation of these facts, in apparent contradiction to the " rule " mentioned above, and to the formula "<^," is not far to seek. The vaso-motor nerves control the calibre of the arteries, but so far as yet known, not that of the capillaries, which have an independent " power " of their own over their contents.* When the larger arteries are diminished in calibre, the blood which they contain is necessarily forced towards, and into, the veins. As the capillaries are the channels through which thi x takes place, their temporary distention is a matter of course ace the capillary circulation generally, including that of the ^. nds within the body, and of the skin, may be rendered more active for a time. Thus, increased blood supply may be present in the tissue or gland displaying temporarily augmented functional activity, although there is no dilatation, but even the reverse, of the arterial tubes leading in that direction. * Dr. Carpenter's Physiology, p. 494. ACTION OF DRUGS. 159 3ntam is 298. In other Ctises, certain drugs cause increased secretion by direct irritation of the tissues concerned, without active determination of blood to the part. Here, according to Prof. Kuss, the secreting cells imbibe the materials on which they iecd from the surrounding tissues.* From these observations it will be seen that the first of these apparent exceptions to the general rule stated above, based on Dr. Radcliffe's physiological law, is not really so exceptional as il might at first appear, and practically is not exceptional at all : and as for the other class of cases, — where secretion results from tissue irritation — we have not claimed that all drugs are neurotics, or that they display their effects solely through the medium of the nervous system ; though this is the rule with many. Thus, aconite, while it is essentially a paralyzcr of nervous tissue, has acrid proper- ties, which are shewn in its effects on the mouth and the adjacent sub-mucous glands • and the anodyne morphia, in its passage out of the system, through the skin, sets up irritation, itching, and even efflorescence. These diverse effects of the same drug, are embarassing to any system of classification ; but as we have set ourselves chiefly to elucidate the effects of drugs operating through the nervous system, we shall give this feature prominence and regard direct tissue irrita- tion, when it occurs, in othenvise neurotics, as incidental and secondary. 299. In considering drugs from this point of view, it is important to bear in mind what has been already advanced as to the effects of impressions made upon different parts of the nervous circuit. Thus, an exciting or depressing influence, affecting a sensitive nerve, is carried to the nervous centre or ganglion with which that afferent nerve is connected, and is reflected thence upon the corresponding motor nerve. This is one mode in which the results of exciting or depressing influences may be attained. A second mode is by impressions made directly upon the nervous centres, or ganglia, themselves ; and a third, where the exciting or paralyzing influence impresses the motor nerves directly. Drugs may impress each of these portions of the nervous circuit, the exclusion of other portions ; and hence, while their general v-ftect may be that of paralyzcrs or excitors of vaso-motor activity, t' .'ir special action may be different, owing to the portion of the .^rvous tissue which they primarily impress. Examples of this will be found as we advance. 300. Before proceeding to a brief notice of several drugs belong- ing to each '^f these classes, we desire to offer a few further remarks in reference lo drug action in general. And first, we have to remind tlie reader, of the marked difference in effect between small and large doses of the same drug. In •Lectures on Physiol., Duval, Aniory, p. 219. i6o PHYSIOLOGICAL THERAPEUTICS, numerous instances, even our most potent poisons exhibit, in minute dose:, effects on the organism, which would appear to entitle them to the designation, in a certain sense, of foods. Thus, com- mon salt, so familiar and indispensible to us as a condiment, is a useful and safe emetic in medium doses, while in extremely large doses it is an irritant poison, and has caused death in several cases.* The now well authenticated use of arsenic by the Styrian people, for nutritive purposes, and the value of strychnia, in small doses, in coldness of the extremities, from deficient dilating nerve power, are examples in point, which might easily be multiplied. " Indeed, it is hardly too much to say that we cannot state with certainty of any food, that it may not also be a medicine and a poison ; nor of any poison that it may not also be a medicine and a food, under some circumstances."-}- 301. Some of the effects we are now considering are doubtless produced upon the tissues, either directly, or through the medium of the trophic or other nerves, which preside over nutrition, or by an influence exerted upon nerve-force acting on the vaso-motor nerves, where the results are attended by increased vascular activity. We have before remarked, that nerve-force is not an entity nor an individuality, to be arbitrarily invoked or restrained ; but depends for its production upon a healthy nutrition of the cells in which it originates.! Those agents, then, which cause its development, must, in some way, contribute to normal nutritive changes, and so to some extent, partake of the character of a food. 302. But we have further to notice, besides this food action of certain drugs, in small doses, the fact, that the minimum or moderate dose of some drugs produces physiological effects of a well marked kind, apparently a degree beyond what can be attributed to a food action; and which, besides, is of an opposite kind to the action of large or full doses of the same drug. Thus, chloroform is a stimulant in the first stage of its operation, but subsequently a profound paralyzer. Chloral hydrate often causes temporary cerebral excitement and a remarkable flushing, before its sedative and narcotic effects are displayed. Opium in small doses, allays bronchial irritability, and is then an indirect expectorant, but in large doses it renders respiration difficult and expectoration impossible. (Headland.) We shall shortly see, that the condition of the system, has, at times, an important influence in determining the effects of certain drugs, of which digitalis furnishes a good example : but this mode of explanation does not suffi'^e for all. As we can neither alter the fact in question, nor ignore it, we must only allow it its full weight in the conclusions to be arrived at. 'Dr. Anstie, Stim. and Narcot., p. 29. t Ibid, p. 31. :J:Dr. Carpenter's Human Physiol., p. 132. ACONITE. i6r 303. In what is to follow, we do not undertake to deal exhaust- ively with the several drugs to be mentioned, as to do so would fill a volume in itself. What is intended, is to show the adaptation of 3 the theory suggested in these pages to the mode of action of lead- ing remedies, and perhaps to blend with this a few practical hints^ which may enhance the usefulness of this work to the student. DRUGS WHICH PARALYZE VASO-MOTOR NERVE ACTION, AND SO TEND TO INDUCE ARTERIAL CONTRACTION. 504. A CON IT E. — This may be taken as a typical drug of the sedative cuss. No one who reads the symptoms of poisoning by aconite, can doubt for a moment that it is a profound paralyzer of nerve-force, both sensitive and motor : while at the same time it leaves the cerebrum and the faculties which act through it, usually uninfluenced, almost until death closes the scene. How, amid such gieneral paralysis as aconite induces, it could ever have been regarded as an excitor* of any part of the nervous system is surprising. And yet, though it is not generally taught that aconite is an excitor, the accepted vaso-motor theory requires that it be so regarded ; for, according to that thetxy : — Vaso-motor excitation induces ^.rterial contraction. Vaso-motor paralysis permits arttrial dilatation.^ Arterial contraction is a prominent feature of aconite poisoning, as seen in the general coldness, palene.>s and faintness ; the failing pulse, in spite of ti e tumultuous action of the heart, the blue lips, livid face, and othei signs of collapse, all betoken obstructed ' circu- lation, owing to diminished calibre of the vessels, through which even the urgent throbbings of the heart can no longer force the blood. Sensory and motor power, too, are extinguished ; and yet amid this scene of rapid and fatal paralysis, we are taught to look for excitation of the nerves of the blood vesse''', (on the theory men- tioned,) as the proximate cause on which arterial contraction depends. Substitute for this impracticable theory the one we have ventured to suggest : — Normal state. — The inherent contractile power of the arterial coacs, opposed by the dilating influence of the vaso-motor nerves, and these antagonizing forces so duly balanced as to maintain healthy circulatory activity. Abnormal state, (from a narcotic or paralyzing drug). — The vaso- motor nerves paralyzed ; their dilating power weakened or abolished ; *Achscharumow, Dr. Ringer's Therapeutics, p. 396. Dr. Meryon, Func. Symp. Syst. of Nerves, p. 52. Dr. Richard Hughes, Pharmaccdynamics, pp. 39, 40. tSee references, § 194. 162 PHYSIOLOGICAL THERAPEUTICS. :p I -11 : giving an undue preponderance to the contracting power of the arterial walls, inducing arterial contraction, with the effect of pale- ness, coldness, collapse, etc. Aconite an example. Abnormal state y (from a stimulant or exciting drug). — The vaso- rnotor nerves excited ; their dilating power increased, so as to over balance the contractile power of the muscular walls of the arteries, resulting in arterial dilatation, as in flushing, hyperaemia, etc. Nitrite of amyl and the first stage of alcohol, examples. This schema accords with the phenomena of aconite poisoning. It recognizes the general paralysis which is predominant through- out. It accounts for the power of aconite in congestive and inflam - matory states, and it does this in a simple and natural manner. 30$. Here, the vaso-motor (dilating) nerves are paralyzed, and have their functional activity suspended. As a consequence, the inherent contractile power of the muscular fibre of the coats of the arteries comes into unrestrained action ; reduces the calibre of the vessels, and so retards, or ends, the undue afflux of blood, with its injurious or ruinous consequences. 306. Aconite is chiefly of use in the early stage of vascular excite- ment, and before secondary changes, or effusion of bioplasm, has taken place. " It has no influence on the blood itself, and will fail to control such fevers as depend upon a poisoned state of that fluid. Its use in gastric, typhoid, typhus and yellow fevers, is mere waste of precious time, and even in scarlatina, variola and measles, it will not lower the circulation until the eruption comes out."* Still, it is often of material use in the latter series of cases ; but where the fever is very intense, the constitution vigorous and the pulse full or bounding, it has a powerful rival in veratrum viride, which may often be substituted for it with advantage. In the hot stage of intermittent fever, aconite is much inferior to gclseminum. It has been recommended for rheumatic and neuralgic affections, but apart from its paralyzing and benumbing effects on sensitive nerves, its utility here will be found limited to those cases attended with, or dependent on, a congested or hyperaemic condition of the neurilemma or nerve sheath ; for which this drug is appropriate, as in similar congestive states elsewhere. 307. Cases of aconite poisoning are not unfrequently attended by tremors, spasms and convulsions. In the antecedent pages we have shewn reasons for attributing these effects to a withdrawal of nerve influence from the muscles, rather than to an " excitation of the nervous centres." The general paralysis of the motor nervous system induced by aconite, accords with this view. 308. There is much confusion in regard to the various prepara- tions of this drug ; there being four difterent tinctuies in ordinary use, one of the leaves and three of the root. From one to foui *Dr. Richard Hughes, Pharmarodynamics, p. 41. VERATRUM VIRIDE. 163 • of the of pale- le vaso- to ovet arteries, Nitrite )isoning. :hrough- inflam - ner. zed, and nee, the ts of the e of the with its ir excite- asm, has will fail hat fluid, ire waste s, it will still, it is rhere the e full or lich may stage of fifections, sensitive attended •n of the 3riate, as ended by s we have of nerve •n of the nervous prepara- ordinary i to foui minims of the B. P. tincture may be given every half hour, hour, two hours, or at longer internals, according to the activity of the circulation and the ur^cn'^y of the symptoms. Fleming's tincture is about six times stronger, and should be prescribed accordingly in proportionate doses. 309. VERATRUM V/RIDE.— This drug has been found inval- uable in sthenic inflammatory fever, of any tissue or organ, with full bounding pulse and great vascular activity. One to four drops of the fluid extract, in a teaspoonful of cold water, for an adult, every half hour, hour or two hours, according to the severity of the symptoms, to be diminished in quantity or frequency as these abate, will succeed even better than aconite in subduing arterial excite- ment, lowering temperature, and modifying the inflammatory or acute febrile state. In presence of such results blood-letting is not to be thought of. 310. Like other paralyzers of nerve tissue, its excessive use will induce prostration and even alarming symptoms ; and like others of this class, also, it is not applicable to adynamic fevers, of a low type, where both nerve and muscular force are already enfeebled. Here, the true remedies are cleanliness, fresh air, and nutrient foods and medicines of a corresponding class. 311. As usual, in accordance with current therapeutics. Dr. Ringer, and others, attribute the muscular spasms and convulsions produced by poiscnous doses of veratrum and its alkaloids, to " heightened reflex . mction of the spinal cord," at the very time, too, when, on his own shewing, the cord and motor nerves are being paralyzed !* The reader can see how much more reasonable and consistent is the view here suggested. Its mode of action is undoubtedly like that of aconite, z. e,, by paralyzing the vaso-motor nerves, the contractile fibres of the arterial tubes are enabled to diminish the calibre of these vessels, thus relieving hyperaemia, congestion, etc., and favoring a returi "> normal circulatory activity. If the dose be too large, or too often repeated, prostration, vomit- ing, etc., will result : while in extreme cases a further extension of this motor paralysis, by setting free the contractile power of muscu- lar tissue will usher in spasms or convulsions. Here, the action attributed to th 3 drug is uniform, consistent and rational ; and applies to a greater or less degree to the action of other drugs of this class, which have yet to be considered. A stimulant is the best antidote to the state of depression referred to, which should never be produced. Besides the special usefulness of this drug in sthenic inflamma- tory fever, it has been highly recommended for internal use in acute inflammatory rheumatism, and externally as a lotion in erysipelas.. The dose has been already mentioned. 'Therapeutics, p, 377"8. l64 PHYSIOLOGICAL THERAPEUTICS. " rigor " often wit- - (Mil: 312. GELSEMINUM. — This is another paralyzer of motor nerves generally, of which effect the vaso-motor nerves receive a due share. Owing to some pecuh'arity of its quality this drug is 'especially adapted for the febrile stage of :ntermittents. It must also impress the sensitive nerves, for it is occasionally highly useful in neuralgia, sciatica, etc. Of its utility in relieving after-pains, the writer can bear witness. Administered to excess, it paralyzes the optic nerve, so as to induce dim-sightedness, or even temporary blindness. 313. The fluid extract of gelseminum in doses of from one to four drops, in a teaspoonful of water, repeated every couple of hours, or as the exigency of the case may require, will be found a very useful remedy, not only in the conditions mentioned, but in simple ephemeral fever, and in moderate fevers generally, inclu- ding those of the exanthemata. 314. It very promptly relieves those states of nessed after parturition, following extraction of a tooth," or other slight operation, where a general tremor, with chattering of the teeth, etc., occurs, but without a real chill, or sensation of cold. In sleeplessness from mental worry, etc., it has induced sleep. It is prescribed with confidence by some persons, in spermatorrhoea. In all these cases, its action is that of a uniform paralyzer of vaso- motor activity, diminishing hyi>viraemia, like other sedative drugs, in the manner already indicated. 315. Dr. Ringer, as usual, furnishes us with a refreshing illustra- tion of the absurdity of the accepted theory of vaso-motor innerva- tion ; or rather of the shifts to which its adherents are driven, in accounting by it for the phenomena of disease. Of this drug he writes : — " It is interesting to observe, that large doses of the alka- loid, at first paralyze, and then excite tetanus, which in a short time gives way to paralysis.*'* What would be thought of a system of Natural Philosophy, which required us to believe that cold, at first freezes water, then melts it, and soon after freezes it again ! When such teachings are orthodox (.?) surely a little medical heresy is commendable, rather than otherwise. But the error here is on the other side ; and the theory of these pages is in strict accord with sound physiological science. 316. OPIUM. — The uses of this great sedative are well known. The difference in effect between small and large doses — a difference which might lead to the supposition that they belonged to different drugs, — is very well marked. The former may, perhaps, be consid- ered equivalent to a species of food action, as supplying a certain want in the system, and thereby reinforcing nerve-power, in those conditions in which such doses are indicated. 317. Itis with the sedative or narcotic dose that we havehere to deal. The manner in which this action of the drug relieves the after-pains •Therapeutics, p. 454. OPIUM. i6s of motor receive a is drug is It must hly useful pains, the so as to m one to couple of e found a ^d, but in lly, inclu- often wit- or other ng of the ti of cold, sleep. It latorrhoea. • of vaso- ive drugs, 5 illustra- innerva- driven, in drug he the alka- hort time system of i, at first ! When heresy is is on the cord with ill known, difference I different 3e consid- a certain in those :re to deal, ifter-pains of parturition, and yet promotes uterine contraction, has been pointed out. (§ 1 86). The same rule holds good in the body generally. Opium and morphia are among the remedies which paralyze nerve- force, producing thereby contraction of the muscular fibre of the arterial tubes, reducing their calibre, diminishing hyperaemia, &c., and accordingly, are among our most valuable remedies for conges- tive and inflammatory states.* That they are narcotics, and so paralyze nerve-force, is undisputed. Their mode of action on the blood vessels accords well with our theory. They also illustrate the general law referred to in the earlier part of this chapter, which asserts that remedies which are found to lessen vascular activity, diminish secretion, as a conse- quence, and the reverse. 318. Opium and morphia diminish arterial blood supply and arrest the secretions everywhere. Hence their general use in the cure of indolent ulcers whose unhealthy state is maintained by pas- sive congestion ; in diarrhoea and other morbid fluxes ; and hence, too, their injurious effects in bronchial disease, where the air cells are loaded with mucous or bioplasm, which it is desirable should be expectorated ; which effect, in larger than food or nutritive doses, these drugs tend rather to check than to facilitate, by paralyzing the bronchial nerves and so permitting a tightening of ^he bronchial tubes owing to the now no longer restrained contractile power of their muscular fibres. On the contrary, in phthisis, these very effects are sometimes an advantage, when bronchial relaxation and its accompaniments are excessive. 319. It is unnecessary to refer at length to the uses of opium. Whenever pain is to be relieved, opium or morphia, by the mouth, or the latter hypodermically, has no successful rival. Here it acts as a paralyzer of the sensitive nerves, just as in reducing the calibre of the bloodvessels it acts by equally paralyzing the vaso-motor nerves : and in its extreme effects it causes convulsions of the vol- untary muscles by an extension of the same mode of action. 320. The relief of spasmodic states sometimes afforded by opium, or morphia, is apparently in antagonism to the theory here suggest- ed, since we have held that spasms and irregular muscular contrac- tions are caused by withdrawal or paralysis of nerve-force, by such drugs as these and other narcotics. But the benefit derived in these cases may be accounted for as follows : — ist. Opium by paralyzing the sensory nerves, stultifies the sensation of pain, till the cause shall have ceased, or otherwise have been removed — as in colic — where a stimulant like chloric ether is often more effectual. 2nd. In spasmodic states of voluntary muscles, if opium proves cura- tive, it must be in such conditions of the organism, and in such doses, as to excite and invigorate, rather than depress or paralyze •Dr. Wilks, Braitli. Retros., July, 1869, p, 35. British American Journal, Montreal i860, p. 179. i66 PHYSIOLOGICAL THEK AP: .h TICS. the already enfeebled nervous centres ; just as we have before quoted Dr. Anstie to prove that the stimulant dose of chloroform cures or mitigates convulsions, which the narcotism of chloroform is prone to induce. The effect of opium in these cases, then, is akin to what we have called its food action,* rather than to its true physiological effect of sedation or narcotism. This view of the case is strength- ened by Dr. Ringer's statement, that the effect of opium as an anti-spasmodic is much enhanced when combined with a stimulant, as alcohol, aether or chloroform .-f* 321. The same explanation will apply to the reported beneficial effects of hypodermic injections of one-fourth to one-eighth of a grain of morphia in cholera, (by Dr. T. J. Gallagher, of Pittsburg, and others). Here, owing to the condition of the bodily functions it is probable only a part of these doses really comes into use ; that portion may suffice to re-inforce nerve-power, and so favor dilata- tion of the blood vessels, with a return to circulatory activity and restoration from coilapse. Too large a dose, produc '^g " sedative " effects, would certainly p-ove dange/ous under circun stances where nervous prostration is already carried to an extreme. Having thus shewn that the action of this drug is consistent with the theory here suggested, and having hinted at its general uses in disease, we deem further reference to it unnecessary. 322. APOMORPHIA. — This is a hydrochlorate of morphia, and is a product occurring in the retrograde metamorphosis of morphia. It is a snow-white, or grey, amorphous powder. In solution, it is prone to acquire a greenish tinge and in time becomes black ; changes wRich impair or destroy its efficacy. Its solution in syrup appears to be most stable. It differs from morphia in its chemical reaction and has apparently but feeble hypnotic powers. 323. The chief quality of apomorphia is its rapid production of emesis, without gastric irritation, and without the prolonged sick- ness attending ordinary emetics. To these advantages are to be added the smallness of the dose required, which enables it to be used hypodermically in certain cases of poisoning, or where swallowing is difficult or impossible, or is resisted, as in the case of children. It has been used for the extruding of foreign bodies from the oesopha- gus, along with, or rather in advance of, the contents of the stoniach. 324. The dose for an adult is from one-tenth to one-twentieth of a grain, and for a child one-fortieth of a grain hypodermically. If swallowed, one-fourth of a grain for an adult, and proportionately to this for a child. Larger doses have been recommended, for example, one-sixth of a grain hypov.ermically and one-half grain by the mouth, as an average dose for an adult man.:|: *Dr. Wilks, Braith. Retros., July, 1869, p. 36. t Therapeutics, p. 490. J Dr. Walter G. Smith, Dublin Journal of Medical Science ; Braith. Retros., July, 1875, p. 219. APOMORPHIA. 167 ; quoted :ures or Drone to what we ological trength- hia, and norphia, )n, it is ! black ; n syrup hemical )duction red sick- »e added De used owing is ren. It [Esopha- of the tieth of illy. If ately to xample, by the Dr. Walter 19. 325. Apomorphia is stated by Dr. Samuel J. Gee, of St. Bar- tholomew's Hospital, to be a powerful depressant and " contra- stimulant." It produces vomiting very promptly, without any gastric irritation, evidently through its action on the crqinial centres, acting, as the same writer states, " like a blow on the head, &c." It paralyzts the motor-nerves, producing effects " as if muscular power were gone : " but " the vascular system does not appear to be depressed to an equal extent." It has the drawback of being extremely costly, which may, hower, be obviated in time. It is the most prompt, certain, and easily administered emetic known, and if further experience guarantee its safety, in proper doses, it will prove a most valuable addition to the materia medica. Its absorption through the skin of those engaged in manipulating it, causes lassitude, weakness, headache, constant nausea, and sud- den vomiting. Apomorphia may be produced from codeia. An intermediate product between the two is chlorocodide, the effects of which are similar to those of codeia, and are salivation, dilatation of the pupil and extreme restlessness ; and in fatal doses, mixed paralysis and spasms, both tonic and clonic, consciousness remaining unaffected.* The effects of apomorphia, from what is stated of its medicinal use above, and, judging from its origin, must be similar. It will be seen how tuUy the action of this drug bears out what we have advanced in a previous chapter, (§ 268), that vomiting is the result of a paralyzing, and not of a stimulating action on the nerves concerned in that process : since apomorphia is admitted to be a powerful depressant, or paralyzer, and at the same time to produce vomiting with remarkable promptitude, in one case within eighty seconds after its hypodermic administration. J.6. BELLADONNA.—h.^'^Xyvci^ the rule laid down in the earlier part of this chapter, as to the relation between vascular supply and secretive activity, we find, that as belladonna arrests the secretions generally, including that of the mammary, perspiratory and salivary glands.-f it must be considered a drug which diminishes the calibre of the blood-vessels. 327. On the other hand, this drug produces a remarkable efflor- escence of the skin, not unfrequently attended by evidence of local hyperemia. We do not include its special effects upon the bram in this category, such as giddiness, intoxication, intolerance of light and sound, cheerful delirium, merry craziness, amaurosis, illusions of vision, &c., because these are all evidences of paralys.' ther than of excitation of the cerebrum \% as the loss of motor power, diffi- culty of swallowing, twitching, jactitation, convulsions and coma, are also indications of a similar state of the motor nerves, jj *Dr. Samuel J. Gee, of St. Bartholomew's Hospital, Braith. Retros., January, 1870, p. 226. tDr. Ringer, Therapeutics, p. 458. :J:Dr. Anstie, Stim. and Narcot., p. 181. LDr. Ringer, ib., p. 462. i68 PHYSIOLOGICAL THERAPEUTICS. r 4:'' 'k Acrid effects were attributed to this drug by Dr. Christison, ow- ii^ to the dryness it produces in the mouth and throat ; but these effects are attributable rather to the arrest of the secretions of the sub-maxillary and other glands.* 328. As for the signs of hyperaemia referred to, they are not inconsistent with paralysis of the vaso-motor nerves and the conse- quent diminution in calibre of the arterial system : for it is over the arteries, and not over the capillaries that the vaso-motor nerves exercise control. When the calibre of the larger arteries is first re- duced, blood is necessarily forced out of them : and it needs excite no surprise if this should occur under circumstances to occasion a temporary excess of vascularity in the terminal or superficial capil- laries. It is asserted by some authorities, that the influence of belladonna exerts itself primarily, or chiefly, on the central portion of the arterial system, while aconite, on the contrary, displays its chief power over the vascular system at the periphery, that is over the smaller arterial ramifications which terminate in the capillaries. If these should contract in advance of the larger arteries, retarda- tion of the flow of blood to the capillaries would be among the earliest effects of aconite ; and this circumstance would account for the great value of this drug in congestive and inflammatory states, as compared with belladonna. 329. Dr. Brown-Sequard compares the effects of belladonna on the blood vessels to that of ergot. He has seen the vessels of the pia mater of dogs contract after large doses of both these drugs.f The effects of atropia are similar to those of belladonna, only more intense. 330. We have seen in the foregoing pages how well our theory accounts' for the production of diminished vascular action, by agents which paralyze the vaso-motornerves; andhowas a consequence of this reduced calibre of the vessels and diminished blood supply, glandu- lar and other secretions are diminished or arrested, and how even the action of the heart may be presumed to be modified through the same agency. The cerebral phenomena, just recounted, are equally consistent with this view of the action of belladonna : and with an anaemic state of the brain ; for Dr. Todd, in " his admirable Lectures on Delirium and Coma, has fully established that the anaemic state is highly favorable to the production of both delirium and coma.":*: 331. How shall we account for the successful treatment of consti- pation by belladonna, as recommended by Trousseau, and confirmed by others .•* In order to reply to this interesting enquiry, let us first see what is the cause of constipation. Is it a want of sufficient peristaltic contractile action to urge forward the contents of the intestinal tube.? If so, what tissue is at fault .-^ Not the nerves supplied to •Dr. Ringer, ib., p. 458. tDr. Riiigsr, Therapeutics, p. 464. J Dr. Anstie, Stim. and Narcot, p. 131. BELLADONNA. 169 )n, ow- t these s of the are not conse- )ver the r nerves first re- 5 excite :asion a il capil- lence of 1 portion plays its it is over pillaries. retarda- long the count for states, as lonna on :1s of the ; drugs.f nly more ir theory )y agents iceoft'iis glandu- 10 vv even •ough the e equally with an Lectures mic state coma."t of consti- onfirmed see what )eristaltic intestinal Dplied to nstie, Stim. the intestinal walls, for Dr. Carpenter assures us that, " the ordinary peristaltic movements of the intestinal canal are fully accounted for by referring them to the contractility of the muscular portion of its walls." And again, " the intestinal tube, from the stomach to the rectum, is not dependent upon the nervous centres, either for its contractility or for its power of exercising it ; but is enabled to pro- pel its contents dy its own in/ierent powers."* The nerves supplied to the intestines are those of the sympathetic ; but "the motor influence does not originate in the sympathetic ganglia, but is derived from the spinal cord."f Now, as these spinal motor nerves, passing through the sympa- thetic ganglia to the intestines, do not incite contraction of the mus- cular fibres of these, since the intestines possess this power indepen- dently of the nerves, it is pertinent to ask what function do these nerves perform } As motor nerves they do not transmit afferent or sensitive impressions, and, besides, sensitive fibres are present for that purpose. In accordance with the theory here suggested, we ask, is not the function of these motor nerves to restrain the contractile tendency of the muscular fibres of the intestinal tube, just as the vaso-motor nerves do for the arteries, and so to keep that great duct dilated, and when acting in excess, to render it sluggish and inactive, by lessening its contractile and propulsive power over its contents } Paralysis of these dilating nerves by belladonna or by electricity,, and other agents, is thus seen to favor contraction of the intestinal muscular walls; reducing their calibre and urging forward their contents by that peristaltic or vermicular wavy motion, for which unstriated muscular fibre is noted. (See § 282, &c.) 332. If this explanation were true, it may be asked, why do not other paralyzers of motor nerves, as aconite or ergot, produce sim- ilar effects on the intestinal tube ? Some of these motor paralyzers do so ; and of those which do not, it may be said that they doubt- less select other portiqps of the nervous tract on which to display their powers ; of which selective affinity we have many examples. Thus, some narcotics paralyze the sensory, some the motor nerves, while others assail the nervous centres, Tartar emetic injected into the veins produces pneumonia, croton oil applied to an abraded surface purges.J Dr. Anstie says mercury has a selective affinity for the fifth pair ;|| and other similar examples might be multiplied.. 333. Of course the process here mentioned is n- ' the only way in which intestinal activity may be brought about. Increased func- tional activity of the numerous glands and follicles which pour their secretions into every part of this long tube induce accelerated pro- gression of its contents. Many of the class of medicines known as purgatives effect this result, by promoting these secretions. But this •Physiology, p. 409. tibid. J Dr. Headland, Action of Medicines, pp. 298-9, !l London Lancet, Nov., 1872, on Lead and Mercury poisoning. "170 PHYSIOLOGICAL THERAPEUTICS. u ' C is not the mode of action of belladonna, which, as we have seen, arrests secretion generally, throughout the body. 334. It is no slight advantage to a theory which professes to in- terpret the action of drugs, that it does so by attributing to them an uniform and consistent action, and does not require alternate or even simultaneous excitation and paralysis of nervous tissue by the same dose to account for the phenomena. Contrast the results of the theory here suggested in this respect with such announcements as the following : — " Belladonna paralyzes the peripheral branches of the vagus, and at the same time stimulates the nervous centres of respiration ;"* these centres being the very root or origin of the vagi themselves. Dr. J. Harley attributes to this drug similarly antagonistic action.f In rebuttal of these views we have Dr. Anstie's authority that "the process of narcotism is an uniform one, and tends entirely in the direction of nervous death," and that the idea of excitation of one portion of the nervous system going on simul- taneously with depression of another portion, " is inconsistent with what any unprejudiced experimenter must observe." :J: 335. Of the action of belladonna on the iris enough has been sug- gested in the section in which the adaptation of our theory to the pupillary changes has been discussed. 336. The therapeutic uses of belladonna depend on the general action heretofore attributed to it. The extract, softened by warm water or glycerine, and freely applied to the mammary glands in threatened mastitis will materially aid in dispersing the engorge- ment of the vessels on which that state depends. The officinal lini- ment, locally applied, is said oy Dr. Ringer to check excessive per- spiration ; and in painful conditions of the 5th pair, the same application, or moderate doses of the drug internally, will often prove beneficial. The constrictive power of belladonna over the calibre of blood-vessels is sometimes advantageously employed in aborting boils and other congestive states, as of the os uteri. Dr. Anstie regards this drug as especially adapted for painful states of the pelvic viscera. In irritable bladder, atten(ied with too rapid ex- foliation of epithelium, simulating the presence of calculus ; and in nocturnal eneuresis from irritation of this viscus, belladonna or atro- pine, I -60th to I -80th of a grain, once or twice a day, frequently relieves. II As belladonna is, in great part, eliminated from the blood with the urinary secretion, its effects on the parts concerned in this function may be partly accounted for in this way. Belladonna has its admirers in the treatment of whooping cough, asthma, delirium of low fever, epilepsy, mania, erysipelas, &c. 337. A great deal has been written in reference to the special in- fluence of belladonna in scarlet fever. Dr. Richard Hughes, a lead- ing homoeopathist, and consequently an authority on that side of the •Dr. S. Ringer, Therapeutics, p. 477. tibid, p. 465, dr^:. JStim. and Narcot. p. 408. ilBraith. Retros., July, 1869, p. 100. DIGITALIS, 171 ; seen, to in- them latc or by the lults of 2ments anches itres of of the milarly ^nstie's ne, and le idea simul- nt with ;en sug- ' to the general y warm lands in ngorge- nal lini- ive per- e same 11 often )ver the oyed in :ri. Dr. tates of apid ex- and in or atro- :quently le blood i in this cough, :c. ecial in- 5, a lead- ie of the :ot. p. 408. controversy, states that in the "miliary" variety of scarlatina bella- donna is useless. In the ordinary form of the disease it does not shorten its duration ; does not diminish the fever ; does not influ- ence the sequela; of scarlatina due to renal affection ; and is con- fessedly unable to cope with the more malignant forms of the disease. Dr. Hughes administers it " somewhat as a matter of faith, resting on analogy," we are led to suppose between the rash produced by belladonna and that of the disease.* This is rather a poor record by a friendly hand, in reference to a drug about which so much has been written, in connection with this disease. 338, DIGITALIS. — There is indubitable proof that this drug not only induces a diminution of the calibre of the blood-vessels, thus increasing blood pressure, but that it also favors the contrac- tion oi involuntary muscular fibre generally, throughout the body.+ Dr. Handfield Jones says, "Kulp's account of the action of digi- talis in inflammatory diseases, seems to prove that it induces arte- rial contraction, rendering the hands and feet cold."| A further or excessive degree of this contractile effect on the vascular channels, gives rise to vertigo, giddiness or syncope, and in animals, to tremors and convulsive movements : while among the other poisonous effects are dryness of the throat, vomiting, weak- ness of the voluntary muscles, and a feeble, intermittent pulse. || Besides these effects, which so far have an uniform character, digitalis notably produces more vigorous heart-beats, a firmer pulse, with increased vascular activity, absorption of serous effusions and increased renal secretion.§ 339. These apparently contradictory effects have given rise to much speculation and to many theories as to the true action of this drug. What has to be accounted for is : — (a.) The lessening of vascular activity in some cases. (b.) The increase of vascular activity in others. (c.) The apparently opposite effects on the heart : — the drug sometimes producing intermittency and at other times deserving to be called "a cardiac tonic." We will consider these separately, in accordance with the theory of vaso-motor innervation presented in these pages, and see how far it affords an explanation of this problem. (a.) In states of the system, with the arteries not unduly dilated, or only so to a moderate extent, digitalis, acting as we have seen aconite and other drugs of this group to act — with differenc ^ to be pointed out hereafter — lessens the activity of the vaso-motor ne; ves,. reduces the calibre of the vessels, diminishes blood supply and less- * Pharmacodynamics, p. 149. tDr. Dickinson, Med. Chirur. Trans.j Vol. XXXIX. ; Braith. Retros., July, 1864, p. 47. JBraith. Retros., January, 1869, p. 75 ; also ditto, p. 274. I! Dr. Pereira, Mat. Med., vol. 2, p. 458. Dr. Robertson, Braith. Retrospect, July, 1864, p, 48. §Braith. Retros., Dr. Reith, January, 1869, p. 73. Ibid, Dr. Fother- gill, July, 1869, pp. 80, 81. 172 PHYSIOLOGICAL THERAPEUTICS. ens vascular activity. This is the first mode of its operation refer- red to above. (b.) When the muscular walls of the heart and arteries arc defective in contractile power, unable to overcome the influence of their dilating nerves, and consequently remain imviodcratcly dilated, digitalis by reducing the proportionally undue activity of these nerves, by partially paralyzing them, restores the normal balance of power between these opposing forces, gives the preponderance to the contractile efforts of the muscular fibres of the cardiac and ar- terial walls, in the manner so frequently indicated, and in this way brings about more vigorous contractions of the heart and a greater or less degree of reduction in the calibre of the vessels, which in their now more tense and elastic state transmit the blood with more force and rapidity than before :* improving the pulse, increasing the temperature, promoting absorption of effusions and favoring a re- turn of the normal secretions, with increased elimination by the kidneys of the fluid previously effused. Thus digitalis, which, in the other case, really lowered the circu- lation, here as certainly quickens and improves it : but in both cases through the same quality of its action ; the difference being in the different condition of the vascular apparatus acted on in each case. 340. The two conditions just discussed find their parallel in Dr. Withering's observations. Writing of the effects of digitalis on the kidney in producing diuresis, he says : " It seldom succeeds in men of great natural strength, of tense fibre, of warm skin, of florid complexion, or in those with a tight or cordy pulse."f Why ? Because in such subjects the development of muscular fibre in the arterial walls, as well as elsewhere, is such, that undue dila- tation of these vascular channels is so strongly opposed that it is not likely to occur. The effect of digitalis in so far as it reduces their calibre, is simply to curtail vascular activity still more : and Dr. Radcliffe's physiological law, already quoted, is to the effect, that diminished blood supply necessitates lessened secretion. Dr. Withering adds, " On the contrary, if the pulse be feeble or intermitting, the countenance pale, the lips livid, the skin cold, the swollen belly soft and fluctuating, or the anasarcous limbs pitting readily under the pressure of the finger, we may expect the diuretic effects to follow in a kindly manner."^ Here, the muscular fibre of the arterial walls, is weakened or relaxed, permitting excessive dilatation of these tubes. Digitalis produces a " tightenmg " of these flabby channels, and with this, an increased rapidity and force of the circulation ; transmitting more blood through a given point in the same time than before. An impetus is thus given both to •Dr. Carpenters Physiolc^y, p. 485. ;ibid. tDr. Pereira, Mat. Med., Vol. II., p. 462. DIGITALIS. ^7^ 11 refer- rics arc lence of ' dilated, )f these .lance of ranee to and ar- il is way greater trhich in ith more ising the ng a rc- \ by the he circu- oth cases g in the ch case. el in Dr. ib on the s in men of florid Why.^ fibre in lue dila- that it ar as it vity still uoted, is lessened feeble or cold, the IS pitting 2 diuretic ir fibre of excessive nmg" of and force l^en point both to II., p. 462. nutrition and secretion, which in the other case were retarded or arrested ; though in both, the mode of action of digitalis was prc- ci.sely the same. 341. It is in the class of cases last indicated that digitalis best displays its power. Our theory points out how this result is achieved. By withdrawing — paralyzing — the restraining power of nerve-force over the inherent contractile power of the muscular fibres of the arteries, the latter are enabled to exert their proper function of reducing the calibre of the dilated vessels to a more normal .size, with the effects just stated, of increased arterial tension, improved circulatory activity and its concomitant results. 342. (c.) We have yet to notice the third of the series of appa- rently antagonistic effects of digitalis, namely, its sometimes produ- cing intermittency and at other times increasing the force of the heart's contractions. We have seen how the effects of digitalis on the general circula- tion differs, in the different condition of the blood-vessels themselves. Let us apply the same conditions to the heart. In the person of tense fibre, or where the coronary arteries are a little more than ordinarily contracted, digitalis, by contracting them still more, and thus diminishing the proper blood supply to the cardiac tissue, lessens the nutritive activities on which the heart's movements depend : and, if administered in sufficient quantity, may prove dan- gerous by a threatened arrest of its action. (§ 246.; Hence its feeble, hesitating, or intermittent action, sometimes produced by digitalis. On the contrary, where the systemic vessels, generally, are enfeebled or relaxed, or where the semi-lunar valves are unal)le to close the expanded orifice of the aorta, and a regurgitation of blood takes place, into the ventricle, weakening the force of the; blood current, which consequently becomes sluggish, tJie nutrition of the heart j/z^Ivj' as well as that of more distant organs. The delicate cells, in which nerve-force is generated, on which the continued action of the heart's mechanism depends, have their functional ac- tivity reduced, and irregularity and intermittency of its pulsations follow as a consequence. Digitalis, by restoring the normal calibre of the vessels, puts an end to this unhealthy condition, at least in ordinary functional cases, where the derangement is not too extreme to be remedied ; assists the more complete closure of the aortic valves ; induces more vigorous changes in the heart's tissue, and, as a result, improves its propulsive power ; a species of improve- ment which once begun tends to perpetuate itself Here, again, the mode of action in both cases is the same, so far as the drug is concerned. The effect exerted on the vascular nerves throughout is one of uniform paralysis, giving preponderance to the muscular fibres of the cardiac and arterial walls. 174 PHYSIOLOGICAL THERAPEUTICS. 343. Other remarkable effects of digitalis remain to be noticed. Dr. Fothergill, in poisoning a frog with aconite, found " the ven- tricle become more and more distended, its contractions slower and more feeble, until each contraction drove only a small quantity of blood off th :; top of the distended ventricle, and at last, the greatly distended heart ceased to beat. At this crisis he administered digi- talis, and soon contractions at long intervals took place imperfectly ; the gaps became shorter and shorter and the contractions more and more complete, until the heart beat naturally."* Aconite, how- ever, failed to dilate the heart of the frog contracted by digitalis. The similarity and difference between these two drugs may be thus stated. Both p>aralyze the vaso-motor nerves, but at different points of the nervous circuit : the action of aconite being exerted at the periphery, and of digitalis at the central nervous ganglia, inclu- ding the cardiac, dilating, nerves. These last being paralyzed, the heart becomes contracted, owing to the inherent contractile power of its muscular tissue finding itself no longer opposed. The heart is more choked with blood in poisoning by aconite, owing to the generally contracted state of the entire terminal arterial system : the blood occluded from the lesser vessels of that system, overfills the larger vascular tubes, and especially the heart, as its chief reservoir. In the case of digitalis, it is the large vessels which proportionately are most contracted, owing to the impression of the drug being greatest on the central and cardiac vaso-motor nerves : consequently these contain less blood, and the terminal arteries more, than in poisoning by aconite. This explains the advantages of the latter over digitalis, as well as over belladonna in congestive and inflammatory states, in which the arterioles and capillary system play so important a part ; though both drugs cause an increase of blood pressure, owing to the tension produced on the vessels, through the action of one drug centrally and that of the other peripherally. 344. Dr. Dickinson has pointed out,-f- and Dr. Archibald Reith confirms the statement, that digitalis, " in full doses, induces violent uterine contraction ; checks uterine haemorrhage and menorrhagia, and 'hat the effect is perraanenJ:.| This remarkable power of producing contraction in both striated and non-striated muscular fibre suggests a similarity of its action to that of ergot. If our theory were to be sustained, and the heart admitted to be dilated by its motor-nerve force, and contracted through the inherent power of its muscular walls, a solution of the action of digitalis on the frog's heart would be found, consistent with its paralyzing action oi; the nerves, and consistent, too, with the similar mode of action attrib' ted to ergot on the nerves of the uterus, permitting contraction of ihat organ. (§184.) *Dr. Ringer's Therapeutic p. 409. t Medico. -Chiiur. Tram: Vol. XXXIX- + Braith. Retrospect, January, 1869, p. 74. CONIUM. 175 loticed. le ven- ver and itity of greatly cd digi- rfectly ; ore and e, how- talis. may be lifferent erted at ., inclu- ded, the I power aconite, :erminal of that e heart, vessels pression p-motor ;erminal ains the onna in es and js cause on the of the d Reith violent rrhagia, striated iction to heart itracted of the nsistent »o, with ; of the XXXIX- 345. In reference to the very large doses of the tincture of digi- talis, which may be taken not only safely, but sometimes with appa- rent advantage, it has been suggested that perhaps the dilute alcohol of the tincture may to some extent antidote the full effects of the drug ; since doses of the infusion, of relative strength, may not be administered without risk of dangerous effects.* 346. CONIUM belongs to the same group of paralyzers of ner- vous tissue as the drugs already considered. The cerebrum and sensory nerves are generally but slightly afifected by it. Its paral- yzing action is chiefly exerted on the motor nerves. The alkaloid conia is one of the most active and powerful poisons ; being in this respect scarcely second to prussic acid, (Guttman) and yet some vegetable feeders, as the goat, sheep and horse, are said to eat hemlock with impunity."f 347. On the popular view of strychnia poisoning, a drug like conium, which so completely paralyzes the motor nerves, should be found a valuable antidote to the spasms of that state. Such is not at all the case, however ; as was demonstrated by Guttman, who found it " failed to check in any degiee the tetanic spasms produced by strychnia." :|: A fact like this is very unfavorable to the popular theory. 348. The death of Prof. F. W. Walker, of New York, in April 1875, from three doses, of fiftv minims each, of Squibb's fluid extract of conium, taken for the relief of facial spasms ; and the circumstance of his dictating to his wife, who wrote for him, the progressive symptoms of paralysis, at intervals during two hours, and up almost to the fatal close, will long be remembered in the annals of this drug. No ^litigation of the spasms took place. The danger of an erroneous theory is here apparent. If spasms and irregular muscular contractions were recognized as depending on a deficiency, rather than an excess, of nervous energy, measures cal- culated to cause a further depression of nerve-force would be prohibited in such a case, instead of being prescribed by the medical adviser, who in this instance acted in accord with popular teaching, and must be held blameless. 349. The action of conium, in accordance with our theory, is easily understood. By paralyzing the musculo-motor nerves, the muscles become incapable of responding to the will ; not because the contractility of the muscle is destroyed, but because the nerves which form the medium of communication between the brain and the muscles are no longer capable of transmitting the molecular change necessary to induce contraction of the muscular fibre. (>IJ77.) As a proof that the vaso-motor nerves are affected by conium. Dr. Ringer says, " the arteries of the frog's foot fail to contract on irri- * Dr. Richard Hughes, Pharmacodynamics, p. 268. tDr. dinger's Therapeutics, p. 437. X Ibid, p. 44j. if"*- ; I'. ' yi! 176 THYSIOLOGICAL THERAPEUTICS. tation, when the animal is poisoned by hemlock."* Why ? The " irritation " referred to is doubtless faradization, ? i -f the latter were a "stimulus " to nerve-force, even the paralyze nerves might be expected to make some response. But if CiCctricity be a paralyzer, there is good reason why its application to the already devitalized nerves should fail to produce contraction of the arterial coats, since the contractile power of the muscular fibre of the vascu- lar walls was already set free from the restraining influence of the nerves, and this effect of the action of electricity was already antici- pated by the paralyzing action of the conium. 350. Dr. Ringer adds, " the motor nerves of some other involun- tary muscles are uninfluenced by conia, as the peristaltic contraction of the intestines of the rabbits killed by the alkaloid, continued active after death."f This is to be accounted for by the fact that the nervous supply of the intestines i- almost, if not entirely, derived from the .sympathetic, which from its ; eculiar relations in the body, and thr' effect of its ganglia in retarding the transmission of impres- sions, doubtless is bu*" slightly influenced by this poison. The vaso-motor nerves, indeed, pass through the ganglia of the sympa- thetic, but they originate in the cerebro-spinal system, and are more amenable to the influences which affect the latter than the former. Conium, then, by paralvzing the vaso-motor nerves, sets free the contractile power of the muscular fibre of the arterial wails, lessen- ing their calibre, dimmishing blood supply, and with this, arresting the secretions of various glands. Hence, its reputed effects in dissi- pating enlargements and indurations of these structures ; as well as in causing wasting of the mammae and testes. It was formerly prescribed much more than at present, in coughs from an irritated condition of the air passages, where its mildly paralyzing effect, in suitable doses, fully accounts for its alleged utility. 351. A great deal of confusion has arisen owing to one species of hemlock being mistaken for another, and from the not unfrequently mixing of the several species. 352. It may be objected, that, on the theory here presented, the voluntary muscles should pass into a state of spasm and contraction, on the paralysis of their motor nerves, by conium, since the restrain- ing power of nerve-force has been withdrawn, and muscular con- tractile power is free, and should produce its characteristic effects. This is really the case in some examples of poisoning by conium in man, but especially in rabbits and other inferior animals, although not in frogs. (Ringer.) For a reason why musclar contractions need not invariably, or necessarily, attend motor paralysis, we refer the reader to our exposition of why spasm or contraction docs not speedily follow the severing of a motor nerve by wound or injury, in sections seventy-four to eighty-five of the preceding pages. ' •Therapeutics, p. 440. tibid. . HYDROCYANIC ACID. 177 ? The e latter s might y be a already arterial e vascu- : of the / antici- involun- itraction mtjnued act that , derived le body, impres- n. The sympa- ire more former. free the , lessen- irresting in dissi- well as formerly rritated Tect, in lecies of quently ted, the Taction estrain- lar con- effects, nium in 1 though Tactions we refer oes not injury, 353. HYDROCYANIC ACID.— Th\s deadly poison apparently kills by paralyzing first the brain, then the spinal cord and motor nerves. It produces its effects with great rapidity. Where death is not too quick in overtaking the victim, spasms and convulsions usually occur. Atter death the arteries are found empty and the venous system engorged with blood. What is the condition of the cranio-spinal nervous centres here } Dr. Pereira states, "Whatever it may be, it is probably identical with that which occurs during an epileptic paroxysm, and that which is produced by loss of blood; for the essential symptoms, insensibility and convulsions occurring suddenly, are the same in all these states ; and ammonia [a stimulant] has been found to relieve them,"* 354. it seems strange that such a prompt and profound paralyzer should ever have been regarded as an excitor of ?ny part of the nervous system. Yet it produces spasms, resembling those of epilepsy, and if this condition depends upon excitement of the nervous centres, and a consequent excess of nerve-force, why the conclusion is inevitable that prussic acid is a stimulant ! Absurd as this conclubion is, and untenable as is the hypothesis on which it is based, it is fully in accord with the accepted theory of the proximate causes of spasm and convulsion, and even continues to be as? r' ,-? by medical writers in recent times, one of whom says, "It : . V to excite the whole motor tract of the cranio-spinal a?cis."f 355. The principal medicinal use of hydrocyanic acid is for the relief of nervous gastrodynia, with or without pyrosis : also, when irritability of the stomach, — probably of nervous origin, — causes vomiting. Dr. Pereira mentions a remarkable cure of periodic pain in the bowels by a ie.vf five minim doses of the dilute acid. Its effects, in these cases, are doubtless attributable to its benumb- ing influence on the nervous centres, or on the symp.ithctic branches of the solar plexus. 356. BROMIDE OF POTASSIUM.— T\^Q sedative effects of this salt over the nervous system is too well known and too gener- ally recognized to need demonstration. The effects of its prolonged use on the mental faculties are seen in drowsiness, mental languor, listlessness, confusion of intellect, impaired memory, lustreless eyes, depressed spirits, etc. On the motor nerves, its results are weak- ness, tottering gait, physical languor, restless and fitful movements, twitching of the fingers, and other indications of depressed power. Its effects on the sensory nerves are still more marked, as seen in partial anaesthesia of the integumentary and mucous surfaces ; espe- cially the insensibility of the pharynx tc impressions which ordi- narily excite reflex action. A lowering of sexual activity, especially when unduly excited, is among its general sedative effects. The *Mat. Med., Vol. II,, p. 788. tDr. Richard Hughes, Pharmacodynamics, p. 23. 178 PHYSIOLOGICAL THERAPEUTICS. m '' pi' Hi, y w f ■Ml occasional emaciation, foetid breath, acne-like eruption and other signs of mal-nutrition, seem to point to depression of those nerves which are beh"eved to preside over the nutritive functions. 357. This drug exercises a no less potent influence over the heart and arteries. It lessens vascular activity generally, and tranquilizes the circulation. In excited conditions of the brain this effect is well seen. " The flushed face, the throbbing of the carotids and temporals, the suffusion of the eyes, the feeling of fullness in the head, all disappear as if by magic under its use." So says Dr. W. A. Hammond, who finds the blood-vessels of the retina contracted, and cerebral anaemia produced from its action on the heart and vaso-motor nerves.* Similar effects are produced on the circulation generally as are witnessed in the arrest of the secretions, the cure of gonorrhoea and clap ;i* the reduction of the pulse and temperature in fever, of which the journals contain abundant proof. 358. Is the influence here exerted on the vascular nerves one of excitation or depression ? Apart from other considerations, it will be readily conceded, that consistency of action reqiures that a drug which depresses or paralyzes the brain, the motor, sensory, and trophic nerves, should also similarly affect the vaso-motor system. But as we have just seen the arteries are contracted under its use, and on the accepted vaso-motor theory, arterial contraction is due to vaso-motor excitation. Then, if that theory be correct, this drug, while depressing or paralyzing all other parts of the nervous system, excites the vascular nerves ! We leave to the advocates of that theory the duty of explaining this anomaly. 359. The theory advocated in these pages presents no such difficul- ty. The vaso-motor, as well as all other nerves, are functionally de- pressed, lessening their restraint over the muscular walls of the arteries, which proportionately contract by their own inherent power, and thus produce diminished vascular activity. From the foregoing considerations, the beneficial effects of this drug in excited, febrile and congested states of the brain or other organs, will be fully apparent, and need not be further dwelt upon. The relations of the bromides to epileptic and other convulsions, however, call for further remarks. 360. In previous pages, (§ 98) strong evidence has been produced to shew that the onset of the convulsive seizure depends essentially on anaemia of the brain. We have just now shewn that the bro- mides lessen vascularity, diminish blood supply, and so tend materially to produce an anaemic condition of that organ, and yet the bromides are among the favourite and successful remedies for the treatment of epilepsy. 361. But if the bromide of potassium produces cranial anaemia, and that is the condition on which convulsions essentially depend, * Diseases of the Nerv. Syst., pp. 56, 65-6. tBraith. Retros., July, 1874, p. 191. i other nerves le heart iquilizes iffect is ids and in the Dr. W. itracted, art and culation 2 cure of perature 3 one of 3, it will t a drug ory, and system. its use, ■ a is due ;his drug, s system, ; of that difficul- nally de- of the inherent of this or other 2lt upon, ivulsions, prod\iced ?sentially the bro- so tend and yet edies for anaemia, depend, 4, p. 191- BROMIDE OV POTASSIUM. m how is the bromide curative of that condition } This enquiry is not so embarrassing to us as it might at first sight appear ; for this drug does not cure all kinds of convulsions : indeed, it not only fails to cure, but actually aggravates a certain proportion of the cases. Dr. Hammond declares it to be " exceedingly injudicious to administer any of the bromides in cerebral anaemia," for the reasons stated, and reiterates the warnin^^ more than once. In nineteen of his cases in which the condition of his patient was aggravated, all were of the nocturnal form, and the aggravation doubtless was attribu- table to the fact that during sleep the brain is already anaemic. In one of these cases the convulsive attacks resulted from the direct effects of the drug. Again, " M. Guerin did not consider the bro- ' mide ot potassium a merely inoffensive remedy, as it has given rise \v his hands to nervous accidents resembling epilepsyr* The following considerations, we think, will account for the suc- cess and failure of the bromides in the disease in question. There is a condition of the circulation, in the cranio-spinal centres as else- where, in which the vessels are unduly relaxed, and their flabby walls distended with blood. Here, the blood current is sluggish and unequal ; the interchange of new and effete materials between it and the nervous tissue is not conducive to the nutrition of the latter. Blood is there in sufficient quantity, but it is there under circumstances which are abnormal, and which, practically, are equiv- alent to its absence. We see a similar state in the sluggish circu- lation of the cedematous limbs, which nevertheless are cold and feeble ; and we have also noted the effects of digitalis in contracting these flabby tubes and the beneficial effects of the consequent pro- pulsion of the blood current at a more rapid rate, in the disappear-, ance of the oedema, and the restoration of healthy nutrition and activity. 362. According to Dr. Beale, it is the sluggish blood current in fever, and the undue growth of unhealthy bioplasts it encourages^ which cause the rise in temperature : the cure for which he holds to be the inducinj^ A a more active movement in the circulating fluid.-}- In consequence of these effects of the sluggish blood cur- rent, in the unduly relaxed vessels, the oppressed brain is wakeful, perhaps delirious, and the outward manifestations of this condition are interpreted as excitement The bromides cure this condition, in the same manner as digitalis improves the languid circulation in the cedematous limbs. By a paralyzing influence over the unduly active vaso-motor, dilating, nerves, it restores the balance of power to the antagonists of these nerves, the muscular fibres of the arterial walls. The calibre of these tubes is reduced to normal proportions ; the blood current is accelerated ; fresh pabulum is imbibed by the languishing ner\^e-cells of the ganglia, whose effete particles are swept onwards to be oxydized : in this way nervous vigor is *Med. Times and Gazette, Vol. I., 1864, p. 96. tDisease Germs, p. 328. i8o PHYSIOLOGICAL THERAPEUTICS. restored, the control of the motor nerves over the muscles is re- asserted, and the convulsions arrested. Such, it is reasonable to assume, are the immediate phenomena of the curative action of the bromides in cerebral excitement and convulsions, and such the class of cases in which it proves beneficial. But when the condition of these vessels has become one of more or less chronic dilatation,* the remedy must be continued, and hence the bromide becomes, as one writer says, " the daily food " of the nervous centres, till after its long use they permanently recover their tone. The first depar- ture from the normal state is the excitation of the vaso-motor centre, or nerves of the cranium, by some cause operating in the brain or some distant organ : undue vascular dilatation is set up as a conse- quence, and the cause continuing, of course it tends to perpetuate itself, and the consequences which attend this state. 363. In other cases, the vaso-motor nerves are not excited, but depressed or paralyzed, by the central or reflex cause ; and, as a result, the vessels instead of being unduly dilated, become spasmod- ically contracted, depriving the nervous ganglia of their necessary nutrition. Convulsions result, as in the former case, and from the same proximate cause, though induced in a manner the very oppo- site. " By contraction of the vessels, the brain is deprived of blood, and consciousness is arrested ; the face is or may be deprived of blood, and there is pallor ; by contraction of the vessels which have been mentioned, there is arre.st of respiration, the chest walls are fixed, and the other phenomena of the first stage of the attack are brought about."f Here, the bromides cannot be expected to cure, but will rather aggra- . vate the malady. Stimulants and food medicines, such as strychnia, phosphorus, iron, and nutrients, ought best to nieet the conditions ; and such is found, practically, to be the case. Strychnia is a very valuable remedy in epilepsy. Dr. Hammond generally combines it with the bromide in doses of from the thirty-second to the twenty- fourth of a grain, " for the purposes of a tonic, and for counteracting to some extent the debilitation produced by the bromide."! ^^■ Brown-Sequard also advises this combination, but admits that the bromides and strychnia mutually counteract each other, so that where these agents are used togethci, the dose of the bromides must be increased. j| Would it not be wiser to give each separately, in the condition for which it is adapted, and in smaller doses .■' 364. Dr. Marshall Hall recommended strychnia in threatened epilepsy ; and Dr. Walter Tyrrell, of London, " who has watched the effects of strychnia upon various forms of epilepsy, has no hesi- tation in affirming that in a large majority of cases its effects are most beneficial."§ *Di. Ifammond, Dis. of Nerv, Syst., p. 578. t Dr. Reynolds, Treatise on Epilepsy- 6-»c, p. 238. t Diseases Nerv. Syst., p. 583. llNaphey's Mod. Therapeu., p. 39- ^rnid, pp. 41-2. BROMIDE OF POTASSIUM. I8l IS is re- lable to n of the the class dition of atation,* omes, as till after t depar- )r centre, brain or a conse- ;rpetuatc ited, but ind, as a spasmod- necessary from the :ry oppo- , of blood, prived of liich have walls are Lttack are heraggra- strychnia, Dnditions ; is a very jmbines it e twenty- nteracting le."+ Dr. that the r, so that bromides eparately, )ses ? :hreatened watched ,s no hesi- efifects are on Epilepsy rapeu., p. 39- Dr. Hammond has found the treatment by strychnia " satisfac- tory " in a number of cases, and in these there were no relapses. He thinks it is more effectual in the nocturnal than in the diurnal form of epilepsy ; that is in the anaemic form, the condition the reverse of that benefitted by the bromides. Of course the reader will not here confound the tonic or " food action " of strychnia with that of its effects in poisonous doses, which are so entirely different. It is in this class of anaemic cases that cures have been effected by stimulating agents : in one instance by assafoetida and carbonate of ammonia ; frequently from inhalation of chloroform or aether to a moderate extent : and, in short, wherever stimulants to nerve func- tion have been found beneficial, which is no small number of the whole. 365. It is difficult, in many instances, to determine the state of the cranial circulation, as a guide to one or other of these classes of remedies. But it may be regarded as a rule, that whenever the pupil is dilated, cerebral anaemia is present, and that stimulants will be found beneficial. Contraction of the pupil, on the contrary, implies, at least, hypera^mia of the iris, and probably also of the cranial mass ; but this need not neces.sarily be active, and is often venous. Bromide of potassium first attracted marked attention as a medi- cine in the cure of enlargements of the spleen. It has cured ague after the failure of quinine. Cases of gonorrhoea and gleet have been reported in which its use has proved successful. Of the bro- mides, this one has proved most successful in the treatment of epilepsy. 366. The same general theory of action will be found tc apply to the bromides of ammonium, sodium and lithium. They are all sedatives and depressants to tht general nervous and vascular sys- tems. The bromide of ammonium appears to possess some special influence over the nervous and vascular system of the uterus, and is ot special value in arresting menorrhagia. The bromide of lithium contains a larger percentage oi bromine than the other salto men- tioned, and is credited with greater hypnotic powers. (Dr. Ringer.) It is very expensive. Dr. Hammond thinks "the bromide of sodium is more readily assimilated, is less apt to produce gastric irritation, but in other respects its action is similar to that of the corresponding potassium salt." 367. Dr. C. B, Radcliffe suggests that much of the good effect of these preparations is due to their dcpurative action on the blood, especially in the case of epileptics who are prone to gorge them- selves with an excess of food. Like other potassium salts, bethinks they assist in eliminating effete materials from the blood, and that 1 82 PHYSIOLOGICAL THERAPEUTICS, they thus contribute to healthy assimilation and nutrition, and in this way exert a beneficial influence over the disease.* The foetid breath, pustular or carbuncular eruptions, and mental and physical debility which attend the prolonged use of these drugs, do not seem to favor this view of their action. 368. HYDROBROMIC ACID \s a more recent acquisition in medicine. It is prepared by the action of tartaric acid on bromide of potassium dissolved in water, in the following proportions : — Dis- solve ten ounces of potassium bromide in four pints of water, and add thirteen ounces of acid tartaric. The hydrobromic acid remains in solution, and potassium bitartrate is precipitated. It has all the properties of bromide of potassium, and promises to be a useful and agreeable sedative in excited or unduly vascular states of the brain or other organs, including tinnitus aurium of congestive origin. The dose is from halt a drachm to a drachm in water as needed. 369. CANNABIS IN'DICA.— Indian hemp is another remedy of this class. It is often of marked use in menorrhagia, in doses of from twenty !o thirty drops, two or three times a day, according to the urgency of the symptoms.-f- It has been recommended in com- bination with bromide of potassium in mania. It doubtless produces its sedative effects on the circulation in the same manner as the remedies hitherto noticed. 370. ERGOT OF R YE. — See special chapter devoted to this drug, owing to its importance in the general discussion of the con- tractions of muscular tissue. 371. QUININE SULPHATE.— \^t have already alluded to this invaluable drug as an aid to parturition, in treating of ergot, (§ 186) and to its influence over the nervous and vascular systems, in discussing the adaptation of this theory to the febrile state. (§ 236.) There is but little to add here, in reference to a drug whose general uses are so well known ; and we content ourselves with what has already bern said of its general action under the theory here pre- sented. 372. ARSENIC. — As a poison, some of the efifects of arsenic entitle it to a place here, but as a food-medicine, it belongs to the next series of drugs ; to which the reader's attention is directed. 17^. PLUMBI ACETATIS.—The profession is indebted to Dr. John Stephenson, of Montreal, for the discovery, and mainly to Dr. J. Workman, of Toronto, for the promulgation — formerly in his lectures to his class, and recently in a published paper J — of the fact that acetate of lead in doses of half a drachm or more, repeated ac- cording to the urgency of the case, is a safe, prompt and effectual *Lectuieson Epilepsy, dr'c., p. 203. tL'Union Medicale, Montreal, 1872, p. 56. tRead before the Canada Medical Association at Montreal, Sept., 1877. ACETATE OF LEAD. 183 1, and in ;'he foetid physical not seem isition in bromide IS : — Dis- fater, and d remains as all the iseful and the brain igin. The d. T remedy 1 doses of ording to ;d in com- 5 produces er as the ed to this f the con- illuded to y of ergot, systems, (§ 236.) ise general what has here pre- of arsenic ngs to the rected. debted to mainly to erly in his of the fact peated ac- efifectual 1872, p. 56. remedy for post partum and other haemorrhages. The acetate should be pure, the crystals bright, and not in the floury state, indicative of the carbonate of lead. It should not be combined with acetic acid or opi .in, as formerly recommended, but be ad- ministered alone, with the aid simply of a spoonful of water. It has been given in teaspoonful doses, in uterine haemorrhage, not only without injuriou.^ consequences, but with positively beneficial eflfects of a most gratifying kind. It is equally applicable to haemoptysis, and haemorrhage from other organs. In the doses mentioned, hav- ing exercised its anti-haemorrhagic effects, it is extruded from the bowels, by a gentle purgative process. 374. What is the modus operandi of its action } According to Dr. Pereira, " it is administered internally to diminish the diameter of the capillary vessels, and lessen circulation, secretion, and exha- lation."* This can only be accomplished through the agency of the vaso-motor nerves, as Physiology teaches. Dr. Workman writes, " I do not believe we have in all our materia medica, a more prompt or potent promoter of uterine muscular contraction." Here is an implied action upon the motor nerves. Assuming that the drug acts upon both the vaso-motor nerves, in its action on the blood- vessels and on the motor nerves, in its action on the muscular tissue of the uterus, in what manner are these two systems of nerves im- pressed ? Are they functionally stimulated or paralyzed .-' 375. A glance at the paralyzing effects of this and the other salts of lead will not favor the idea that it can assist in promoting the nutritive process in tliose cells in which nerve-force is generated. Thus, among the poisonous effects of the acetate, are great prostra- tion of strength, cramps of the extremities, cold sweat, giddiness, numbness and even paralysis of the lower limbs and sometimes coma.f This last state is attributed by Dr. Carpenter to paralysis of the sensory ganglia. Among the earliest symptoms of lead colic, before any of the local effects are fully developed, are " more or less depression of the nervous functions, despondency, mental debility, and a disinclination to either mental or physical effort; with a feeling of wretchedness and gloom. . . . There is a sense of weakness, a sinking, col- lapsed feeling in the epigastrium. . . . The bowels are really in a state of permanent muscular contraction."! 376. If these are the effects of poisonous doses, have we any right to conclude that the drug administered in teaspoonfuls, acts the part of a tonic, or increases nerve-force so as to furnish an unusual " stimulus " to muscular contraction .'' On the theory here advo- cated, the acetate of lead paralyzes the motor nerves, and propor- tionately sets free the muscular contractile tissue of the uterus, intestines, &c., which passes into a state of contraction accordingly. •Mat. Med., vol. I, p. 710. +Dr. Ringer, Therapeutics, p. 174. Sherwood, Prac. of Med., Vol. I., p. 703. JDrs. Jones and 184 PHYSIOLOGICAL THERAPEUTICS, By a similar paralyzing effect on the vaso-motor nerves, the muscu- lar coat of the arteries is permitted to contract ; shutting off blood supply, and arresting haemorrhage. This view of the case is not based upon a single fact, but upon a whole series of facts, to which the preceding pages bear witness. To these accumulated proofs we have nothing further to add in this connection. 377. OXIDE OF Z/NC.—ThQ mode of action of this drug is similar to the last, and to the medicines of this class. It acts as a sedative to the vascular system, checks secretion, &c., in a less degree, however, than the acetate of lead. Dr. W. A. Hammond classes it among remedies which produce cerebral anjemia, drowsi- ness, faintness, pallor of face, &c., and administers it in two grain doses, three times a day, in cerebral congestion.* 378. It has been recommended for diarrhoea in children ; and in appropriate cases, namely, those of a congestive type, or depending on undue nervous excitation, it would be advantageous ; but prolj^t- bly not more so than other drugs which tend to bring about vascu- lar contraction, diminished blood supply, and the effects of these changes, lessened secretion in the intestinal tract. It may some- times be advantageously combined with pepsin or bismuth. 379. SULPHA TE OF ZINC— This drug is also a type of the general class we are now considering. In moderate doses, it lessens the activity of the vaso-motor nerves, giving the preponderance to the antagonists of these nerves, the muscular fibres of the vascular walls, and so causing diminished blood supply and lessened secretion. A further degree of its action leads to paralysis of the motor centres or nerves, which normally restrain the gastric muscle, the stomach ; vomiting ensues as a consequence. It is a useful emetic where it is desirable to avoid much depression. Dose for this pur- pose, from 10 to 20 grains for an adult. 380. PHYSOSTIGMA, or CALABAR BEAN.—ThQ experi- mental investigations of Dr. Frazer, of Edinburgh, have led him to the conclusion that this drug first paralyzes the spinal tord and soon after the motor nerves. Consequently, — in accordance with the popular theory — he anticipated that physostigma would prove highly valuable as an antidote to strychnia. This hope has not been realized : for while calabar bean " modifies strychnia tetanus," . . . . " so far from saving life, it actually aids its destruction, for when both poisons are administered together, but each in quan- tity less than the minimum fatal dose, their combined action in this dose will destroy life."-f- We see in this fact, a proof — in addi- tion to what has been said in previous pages — that the spasms and convulsions of strychnia are not due to excitation of the cranio- * Diseases of New. Syst., p. 57. tDr. Ringer, Therapeutics, pp. 503-504. ■ i" PHYSOSTIGMA, OR CALAUAR BEAN. 185 t muscu' )fif blood se is not to which »roofs we i drug is lets as a in a less Hammond I, drowsi- wo grain I ; and in epending ut prol^- >ut vascu- s of these ay some- 'pe of the , it lessens lerance to : vascular lessened :he motor luscle, the ul emetic this pur- le experi- d him to tord and ance with uld prove e has not tetanus," istruction, in quan- action in — in addi- lasms and le cranio- spinal centres; otherwise so profound a paralyser of these centres could not fail to antidote them. 381. This drug has, in recent years, been popular in the treat- ment of tetanus. Owing probably to variations in the strength of the preparation used, and to the susceptibility of patients, the dose has varied from one-fourth to two and even four grains — for a short time — of the extract every hour.* In a former reference to tetanus, (|§ 118) we quoted statistics of this disease, showing that while calabar bean had proved cura- tive in thirty-nine per cent, of the cases, other drugs shewed a more favorable record, and the treatment by stimulants alone showed a curative result in no less than eighty per cent. — the highest on the listt This is a very striking result from a class of remedies whose ac- tion is precisely the reverse of that attributed to calabar bean ; and naturally leads to the enquiry, how far were the beneficial results of the latter attributable to the paralyzing influence of the drug. Dr. Ringer has no doubt upon this point, for he says, " it is general- ly, nay probably always, necessary to produce a certain degree of paralysis amounting to heaviness of the limbs ;" and again, " to be of any use, it must be given in quantity sufficient to produce paral- ysis . . . indeed to such an extent that but a little more would permanently arrest the breathing.":]: 382. On the other hand, it would appear as if certain of the ele- ments of calabar bean are antagonistic to each other. Thus a recent writer states, " The alkaloids of this drug, upon which its virtues depend, are eserina or physostigma, and calabarin, which acts like strychnia. ... It sometimes occasions in frogs, tetanus, prob- ably due to the calabarin :" and again, referring to its use in tetanus, it is said, " care must be taken that it contains no calabarin, which tetanizes."|l 383. We have already remarked that in by far the greater num- ber of reported cases of tetanus treated by calabar bean, not only nutrients, as broths, etc., but even stimulants are freely admin- istered ; though why stimulants should be admissible at all, if the disease depends on undue excitation of the nervous centres, is a question for the advocates of the popular theory to solve. We have seen above, the large percentage of cures by stimulants alone. How much of the good results attributed to calabar bean may be fairly allotted to the generous diet and free stimulation used in conjunc- tion with it, is a question which in protracted cases, at least, is en- titled to consideration. In numerous instances, the administration of the drug was followed by speedy and marked amelioration of the symptoms, as reported in the journals ; but from the antago- nistic effects of the alkaloids contained in the bean, as noted above, *Braith. Retros. : Dr. Ringer. tDr. W. A. I .immond, Dis. Nerv. Syst., pp. 540-1. :t Therapeutics, p. 450. l|Dr. Ott, Action of Medicines, pp. 137, 138. ,%, ^. IMAGE EVALUATION TEST TARGET (MT-3) // 1.0 I.I i" 1^ iilM I 32 '-■ itt |||||Z2 i:^ 12.0 1.8 " 1.25 1.4 1 6 1 ^ ^" ^ V] v) ^» y /A Photographic Sciences Corporation ,\ ^^ •17 v> A fC 33 WEST MAIN STREET WEBSTER, NY. MSSO (716) 872-4S03 ft o^ i8$ PHYSIOLOGICAL THERAPEUTICS. it must be difficult to say whether the " paralyzing " dr " tetanizing " effects predominated. Doubtless further light will in time be thrown on this part of its action. In the meantime, there is nothing in the reported relations of this drug to tetanus which can be quoted against us. 384. The same theory of the action of calabar bean which sug- gested its applicability to the treatment of strychnia poisoning and tetanus, led to its administration in chorea. Dr. W. H. Fuller, phy- sician to St. George's Hospital, London, who has tried it in this disease, in seven consecutive cases, beginning with ten minim doses of the tincture, three or four times a day, and increasing the doses till the characteristic poisonous effects began to be produced, reports unfavorably of the result. He says " the pulse became accelerated, feverishness supervened, loss of appetite and vomiting ensued, and ■ uneasy sensations were complained of in the head. A drachm and a half or two drachms of the tincture taken three times a day usually sufficed to induce these symptoms. Beyond this, no appreciable effect was observed. There was no evidence of the accumulative action of the drug; it did not appear to influence the secretions ; it did not materially affect the pupils, and it certainly did not exercise the slightest influence over the disease." Dr. Fuller concludes it has no value as a curative agent in chorea. The tincture adminis- tered was made by macerating one drachm of the powdered bean in one ounce of rectified spirit.* Here again the popular theory is out o! joint with practical results. 385. We have now to note a different application of calabar bean. Dr. Crichton Browne finds it remarkably useful in general paralysis of the insane, and has effected cures of such cases with it. Dr. Ringer vouches for its value in such states as general paralysis, progressive muscular wasting and chronic hemiplegia, in doses of one-thirtieth of a grain of the extract every two hours. Also in paraplegia, in one-tenth grain doses, and in locomotor ataxy .+ It has also proved curative in paralysis of the 3rd and 6th pair of cranial nerves ; as shewn by a return of functional activity in the former towards the iris, and of both over the muscles of the eye supplied by these nerves. The drug here was used locally ; one- fourth of a grain of the extract, made into an emulsion with a few drops of water, freely poured into the eye. J These results shew that this drug, like some other poisons, in small or moderate doses, by a species of fooarent. If and the »n by the )led ?" It ther falla- untenable. condition enfeebled, le muscles paralyzed iologically tion, were the brain, ely spinal scles, pre- s, pp. 23-4- vents contraction and secures their relaxation. When the spinal nerves, with which arc properly included those of the medulla oblongata, are also more or less paralyzed, spasms, tetanic contrac- tions or convulsions, will be found to be present, as sometimes occurs, in the later stages of alcoholic poisonmg. JJ 29. 407. Indeed, Dr. Richardson, in a subsequent lecture, concedes the general principle for which we are here contending. He says, — " One of the first effects of alcohol upon the nervous system, in the way of alienation from the natural state, is shewn in the loss of memcry If this failure of mental power progresses, it is followed usually by the loss of volitional power. The muscles remain ready to act, but Jie mind is incapable of stirring them into action. The speech fails at first, not because the mechanism of the speech is dehcient, but because the cerebral power is insufficient to call it into action. The man is reduced to the condition of a dumb animal The failure of speech indicates the descent still deeper to that condition of general paralysis, in which all the higher faculties of the mind and will are powerless, and in which nothing remains to show'thc continuance of life except the parts that remain under the domir ition of the chain of organic or vegeta- tive nervous matter."* 408. Practically then, as we have remarked above, and as Dr. Richardson's later statements indicate, the action of alcohol, in health, comprises two stages ; one of stimulation, and the other of narcotism or paralysis. It is difficult to draw the exact line between them ; for it varies greatly in dififerent persons, and even in the same indiviiiual under different bodily conditions. As is well known, a dose which will merely produce a stimulant effect on one man, will serve to narcotize, and so to prostrate, another : and the presence of food in the stomach will also serve materially to modify or retard its full effects. 409. The habitual occurrence of the paralyzing effect of alcohol on the motor centres, is well seen, in accordance with our theory, in the permanency of the partial release of muscular contractility from tlie control of the nerves^ and the consequent trembling of the hands and incertitude of action in the attempted adjustment of the muscles for operations requiring precision. This same paralyzing effect, in a certain stage of its operation on the cerebrum, and its associated ganglia, gives rise to perverted ideas, disordered mental manifesta- tions, hallucinations of sight, hearing, and sensation. These com- bined effects on the sensory and motor ganglia, and on the higher cerebral mass, constitute the state known as delirium tremens ; which is essentially a state of depression and not one of increased action or exalted vigor. The most successful treatment for this state, accordingly, is not of a depletive or antiphlogistic kind : but 'Lectures, pp. 1 11, 112. 196 PHYSIOLOGICAL THERAPEUTICS. p 1 B • •' i f H ■ • "3 \^ f rather one calculatcc' to re-invigorate the enfeebled nervous ganglia and to restore the healthy nutrition of the cells on which the gener- ation of nerve-force depends.* Dr. Wilks regards the brain as weakened and impoverished in delirium trempns ; and so closely do the symptoms sometimes re- semble general paralysis of the insane, that he has twice seen it mistaken for the latter by the same physician.t 410. The first, and more active stage of this disease, however, offers an apparent exception to what has just been stated ; for here, although the cranial ganglia are more or less paralyzed, yet in con- sequence of the previous and recent excitation of the vaso-motor nerves, during the stage of stimulation, the arteries probably remain for a time unduly distended with blood. As the secondary stage, of deprcssipn, occurs, and the propelling power of the heart is weak- ened by the narcotic, the blood stieam becomes sluggish ; thus, it not only favors the development of a higher temperature (Dr. Beale) which is in itself injurious to the tissues, but it fails to effect a suffi- ciently rapid metamorphosis of tissue, or to furnish an adequate supply of new material for its due nutritioo. Here, then, in addi- tion to the direct effect of the narcotic, is an indirect cause of depression, in the state of the cranial circulation, the effect of which is seen in the restlessness, sleeplessness, perversion of ideas, halluci- nations, etc., before referred to. Bromide of potassium is of use in this first stage of delirium tremens, (Dr. Ringer) because it restores the dilated vessels to their normal calibre, quickens the blood current, with the result, under these circumstances, of sweeping away the effete particles, intro- ducing new pabulum to nourish the ganglia and hemispheres ; and thus aids in restoring normal and healthy function. These effects will not follow the administration of the bromide, in ansemia of the brain ; in which condition this drug is not only useless, but danger- ous, and should never be administered. (Dr. Hammond.) In a later stage of delirium tremens, or after the bromides, or other sedatives, as digitalis, cannabis indica, etc., have done their work, more direct restoratives, nutrients and food medicines, are required, and will be found beneficial. 41 1. Let us present this view of the case in another light. Would any intelligent physician, called upon to prescribe for the tremors of the habitual toper, say to himself, " This man's nervous system is excited. The motor ganglia are generating and discharging nerve-force towards the muscles in undue quantity, and these trem- ors, abnormal muscular manifestations, and incipient spasms, are the consequence. The exalted activity of these nerve centres, from which this excess of nerve-force emanates, must be lowered. My patient must be bled, purged, starved, and treated with depressing •Dr. Aitkin, Naphey's Moderh Therapeutics, p. 32. t Braith. Retros., January, 1869, pp. 49. 50- Al.a)HOL AS A NARCOTIC. »97 H {ifanglia lie gener- rishcd in times re- 2 seen it however, i for here, ;t in con- ISO-motor \y remain irv stage, t is weak- ; thus, it Dr. Beale) ct a suffi- adequate in addi- cause of : of which 5, halluci- dclirium s to their lit, under es, intro- res ; and se effects lia of the danger- 3, or other eir work, required, Would tremors 5 system scharging ese trem- is, are the res, from red. My epressing 3S., January, drugs, in order to bring about this result and cure these tremors." Fortunately for humanity, the prevalent theory under which wc oug-/// to act would be here ignored, and instead of a debilitating, h tonic and nutritive treatment, after cutting off the poison, would be reiiorted to. The intelligent physician would seek to impart fresh vigor to the weakened brain, in exact accordance with the theory of these pages, and so enable the motor ganglia and nerves to con- trol, that is to restrain, the inherent contractile power of the muscles ; the partial liberation of which from nervous domination gives occa- sion for these tremors, just as is the case with other spasms, convul- sions, or irregular muscular contractions. 412. If, in the foregoing remarks, we have not referred more fully to the authorities, in proof of the assertion that alcohol in relatively large doses is a narcotic and paralyzer, it is because the fact seemed too obvious to require confirmation. There is no lack of such proof, which the reader will find at length in Dr. Anstie's work on Stimu- lants and Narcotic^. Dr. Carpenter says, " In ihe third w "1 niost profound state of intoxication there is extreme diminution 01 entire suspension of cerebral and sensorial power ; a state of roma super- vening upon that last described." 77iis is paralysis^ aich, in Di Carpenter's previous s*-age, was only partial, but is here co> iplete. More than once he rcicrs in this connection to the '* complei pros- tration of cei'-Sral and sensorial power," and to " a totrl io.vs of sen- sibility and voluntary pow^i. ' Again, " the functions '^f the cerebrum and sensory ganglia appear to be completely suspended." Sometimes the medulla oblongata and its — spinal — nerves share in the prostration. As the result, there is sometime.-^! " difficulty of respiration, strabismus, dilated pupil, tetanic spasms, general tetanic convulsions or spasms of particular parts."* 413. Here is a problem for the admirers of the popular theory. If spasms and convulsions depend upon undue activity of the ner- vous centres, .stimulating the muscles with an excess of nerve-force, from whence is that nerve-force derived, in view of the general and complete suspension of cerebral, sensory and motor power Vouched for above .•* The occurrence of these spasmodic phenomena, in paralytic states of the cranial ganglia, when their function is " completely suspend- ed," is in exact accordance with the theory here advocated ; since by motor paralysis, muscular contractile power is liberated, ani.1 ex- erts itself proportionably to its freedom from nerve restraint. Hence in the slighter forms of alcoholic narcosis, these spasmodic contrac- tions are not present, because motor nerve power is not "suspended" to a, sufficient degree to permit of independent muscular action. 414. An agent which produces such profound effects upon the cranial nervous system, cannot fail to injuriously impress other im- portant tissues and organs to a greater or lesser degree. Besides * Use and Abuse of Alcoholic Liquors, pp. 20-24. 1 I I.I r ' ^4 I >' \ ;i (fi- r ' Ix. r98 PHYSIOLOGICAL THERAPEUTICS. the brain and spinal cord, the stomach, the liver, the kidneys, and^ the tissues generally, suffer either from nutritive changes of struc- ture or modifications of function. This is accounted for by the fact that in health, it is simply an element in excess of the requirements of the body ; and as such it is a disturber of the organic harmony, and has to be extruded as quickly as possible, either by a process of oxidation or elimination, or both. 415. As we shall see by and by — in a future chapter — the effects of alcohol in low and wasting disease, is of an entirely difterent character, and its ro/e there is neither that of a stimulant nor a narcotic. The narcotic effect of alcohol, however, is sometimes re- sorted to empirically, for quasi medicinal purposes ; for instance, as a reputed antidote for the bite of poisonous serpents ; as a " night- cap " to excited brains, in order to induce sleep, (§ 223) ; as a sedative to " drown grief " ; as an anaesthetic in painful states, etc. Here its effects are not unlike those of other narcotics, and are brought about in a similar manner. The sensitive, motor and vaso- motor centres and nerves are more or less paralyzed, with the char- acteristic effects already described, which attend this condition. This concludes what we have to say of the narcotic effects of alcohol, and of the adaptation of our theory in explaining them. The stimulant or quasi food action of alcohol belongs to the next succeeding series of drugs, and will be considered in connection with these. (Jj 459). 416. CHLOROFORM.— Xx. is with the narcotic or anaesthetic effects of chloroform that we have here to deal. This result follows speedily upon the brief stage of stimulation ; after which, " the whole subsequent train of symptoms rs that of depression of the. various portions of the nervous systenx. in consecutive order of occurrence ; the brain being the first to lose and the medulla oblon- gata and sympathetic system the most tenacious in retaining their proper functions."* 417. We have already referred to the successive steps of this pro- cess in a previous page, in discussing muscular relaxation, (§35) ; and need here only recall to the reader what is stated above, that the syfnpathetic system usuallv resists the paralyzing effect of chloroform longer than the other cranial ganglia. Thus the flush- ing induced by the previous stage of stimulation does not fade until narcotism is well advanced, and at no time — in the normal process — is the pulse materially reduced below the ordinary rate. When this does occur, and coincident paralysis of the medulla oblongata threatens arrest of respiration, the situation is grave, and a slight further advance of narcosis and paralysis miy prove fatal. 418. Coughing is among the earliest reflex effects of the first stage : but vomiting, which is not unfrequent, especially if the * Dr. Anstie, Stim. and Narcot, p. 309. CHLOROFORM AS A NARCOTIC. 199 leys, and of struc- r the fact lirements tiarmony, arocess of he effects difterent mt nor a jtimes re- stance, as I •' night- 53) ; as a tates, etc. 5, and are and vaso- the char- ition. effects of ing them, the next ction with naesthetic lis result er which, •ession of \ order of lla oblon- ing their this pro- n.(§35); )Ove, that effect of :he flush- fade until il process J. When )bIongata d a slight the first ly if the -stomach contains undigested food, never occurs until narcotism is well advanced, proving what we have before alleged, that vomiting is due to paralysis and not to stimulation of the nerves concerned. 418. Other interesting phenomena in connection with the process might be referred to, and utilized, to indicate the adaptation of our general theory to their interpretation ; but the chief points have been already indicated, and it is desirable to avoid an undue expan- sion of these pages. The chief uses of chloroform for anaesthetic purposes, do not require any remarks from us. It is more prompt, powerful and pleasant in its action than jether ; but in these very qualities lies its danger. When a fatal result is threatened, Nela- ton's method of inverting the patient's body, is among the most effectual means of resuscitation. (§ 39). For the action of chloroform as a stimulant see § 487. 419. SULPHURIC ^THER.—T\it general effects of this anaesthetic are similar to those of chloroform. It also has its first stage of stimulation, which is produced by small doses and is of brief duration. (See next series of drugs, where this part of its ef- fect is discussed.) Dr. Anstie strongly insists that those symptoms which have been ordinarily regarded as indicating excitement, such as muscular rigidity, half delirious movements, and incoherent talk — \vhich are witnessed to a much greater degree from aether than from chloro- form — are really not due to excitement proper, or indicative of true stimulation, but belong to the stage of narcosis and paralysis. He refers to cases to prove that " the symptoms referred to did not oc- cur till the signs of advancing paralysis had developed themselves. . . . The garrulous talk was quite incoherent ; the muscular rigidity did not appear till even a later stage, when the symptoms of paralysis were still more apparent, etc."* Once the stage of true stimulation " produced by doses altogether insufficient to produce paralysis of any part of the system," is past, and narcotism is begun, as shewn in the symptoms above recorded, " the whole process is essentially one ; it consists, both in its early and later stages of par- alysis of the various sections of the nervous system.""!' 42a Among the differences in aether administration compared with chloroform, one of the most striking is the flushing, vascular fulness and general signs of congestion of the head and face, accom- panied by a copious flow of saliva, which attends the inhalation of aether. These effects commence with the first, or stage of stimula- tion, and continue and intensify till anaesthesia is complete. They are consequently coincident with the struggling and incoherent talk- ing referred to. Dr. Anstie attributes this "flushing" to paralysis of the vaso-motor nerves of the sympathetic, permitting vascular dilatation, in accordance with the popular theory. But he states * Dr. Anstie, Stim. and Narcot., p. 259. t Ibid, p. 285. 200 PHYSIOLOGICAL THERAPEUTICS. that it begins among the earh'est signs of narcosis, while he also admits, that the sympathetic is among the last portion of the ner- vous centres to become impressed, towards the close of the process. Here is a palpable discrepancy as to time, which alone would inval- idate his theory of the cause of flushing. 421. We have ventured to claim that in flushing and vascular ful- ness, the vaso-motor nerves of the sympathetic are not paralyzed, but excited, and that their function is to dilate the vessels under their control and not to contract them. (See vaso-motor chapter). On this view, the vaso-motor nerves are excited, in common with other portions of the nervous system, in the early or stimulative stage,, and remain so, till as narcosis progresses, and the sympathetic is reached, they are depressed in turn. But as forming a part of the sympathetic, they are the last — in normal inhalation — to suffer de- pression, the vascular fulness previously set up, continues through- out the paralysis of the other centres, until their turn comes to suc- cumb, as anaesthesia approaches completion. Then, with partial paralysis of their nerves comes contraction of the distended vessels,, cessation, in part at least, of the capillary engorgement, arid a more natural aspect of the features. The salivary glands, however, hav- ing their functional activity excited by the unusual supply of blood — the effect of the vascular fulness of the first, or stage of stimula- tion — maintain their functional activity for a time, notwithstanding the partial paralysis of the vascular dilating nerves, and only grad- ually return to their ordinary rate of secretive activity. 422. In those cases referred to by Dr. Anstie, where life is speed- ily arrested by the too rapid charging of the blood with aether, chloroform or alcohol, the sympathetic is reached — as it were — at a bound, and paralyzed almost simultaneously with the other centres. As a consequence, the vessels suddenly contract ; and the heart de- prived, as by a stroke, of its proper blood supply, is unable to pulsate. Swift paralysis overtakes the medulla oblongata , respira- tion is speedily arrested, and the man or animal dies. 423. The flushing and congestive fullness of the face and head are much less seen in chloroform than under aether ; because chloroform is more active as an anaesthe<"ic. It leaps, so to speak, from one nervous centre to another at a more rapid rate, and sooner reaches the sympathetic and controls it, arresting the vascular fulness of its first or early stage. This is why chloroform is more dangerous as an anaesthetic than aether, as its effects are more rapid, and it traverses more quickly the entire range of the nervous centres, par- alyzing as it goes. It will be seen how well this view serves to explain the flushing which commences with the first stage — of stimulation — and continues until the sympathetic is depressed, as the process becomes complete. The deadly pallor which marks the onset of fatal results, indicates m 1 HYD , OF CHLORAL. le he also ►f the ner- le process. )uld inval- .scular ful- ilyzed, but mder their pter). On with other :tive stage^ pathetic is lart of the suffer de- ls through- nes to suc- ith partial led vessels, irid a more /ever, hav- y of blood of stimula- Ithstanding only grad- "e is speed- rith aether, ivere — at a ler centres. e heart de- unable to L , respira- \' ■ d head are hioroform from one er reaches ness of its igerous as id, and it ntres, par- te flushing continues complete, indicates complete paralysis of the vaso-motor nerves, which leaves the mus- cular fibres of the arteries wholly unopposed, aiid a!s a corisequende the calibre of thrain. Professor H. C. Wood, of Philadelphia, who has lately written a valuable paper on the action of the nitrite, found no con- vulsions after injecting it subcutaneously. By giving it in this way, the blood was not acted on in its passage through the lungs, and aspl^yxia was prevented."'!' Nitrite of amyl has also the effect of " changing both arterial and venous blood to a chocolate color, due, as Dr. Arthur Gamgee shews, to the formation of nitrite oxyhaemoglobin, and by this means the 4)zonizing prbperty of the blood, and hence oxydation of the tissues is lessened." J i)j 433. DrvtUnger wrjtw favourablly of its use in certain irregular iqcal flushings., or burning sensations, with perspiration, which some- .times^ attend the/' change of life." It may be administered by the ^outliy but as the effect differs geatly in different persons, less than a drop should be used at the commencement. " It may be dissolved in rqctified spirit, two minims to the drachm, and of this the dose * Addresses on Total Abstinence, 1878, pp. 31, 33. t Royal Society's Transactions,— Bnuth. Retros., July, 1872, p. 72. {Dr. Ringer, ib., p. 313. GLONOINE. 205 '1 as " the tie use of ame for a he nitrite, ition," for lentioned, How its large dose We have 1 this view 5 enough ; ct he pre- jonds with discarded. :dies most ted above, essful, the as to pre- eir use, so y contain, of this, Dr. te is passed tve convul- [irough the brain just and no air pulmonary caches the has lately id no con- n this way, lungs, and irterial and igee shews, means the the tissues n irregular rhich some- red by the less than De dissolved is the dose ransactibns, — is three to five drops on sugar every three hours, with an additional dose as the flush begins."* t)r. Ringer offers no explanation of this apparent illustration of the Homoeopathic theory, that drugs in small doses cure symptoms and conditions similar to those they cause in large doses. His book, and the records of drugs generally, furnish numerous exam- ples of this kind of action. The efficacy of small doses of ipecacu- anha in functional vomiting, is a case in point, and others might be mentioned. On the contrary, neither nux vomica nor strychnine has pjroved of use in tetanus ; iron in plethora ; nor conium in mptor paralysis ; while iodide of potassium produces no effects, in any dose, which are at all to be comparable to syphilis. Perhaps, like the hot and cold stage of ague, the " flushing " re- ferred to has also its zero, in which a contracted state of the capil- laries may be present : and as quinine cures the cold as well as the hot stage, so may nitrite of amyl cure the condition upon which the vascular contraction depends, and with that its alternative flushing. At any rate, we are not called upon to explain every problem in "Physiological Therapeutics," and are quite content to leave some of the mysteries to future editions, or to the critics, who, of course, can readily solve them all. 434. GLONOINE. — This is not an officinal preparation, except among homceopathists, to whom it was first introduced by Dr. .Hering.of Philadelphia, in 1850. It is the now well known and highly dangerous explosive, nitro-glycerine. It is prepared by dis- solving glycerii' t in nitric and sulphuric acids. It is dissolved and diluted in alcoL \ for medicinal purposes. Like nitrite of amyl it is a prompt and powerful excitor of vaso-motor nerve action, as seen in the dilatation of the blood-vessels and the quickened action of the heart. Dr. Richard Hughes says of it, " If you touch your tongue with a five per cent, solution, you will find that in a few minutes your pulse will have increased by from 20 to 40 beats, and your head \yill b^in to throb and beat until a pretty violent bursting headache developes itself. With this, there will be some giddiness and' a sense of constriction about the throat. If you are sensitive to the drug, nausea and faintness may supervene, and even complete insensibility ensue. This is the nearly uniform action of glonoine upon every one who has taken it."-f- Dr. Hughes regards this substance as " a direct sedative upon the medulla oblongata," and interprets its mode of action as " the pre- cise opposite " to that of hydrocyanic acid. He denies that vas- cular activity generally, throughout the body, is augmented, as would necessarily appear to bie the case from its action on the head and heart. The drug, however, has not had that attention paid to * Therapeutics, p. 319. t Pharmacodynamics, p. 288. zo6 PtnrSIOLOGICAL THERAPEUTICS. !•?:■ i ii it which its remarkable physiological action would appear to deserve. It is used among homoeopathists, in diluted doses, for the treatment of congestive headache, sunstroke, and the disturb- ance of the intercranial circulation which obtains in menopausia and sometimes in menstrual suppression.* 435. /'//C>5/'/^(9;e£/5.— Phosphorus is absorbed into the blood, and there acts as " a stimulant to the nervous, vascular and secreting organs. It excites the mental faculties and the sexual feelings, raises the temperature of the skin, increases the frequency of the pulse and promotes the secretions."f In large doses it is a power- ful irritant and caustic, first producing inflammation of the stomach when swallowed, and subsequently of the lungs, as it reaches them in the circulation of the blood. It induces jaundice, vomiting of a substance of a dark green or black colour, and sets up fatty degener- ation in all the muscular tissues. 436. Dr. Ringer writes, " For many years this substance had fallen into disuse, but owing to its signal success in neuralgia, in the hands of homoeopathic practitioners, it has recently been restored to favor." Dr. Fleischmann, of Vienna, used it with marked success in pneu- monia, in minute doses, and Dr. Richard Hughes says its effects are of the happiest kind in ulceration of the rectum and in chronic sinuses left in the mammary gland after extensive suppuration. J Administered in small and proper medicinal doses, it is regarded as exerting a special restorative effect upon the nervous tissues, and doubtless in this way is beneficial in neuralgia and other diseases of exhausted vitality. Its " food action " is shewn in improved appe- tite, increased rate of circulation, a heightened temperature, increased perspiration, abundant urine, a sharpening of the mental faculties, etc. (Ringer.) Dr. Hammond praises it in cerebral softening and hysterical paralysis ; Dr. Anstie in chronic alcoholism, and Dr. Thompson recommends it strongly in megraine. It is often service- able in angina pectoris, a disease which is closely allied to, if it be not a true neuralgia. (Ibid.) 437. The medicinal use of phosphorus is a strong proof of the truth of our theory of vaso-motor innervation. For it is admitted that it increases nerve-force, and at the same time produces vascular fullness and congestion. Nerve-force, then, dilates the arteries ; whereas, on the accepted theory, the arteries are dil?<:ed only in proportion as nerve-force is paralyzed, and to excite n.^rvous agency is to cause vascular contraction. Here, then, is a drug acting pal- pably in antagonism to the popular theory ; a fact which we leave to the advocates of that theory to explain. 438. AMMONIA. — The preparations of ammonia, as used medi- cinally, are mild stimulants, which through their action on the vaso- * Hughes, p. 289, etc. tDr. Pereira, Mat. Med., Vol. I., p. 257. $ Pharmacodynam> ics, pp. 439, 449. AMMONIA.. 207 tpear to loses, for disturb- siusia and le blood, secreting fe';:lings, y of the a power- stomach [les them :ing of a degener- lad fallen :he hands to favor." in pneu- ;ffects are chronic •uration.J regarded sues, and seases of ed appe- ncreased faculties, ling and and Dr. 1 service- if it be of the admitted vascular arteries ; only in s agency :ing pal- ve leave ed medi- he vaso- acodynam> motor nervous system, assist in maintaining the circulation, and partly in this way and partly by a direct action on the secreting follicles and glands, increase the secretions generally. Dr. Head- land states that " ammonia has been used with advantage in the prevention of epileptic fits,"* another proof of the theory here advo- cated. As a stimulant, however, its action is transitory, and it is much inferior to dilute alcohol. The carbonate of ammonia is occasionally administered in low fevers and asthenic inflammations of the respiratory organs, chiefly for the purpose of sustaining the circulation. The solution of the acetate of ammonia serves the purpose chiefly of a mild diluent, and as such is prescribed ad libitum^ in combina- tion with diaphoretics or diuretics. The muriate, or chloride of ammonium, is a very valuable drug. Under its use the tongue is cleaned, the secretions increased, expec- toration rendered easier, and elimination oi eflete products facili- tated. It is of much service in relieving inflammatory face-ache, intercostal and muscular pain, the megraine consecutive to profuse menstruation, neuralgia of the uterus and other organs. These beneficial results of the drug are doubtless attributable to its action in improving circulatory and nutritive activity in the suffering parts, as well as to the general " alterative " action' it exerts. Among its other uses, it sometimes aids in restoring the menses. It is said that a full dose of spirits of ammonia will often speedily steady and sober a drunkard. Dr. Pereira speaks highly of its use " in poisoning by those cerebro-spinants cx)mmonly termed seda- tives," from which it would appear that this antidotal action of ammonia is exerted through the nervous system. Liquor ammonia is useful in neutralizing the effects of formic acid, which constitutes the poisonous principle of the stings of wasps, bees, and other insects. 439. TURPENTINE. — This drug, in small doses, of five to ten minims, is a stimulant. In very large doses, half an ounce to an ounce, when not speedily extruded from the system by purging and diuresis, it produces a species of intoxication, shewing it to possess narcotic powers. Its effects on the vaso-motor nerves are similar to other medicines of this class, and its action over the circulatory system accords with our theory. It is inadmissible in acute sthenic fever ; but in atonic or ady- namic states, depending on the poison of typhus or puerperal fever, in tympanitic distention of the abdomen, from accumulated flatus, it is prescribed witt much advantage. The student will do well to remember that in typhoid states, when the coating of the tongue peels off irregularly, or when the •Action of Med., p. 269. k 20$ PHYSIOLOGICAL THERAPEUTICS. t ■ "A K^ •M m surface of that o^an is dry and glazed, this drug will be found specially indicated. An emulsion is a convenient and agreeable form for its administration. As an enema in tympanitis, it may be mixed with the white of a raw egg, and repeated according to cir- cumstances. Besides the mode of action referred to above, on the nervous system, turpentine doubtless also exerts an influence directly on the blood, on the mucous surfaces, and on the glands, through which it is eliminated, and is prone to set up irritation of these structures, in this process, when too freely administered. 440. GUIACUM. — This is another remedy of this class, and to some extent exerts a stimulating effect over the vascular system^ combined with an " alterative " influence over the secreting organs. It is sometimes used with advantage in chronic rheumatism, gout, dysmenorrhoea, etc. The ammoniated tincture is the most active preparation of this drug, combining, as it does, the stimulating qualities of both ammonia and guiacum. 441. SULPHUR. — This useful but neglected remedy belongs to the class we are now considering. Dr. Pereira says of it, " In small and repeated doses it acts as a gentle stimulant to the secre- ting organs, especially to the skin and the mucous membranes, par- ticularly the bronchial membrane. It promotes the capillary circulation of these parts and increases their secretion."* Pr. Richard Hughes says it produces a "decided determination of bipod to the head," sometimes causing vertigo.-f* Here, again, we have a stimulant producing increased vascular activity. How is this brought about if vascular fullness depends on vaso-motor paralysis } The position is very clearly understood if vaso-motor nerve -force dilates the arteries, and a mild stimulant assists them in doing so. That is what we claim for it, in antagonism to the popular theory. Besides a gentle stimulation of the nervous system, sulphur pro- duces effects also on the blood and tissues ; on the mucous mem- branes and skin, which are well known, or the facts in relation to which are easily accessible to every reader. 442. COLCHICUM. — Dr. Ringer says "the physiplogical ef- fects of colchicum are very similar to those of veratrum, yet one cannot be therapeutically substituted for the other." jt is a vas- cular depressant, but while " it will abolish gouty inflammation as if by magic, it exerts scarcely any influence in other inflammations." (Ibid). Gout is believed to depend chiefly upon an excess of uric 4Cid or urate of soda in the blood. (Pr. (^arrod). Colchicunn cufes gout, but " exerts no influence on the elimination of uric add tn gouty people." (Ringer). It causes notable purging, but its cura- tive effects on gout are said to be best displayed', when purging does npt accompany its admmistration. * Mat. Med., Vol. I, p. 356. t Pharmacodynamics, p. 515. COLCHICUM. 209 found jreeable may be to cir- nervpus Y on the Mrhich it tures, in and to system* orgs^ns. m, gout, it active nutating belongs it, "In le secre- ines, par- capillary "* Dr. I of blood e have a is this »aralysis ? ;rveforce 4oing so. theory, phur pro- »us mem- dation to pgical ef- , yet one is a Y^s- cn^tion as |pi?i^ip>is." ;ss of uric cuni cuf es c acid in it its cura- rgihgdoes 443. Dr. Wilkes confirms the interesting fact, observed by Dr. Garrod and others, that lead poisoning produces gout, " and appa- rently true gout, since the arthritic inflammation is due to the de- posit of urate of soda in the joints ;" and is attended by the usual concomitants of gout. Dr. Wilkes, after calling attention to the causes of gout, such as mal-assimilation of food, excess of nitro- genous food, wines, etc., asks, in what way lead poisoning so affects the digestive and assimilative processes as to favor the production of urate of soda ? He says, " This, we believe, is the question to be asked, and not a simple chemical one, because we find attacks of gout caused by disturbances of the nervous system, and relieved by such remedies as quinine, mineral acids and colchicum ; causes and remedies which can only indirectly affect the functions before named, and do not act by simple chemical methods.* 444. This view of gout points to the nervous system, as the por- tion of the organism chiefly concerned in its cause and cure. What, then, are the effects of colchicum on the nervous system ? The profound prostration and general muscular weakness caused by excessive doses, seem to point to depression of the motor nerves. If pain be a form of sensory paralysis, as Dr. C. Handfield Jones,*!* Dr. Radclifte, Dr. Anstie, and others believe, then the sensory nerves are also depressed, for colchicum causes severe pains in the extremities and head. The vaso-motor system is also more or less paralyzed, and, as a consequence, the arteries are abnormally con- tracted, as is seen in the weak and intermittent pulse, pinched features, and cold extiemities. 445. But there are also evidences of tissue irritation, shewn by congestion and ecchymoses in the stomach, intestines, lungs, heart,- diaphragm, etc. In this, the intestines are the part of the organism which, if not always the most inflamed, appear to be the most actively disturbed, since even when injected into a vein, it is through the glandulae and follicles of this canal that the poison is chiefly eliminated. This task the kidneys appear only to share in a second- ary degree ; since the urine, though usually rendered hot and pain- ful, is not as a rule materially increased. The salivary glands display considerable functional activity. Colchicum, then, in large doses, would appear to be a general nervous sedative, and at the same time an active tissue irritant. Perhaps the latter quality may furnish a reason why its sedative action does not assist in the cure of other and ordinary inflamma- tory attacks ; the irritation set up in some organs proving too strong for the vascular sedation accompanying it. ;. 446. The effects recounted above, however, are the result of doses niore or less poisonous ; and like some other drugs of this class, the effects of small or moderate doses may be of a different or opposite •Brit. Med. Jour., 1875, p. 10. Braithwaite's Retros., July, 1875, p. 49. tBraith' Retros., July, 1876, p. io. T 3ro PHYSIOLOGICAL THERAPEUTICS. 11% kind to that of large ones. Thus, Dr. Austin Meldon, (Dublin) has found by experiments on himself, that ten or fifteen minims of the tincture of colchicum seeds produced " increased action of ail the organs of the body ; the skin became moist ; the action of the kid- neys iind liver increased ; the mental faculties invigorated and the heart's action accelerated so as to cause palpitation. All these results," he says, "can only be produced by a nervous stimulant."* Dr. Meldon says, " In Ireland gout is one of the rarest affections met with in hospital practice, yet I have repeatedly found the blood, in otherwise healthy men, lying in our accident ward, loaded with urates, and my own blood has been in this condition for years, although I have never had the least symptoms of gout. Dr. Gairdner found urates in the blood of a boy four years of age, in whose family gout had never been known."f From this he infers that the presence of urate of soda cannot be the sole cause of this distressing malady. His theory is that the uric acid and soda are kept in a separate and fluid state, a condition in which they may be eliminated, so long as nerve-force is normal and active : but when nerve-force is depressed, " these two substances unite in the tissues most removed from the centre of the circulation." Irritation and inflammation are then set up, and " excite the nervous system to increased energy and the disease is for a time arrested." Colchicum, as a nervous stimulant, assists and shortens the process. Dr. Meldon thinks that the onset of the paroxysms at night, when nerve-force and circulatory activity are weakest ; and the seat of the disease, the great toe, favour this theory. If this view were correct, then nerve tonics or stimulants ought also to prove benefi- cial in gout ; and accordingly, he points out sulphate of nickel and the triple phosphate of iron, strychnia, and quinine, as remedies from which he has derived most benefit. J Dr. Rees, of Guy's Hospital, thinks " the phenomena of the acute gouty paroxysm are best explained on the theory that the disease is essentially a capillary phlebitis ; the venous inflammation being ca sed by the circulation of a blood poison." || Ur. Gairdner differs materially from Dr. Garrod in regard to the pathology of gout ; and insists that if the painful symptoms are owing to the deposition of urate of soda, the pain should occur coincidentally with it : whereas the pain and vascular excitement occur before the swelling, and subside on its appearing.§ It is impossible, at present, to reconcile these conflicting views, and we submit them to the reader as we find them. Colchicum, in some way, relieves the pain of gout ; but is better adapted for the strong and vigorous than for the weak and asthenic. It does not prevent a return of the disease, and is even thought by some to favour its recurrence. Hence it is more palliative than curative. "•Lancet, 1872, p. 114. Braith. Retros., January, 1873, p. 46. tibid, J Ibid. HBraith. Retros., July, 1877, p. 42. §Ibid. ARSENIC. 211 ublin) has ns of the of all the the kid- and the All these lulant."* affections the blood, laded with for years, out. Dr. of a{?e, in I he infers iise of this , soda are they may : but when the tissues itation and system to Colchicum, i at night, nd the seat view were ove benefi- nickel and ls remedies of the acute the disease ition being gard to the nptoms are lould occur excitement :ting views, jlchicum, in pted for the It does not by some to lan curative. bid. Tibid. It has no proper anodyne properties and amid its marked general disturbance, it leaves the cerebrum and the mental faculties com- paratively unaffected 448. ARSENIC. — This is a remarkable drug. \X% action upon several distinct parts of the organism is worthy c. special study. We will glance at these effects separately. 1st. Arsenic, by one mode of its poisonous action, paralyzes the sensory and motor gaiiglia of the brain and motor nerves. This result is seen in that mode of death from its use, in which profound cofrta, from which the victim never wakes, sets in early, without the occurrence of the usual intestinal inflammation.* This state of coma depends primarily, and perhaps solely, upon a suspension of the functions of the ganglia mentioned.i* The paralyzing action of arsenic on the motor centres or nerves is seen in a less degree in the chorea-like restlessness, trembling, twitching, cramps or convulsions which constitute ordinary pheno- mena in arsenic poisoning. Hahnemann long ago pointed out the *' constricting power of arsenic," over muscular tissue, as shewn in the extremely contractt states of the cardiac and pyloric orifices of the stomach and of the sphincters and ducts generally, as well as of the voluntary muscles. Dr. Richard Hughes, recounting these effects, remarks that " they can hardly be produced through the motor nerves, as these are more or less paralyzed." Precisely, and that very paralysis, as we have heretofore shewn, is the neces.sary condition under which these spasms and contractions invariably occur. Nor is it the musculo-motor nerves alone which are paralyzed. The vaso-motor nerves, which dilate the blood-vessels, also partake of a similar depression : and, as a consequence, we find an effect sometimes produced on the circulatory channels not unlike that of aconite, as seen in coldness, faintness, collapse, etc.| 449. 2nd. Arsenic is also a tissue irritant, and, in other than the comatose cases, produces inflammation of a corrosive or ulcerative kind' throughout the whole mucous tract of the alimentary canal, consti- tuting a gastro-enteritis of a most painful and fatal kind. Nor are its effects confined to the mucous tissue. The serous membranes, the skin and the large viscera are also involved in its action, though to a lesser degree. Hence the effusions, petechial eruptions and ecchymoses witnessed after death from arsenical poisoning. 450. Are these degenerative changes in tissue, which in the liver, kidney, heart, etc., are said to assume the fatty kind, the effects ot this poison on the nervous centres, transmitted from thence to the viscera and surfaces of the body ; or are they the effect simply of an irritant action exerted directly upon the tissues themselves? •Dr. Ringer, Therapeutics, p. 225. tDr. Carpenter's Physiol., p. 840. $Df Pereira, Vol. I., p. 632. Dr. R. Hughes, Pharmaco., p. 108. 212 PHYSIOLOGICAL THERAPEUTICS. » .m^i d to the ferred to secretion jrience is whenever led, jabo- ind efifec- : will yet 2d it with with cer- ecognizes ency.* lladonna ; :he vascu- t drug, as iealt with rge doses, of drugs, /hich it is ; and sus- eness and ference to lich alone (wever, by nd bodily far better Ts. Anstie e general rrin — that ity, only le emunc- the vital i-han can ■lanner in which it Brunton, the views •s on this ol under- oxydized g up the Vs. ALCOHOL AS A STIMULANT. 215 animal heat, or for both, and will therefore be entitled to rank as food, while if it is excreted unchanged, it will have no claim to the name, and must be classed with such substances as the organic al- kaloids, which after acting on the nervous and muscular systems, while they are circulating in the blood, pass out after a while by the emunctories. It is the merit of Baudot, Anstie and others, who have worked at this subject, to have shown that aicoliol is oxydised, and is thus to be reckoned as a food and not merely as a drug. But still more satisfactory evidence of its claim to the title of food is afforded by the fact that it will keep up the weight of the body and prolong life when the supply of other food is insufficient or is en- tirely wanting." "Dr. Hammond found that when he took an insufficient diet, and was daily losing weight, the addition of alcohol not only prevented this loss of weight, but converted it into an actual gain. In his work on " Stimulants and Narcotics," Dr. Anstie has collected a number of cases in which persons have lived for a considerable time upon it alone, or along with a quantity of food so small as to have been utterly inadequate without it." " " From a survey of all the evidence on this subject, I think we ■may conclude that in moderate doses, alcohol undergoes com- bustion in the body, and will supply energy, yield warmth, and tend to sustain life, in the same way that sugar would do, and is therefore to be reckoned as a food. At the same time it has a power of diminishing oxydation, which prevents its employment as food to any great extent in health, but greatly increases its utility in disease." " In feverish conditions it diminishes tissue waste and thus keeps up strength in three ways : — i. It undergoes combustion itself as a food, instead of the tissues. 2. It lessens oxydation in them. 3. It lowers the temperature which itself increases tissue degeneration. It may perhaps seem rather cont«-adictory to say that it undergoes combustion and yet diminishes combustion ; but in this respect we may compare it to the sulphur which some people are accustomed to throw into their grate, when the chimney takes fire, the sulphur burns but it puts out the blazing soot." . ..." If alcohol al- w^ays quickened the pulse in disease, as it generally does in health, it would probably be injurious in prolonged illness, as it was found to be in prolonged exertions by the soldiers in Ashanti. But this is not the case, for in fever the quick pulse frequently becomes slow- er after the administration of alcohol ; and, indeed, an excellent rule of practice is not to give alcohol if it increases the rapidity of the pulse already too quick. Alcohol thus economizes the vital power of the heart, and tends to prevent death from exhaustion." Dr. Brunton enumerates the foUov/ing as the chief points of his paper : — " I. Alcohol in small quantities, increases the secretion of gastric 2l6 PHYSIOLOGICAL THERAPEUTICS. mm juice, and the movements of the stomach, and thus aids digestion. Although unnecessary in health, it is useful in exhaustion and de- Uility. " 2. It increases the force and frequency of the pulse, by acting reflexly through the nerves of the stomach. " 3. In large doses it impairs digestion by over-irritating the stomach. " 4. It may produce death reflexly, by shock. " 5. After absorption into the blood it lessens the oxydizing power of the red blood corpuscles. This property renders it useful in reducing temperature ; when constantly or very frequently present in the blood, it causes accumulation of fat, and fatty degen- eration of the organs. " 6. It undergoes combustion in the body, maintains or increases the body weight, and prolongs life on an insufficient diet. It is therefore entitled to be reckoned as a food. " 7. If large doses are taken, part of it is excreted unchanged. " 8. It dilates the blood-vessels, increases the force and frequency of the heart, by its action on the nervous centres, to which it is con- veyed by the blood, imparts a feeling of comfort, and facilitates bodily and mental labour. It does not give additional strength, but merely enables a man to draw upon his reserve energy. It may thus give assistance in a single effort, but not in prolonged ex- ertions. [The last sentences apply to its use in health and not in disease.] " 9. The same is the case with the heart ; but in disease alcohol frequently slows, instead of quickening, the pulsations of this organ, and thus economizes instead of expending its reserve energy. " 10. By dilating the vessels of the skin, alcohol warms the sur- face at the expense of the internal organs. It is thus injurious when taken during exposure to cold, but beneficial when taken after the exposure is over, as it tends to prevent congestion of internal organs. "II. The symptoms of intoxication are due to paralysis of the nervous system, the cerebrum and cerebellum being first affected, then the cord, and lastly the medulla oblongata. It is through paralysis of the medulla that alcohol usually causes death. " 12. The apparent immunity which drunken men enjoy from the usual effects of serious accidents, is due to paralysis of the nervous mechanism, through which shock would be produced in a sober condition."* 462. The foregoing is not a merely individual or isolated opinion; but is held by all but a mere fractional part of the profession. The only dissentients of note, to the opinion which asserts the food ac- tion of alcohol, so far as we have been able to learn, are Dr. B. W • Practitioner, 1876, p. 121.— Braith. Retros., July, 1876, p. 232. ALCOHOL AS A STIMULANT. 217 digestion, n and de- by acting :ating the oxydizing rs it useful frequently itty degen- ir increases diet. It is iianged. d frequency ich it is con- d facilitates al strength, energy. It •olonged ex- k and not in ease alcohol )f this organ, lergy. rms the sur- jurious when en after the of internal alysis of the 'rst affected. It is through ,th. ijoy from the the nervous in a sober ited opinion; ["ession. The the iood ac- Ire Dr. B. W Richardson, F.R.S., and Dr. Lionel S. Beale, F.R.S. The former bases his argument on the admitted fact, that alcohol does not con- tain the materials from which the tissues of the body are nourished or built up. Taking his stand on the purely chemical facts of the case, he insjsts " that alcohol cannot by any ingenuity of excuse for it, be classified among the foods of man."* He admits, however, that alcohol is " decomposed in the body," and " is transmutable into new compounds," and not eliminated unchanged, and also that " by some unknown process it may be transferable into fat."-|* As a matter of fact, on the subject of vital chemical changes, very little is yet definitely settled ; and an appe'al of this kind, on purely theoretic grounds, will not suffice against the well authenticated facts of practical experience, which Dr. Richardson seems to have system- atically ignored, or which, at all events, he makes no effort to ex- plain. 463. Dr. Beale fully recognizes the value of alcohol as a remedy- in febrile and other exhausting diseases ; but he denies its food ac- tion. What it does, he claims, is to restrain the undue growth of bioplasm, with which the blood-vessels are loaded, the circulation retarded, and the temperature increased in fever. It does this, if not by actually coagulating the surfaces of these minute masses of albumenoid germinal matter, at least by condensing their substance and rendering them less permeable, and so less accessible to the nutrient fluid surrounding them. Alcohol, he intimates, also les- sens the calibre of the vessels, through an influence exerted on their vaso-motor nerves, and so condenses their walls as to lessen the ex- udation through them of these amaeboid particles. Dr. Beale differs from his contemporaries in holding that there is deficient oxydation in the febrile state, the effect of which is, that quasi nutrient mate- rials which ought to be eliminated, as urea, uric acid, etc., are retain- ed in the blood, and furnish pabulum in undue quantities for its bioplasm, which consequently not only grows and multiplies in the vessels, but that passing through these — as in pneumonia— the neighboring tissues become the seat of active proliferation and ex- cessive cell growth. Fever and inflammation, he holds, are essen- tially the same process, in one case general and in the other local : the condition he describes is applicable to both. Alcohol, by its alleged action, reduces the rate of growth of the rapidly increasing bioplasm, and in so doing reduces the temperature, favors a slower and more healthy cell growth, and promotes a return to normal nutrition. Besides, by maintaining the force of the heart's action, and thereby " promoting free circulation, so as to keep the whole mass of the blood moving and mingling and changing, not only is the growth of its bioplasm impeded, but the bioplasm already formed is exposed to oxydation and other changes, which lead to its disintegration, to be soon followed by the removal of the pro- t Six Lectures on Alcohol, p. 73. t Ibid., pp. 62, 68. 2l8 PHYSIOLOGICAL THERAPEUTICS. ««f ^ II ducts of its decay." A favorable effect is thus exerted on the temperature, which increases as the circulation becomes more feeble. Dr. Beale believes that in this way " we may explain the beneficial action of alcohol, without assuming that it is a food, or contributes directly to the ordinary process of nutrition.* 464. Dr. Anstie objects to this view of the case, on the ground that the alcohol in the blood is much too dilute to produce the effects attributed to it ; and also, because it does not serve to ex- plain " how alcohol calms delirium and promotes natural sleep, in a manner not distinguishable from that in which ordinary food as meat and soup acts."-h And certainly Dr. Be&le, in the work from which we have quoted, is extremely reticent as to the manner in which alcohol produces sedation. ' Here, as elsewhere, the weight of authority must determine con- clusions ; and as we have already stated, the great mass of medical authority pronounces alcohol to be in a certain sense a food ; not in health, but in certain states of disease attended with exhaustion. 465. As regards the effects of alcohol on the temperature of the body, Dr. Richardson, from experiments conducted by himself, finds that in the first stage, that of stimulation, alcohol increases the ex- ternal temperature of the body in man, from half a degree to a de- gree and a half ; but at the same time he claims that the internal heat is lessened. During the subsequent stage of narcotism, he finds the temperature increasingly reduced in man often as much as two ■t>r three degrees. The greatest decline occurs in alcoholic coma, and of course indicates danger to life. This condition is distinguish- able from apoplexy owing to the fact that in the latter disease, the temperature, instead of being lowered, is above the normal standard of 98" Fahrenheit's scale. { In proportion to the decline of temperature. Dr. Richardson finds ** a decrease in the amount of the natural product of combustion in the body," notably carbonic acid ; the inference he draws from which is, " that the alcohol is not burned after the manner of food which supports animal combustion ; but that it is decomposed into secondary products by oxydation, at the expense of the oxygen which ought to be applied for the natural heating of the body :" and as a consequence that it is useless as an agent for maintaining the heat of the body.]] 466. Dr. C. Binz, Professor at the University of Bonn, replies as follows to the foregoing views. After quoting the above from Dr. ??: V son, he says : — i .V -rus to me that the inference so drawn, however plausible . l.!.e«*'. . Jf-. overborne by the following facts elicited from experi- a- :. ^ * 5t, that after smaU doses of alcohol, neither the temper- atiu.- ^t ilii. blood, nor the quantity of urea in process of being * Disease Gernis, pp. 328, 420, 423, etc. fStim. and Narcot., pp. 238, 380, 384. t Lectures on Alcvihoi )p. 32». 1, p. 70. yibid, pp. 71, 72, 73- ALCOHOL AS A STIMULANT. 219 i on the les more :plain the t food, or he ground oduce the irve to ex- sleep, in a ry food as work from manner in rmine con- of medical od ; not in austion. ture of the mself, finds Lses the ex- ree to a de- he internal sm, he finds luch as two lolic coma, distinguish- disease, the lal standard ardson finds nbustion in draws from ner of food iposed into he oxygen body :" and itaining the 1, replies as ve from Dr. er plausible rom experi- the temper- ■ss of being . 238. 380, 384- thrown off, is found to be measurably diminished. Secondly, that even such quantities as lowered the temperature of the blood at first, cease to produce this effect after having been repeated a few time Thirdly, that when there is no impediment to the respira- tion, the organism obtains much more oxygen than it can consume. Fourthly, that no ' secondary ' product of alcohol has been found as yet in the organism." The Editor of Braithwaite's Retrospect, says " the observations of Dr. Binz are peculiarly valuable upon this subject, as they are based upon his own experimental researches." We therefore quote him further on the question of temperature. He says : — " I have con- vinced myself by a series of experiments that alcohol is completely destroyed in the animal organism The facts observed all seem to lead to the conclusion that alcohol in the body, just as in the flame of the spirit lamp, is oxydized to carbonic acid and water. Such being the case, it is evident that every molecule of alcohol burned within the system must yield not only warmth but that power to accomplish work with which the development of cal- oric is always accompanied." Dr. Binz then proceeds to compare the relative heating power of alcohol, pure coal, hydrogen, and cod-liver oil, which stand to each other as 7, 8, 34.5, and 9.1, respectively. Four tablespoonfuls of cod-liver oil — about fifty grammes — are equal to sixty-five grammes of alcohol, for the purposes of producing heat. He continues : — " The advantages possessed by the latter over the oil are obvious. Besides being infinitely more pleasant to take, the alcohol, if lai^ely diluted with water, in the form of good wine, is readily digested, even in the weakest stomach ; and as has been shewn, is easily and completely disintegrated in its passage through the system. On the other hand all fatty substances require for their emulsion, absorp- tion and assimilation, a very considerable amount of work, which of course is only that much more drain upon the powers of the patient." We pass over the testimony of Dr. Binz as to the value of a con- tinual supply of wine in enabling the patient to resist for a length of time the ravages of severe disease, where no other form of nour- ishment is accepted by the stomach. Typhoid fever and the earlier stages of pulmonary tuberculosis are especially referred to in this connection. A good deal of importance is attached to the purity of the alcoholic fluid, and also to the manner of its administration, which he appears to intimate should be in moderate and repeated doses. In this way " it will not afTect the temperature of the body to any measurable extent: it will simply burn, as will any other innocent digestible hydro-carbon, giving off its proper quantity of heat to the tissues, and resolving itself into carbonic acid and water."^ " To produce an antipyretic effect, an adult will require a dose of 230 PHYSIOLOGICAL THERAPEUTICS. i- M about two fluid ounces of absolute alcohol Where the digestion is healthy, and where a sufficient transfer of nutritive material takes place from the food to the blood, the human body is capable of accomplishing all the functions for which it is designed, without the use of spirituous drinks, which in health are entirely superfluous." • Dr. Binz sums up his views as follows. " ist. That alcohol is very frequently a stimulant of transitory power. 2nd. That in relatively large doses it can serve as a vigorous antipyretic. 3rd. Alcohol given in small and oft repeated doses is a food particularly adapted to cases where the stomach can take no other * combustible mate- rial ' to supply warmth and working energy to the organism."* Other observers — Dr. Parkes, Dr. Ringer, Dr. Rickards — find that while alcohol in two-ounce doses, given to a healthy fasting man, reduces the temperature, this result does not follow if given with food, even to the extent of four to eight ounces. Nor is a reduction in the temperature readily produced in those habituated to its use, as was shewn in the administration of twelve ounces of good brandy to an habitual drunkard, making him " dead drunk " without the smallest reduction of the tetnperature.f 468. From the foregoing it will be seen how wide is the diflference between the views of Dr. Richardson as to the sustaining and heat- ing qualities of alcohol, and those of other observers, numbers of which might be quoted, equally capable and sincere as he. Leaving the r od question out of sight for the moment, we find that all agree that alcohol in moderate doses, produces temporary stimulation, with increased vascular and functional activity : and that in large doses — varying with the habits and temperament of the patient — it produces sedative, depressing or paralyzing effects on the nervous system, with reduction of temperature as a rule. 469. The question may reasonably be asked, if the first of these effects are produced by the combustion of alcohol, and the conse- quent liberation of heat and force in the body, why should not the same process be continued and even intensified, instead of being partially arrested, by the larger quantity } The theory of these pages supplies the answer. The small dose increases nervous activ- ity, dilates the arteries, quickens the pulse, increases vascular activ- ity generally, and so favors those changes in the minute vessels and capillaries, where the effete matter is exchanged for new, where the carbon of the tissues meets the oxygen to produce combustion, for this process is going on all over the body in the vascular ramifi- cations as well as in the lungs, and hence the increase of temper- ature. 470. On the contrary, the narcotic dose of alcohol, as we have seen in our former reference to this drug, paralyzes not only the •Practitioner, May, 1876. Therapeutics, p. 276. Braith. Retros., January, 1877, p. 30. tDr. Ringer's ALCOHOL AS A STIMULANT. 221 here the nutritive I body is iesigned, entirely ol is very relatively , Alcohol r adapted )le mate- m. -find that ting man, [iven with reduction to its use, , of good " wi&out difference and heat- umbers of Leaving t all agree imulation, Lt in large Datient — it le nervous st of these the conse- d not the d of being of these vous activ- :ular activ- vessels and where the ombustion, Lilar ramifi- of temper- ,s we have )t only the tDr. Ringer's sensory and motor, but the vaso-motor ganglia or centres. Paral- ysis of the latter, as so often indicated in these pages, puts an end to vaso-motor, dilating, force, sets free the inherent contractile power of the muscular coat of the arterial vessels, which contracts accordingly ; thus reducing the calibre of the arteries, lessening vascular activity, and so diminishing, or in extreme cases arrest- ing, the interchange of gases and elements just referred to, on which the process of combustion and calorification essentially de- pends. A decline in the temperature of the body necessarily follows. 471. This explains why it is that when food is taken with the narcotic, it not only retards its action, by delaying absorption, but the stimulus of food on the nervous sytem, to some extent, antidotes the depressing effect of the alcohol, and accordingly, as stated by Dr. Ringer, the temperature is little if at all reduced. Again, in the habitual toper, in whom the reduction in temperature sometimes fails to occur, even from narcotic doses, whose vascular nerves are subjected to frequent stimuli, the blood-vessels may be assumed tq be perpetually dilated. The muscular fibres of their walls are doubtless enfeebled, so that when liberated by the paralysis of their nerves, they contract slowly or imperfectly, and thus fail, for a time, materially to diminish capillary fulness, or to arrest the process of combustion going on within them. Thus the theory we advocate, we think, furnishes a reasonable exposition of the double effect of alcohol, as administered in small or large doses. There are times and conditions in most men's lives when the first or stimulant action of this drug is found grateful and beneficial. It is doubtful if this can ever be said of the resort to narcotism from alcohol. 472. It is necessary especially to note that in the use of alcohol in low and wasting diseases, even when comparatively large doses are resorted to, the effect sought and produced is neither " stimula- tion," in the sense of excitement, nor narcotism. There is thus a great difference in the effects of alcohol in health and disease, which must not be overlooked. In perfect health, alcohol, in a stimulating dose, is something super-added to the needs of the ot^nism, in excess of what is really required, and is hence injurious. In narcotic doses, it is a poison, and as such is a disturbing cause until it is decomposed, or eliminated. In disease there is a want in the system, which alcohol supplies, just as arsenic, strychnia, or quinine, respectively supply certain deficiencies of different kinds in corresponding states of the system. In exhausted conditions of the body, this want is so comparatively great, that relatively large doses of this quasi food are required to supply it : and its effects in such conditions are similar to those of other foods, when these can be digested. That is, it retards the waste of the body, improves 222 PHYSIOLOGICAL THERAPEUTICS. III ; 1 il-- circulatory power, diminishes the frequency and increases the force- of the pulse, calms deh'rium, promotes natural sleep, sustains the faltering powers of the organism, and so tides it over the crisis through which it is passing. All this is so well known by those conversant with disease and its treatment, and is supported by such a mass of credible and indis> putable testimony, from all ranks of the profession, that blunt denials or counter arguments of a technical or theoretic kind, fail to- subvert it. ' 473. Among the beneficial eflfects of alcohol in moderate doses» and taken with the food, its action on the digestive organs deserves notice. Dr. E. A. Parkes, F.R.S,, who is an excellent authority, says : " I have two observations on this point which seem to be really exact. A relative of my own, and a man of singularly good' judgment and honest mind, was a total abstainer for many years. When he was between fifty and sixty years of age he got out of health ; his digestion became feeble ; he ate less, and began to get thinner. He was advised to take one-half to one pint of beer with dinner. He did so unwillingly, but found to his surprise that he ate more, digested better, and soon recovered all his lost ground. He has continued to take beer once a day, and occasionally one or two glasses of wine, ever since. He is now seventy years of age, very healthy, and has no doubt that he has been greatly benefitted by this alteration in his diet." We have here to remark that while with many persons, so large a quantity of ale or beer would disagree, a much smaller portion, even a wine glass or two, which would not affect the brain, would be productive of similar advantage in debilitated states of the digestive organs ; the explanation of which appears to be, that these beverages, though not in themselves foods, in the strict sense of the term., nevertheless, in some way, aid in the digestion and assimila- tion of foods proper. Dr. W. B. Carpenter, author of " Use and . Abuse of Alcoholic Liquors," bears testimony to this as follows : " There is another class of cases, in which we believe that these malt liquors, either beer or pale ale, constitute a better medicine titan could be adminis- tered under any otlter form; those, namely, in which the stomach labors under a permanent deficiency of digestive power, consequent either upon original debility or upon persistence in some unhealth- ful system during the preceding part of life."* Within a few years, Dr. Carpenter confirmed the foregoing, from his own experience, in a letter to Dr. Parkes, which he permitted him to publish, as follows : " After having been a water drinker during all the earlier part of my life, and enjoying a fair measure of health and vigor, I broke down about ten years ago, under the * Scottish Review, No. i, p. 24, ALCOHOL AS A STIMULANT. 223 the force- istains the the crisis ase and its and indis- ;hat blunt ind, fail tc rate doses> IS deserves authority, leem to be^ ilarly good lany years, got out of :gan to get • beer with ise that he )st ground, illy one or ars of age, ' benefitted is, so large ler portion, ■ain, would ites of the B, that these sense of the id assimita' if Alcoholic I is another uors, either be adminis- he stomach consequent e unhealth- going, from e permitted Iter drinker measure of under the pressure of excessive work, and besides a local disorder, I then suf- fered from a total loss of appetite and enfeeblemcnt of the digestive power, so that my whole system was rapidly lowering. My medi- cal friends recommended me powerful tonics combined with three glasses of sherry daily, and on this regimen I improved even more rapidlylhan they expected, and was able in a months' time to enjoy a tolerable dinner, gradually reducing the quantity of wine I took with it. . . Ever since that time I have taken a couple of glasses of light claret with my dinner, and this fluid suits me very well. I often reach home very tired and feeling as if I could eat nothing, and I am certain that without this little ' fillip ' I should eat nothing. The question lies, therefore, in such cases, be- tween the use of the slight alcoholic stimulus and the inadequate nutrition of the body, and I cannot myself doubt which is the least of what I am willing to admit to be two evils." ' Dr. Parkes adds, ** coming from such a man, this evidence seems to me indisputable ; and coupled with that derived from watching patients with weak digestions, I think may be called conclusive."* 474. Dr. B. W. Richardbon quotes some experiments made by Dr. Parkes and Count Wollowicz, in which it is shewn that in " a healthy young adult man," a course of alcoholic administration, (extending over six days, during which the daily dose was increased from one ounce of alcohol on the first day, to eight ounces on the sixth,) increased the action of the heart on the last day at the rate of 25,000 beats beyond what is natural ; thus causing it to perform extra work equal to lifting twenty-four tons weight one foot from the earth. This is a very striking illustration, and one well calculated to impress the popular mind, as it was no doubt intended to do. But there is a fallacy underlying it, which requires no very keen pene- tration to discover. It is, that under the circumstances, tlie heart, indeed, beats faster, but its beats are feebler; and the feeble beats, oftener repeated, really accomplish no more than slower and more forcible ones. Just as in a pump, with a defective valve, you must work it faster, two strokes for one, in order to procure the same quantity of water as the pump formerly supplied at the ordinary rate of working. 475. The quantity of blood to be propelled by the heart, in a given time, is definite and uniform, although subject to great varia- tion in its rate of propulsion, from various causes. In its normal healthy state, the heart can accomplish its work by a rate of pulsa- tion averaging 73.57 strokes per minute. When the vaso-motor nerves are stimulated by the early effect of alcohol, and the arteries dilate in consequence, the coronary arteries, in common with others, share in tiie excitement, and convey increased blood to the • *Bnuth. Retrospect, January, 1875, p. 116.— From the Lancet, 1874, pp. 722, 758. 2J4 PHYSIOLOGICAL THERAPEUTICS, ;■ i: ¥'•'■[. ? ISL' heart muscle and the motor centres it contains.* The result is felt in increase of the frequency and force of the heart's action. But when the narcotic effect is produced, and the vaso-motor nerves are depressed, functionally, the muscular walls of the arteries, no longer adequately restrained, close in upon themselves, and in the coronary arteries as well as others, the vascular supply is abnormall|^ dimin- ished ; the functional power of the heart is lessened ; its " lifting " power is enfeebled, so that i/te weight of blood which it ought to pro- pel at a single stroke is divided over several. Hence, although on the sixth day of the experiment, the heart beat 25488 times taster than its ordinary rate, the quantity of blood passed through it was precisely the same as before the experiment began ; and the tissues and organs of the body were no better, but probably much worse, supplied with blood than before. 476. What is just stated, is not invalidated by the fact, that in the onset of sudden coma and paralysis, from apdplexy, or opium poisoning, and probably also from alcohol, before tJie paralyzing effect lias reached the semi-independent motor ganglia of tlie Jieart, (8 243) the pulse is often slow and full, in correspondence to the slow and sterterous breathing which characterizes the same state. So soon as the motor cardiac ganglia are impaired, in the manner already discussed, (§ 246) the action of the heart becomes quick and weak, and progressively so until it becomes imperceptible. Prof Kuss has this state in view when he writes," but the quickness of the pulse yields no indication as to the state of the circulation, properly so called. If we go back to our study of the mechanism of this phenomenon, we shall understand how the pulse may be quick without the circulation being active ; if, for instance, the heart at each contraction sends out less than the usual quantity of blood. So, at the moment of death, the pulse may be very rapid, while the circulation declines.''^ Professor George B. Wood, treating of the pulse in general^ states : " Indeed, it often happens that debility is one cause of ex- treme frequency of the pulse. A certain supply of blood is demanded by the functions, and the heart, be5ng too feeble to act forcibly, is driven to excessive frequency of contraction in order to compensate for its want of strength." J Sir Thomas Watson, in his admirable Lc*.tr res, among a mass of interesting details respecting the pulse, writes : ** In disease, the pulse may acquire a degree of frequency which is scarcely calcula- ble by the touch ; and the less so, because, when it is extremely frequepi it is also extretnely feeble."^ It is needless to multiply cita- tions, ior though the heart's action is frequently increased in fre- quency and in force, this is the result ot the agency of a stimulant^ and never the effect of narcotism. •See chapter on the heart and its nerves. t Lectures on Physiol., Duval — Amory, pp. |68-9. t Practice of Med., Vol. I., p. 188* llPrin, and Prac. of Physic, p. ill. ALCOHOL AS A STIMULANT. 225 ult is felt ion. But nerves are no longer 2 coronary 11^ dimin- ;" lifting" r/a to pro- hough on mes taster igh it was the tissues ich worse, ct, that in or opium paralysing <" tJie lieart, nee to the same state, he manner s quick and le. e quickness circulation, mechanism sc may be e, the heart ty of blood, while the in general, luse of ex- jf blood is eble to act in order ta a mass of disease, the rly calcula- s extremely ultiply cita- ised in fre- stimulant^ 3uval — Amory, Physic, p. m- 477. In the experiment in question the stimulating stage of alco- hol was far exceeded, and the narcotic effect was early entered upon. This is shewn by the fact that two to four ounces of brandy usually induce narcotism. Dr. Anstie, in his experiments, produced this effect in himself by one ounce and a half of whiskey, taken upon an empty stomach, in the morning ; not anticipating the pro- duction of "the poisonous results " from so small a dose. The " healthy youn^ man " of the experiment in question, took, daily, during the six days, a quantity of alcohol equivalent to from two and a-half, on the first day, to eiglitiien ounces of brandy, (i l-8th pints), on the sixth. He must have been deeply narcotized,when Dr. Ringer's habitual toper was rendered " dead drunk " from twelve ounces. There can, then, be no doubt, as to the fact of narcotism^ during the greater number of the six days during which the experi- ment lasted. Dr. Anstie says, " ordinarily the first poisonous effect of a narcotic upon the circulation is considerably to increase its fre- quency and to diminish its strength^ What is here said of narcotics generally, tallies exactly with what Dr. Anstie subsequently states of the narcotic action of alcohol.* 478. What is the legitimate conclusion from these facts ? That in a state of daily and profound narcotism, the heart beating with increased frequency, but with diminished force, // could not^ on the last day of the experiment, have lifted twenty-four additional tons weight of blood, in excess of its ordinary task ; for to have accomplished this, it would require to act not only with increased frequency, but also with increased force; both of which conditions are impossible under the circumstances. As a matter of fact, then, the heart actu- ally " lifted " no more in the twenty-four hours than it was accus- tomed to do, but it " lifted " in lesser quantities, and its lighter loads were more frequent. The effect of alcoholic narcotism, on both the mental and bodily organs, is surely bad enough, without seeking to intensify it by needless exaggerations, which, in the long run serve only to defeat the object intended. 479. The argument sought to be drawn by Dr. Richardson from these experiments is valid against the use of alcoholic liquors, in large doses, by persons in health, and that is all. It proves nothing against the judicious use of the drug in moderate doses, in the lesser or graver aflments to which the organism may be subjected. For, as already pointed out, the action and effects of silcohol in disease are of an entirely different character from those in health. 480. We trust these remarks will not be construed to imply that we mean to justify or defend the use of alcoholic liquors indiscrimi- nately or without obvious necessity. It would be well for man- kind if so potent and dangerous a drug were restricted solely to its chemical and medical uses. All the medical authorities agree that *Stim. and Narcot., pp. ao2, 353. 226 PHYSIOLOGICAL THERAPEUTICS. if it is injurious to persons in health ; and that its irregular and un- timely use, especially, is disastrous to the well being of the bodily organs. 4iii. Dr. B. W. Richardson, however, goes further than most of his medical contemporaries, and asserts that at all times apd under all circumstances, it is not only of no advantage but that it is essen- tially poisonous and hurtful. In supporting this thesis, he entirely ignores a large mass of facts, establishing its value under proper restrictions, and in certain abnormal states of the system. In his zeal he oversteps the bounds of legitimate argument, and strains his facts and draws inferences which the premises do not warrant, thereby inflicting injury on the cause he intended to serve. The argument based on the experiments of Dr. Parkes and Count Wol- lowicz just referred to, is an example of this. Another is to be found in his later assertion, that alcohol coagulates the fibrin of the blood while still circulating ici the vessels. His words are, *' If the alcohol be taken in very great excess indeed, it causes in the blood coagulation of the plastic part or fibrin. The fibrin, under these circumstances, becomes solidified in the blood-vessels, and so charged, stops the current of blood through the vessels Some foolish man, for a wager, or other silly motive, has swallowed, straight off, a large draught of strong spirit, and thereupon has died on the spot. In instances of this nature the blood may be affected by the poison in a few seconds, and the whole of the blood in the heart be made a semi-solid mass or clot, by which the circulation is absolutely stopped and death is rendered inevitable."* Now, the argument might have been rendered quite as cogent, and the closing scene equally tragical, had Dr. R. confined himself to the true pathology of the case, instead of ignoring the primary facts of science. Would it have been too much to have expected him to consider that alcohol primarily and chiefly assails the ner- vous tissue, that it paralyzes this tissue,"!" ^^^ that paralysis of the nervous centres affords an equally adequate and perhaps more natu- ral explanation of the cause of the sudden death referred to. Sim- ilarly sudden deaths sometimes occur from drinking ice water, and from a severe blow on the stomach, which are accounted for through their effect on the nervous system. Where the heart nas been paralyzed and unable to contract upon its contents, it is no unusual thing to find that the blood it contained has coagulated after death. By what right is it assumed that the heart clot referred to, was of ante mortem formation, and was itself the cause of death ? Pro- perly speaking, fibrin does not exist, as such, in the circulating blood at all, J and is only formed after the blood is withdrawn from the circulation, by the union of albuminous constituents of the blood. II Under the circumstances, to refer to the coagulation of *The Temperance Reader, pp. 158, 159. tDr. Carpenter, before cited. J Dr. Burdon-Sanderson, Hand-book for the Physiol. Labor., p. 1S3. Illbid, p. 179. ALCOHOL AS A STIMULANT. 227 and un- lie bodily 1 most of ,pd under t is essen- 2 entirely ler proper 1. In his id strains t warrant, rve. The sunt Wol- is to be rin of the e, "If the the blood ader these s, and so • ♦ • • swallowed, )n has died be affected pod in the culation is as cogent, ed himself le primary i expected Is the ner- i^sis of the more natu- to. Sim- water, and for through t nas been no unusual iter death, to, was of ith? Pro- circulating rawn from mts of the ulation of ted. p. 179- JDr. fibrin in the vessels and heart, during life, is not only wanting in scientific accuracy, but is an assertion, we venture to say, unparal- leled in the annals of pathology, and entirely unwarranted in fact. 482. The endothelium, or lining membrane of the blood-vessels, exerts a peculiar influence in preventing coagulatory changes in the circulating fluid. This is shewn by the fact that a quantity of blood may be arrested for days, in the jugular vein, (by careful pressure on two points of the vessel, at a convenient distance,) without be- coming coagulated, and on removing the pressure, the normal circu- lation is restored. If the endothelium has been injured, the case is different, and coagulation occurs, owing to changes of its tissue, not unlike those which form the chief cause of thrombosis, in which the calibre of the vessel is reduced preparatory to its occlusion.* Em- bolism, too, has its source in vegetative alterations of the lining of some part of the vascular tube ; but as in the case of the sudden death from alcohol, referred to, there is no pretence that tissue change occurred, for which indeed there is no time, any reference, by comparison,, to cases of thrombosis or embolism, in justification of the above assertion, is impossible. 483. Dr. Beale, who has perhaps gone further than any other physiologist in attributing to alcohol an influence over the blood, states, " Of course, when absorbed by the blood of a living person, alcohol does not coagulate the albuminous matter,"+ Dr. AnstieJ denies the possibility of alcohol in " the thousand-fold dilution," in which it exists in the Wood, producing even such comparatively moderate effects as those referred to by Dr. Beale. How much less can it affect the solidification of the Wood in the manner«referred to by Dr. Richardson ! 484. In the very next lesaon of" The Temperance Reader," from which we have quoted above, the same writer, with strange incon- sistency, founds a new argument against alcohol, on the ground that " in most persons who indulge fireely in alcohol the blood is thin, etc."; and again, " Alcohol, when it is freely diluted, acts as I have already said, on the fibrin of the blood, rendering the fibrin unduly fluids \ Now, this statement, though as inaccurate as the former one, will have a widely different effect on the " reader," who, if disposed < relinquish his potations from fear of a heart-clot, will very naturally conclude that so long as alcohol thins the blood and renders the fibrin fluid, the danger after all is not very imminent. 485. In his latest work, " Addresses on Total Abstinence," just issued, we understand Dr. Richardson to admit the utility of alcohol in certain cases, as an antispasmodic, as a febrifuge, as a remedy \n the early stage of phthisis, in deficient surface circulation and tn shock ;§ but he does so with apparent reluctance, and, as it were. • Dr. Bastian, Paralysis in Brain Diseases, drs:., p. 22. jStim. and Narcot., pp. 238, 380, 384. II Pages 162, 163. t Disease Germs, p. 420. § Pages 30, 31. 228 PHYSIOLOGICAL THERAPEUTICS. V hi' u\ under protest. He makes no attempt to explain how alcohol acts beneficially in any of the cases referred to ; nor does he endeavour to reconcile this beneficial action with his other assertions in the same work, of its utter uselessness, or positive injur}*, to the system in all cases. This is not what was to be. expected from such a source ; while the graver errors referred to, are the more to be regretted in the champion of a noble cause, because they weaken confidence in his other arguments, which, unfortunately, are not wholly free from the taint of a too zealous partizanship. 482. We have now a question to ask. If a small dose of alcohol be a stimulant, and induces relaxation of the peripheral blood- vessels, as will be universally admitted, how is this accounted for on the theory now in vogue } On that theory, stimulation of the vaso- motor or vascular nerves contracts the arteries ; and the relaxation of these is depending upon nervous paralysis. The organism is stimulated, and as the nervous system is primarily influenced by alcohol, the vaso-motor nerves must be stimulated also. This ought to secure contraction of the calibre of the arteries. But instead of being contracted they are relaxed, as seen by the injected capil- laries and flushed face. The result is in antagonism with the theory. Is the organism at fault, or does the theory fail to meet the condi- tions of this very ordinary case ? We assert that the theory is wrong; that stimulation of the vaso-motor nerves and relaxed arteries go together, as do also paralysis of the nerves and arterial contraction. 483. We have dwelt lengthily on this subject, both from its in- trinsic interest and importance, and from a desire to show that our theory* is not without advantages in its simplicity and adaptation to explain the phenomena of stimulation in the early stage of the administration of alcohol, with its increased motor and ^'aso-motor activity, dilated blood-vessels and heightened temperature : and also the phenomena of the second or narcotic stage, with its pro- gressive paralysis of the nervous system, its mental incoherence, loss of muscular co-ordination, arterial contraction, weakening the heart by excluding blood and pabulum, from its tissue ; rendering the surface pale and the extremities cold from the same cause ; and in- ducing death itself when the nervous prostration becomes sufficiently profound. All this, we think, appears natural and consistent, and commends itself to candid consideration. 486. It is peculiarly unfortunate that an agent which properly used, is potent for good, should also be made the instrument of im- mense evil. Some of this evil has been laid, — perhaps not undeserv- edly — at the door of physicians, who are charged with prescribing it , under circumstances which sometimes lead to its subsequent abuse. In this connection, the late declaration of two hundred and seven- ty leading physicians of Great Britain, is a document of importance, CHLOROFORM AND .ETHER. 229 ohol acts ndeavour is in the le system :e ; while ed in the ice in his from the af alcohol al blood- ited for on the vaso- relaxation •ganism is lenced by rhis ought instead of :ted capil- :he theory, the condi- theory is id relaxed id arterial •om its in- that our iptation to ige of the aso-motor ure : and 1 its pro- rence, loss the heart dering the and in- ufficiently istent, and properly ent of im- : undeserv- ^scribing it lent abuse, and seven - nportance, and merits, as it is sure to receive, the approval of physicians every- where. While declaring themselves " unable to abandon the use of alcohol in the treatment of certain diseases," they are yet of opinion that " in whatever form, it should be prescribed with as much care as any powerful drug, and that the directions for its use should be so framed as not to be interpreted as a sanction for excess, or neces- sarily for the continuance of its use when the occasion is past." It is unnecessary for us to pursue this part of the subject further. The medical profession, to which we address ourselves, are not be- hind others in the community in aiding in suppressing the vice of intemperance, both by precept and example. Medical authority is unanimous that to person? in health alcoholic liquors are not only not necessary but are injurious, and more especially so in the irreg- ular and untimely manner in which they are usually taken. If the public could realize this fact, and shun the fiery fluids, often greatly adulterated, to which a false sociality too frequently invites them, they would gain immensely in mind, body and estate. 487. CHLOROFORM AND jETHER,—{?.s stimulants).— The general action of these agents having been already referred to, (§ 35, 95, 105, 416, etc.) very little is necessary here as to their pure- ly stimulant effects, which, as before remarked, occur early in the process of inhalation and are of comparatively short duration. *' During the very earliest inspirations and before the slightest de- gree of true anaesthesia is produced," chloroform inhalation will sometimes relieve a severe tic. " This is its true medicinal action, and it is certainly a form of stimulation." In other cases of this painful affection, no impression will be made on the pain until un- consciousness arises from its narcotic effect, and the sensory nerves are paralyzed.* 488. In this first, or stimulant action, chloroform inhalation is a very efficient remedy for temporarily arresting spasms and convul- sions of every kind, (§95, 105.) Here, we claim, nerve-force is de- veloped in increased quantity, or rendered more active, and consequently more capable of restraining the inherent tendency of the muscles to pass into a state of contraction. On the contrary, in extreme narcosis from these agents, when both cranial and spinal nerve centres are paralyzed, and nerve-force suspended, spasms and convulsions are prone to occur.f 489. Dr. Anstie speaks highly of the anodyne effects of fifteen minims of chloroform, inhaled at the commencement of each pain in parturition. He has seen the previously weak and irregular pains become strong and active, and at the same time the suffering of the patient much diminished. Chloral Hydrate is ver ■ effective in this way, in mitigating the suffering of the first stage of labor when little progress is being •Dr. Anstie, Stitn andNarcot., pp. 331-2. tibid, p. 124. 250 PHYSIOLOGICAL THERAPEUTICS. made, and the patient is in danger of being weakened and worm out by the unavailing suffering. It is the anodyne, and not the stim- ulating effects, which are here sought; a purpose for which the soothing qualities of opium or morphia, in small doses, are often re- sorted to. 490. The narcotic, or anaesthetic effects of chloroform in labour, favours relaxation of the outlets from the womb, but has the disad- vantage of sometimes inducing uterine inertia, by which the process is prolonged,^ and also of predisposing, for the same reason, to post partum haemorrhage. This behaviour of a paralyzing agent towards the uterus would seem to be a fact hostile to our theory ; for in the paralytic stage of chloroform inhalation, the uterine muscle might be expected to be liberated from motor nervous control^ in the manner we have pre- dicated of ergot, and its conti,jctile power left free to act with greater power because no longer restrained. But there is no proof that the spinal cord or its motor r; -rves are paralyzed, in ordinary normal chloroform inhalation. All tLe effects of that state may be fully accounted for by the paralysis of the cranial centres. When the cord, too, succumbs in extreme narcosis, we have spasms and convulsions of the muscles. The effect of chloroform narcosis, short of this extreme stage, is shewn in muscular relaxation, owing to the cord and its nerves retaining and exerting their control over the tpuscles ; and they do this all the more effectually since the inhibi- tory power of certain parts of the brain over the spinal cord centres is withdrawn during the narcosis of the cranial ganglia, leaving the cord free to act on the muscles with increased power. (§ 29, 36.) 491. Unlike alcohol, chloroform and aether pass rapidly out of the system. They are therefore not at all adapted to sustain it in cer- tain conditions of exhaustion, in the manner alcohol does, and serve only a temporary purpose. 492. Chloroform or aether is sometimes combined with other rem- edies in the treatment of paroxysmal or violent coughs. A tew whiffs will otten be of use in asthma. A small quantity inhaled from the palm of the nurse's hand will promptly arrest the paroxysm of whooping cough. It is sometimes combined with soothing lotions, and favors the absorption of these through the skin. It is seldom administered internally, as other stimulants are generally more readily procurable, and are equally advantageous. Conclusion. — We do not propose to further extend these pages at present. They have already far outgrown our original intention. E nough has been written to present the subject of this essay fairly, though imperfectly, before the reader ; and it now awaits his ap- proval or condemnation. . nd worn :he stim- hich the often re- n labour, le disad- e process I, to post tis would c stage of ted to be have pre- act with ', no proof ordinary e may be 5. When isms and osis, short ing to the I over the [he inhibi- •d centres laving the I. 36.) out of the it in cer- land serve ither rem- A tew inhaled aroxysm soothing im. It is generally CONCLUSION. 231 The opinions here expressed, should they see the light, will no doubt excite adverse criticism : for prevailing theories and precon- ceived opinions are with difficulty relinquished : nay, even manifest error dies hard, especially when reputations are bound up with its maintainance in life. We shall doubtless be accused of many things ; among the rest, with boldness in venturing to challenge great names and current opinions ; and we may as well in advance plead guilty to the charge; adding in mitigation of sentence, that the expression of the views herein contained seemed necessary in the interests of true physio- logical and therapeutical science. Some will treat our pages with silent contempt ; others will char- acterize them as " mere theory," and consequently regard them as unworthy of serious attention. To this latter class we would say, ask yourselves to what extent your present views of the phenomena of disease rest on a foundation purely hypothetical ; and how far also the most approved treatment of disease is entirely empirical ? If, in the present state of physiological and therapeutical science, some theory be necessary, that surely is the best, which be^ ac- cords with most of the facts of the case. We put forward this claim for the theory here presented ; and ask for it no favor beyond that to which on fair and candid consideration it may be found to be justly entitled ; for we know well that if it be true, it will survive adverse criticism, and find abler advocates ; while, if it be false, it will sooner or later pass into deserved oblivion. THE END- -I ise pages lintention. say fairly, ts his ap- ik ? ADDENDA. Note to § 8i, page 40. — We have been asked, by way of friendly criticism, if the converse of what is here stated holds good where the muscle is contracted, instead of relaxed, at the moment when the mo- tor nerve is severed. We do not pretend that the muscles would neces- sarily remain contracted, after section of their motor nerves, when con- tracted previously, at least in ordinary cases. During conscious- ness, mental emotion in man, and in the inferior animals, terror, would doubtless vitiate such a result, by involuntarily causing a re- versal of the tiiolecular nerve arrangements, before the motor nerve, or all the motor nerve communications, were cut across. There may also be unknown differences in the character or intensity of the molecular arrangements for inducing contraction and relaxation of ntuiscle respectively, which come into play under such circumstances, and modify the result. There is, however, aburdant -'oofthat muscular contraction, vol- untarily induced, continue. s c*i'L'..i, the cessation of the action of motor, nerve-force. Thus drowning men, not only " catch at straws," but hold them. As is well kuowi^ sm?'' objects, as gravel, sand, a few hairs or a bit of clothing, seized in the last moments of life, have been firmly retained in the grasp: as have also the bodies of per- sons drowned togetheir. Those who object to our theory, must ex- plain how the firm contraction of the muscles is maintained in these cases, after the extinction of nerve-force, and before the setting in ot rigor mortis : as well as the numerous other instances mention- ed in these pages, of post mortem contractions of muscular fibre, as in the arteries and hollow viscera. Dr. Alfred S. Taylor even intimates the possibility of a dead body being found " still holding to a rope, cable, or oar,"* and elsewhere he writes, '• It may be remarked, that muscles, contracted by living force, in the act of dying, do not necessarily become relaxed in death."-f- If this be true, then what we have predicated of molecular polar nerve-force, when adjusted for relaxation, is shewn to apply also, under certain conditions, to the adjustment of the same force for muscular contraction : that is, that nerve-force maintains a fix- edness or permanency in both cases, when not reversed by volun- tary impulses from the central motor ganglia. Note to § 126, page 63. — An additional point of distinction between nerve-force and electricity, is to be found in their respective rate of motion. Thus, nerve-force moves at an average, in man, at a speed of only about one hundred feet per second ; J while the rapidity of electricity is, of course, immeasurably greater. • Medical Jurisprudence, 6th Amer. Ed., p. 387. tibid, p. 58. jDrs. Beard and Rockwell, Med. and Surg. Elec, p. 200. )f friendly where the :n the mo- uld neces- when con- sonscious- ils, terror, ising a re- >tor nerve, ;s. There sity of the Eixation of imstances, ction, vol- n of motor , raws," but and, a few life, have ies of per- , must ex- d in these setting in mention- r fibre, as ead body elsewhere by living slaxed in molecular to apply ime force ins a fix- y volun- "listinction respective man, at mile the :Drs. Beard INDEX. Aoortion, a suf;K<^sted cause ot, 95. Aconite, 120, 159, 161. and vaso-niotor theories, 161. Bpastns produced by, 162. -^tber Sulphuric, as a narcotic, 199. as a stimulant, 229. "excitement," under, apparent, not real, 199. flushing, &c., from, 199. compared with chloroform, 199. (See chloroform, chloral, alcohol, etc.) After pains, 94, 164. Albumen, a source of fibrin, 27. and muscle, 26. Alcohol, as a narcotic, 48, 126, 192, 197, 225. as a stimulant, 126, 214, 220, 228, two stages of action, 1^, 195. paralyzing effects of, 48, 126, 195 197, 225. delirium tremens of, 196. use of brom. potass, in, 196. and vaso-motor theories, 126, 196, 197, 228. spasms, etc., from, 197. oxydized in the body, 215,216,219. quasi food action of, 126, 215, 221, 222 in fever, 126, 127, 215, 217, 221. and shock, 216. effect on bionlasm, 217, 227. effect on blood, 196, 226, 227. effect on temperature, 126, 196, 215, 218, 219, 220. effect on circulation, 196, 215, 223, 225, 227. and sleep, 116. in spasms, etc., 49, 54, 57. in weak digestion, 222. effects of, in health and disease, differ., 127, 198, 215, 221. 225. effects of, modified by food, 221. sudden death from, 216, 226. Medical Declaration regarding, 229. Ammonia, 53, 206. chloride, uses of, 207. Amy] Nitrite, 95, 203. Anaesthesia, (See chloroform) Anaemia, and wakefulness, 114, 116. of brain in epilepsy, 44, 45, 60, 51, 52. favQrs delirium and coma, 168. Angina pectoris, 203. Antispasmodics are stimulants, 60, 229. Antidotes to strychnia, ffj, 68. to belladonna, 214. Antidotes to chloral, 58. to calabar bean, 58. to quinine, 124. Apomorphia, 166. and theory of vomiting, 167. Arsenic, as a poison, 211. a quasi food, 160, 213, 221. a tissue irritant, 211, 213. Arteries, muscular coat of, 97, 08. controlled by sympathetic, 98, 101, 102, 105, 107, 161. 203. effects of " pithing * on. Ill, 130. contracted after death, 08, 106, 115. of brain in convulsion, 60, 61. in sleep, 115. in malaise, cholera, etc, 114, 115. drugs which contract, 161. drugs which dUate, 203. torslonand vaso-motor nerves, 110. effects of cold on, 110. coronary and cardiac motor pow- er, 130, 133. 173. thrombosis of 184, 227. ■ Asthma, chloroform in, 230. arsenic in, 212. nitrite of amyl in, 203. Asthenic states, treatment, 114. Atrophy of muscle, 34, 80, 82. electricity in, 76, 77, 80, 81, 83, 87, 90. Atropia, 128*, 170. Baths in fever, 123. Belladonna, 137, 167. effects on iris, 137. on vaso-motor nerves, 168. in constipation, 168, 160. various uses of, 170. an antagonist to, 214. •Blisters, action of, 149. Blood, quantity in body, 27, coaguludon of, 26, 226. fibrin not in living, 27, 226. effects of strychnia on, 55. nitrite of amyl on, 204. cathartics on, 161. mercury on, 190. alcohol on, 226, 227. impure, not stimulating, 24, 52. in epilepsy, 52. " determination to the head," 45, 46,50,53. in pregnancy, 52. in Bright's disease, 53. circulation of regulated, (see vaso- motor action.) drugs which quicken circulation of, 203. INDEX. I- 5.1 li Blood, druRs which restrain circulation of, 161. Brain, lesion and paralysis, 47, 48. inhibits reflex power of b. cord, 20, 21, 23, 230. paralysis of, in anaesthesia, 23, 24, 48, 67. 92, 198, 199, 230. in aelirium tremens, 195. in narcotism, 48, 67, 92, 124, 136. 165, 167, 170, 200, 225. sympathetic ganglia of, 100. Sialvanization of. 88. aradization of, 105. aneemia of, in sleep, 7, 116. and delirium, 168. dilated pupil, 138. 181. hypereemia of, 115, 138, 1&5, 178, 203. and stomach and nerve-force, 146. Briffht's disease, blood In, 53. Bromide of potassium, 64, 177. {>rodnce8 brain aniemia, 178. n delirium tremens, 196. in convulsions, 179. Bromide of ammonium, 181. Bromide of sodium, 181. Bromide of lithium, 181. Bronchitis, 165. ipecacuanha spray in, 189. Calabar bean, 184. in tetanus, 59, 185. in chorea, 186. in paralysis, 186. effects on iris, 138, 187. antagonism to bellado.ana, 167. Cancer, arsenic in, 213. Cannabis indica, 182. Capillaries, independent power of, 158. suction power of, 98, and vascular nerves, 168, etc. Cathartics, action of, 151. Cells developing nerve-force, 38. Chloral hydrate in convulsion, 58. an antidote to strychnia, 57. action like chloroform, 58, 201. as a narcotic, 58, 201. as a stimulant, 57, 201. in parturition, 229. Chloroform, ansBSthesia of, 23, 48, 58, 198, 200, 230. rigidity and flaccidity from, 23, 48 230. as a narcotic, 23, 48, 198. as a stimulant, 53, 54, 58, 229. use in spasm and convulsion, 53, 64, 58, 229. in parturition, 230. in whooping cough and asth- ma, 230. delirium of, not excitement, 23, 190. brain paralyzed by, 23, 48, 196, 230. sympathetic survives longest, 23, 196. true medicinal action of, 229. Chorda tympani, 109. -Chorea and paraJysis, 49. unilateral and rotary, 49. slectricity, useless in, 85. Cilia, movements of, 11. Colchicum, 208. Colic, 151, 152. Coma, a state of paralysis, 183, 197, 211. from brain anteniia, 168. Combustion in the body, 123, 215, 216. 220. Congestion, 92, 162, 174. Confum, 175. motor paralysis of, 175, 176. fails to antidote strychnia, 175. death of Prof. Walker from, 175. Constipation, 150. belladonna in, 168. purgatives in, 169. Convulsions and spasms, 48, 51. 178, 186. aneemia of brain in, 45, 46, 50, 51, 53, 60, 178. nerve force enfeebled in, 44, 45, 46, 52, 53, 229. epileptic, 44, 46, 50, 53, 203. from brain lesion, 47. paralysis and, 48, 167. puerperal, 102, 229. unilateral, 49. during sleep, 52. of teething, 54. stimulants in, 53, 57, 58, 60, 203, 229. strychnia in, 180. bromide of potassium in, 55, 178, 179. chloral hvdrate in, 58. chloroform in, 48, 53, 58, 229. niirite of amyl in, 203. treatment of, 53, 58, 180, 229. Counter irritants, action of, 149. Cranial nerves, influence on iris, 138, 140. Curare, and submaxillary gland, 109. in vivisection, 132. . relations to strychnia, 56, 175. Danger of electricity, 88. Death, somatic and molecular, 19. contraction of muscles in, 25, 31, 32 of arteries, 98, 106, 115. of ducts, 106. of intestines, 150, 154. vital actions after, 19, 20. parturition after, 32, 92, 93. threatened from chloroform, 24, 199. nerve-force in somatic, 19, 20, 21, 22. Delirium and coma, 168. indicates paralysis, 23, 126, 167, 199. tremens, 195, 196. Diabetes, ergot in, 96. Diaphoretic, a new, 213. Dlarrtioea, oxide of zinc in, 184. chronic, 150. Digitalis, contracts arteries, 171. contradictory effects explained, 171, 174. effects on pulse, 173. compared with aconite, 174. 1% I S*'. 83, 197, 211. 3. \ 215, 216, ,176. mia, 175. from, 175. , 51, 178, 186. ;, 46, 50, 51, in, 44, 45, 46, ,203. INDEX. , 58, -60, 203, 1 in, 55, 178, 58, 229. So, 229. :, 149. on iris, 138, ;land, 109. ,, 56, 175. lar, 19. SB in, 2o, 31, 06, 115. iO, 154. 20. 92, 93. oroform, 24, ic, 19, 20, 21, 23, 126, 167, 184. 1, 171. explained, 174. Digitalis, promotes uterine contraction, 174, Dropsy, 172. Drugs, how they act, 157, 158, 159, 160, 169. effects of small and large doses, 159, 164. series of, causing arterial contrac- tion, 161. dilatation, 203. which increase vaso-motor dila- ting nerve power, 157, 203. which depress vaso-motor dilating power, 157, 161, which dilate the pupil, 137, 141. which contract the pupil, 136. effect of, on heart, 131, 158, 161. 163, 173. as tissue irritants, 159, 160, 209, 211. as quasi foods, 54, 120, 148, 160, 160, 213, 215, 181, 206. Barly and late rigidity, 83. Electricity, 3rd principle asserted, 65. popular errors regarding, 62, 64. nerve and muscle currents, a myth, 62. • not. comparable to nerve force, 63. weak and strong currents consid- ered, G3, 64. not a tonic or vitalizer, 64, 67, 70, 83, 85. dangerous in asphyxia, etc., 71,88. the galvanic, or continuous cur- rent, 66. paralyzing effects of, 66, 67, 69, 71. muscular contractions from, 67. the relief of pain by, 69. in other morbid states, 69. the galvanic current interrupted, 71, 73. important results, 72, 73. special qualities of, 72, 80,84. the faradic, or interrupted cur- rent, 74. paralyzing effects of, on nerves, 67, 69, 71, 73, 75, 85, 87,88. how it benefits muscles, 76, 77. why muscles not paralyzed as well as nerves, 77, 78. objection considered, facial paralysis, 78. in cerebral and spinal paral- sis, 80, 81. early and late rigidity, 82,83. in nerve wounds, 83b a double problem solved, 84. useless in spasmodic states, 85. application of, in disease, 86. difference between poles, 87. qualities of currents, 87, 89. general and local applica- tions, 87, 80, 90. neuralgia, 87, 89. Electricity, galvanization of the sympa^ thetic.64, 88. faradization of sundry nerves, 105, 107, 108, 129, 131, 138. secretion of milk, increased by, 90. saliva, 107, 108. effects on parturient uterus, 90, 92. induces early rigor mortis, 25, 20, 68. effects on oesophagus and stom- ach, 143. intestines, 145, in constipation, 150; increases the paralysis of conium, 175, 176. action on nerves controlling the iris, 138, 140. Emetics, action of, 144, 14d. a new and prompt, 166. are paralyzers, 144, 145, 167. Epilepsy, (see convulsions). Erectile tissues, iris, 136. penis and erection, 117. Ergot of rye, 4th principle asserted, 9L action on muscular fibre, 91. lessens calibre of arteries, 01, 9?.< a narcotic and paralyzer, 92, 95, 97. effects on gravid uterus, 98. diseases in which it is useful, 96, 97: suggested use in diabetes, 06. Erysipelas, 311. Excitability of muscle, 42, 44. Experiments, physiological, on rigor mortis, W. reflex action auring insensibility, 18. after eomatic death, 20. effects from cold, 110. influence of sensitive nerves 110, 121. on the nerves and circulation in convulsion, 44, 45, 46, 47, 51. cervical sympathetic, 101, 105. submaxillary gland, 107, 109. chorda tympani, 100. 5th pair, 107. effects of destruction of nervous centres. 111, 113. "pithing," etc., on arte- ries, 111, 113, 130. on oesophagus and stomach, 142, 143. intestines, ISO. with strychnia, 46, 55. digitalis and aconite, (frog) 174. on nerves controlling the iris, 138, 140, vagi and heart, 128, 131. olivary bodies, 105, example, to show sources of fal- lacy, 132, 133. with alcohol, 223. Faradization, (see electricity.) Fever, applications of theory to, 121. n INDEX. iws. Mi I r « r ^ (A "it'- i;i ii; '!■ Fever, yaso-motor nerve action in, 122. waste of tissue in, 123. treatment of, 123, 124, 162, 163, 164. convulsions absent durinpc, 53. alcohol in, 215, 217. and inflammation, one process, 123. Fibrin and muscle, 26. proportion of, in blood, 27. albuminous origin of, 27, 226. not present in circulating blood, ^,226. not coagulable by alcohol, 227. non-living matter, 30. Flaccidity of muscle, 19, 21, 22, 23. in anffisthesia, 23, 230. " pithing " and, 22, 111, 113. Flushing, from aether, 109, 200. from chloral hydrate, 67. chloroform, 106. nitrite of amyl, 95, 203. other causes, 96. and sympathetic nerve, 95, 116, 199, 200. Faradization, 74 (see electricity). Food action of medicines, 64, 126, 148, 160. 181, 206, 216. Foetal heart, antecedent to nerves, 11, 129. Frog, motor gangli^ of heart, 127. Galvanization, central, 64, 73, 88. (see electricity). Ganglia, cranial, 100. spinal, 15, 17,21,100. sympathetic, 100. of brain, inhibit reflex power of s. cord, 20, 21, 23, 230. t alTected in anwsthesia, 23, 24. relation of to Hpasran, 21, 195, 2.')0. aneeraia of, 114. periiiheral effucta of aectiun, 22, 153, 154. inhibited by bram, 20, 21, 23, 230. paralyzed liy electricity, 06. parturition tn paralysiB of, 33, 03. in deHtruction of, 'X.\, 03. relation to Hphincteis, 133, 154. Stimulants, miHuamed,' 12. in spaHnis and convulsions, 49, 33, 57, 59, 60, 203, (U. in painful states, 51, 57, 50, 119, 204. in fever, 120, 207. antispasmodics are, 00. dilate the arteries, 106, 122, 138, 203, 206, 2(W, 216, 228. chloroform as a, 53, .58, 229. aether, 229. alcohol, 126, 214, 228. chloral hydrate, .")7, 38, 201, series of druKs which act as, 203. and muscular power, 14. Stomach, nerves of, 141. cardiac sphincter of, 143. reciprocal action with brain, 146. and pregnant uterus, 147. (see vomitin»£>. mulinK, 47. otrength, delusive appearance of, 14, 193, 194, 199. Strychnia, 213. and muscular contractions, 46. hastens ri^or mortis, 47, u devitalizing agent, 47, 55, 57. intoxication from, 5l and curare, 56. effects on sensitiveness, etc., 56. food action of, 126. in epilepsy, 180. effects on the blood, 55. antidotes to, 57, 58. Submaxillary gland, nerves of, 107. experiments on, 107, 109. Sympathetic nerve, ganglia of, 100. ganglia, retard impressions, 107. section of cervical, 101, 102, 105, 139. influence over arteries, 97, 98, 101, 105, 100, 108, 111, etc. relation to flusiiiog, blushing, 57, 95, 116, 193, 199, 20a last to succumb to chloroform, 23, 198,23a partly of spinal origin, 101, Tartar emetic, 300, 269. Temperature m fever, 123, 126. effect of alcohol on, 126, 215, 218, 220. Teething of children, 54. Tetanus, calabar bean in, 59, 185. stimuiiiatH in, 50. 60. not depending on spinal excita tton, 59. occurring in "a dying cord," 00. electricity in, 68, 83. Tissues, waste of, in fever, 122, 123, 215. erectile, 116, im irritants of, 160, 209, 211, effects of alcohol in, 21.5. " Tonic" effectH of electricity, 75. 77. Torsion of aiterios, and vascular nerves, 119. Tremor, 53. Turpentine, 4^19. in typhoid states, 439. Uterine contractions, 33, 92. in parturition, 92. by ergot, 33. post mortem, 33, 93. in paralysis, '.Hi, 93. destruction of spinal cord, 33, 93. absence of nervous agency in, Xi, effect of quinine on, 95. of opium on, 94. of digitalis, 174. of electricity in, 90. Uterine haemorrhage, 91, 174, 182, 183. Vagi, effects of section of, on heart, 131, on oesophagus, 11:^, 143. on lungs, 131. on stomach, 143, 145. Vaso-motor theory, now popular, 95, 97, 98, 99, 102, 106, 110, 115, 120, 161, 199, 228. objections to, or dlfTirulties of,103, 106,114, 120, 161, 104, 167, 170, 175, 1T7, 178, 190, 197, 204, 206, 208,228. Vaso-motor theory, here suggested, 97, 98, 106, 11.5, 116, 117. 119, 120, 122, 130, 137, 161, 163, 178, 183, 195, 200, 206, 208, 220. Vaso-motor nerves, 98, 101, 105, 107, 108, 110, 111, 11 , 126, 128, 157, 158, 162. influence over arteries, 97, 98, 101, 105, 106, 108, 111, 122, 130, 158, 161, 172, 180, 193, 200, 228. relation to flushing, blushing, 57, 95, 116, 193, 199, 203. Vaso-motor centre, 100, (see sympathetic nerve.) Veins, larger than the arteries, 113. distension of in pithed frog, 112, 114. Veratrum viride, 163, in inflammation, 120. spasms from, 163. Vital actions after death, 19. processes and nerve influence, 92. Vivisection, 107. Vomiting, depends on paralysis, 17. 144, 146. 146, 107, 198, 199. ti-v INDEX. Vomiting, nervous circle concerned in, 141, 142, 143. from a fall or a blow, 144. action of emetics in, 144, 146. from tickling the fauces, 146. of pregnancy, 146. Ipecacuanha in, 148. infantile, 140. from apomorphia, 165, 167. . Vomiting, from ehlorofonn, 198, 199. Vortioella, a spiral a.. ^>« nf the, 36. Walker, Pnrf;, tfaath from coniuu*. 1?5. Whooping cough, belladonna in, 170. chloroform In, 290. Will, relation of, to muscle, 13, 40. Zinc, oxide of, 184. sulphate of, 144, 184. if '• m, 198, 199, • of the, 36. n coniuiu, 175, una in, 170. le, 13. 40. k1