ART. XV.-The Treatment of Surgical Inflammations by a New Method, which greatly shortens their Duration. By FOURNEAUX JORDAN, F.R.C.S. Eng. . ART. XVI. Lectures on the Theory and Practice of the Ophthalmoscope. By HENRY WILSON, F.R.C.S., Assistant-Surgeon to St. Mark's Ophthalmic Hospital, &c. Dublin, 1868. Pp. 146. 2 plates ART. XVII.-Handbook of the Diseases of the Eye: their Pathology and Treatment. By A. SALOMONS, M D., Fellow of the Massachusetts Medical Society, formerly Oculist in Government Service at Veenhiven, Holland, &c. London PAGE 439 440 441 ART. XVIII.—Public Health: a Popular introduction to Sanitary Science. 444 446 GOR 447 419 ART. XXI.-Remarks on Army Surgeons and their ART. XXIV.—The Medical Directory for 1871, and General Medical Register, Original Communications. ART. I.—The Army in Relation to Public Health. By CHARLES ALEXANDER Chronicle of Medical Science. (CHIEFLY FOREIGN AND CONTEMPORARY.) Report on Materia Medica and Therapeutics. By ROBERT HUNTER Semple, M.D., Member of the Royal College of Physicians, Physician to the Bloomsbury Dispensary, London Chronicle of Micrology. By J. F. STREATFEILD, F.R.C.S., Surgeon to the Report on Pathology and the Principles and Practice of Medicine. By FRANCIS . 515 539 552 558 TITLE, CONTENTS, INDEX. THE BRITISH AND FOREIGN MEDICO-CHIRURGICAL REVIEW. APRIL, 1871. Analytical and Critical Reviews. I. Pathology of the Microscopic Arteries.1 "PATHOLOGY"-yes, but where does pathology begin and physiology end? The reader must be left to decide; and if to him the first pages of this article appear to smack too much of the teacher's chair, let him dream himself a pupil again, and thank us for an agreeable sensation. The walls of arteries may be considered practically to consist entirely of two anatomical elements, yellow elastic tissue and the unstriped muscular fibres employed in organic life. The functions of these elementary tissues are in a manner antagonistic to one another, wherever they appear, and the blood-vessels are no exception to the rule; for while the contraction of the contractile fibres must tend to alter their calibre, the elasticity of the elastic tissue keeps and restores the area to a constant form. It opposes an excessive dilatation when the muscles are not acting, and an excessive contraction when they act vigorously. In the act of dying the arteries are emptied, presumably because their muscles continue to energise longer than the heart has sufficient strength to drive the blood at that distance; but if in an animal recently slaughtered the blood-conduits are injected with a syringe, they remain in a state of distension, even after the injected substance is cleared out of them. The reason is, that their muscles have ceased to act. Again, when the nerves leading to the arterial walls are destroyed, the vessels dilate, 1 Recherches Experimentales sur la Circulation, &c. By MM. LE GROS et ONIMUS. Journal de l'Anatomie et de la Physiologie,' 1868, 1869, 1870. On Cholera and Choleraic Diarrhea: their Nature, Cause, and Treatment. Two Lectures delivered to the Church Missionary College, Islington, 1870. By GEORGE JOHNSON, M.D. Hypertrophy of the Minute Arteries in Cases of Chronic Bright's Disease. By GEORGE JOHNSON, M.D. Brit. Med. Journal,' April 16th, 1870. 94-XLVII. 19 for the elasticity of their yellow tissue is still intact while the muscular coat is paralysed. These powers of contraction, and of again resuming the middle state jointly regulate the distribution of the vital fluid. By their means there is served out to the capillaries in an even stream that which has been supplied by an intermittent force. They are to the heart as the fly-wheel is to the piston. The arteries are regulators of the circulation. But they are something more also; for, as well observed by John Hunter, in lower animals devoid of a heart, the blood nevertheless circulates; and even in the higher mammalia, Brodie's case of a heartless fœtus, which lived several days after birth, shows that they are not dependent for propulsive force on the central organ alone. A fly-wheel, indeed, continues to revolve after the piston is detached, having accumulated force previously; and the resilient elasticity of the arteries may act likewise, by storing up the heart's force. But the flywheel has no autonomy, and it would not have moved at all had there been no prevenient piston; while the example of the heartless foetus shows that the arteries have a propulsive force originating in themselves, over and above that which is stored up by their elasticity. The elastic and muscular tissues are very unequally distri buted through the arterial system; the larger tubes are composed almost entirely of the former substance, while those next the capillaries have their middle coat made up of muscular fibres and nuclei encircling the canal; and the medium-sized have a mixed character. The microscopic contractile arteries would, therefore, seem to be an independent motive power in the economy, and worthy of a separate consideration, such as we are now allotting to them, apart from the organs to which they are distributed, and of which the special functions are affected by general arterial derangements. In more than one instance a diseased state, universal over the whole arterial system, has attracted attention, solely or mainly by its affection of one part; and it has received a title therefrom, tempting thus to faulty pathology and injurious therapeutics those who have the natural weakness of being led by a name. The danger would have been shunned had the general, rather than the local, ailment been looked at. The natural classification, or the art of seeing likenesses in disease, conduces much more to the relief of pain than diagnosis, or the art of seeing differences. The contractility, under the influence of suitable irritation, of the coats of the arterioles, contended for by John Hunter, was afterwards experimentally demonstrated, from their behaviour Phil. Trans.,' 1809, p. 161. under galvanism, by Wilson Philip, Kaltenbrunner, and Wiedermeyer. And it was universally allowed that they regulated the supply of blood to the organs. Hunter thought they regulated it by somehow promoting the cardiac force. But he was apparently puzzled by the direction of the fibres; which, he says, he "never could discover, but should suppose them oblique, because the degree of contraction appears greater than a straight vessel could produce, in which light a circular muscle is to be considered, as its effects are in the direction of its fibres; for either the diameter or the circumference of the artery will decrease in the same proportion, but not the area, which will decrease in proportion to the square of the diameter." We know now how the desired result is secured by the double layer of circular and longitudinal fibres. Yet what a striking example of prescience was it for naked mathematical reasoning to hit upon the requirement, and suggest a feasible means of accomplishing it so like the actual. But still it was hard to imagine how contraction, simple and uniform, as it was supposed to be, should aid the flow of the blood. And on this ground some ascribed to the muscular fibres a mere "stopcock" action, controlling by antagonism the heart's force, and in fact serving merely the same purpose as the elastic tissue. But this antagonism of two parts of similar construction seemed unlike the usual machinery of nature. It was strange if the involuntary muscles of the arteries should have nothing else to do beyond opposing the free action of the involuntary muscles of the heart. Such an arrangement would remind one rather of the checks and counterchecks in bungling human statecraft than of the choicest work of the Divine Architect. And it was remarked that if the fibrous layer of the pipes served only to moderate the rush of the stream, they would surely be found most prominently displayed at those points where the current is most immediately under the influence of the ventricle. But the reverse is the fact; it has been pointedly demonstrated by Hunter that the quantity of muscular fibre in the arteries is in inverse proportion to their exposure to the influence of the heart; and his most glaring example of its abundance is in the umbilical cord, where the cardiac influence is absolutely null. In this condition the question remained during the first half of this century, till the acute observation of Dr. Waller, followed up by the brilliant experiments of M. Claude Bernard, led to the generally diffused knowledge of the influence of the great sympathetic nerve on the circulation. When the fibres of the sympathetic nerve leading to any separate part of an animal's body are divided, the arteries of the part become fuller, and the temperature is raised by the increased quantity of hot blood which runs through. When the same fibres are submitted to electric influence, the arteries become empty and the flesh chill and pale for lack of blood. These experiments, so neatly crucial, seemed to prove clearly that a special department of the nervous system contracts and enlarges the vessels and modifies the capillary circulation. "They teach that it is the great sympathetic which plays the part of constrictor to the small arteries and slackens the capillary circulation. In fact, cutting the nerve paralyses in a manner the small arteries, which become proportionally relaxed; whilst, on the other hand, exciting the nerve action by galvanism causes such a constriction of the small arteries that their area is obliterated." (Rapport sur les progrés et la marche de la Physiologie génerale, &c., par M. Claude Bernard, 1867.) So, in spite of its apparent incongruity, physiologists were driven to admit the theory that the heart is a force-pump, which drives the blood indiscriminately through the larger arterial canals, while the small arteries, entirely destitute of propelling power, check the supply in accordance with the requisitions of each part. A further system of countercheck was suggested by M. Bernard in 1858, when he found that, on stimulating the corda tympani nerve which goes to the submaxillary gland, there was provoked an excess of activity in the capillary circulation, and such a dilatation of the small arteries that the blood issued from the vein of the gland with all the characters of arterial blood, that is to say, ruddy in colour and in a powerful jerking stream. This phenomenon he attributed to such a "paralysing action of the corda tympani on the sympathetic," that the corda tympani becomes practically a dilator. But there are between the two neat crucial experiments on the great sympathetic a number of examples of intermediate phenomena, where redness of skin and increased vascularity follow what we can hardly allow to be a paralysing influence. Not to cite any but commonplaces, do not the action of light and of moderate warmth increase the circulation? Yet it is hard to assign to these agents such a part to play as that of paralysing life. At this stage of the solution of the enigma, therefore, great interest attaches itself to the researches carried on during the last few years in the laboratory of the Academy of Medicine at Paris by Messrs. Legros and Onimus. Their attention was aroused by the fact that in the normal condition the contraction of unstriped muscular fibre is rarely spasmodic or in mass, but |